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State, Local Biodefense Inconsistencies 'Placing the Entire Nation at Risk'

biohazard suits at U.S. Army Medical Research Institute of Infectious Diseases in Fort Detrick

A grim report on the nation's biodefenses finds that states and localities with no uniform standards on responding to a mass attack or outbreak "will have to fend for themselves while the federal government puts what assets it has available towards ensuring national security and societal stability."

"We can describe scenarios in which fast-moving and deadly diseases spread throughout the nation and the world. We can zero-out resource availability in inventories and spreadsheets, and accurately describe the impact on patient management, waste management, disposition of the dead, public safety, and public health," says the new study from the Blue Ribbon Study Panel on Biodefense. "Despite the predictability these afford, each level of the government has yet to develop sufficiently comprehensive plans for addressing the need to provide for public health, safety, and security during and after large-scale biological events."

Former Sen. Joe Lieberman (I-Conn.) and former Pennsylvania governor and Homeland Security Secretary Tom Ridge co-chair the privately funded commission founded in 2014. Former Secretary of Health and Human Services Donna Shalala, former Senator Majority Leader Tom Daschle (D-S.D.), former Rep. Jim Greenwood (R-Pa.), and former Assistant Attorney General for National Security Kenneth Wainstein round out the panel.

The report focuses on "grave concern" that a large-scale biological event would overwhelm first responders on the front line at the city, state, county and tribal or territorial level.

"Devastation could be vast and swift, and local resources would be very quickly depleted," the report warns, as local governments "will have to fend for themselves for far too long until federal assets arrive and Congress can provide emergency supplemental funding to support response and recovery."

At a January meeting, the panel found that "basic biological preparedness, response, and recovery infrastructure varies widely throughout the United States, placing the entire nation at risk."

"If one community, for example, does not have access to a laboratory in their state that can quickly identify a biological threat, then they are immediately vulnerable and so are those who live in bordering states. It reminds us that states, localities, tribes, and territories play a huge role in national security," states the new report. "We would like to see state governors, territorial governors and administrators, tribal leaders, mayors, borough council presidents, and township supervisors make biodefense a greater priority before biological attacks, accidents, outbreaks, epidemics, and pandemics place the lives of their constituents at risk."

The panel offers a chilling scenario: "Plague has broken out in two states and the initial response is slow," with information trickling into governors' offices from hospitals and health departments at the the local level. "Eventually, the federal government offers some preliminary support, but only after they make two frightening discoveries: the disease has been genetically engineered and aerosolized, and two terrorist groups are claiming that they have successfully attacked the United States with plague. Outbreaks are expected to continue for months."

In the hypothetical outbreak, an initial 20,000 cases of antibiotic-resistant bubonic plague diagnosed as of Aug. 1 would snowball into some 100,000 case of bubonic, pulmonary and septicemic plague being diagnosed daily by early October.

The report underscored that the "infrequency of epidemics and pandemics means they rarely attract enough political attention to produce the proactive legislation and sustained funding needed" to support state and local preparedness and response. "The public and its elected officials tolerate far more disease (e.g., the thousands of cases of Chikungunya still prevalent in Florida, New York, and Puerto Rico) than they should."

"How we respond to biological events–especially those large in scale and impact– is now out of balance with how we prepare," the report adds. Government programs established in response to the 2001 anthrax attacks largely "languished as recurring budget cuts and declining awareness of the biological threat rendered them ineffective."

The panel made several recommendations to shore up response to a biological incident so it doesn't spiral out of control before the feds step in.

First responders, who will likely not know at the point of first contact which pathogen is afflicting victims, need proper training. "Today, many of those previously trained under the Domestic Preparedness Initiative have retired, and current EMS and other first responders receive little or no training in how to deal with biological agents and those infected with them," the report states.

"Unify and establish a new National EMS System," the panel recommends. "Current demands far exceed requirements for rapid transportation and limited treatment that Congress originally envisioned for EMS more than 50 years ago. It is time to provide a federal home for EMS that is responsible for developing policy and serving as an advocate for preparedness, quality, funding, and reimbursement."

Action also should be taken, the report continues, to improve distribution of life-saving medicine and supplies from the Strategic National Stockpile in the event of a biological incident. Healthcare facilities at all levels also need to prepare for the surge in patients that would occur with a large-scale biological event. "In the absence of government-issued quarantine and isolation orders confining the ill and those possibly exposed to specific geographic areas, the public will flood their local hospitals," the report says. "The usual actions taken when they reach capacity (e.g., temporary diversion of patients from an emergency room when it is full) will not be an option since health care deliverers in surrounding areas will also be affected."

"Establish a national stratified health care delivery system capable of surging medically to respond to large-scale biological events," the panel recommends. "Hospitals in any region in the United States must be able to surge medically to respond to and recover from large-scale biological events."

Another problem is that not all laboratories "possess the same capabilities, biosafety, or biosecurity"; the panel recommends that all laboratory networks be authorized to test for biological agents. Barriers also must be addressed regarding health infrastructure, care and emergency response in tribal and territorial jurisdictions.

"The quality of biosurveillance programs varies among insular areas, and they find it difficult to produce and obtain data," the report notes of U.S. territories. "Despite their locations and the ease with which to travel through them to other areas in the United States, the federal government has yet to establish the robust biosurveillance needed to ensure national security."

All leaders at all levels need to "assume broader leadership of biodefense" and "assume that for large-scale biological events affecting huge regions of the United States, if not the entire nation, federal assets may not be readily or continuously available to send to every affected area."

"Beyond a certain point during a biological catastrophe, everything will become public health. Leaders will then have to do the best they can with the resources they have at their disposal to ensure the survival of the constituents for whom they are responsible," the report concludes. "We can take steps now to reduce the impact large-scale biological events will have on our states, localities, tribes, and territories."