Roger Clemens

The furor over the prospect of United States ports being operated by a Middle Eastern company, the detection of a suspicious substance in the Russell Senate Office Building, and the ricin scare at the University of Texas make it abundantly clear that bioterrorism is still very much a concern, despite legislative and institutional safeguards already in place.

Not long ago, as he resigned as Secretary of Health and Human Services, Tommy Thompson said that he worried on a daily basis about the vulnerability of our food supply to terrorist action, despite the Bioterrorism Act’s requiring registration of food production facilities and meticulous tracking and recordkeeping of the origin and shipping of food.

Indeed, the coordinated efforts of the Federal Bureau of Investigation, U.S. Dept. of Homeland Security, U.S. Dept. of Agriculture, and Food and Drug Administration, in conjunction with industry through the Strategic Partnership Program Agroterrorism Initiative, appear to provide a reassuring response.

Nevertheless, when queried about our worries involving the vulnerabilities, preparation for, and response set of the health care system to terrorist assault on the food supply, the director of the Homeland Security National Center for Food Protection and Defense stated that "we do not have any special projects or information on threats or vulnerabilities to food or medicine in the health care system."

Clearly, despite the considerable good work that has gone into laying some of the foundation of our response to the specter of bioterrorism, there is more to be done, and quickly. A Midwestern Multi-State Consortium for security, threat detection, and response in agriculture was launched in 2004 but was supported with a budget allocation of only $2 million.

In response to a request from the HHS Office of Emergency Preparedness (OEP), the Institute of Medicine (IOM) was charged to assess the effectiveness of the Metropolitan Medical Response System (MMRS), which attempts to enhance the preparedness of major U.S. cities with regard to the health and medical consequences of attack or threatened attack with chemical, biological, or radiological agents.

The IOM report said that OEP must be empowered to take a stance that fosters voluntary collaboration and be willing and able to enforce integration of local, state, and federal services as a pressing societal need for coping with inevitable future acts of terrorism. It added that it is critical that OEP develop an essential and rational approach that is rigorous and continue to evaluate and improve its response program.

IOM also said that the enhanced organization and cooperation demanded by a well-functioning MMRS program will permit a unified preparedness and public health system with immense potential for improved responses not only to a wide spectrum of terrorist acts but also to mass-casualty incidents of all varieties.

The White House noted in 2002 that many of our health care systems, facilities, and institutions need improved defense against biological terrorism. It said that national efforts to strengthen infrastructure at the state and local levels were needed to improve bioterrorism responsiveness at the national level, and recommended implementing an aggressive research program directed at developing vaccines, medications, and diagnostic protocols.

This "early warning" initiative addressed concern that our health care system is inadequate to serve large numbers of victims and contagious patients, coordinate emergency information, coordinate regional health care organizations, and provide appropriate personnel training in the management of bioterrorism.

In 2005, the Texas Medical Association updated its bioterrorism toolkit for physicians and their patients (www.texmed.org/Template.aspx?id=2500). The toolkit includes protocols for the diagnosis, reporting, etiology, and management of anthrax, botulism, smallpox, and plague.

Plant viruses, phages, fungi, and bacteria will likely continue to be far more readily obtainable than virulent pathogens that may have been packaged in various delivery systems in military laboratories.

The agricultural and food industries are arguably responsible for more activism and productivity in public health research and development than either academia or the federal government. The private sector is challenged again to demonstrate the strength, vision, and adaptive capacity that reside in American capitalism, to help us fight and prevent terrorist attack, meaningfully and incisively address threat detection and assessment, and develop coordinated and informed response.

by Roger Clemens,
Dr.P.H., Contributing Editor
Director, Analytical Research, Professor,
Molecular Pharmacology & Toxicology,
USC School of Pharmacy, Los Angeles, Calif.
[email protected]

by Peter Pressman,
M.D., Contributing Editor
Attending Staff, Internal
Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif.
[email protected]