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Preparing for Bioterrorism

Tevi Troy

As citizens across the nation debate and dissect President Obama’s State of the Union address, we should not miss the opportunity to make good on one of his promises. President Obama devoted one line of his 70-minute speech to announcing a new plan to address the potential for bioterror attacks.

In light of increased chatter among terrorists and last fall’s experience with the H1N1 virus, it is clear we need new ideas and mechanisms of delivery if we want to save American lives. In fact, the bipartisan Commission on the Prevention of Weapons of Mass Destruction, Proliferation and Terrorism just gave the United States an “F” for our “capabilities for rapid response to prevent biological attacks from inflicting mass casualties.”

Unfortunately, facing this problem will require more than a few lines in an otherwise crowded speech, including some creative thinking that uses the wherewithal and ingenuity of the American people.

Although the president did not elaborate on his plan, the White House did issue a brief statement that gave a little more detail, saying that the president would ask “U.S. government leaders to re-design our medical countermeasure enterprise to protect Americans from bioterror or infectious health threats.” There are a number of elements to fighting biological threats. We know that the federal government is good at certain aspects of preparing for a pandemic or a biological attack—specifically, stockpiling needed materials. The federal government already has huge caches of countermeasures for a variety of challenges, including flu, anthrax, and smallpox. While the stockpiles are carefully placed around the country in the Strategic National Stockpile, the issue of distributing these countermeasures is one of the most difficult challenges that the federal government faces.

The Strategic National Stockpile was designed so that officials can direct bulk shipments of countermeasures anywhere in the country within 12 hours. But getting the materials distributed to individuals in a specific community is extremely difficult. For the last five years, the federal government has been experimenting with a variety of distribution methods. Here are some of our options for achieving the president’s goals.

Option 1: The first approach is to use the U.S. Postal Service, and the Obama administration issued an executive order at the end of December calling for the establishment of a national U.S. Postal Service medical countermeasures dispensing model. The postal service already has the ability to reach every mailbox in the United States every day. Using this logistical capability, the federal government could distribute countermeasures to individuals within a targeted community in a public health emergency. HHS has conducted successful tests of this method in Seattle and Philadelphia, and post office distribution is likely to be a useful tool in our distributive arsenal in the future.

The drawback is security. The postal workers’ union has expressed concern about its members carrying sought-after countermeasures and requested that each mail carrier involved in such an effort be assigned a public safety officer for protection. This request adds an additional challenge, especially given the constraints that local police departments would face during a public health crisis.

Option 2: Another approach is the point of distribution concept, where individuals converge on a specific site to receive the needed remedy. We saw during the H1N1 scare how many people were turned away from vaccine facilities because of shortages: This approach rewards patient people, who will arrive early and are willing to wait in what will likely be extremely long lines.

Unfortunately, this is not necessarily the most effective way to distribute countermeasures because it does not target the highest-risk or highest-need individuals. This method also discriminates against individuals who cannot travel, who are disabled, or caregivers who cannot get away from their charges. And the point of distribution approach puts an undue burden on rural Americans, as distribution centers are typically located in cities or suburbs.

Option 3: A third distribution system that deserves further exploration is home medkits, which allow individuals to store countermeasures for home use in case of a publicly declared health emergency. The kits can also be purchased by employers or universities to distribute in time of need, or given to first responders to use before being deployed into action.

Although this method will not work for vaccinations—vaccines are not typically self-administered and need to be refrigerated at specific temperatures—there are a variety of useful countermeasures that can easily be stored and administered.

Widespread adoption of home medkits would considerably reduce the distribution challenge faced by federal officials in a crisis. It would also promote individual responsibility and self-reliance, and individuals nervous about the federal government’s performance during the current vaccine difficulties could find assurance in knowing they had taken important steps to protect themselves and their families.

Unfortunately, medkits still face a number of hurdles before federal officials can make them a key part of our national preparedness planning.

First is the resistance from public health authorities. When former secretary of health and human services Mike Leavitt promoted this idea, he was met with near unanimous opposition, in large part because they did not trust individuals to use countermeasures both when and as directed by the appropriate officials. But a 2006 study in St. Louis, sponsored by the Centers for Disease Control, found that 97 percent of households entrusted with medkits did not open sealed containers without being directed to do so by the appropriate officials.

Secretary Leavitt also requested that federal officials develop medkits that individuals could use in a variety of scenarios. Thus far, the kits are not available, and the Food and Drug Administration has determined that already-approved drugs repackaged in a medkit require separate approval and labeling, which slows their development.

Another obstacle has been the recent crisis directing resources towards dealing with the H1N1 virus. Government officials will now shift their attention to the new biodefense initiative.

With the recent executive order highlighting the postal service distribution plan, the Obama administration appears to have put medkits on the back burner. If so, this is a mistake. The president’s requested redesign of our countermeasure system should continue to develop the concept of home medkits and make them part of the federal distribution arsenal. Otherwise, our recent distribution problems could serve as an unfortunate foreshadowing of a problem that could very well be avoided.

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