By Lynn Klotz
Senior Science Fellow at the Center for Arms Control and Non-Proliferation
Published in Biosecurity and Bioterrorism, December 2007.
In a new paper, Center Senior Science Fellow Lynn Klotz calls for greater public debate of policy and risk assessment arguments that he says place bioweapons attacks ahead of naturally occurring infectious diseases and a potential influenza pandemic when it comes to making funding and resource decisions for basic infectious disease research and medical countermeasure development.
The Department of Homeland Security (DHS) currently performs detailed risk assessments for potential attacks with specific bioweapons agents (anthrax, smallpox, etc.) to help guide U.S. biodefense strategy. Klotz argues for developing a “combined risk assessment,” one that takes the DHS bioterrorism risk assessments and combines them with detailed assessments for particular endemic (i.e., always present) infectious diseases and pandemic influenza. He says that such a combined risk assessment “would reduce the ‘fear politics’ that likely now dominates funding and resource allocation decisions” and “should allow us to make better funding decisions that are less dependent on political whim.”
To illustrate his concept, Klotz undertakes a “simplified combined risk assessment.” While noting that any conclusions from such a simplified assessment should only be considered a “first word” on the subject, he says that his results are “sufficient to alert us to a likely real imbalance in funding and effort between biodefense and endemic infectious disease.” For instance, Klotz notes that the U.S. National Institutes of Health spent $1.77 billion on biodefense research in Fiscal Year 2006, nearly two-thirds as much as the $3.1 billion it spent on research for all other non-HIV/AIDS infectious diseases, even though the latter kill approximately 160,000 people in the United States every year. “Bioweapons attacks with these fatalities are quite unlikely in any year, and for such an attack to happen every year is unimaginable,” he says. (An analysis of overall federal funding for biological weapons prevention and defense is here.)
Moreover, argues Klotz, the current “one bug, one drug” biodefense strategy, which focuses on developing drugs and vaccines against specific bioweapons disease agents such as anthrax, “does little for endemic infectious diseases. We should focus instead on research and countermeasure development focused on combating endemic infectious disease by developing broad-spectrum countermeasures” effective against multiple disease agents. “This research focus would equally benefit biodefense,” he says. The U.S. Department of Health and Human Services recently began to adopt such a strategy through its Public Health Emergency Medical Countermeasures Enterprise.
Assessing likelihood and consequence is notoriously difficult for very rare events such as bioterrorism attacks and pandemic disease outbreaks. Klotz acknowledges this difficulty, but argues that “reasonable bounds can be established as a first step toward making a crude estimate of probability – fortunately, good enough to draw qualitative conclusions.” Moreover, says Klotz, “it is better to go through the exercise of putting numbers on our risk assessments even if some of the numbers can only be guessed at,” because “it parses biodefense decisions into their component parts, so discussion can be focused and differences in thinking can be uncovered.”
Such differences in thinking are uncovered in part by a commentary on Klotz’s article which appears in the same issue. Gerald Epstein, of the Center for Strategic and International Studies, argues that “security entails more than public health,” and that Klotz’s public health framework “does not fully capture the threat that policymakers seek to counter with their biodefense investments.” According to Epstein, bioterrorism could threaten “values more traditionally associated with security investments,” in particular “national sovereignty and freedom of action.”
Klotz agrees that additional factors must be considered, including economic, environmental and psychological impacts, not the least of which he calls “the cost of widespread unwarranted fear.” He also acknowledges that “it is a political reality that we spend a staggering amount on defense, and that mindset is reflected in our biodefense spending … our relative allocation of funding accurately reflects the relative values that policymakers attribute to biodefense and endemic infectious disease.” But in his opinion, policymakers “are not responding rationally to the threat of bioweapons attacks.” Moroever, he says “our focus should not be defined so narrowly as to encompass only the explicit direct threat of a bioweapons attack; it should include indirect threats such as the cost of deflection of any new funding from traditional public health where new funding is needed” and other broader consequences of narrowly defined biodefense activities, including the potential risks to public health generated by biodefense research itself.
DHS will issue its second bi-annual bioterrorism risk assessment later this year. But as with the first, the results are likely to be classified – even the methodology and assumptions behind the current risk assessment have not been made publicly available, despite DHS statements that they would be.