Both the CDC and the NIH need to dramatically improve their communications with outside doctors and scientists--and key government officials--to best protect the United States from any biological attacks, Tara O'Toole, director of the Johns Hopkins Center for Civilian Biodefense Strategies, told Global Security Newswire.
Singling out the CDC for an "absolutely terrible" response to the anthrax epidemic last fall, when four anthrax-laden letters seriously infected 18 people and killed five, O'Toole said the CDC is "not big enough" to handle the responsibility of coordinating preparations for a biological weapons attack.
"I know there aren't enough human resources to create a plan, much less implement one," said O'Toole, who in recent months has briefed a host of leaders, including Defense Secretary Donald Rumsfeld, on the major gaps in the public health care system.
O'Toole accused both the CDC and the NIH of being small, tightly knit organizations that rarely open up to outside circles--contentions denied by their officials.
"We're going to need a [wide-scale plan] to get the new talent in the system. We need an immediate infusion of seasoned professionals," said O'Toole, a former Clinton administration health official. "I hope we do it fast enough so we don't spend a truckload of money and not go anywhere and get discouraged."
The medical community is suddenly being swamped with funds--this year's federal budget is pouring about $2.2 billion into various bioterrorism prevention and protection programs, and White House officials want to almost triple that amount for fiscal 2003. The NIH's Institute for Allergy and Infectious Diseases is slated to receive $1.7 billion of the funds proposed for next year, a $1.4 billion jump from this year, and the CDC is due to collect $1.6 billion for its bioterrorism programs alone--$661,000 less than this year.
"We need to restructure organizations and create new organizations," O'Toole said. "We need a 21st century medical system. Simply refurbishing the [existing] system won't do."
The current medical system is based on a 1930s model, which resulted from former President Franklin Roosevelt's efforts to improve living conditions during the Great Depression. In 1988 the National Academy of Sciences' Institute of Medicine issued a report highly critical of the system, but no major changes resulted.
O'Toole said that when the 1988 report came out the public health system was "glued together with Scotch tape, and since then things have grown worse."
New Information Network Needed
The United States needs a new national information network that scientists, doctors and researchers can not only tap into, but also use to send vital information in times of emergency, O'Toole said.
Any such information network "needs some national guidance--and it can't come from CDC," she said. "The CDC is not prepared to go big picture very fast."
During the recent anthrax outbreaks the CDC "did an awful job of allowing outside information" into its inner circle, O'Toole continued. "The political community was out of the loop during the early stages … and there was no clear process to identify the 'science problems,' as I call them. They didn't get better as events unfolded."
During the beginning of the anthrax attacks, Canadian researchers discovered that when an envelope containing anthrax spores was opened, the spores dispersed more widely and in much higher numbers than previously believed, according to the Wall Street Journal. The study also found that if tainted envelopes were not completely sealed, they could pose risks to postal workers who handled them.
The microbes "were going all over the room" of the Canadian researcher and "the CDC apparently wasn't aware of that until very late in the process," O'Toole said.
Outside bioterrorism experts "did not get called in until later in the game," O'Toole said, and then only for "last minute" conference calls during which "it wasn't clear who was in charge. Even those conversations were chaotic."
CDC officials refused several opportunities to comment the past couple days, leaving spokeswoman Sharon Hoskins to say she was unaware of any such problems.
NIH Doesn't Escape Criticism
Early this week, top NIH officials met with what Anthony Fauci, director of NIH's Institute of Allergy and Infectious Diseases, called "a very elite group of ad hoc advisers" to determine the research initiatives the institute will pursue with the more than $1.7 billion the White House is seeking.
NIH plans to spend $441 million for basic research into anthrax and smallpox, and how the human body reacts to them, Fauci said. Another $592 million would go towards the research and development of vaccines and drugs to prevent and treat those diseases, he said.
Fauci said $195 million would be slated for clinical research, with an additional $520 million used to build special facilities to conduct the research with the deadly agents.
O'Toole said Fauci and NIH officials merely met with "the feds" and that the group is approaching the threat of bioterrorism by only preparing for anthrax and a couple of other infectious diseases such as smallpox.
"That's wrong. We're talking about a thinking enemy," O'Toole said, arguing that NIH should research a wider range of deadly diseases that could be launched against the United States.
Concerning the $592 million earmarked for drug research and development, "NIH does not develop vaccines and antidotes. Private industry does," O'Toole said.
Fauci disagreed, however, saying that NIH is involved in "several" of the six or seven steps it takes to develop a new vaccine or antidote. "We develop the product and then partner with industry" to mass-produce and market it, Fauci said.
Rethinking Research Resources
Regardless of who develops drugs and antibiotics, both the CDC and the NIH should be more open to outside expertise, O'Toole said.
"The NIH needs to think about getting new people into this" bioterrorism research, she said. "A lot of scientists have some great ideas and will help in the near term, but they don't want to deal with NIH's lengthy and laborious grant process," which can take several months.
Fauci said that the NIH is utilizing its "remarkable accelerated review process," an expedited grant approval sequence used for research into AIDS and certain cancers. "We rely very heavily on outside expertise, blue-ribbon panels and such," he added.
O'Toole, however, said, "NIH is going to have to rethink how to solicit research and allow outside information …. To get top scientists in this game they need to make sure the money's going to stay and won't dry up in a year or two."
The infusion of money is unlikely to go away soon--in Congress there is talk of adding to the $6 billion President Bush has requested for the bioterrorism field for 2003. Health and Human Services Secretary Tommy Thompson has said the record funding merely represent a "down payment" on future expenditures.
"I'm surprised and pleased. They're finally putting their money where their mouth is," O'Toole said. "We're definitely going to need sustained investments over the next several years, at least a decade."
She added, however, "the science community will have a hard time absorbing so much money while taking a new direction …. We really need a strategy for some of these investments so we come out with come tangible results."