good bug, bad bug: biology as a weapon of war and...

National Preparedness & Response (NPR) Task ForceNational Preparedness & Response (NPR) Task Force

Good Bug, Bad Bug: Biology as a Weapon of War and Peace

Update from the HIMSS National Preparedness and Response Taskforce

Rosemary Nelson & Simmi SinghFebruary 2003

San Diego, California


Learning Objectives

The battle over good and evil on the biological front ...What does it mean for each of us who work in health care or inhabit society?

The complex backdrop ...Politics, population-health, financial trends, clinical research, genetic surveillance, bio-weapons, government and private industry

Impact on health care I/T professionals and Preparedness in America's communities ...


Learning Objectives (continued)

Primer from the HIMSS National Preparedness and Response Task Force - what you can do to help? An update from Capitol Hill, including a review of progress and happenings on the legislative, funding and HHS frontGlossary of resources you can use to aid in your preparedness efforts


The battle over good and evil

Religion, money, dogma, power, politics, science, the ethics of progress and the future of a planet ...... Finally a pursuit more ambitious than world peace!What does biology have to do with this and why should we care?


Life Sciences

Transformational science of the 21st centuryThe longest “permanently emerging” sector of the US economyThe road ahead, but where to?

Nirvana or Armageddon?


The Theater of Operations

Humanity (Patients): Both the Target and WeaponOrganized Medicine (Clinicians) and Ordinary Citizens: On the FrontlinesPoliticians and Governments: At a crossroads that comes along once in a ... species?


Life scientists and their sponsors face critical choices

For physicists in the 1930s and 1940s, it was the Manhattan projectWho is leading/will lead biology’s Manhattan project? What are/should be the goals? Are we the hunters, the hunted or both?


The Yin and Yang ...

What is the right cure for this disease?How do I tailor a treatment to correct a certain genetic defect? How do I take a large molecule and turn it into a miracle cure?

What is the right pathogen for this war?How do I customize the pathogen to target a certain enemy (race/gender/ population)?How do I take a “bad bug” and turn it into a predatory killer?


Is the threat real?

“... during the 20th century, disease epidemics claimed more lives than all the wars of the

world combined ...” Natural Disasters


Is the threat real?

“... $ for $, biological agents can be the cheapest ... most effective weapon for

asymmetric warfare ...” Dr. Michael Osterholm


Is the threat real?

“... the most serious threat to our security may consist of unannounced attacks on American

cities by sub-national groups using genetically engineered pathogens”

Hart-Rudmann Commission


Is the threat real?

“Bio-weapons are one of only two categories of weapons that have the theoretical capacity to "push the nation to the point of non-recovery.”

Admiral Stansfield Turner


Is the threat real?

“... not a “lights and sirens” kind of emergency, by the time it clearly manifests ... it could be beyond control. ... front lines are manned not

by military or police workers, but by health care workers ...”

Dr. Tara O’Toole and Dr. D.A. Henderson


Is the threat real?

“... can theoretically build a bio-weapon in a space the size of a two car garage ... using

technology typically used to develop a vaccine ... and clean up leaving virtually no

trace within twenty four hours...”

Congressional Testimony by Dr. D.A. Henderson


The technology to harm exists today ...

Methods for making new influenza strains never before seenDirections for making Ebola virus from non-living fragments of genetic materialTechniques to make anthrax or plague resistant to many or even all available antibioticsAttempts to combine a set of genes from viruses that cannot spread to viruses that canBiological aerosols that might once have harmlessly floated away can be stabilized in the environment and altered to become more easily inhaled

Johns Hopkins Center for Civilian Bio-defense


What does this mean for each of us?

Bio-events are differentThey require fundamentally different response strategiesThe threat can come from at least three sources:

Naturally occurring pathogensAccidentally released pathogensDeliberate use of a bio-weapon


Lessons learned

Practice exercises and real life experiences have yielded valuable lessons

The Anthrax incidents“Top Off” and “Dark Winter”

Paramount among the challenges encountered ...

Communication and Coordination ChallengesKnowledge LimitationsRole ConfusionResource bottlenecks: Skill versus Scale


We are making significant progress

CDC and HHS’ Office of Public PreparednessSound goals defined, funding allocated, critical benchmarks set and being reached

Challenges remainTime, Money, R&D, Skill versus Scale, Managing the Threat, Anticipating the Unknown ...Homeland Security and Health and Human Services - will the new structure help or hinder dual use programs?Who’s on first?


We are making significant progress

Initiatives across the G-7 and within the World Health OrganizationCommunity, regional, public and private pilots across the country - examples abound

KentuckyTexas/New MexicoPennsylvaniaConnecticutFlorida


Challenges remain ...

Unprecedented collaboration between private, public and academic sectors is needed

More definitive, rapid, automated means of diagnosing major pathogensMechanisms to rapidly develop and produce new antibiotics and antiviral drugs for new and emergent diseases.Mechanisms for enhancing the immune response generally, so as to get beyond the one organism-one drug approach


Challenges remain ...

Regional plans to cope with extended mass casualty attacksCapacity - infrastructure, communications, bricks and mortal, intellectual, workforceSafety net decisions - insurance, cost, liability, civil rights and libertiesPublic policy - deep engagement of the scientific, medical and government communities in seeking new ways to manage and control this growing science


What can health care I/T professionals do?

Recognize your role on the front lines - engage in the debate - your life just might depend on itLearn more about this kind of threat and help lead the evolution of your institution’s/community’s plansEnergize and FOCUS those around youBe willing to face up to the trade-offs and compromises required

Ethically, Morally, Financially, Individually, Idealogically ... (easier said than done)

Practice, train, practice and train again Build on the excellent work completed to date by communities across the country


Einstein’s View was and is Strangely Prescient ...

“You can’t control information about how to build an atomic bomb - it’s written in

the stars ...”


How is health care responding?Core industry playersHIMSS and other professional societies/movementsGrass roots effortsGovernments and think tanksThe academic, corporate, financial, technology, intelligence and defense communitiesPoliticians and GovernmentsCivilians


BackgroundGoals/Position StatementPreliminary ObjectivesCurrent InitiativesMembers/Subject Matter Experts

National Preparedness & Response Task Force


National Preparedness Response (NPR) Task Force

BackgroundHIMSS requested to participate in National Initiatives

Member, Framework for the Information Technology Infrastructure for Bioterrorism

RAND, Science & Technology Policy InstituteParticipant, Frontline of Medicine Delphi Survey

Association of Emergency Room PhysiciansContributor/Interviewee, Professional journals

HIMSS decision to take a central role in supporting members in this topic area


Advocacy - Pillars of Excellence


The NPR Task Force will take a leadership position in advocating for the following:

Development & deployment of enhanced surveillance methods and technologies to detect, manage, and prevent public health crisesEnhanced members’ understanding of crises coordination processes used by national, federal, state, local, & public entitiesDocumentation, creation, and sharing of recommended standards, best practices and case studies

Position Statement


Identification & communication of pilot efforts and best practices currently underway in various communitiesCoordinated creation of a “blueprint” to serve as a checklist to monitor progress in critical areas(e.g., infrastructure deployment, standards, training)Tracked usage of public/private resources for emergency preparedness, and encouragement of health institutions to raise capital for preparedness & response efforts

Position Statement


Enhance the preparedness of America’s communities in advance of and in response to expected & unexpected public health crisesEnhance our Nation’s level of preparedness and response through a program of activitiesParticipate and partner with other affiliates to advance preparedness, as well as be a force of pragmatism and actionEducate our members

Goals


FELT MANAGEMENT INCExcellence in Action

Members



MembersRosemary Nelson, Deputy Director, Strategic Operations and Planning, TRICARE NortheastSimmi Singh, Executive Vice President, Felt Management, Inc., Advocacy Committee LiaisonHerb Schmaltz, Board Liaison, CKO & Chief, Applied Knowledge Management, USAFPenny Dobb, Executive Director, Shared Information Services, Memorial Health Services, Long Beach, CA Kim Hlobik, Business development and Strategic planning, Cerner CorporationRichard Hopkins, MD, MSPH, Medical Epidemiologist, Science Applications International Corporation (SAIC)Richard Klasco, MD, Chief Medical Officer, Micromedex, IncEdward Kline, Senior Consultant, First Consulting Group John McLamb, Director of Informatics, University of North Carolina School of MedicineHelga Rippen, MD, PhD, MPH, Director of Science and Technology Policy, RAND CorporationCharlene Underwood, Manager Clinical Marketing, Siemens



Subject Matter ExpertsNPR Task Force also leverages the experience of a group of experts from the following affiliations:

IBMKeaneInvizeonESRILifespanAdvanTechCleveland ClinicAnd many others ...



Current Initiatives

Survey on Emergency Preparedness & Bio-defense Conduct survey to identify memberships’ needs with regard to healthcare information management in disaster and bio-defense events.

Formulation of Resource Grid & White PaperCreate, document, and analyze existing preparedness initiatives in central location for membership access.

Health Information Sharing and Analysis CenterParticipate with HHS in establishing a Health ISAC to improve the confidentiality, integrity, and availability of the national health information infrastructure to better serve patients, emergency services and national health and security.


Initiatives in DOD

LEADERS (Lightweight Epidemiology Advanced Detection and Emergency Response System)

Web-based Bio-surveillance Tool designed to assist in a national response to medical emergencies and intentionally perpetrated attacks of a biological natureVendor(s): 4 company consortium (Oracle, YET, ScenPro, and Idaho Technology

Training with Industry (TWI) InternshipsMedical Service Corps officers fill TWI slots @ Office of Emergency Preparedness w/affiliations to DOJ, FBI, FEMA, and others


NetworkFirstIP-Based Network to Connect Emergency AgenciesVendor: M/A-Com Inc.

Outsourcing Disaster Management/Recovery Plans

Chester County Hospital, West Chester, PAVendor: Daou Systems, Inc.

CBW Bloodhounds--Biosensors

Other Initiatives


Congressional Activities

Bioterrorism Preparedness Act of 2001 (H.R. 3448)

Rep Billy TauzinA bill to improve the ability of the US to prevent, prepare for, and respond to bioterrorism and other public health emergenciesStatus: Introduced 12/11/01; Public Law 107-188 on 6/12/02



Department of Veterans Administration Emergency Act of 2002 (S. 2132)

Senator John D. Rockefeller IVA bill to amend title 38, United States Code, to provide for the establishment of medical emergency preparedness centers in the VHA, to provide for the enhancement of the medical research activities of the DVA.Status: Introduced 4/16/02; Public Law 107-287 on 11/7/02



National Emergency Telemedical Communications Act, (S 2748)

Senators Conrad & Bailey HutchinsonAuthorize formulation of State and regional emergency telehealth network test beds and, within the DoD, a telehealth task force Bill based on white paper developed by ATA in 12/02, as well as work of Southern Governors Association & several federal agenciesStatus: Introduced 7/17/02; Referred to Committee on Armed Services



Regional Comprehensive Emergency Preparedness, Coordinating, and Recovery Act of 2002 (HR 5461)

Rep Jack KingstonTo enhance homeland security by encouraging the development of regional comprehensive emergency preparedness and coordination plansStatus: Introduced 9/26/02; Referred to the House Committee on Transportation & Infrastructure



National Homeland Security and Combating Terrorism Act 2002

(S. 2452, H.R. 4660, 5005, 5710, S.1449, S1534)Senators Joseph Lieberman A bill to establish the Department of National Homeland Security and the National Office for Combating Terrorism Status: Introduced 5/2/02; Public Law 107-296 on 11/25/02Formally established the Department of Homeland Defense



Additional ResourcesHIMSS websitewww.himss.orgCenters for Disease Control and Preventionhttp://www.cdc.gov/cic/functions-specsNational Academy of Scienceshttp://www.nationalacademies.org/topnews/#tn1119Johns Hopkins Center for Civilian Biodefense Strategieshttp://www.hopkins-biodefense.org/index.htmlAHRQ and University of Alabamahttp://www.bioterrorism.uab.eduRAND Center for Domestic and International Health Securitywww.rand.org/health/healthsecurity

good bug, bad bug: biology as a weapon of war and...

Documents