Biodefense: a (very) bad idea whose time has come?
This week more than 750 microbiologists sent an open letter to NIH Director Elias Zerhouni warning that an overemphasis on "biodefense" was threatening to harm fundamental research in public health (.pdf here and supporting material here, also .pdf). Using publicly available data the scientists demonstrated the baneful effect the biofense agenda was having on support for important research into organisms of genuine public health concern, while simultaneously diverting vast sums into research of little public health significance, all on the grounds it involved potential biowarfare agents. This is an important development and a good start. But the argument they advance is too narrow. The problem goes far beyond effects on basic research in the physiology, pathophysiology, genetics and epidemiology of infectious disease agents.
Here are other important issues:
1. The wholesale distortion of priorities entailed by the biodefense agenda is not limited to infectious disease research. Virtually all of public health is affected. It is no secret that fiscal pressures on federal, state and local health authorities have produced cutbacks in routine public health services like substance abuse, maternal and child health, immunization programs, vital records and surveillance, sexually transmitted disease clinics and programs, and many others. Simultaneously, earmarked funds for biodefense have been flowing uncontrolled into the system. The result is that personnel are taken off routine public health activities that deal with problems that happen daily and put onto worthless biodefense "leaf-raking" exercises (like repeated needs assessments and contingency planning for events that will likely never happen). This produces major personnel reassignments and massive reordering of priorities.
2. Infiltration into the public health mentality of the military mindset is now taking place. The money comes from Department of Homeland Security and the DHS boys don't take you seriously unless you talk the Homeland Security talk. And that vocabulary is the vocabulary of terrorism and terrorists, al-Qaeda targets, strike opportunities, assets, threat assessments, vulnerabilities and on and on. It used to be if you went to an interagency meeting, the fire folks sent their chief, the police their commander, public works their director and public health sent a committee. Public health used to be horizontally organized: many programs working together across different populations but for a common purpose. Now public health is part of the "chain of command" and is organizing to respond via the "incident command system," becoming an arm of public safety (fire, police, EMS), not the care-givers and invisible supports of the community. There is an old saying, "When public health works, nothing happens." Now, public health doesn't work until something happens. And maybe not even then. Meanwhile we have named our own "commanders" to send to the meetings and everything travels up and down the "chain of command."
The Science Friday NPR show on 3/4/05 provides a poignant illustration (link to streaming audio here). In an otherwise sensible discussion of the total lack of "biosecurity infrastructure" in the US (by which the discussants meant basic public health infrastructure, but the change in terminology itself is telling), Jeffrey Romoff, president of the University of Pittsburgh Medical Center, strongly pushed the notion that the model to use is not a public health model but a defense model. He blatantly tried to hook the public health wagon to the biodefense star by saying the threat of an avian influenza pandemic was like a terrorist threat and should be approached and treated in the same way. It is obvious what he meant here and equally obvious what his strategy is. But the end result is that we play with their ball, on their field and by their rules. Bad idea. Here are some other reasons why.
3. The "biodefense" agenda is likely to make us less safe, not more safe, even from bioterror weapons. Terrorists aren't sitting around reading molecular biology journals and planning intricate experiments that are not likely to succeed, even after months or years of effort. These kinds of experiments require years of training and equipment not found in apartments in Hamburg or ranches in Montana. If they are so inclined they fill up a truck or a car with explosives or buy a dozen assault rifles and hit a "soft" target. The weapons are ready to hand. Novel pathogens are not . . . They aren't, that is, unless someone is obliging enough to make them for you, which is exactly what is happening under the guise of the biodefense research and development agenda. If you want to make a detector, a diagnostic reagent kit, a therapeutic drug, a vaccine--the first step is to make the organism. Now, something that never existed before is ready to hand. Forget about the high containment and high security laboratories are springing up to house this work. No matter what the containment, the weak link is always the human element. Even without considering the inevitable lab accidents (and they happen and even cause death to workers in the highest containment laboratories in the world), we shouldn't forget that the weaponized anthrax that brought American public health to its knees responding to "white powder events" in 2001 almost certainly came from one of these laboratories.
4. Some of the research will inevitably be secret or classified. No public health research that is classified can serve a public health purpose or even a legitimate scientific agenda. If the results of our research is not to be made available to the global public health community of scientists and public health workers, we are not serving public health, a global enterprise of shared knowledge and endeavor. Instead, we corrupt that enterprise, just as physics was corrrupted by the Cold War.
5. There is no effective civilian oversight for this research. This means we will have no way of knowing whether it violates the community standards of public health, or as a public health leader put it, no way of guarding against public health pornography, by which he meant research on ways to hurt people or make them sicker.
6. Parts of the biodefense agenda will plausibly stimulate a biological arms race. In Boston they are building a "biodefense" laboratory that, from the outside, has all the appearances of an offensive weapons laboratory (although I hasten to say I doubt it is). But appearances are crucial. The laboratory will have animal quarters, aerosol exposure chambers and high containment laboratories (BSL4) which could also be used to work on offensive biowarfare projects. Even for our allies, this is liable to give pause and suggest to them they might want to hedge their bets and start or augment their own programs.
Public health advocates initially welcomed biodefense money on the grounds it would have "dual use" effects. But it hasn't turned out that way. The infrastructure continues to decay, and deforms in the process. As one leader put it recently, public health is like the man who goes to the gym every day and exercises his right arm, which becomes hypertrophied, while the rest of his body atrophies. The same source compared trying to build public health with bioterrorism money with trying to invent Tang by building the space program.
Unfortunately, the Bush Administration seems to have gotten public health to drink the KoolAid, not the Tang.
Here are other important issues:
1. The wholesale distortion of priorities entailed by the biodefense agenda is not limited to infectious disease research. Virtually all of public health is affected. It is no secret that fiscal pressures on federal, state and local health authorities have produced cutbacks in routine public health services like substance abuse, maternal and child health, immunization programs, vital records and surveillance, sexually transmitted disease clinics and programs, and many others. Simultaneously, earmarked funds for biodefense have been flowing uncontrolled into the system. The result is that personnel are taken off routine public health activities that deal with problems that happen daily and put onto worthless biodefense "leaf-raking" exercises (like repeated needs assessments and contingency planning for events that will likely never happen). This produces major personnel reassignments and massive reordering of priorities.
2. Infiltration into the public health mentality of the military mindset is now taking place. The money comes from Department of Homeland Security and the DHS boys don't take you seriously unless you talk the Homeland Security talk. And that vocabulary is the vocabulary of terrorism and terrorists, al-Qaeda targets, strike opportunities, assets, threat assessments, vulnerabilities and on and on. It used to be if you went to an interagency meeting, the fire folks sent their chief, the police their commander, public works their director and public health sent a committee. Public health used to be horizontally organized: many programs working together across different populations but for a common purpose. Now public health is part of the "chain of command" and is organizing to respond via the "incident command system," becoming an arm of public safety (fire, police, EMS), not the care-givers and invisible supports of the community. There is an old saying, "When public health works, nothing happens." Now, public health doesn't work until something happens. And maybe not even then. Meanwhile we have named our own "commanders" to send to the meetings and everything travels up and down the "chain of command."
The Science Friday NPR show on 3/4/05 provides a poignant illustration (link to streaming audio here). In an otherwise sensible discussion of the total lack of "biosecurity infrastructure" in the US (by which the discussants meant basic public health infrastructure, but the change in terminology itself is telling), Jeffrey Romoff, president of the University of Pittsburgh Medical Center, strongly pushed the notion that the model to use is not a public health model but a defense model. He blatantly tried to hook the public health wagon to the biodefense star by saying the threat of an avian influenza pandemic was like a terrorist threat and should be approached and treated in the same way. It is obvious what he meant here and equally obvious what his strategy is. But the end result is that we play with their ball, on their field and by their rules. Bad idea. Here are some other reasons why.
3. The "biodefense" agenda is likely to make us less safe, not more safe, even from bioterror weapons. Terrorists aren't sitting around reading molecular biology journals and planning intricate experiments that are not likely to succeed, even after months or years of effort. These kinds of experiments require years of training and equipment not found in apartments in Hamburg or ranches in Montana. If they are so inclined they fill up a truck or a car with explosives or buy a dozen assault rifles and hit a "soft" target. The weapons are ready to hand. Novel pathogens are not . . . They aren't, that is, unless someone is obliging enough to make them for you, which is exactly what is happening under the guise of the biodefense research and development agenda. If you want to make a detector, a diagnostic reagent kit, a therapeutic drug, a vaccine--the first step is to make the organism. Now, something that never existed before is ready to hand. Forget about the high containment and high security laboratories are springing up to house this work. No matter what the containment, the weak link is always the human element. Even without considering the inevitable lab accidents (and they happen and even cause death to workers in the highest containment laboratories in the world), we shouldn't forget that the weaponized anthrax that brought American public health to its knees responding to "white powder events" in 2001 almost certainly came from one of these laboratories.
4. Some of the research will inevitably be secret or classified. No public health research that is classified can serve a public health purpose or even a legitimate scientific agenda. If the results of our research is not to be made available to the global public health community of scientists and public health workers, we are not serving public health, a global enterprise of shared knowledge and endeavor. Instead, we corrupt that enterprise, just as physics was corrrupted by the Cold War.
5. There is no effective civilian oversight for this research. This means we will have no way of knowing whether it violates the community standards of public health, or as a public health leader put it, no way of guarding against public health pornography, by which he meant research on ways to hurt people or make them sicker.
6. Parts of the biodefense agenda will plausibly stimulate a biological arms race. In Boston they are building a "biodefense" laboratory that, from the outside, has all the appearances of an offensive weapons laboratory (although I hasten to say I doubt it is). But appearances are crucial. The laboratory will have animal quarters, aerosol exposure chambers and high containment laboratories (BSL4) which could also be used to work on offensive biowarfare projects. Even for our allies, this is liable to give pause and suggest to them they might want to hedge their bets and start or augment their own programs.
Public health advocates initially welcomed biodefense money on the grounds it would have "dual use" effects. But it hasn't turned out that way. The infrastructure continues to decay, and deforms in the process. As one leader put it recently, public health is like the man who goes to the gym every day and exercises his right arm, which becomes hypertrophied, while the rest of his body atrophies. The same source compared trying to build public health with bioterrorism money with trying to invent Tang by building the space program.
Unfortunately, the Bush Administration seems to have gotten public health to drink the KoolAid, not the Tang.
posted by Revere at
3/07/2005 04:18:00 AM
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