January 16, 2006

NEJM: Bioterrorism — Preparing to Fight the Next War

Dr. David A. Relman is warning that we should be taking the threat of bioterrorism and biowarfare more seriously, and that our current failure to do so is because we haven't yet acknowledged what the next 'war' will be like.

In his New England Journal of Medicine article, titled "Bioterrorism — Preparing to Fight the Next War," Relman is essentially saying that we run the risk of preparing for the last war when instead we should be realizing that the next 'conflict' or struggle will be the result of asymmetric threats.

"In devising a robust biodefense strategy," he writes, "a key challenge will be to define the optimal balance between fixed and flexible defenses. The Maginot Line built by the French in the 1930s serves as a symbol of static defenses designed to protect against known threats. Although these elaborate fortifications bought the French some time, the advancing German army maneuvered around them. Similarly, the creation of static defenses can be justified for clear, imminent, and potentially catastrophic biologic threats — including avian influenza virus and prominent drug-resistant bacteria, such as Staphylococcus aureus, as well as anthrax and smallpox."

These ain't your daddy's bioweapons, he argues, with potential threats capable of wreaking intense havok. To this point in history, nature has been the most efective bioterrorist, but in the future, the ability of experimenters to create genetic or molecular diversity not found in the natural world may result in new biologic agents with previously unknown potency. Relman believes that such agents may not survive long in the natural world and could, from an evolutionary standpoint, be dismissed as poorly adapted competitors, but they may prove extremely destructive during their lifespan.

He writes:
[We should not presume] on the basis of history, that when biologic agents are used deliberately and maliciously, they are capable of causing only relatively limited harm. The large biologic-weapons programs of the late 20th century were never unleashed. And the use of such weapons by smaller groups, such as the Aum Shinrikyo cult, has been relatively unsophisticated — far from representative of what moderately well informed groups might do today. The consequences would have been far more dire, for example, had the anthrax spores circulated in the U.S. mail in 2001 been disseminated by more effective routes. Tomorrow's science and technology will present a new landscape with features that are both worrisome and reassuring: the methods and reagents used for reverse-engineering a novel virus, for instance, can also be used to engineer a vaccine against it.
Relman's advice? He lists a number of starting points, including the strengthening the public health infrastructure [hear, hear], especially in terms of personnel, communications, and surge capacity. Scientists and clinicians, he asserts, will need to play a bigger role in biodefense planning, including the articulation of needs, policymaking, and the assessment of future threats. These measure would assist in early intervention followed by proactive counter-measures.

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