On September 11, 2001, America's relative peace and security were shattered, perhaps forever, when foreign terrorists hijacked domestic airliners and rammed them into the World Trade Center in New York City and the Pentagon in Arlington, Virginia. People had barely absorbed the horror of these events, when anthrax slowly invaded the most unlikely place: the United States Postal System.
Source: The Washington Post, www.washingtonpost.com
This course will cover:
The federal agencies that will lead the defense against possible biological and chemical threats; Potential biological and chemical threats to the U.S. population; and State of preparedness among federal agencies.
Although broad-based federal responses have been deployed in the past to deal with natural disasters, the federal government has little or no real-world experience with the deliberate release of harmful pathogens or deadly chemical agents. A host of federal agencies are responsible for responding to medical emergencies, many of which receive overall direction and coordination from the U.S. Department of Health and Human Services (HHS).
The country's medical "911" is the Office of Emergency Preparedness (OEP). It coordinates the federal response to natural and man-made catastrophes. Some examples follow:
Airline disasters; The Olympic games in Atlanta, GA; World Trade conferences; The Oklahoma City bombing; and Terrorist attacks against U.S. embassies in Africa.
Responding to a massive biological or chemical attack on U.S. residents would result in utilization of all HHS resources including:
Centers for Disease Control and Prevention; National Institutes of Health; and Food and Drug Administration
The Departments of Agriculture and Defense also would play a role.
CDC is the first line of defense in the federal response to bioterrorism. Established in 1946 to combat malaria, typhus and other infectious diseases, the agency has grown to 8,500 employees, who are based across the country and at its headquarters in Atlanta, Georgia. Table 1 presents milestones in the CDC's evolution to premier disease-fighting entity.
Table 1. Important Events in CDC's History
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CDC's primary mission is to monitor and protect the health of the civilian population through:
Detection of illness through surveillance Diagnosis of illness Rapid response to disease outbreaks; and Prevention of disease.
A major part of the CDC's response is the Epidemic Intelligence Service (EIS). Using epidemiological tools, EIS officers investigate outbreaks and help local health teams to control further spread.
An integral part of EIS activities is a two-year, postgraduate training program for health professionals. Nurses who have attained a Masters of Public Health or equivalent degree are invited to apply.
Perhaps the CDC's most ambitious undertaking, the Health Alert Network (HAN) is intended to allow state and federal health authorities to communicate rapidly with each other and with law enforcement agencies. Features of HAN include:
High-speed, continuous, secure connection to the Internet Access to public health information; Distance-learning capacity, using satellite- and web-based technologies for continuous upgrading of skills to prepare for threats; Early warning systems to alert local and federal authorities and the media about threats; and Instantaneous access and sharing of disease reports, response plans and CDC diagnostic and treatment guidelines among local health officials.
CDC maintains the National Pharmaceutical Stockpile, a collection of life saving pharmaceuticals, chemical interventions and medical/surgical supplies. Experts consulted by CDC officials prioritized the biological agents most likely to be used against citizens: smallpox, anthrax, pneumonic plague, tularemia and botulism toxin. Antibiotics for anthrax, plague and tularemia are immediately available for distribution. Approximately 12 million doses of smallpox vaccine currently are available, with the expectation that enough to vaccinate every citizen will be available by the fall of 2002.
Eight 12-ton Push Packages are available for delivery within 12 hours of a federal decision to release them. Packages contain 50 tons of material that permit emergency medial staff to treat a variety of different agents.
Metropolitan Medical Strike Team
In the event of a nuclear, biological or chemical attack, the Metropolitan Medical Strike Team (MMST) will be mobilized to respond on a local, state and national basis. It falls under the jurisdiction of the OEP.
If there is a significant man-made disaster, coordinated assistance by the team will focus on the following areas:
Assessments of health and medical needs Health surveillance Medical care personnel Health/medical equipment and supplies Patient evacuation In-hospital care Food/drug/medical safety Worker health safety Radiologic hazards Biological hazards Chemical hazards Mental health Public health information Vector control Portable water/wastewater and solid waste disposal Victim identification/mortuary services
National Institutes of Health
The National Institutes of Health (NIH) is the federal nexus of medial research in the U.S. Its mission is four-fold:
1. To conduct research in its own laboratories
2. To support the research of non-Federal scientists in universities, medical schools, hospitals and research institutions throughout the country and abroad
3. To help in the training of research investigators
4. To foster communication of medical information
The institute most closely involved with the bioterrorism threat is the National Institute of Allergy and Infectious Disease (NIAID). Its most relevant component is a unit that develops vaccines. To date, NIAID support has led to vaccines for rabies, meningitis, whooping cough, hepatitis A and B, chickenpox and pneumococcal pneumonia.
Food and Drug Administration
Protection of the nation's food supply is shared among the Food and Drug Administration (FDA), the Food Safety and Inspection Service of the U.S. Department of Agriculture (USDA) and the Environmental Protection Agency (EPA). These agencies are augmented by the Department of Treasury's Customs Service, which checks and occasionally detains imported food.
The FDA is responsible for protecting consumers against impure, unsafe, and fraudulently labeled food other than in areas regulated by the agriculture department's food inspection program. Agricultural inspectors are charged with the safety of meat, poultry and egg products. Protection against plant and animal pests and disease also falls under the jurisdiction of the agriculture department.
Department of Agriculture
Prevention, containment and eradication of harmful plant and animal diseases entering the country are the principal objectives of the USDA. The agency works together with the CDC, FDA, and U.S. Custom's Service and law enforcement agencies. Activities focus on ports of entry, food processing plants and research laboratories. Inspectors are not all two-legged; USDA employs a cadre of dogs specially trained to sniff for food and plant imports.
Source: USDA, Animal and Plant Health Inspection Service, Washington, DC.
USDA's emergency funding increase of $45.2 million for the current fiscal year will:
Improve security at USDA facilities Provide technical assistance to government and private sector agencies to enhance security Improve data collection and dissemination.
Department of Defense
Fort Detrick, MD is home to the U.S. Army Medical Research Institute of Infectious Disease (USAMRID). The facility has the only Department of Defense laboratory equipped to study highly hazardous viruses at biosafety level 4. It collaborates with the CDC and the WHO in conducting research and developing vaccines, drugs and diagnostics for laboratory and field use. Although the institute's primary focus is protecting military service personnel, its investigations are widely shared to benefit the civilian population as well.
