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BIOTERRORISM AND CONFLICT BIOTERRORISM AND CONFLICT MANAGEMENT:MANAGEMENT:Challenges and Consequences for India, Challenges and Consequences for India, Israel and the United StatesIsrael and the United States

 Dr. Venkat Rao

Presentation at theSeminar Sponsored By:

The India Forum

School of Public Policy, George Mason University

The Conflict Resolution Research Group (Israel)

May 15, 2003George Mason University

Arlington, VA

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KATEUA’S TRAP

Year: 67 BC

Stage: Trabzon (Black Sea coast, Turkey)

Actors: Roman General Pompey versus King Mithridates of Pontus

Weapon: “Mad Honey”

Excessive salivation, vomiting, loss of coordination, tingling and burning sensations in the mouth and extremities, low blood pressure, decreased heart rate, muscular weakness, and sometimes convulsions. Although few attacks are fatal, even a small amount of mad honey can result in total incapacitation, which lasts for about twenty-four hours.

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TOPOFF 2

Year: 2003 ADStage: Hypothetical—Seattle and Chicago

At Noon in Seattle, a bomb explodes causing more then 100 casualties.Significant level of radioactivity detected at the site.Local officials and first responders conclude it is a “dirty bomb”

Next day, some 2,000 miles east, in Chicago, people arrive at the local hospitals complaining “flu-like” symptoms.

Next 24 hours, the number of “flu-like” reports increase dramatically, bringing CDC.

CDC confirms a deadly biological agent.

*DHS Drill, May 12, 2003.

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Threat is Global—Emerging Landscape

• Global travel

• Globalization of food supply and centralized processing of food

• Population movement (urbanization)

• Transportation system

• Access to specialized technologies

• Internet

• Environmental Degradation

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WHY US, India and Israel?

• Threat real, differentiated only by local environment

• Difference in endemic disease profiles and geography exist

• Levels of preparedness vastly different—Israel:US:India.

• Promising S&T base

• Opportunities for collaboration (pharmaceutical stockpiles, vaccine technologies, sensor systems, bioinformatics, to name a few)

 

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WHY US, India and Israel?

• Anthrax in the mail in the US, India and Israel–Nov, 2001: Envelope containing a suspicious power received

by Maharastra’s Deputy Chief Minister (Mr. Bhujbal). Anthrax test was positive (confirmed by Haffkin Institute and Molecular Diagnostic Research Center)

– 2001: One person diagnosed with Anthrax (Karnataka)

– 2001: Goa’s Secretariat received mail with suspicious power (inconclusive results)

– 2001: Uttaranchal’s Chief Minister’s (Mr. Nityanand Swami) residence received mail with suspicious power (inconclusive results)

–Anthrax endemic in Tamil Nadu, Karnataka, and Andhra Pradesh

 

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WHY US, India and Israel?

• Anthrax in the mail in the US, India and Israel–October, 2001: Three parliamentary office received letters with

suspicious powers leading to closure of section of the parliament building

–October 2001: Parliamentary opposition leader Yossi Sarid, head of the Meretz party, received a similar letter.

–Test results not available.

–October 4 to November 23, 2001: 23 confirmed cases of anthrax in the US from exposure to spore-laden mail. 11 confirmed pulmonary anthrax and 12 confirmed/suspected Cutaneous anthrax.

 

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WHY US, India and Israel?

• Opportunities to share capacity and expertise in preparedness and countermeasure areas:– India reported development of a new Anthrax vaccine

(Panacea Biotechnology)

– India offered 20 million Ciprofloxacin to US in the aftermath of October 2001 anthrax mail to meet shortage in stocks

– Israel reported development of a new Anthrax vaccine (Nes Tziona Biological Center). One dose regimen.

– Israel's Home Command and Medical Corps provided guidance document to US DOD on hospital preparedness, “incident” analysis and risk assessment

– Information and intelligence on threat assessment

 

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Consequences of Traditional vs. Early Detection

Detection

24 48 72 96 120 144 168

Incubation Period (Hours)

0

0.2

0.4

0.6

0.8

1

0

Dis

ea

se

De

tec

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Early SymptomsDisease-specific

Symptoms

Advantage of Advantage of Early Early DecisionDecision

* Adopted from Kaufman, AF, et al. 1997. Emerg. Infect. Dis. 3: 83-94.

Detection

MonitoringMonitoring

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Technology as an “Enabler”

• Ability to generate real-time reporting

• Capacity to incorporate Chem-Bio Detection with clinical surveillance/report

• Flexibility of open standards-based incidence reporting and tracking platform

• Ease to include biosensor modules on existing environmental monitoring networks

• Weakness in expert decision systems

• Ability to integrate GIS in EMS

 

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Innovative Technologies and Solutions

Emerging Public Health Threatsand Role of Enabling Technology

Detection and Surveillance Mitigation and Response

EmergingPublic Health Threats

eLEXNET Laboratory electronic exchange network Track and respond to outbreaks of

food-borne illness Promote collaboration/data exchange

BTADT Integrate intelligence data with medical

and other inputs Decision tool to detect BW event

HIRTS Integrated electronic network for NCBR

incidence first response Expandable decision logic for

incidence analysis

TB Surveillance Laboratory surveillance of Mtb/NTM

worldwide Detection of resistant forms of Mtb

D, S

D, S

R

S

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Bioterrorism—Multiple Source

• Contamination of water supplies (eg. Girardiasis)

• Agricultural produce

• Packaged food

• Ventilation system (Legionnaires disease)

• Package/cargo (Anthrax mail)

• Transportation network (B. Subtilis)

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Bioterrorism—First Responders

• Public Health Officials• Epidemiologists• Physicians• Pharmacists• Microbiologists• Agriculturists• Package designers• Industrial engineers• Law enforcement

Both Prevention and mitigationPrevention

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Bioterrorism Monitoring Component Systems

•Biosensor system/suite

•Data capture/analysis

•Reporting and tracking system

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Incidence Reporting-Tracking Systems Model

HIRTS*Virtual

CommandCenter

* CSC’s Hazard Incidence Response Tracking System

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Bioterrorism Preparedness and Response--USA

• Implement the National Strategy• Enhance Infectious Disease response, coordination, and

support (NEDSS)• Enhance local epidemiology and surveillance capability• Improve coordination, communications in public health and

medical care (hospital preparedness)• Conduct detailed preparedness assessment (city/region)• Enhance CBRN countermeasures R&D Tech base• Improve Stockpiles (NPS, Vaccines etc.)• Invest in public health informatics

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Bioterrorism Preparedness and Response—India • Perform integrated threat assessment

• Establish Rapid Response Laboratory network for detection/identification

• Establish dedicated bioterrorism workforce at state level (Ministry of Health, Drug Control Dept.)

• Develop coordinated state government departments planning (Ministries of Health, Agriculture, Home and Drug Control Dept.)

• Animal vaccination program (eg: Anthrax)

• Leverage telecommunication tools for rapid infusion of training

• Coordination with international partners in information sharing and joint ventures

• Explore ways to co-opt Private Sector

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Bioterrorism Preparedness and Response—Israel

• Completed final phase of smallpox vaccination

• Priority in first response to incidence

• Improvements in water supply, food supply systems

• Secure infrastructure for medical professionals to treat victims

• Robust Medical Technology Sector

• Improvements in interlinked hospital network

• Need CBRN countermeasure products approval process compliant with US

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US-India-Israel Partnership Needs

• Collaboration of Preparedness/Prevention Programs

– Improve coordination, share information and responsibility– International strategy to guide implementation

• National Strategy Initiative–Need baseline for performance goals and measures for

preparedness–Collaborations with private sector and stakeholders–Training, equipments, communication

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Research Activities—Areas of Collaboration

•Detection of Agents (Bioinformatics, Proteomics based systems)

•Development of New and Improved Vaccines (Recombinant products, biotechnology)

•Development of Antibiotics and Antiviral products (Pharmaceuticals)

•Performance standards for emergency response equipments (IT tools, data collection and KM systems)

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Knowledge makes bioterrorism

possible;

Knowledge also provides a strong defense against it.