When Time Is Running Out

In a November 2016 letter to the President, the President’s Council of Advisors on Science and Technology (PCAST) offers recommendations to the U.S. government for its reactions to the growing field of advanced biotechnology. While the council emphasizes the need for increasingly developed biotechnology and biosurveillance strategies, PCAST also hints at a more somber truth – once a threatening pathogen is on the loose, there isn’t much they can do.

While, through this letter, PCAST establishes recommended measures for dealing with biotechnology and the prospect of an active bioattack, its real emphasis is on prevention. As PCAST observes, “it is possible that a well-planned, well-executed attack might go unnoticed for days or weeks.” With a U.S. population of 318.9 million citizens spread across 3.797 million square miles, the brewing of a dangerous bioattack is likely to go unnoticed in its vulnerable early stages, making the detection of a pre-epidemic strand extremely difficult.

Further, the council emphasizes that the U.S.’ chances of escape from a bioattack depend on “effective detection,” “response,” and “recovery capabilities.” If a bioattack has the capability of reaching the level of an epidemic (Ro > 1), it will likely have the capability of spreading before eradication measures instilled by the government can catch up. PCAST makes the harrowing statement, “Despite recent improvements, analysis by U.S. Government agencies confirms that the pace of vaccine development and deployment remains too slow to materially affect the outcome of most plausible attacks.” According to PCAST, once a bioattack is out there, it’s very difficult, if not impossible, to reel back in. Because of the severe ramifications of a bioattack on the loose and lack of the ability for prompt eradication, PCAST highlights the need for “enhanced threat awareness” and “deterrence.”

This introduces a tough parallel – though prevention is the government’s strongest defensive measure, the thought of a raging bioattack is a frightening prospect for most citizens and politicians alike. Consequently, PCAST still issues a long-term recommendation for a development of a countermeasures program. The question PCAST faces is, how should limited government resources be best allocated when facing a faceless enemy? How much priority should be given to “recovery capabilities” rather than prevention? Perhaps, rather little. — Katherine

20 thoughts on “When Time Is Running Out

  1. I think Katherine’s emphasis on PCAST’s letter to the President is particularly interesting in light of last week’s reading by Watts in Six Degrees: The Science of a Connected Age. The idea that we are all connected by “six degrees of separation” is both fascinating and terrifying. PCAST’s focus on prevention is consistent with Watt’s analysis of efficient viruses and their performing of “broadcast searches.” Because the efficiency of a virus determines how quickly it will spread and how lethal the virus is, it is quite possible—as PCAST’s letter states—that a well-planned attack could go unnoticed for days or weeks. That coupled with Watt’s mention of the fact that “we have built an international system of transportation networks that can transmit an infectious disease to the world’s metropolises and power centers within a few days” makes the prospects of viruses against which we are defenseless frightening.

    Watt also discusses the power of exponential growth as it relates to viruses on the internet. In the same way that six degrees of separation make us unavoidably interconnected in terms of infectious diseases, we are prone to the uncontrollable spread of information on the internet. I think this will be an interesting topic to come back to when we begin our discussions on cybersecurity.

  2. Of course it is better to prevent an outbreak than to try to control one. PCAST’s greatest recommendation to this effect is the development of a biosurveillance framework. The benefits of biosurveillance would be twofold. Primarily, the government could prevent the creation of pathogens by rogue technically capable agents, such as terrorists. As such agents could operate in foreign nations, biosurveillance would necessitate international cooperation but would be feasible with recent technological advancements. The second benefit of biosurveillance would be to detect emerging threats such as new diseases in order to begin combatting them before an epidemic breaks out.

    As we have seen in the past, although the United States has the most robust intelligence community, attacks by terrorists and other nations still occur. Surveillance of any kind has its limits, and preventive measures alone are not enough. This is especially true in relation to biotechnology; since new technologies allow for the creation of an infinite number of pathogens and dissemination methods, it is impossible to anticipate or even quickly identify every biological threat. As such, PCAST’s recommendation that we also invest in response efforts is sound.

  3. Katherine ends her post with two very precise questions: “How should limited government resources be best allocated when facing a faceless enemy? How much priority should be given to “recovery capabilities” rather than prevention?”. To answer both questions, one needs to weigh in the benefits of such an investment in “recovery capabilities” and the value of the government investing in alternatives.

    It is very clear that the lethality level of a well-executed biological attack can be extremely high. This especially because the US population has been more vulnerable than ever to seemingly “fossilized” infectious diseases, like smallpox, for which no US citizen currently gets vaccinated, and deadly mutations of modern viruses, like influenza, which can be genetically engineered in the lab. In this kind of cases, “recovery capabilities” would be US’s only line of defense, as prevention mechanisms are either not enforced in the first place (smallpox) or they cannot be possibly enforced because the biological threat/agent is unknown due to the infinitely possible mutations of certain viruses (influenza). Thus, ensuring a well-established and efficient first response public health system that restricts the infection rate of an epidemic and/or biological attacks is the only viable defense mechanism. This means that “recovery capabilities” should indeed be prioritized over prevention because a) the US vaccination system is already well-established in the US (95% of Americans have had vaccines for preventable diseases, according to CNN) and b) in many cases, prevention simply is not as an efficient defense mechanism.

    Nevertheless, even if there is value in the government funding “recovery capabilities”, one needs to understand whether this value outweighs the benefits of alternative investments. And in this case, the alternative to focus on is the military, which received an aggregate of 597 billion USD in government funding in 2015. This amount is more than the sum of military funding provided by the next five biggest government investors.

    The benefits of such high military funding are clearly marginal, due to the global dominance of the US in military power and political leverage. Given that, the US could easily preserve its political and military leadership internartionally with 4/5 of its current military funding (close to 480 billion USD) and invest the remaining 1/5 to the aforementioned “recovery capabilities”. This would be net beneficial because not only does the US lose little on the military side, but it also ensures a proper response system against its biggest weakness, an unforeseen biological attack, which also has the external benefit of improving the public health system overall.

    The question still to be answered though is to what extent there is the political will to introduce the policy necessary for this transition in government investments to occur. Does the US government feel compromised enough to reduce its military funding for a more effective “first response system” for epidemics and biological attacks? Given the fact that US channeled significant investments in counter-terrorist measures only after the 9/11 attack and given that no such biological attack has occurred other than the low scale Anthrax attack for 2001, it is highly unlikely. But one can always hope for the best.

  4. At the end of her post, Katherine poses the question: “how should limited government resources be best allocated when facing a faceless enemy?” I argue that government resources should focus on increasing intelligence and biosurveillaince capabilities. Biosurveillaince capabilities must be enhanced on the local level, but perhaps more importantly, on the international level as well. At the local level, PCAST recommends, “strengthening state and local public health infrastructure for surveillance and response.” This will require a grassroots effort to enhance the surveillance capabilities of local areas that are on the “front lines” of biological intelligence collection. While strengthening national biosurveillaince capabilities is certainly important, I argue that the principal biological threat to the United States comes from international emerging infectious diseases.

    In their letter to the President, PCAST emphasized the “need to dramatically strengthen international disease surveillance efforts.” This will give an early warning to the outbreak of human disease abroad that has the potential of spreading quickly to other countries. By “bolstering the public-health capacity of other countries,” the U.S. will be in a much better position to assess foreign outbreaks and prevent the spread of the disease across international borders. International biosurveillaince should also include enhanced capabilities to monitor agriculture. This effort will require consolidating the various US Government agencies into a unified front aimed at increasing international disease surveillance. These agencies should focus on detecting initial outbreaks of deadly diseases, such as Ebola and HIV, which originated in remote regions of central Africa. Increasing the surveillance capabilities as well as the public health capacities of these vulnerable regions, will ultimately serve to lessen the global and national impact of deadly diseases.

    When an outbreak is detected overseas, it becomes much easier to enhance national surveillance and recovery capabilities, for the “faceless enemy” Katherine describes, is given a face.

  5. In response to your question about how much weight a government should give a “faceless enemy,” I think an interesting debate that runs relatively parallel to this question is that over geo-engineering. While some argue that resources should be put into the development of future methods to combat the effects of climate change and global CO2 emissions (such as using sprays to reduce the temperature of the global atmosphere, using giant mirrors to reflect the sun’s rays, and ocean alkalinity enhancement), others find issue with this field of research. For one, geo-engineering could provide what is known as a moral hazard, meaning that individuals, nations, and corporations will continue to mistreat the environment/not modify their behavior because they believe that it will be fixed by these engineering techniques. If there is an aerosol spray that will reduce the impact of CO2 emissions, the reasoning goes, why should I inconvenience my lifestyle to reduce CO2 I produce? Similarly, will putting money and effort into preventative research create a moral hazard with scientists taking on more risks for experiments that might (unintentionally) cause a global outbreak?

    Of course, this report cannot be viewed by itself. With a new administration, it is unclear how policy towards research precautions will change, or more likely, if money will be slashed from research efforts. This might reduce the risk of a moral hazard, but on the flip side, would leave us unprepared for a global epidemic, intentionally released or otherwise. Unfortunately science has a lot to fear about a Trump presidency.

  6. Katherine suggests that government resources should be allocated towards preventative measures with respect to bioattacks. This closely echoes the sentiment of the PCAST recommendations on how to best handle threats, which could eventually be carried out. In the letter to the president, this council emphasizes how the resources necessary to pick up the pieces after an attack are far greater than what is needed to maintain a system of deterrence, though initial establishment of this system could be more costly. Logically, this makes sense. Why would the government waste time and resources on a huge recovery program if deterrence is obviously the best option? Well, absolute prevention just does not seem that easy to me.

    We saw six different recommendations for the president on handling bioattacks. They are split between short, medium, and long-term goals… and for good reason. The gap between the potential to effectively follow the first two recommendations and the next two is astronomical. Recommendation 3, for example, suggests that the government “promote[s] a stronger international system of disease surveillance.” Yes, this is a valid point, but it is simply not realistic. The whole reason that we face a challenge with disease and epidemic prevention is the fact that it is extremely difficult to discern between who is ill with a pathogen that has not been seen in decades—or ever—and who has the seasonal flavor of the flu. The problem is that we simply cannot expect the unexpected; we don’t know how to. There are countless possible pathogens that could lead to an epidemic, and while the government can try its best to protect against the threats it deems most likely, it will never cover everything.

    To answer Katherine’s question at the end, maybe absolute priority should not be given to recovery capabilities, but they must not be forgotten. Even as we move forward in research and discovery on pathogens, there must be a strong safety net to fall back on when preventative measures fail. This net comes in the form of response power.

  7. In its letter, PCAST urges the president to build a new interagency entity that governs national biodefense activities and outlines the need of ensuring appropriate funding for biosecurity research efforts. Although each recommendation is healthy in its motive and detailed in its specifics, it clearly lacks a further explanation about on what basis the figures for funding were estimated.

    Among piles of different proposals that luckily end up in a policymaker’s desk, one that addresses the need of preventive action is probably the most difficult one to win his heart; the issue at stake is so often ambiguous, if not purely hypothetical, to the eyes of a non-expert, and even if he considers it with an open mind, there still remains an arduous task to acquire concession from another big pool of non-specialists who draft regulations and plan budgets. Therefore, I believe everyone would appreciate even a few lines of footnotes that go over how the sums like $2 billion, $250 million per year and $75 million per year were estimated .

    Regardless of how disastrous the outcome of an event can be, a decision-maker would not give away a dollar for its prevention if its probability of occurrence is practically zero (For example, our government does not publicly run any program pertaining to preventing potential zombie apocalypse, even though such a situation would lead to a global humanitarian catastrophe). As much as new technologies give rise to more varied biosecurity threats, it seems it is more than ever important to create a balance sheet of risks and costs at stake. Proving that prevention is better than cure surely will be a very difficult task, but even a rough scheme with plausible assumptions would definitely alert the decision-makers.

    I do not know whether the proposals by PCAST were given acknowledgement at least partly, but I sincerely hope it was paid some attention and facilitated some discussion in the higher office. However, if the proposal, by any possibility, was ineffective in arousing any real policy response, I believe the next step must involve a rigorous marginal benefit and potential cost assessment that actually proves the need of prompt and extensive preventive measures.

  8. I strongly disagree with the argument in Katherine’s blog post. Katherine writes, “How much priority should be given to “recovery capabilities” rather than prevention? Perhaps, rather little.” Simply because our ability to fight back against a pandemic isn’t particularly well-developed at the moment doesn’t mean that we shouldn’t try to develop the critical infrastructure capabilities necessary to fight one. For example, the PCAST report, despite its bleak tone on prevention, also discusses the need to create new Medical Counter-Measures (MCMs) and in particular the need for “platform technologies,” or general remedies that can be adapted to specific pathogens. Although these countermeasures may be more difficult and time-consuming to create, it does not mean that they are any less worth pursuing.

    While prevention may be the best option for stopping future biological threats, we cannot neglect the infrastructure required to react to and recover from a future outbreak. Effective prevention measures are attainable; we just need to commit to developing them, since at the end of the day, we won’t be able to prevent every pandemic, and will need to be prepared to respond in the event of one.

  9. One surprising point in the report for me was the comment that in terms of process and response, bio-attacks and naturally occurring epidemics aren’t too far apart (1).

    Between what they term “intentional biological attack” and the “spread of unanticipated organism,” medical countermeasures, logistics, and overall resource and response mobilization are all key regardless of who sets off the initial spark, nature or man. They conclude by urging “maximal coordination between biodefense efforts directed at deliberate and naturally-occurring threats. As I recall from lecture, I think Professor Liefer mentioned how the Ebola vaccine came from a laboratory that was funded by defense spending. The market doesn’t naturally create for these defenses and ountermeasures. But were we just lucky then, that the defense program oriented toward safeguarding against the weaponization of viruses happened to prepare us for a natural threat? What happens when it doesn’t, i.e. if a virus or bacteria mutates to reach the human species and is out of the realm of considered bio-weapons (and thus appropriate countermeasures)? The report seems to believe that it doesn’t really matter if there’s a “face” on the pathogen at all, as long as we prepare for it somehow. I almost wonder if natural epidemics are a worse threat than deliberately weaponized pathogens, in that they can occur randomly, whereas human actors may at least follow discernible motives when selecting which strain or pathogen to use, and are hopefully more likely to pick something that already exists.

    While the PCAST report does note how “a pathogen might be deliberately modified to affect its spread or to be resistant to current preparedness and response capabilities,” if the pathogen is indeed resistant or modified I don’t see how any of these recommendations can significantly help (4). As they write later on developing therapeutics to inhibit part of an infectious agent (compared to vaccines), is even more laborious of a process and not “not suitable for creating a truly novel drug on a rapid timescale for a novel biological agent.” (11) So do we fund those measures, given their timeline and likelihood of use? While joint coordination between the bio threat and natural pathogen emergence sides is crucial, and having a joint platform or template to rush vaccine development or health responses, I wonder whether it’s ever possible to truly prepare for any kind of human-developed new bio-agent. But as Yannis mentions, perhaps the next worst thing would be fossilized viruses, so preparation against those types would still seem worth the effort.

    Hopefully there’s a natural deterrent against using or creating novel agents; after all, the ones releasing a new agent may be less sure of protecting themselves against this new untested pathogen and thus more likely to stick to something we have seen before and can prepare against.

  10. Katherine has clearly stated that prevention is the government’s preferred strategy with regard to an active bioattack, so I will not simply restate PCASTs arguments. Instead, I will explore another aspect that could play a role in the distribution of government resources in this situation. Perhaps an important point to note before we decide whether to allocate the majority of funding towards prevention efforts or towards recovery capabilities is the ethical aspect of responding to an epidemic that results from a bioattack. In ‘Contagion’, once the epidemic breaks out, the decision of who receives the vaccine within a survivable period of time is truly a life or death decision. Although the government decides to pick those whom receive the vaccine randomly using birthdays, from a statistical context this distribution will never be truly random due to the fame, power, and corruption of world leaders and others in high places and their abilities to gain access to the vaccine. Additionally, the movie shows people mobbing one another for food, water, and first aid supplies, the distribution of which also contributes to the ethical dilemma of deciding who gets to live or die once an epidemic breaks out.

    The questionable ethics of distributing vaccines and survival supplies to certain people during an epidemic arise due to desperation, which arises due to the epidemic itself. This is to say that should the epidemic not have broken out, but instead be prevented, people would not be desperate to survive. This statement proves that recovery capabilities come with significantly larger ethical baggage than do prevention efforts. It can be argued that the same ethical dilemma of vaccine distribution would arise should the preventative technique for a bioattack or epidemic be a vaccine. However, I would argue that with the preventative case, there is not as strong a time constraint as with the recovery case, in which the vaccine would be needed more immediately.

    From this analysis we can see that the ethical dilemma of the distribution of a cure is inextricably entangled with recovery efforts, while preventative efforts have a significantly smaller ethical aspect. For this reason, in addition to the reasons already argued by PCAST in their letter to the President, I believe the majority of government resources allocated towards anti-bioterrorism should be utilized to develop preventative techniques over recovery capabilities.

  11. When I started to read this report, I was shocked by the same remarks that Katherine commented on. Every strategy they recommended was accompanied by a acknowledgment that truly there was little they could do. The report had commented that while a natural disease outbreak was also plausible, the threat of an intentional pathogen release was not only not detectable but more lethal. They claimed that, for instance, the pathogen could be released in multiple locations at once, instead of just coming from patient zero, therefore increasing the probability that the disease would contaminate more people. Furthermore, in the report they remarked that the other threat comes from the fact that the criminals could manipulate the pathogen to be more resistant or unidentifiable. If they were to do this, the scientists would have an even harder time developing vaccines and by the time they do it might be too late. Together with the information that Katherine pointed out, I found myself pessimistic that there was any true preparation the government could make for a threat such as this.

    The other acknowledgment that the report makes, and that Katherine talks about, is that biosecurity is also in some ways a lost cause. As the information for pathogen sequencing is largely public, there is little the government can do to prevent certain individuals from learning about, and then recreating, pathogenetic materials. I think this is an interesting questions as well- is it ethical to keep information- especially scientific information- from the public if it is for national security? I have to say I agree with the justification that the information should be made public for several reasons. First, in this era the information would become public no matter the security around it at some point. If people wanted the sequencing, they would find a way to discover it. Secondly, just as the information on how to make bombs can be found, so can the information for deadly pathogens. That does not warrant the creation of the diseases- however, there is little the public can do to limit the public’s access to the information. Finally, as the understanding and discovery of pathogens furthers science and could develop into information that proves life-saving, I think the government has an obligation to share the discoveries. Therefore, I agree with the idea that biosecurity form the prevention standpoint is almost completely ineffective.

    What I found most compelling was the report’s plea for the President to create an interagency mechanism. While discussion and liaisons already exist between the public institutions and scientists, there is no formal position for someone to deal solely with biothreats. I think we need this institution because while there might not be these types of threats most of the time, during the one percent of the time where this position is warranted we will be glad we have it. Throughout the other readings as well it has become apparent that the hardest part of dealing with a bio crisis is the infrastructure. The man-power, research and money that needs to be at the government’s disposal at a minute’s notice is absurd. Therefore, I believe that a agency that is purely there to be prepared for such an event could create an easier transition for the country from crisis into action.

  12. Katherine ends her post with an interesting question for policy-makers regarding the balance between recovery capabilities and prevention techniques. In the context of constrained funding, this question remains highly relevant to any realistic discussion of creating a comprehensive biodefense plan. As Katherine writes, “prevention is the government’s strongest defensive mechanism”, and thus she seems to imply that our resources would be better spent on prevention, rather than building up our recovery capabilities.

    However, I would argue that the authors of the PCAST letter believe that better recovery capabilities are within the realm of possibility. By focusing on research and development of platform technologies, one could imagine a more robust ability to respond to an outbreak, something that would greatly strengthen our biodefense. While I agree that perhaps the government’s greatest strength is prevention, that doesn’t necessarily necessitate devoting much more funding to it. Rather, if scientists can envision the development of a specific technology that would greatly enhance the speed and quality of our response to an outbreak, such as platform technologies, financing R&D toward that goal certainly merits a serious discussion in the policy realm.

  13. In general, I am inclined to agree with the recommendations set forth in the PCAST letter. I whole-heartedly agree that the majority of our resources should be devoted to effective regulation and monitoring of potential biological threats, both malicious and accidental. Indeed, the best way to stop a biological attack/outbreak is to prevent it from happening in the first place. This, however, does not mean that we should not also devote resources to coming up with ways of slowing down and, ultimately, eradicating outbreaks. I think that an effective allocation of resources relies heavily on implementing specific prevention strategies and also places a focus on outstanding and reliable public health infrastructure.

    When it comes to stopping already initiated bio-attacks, however, there are not many efficient ways to do so. For example, the United States could stockpile all the smallpox vaccine it can make (as it has), but if there were to be an outbreak of bubonic plague, this smallpox vaccine would be useless and the money allocated to it would have been effectively wasted as it is money that could have been spent to treat the outbreak of plague. While it is good that we do have smallpox vaccinations stockpiled, it only protects us from one threat out of an almost infinite amount threats that could potentially face the world today. As I said before, I do think that the majority of our resources, therefore, should be used on prevention and public health measures that can help us defend and deal with a variety of biological threats as opposed to just one.

  14. I believe Katherine makes a good point that a bioattack is very hard to reel back in once out there. In fact, after reading the report, it seems to me to be a catch-22, with the advancement of biotechnology utilized to combat such outbreaks and improve biodefense, the very same biotechnology can be used to engineer more complex and more dangerous biothreats. As biotechnology improves, so do the threats. The report mentions the second generation of bio-engineering, while leading to many advances for humanity in terms of agriculture and medicine, similarly increases the number and severity of biothreats available for attack.

    The question then for policy makers is how to address the potential outbreak of a biothreat. Additionally, there are many dimensions to be taken into consideration. As today’s guest speaker elaborated on, there are not only biological and security threats, but also economic problems and other societal effects that cascade from policy designed to address biothreats. There needs to be a balance between the insights from the scientific research and technology, as well as the societal dimensions that people operate under. One potential area of interest is the psychology of mob mentality. Upon facing a biothreat, apart from surveillance, response, and recovery on a purely biological front, there is the sociological effects as well from dissemination of information regarding the threat, and people’s perceptions of the threat. Nina Fefferman gave the example of the influenza virus, being the perfect storm of epidemiological issues, as in public perception, the influenza virus is often not taken seriously enough to warrant vigilance, yet is still a major cause of death in the United States.

    Essentially, one thing I think the report failed to address is the disconnect between policy and actual human reaction and perception. There are a lot of factors driven by word choice and social groups, which create panic and response separate from policy action and intended response. An example Nina gave was when in New Jersey, children who visited Rwanda were banned from public school due to Ebola risk, when in reality, New Jersey was actually closer in distance to the source of Ebola than Rwanda. These types of perceptions, spurred on by media coverage, often have larger consequences and effects than policy-makers give attention to. There is a top-down approach that should be addressed when looking at biothreats, which sometimes virtual studies may be able to shed light on, regarding risk perception and how this risk perception translates into actions.

  15. Katherine brings up some important issues in her blog post about the PCAST letter to the President. Especially after listening to Dr. Chyba in lecture today, it seems crucial that the United States allocate more funding towards the prevention of disease outbreaks. Especially given the current political climate, allocating more funding towards research and preventative measures might be the best course of action.

    One part of the PCAST letter that struck me was when they argue that for the creation of “laboratory networks in the United States and abroad with the capability for early detection and rapid monitoring of both human-made and natural emerging infectious agents in public health, agricultural, and wildlife settings.” It is important for us to consider naturally occurring epidemics as well! The movie Contagion serves as a good example for naturally occurring epidemics that could be preventable.

    When considering funding for attacks AFTER they happen, I find it hard to believe that the government would not immediately fund an effort to stop a bioattack or infectious disease spread of some sort. Dr. Chyba mentioned the importance of having an emergency response fund so that FEMA does not have to constantly ask for funding from Congress. This seems to happen every time there is some sort of national disaster; FEMA and other agencies should definitely have a rainy day fund in case of emergency. However, he also mentioned how the CDC’s budget is expected to drop about 12% in the near future. Extreme budget cuts, while perhaps considered necessary by the Trump Administration, would be harmful if we are to attempt to prevent disease outbreak BEFORE it can occur rather than just containing it.

    I wish that the guest lecturers would have explained a little bit more about the work that they did together. I agree with Jenny that it would have been interesting to learn more about how the virtual game model could be used from a policy perspective to urge the government to allocate more funding towards preventative measures and scientific experiments regarding biothreats and disease outbreak.

  16. In the end of Katherine’s response, she teases a bit of her personal political philosophy, questioning the extent of a government role in a potential bioattack or virulent pandemic. Setting aside the obvious ideological argument to be had on the role of government, this line of thinking risks discrediting the one organization with plausibly sufficient authority, resources and infrastructure to manage a crisis as complex and dangerous as a pandemic or bio-attack.

    The above only holds true, however, if government is provided the resources and personnel to adequately plan for and execute contingencies and strategies designed to cope with bio-disasters. Dr. Chyba’s discussion in class today of a bio-disaster relief fund similar to the natural disaster relief fund from which FEMA draws makes perfect sense in this context, providing a contingency fund for quick response as determined by experts whose sole job is to plan for these types of events. Moreover Dr. Chyba’s and the PCAST report’s discussion of organizational structure and personnel does serve as cause for worry as to the government’s ability to manage a crisis. Speaking about the current group of individuals tasked with biosecurity portfolios, PCAST notes that “practically all of them had to divide their time among many other responsibilities, many of which have a day-to-day urgency that preparing for potential future biological attacks does not.”

    American government at all levels has a habit of procrastinating on necessary action in the name of fiscal restraint, financial responsibility and limited government. Even those organizations with the resolve to make changes or to plan ahead for various contingencies often run into internal conflicts and turf wars among agencies and bureaucracies that stunt momentum and resolve. While I believe powerfully in the ability of government to be an effective manager of crisis and guardian of stability–as it has been through two world wars, several terrorist attacks, and countless other episodes–the PCAST report does cast doubt on the ability of executive government, as currently structured, to be an effective arbiter of biosecurity in the case of natural or artificial bio-disasters. When coupled with the social behaviors witnessed for small-scale outbreaks of Ebola and other diseases, and the socialization factors that accompany disease studied by Dr. Fefferman, this failure to plan on behalf of the government may well translate into a plan for failure. While I hope Katherine’s skepticism of government’s role in managing an outbreak is unfounded, she may well prove prophetic–to the detriment of all Americans.

  17. As some people have brought up in the comments, I was particularly struck by the fact that the PCAST report focused so much on the implications of biological attacks, while at the same time it acknowledged that the dangers posed by naturally occurring outbreaks of disease were both more likely than and potentially as dangerous as a biological attack. As Nicole mentioned, this may be a result of what Andy Leifer brought up in his guest lecture: the fact that preventing naturally occurring epidemics is neither immediately profitable for private enterprise nor a popular policy move for government agencies. However, as Chris Chyba brought up in today’s guest lecture, the problem of long-standing potential dangers that go unaddressed due to the perceived “more urgent or immediate nature” of other threats is one of the greatest threats to public health today. Working to prevent natural diseases is unsexy, but that does not make it any less crucial.

    While the report does address Medical Countermeasures (MCM’s) in depth, and responses to natural outbreaks are included in the analysis, the section is based around countermeasures to inflicted attacks and natural outbreaks are merely included. This is made very clear by the language used in the PCAST memo: “Despite recent improvements, analysis by U.S. Government agencies confirms that the pace of vaccine development and deployment remains too slow to materially affect the outcome of most plausible attacks.” The Committee chooses to focus on researching prevention and all but disregard researching vaccines and countermeasures in large part based on fears of the hypothetical of a biological attack, rather than on the eventual certainty of another outbreak similar to the Spanish Flu of 1918.

    Bill Gates, in a TED talk given in March 2015, discusses the potential damage that a modern epidemic could cause, noting the lack of of a “Contagion”-style task force in the real world that would be prepared and equipped to quickly respond. He discusses the necessity of similar procedures to the ones discussed in the PCAST letter; namely, investments in organizations to prevent and research pathogens and increased investment in public health to end preventable diseases. But he does not once mention biowarfare in a TED talk named “The Next Outbreak? We’re not ready.” This, along with the pieces of information from our guest lecturers and the PCAST letter, seems to paint a picture of a house of kindling waiting to be set alight, full of inhabitants who are unwilling to invest money to begin fireproofing the house. The experts in the field and other concerned observers are showing us the necessity of taking the unpopular and unglamorous steps towards protecting ourselves from devastating outbreak, and from this point it is up to those with the ability to incentivize action to make it happen. Fortunately, in a democracy, this includes us, the constituents.

  18. I commend Katherine on her thought-provoking question regarding the focus and budgeting expenditure of the U.S. government on either prevention or response measures to prevent and contain bioattacks. Katherine writes that a pre-epidemic strand stemming from a bioattack may be extremely difficult to detect and it will most likely spread before the government can take appropriate measures to catch up, making our response capabilities appear weak and futile. This is stated in PCAST’s observation that “a well-planned, well-executed attack might go unnoticed for days or weeks”, which is appalling and frankly something I think can be easily addressed and countered rather than accepted as a sad truth.

    PCAST’s belief that a well-planned attack could go noticed within days and weeks could be true with our present poor infrastructure and communication networks, but bioattacks and new viruses can also be detected within hours or days if proper measures are in place. For example, as suggested in Duncan Watts’s Six Degrees, if hospitals and CDC sources are well-connected and share information quickly and effectively, a new outbreak of a disease or bioattack could be detected within hours or days if similar symptoms suddenly emerge in different hospitals. This is an example of a recovery capability and process that the government must invest in and put in place.

    Although deterrence, biosurveillance, and the monitoring of gene laboratories is essential and our foremost defense against bioattacks, recovery capabilities and response tactics cannot be simply overlooked and must receive investment. Recovery measures that identify outbreaks quickly and eliminate shortcuts that spread disease are incredibly necessary as a second – and last – line of defense, so the government should not overlook them.

  19. I am about to offer what I surmise will be an unconventional and unpopular opinion: the primary, if not the only, conclusion from the PCAST letter worth heeding is that “the challenges are considerable.”

    I applaud my colleagues’ wishful thinking in suggesting massive spending on both prevention and recovery in addition. Unfortunately, budget constraints preclude this. And political constraints as Yannis alludes to preclude much progress in reorganizing the budget. A 20% cut in military spending to finance research against the “faceless enemy” is a pipe dream. And so policymakers must choose—given tight financing—between prevention and recovery.

    In either case, policymakers should be appropriately cautious and aware of the magnitude and likelihood of the “somber truth” that Katherine writes about (in a way that, if you go back to the Global Catastrophic Risks poll, I’m not sure we fully handled well). Government policy should—and this is where I think this opinion probably gets really unpopular—recognize that such an epidemic is simultaneously unprecedented (and therefore rare) and unfathomable (and therefore of very high magnitude). For both of these reasons, I think our policy could be one that could be described as realistic, pessimistic, or defeatist (pick your poison: I’d say realistic). I wouldn’t move mountains to prevent an epidemic that we’ve successfully avoided (except maybe the 1918 Spanish flu) for such a long time. And if the epidemic is so terrible, I think the “somber truth” is just that: there’s little we can do. To drastically restructure our budget (i.e. cutting 20% of military funding, cutting entitlements, other precious government services and thereby making a devastating impact on countless Americans’ qualities of life) to hold a massive check in reserve against the epidemic of “someday” seems politically unjustifiable, financially untenable, probabilistically inadvisable, and overall undesirable. I’m sure this takes us beyond the scope of this blog post, but I do think that it is also realistic to question—especially after watching Contagion—if life as we know it is recoverable after a decimating epidemic. Imagine the grief, the survivor’s guilt, the trauma. If we fail to prevent an epidemic of truly biblical proportions, something we’ve always managed to do successfully heretofore, I don’t see how humanity can recover.

    I’ll conclude then opposite the way I began—with an opinion that we probably can all agree upon: I do not envy those in Washington who have to make these decisions.

  20. While I agree with the basis of your argument that there should be an increased focus on the prevention side of fighting a biological attack, I think you are overlooking a key point of the PCAST letter which focused on the scenario that we are confronted with a disease we have never encountered or could possibly prepare for.

    From PCAST: “In view of the rapid advances in biotechnologies, a biodefense strategy must prepare not only for known biological agents, but also for a much wider array of novel and ever-changing biological threats that may be impossible to fully anticipate.”

    As emphasized in lecture, the key to fighting a biological attack appears to be through pre-emptive countermeasures such as health standards, vaccine production, and constantly searching for biological development units in enemy territory. It’s been talked about extensively that the US has vast amount of storage units filled with vaccines for certain strains that they believe are most likely to be used in a biological attack. However, what use is all that investment when we face an enemy that we have yet to prepare for?

    I’m inclined to agree when you say that we shouldn’t give priority to “”recovery capabilities” rather than prevention”. However, to finish the statement with an ominous thought that “perhaps, rather little” if any focus should be given towards our response preparedness leads me to think we are then in trouble of being a little too confident that we have accurately predicted what enemy we are facing. The world is moving quickly and countermeasures should be discussed with the mindset that we are responsive enough that even when facing unfamiliar enemy there is a clear plan with tools/funding to accomplish it.

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