ASM Biothreats – Keynote

By Georgia Ray

Two keynote speakers kicked off the 2019 ASM Biothreats meeting with some words about horrific diseases, and how health security learns from experience. Robert Kadlec and Anne Schuchat led this informative and engaging keynote event.

Robert Kadlec is a guru of the US Biodefense landscape. He was the main author on the Pandemic and All-Health Preparedness Act. He directed Biodefense efforts at the White House, first as the biodefense director of the Homeland Security Council, and then as the Special Assistant for Biodefense Policy to George W. Bush. Now, he’s the Assistant Secretary for Preparedness and Response at the US Department of HHS.

During the keynote speech of the 2019 ASM Biothreats conference, he talked about the 2014 Ebola pandemic, one of the worst outbreaks of one of the most lethal diseases seen in recent memory. As he saw it, this outbreak proved that two changes to the US disease response system were needed:

• Training (since answered by the GHSA)
• Medical countermeasures (still unsolved)

The response to Ebola and other high-consequence infectious diseases in the US is in a fragile state. While funding may run out, Ebola, obviously, will not. Kadlec also talked about the 2018 National Biodefense Strategy. He likes that it’s deliberate and detailed, and includes risks from emerging technology. Often, bold strategies of its ilk are not tied to reality – for instance, to budgets or the skill levels. That’s what Kadlec is working on. For U.S. biodefense efforts, HHS is most involved, but so is the DoD as well as others, including local governments and communities. Right now, ASPR (Kadlec’s office) is fleshing out the National Biodefense Strategy, starting with assessment and data-gathering methods. The B-PLAT, a policy exploration tool put together by PNNL, will explain this as it happens. Note that the plan is intended to be a living document, with refinements every year. As it develops, the office will seek feedback feedback from public groups, including from ASPR’s existing connections.

Kadlec ended by noting that the US currently has 12 aircraft carriers, each costing about $12 billion to build. Each year, we spend half the cost of a single one of them on biodefense. While attention paid towards biodefense is growing, it is still a tiny fraction of the defense budget.

Dr. Anne Schuchat is another storied figure in health security – she’s the acting director of the CDC. She spoke about four different Ebola outbreaks, their cultural contexts in the United States, and the lessons she takes from them:

1976: Zaire Yambuku hospital. Concurrent with H1N1 concerns at Fort Diz and the first emergence of Legionnaire’s Disease.

Lessons: Most Ebola cases were spread by the hospital reusing scarce needles. This also demonstrated burial transmission risk, and in the context of the United States- diseases competing for media attention.

1995: Kikwit, Zaire. 25% of cases were in healthcare workers.

Lessons: importance of training, technique, and infection control – severity reduced by staff who had epidemiological training on influenza and on polio eradication. There was delayed diagnosis, and a concurrent messy political situation with media control, both which contributed to confusion and slowed action around the outbreak.

2014-16:The largest ebola outbreak ever, which hit West Africa. It claimed a full ten times as many victims as all previous outbreaks combined. Alongside, in the US, were the first outbreaks of acute flaccid myelitis associated with enterovirus D68 well as an unusually severe flu year.

Lessons: This outbreak showed the value of speed and infection control in response. Also, echoing the 1976 cases, access to basic resources: the first and last hospital hit by the disease, Redemption Hospital in Motserrado county, Liberia, ran out of gloves during the outbreak.

2018-19: The ongoing DRC outbreak, the second deadliest ever. Ebola’s legacy here is yet to be determined.

Lessons: The hardest hit countries had recent wars and thus less stable public health systems.

The keynote talks by Kadlec and Schuchat started the ASM Biothreats conference with honest lessons in not only effective biodefense strategy and outbreak response, but the cultural dynamics of infectious diseases that might test us unexpected ways.