Bioterrorism is "the use, or threatened use, of biological agents to promote or spread fear or intimidation upon an individual, a specific group, or the population as a whole for religious, political, ideological, financial, or personal purposes" (Arizona Department of Health Services, 2005). Bioterrorism is the weaponization of biological agents or material; as such, it poses a huge potential risk to the United States, given the relative affordability and accessibility of its components. A critical determinant of the nation's ability to effectively respond to such an attack is the capacity of the nation's public health system, at the local, state, and federal level.
Gail Dudley and Robin McFee's article "Preparedness for Biological Terrorism in the United States: Project BioShield and Beyond" is an introduction and explanation of one of the most important pieces of federal legislation addressing bioterrorism; as such, it falls into the 'federal preparedness' research category. The piece of legislation under review by the authors is BioShield, signed into law in 2004. BioShield "establishes a mandatory and protected source of funds within the annual budget for countermeasures -- ranging from vaccines to biodosimetry to surveillance -- related to biological weapons," as well as other weapons of mass destruction; billions of dollars are allocated to the development, production, acquisition, and distribution of "next-generation medications and vaccines to protect against biological, chemical, radiological, and nuclear weapons" (2005, 418). This legislation is worthy of examination for several reasons, including the amount of money involved and the potential ramifications of the choices made by those implementing and executing the program. These choices include who is to be awarded money, in what amounts, to study or develop what? Each component of this choice is fraught with consequences, real and potential, for large numbers of people.
While championing the goal and work of BioShield, the authors also identify significant barriers to the "development of medical interventions against biological weapons," including inadequate research funding, insufficient protections against corporate liability, and safety consideration-related restraints, including the ethical prohibition against exposing human subjects to weaponized biological agents, a necessary step in order to test the efficacy of proposed countermeasures (418). The article provides a useful overview of the BioShield act itself, as well as the financial, legal, and other considerations at play in the context of developing medical countermeasures to bioterrorism. The article would have benefitted from a more involved exploration of the possibilities and potentialities of increased research collaboration between private, public, and academic institutions.
Rachel Garfield's issue brief, "State Preparedness for Bioterrorism and Public Health Emergencies," examines the ability and capacity of the states' public health systems to respond to the effects of a bioterrorist act or attack; this article falls into the 'state preparedness' research category. Garfield identifies the three major changes that state public health systems must make in order to effectively fulfill their responsibilities in the event of an attack. They include: rebuild and reinvest many parts of the public health infrastructure; expand the systems' focus to incorporate the threat of biological and chemical terrorism; and, coordinate efforts across levels of government (2005, 1). Garfield cites an Institute of Medicine report identifying problems in the public health infrastructure, including outdated technologies, a workforce in need of training and reinforcements, antiquated lab capacity, a lack of real-time surveillance and epidemiological systems, ineffective and fragmented communication networks, and otherwise incomplete emergency response capabilities (2-3). This litany of issues requiring redress is further compounded by a lack of basic supplies and decontamination materials, a straightforward emergency preparedness measure that remains incomplete.
Garfield's mention of communications is particularly salient. The inadequate communications equipment is particularly troubling considering the absolute necessity of early alert systems and rapid governmental response in such situations. The quick transfer of information, including real-time updates and the tracking of exposure or contamination trends, is of crucial importance to the efficacy of disaster and exposure mitigation efforts, as resources must be coordinated in order to achieve the best possible outcomes in a given set of circumstances. Inadequate or outdated communications technologies could severely hamper, or even cripple, an emergency response, thus leading to even greater damage.
The government's commitment to cooperation and coordination in the face of a biological attack is reflected by the Department of Health and Human Service's efforts to coordinate strategy with the states. Receipt of federal funds for bioterrorism preparedness is contingent upon adherence to the guidelines and improvements set forth by the funding agencies; these agencies have established key areas of focus and core competencies, as well as benchmarks that must be met in order to receive further funds (4-5). Garfield identifies several challenges to preparedness, including fiscal conditions, workforce issues, and competing problems (including overall funding for public health concerns) (7). In particular, Garfield's articulation of the struggle over the allotment of relatively scarce public health spending resources is instructive. While bioterrorism is a real, and growing, public health threat, many other, less flashy or visible public health issues plague America. Faced with limited resources, deciding whether to fund preparedness for a real but as of yet unrealized public health threat or whether to instead spend the money combating a real, current public health problem is a real, practical question for the nation's public health officials, be it at the federal, state, or local level. Garfield's paper provides a useful overview of the major challenges facing state public health agencies' attempts to improve their level of emergency preparedness in the face of a bioterrorism attacks, as well as an overview of progress that has been achieved. The primary weakness of this paper is its over-reliance on spending as a measure of improvement; a more comprehensive, and illustrative, accounting would have given more emphasis to measurable outcomes.
"Public Health Assessment of Potential Biological Terrorism Agents" in the Journal of Emerging Infectious Diseases "outlines the overall selection and prioritization process used to determine the biological agents for public health preparedness activities" (2002, 225); in other words, the article explains the process by which the biological agents posing the greatest risk to civilians are identified as such, and prioritized. This article falls in to the 'bioterrorism overview' research category. Such categorization and prioritization is critical to the formulation and implementation of emergency preparedness plans, particularly with respect to coordination.
The authors identify the primary criteria used to determine the potential threat of a particular agent to the civilian population. These are: public health impact, i.e. illness and death; delivery potential to large populations (agent stability, mass production and distribution ability, potential of person-to-person transmission); public perception, including public fear and potential civil disruption; and, special public heath preparedness needs with respect to stockpile requirements, diagnostic needs, or heightened surveillance (225). This criteria, as part of the entire process, resulted in the creation of three categories of biological agents, organized according to the potential threat level exhibited (226). The authors' explanation of this process is useful, as it sheds light on what can seem to be an arbitrary or politically influenced decision-making process. The article also makes clear the necessity of such classification exercises, guiding as they do the prioritization of activities and resources.
The "Initial Evaluation of the Cities Readiness Initiative" is concerned with the effectiveness of the Cities Readiness Initiative, a multi-million dollar program to "improve the ability of the nation's largest metropolitan regions to provide life-saving medications in the event of a large-scale bioterrorist attack or naturally occurring disease outbreak" (2009, iii). The paper is an evaluation of the program, and includes evidence of real improvement and achievement, as well as provides recommendations. This paper falls into the 'local preparedness' research category.
The authors find that, overall, the major metropolitan areas participating in the Cities Readiness Initiative have shown improvement in their levels of emergency preparedness; they use a sophisticated scoring and assessment system to account for the differences between cities and regions, in order to objectively evaluate the effectiveness of the program, particularly in light of the investment; functional areas showing major improvement over the period under review include the management of SNS (strategic national stockpile) operations, tactical communication, public information and communication, security, inventory control, distribution, and dispensing (14). The authors also found that, with respect to preparedness, implementation and coordination has lagged behind planning (16). This is an important finding, pointing as it does to the possibility that an increased emphasis on making plans operational may be necessary. The paper provides a thorough accounting and explanation of the evaluation process, as well as provides recommendations for improved metrics in order to provide a more comprehensive, and reflective, overview of the Cities Readiness Initiative's impact; evaluation process aside, the paper is an interesting and informative overview of the program itself, providing a real-life example of an emergency preparedness improvement program.
"Ready or Not? Protecting The Public's Health From Diseases, Disasters, and Bioterrorism, 2011" is the annual analysis of the improvements, and continued weaknesses, of the public health system's preparedness. Given the scope of the report, this paper falls into the 'overall preparedness' research category.