Homeland Security Watch

News and analysis of critical issues in homeland security

September 13, 2011

Contagion of Fear

Filed under: Biosecurity — by Alan Wolfe on September 13, 2011


So we successfully made it through the tenth anniversary of 9/11  without “anything coming in over the water, chemical, biological, radiological.”

Better safe than sorry? Perhaps, but the degree of over-preparation cost time and resources that aren’t as plentiful as before. There are continued questions as to the adequacy of our nation’s preparedness to biological terrorism, fueled on ever more by the latest Hollywood thriller, “Contagion,” where a new deadly, contagious virus that infects a billion people and kills million before the end of the movie.

There’s been a lot of conjecture as to how “real” this movie plot was, whether a virus today could cause a global pandemic of that scale. From scanning the news articles on the net, it seems that many public health officials are quite willing to suggest that this is a realistic concept, in as much as there are viruses that can be highly infectious, that there are viruses that jump species, and that human contact and sneezing can be a source of transmission from person to person.

However, they don’t seem to confirm the idea that a virus that has all of the worst possible characteristics could break out tomorrow and infect a billion people within a few months. As one example, the movie’s virus (MEV-1) had a 20 percent mortality rate; the so-called “Spanish flu” had a 2.5 percent mortality rate.

But hey, it’s just Hollywood, right? You need to move the plot along, and what could cause more stress than an airborne virus that is highly infectious, has a high mortality rate, and doesn’t burn out like other viruses?

What’s perhaps more despicable are the people who might take advantage of the public’s fear of biological diseases,  like the authors of the “World at Risk” report:

“Hoping to capitalize on the movie, Talent and former Sen. Bob Graham, D-Fla., the chair of the WMD commission, plan to release a new report that reiterates the threat of biological attack and grades the nation on its preparations to withstand it. Previewing the report, the former senators said they worried especially about cuts in security spending, cuts felt already by states and localities that would be on the front lines of responding.

Talent has been warning former colleagues in Congress not to let down the nation’s guard. His message: The capacity to withstand attack is a form of deterrence because terrorists would choose only targets where they could inflict maximum damage.

Talent worries he’s not getting through. “On the Hill, they’re putting an enormous amount of energy into denying reality,” he said. “To a great extent, we’re just hoping it doesn’t happen.”

Graham, who headed the Intelligence Committee during an 18-year Senate career, said the WMD report was likely to reflect success in securing nuclear weapons and radioactive materials around the world.

“I don’t think we’ve made that progress on the biological side,” he said. “Some of the most powerful pathogens are available in nature. There are others that can be manufactured in the lab, and there are thousands of people around the world who know how to weaponize them.”

This article also features Dr. Tara O’Toole, director of DHS’s Science and Technology Directorate, lamenting the deep cuts in research that the House of Representatives is proposing.

“It’s really difficult before somebody’s had their heart attack to get them to think about their cholesterol or go on a diet,” said O’Toole, a physician. “It’s really difficult before we see what a genuine bioattack would be like to continuously focus on biodefense.”

Of course, one could make the same argument about preparing for a Texas-sized asteroid from impacting the Earth, preventing terrorists from taking control of a Russian submarine and nuking the United States, or responding to a band of disgruntled American soldiers who have stolen nerve agent-filled rockets and are holding a US city ransom.

There are estimates that the US government has spent up to $60 billion on biodefense efforts, depending on how you count the federal funding. That sounds like a lot of money, but as homeland security analyst Randall Larsen notes, “The question is whether it has been spent properly.”

I don’t question how the funds were spent as much as the lack of strategic thinking and unrealistic expectations of what the biodefense efforts should accomplish. The federal government is unwilling to fully fund Project BioWatch to populate every major city with biological sensors and to fully fund Project BioShield to develop vaccines and other countermeasures for every dangerous biological disease and potential emerging disease. So why are we attempting half measures today? There are just too many other health concerns out there, such as the annual influenza season, while medical care costs continue to soar.

The good news behind the “Contagion” story could be the boost to the reputation (and hopefully, the budget) of the Centers for Disease Control and Prevention (CDC), whose professionals were the real heroes of the film. It wasn’t an Army colonel from Fort Detrick (“Outbreak”), it wasn’t a single brilliant researcher in an isolated lab (“Legend”), and it wasn’t a spiritual old woman in a Nebraska farm (“The Stand”). People don’t generally become infected by contagious diseases without direct and fairly prolonged face-to-face contact. And the Army isn’t going to quarantine cities and shoot people who are streaming out of the “hot zones” in panic.

Along that line of thought, Very Serious People shouldn’t be using Hollywood films to promote fear and to generate more funds for bioterrorism efforts without offering a strategic plan, metrics to determine how well the money is spent, and without consideration of all the other challenges our nation has to face.

As Winston Churchill noted, “Gentlemen, we have run out of money. Now we have to think.”

 

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12 Comments »

Pingback by Homeland Security Watch » Contagion of Fear » Security Ops | We test your lines of defense

September 13, 2011 @ 2:42 am

[...] article: Homeland Security Watch » Contagion of Fear function bfi_equal_heights() {}; st_go({blog:'26618212',v:'ext',post:'2252'}); var [...]

Comment by Philip J. Palin

September 13, 2011 @ 5:35 am

Alan, Based on this post and previous posts, I perceive you are concerned the homeland security enterprise is:

1. Too often distracted by low likelihood, high consequence events regarding which we can do rather little,and

2. Too often fear-mongering over catastrophic possibilities rather than encouraging a realistic readiness for weapons (or events) of mass disruption (as opposed to destruction), and

3. With the time, money and other resources expended on “fantastic” risks, we might better prevent and be prepared for more likely risks.

Am I hearing you correctly?

Or… perhaps I am hearing you say it is not an issue of catastrophic or non-catastrophic risk, but an issue of meaningful and realistic strategic engagement with whatever risk. Which would then beg the question: what does meaningful and realistic strategic engagement look, sound, and smell like?

Redirection?

Comment by William R. Cumming

September 13, 2011 @ 7:08 am

Noting for the record almost $1B cut out of CDC and HHS funding for various biological threats in last three fiscal years including one about to end.

But hey those F-35′s keep on rolling off the line!

Comment by Alan Wolfe

September 13, 2011 @ 7:08 am

I believe you correctly read me on points 1 and 2. Re: Point 3, I am not arguing against spending money on exotic threats, but as Chertoff used to say, it’s all about risk-based management. We cannot eliminate the threat of biological or nuclear terrorism through massive monitoring networks or tons of medical countermeasures, and certainly the current risk to US populace of other public health diseases and other hazards also need to be addressed.

On the other hand, we can’t just throw billions of dollars to the public health community and hope that they address bioterrorism as part of their large menu of issues. Yes, improving the public health network will have the benefit of improving our response to bioterrorism, but it will not be focused and it could easily be lost in the larger landscape of infectious diseases and other health treatments.

I will take the radical step of disagreeing with the President’s “Countering Biological Threats” strategy and say you can’t address terrorist anthrax attacks the same way that you address pandemic flu outbreaks. They are fundamentally different in source, target, scope, and general response. If we are to address bioterrorism, we need to emphasize intelligence/law enforcement to watch for terrorism trends, rely on the CDC’s lab response network and DHS’s NBIC, and maintain national stocks of anthrax vaccine, smallpox vaccine, and maybe plague vaccine. That’s it.

For the pandemic infectious threats, I think our biosurveillance capability (as above) is adequate for most cases where we need warning of global outbreaks. The failure in response was because our Big Pharma isn’t incentivised to have a medical treatment response for the general public. So DHHS’s decision to build two “private-public partnership” vaccine production facilities to jump-start the process makes sense. Buw we need to be careful not to go overboard with public health funds, at least until the USG can get its health care costs under control.

Comment by Alan Wolfe

September 13, 2011 @ 7:11 am

Great point, William. Our Congress tends to be very myopic when it comes to DHHS/CDC/DHS funding as opposed to DOD, and that’s very frustrating. I don’t know how to address that other than we need to have better publicized public policy discussions on the detrimental impact of such decisions on our nation’s ability to respond to biological threats.

Comment by William R. Cumming

September 13, 2011 @ 8:58 am

With the flag ranks announcing that 75% of all American males do NOT qualify for the military largely because of health and fitness perhaps they should be explaining those results in detail before Congress. This fact if true could mean that the military long ago stopped reflecting the population at large. Give jobs to the fit and healthy who stay out of the military and let the others join up. Being somewhat facetious of course. And by the way the actual DOD capability on CBRN is very limited. The E [explosives] has some play for the moment but wondering about promotions of all those EOD types needed when the US was expanding its role in Iraq and Afghanistan. Why not just support the UN more actively on EOD and CBRNE?

Comment by Donald Quixote

September 13, 2011 @ 9:34 am

To carry on a long-held tradition, it is much better to plan for what has already happened. The funding is so much better and the interest exists. On 09/10/01, 09/11/01 was believed to be possible but rather improbable and did not require a significant amount of planning or preparedness with the limited resources. It was a thing of movies to frighten the public.

I believe that the movie Contagion did a nice job explaining the current and possible future threat and the very likely cascading consequences of a significant, novel, emerging (or re-emerging) infectious disease, in the expected Hollywood fashion. In another forum (pubs work well), I would love to discuss my previous, first-hand experience in this arena.

Previous planning for this topic, one with much broader consequences than a single, conventional (non-WMD) terrorist attack, has been lost in the long list of things to do. Let us hope that our recent experience with H1N1 was a dry-run that we shall truly learn from and better prepare for in the future. Unfortunately, the lessons learned shall be likely shelved until the inevitable future hearings and finger-pointing. Some traditions are hard to break.

Comment by anonymous

September 14, 2011 @ 11:52 pm

Someone on the Hill ought to ask why HHS just shuttered a few months before 9/11/11 the National Capital Region’s (metro Washington DC’s) National Medical Response Team, a local/state, regional multidisciplinary response team of medics, docs, firefighters and cops that was specially trained and equipped for Chem-Bio-Rad incidents and first established after the Aum Shinryko attacks, and then enhanced after 9/11/01.

Yep, 10-years after anthrax in DC, the regional team established for leading the first response coordination and expertise to those kind of events in our Nation’s Capital was shut down.

These are the guys and gals that US Capitol Police and the Secret Service have for the past decade kept on standby during State of the Unions and such in order to rescue Congressional and Executive Branch leadership.

I want to see that program manager from HHS (Health and Human Services — the folks who claim to bring us the leadership for these “contagion” kind of events) dragged up to the Hill and held to account. Until that happens, not too confident in our ability to act on ANY of these kind of threats or hazards, natural or man-made.

Comment by Donald Quixote

September 19, 2011 @ 9:32 am

Uh-oh: Scientists Say Film ‘Contagion’ is for Real

By: Mike Stobbe, AP Medical Writer
09/16/2011 (12:00am)

ATLANTA (AP) — Yes, it could happen. But it’s a stretch.

“Contagion,” a Hollywood thriller that opened last weekend, rocketed to No. 1 at the box office through its gripping tale of a fictional global epidemic driven by a new kind of virus. Audiences have gasped in horror at what happens to Gwyneth Paltrow.

Before it was out, the movie made real-life disease investigators anxious, too, though for a different reason: They had worried the filmmakers would take so many artistic liberties with the science that the result would be an incredible movie that was … not credible.

Well, cue the applause.

“It’s very plausible,” said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which would investigate such an outbreak.

A new virus jumping from animals to humans? Nothing fictional about that. Global spread of a disease in a few days? In this age of jet travel, absolutely. A societal meltdown if things get bad? Plan on it…………………………

http://articles.boston.com/2011-09-15/ae/30161076_1_new-virus-contagion-cdc

—————————————————-

This is another homeland security\public health topic requiring serious evaluation and consideration to determine our level of preparedness. There are so many questions, beginning with:

• Are we ready to truly and seriously implement quarantines and isolation today?
• Do we implement border control operations?
• How will the International Health Regulations (2005) affect or influence our policies?
• Will quarantines be federal, state or both?
• Is the federal government prepared to implement quarantines today or tomorrow under the Title 42 authorities, to include 42USC97 and 42USC268?
• Do we have surge capacity in the public health and law enforcement communities?
• How many surge ventilators and trained personnel do we have for a minor or significant threat?
• If we utilize martial law, will we have the resources readily available with so many resources overseas?
• What portion of the public health and other workforces may be affected by the closure of schools and the worried-well staying at home?
• How robust is our critical infrastructure with a diminished workforce?
• And most importantly, should we really be concerned until it happens?

As always the issue is funding, but it is so much more than that. It is honest planning, coordination and collaboration permitting the public to better understand the capabilities of the government and responsibilities of its citizens.

Comment by Donald Quixote

September 26, 2011 @ 9:01 am

An indicator of the future or just a routine public health concern? It may help sell movie tickets, but shall likely be ignored for future planning priorities.

—————————————————
Measles Among U.S.-Bound Refugees from Malaysia — California, Maryland, North Carolina, and Wisconsin, August–September 2011

September 23, 2011 / 60(37);1281-1282

On August 26, 2011, California public health officials notified CDC of a suspected measles case in an unvaccinated male refugee aged 15 years from Burma (the index patient), who had lived in an urban area of Kuala Lumpur, Malaysia, which is experiencing ongoing measles outbreaks. Currently, approximately 92,000 such refugees are living in urban communities in Malaysia (1). Resettlement programs in the United States and other countries are ongoing. The health and vaccination status of urban refugees are largely unknown.

The index patient developed a fever on August 21 and a rash on August 22. He and his family (his mother and two siblings, aged 13 and 16 years) departed Malaysia on August 24 and arrived the same day in Los Angeles, California, where they stayed overnight. He was hospitalized for suspected measles on August 25. Serologic testing for immunoglobulin M confirmed the diagnosis of measles on August 30 (2). The sibling aged 16 years was unvaccinated and had onset of a febrile rash illness in Malaysia on August 18. Serologic testing performed on August 30 in Los Angeles indicated evidence of recent measles infection. However, the sibling was not infectious during the flight.

On September 1, Maryland public health officials notified CDC of laboratory-confirmed cases of measles in two unvaccinated refugee children (aged 7 months and 2 years) who were on the same flight as the index patient. A suspected case of measles in an unvaccinated refugee aged 14 years, who had traveled on the same flight, was reported by North Carolina public health officials on September 4 and confirmed on September 9. Whether these three patients were exposed to measles in Malaysia or during travel to the United States is unclear. On September 7, CDC was notified of another laboratory-confirmed case in an unvaccinated refugee child aged 23 months from Burma who traveled from Malaysia to Wisconsin through Los Angeles on August 24, but on a different flight than the index patient.

Thirty-one refugees who traveled from Malaysia on the same flight with the index patient on August 24 arrived in the following seven states: Maryland, North Carolina, New Hampshire, Oklahoma, Texas, Washington, and Wisconsin. State and local health departments and CDC were contacted and initiated contact investigations and response activities. As of September 12, contact investigations and heightened surveillance had revealed three additional laboratory-confirmed measles cases that were epidemiologically linked to the index patient: one case in a U.S. Customs and Border Protection Officer with unknown vaccination status who processed the index patient in the Los Angeles airport (reported by California public health officials on September 8), and two cases in nonrefugee, unvaccinated children (aged 12 months and 19 months) who were seated nine rows from the index patient during the flight (reported by California public health officials on September 9).

Rapid control efforts by state and local public health agencies have been a key factor in limiting the size of this outbreak and preventing the spread of measles in communities with increased numbers of unvaccinated persons. To prevent measles transmission and importation in this refugee population, refugee travel from Malaysia to the United States was temporarily suspended. CDC recommended that 1) U.S.-bound refugees in Malaysia without evidence of measles immunity (3) be vaccinated with measles, mumps, and rubella (MMR) vaccine and their travel be postponed for 21 days after vaccination; 2) refugees arriving in the United States receive their post-arrival health examinations as soon as feasible; 3) clinicians consider measles as a diagnosis in a refugee with a febrile rash illness and clinically compatible symptoms (i.e., cough, coryza, and/or conjunctivitis); 4) patients with suspected measles be isolated and appropriate specimens be obtained for measles confirmation and virus genotyping; and 5) cases be reported promptly to local health departments. To prevent measles in U.S. residents at home and abroad, CDC recommends that eligible persons without evidence of measles immunity (3) be vaccinated as recommended. Before international travel, infants aged 6–11 months should receive 1 MMR vaccine dose, and persons aged ?12 months should receive 2 doses unless they have other evidence of measles immunity (3).

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6037a4.htm

Pingback by Homeland Security Watch » Fiction as a way to the truth: Making meaning of homeland security

October 7, 2011 @ 7:20 am

[...] has already received plenty of kudos in prior Homeland Security Watch posts.   Arnold Bogis and Alan Wolfe who seem to agree on nearly nothing, nonetheless each endorsed the movie.  In his New Yorker review [...]

Comment by Donald Quixote

October 31, 2011 @ 9:30 am

How Ready Are We for Bioterrorism?

The New York Times Magazine

October 30, 2011

By WIL S. HYLTON

A number of former and current officials also point out that no one in the Obama White House is focused exclusively on biodefense. In both the Clinton and Bush administrations, there was a biodefense director whose primary job was to coordinate the agencies. Today, there are four senior White House officials with partial responsibility for biodefense, but each of them is also responsible for a raft of other issues, like natural disasters, terrorism and large-scale accidents like the Deepwater Horizon oil spill. Whatever you think U.S. biodefense policy should be, it is difficult to imagine that it would not benefit from clear, central leadership. Kenneth Bernard, the biodefense czar in both the Clinton and Bush administrations, told me, “The only way that you can get all of those people in the room is to call them into the White House, and to have a coordinating group under a single person.” Robert Kadlec, who was the senior official for biodefense in the second Bush term, said, “Unless someone makes this a priority, it’s a priority for no one.”

Randall Larsen, who first smuggled a tube of weaponized powder into the meeting with Dick Cheney 10 years ago — and went on to become the executive director of the Congressional Commission on Weapons of Mass Destruction — said: “Today, there are more than two dozen Senate-confirmed individuals with some responsibility for biodefense. Not one person has it for a full-time job, and no one is in charge.”

http://www.nytimes.com/2011/10/30/magazine/how-ready-are-we-for-bioterrorism.html?_r=1

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