Bio-Preparedness Needs to Start at the Frontlines of Disease Control

Recently, CNN released an article on how the United States is not prepared for a bioweapons attack. Discussions like these have grown in recent years as concern for a North Korean bioweapons program grows. Truly, very little is known about the kind of active bioweapons program North Korea may possess. Playing on the increasing fears and concerns, many experts have highlighted the sheer lack of preparedness within the United States for biological weapons attacks.

The Blue Ribbon Study Panel on Biodefense highlighted weaknesses with the US preparedness and biodefense capacity, of which few would likely argue. Although the Trump administration seeks to develop its own biodefense strategy, the truth is that defending against biological threats requires a Herculean effort against a hydra of a beast.

The recent focus on bioweapons isn’t surprising; however, I think the attention on biopreparedness needs to be much larger. It’s easy to say we are not prepared for a biological weapon attack, but let’s be honest, no one is. That’s the tricky part about bioweapons, they can easily pose as natural outbreaks or involve deadly pathogens we rarely deal with in a typical outbreak scenario. The challenges of preparing for biological threats go beyond establishing medical countermeasures (MCM) and early warning systems like BioWatch and BioSense. These efforts are critical; however, it is important that we take a step back and address how an outbreak or attack is first recognized. Whether the biological incident is a natural outbreak, laboratory accident, or an act of bioterrorism, identification of the source tends to first come from within the health care system and through public health reporting (unless, of course, the nefarious actor revealed him/herself.)

The Blue Ribbon Panel report and the CNN article both highlight the bureaucratic challenges with coordination at a national level across many agencies and sectors. The crux of it all is that from a grass-roots level, we’re struggling to better prepare and respond for a host of reasons. Public health funding is always in a chronic state of too little too late and often, we don’t push out resources until we’re already in the throes of a major incident (Ebola, Zika, etc.). Preparing for biothreats, regardless of origin, requires that we strengthen the most basic surveillance and response systems within public health and health care.

During the 2014—2015 Ebola outbreak, for example, there was a lot of attention on enhanced precautions. Although this was beneficial and brought attention to several gaps infection control and prevention measures, I found myself reminding staff that we can’t truly prepare and respond to rare events if we can’t get our daily practices down. The shear challenges of ensuring staff practice appropriate hand hygiene and isolation precautions in health care are indicators that we are struggling on the frontlines of disease preparedness. It’s easy to say that we’re not prepared at a national level, but it’s a bit more of a sting to acknowledge that hospitals and public health programs already become overwhelmed during rough flu seasons, let alone during outbreaks of high-consequence pathogens. Support for bio-preparedness efforts needs to come from the agency and bureaucratic level, and on the frontlines of public health. Hospitals and public health programs need to be supported in strengthening infection control, surveillance, and response efforts or else small outbreaks will turn into big problems. Building up critical public health infrastructure will translate to better outbreak response and a greater capacity to respond to bioterrorism.