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    Monday, November 08, 2004

    Preparedness Watch: The Washington Post has a good summation of the sorry state of our bioterror preparedness:

    According to former White House official Falkenrath, the U.S. government's reliance on state and local health agencies to speedily distribute vaccines and drugs is "the Achilles' heel" of U.S. biodefenses.

    "The single biggest problem is the non-performance of state and local public health agencies" in drawing up plans that U.S. officials have requested on how they would respond rapidly to a biological attack, he said. The plans would detail how officials expect to deliver medicine to people after the drugs are flown to airports. "From tarmac to bloodstream, their time frames are way too lackadaisical," he said.

    This season's flu vaccine shortage amply illustrates the problem with relying on the CDC and public health departments to distribute something nationwide. But what about all that federal money they got to prepare for just such situations?

    Federal officials have given state health agencies and hospitals $4.4 billion in the past three years to develop such plans. But experts say that beyond buying computers or walkie-talkies and hiring some staff, the funds have hardly helped them prepare for large-scale bioterrorist strikes.

    "This won't be solved by money alone," said Elin Gursky, a biodefense specialist at the private Anser Institute for Homeland Security.

    Federal statistics show that among the 50 states, only Florida, Illinois and Louisiana are close to being ready to swiftly distribute vaccines or antidotes from the national stockpile, according to the nonprofit Trust for America's Health, which studies public health issues.

    The article correctly identifies the greatest weakness in the system:

    "The main priority of our biodefense program should be enlisting hospitals and private doctors to prepare [for bioattacks], but hospitals and private doctors are not now in the game," said a federal official with direct knowledge of the shortcomings. "This issue has completely fallen through the cracks. . . . No part of the federal government can deal with mass casualties."

    I don't know what Ohio did with their bioterror money, but they've done nothing to enlist practicing physicians or even to educate them about bioterrorism preparedness. When I made inquiries to the state health department a couple of years ago, they referred me to my local health department, which had a fourth year medical student call me up to ask me some survey questions for a "study" they wanted her to do during her clerkship with them. She thought it was weird that they were giving the job to a student, who would only be with them for a few weeks. I did, too. We both concluded it just wasn't a priority for them.

    Clearly, someone needs to take the bull by the horns:

    "There's a lack of an overarching federal game plan in biodefense," said Shelley Hearne, executive director of the Trust for America's Health. "States aren't being told, 'Here are the things you need to do, and why.' . . . Nobody's in charge."

    ... Some believe that Bush should publicly declare the seriousness of the government's bioterrorism concerns, name a bioterrorism "czar" to focus public attention, and initiate vastly expanded research into new drugs. Administration officials said that such steps are unnecessary, and that the current arrangement works fine.
    (emphasis mine)

    But the biosecurity center's O'Toole disagreed.

    "The country cannot do what's needed to get prepared for bioattacks without very visible national leadership from the president," said O'Toole, who worked in the Clinton Energy Department. "We're not yet treating this like a national security emergency."

    Looks like a job for a leader with a "mandate." We've grown far too complacent since 9/11 and the anthrax attacks about the very real threat of bioterrorism. It's time to take them seriously again. And with the abysmal performance of the CDC in the wake of the flu vaccine shortage (see the post below), it's time to re-examine that agency's role in the preparedness equation. Wouldn't plans for bioterrorism defense be better placed in the Defense Department or Homeland Security? (Certainly better placed than with a bunch of epidemiologists!)

    UPDATE: As further evidence of a lack of preparedness on the local leve, in the wake of the flu vaccine shortage, the CDC found it necessary to distribute these instructions on operating a mass vaccination clinic. If the response to a bioterrorist attack with smallpox is to consist of local health departments having mass vaccinations, shouldn't they already have had plans like this in place?

    UPDATE II: And the news that the WHO is considering allowing new research on a genetically altered smallpox virus to "investigate treatments" for the disease isn't too reassuring, either. Why would someone want to look for a treatment for a disease which no longer exists - unless they have reason to believe that the disease will be re-introduced.

    posted by Sydney on 11/08/2004 07:52:00 AM 0 comments


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