United States:  Many Hospitals Not Prepared for Bioterror Attack, GAO Says

By Joe Fiorill
Global Security Newswire

WASHINGTON — Most urban hospitals in the United States lack adequate equipment for dealing with the large influx of patients that would result from a bioterrorist attack, the U.S. General Accounting Office said yesterday in a new report.

The report indicated most U.S. hospitals take part in basic planning and coordination but that there are important deficiencies in training and equipment.

American Hospital Association Senior Associate Director for Policy Development Roslyne Schulman told Global Security Newswire that U.S. hospitals’ preparedness for bioterrorism has improved in the wake of the Sept. 11, 2001, terrorist attacks, but that much work lies ahead.  The GAO solicited comments on the report from the association, which generally agreed with its findings.

“The hospitals have made a lot of progress since Sept. 11.  They’ve made a lot of important steps, but there is a great deal that needs to be done,” Schulman said.

Responding to a GAO survey, most hospitals reported participation in basic planning and coordination for a biological attack; 80 percent reported having written emergency response plans that address bioterrorism; nearly all said they participate in interagency disaster planning committees; and most indicated they train personnel in identification and diagnosis of diseases, such as anthrax and botulism, caused by likely agents of biological warfare.

However, the hospitals said their equipment is insufficient for responding to a large-scale attack.  Half the hospitals have fewer than six ventilators per 100 beds, meaning they could find themselves seriously underequipped for a concentrated anthrax or botulism outbreak ― a finding, the GAO noted, that comes three years after the May 2000 TOPOFF terrorism exercise, in which ventilators and other equipment were found insufficient within three days of a simulated pneumonic plague outbreak.

In addition, hospitals’ written response plans often lacked key contacts, the GAO said, and most hospitals have not conducted bioterrorism simulation drills.

In its report, the GAO took note of new federal funding vehicles that could help improve bioterrorism preparedness in hospitals, including the Health and Human Services Department’s Bioterrorism Hospital Preparedness Program, which the department said in March will provide $500 million in fiscal 2003 to states and municipalities (see GSN, March 21).

Schulman said hospitals are “appreciative” of the federal funds but that the money is “just a drop in the bucket” and “a first step.”

“We’re pleased that they’re continuing that funding stream. … We do support a continued increasing investment in readiness,” Schulman said.  “The funding’s been very slow to get out, and … not very much of it has yet gotten to hospitals,” she added.

Schulman’s group reported to Congress after the September 2001 attacks that an estimated $11 billion would be needed to get U.S. hospitals ready for one potential bioterrorism scenario.

Besides distributing funds to state and local health officials, Washington has also created a stockpile of drugs and supplies in case of a biological attack.  Health and Human Services has announced plans to buy 2,700 ventilators by next month to bolster the stockpile, parts of which could be deployed within 12 to 36 hours of a declared emergency, according to the GAO.

Required under public health legislation passed in 2000, the GAO report was based on part of a survey conducted between May and September of last year.  Of 2,041 hospitals surveyed, 1,482 responded, a rate of 73 percent.  The other part of the survey formed the basis for a GAO report issued in March on general emergency room performance.

Yesterday’s report follows an April 7 GAO report indicating state and local officials around the United States display varying levels of preparedness for a bioterrorism attack, with significant deficiencies in capacity, communications and coordination (see GSN, April 8).  That report included references to a lack of guidance for hospitals about preparing for a biological attack.

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Ebola:  Researchers Develop Ebola Vaccine

U.S. scientists have developed a vaccine that protects monkeys from Ebola with a single shot and could be eventually used to defend humans against biological terrorism, the Washington Post reported today (see GSN, July 17).

“In terms of what we need for countermeasures against terrorism, it’s highly significant,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.  “This could be a real advance in our ability to contain Ebola,” he added (Justin Gillis, Washington Post, Aug. 7).

Scientists at the Dale and Betty Bumpers Vaccine Research Center at the U.S. National Institutes of Health and the U.S. Army Medical Research Institute of Infectious Diseases collaborated to conduct the research over the past three years, the BBC reported yesterday.

The scientists gave eight monkeys a booster shot, then injected them with the Ebola virus. The single injection protected all eight monkeys against Ebola — even those who received high doses of the virus.

If the vaccine proves to be effective in humans, it could be used to stop the spread of Ebola through a strategy known as ring vaccination — vaccinating everyone who has been in contact with an infected person — the same technique that was successfully used to eradicate smallpox worldwide (BBC Online, Aug. 6).

Since the 1970s, Ebola has killed hundreds of people in Africa and possibly tens of thousands of endangered apes (James Janega, Chicago Tribune, Aug. 7).

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U.S. Response:  Two Groups Urge Better Health Communication, Coordination

By Joe Fiorill
Global Security Newswire

WASHINGTON — The United States needs better communication and coordination among agencies at various levels of government in order to better respond to fast-moving disease outbreaks, such as in the case of a bioterrorism attack, two groups of researchers said yesterday in new reports.

According to the first report, released yesterday by the Chemical and Biological Arms Control Institute, Washington must commit long-term funding to build a nationwide health communication system if the nation’s health system is to be adequately equipped to detect or respond to a potential bioterrorism incident.

Funded by the National Memorial Institute for the Prevention of Terrorism, the report was prepared over 18 months.  It includes a broad variety of recommendations for improving public information and intra- and interagency communication to better deter and respond to a potential terrorist attack.

Led by Michael Powers, a senior fellow at the Chemical and Biological Arms Control Institute and former arms control and nonproliferation analyst with Boeing, the authors said U.S. public health officials need more “robust” communications systems at and among all levels of government to foster better outbreak monitoring, communication before and during crises and training and education programs.

“Federal funding must be provided with a long-term commitment to support a national health communication system,” the authors wrote, adding that state and local governments do not have the requisite resources to fund such an enterprise.

“The foundations for a nationwide health and medical communications network have just been established.  In the end, only a serious and sustained financial commitment can put the technical infrastructure in place and build the social network to make a truly effective public health information and communication system a reality.  Efforts to build the necessary technical and social infrastructure are ongoing, but not at the needed levels of intensity,” the report reads.

Powers said in an interview that the U.S. public safety and public health spheres present two separate problems where communications infrastructure is concerned.  Public safety networks exist that can be gradually integrated into an adequate national system, he said, while public health presents a chance to build infrastructure that in many cases is sorely lacking.

“What you’re trying to do is almost, in a sense, build from scratch,” Powers said of information technology infrastructure in some parts of the country’s health system.

Powers said health facilities in even some medium-sized cities rely on antiquated computers and do without the most basic networking capabilities.

“For them to put together some kind of IT-based monitoring system or communication system [would] be very difficult,” he said.

Institute senior fellow Jonathan Ban said existing Centers for Disease Control systems — including the Health Alert Network, which relies in part on faxes and e-mail, and the nascent National Electronic Disease Surveillance System, which now has at least a small presence in most states — could provide a basis for an eventual national network capable of detecting and responding to a bioterrorism incident in timely fashion.

The National Electronic Disease Surveillance System, he said, could support the wide dissemination of data from many small-scale systems such as the University of Pittsburgh’s Real-time Outbreak and Disease Surveillance project (see GSN, Dec. 3, 2002) and the Rapid Syndrome Validation Project in New Mexico.

Ban cautioned, though, that any rapid, truly national disease surveillance system will take time to emerge.

“It’s a long-term prospect to get this into place. … If we put a lot of money at it, we might be able to get something in the five- to seven-year range,” he said.

Despite their call for federally funded infrastructure improvements, the researchers stressed the importance of improving health workers’ ability to recognize signs of a chemical or biological attack.

“Technical surveillance systems should not be viewed as a ‘silver bullet,’” they wrote, calling for improved training and education programs for health workers that “include response techniques for a wider variety of terrorism contingencies.”

Trust for America’s Health Calls for More Coherence

The Trust for America’s Health said yesterday in a separate report that U.S. handling of animal-borne diseases is largely uncoordinated and in need of reform.

The study, funded by the Pew Charitable Trusts and the Palmer Foundation, focused on recent outbreaks of monkeypox, West Nile virus, “mad cow” disease, Lyme disease and chronic wasting disease (see GSN, June 12).

The authors, who included American Public Health Association Executive Director Georges Benjamin and Trust for America’s Health Executive Director Shelley Hearne, said that up to seven Cabinet-level agencies and hundreds of state and local organizations have participated in responding to the outbreaks, with little discernible overall coordination.

The researchers called for congressional hearings on creating a national system to handle such diseases and for a national tracking network.

“Leadership is needed to ensure that the various governmental agencies — at the federal, state and local level — are coordinated, well-functioning and capable of responding rapidly across jurisdictional boundaries.  Just as the Department of Homeland Security coordinates different aspects of national security, there must be a concerted effort to ensure that we, as a nation, attack animal-borne diseases in a high-priority, unified, coherent, streamlined and well-managed way,” the report reads.

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