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[Note: A transcript of this meeting is unavailable. The discussion is summarized below.]
Bioweapons are a strategic -- and growing -- threat to international security. They can be massively lethal, just as nuclear weapons. For instance, 100 kg of anthrax can have the same lethality as a 1 kiloton nuclear bomb; two grams of anthrax can contain as many as 2 trillion lethal doses.
Bioweapons represent the perfect asymmetric weapon to counter our overwhelming military advantage. All the materials and know how to create these weapons are widely available. There are literally tens of thousands of people in the world who have the knowledge to produce bioweapons. Their components can be easily hidden; they do not cost a lot of money; and it is very difficult to figure out who perpetrated the act after a bioweapon has been unleashed. This is complicated by the fact that much of the technology needed for bioweapons development is inherently 'dual-use;' it could just as easily be used for perfectly legitimate purposes.
The danger is also enhanced by the fact that we stand at a momentous historical point in the maturation of the biomedical sciences. We are building on advances of computing power and using technological improvement to create vast amounts of biological information and knowledge, and we are disseminating it as never before. The same knowledge that gives you an understanding of virulence of bacteria also allows you to make it more resistant to therapy. And perhaps most troublesome is our developing ability to alter genes. Finally, we are developing technologies that allow these weapons to be disseminated more easily and readily.
The current reality is that we lack effective drugs and vaccines for many "20th Century" bioweapons agents. The coming danger is that terrorists – a 'thinking enemy' –will use this deficiency against us.
Compounding this problem is the fact that our response systems are inherently vulnerable. The U.S. health care system is fragile, inelastic, and fragmented. It is unprepared for mass casualty response: no hospital can handle 500 patients at once. Our public health system is an archipelago of neglected agencies that are unprepared to manage epidemics. And finally, the U.S. political leadership is by and large unfamiliar with bioscience, the possibilities of an attack, and the key institutions that would respond to it.
The SARS epidemic is a good snapshot of what an epidemic/disease is like; it is useful because we do not see many of those in the United States these days. SARS spread among hospital workers and patients -- this is what we would see with smallpox, and presumably what a bioterrorism attack would look like.
The eventual containment of SARS is a victory for 19th-century public health methods: isolation and quarantine. We saw the World Health Organization at the limits of its authority and capacity. It is important to note that half of all cases of SARS were within the health community and their families. Hospital capacity was stressed to its limits in Toronto and Hong Kong due to infection of Health care workers and the stigma associated with their being the primary transmitters of the disease. One big lesson: hospitals currently have no capacity to take on an added burden of patients.
SARS also represented a severe economic disruption. It is estimated that the outbreak cost US$30 billion overall; Southeast Asia, US$10.6-15 billion in losses as of April 1; China, US$2.2 billion (with Hong Kong worst hit); and Ontario, Canada, US$1.5 billion in health care costs alone.
What do we know about the U.S. hospitals and health system? First, of the roughly 5000 hospitals in the United States, thirty percent do not meet operations costs. The entire system is fragmented, inelastic, and relies too much on just-in-time supplies and staffing, limiting its ability to handle surges. No one pays for hospital disaster planning, as drills disrupt routine work. Hospitals generally are not participants in U.S. bioterrorism preparedness programs.
A long term strategy for biodefense would require a massive investment in biomedical research and development and in public health, with the vision to render bioweapons obsolete as weapons of mass lethality and epidemics a thing of the past. We are not currently engaging our best scientists, and we have misplaced spending priorities. This is partially because no vision of what 'victory' would look like has been described. We must create a 'bio-Apollo project' to eliminate epidemics of infectious disease in our lifetime (within the next quarter century). The senior scientists of the biological community, who have not been 'read in' to this threat yet, would respond to such a vision.
