Scathing Evaluation of U.S. Biopreparedness
The Bipartisan Weapons of Mass Destruction (WMD) Terrorism Research Center just released its Bio-Response Report Card (view Report Card). The results were less than encouraging. In total, the U.S. received 0 “A’s,” 10 “D’s,” and an astounding 15 “F’s” out of a total of 40 possible grading categories. Preparedness for large-scale, drug resistant and global scale, contagious pathogens was viewed as particularly poor (11 combined F’s).
These failing grades are in large part attributable to failing funding. While there is no shortage of well-intentioned, hard-working people at all levels of the public health preparedness spectrum, the future appears tepid at best for seeing the types of improvements those of us in the field know are important. At some point, it will become necessary for the U.S. to reevaluate its expectations for biopreparedness and perhaps place greater emphasis on the core public health competencies that support an all-hazards approach, rather than focus on select agents, scenarios, and models.
The WMD Terrorism Center, formed at the completion of the Congressional Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism in 2010 by former U.S. Senators Bob Graham (D – FL) and Jim Talent (R – MO), views funding as a clear and present danger to the improvement of these performance markers. The report states that “medical counter-measures are the most important arrow in the biodefense quiver.” However, efforts like Project BioShield have endured several or attempted raids of their funding. The Biomedical Advanced Research & Development Authority (BARDA) receives roughly 10% of its necessary funding, and the Food and Drug Administration (FDA) consistently has to expand its surveillance to respond to foodborne outbreaks while possessing inadequate authority to prevent the conditions that create the outbreaks in the first place. While the report highlights the various planning initiatives that are federally funded, it also underscores the reality that state and local health departments, by virtue of budget cuts, furloughs, layoffs and a generally aging workforce, may require significantly greater investment and commitment to respond to bioterrorism or large scale infectious disease outbreaks. Considering that the constraints on local and state health department budgets are unlikely to see significant gains anytime soon, it is difficult to imagine a widespread improvement in the ability of these organizations to effectively implement the plans and expectations that are set forth at the federal level without timely deployment of federal personnel and emergency response assets.
The report card does provide some areas where improvements have been made, however. For example, response to small scale incidents has grown markedly better over the last decade. The mantra of regional collaboration and coordination of resources, intelligence, and expertise has permeated the local and state preparedness agencies. This has allowed for a more rapid and effective recognition of, and response to, isolated outbreaks of illness. Unfortunately, in the economy of scale, many of these partnerships begin to struggle with larger events where resources and personnel in all surrounding areas become taxed or depleted. That helps to define the need for greater federal investment in large scale events.
In the mammoth enterprise that is homeland security, public health preparedness, particularly as it relates to biological agents, has received an inadequate share of the resources to meet the expectations laid out after 9/11 and the subsequent anthrax attacks. The Bio-Response Report Card illustrates the key initiatives that have been under-supported at the federal level. When you overlay the economic crisis, particularly at the state and local levels, it’s easy to understand why the U.S. is falling far behind in meeting the expectations it has set for itself.