Reports of biological threats pour into the Department of Homeland Security (DHS) at a rate of 20 to 30 a day"heroin laced with anthrax appears in Scotland; there's melamine in Chinese dairy products" again; there's salmonella in New Mexico and Texas.
Are these hostile acts, accidents or naturally occurring outbreaks? Do they threaten the lives or health of American citizens? Will they damage the U.S.economy? That's what Robert Hooks has to determine. Hooks is the DHS's deputy assistant secretary for weapons of mass destruction and biodefense, and he heads the National Biosurveillance Integration Center.
The center is supposed to be the U.S.government's nerve center for early detection of biological attacks by terrorists. It is designed to "rapidly identify, characterize, localize and track significant biological events of national concern," Hooks said.
But 16 months after it began operating, the NBIC is struggling. "It's functioning, but not at full capability," Hooks said during a late January interview.
A federal commission offered a much bleaker assessment Jan. 26. It gave the U.S.government an "F" for failing to develop the ability to rapidly recognize, respond to and recover from a biological attack.Eight years after the terrorist attacks of 2001, the United States s still "seriously lacking" in its ability to defend itself against a biological attack, the Commission on the Prevention of Weapons of Mass Destruction, Proliferation and Terrorism warned.
There's inadequate ability to keep federal, state and local leaders and the public informed in the event of an attack, there are insufficient stocks of medicine and deficient ability to distribute what medicine there is, the commission said.
And the situation's not improving.
"The forces and factors that imperil the country have been outracing defensive efforts and overwhelming good intentions," the commission warned Congress.
That dismal appraisal came just a day after a former CIA official warned that al Qaeda leaders appear bent on attacking the United States with weapons of mass destruction. Anthrax is a weapon of choice for a "9/11-scale" attack, said Rolf Mowat-Larssen in a report released by Harvard University.
Data trickle
Protecting the United States against biological attacks has been a top priority" at least on paper"since shortly after the 2001 attacks. Congress has passed laws requiring it, and presidential directives have ordered it. Yet for the most part, it hasn't been done.
For the NBIC, the problem is depressingly familiar"federal agencies are still unwilling to share information.Eleven agencies that gather healthrelated data are supposed to share it with the National Biosurveillance Integration Center.
But so far few do, the Government Accountability Office said in a December 2009 report.
Seven of the 11 have signed memoranda of understanding to cooperate with NBIC, but only one has completed a more formal "interagency security agreement" pledging to share data with the integration center.
So for now, little useful government data trickles in.Five agencies provide "written final products." But these are after-the-fact briefings, the GAO said, not the raw data gathered at the earliest stages of an incident, which would be useful for monitoring developments and issuing timely warnings.
So instead, the NBIC depends almost entirely on information that comes "from non-federal, open sources," such as a service that screens news reports from 13,000 media sources in more than 34 languages, the GAO said.
Interviews with the 11 agencies revealed "widespread uncertainty and skepticism" about the value of the NBIC and the usefulness of providing it data, the GAO reported.
Congress didn't help when it passed the 2007 law creating the NBIC, but didn't require the agencies that collect critical health data to share it with the integration center.
So for the most part, they don't. The 11 agencies are the departments of Health & Human Services, Agriculture, Commerce, Defense, Interior, Justice, State, Transportation, Veterans Affairs, the Environmental Protection Agency and the U.S. Postal Service.
Hooks attributes their lack of cooperation, at least in part, to the NBIC's newness. "One of the challenges we face is that this is not the tried and true method done by paper and pencil for 50 years," Hooks said. "We're on a new frontier."
The NBIC has to demonstrate that it can merge different types of information gathered from multiple sources and create meaningful national situational awareness to win over its federal partners, he said.
But there's also a hint of turf warfare
"We're not trying to replicate what CDC [the Centers for Disease Control] does," Hooks said. "We're trying to take USDA, CDC, VA information, DOD information, EPA information and bring it all together so that we can get out in front of significant biological events.
Some say even if Hooks can convince the 11 federal agencies to cooperate, that's only part of building a comprehensive national biosurveillance capability.
"Integration at the federal level is very small piece," said Jennifer Nuzzo, an associate with the Center for Biosecurity at the University of Pittsburgh Medical Center. Most of data that winds up being useful actually comes from the state and local level.
"Doctors' offices, hospital emergency rooms, medical labs and local public health services are invariably the first to detect disease outbreaks. Their reports alert authorities at the state level, who then report to federal agencies.
Budgets threaten safety
"State and local surveillance programs are the foundation," Nuzzo said. "I really believe that we've got to build from the bottom up.
"But that won't be easy.
There are "hundreds of separate surveillance programs that serve a range of purposes. Many are duplicative or have overlapping missions, and most are not interoperable," Nuzzo said.
And at present, any effort to sort them out and make them interoperable is being stifled by economics.
"State budgets are in terrible shape," Nuzzo said. "There have been massive layoffs in state health departments across the country.
"Even where money is still being spent on biosurveillance programs, it is not clear that they are actually yielding useful results. The BioWatch program, for example, has spent more than $60 million installing and operating air samplers designed to detect airborne pathogens in 31 U.S. cities. But there has been scant rigorous assessment of the program's efficacy and cost-effectiveness, Nuzzo said.
Questions are raised about even the best biosurveillance systems. "One of crown jewels of biosurveillance is the flu surveillance program," Nuzzo said. Flu arrives annually, so health authorities "get to exercise" flu surveillance regularly. It should be top notch. But last year, when swine flu showed up, "we learned how much we didn't know," she said.
How serious was N1H1? "We closed schools across the country," Nuzzo said. "Then we realized that wasn't a good idea." The resulting daycare crisis may have caused economic hardship more serious than the disease itself. Vaccine production was months behind schedule.
Overall, the experience was not reassuring. "What you saw in N1H1 was an allhands- on-deck response," Nuzzo said. "If this was an anthrax attack, we'd have been in real trouble."
