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PUBLIC HEALTH Health Forces Muster Against BioterrorismListening to the five speakers at a special dean's symposium on bioterrorism at HSPH on Oct. 25 and 26, you could hear the stirring of a new paradigm in public health. The following Monday, an HMS Primary Care Division lecture reinforced this sense of reorganization and mobilization.
Matthew Meselson (left) and David Franz take sharp questions from the audience at the HSPH symposium on bioterrorism. Photo by Kent Dayton "Public health is public safety," said Margaret Hamburg, who opened the first day of the symposium, moderated by public health dean Barry Bloom. The audience had filled Snyder auditorium, the latecomers tuning in via closed-circuit TV in two overflow rooms or by live webcast. Vice president for biological programs of the Nuclear Threat Initiative in Washington, D.C., Hamburg urged a strengthening of the public health infrastructure. A closer partnership needs to exist between health officials and physicians, for example, emphasizing local resources and ways to augment them through state and federal aid to ensure adequate surge capacity. Planning is the key, she said, "so that we're not exchanging business cards on the first day of a crisis." More broadly, Hamburg continued, the scientific community needs to join the effort against bioterrorism by improving diagnostics, detectors, drugs, and vaccines, and by reducing access to dangerous pathogens through more secure storage and handling. Sleeping Through the AlarmIf any members of the audience doubted the urgency of these measures, their complacency was likely rattled by David Franz and Matthew Meselson in their talks on the epidemiology of biological warfare.The 1979 outbreak of anthrax in the Soviet city of Sverdlovsk should have been a wake-up call, said Franz, former commander in the U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Md., and current vice president of the Chemical and Biological Defense Division, Southern Research Institute. The accidental release of anthrax spores from a bioweapons facility pointed up the gaps in U.S. intelligence on the Soviet biowarfare capability. "The Soviet program was enormous," he said, up to 1,000-fold greater in tons-per-year of output than the U.S. effort. Then with the economic implosion of Russia in early 1994, there were "30 to 40 thousand scientists and engineers working in biological warfare facilities in the former Soviet Union ... who were suddenly without work. ...Where did they go?" The next wake-up call was the Desert Storm operation against Iraq, which uncovered an Iraqi biowarfare program that had weaponized anthrax, aflatoxin, and botulinum and put them into bombs. Referring to bioterrorism, Franz said, "It is fundamentally a public health problem," with surveillance and education being key components of a solution, which must be founded on technology and basic research. Meselson, the Thomas Dudley Cabot professor of the natural sciences in Harvard's Department of Molecular and Cellular Biology and a consultant on chemical and biological weapons, discussed aspects of prevention, protection, and treatment. "What are the chances that we can as a species avert the hostile exploitation of biotechnology?" he asked, urging the creation of a powerful global norm against it. Getting down to street level, he questioned the hygiene of behaviors like shaking hands. He also criticized the portrayal of anthrax infection in the media. There is no threshold dose, he said, even one spore may cause disease. One reason for the misconception may have been that the 8,000-spore figure cited as a minimum for infection actually is just one of the experimentally determined LD50 levels for inhalation anthrax--that is, the number of spores that would constitute a lethal dose in 50 percent of people (or test animals) receiving it. Communicating DangerAfter a presentation by Jonathan Burstein leading the second day of the symposium, Howard Koh, the Massachusetts commissioner of public health, expanded on Meselson's concern, saying to the audience, "Our role as public health professionals has never been more needed than now. And what we really need your help in is risk communication." Koh also described the unprecedented degree of collaboration among public health professionals in the state and nation.Focusing on Boston, Burstein, who is an HMS assistant professor of medicine at Beth Israel Deaconess Medical Center and a research scientist on emergency and disaster public health sciences at the CDC, detailed the city's highly effective and automated public health infrastructure. Nevertheless, he said, the current danger of bioterrorism demands retraining thousands of health care practitioners and incorporating relevant materials into the curriculum at the nation's medical schools. The following Monday, Oct. 29, the HMS Primary Care Division held a Cabot lecture on bioterrorism. One of two speakers, Gary Fleisher, HMS professor of pediatrics at Children's Hospital and commander of the Pediatric Specialty Team-1 for the National Disaster Medical Service, said that unlike cases involving bombs or chemical weapons, those with biological weapons require medical personnel to be the first line of detection. He outlined steps being taken to mine data collected every day from sources like hospital and pharmacy information systems. The working premise is that if you collect enough data, a picture of the public health dynamic emerges, speeding and targeting the response. Susan Briggs, HMS assistant professor of surgery at Massachusetts General Hospital and supervising medical officer of the National Disaster Medical System Specialty Teams, gave a report on the help that Boston medical personnel volunteered at ground zero in the wake of the attack on the World Trade Center. She addressed her remarks to medical students in the audience who might be considering volunteering in the disaster relief system. She described the unpredictability of disasters and the demand that this makes on the response team in terms of preparation, flexibility, and mobility. All the more reason for an integrated system of prevention, detection, and response. --Robert Neal |
