Publications

Abstract: Hurricane Katrina demonstrated that a catastrophic event in the continental United States (US) can overwhelm domestic medical response capabilities. The recent focus on response planning for a catastrophic earthquake in the New Madrid Seismic Zone and the detonation of an improvised nuclear device also underscore the need for improved plans. The purpose of this analysis is to identify the potential role of foreign medical teams (FMTs) in providing medical response to a catastrophic event in the US. We reviewed existing policies and frameworks that address medical response to catastrophic events and humanitarian emergencies and assess current response capabilities by a variety of FMTs. While several policies and plans outline the role of the US in providing medical assistance during foreign disasters, further planning is necessary to identify how the US will integrate foreign medical assistance during a domestic catastrophic event. We provide an overview of considerations related to federal roles and responsibilities for managing and integrating FMTs into the overarching domestic medical response to a catastrophic disaster occurring in the continental US.

The UPMC Center for Health Security and the Rad Resilient City Initiative commend the public health leaders of Ventura County, CA, and their partners  on the launch of the jurisdiction’s pre-nuclear explosion public information campaign and on the thoughtful groundwork that went into it.

Ventura County, CA, Launches Nuclear Response Public Information Campaign

September 18, 2013—The UPMC Center for Health Security commend the public health leaders of Ventura County, CA, and their partners today on the launch of the jurisdiction’s pre-nuclear explosion public information campaign and on the thoughtful groundwork that went into it.

These authorities have rightly trusted in the maturity of county residents to handle the issue of nuclear incident preparedness. In a potential or actual public health crisis, the dangers of alarming people unnecessarily or having them not grasp the complexity of the matter are far less than most leaders imagine. A nuclear terrorist attack, while low in probability, is still possible given present day politics and technology, and people deserve to know the correct protective actions to take.

In the interest of public health, Ventura County is taking reasonable steps by providing its citizens with life-saving information. If prevention of nuclear terrorism fails, then reducing exposure to radioactive fallout is the intervention that can save the greatest number of lives following a nuclear detonation. In the aftermath of a nuclear explosion, promptly finding and staying in a robust shelter will reduce exposure and save lives. Acting on the instinct to flee the affected area will result in lives lost.

Through this campaign, and the opportunity for dialogue it provides, county residents will be empowered with the information to save their own lives. Pre-incident public education is a top priority because people cannot wait to be told what to do. Fallout is the most dangerous in the first few hours after detonation, and degraded communication will keep officials from warning people in the areas that most need the information.

We encourage the citizens of Ventura County, CA, to ask questions at the planned town hall meetings and become more informed. We also invite other jurisdictions interested in learning more about nuclear preparedness to visit the . There they will find 7 clear, actionable steps for communities to protect inhabitants from radioactive fallout, thus saving many tens of thousands of lives following a nuclear blast.

In 2009 the state of Florida confirmed that native transmission of dengue fever was occurring—something that had not happened for decades. An astute clinician in New York made the diagnosis in a patient who had just returned from Key West. In the years prior to that outbreak, local transmission of dengue fever had occurred in both Texas and Hawaii.

That such a scenario occurred in 21st-century America, where other mosquito scourges such as yellow fever and malaria are historical curiosities, reinforces the fact that so long as mosquitoes capable of spreading disease inhabit a country, that country will harbor some risk of an outbreak of a mosquito-borne disease occurring.

Not only do dengue outbreaks have the potential to cause significant morbidity in the populace, but the identification of the presence of dengue in a region can also have a negative impact on the local economy in decreased tourism and added expenses for augmented vector control activities.

This commentary on the scope, content, translation, and policy utility of research is shaped by the authors’ perspectives from federal, state, and local levels and national policy making. The reflections presented here were offered in response to presentations at the Dynamics of Preparedness Conference in Pittsburgh, October 22-24, 2012, many of which are included in this journal supplement issue.

We sought to determine the proportion of refugee patients at the Baltimore City Health Department Tuberculosis program (BCHD-TB) successfully completing latent tuberculosis infection (LTBI) treatment, as compared to other referral groups, and to identify factors associated with treatment completion. We completed a retrospective cohort analysis of individuals referred to BCHD-TB program for LTBI care between February 1, 2009 and March 31, 2011. Among 841 patients evaluated by BCHD-TB and diagnosed with LTBI, 81 % of refugees, 50 % of non-refugee foreign-born, and 35 % of US-born patients completed LTBI treatment. In multivariate analysis, refugees had greater odds of LTBI treatment completion (Adjusted Odds Ratio 7.2; 95 % CI 4.2–12.4, p < 0.001) compared to US-born individuals adjusting for age, gender, and treatment regimen. Overall, LTBI treatment completion remains suboptimal. At BCHD-TB, LTBI treatment completion was significantly higher among refugees than other referral groups. Additional efforts are needed to optimize LTBI care, and future efforts may need to be tailored for different risk groups.

In April 2009, following an experimental protocol, staff members at a Navy lab in San Diego tested specimens from two patients using a new diagnostic device. Both tested positive for influenza, but, oddly, neither specimen matched the influenza A subtypes that are known to infect humans. This finding raised suspicions, and so the samples were sent to the US Centers for Disease Control and Prevention (CDC). Further tests would reveal that these two patients were the first reported cases of a novel H1N1 influenza virus that would cause a global pandemic in 2009.

Approximately 6 years ago, then-President George W. Bush first signed the Pandemic and All-Hazards Preparedness Act (PAHPA) into law, reforming the nation's public health preparedness landscape. On March 14, 2013, President Barack Obama reauthorized the legislation, incorporating important lessons learned and setting the path for the next 5 years. When the law was originally passed by the 109th Congress, policymakers were acting in response to Hurricane Katrina and the threat of a possible influenza pandemic. Members of the 113th Congress have reauthorized PAHPA, seeking to enhance existing programs and authorities in light of recent public health emergencies. This article examines PAHPA, considers its impact on preparedness over the past 5 years, and describes the recently signed reauthorization legislation.

In this CFR working paper, author Gigi Kwik Gronvall examines the controversy surrounding the publication of two H5N1 flu–transmission and clarifies the arguments that arose for and against publication; offers lessons learned for future dual-use research to scientists, research directors, publishers, and policymakers; and promotes a reasonable consideration of the risks and benefits of dual-use research.
 

We celebrate the 35th year without smallpox, once the most serious pestilence known to mankind. The achievement was the product of a global eradication program that was launched in 1967 with a 10-year time target. The last case occurred in October 1977. The total cost of the program was estimated to be about $300 million, one-third of which constituted international contributions. The achievement has been lauded as one of the most important of the 20th century. However, the decision by the 1966 World Health Assembly to undertake this campaign had been controversial. At the time, a global malaria eradication program, then in its 12th year, was failing. Many argued that it was technically impossible to eradicate any disease and questioned the judgment of WHO and professional public health. The decision to proceed was decided by a margin of only two votes.

When letters containing anthrax spores were mailed to several US senators and media offices in September 2001, just one week after the 9/11 attacks, bioterrorism catapulted to the national stage. Political leaders and public health officials, desperate for guidance on this once-theoretical scenario, turned to experts including Tom Inglesby, then deputy director of the Johns Hopkins Center for Civilian Biodefense Strategies, a bioterrorism research and analysis think tank in Baltimore. In the years that followed, Inglesby and his colleagues ran exercises to simulate bioterror incidents, established a peer-reviewed journal on biodefense and advised government agencies on how to reduce the public health impact of biological threats.

Diagnostic tests are critical for diagnosing diseases in US troops, for domestic and in­ternational early disease detection and bio­surveillance, and for improving global health.¹ Advances in diagnostics could improve clinical management of a range of diseases in the US healthcare system. The ability to rapidly di­agnose infectious disease has been identified as a strategic priority by the White House,^2,3 the US Department of Health and Human Ser­vices (HHS),⁴ the National Institutes of Health (NIH),⁵ the US Centers for Disease Control and Prevention (CDC),⁶ and the US Department of Defense (DoD).⁷

Pulmonary agents (also known as “choking” agents) compose a class of chemical compounds that disrupt normal breathing.

It has been suggested that the true case fatality rate of human H5N1 influenza infection is appreciably less than the figure of approximately 60% that is based on official WHO confirmed case reports because asymptomatic cases may have been missed. A number of sero-epidemiological studies have been conducted in an attempt to identify such missed cases.

Nerve agents are a class of chemicals grouped together based on their common mechanism of action, which is interruption of vital nerve transmissions to various organs.

Blister agents, also known as vesicants, are a class of chemical weapon first used in combat during World War I. The prototypical and most common blister agent is sulfur mustard (SM) (bis-(2-chloroethyl) sulfide), known as mustard gas.

The vulnerability of the public’s health to cyber security threats has received insufficient attention in the research literature to date, and has yet to be well understood (Harries & Yellowlees, 2013). This paper is intended as a step toward analyzing cyber-related public health challenges in a systematic fashion. The research gaps on cyber security and public health are particularly striking in light of an April 2012 report by the Government Accountability Office, which noted not only the ever-increasing prevalence of cyber security threats (“cyber threats”), but the many intentional and unintentional sources from which such threats can originate, the numerous targets that malicious actors might exploit, and the varied tools at the disposal of those who would seek to launch cyber attacks (U.S. Government Accountability Office, 2012a). The adage noted by security expert Bruce Schneier in his 2012 Science piece rings truer with each passing day: “Everything gets hacked” (Schneier, 2012).”

Foodborne illness sickens or kills an extraordinary number of people each year. It also has great economic costs. Last year, an outbreak linked to contaminated cantaloupe in the United States sickened 146 and killed 30. In 2011, another outbreak in Germany that was eventually linked to contaminated sprouts, sickened more than 4,000 and caused at least 50 deaths. Foodborne disease outbreak response is a critical part of reducing the consequences of outbreaks that will occur in the future. If public health officials can more quickly recognize when a foodborne illness outbreak has occurred and identify the food causing the outbreak, lives can be saved and economic losses averted. The lessons learned from outbreak investigations can be used by industry and government to address the underlying causes of contamination that lead to illness, thus making food safer for everyone.

This is an eclectic overview of social-science theory and its interdisciplinary connections, with a practical objective: to clear the ground for constructing a large-scale historical data resource that ranges across social-science data with links to natural-science data in health and climate. The hope of finding empirical patterns at the global level—and of finding empirical linkages among various sorts of human experience over time—requires that analysts spell out theoretical linkages among social sciences. If we can’t link social sciences explicitly into a larger web of theory about human behavior, we are left with a positivistic segregation of economy from society and culture as the best we can do in analysis. Such an approach, which still survives in parts of the academy, runs counter to the widespread intuitive sense that we live in a highly connected and interactive society. Our limited ability to express this connectedness in theoretical terms means that, in describing a past that precedes our contemporary intuition, we have only the analytical tools of segregated disciplines. World historians have been writing narratives that suggest a global interweaving of complex historical dynamics, but they have made little progress in formalizing their interpretations.1 For lack of clear statements on past links among the domains of economics, society, and politics, we underestimate the degree of past connectedness in human affairs. As a result, our comparisons of past and present overestimate the rate of change in social interaction. In turn, such miscalculation of current rates of globalization exaggerates and misdirects our ability to intervene with policy to address current crises and to project future changes. Fortunately, there have been some advances in exploring interdisciplinary connections in the social sciences. These advances have been achieved particularly at macro levels, for instance in historical world-systems analysis and in studies of contemporary globalization. In addition, many more cross-disciplinary insights have doubtless been developed but remain below the radar for lack of a sufficiently robust overall discourse on unifying the social sciences.2

The Center for Biosecurity of UPMC conducted this study to provide leaders in the US Department of Defense (DOD) with an expert assessment of the technical feasibility and strategic implications of next-generation monoclonal antibodies (mAbs) as medical countermeasures (MCMs) for DOD personnel. Our assessment includes identification of potentially appropriate DOD investments in mAb technologies.

With the 2001 anthrax attacks, the threat of bioterrorism became real to the nation. Before that, biological weapons were a known threat to warfighters, but after, the vulnerability of US civilians was clear. It was also clear that the US government was not organized to address the national security and civilian threat of bioweapons. Only a handful of civilian experts were involved, and the Alfred P. Sloan Foundation was the only US philanthropy willing to commit resources to confront the challenges of preparing for bioterrorism. When Sloan got involved in 2000, the professional field of biosecurity did not exist. There was little science or scholarship. There were no guidelines or planning tools and few policies or officials to direct civilian preparedness, planning, and response. Over ten years, the Sloan Foundation awarded more than $44 million in biosecurity grants and was instrumental in establishing the field and many of its most prominent leaders. That was money well-invested. The nation is now vastly better prepared for bioterrorism and other catastrophic threats to the public's health and national security. Author Gigi Kwik Gronvall chronicles the foundation's leadership in the field and the innovations that followed to show how the Sloan Foundation help to build the foundation on which US civilian biosecurity now stands.