By Alexandria Tepper and Michael Krug, GMU Biodefense
On October 9th, 2018, the Blue Ribbon Study Panel on Biodefense presented a discussion session entitled “Fits and Starts: Reactionary Biodefense”. The five-hour event was composed of a series of expert panels spanning multiple fields, agencies, and backgrounds. The panels were moderated by four co-chairs from the Blue-Ribbon Study Panel, including: Former Senator Joseph Lieberman, Former Governor Thomas Ridge, Senator Tom Daschle, and Kenneth Wainstein. The discussion centered around the steps taken, 17 years later, since the anthrax events of 2001.
The event kicked off with an in-depth recollection by Sen. Daschle of October 16th, 2001; the day that letters containing Bacillus anthracis spores were opened in the Hart Senate Building. “Confusion and chaos” were the words the senator used to describe the situation that ensued when one of his interns opened the letter and aerosolized the fine white powder, exposing 28 staff members to the deadly B. anthracis. He expressed the helpless feeling that overcame him when he received a phone call describing the situation. As he rushed to the Hart Senate Building, he recalled the disorganization of the federal investigators during the bio-threat, as responders were devastatingly unprepared for such an event. The lack of standardized protocols became startlingly evident when the exposed staff members were cleared to return home in the same clothes worn during the attack. Fortunately, no one was killed in this specific attack and Sen. Daschle attributed that to a select few individuals who stepped up to lead the treatment and recovery process.
The co-chairs called the 2001 anthrax events “wake-up calls” to the biothreats of the United States, both naturally-occurring and man-made. Each co-chair exemplified the steps taken because of those events 17 years ago, including a significant step forward with the recent release of the National Biodefense Strategy by the White House. However, all four co-chairs clearly articulated that the energy behind the push for biodefense funding, legislation, and even support has slowed over the years since the anthrax threats. Senator Liebermann argued that, “We [U.S.] must prevent a reactionary response moving forward.” This reactionary nature towards national security is a trend that all four co-chairs warned against, urging for a preemptive attitude in the biodefense field.
The following are summaries from some of the expert panelists:
Dr. Scott R. Lillibridge –Vulnerabilities and Advancements: Past and Future
Panel One- Dealing with Anthrax
Dr. Lillibridge is a Chief Scientist at the Center for Innovation in Advanced Development and Manufacturing at Texas A&M University. Dr. Lillibridge was also the founding Director of the Bioterrorism Preparedness Program at the CDC.
Dr. Lillibridge spoke on his experiences leading up to the 2001 anthrax events. Specifically, founding the CDC’s Bioterrorism Preparedness and Response Program and having to plug vulnerabilities, focused primarily on anthrax and smallpox threats, in civilian infrastructure. Dr. Lillibridge recalled the struggles of communicating information between multiple agencies, including state and local authorities. He mentioned that the news cycle, calling it the “CNN surveillance system”, was constantly eclipsing HHS and CDC ability to communicate. He argues that this system is completely backwards and can actually hinder the proper emergency response.
As far as looking forward, Dr. Lillibridge explained that the U.S. should be optimistic due to the fact that steps have been taken to strengthen the U.S. against biothreats. But Dr. Lillibridge argues that advancements in biology, over the past 17 years, are “more complex, larger in scale, more global, and strategic than we were thinking 20 years ago. We were thinking about vulnerability to specific agents. We weren’t thinking national scope, synthetic biology, genetic sequencing, manipulation of resistance patterns. This has gotten much more complex.” To address this complexity, Dr. Lillibridge believes that four steps can be taken to meet these advancements. These steps include: 1) setting up 5- and 10-year programs to build up the collective infrastructure necessary to meet biothreats, 2) successfully engage private industry, 3) building up a centralized structure between agencies, and 4) organizing a leadership structure.
Dr. Randall Murch – Attribution Innovation – Genomics to Proteomics
Dr. Murch is the Associate Director, Research Program Development, National Capital Region, and Professor of Practice, School of Public and International Affairs, Virginia Tech.
Dr. Murch provided an FBI perspective on how diagnostics for attribution has changed since the 2001 anthrax attack. Forensic attribution determines if samples are a natural, deliberate, or accidental occurrence. Existing presumptive field testing used back in 2001 has been discarded. Now, the FBI moves the samples to the laboratory for presumptive, confirmatory, and deep characterization. Dr. Murch stated that diagnostics for attribution can become better-cheaper-faster and needs to be as close to “time zero” as possible. The FBI is also innovating diagnostics by looking at proteomics as an adjunct to genomics. Proteomics is the study of proteins produced by organisms translated from genomics into action molecules, which have more information for deeper, more precise characterization towards source attribution.
In close, Dr. Murch looked toward future innovation for attribution, stating “What about machine learning and AI? How can we explore that? How do we tackle synthetic biology?”
Dr. Andrew Cannons – State Laboratory Protocols in 2001 and Now
Dr. Andrew Cannons is the State Laboratory Director, Bureau of Public Health Laboratories –Tampa Division of Disease Control and Health Protection, Florida Department of Health.
Dr. Cannons was working in a Florida state laboratory in 2001 and supported the processing of 1,500 samples sent to the lab for anthrax testing. He presented the stark difference in diagnostics, protocols, staff training, and communication between 2001 and today, where just last week they processed 4 unknown powder samples.
In 2001 labs were still doing culturing at that time and had to wait a day to get the results. There weren’t standards for personal protective equipment (PPE). The samples were haphazardly received in the form of whole mailboxes, car parts, and samples sent in paper bags. Reporting back results was also slow and cumbersome, each response was a fax, or a phone call. Dr. Cannons also stressed that an overarching issue was an overwhelming sense of isolation because there was not a lab network in place at the time.
Things have much improved since that time. During the 2009 H1N1 outbreak the labs were better prepared, they had a surge staff, electronic reporting was in place, and there were regular discussions between labs. Labs are renovating to BSL-3 protocols for PPE and receiving samples (now delivered in 1-gallon paint cans). Testing is molecular-based and faster. The feeling of isolation is over – there are regular meetings with other labs.
Dr. Tara O’Toole on ‘Keeping Things Secret’ vs Open Publication
Endnote- Looking to the Future
Dr. O’Toole is the Executive Vice President of In-Q-Tel. She spoke on Big Data processing, the need for rapid diagnostics, and the concern that the US is behind the curve on the growing bio-revolution. During the Q&A session, Dr. O’Toole provided an insightful reflection on a question raised by Dr. William Karesh, Executive Vice President for Health and Policy of EcoHealth Alliance. He referred to the Global Virome Project, which has a goal to identify 700,000 viruses of mammals. But its open-data concept is getting push-back: “you wouldn’t want to make that information public, what if it’s used maliciously?”
Dr. O’Toole thoughtfully responded “The whole question of ‘we can’t let that out… that’s too secret, or that’s too dangerous’ beleaguers us constantly in all sorts of situations. One of the issues in biology about ‘talking about dangerous pathogens’ is that we are still in shock at the notion that we can make bad pathogens on purpose or by accident, instead of having God visit them upon us.” She refers back to a debate in 1999 regarding whether or not to tell the public about how few smallpox vaccines the US had at the time. She said they decided in favor of truth and openness – she believes this is always the default posture. “The reality is that all the information you need to do something evil with is out there now if you have the will. It’s a fantasy that we can keep it secret.”
Final Remarks on the Event
These are experts on the front lines of biodefense preparedness and response. Since 2001 they’ve implemented protocols and procedures, increased laboratory capability, innovated forensic attribution methods, modernized information sharing, and coordinated exercises. However, they all stressed two points that are serious vulnerabilities – it is a certainty that the United States will lose the edge on these capabilities without continued funding to maintain our current preparedness and response posture; and although there are successes, they are disparate across federal, state, and local agencies because there is no central authority to guide and manage our Nation’s biodefense.
The event exemplified all the right motives towards developing a successful and robust U.S. biodefense network. However, the road to developing these networks is full of obstacles. One obstacle that was extremely evident during this event was communication. The gaps in lingo, terminology, and even expertise could prevent productive communication between policymakers and scientists. One such incidence occurred when Sen. Liebermann asked for clarification on the term ‘Proteomics’. Moving forward I would expect an increasing need for interdisciplinary experts who could help bridge the gap between policy and science. In conclusion, this Blue Ribbon Study Panel does offer a significant beacon of hope that consistent open dialogue and discussion on these topics will spark action, hopefully before another event like the anthrax letter on October 16th, 2001.
Website:Blue Ribbon Study Panel
Website: Hudson Institute- Fits and Starts: Reactionary Biodefense
The Pandora Report 
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