by Stephen Taylor
“Things have changed in a very significant way.” This was Dr. Robert Kadlec’s, Assistant Secretary for Preparedness and Response (ASPR), opening line at the February 12th, 2018 ASM Biothreats keynote address. Coming out of the Cold War era, Dr. Kadlec elaborated, defense leaders asserted that the United States had “won history”. For a brief time, U.S. global military dominance seemed immutable and the security of the American people against foreign threats enduring. Today, however, the threat landscape includes sophisticated state actors, such as China and Russia, as well as less sophisticated, but still effective countries like Iraq and Syria, which have shown few scruples in developing and deploying chemical weapons like sarin and chlorine gas. The Islamic State of Iraq and the Levant, though in retreat, still poses a multi-state threat in the Middle East. Additionally, pandemics such as Ebola and Highly Pathogenic Avian Influenza have become increasingly common in our interconnected world. Dr. Kadlec also acknowledged that global climate change will continue to contribute to unpredictable and intense weather events with potentially disastrous consequences. The post-Cold War days of peppermint, ponies, and unicorns, Dr. Kadlec emphasized, were short-lived.
Fortunately, the United States has a policy framework to prepare for and respond to various threats to the U.S. population. The Pandemic and All Hazards Preparedness Act (PAHPA), which established ASPR as an office within the Department of Health and Human Services (HHS), gives HHS responsibility for mass casualty event planning and preparation, such as the development and acquisition of medical countermeasures. PAHPA also requires the development of a quadrennial National Health Security Strategy (NHSS). Dr. Kadlec noted that the next iteration of the NHSS is due next year, in time to address our increasing need for infectious disease surveillance that integrates the rapid identification of emerging and re-emerging pathogens with platforms to rapidly determine their sensitivities and develop medical countermeasures. Outside PAHPA’s purview, this year’s forthcoming National Biodefense Strategy will address natural, accidental, and deliberate biothreats in granular scientific detail. Dr. Kadlec appeared optimistic about the efforts of the U.S. policymaking community, but emphasized the need for further vision from the White House, federal agencies, Congress, and the lay public.
Dr. Kadlec also detailed ASPR’s current priorities for implementation on the ground. At the top of his list was the augmentation of America’s regional disaster healthcare systems. In a disaster, the quickest, most-high impact response comes not from the national level, but regionally. By better equipping our patchwork of regional healthcare response systems, the U.S. will be better prepared for disasters nationally. One area that needs considerable support is emergency medical services (EMS). EMS responders are, as Dr. Kadlec put it, “the tip of the spear” in a mass casualty event. During pandemic events, an appropriate EMS response can be the difference between containing a deadly pathogen and seeing it propagated across the population. Increasing hospital surge capacity is also essential during a crisis, so that once the sick or wounded are transported arrive at the hospital, they can receive treatment in a biologically safe manner. The development of cutting edge technology in partnership with the private sector will be essential to supporting these efforts, enabling EMS responders to decrease the time between patient encounter, diagnosis, and treatment and allowing hospital capacity to be used more efficiently.
Dr. Kadlec closed out his address by reminding everyone that “amateurs talk strategy; professionals talk logistics.” It is essential for community, regional, national, and private sector leaders to commit to emergency preparedness and response efforts by investing resources. As we observe the 100th anniversary of the 1918 Flu Pandemic, Kadlec exhorted, we must look to the future and prepare ourselves for the Next Big Incident.