Public health and bio-defence

The lessons learned from public health planners in dealing with naturally occurring threats can benefit civilian bio-defense practitioners according to Christopher Boucek

Current public health practices present some very useful and applicable lessons to the present thinking on homeland security. This is particularly the case when it comes to civilian bio-defence preparation, and the mitigation of infectious disease outbreaks. Not only can lessons learned from public health practitioners aide domestic security planners in preventing intentional epidemics but they can also illuminate areas that have heretofore received little attention from traditional security-minded officials.

For many years, public health agencies have provided essential services to their respective constituencies. Their greatest triumph, the eradication of smallpox in 1979, demonstrates how internationalised co-operative public health measures can reap enormous benefits. The vast amount of literature on the subject testifies to the benefits of such collective endeavours, as smallpox, presumed to be the greatest killer of all time, is the only disease to ever have been eliminated from nature.

The rapid course of current events has unfortunately drowned out several recent significant news stories. It seems that when it comes to security and guarding the homeland, people’s attention naturally turns to the latest musings reportedly from Osama bin Laden or developments from halfway around the world. Civil aviation continues to be a primary focus in homeland security, and governments have seized on the idea that visa authorisation is a way to insulate societies from terrorism. In today’s security calculus, the threat matrix must include unconventional threats, including dangers posed to the public health system. Such threats do not need visa authorisation or civilian air travel to be a danger today.

The continuing wars in Iraq, Afghanistan, and the faltering Israeli-Palestinian ‘road map’ has diverted serious attention away from the emergence of Severe Acute Respiratory Syndrome (SARS) and the outbreak in the Western hemisphere of the heretofore unknown monkeypox virus. Likewise, the spectres of mad cow disease and avian flu are lurking novelties, rather than the serious threats they represent.

These naturally occurring epidemiological events have rightly been attributed to benign causes, yet these developments serve as another clarion call warning of the dangers posed by the malevolent threat of biological warfare.

War takes precedence over pestilence in the media

These outbreaks have caught the world’s attention, albeit for pedestrian and sensational reasons. They have been treated in the American media as medical curiosities, and not the public health and homeland security threats that they represent. Considered as distractions to the immediate dangers of continuing guerrilla warfare and the elusive hunt for weapons of mass destruction (WMD), SARS and monkeypox have been presented as exotic oddities.

The reality of the situation, however, could not be farther from the truth. Disease, the WMD when it comes to human history, has not received the attention it deserves or the proper funding to keep us all safe.

It is true that disease will always be with human civilisation and outbreaks will always claim new victims. Separated by two great oceans and a gargantuan psychological immunity as a result of the advances in North America’s health care and public health infrastructure, the emergence of SARS and monkeypox enjoyed little fanfare in the media in relation to their enormous medical consequences. These diseases were treated as diversions to the media’s oversaturation of coverage of the Bush administration’s nascent attempts at civil reconstruction and post-conflict management in a wide arc of instability resulting from recent adventurism in the heart of the Muslim world.

Yet it is important to note that the ways in which we live have increased our potential exposure to deadly pathogens. Modern air travel, in which someone can fly to most places on the planet in 24 hours, has had an enormous impact on the effects of the incubation period of infectious diseases. Unlike the past, when the human incubation period would often serve as a de facto control of infections, this has changed in the 21st century.

Similarly, as our lifestyles have changed - today we live in closer proximity to each other and consume increasingly industrialised food - so our risk exposures have increased. Terrorists seeking to attack civil society are aware of these factors - and so must our public health/national security first responders.

SARS and monkeypox demonstrate the ways in which emerging biological threats can endanger national security by exposing failures in the public health infrastructures, nationally and globally.

To date, it is disturbing how little is known about SARS. It is believed to have emerged in Guandong province, southern China, in November or December 2002, when the disease jumped from its presumed animal host - the civet cat - to humans. Beijing’s decision to keep the ravages of SARS secret from the outside world played into commonly held perceptions of how authoritarian China maintains power and internal security. Yet these decisions, while explained by the Chinese Central Committee’s perception of security management, unwittingly spread SARS beyond China’s national borders. The disease’s explosive spread, throughout South East Asia and into North America and Europe, was fuelled by 21st century travel.

The emergence of avian flu has raised similar questions with regard to government secrecy. In both cases, consequence management measures have been significant: massive culls of livestock; economic fallout from a loss of market share; a downturn in tourist revenue; and, most importantly, an unfounded psychological fear driven by governmental fears of openness. SARS and avian flu represent unique challenges to governments seeking to come to terms with the possible disease outbreaks. It runs counter to most thinking to publicise such news. In the event of an intentional terrorist biological attack, concerns of national security can often be counterproductive to the means in which a public health problem is addressed. In these situations, while governments must be cautious not to exacerbate public fear and paranoia, we have learned from prior public health crises that public awareness is one of the greatest weapons available to combat disease outbreaks.

Governments and national security planners can learn much from their public health counterparts. Today, we can help to slow the spread of certain diseases and, hopefully, the following points can help in those efforts:

• quarantines: these must be strictly enforced. It is important, however, to temper this with an approach that fosters openness and co-operation from the public. The public is the first line of defence in combating disease and it is vital that they not feel stigmatised or driven to conceal information that could lead health officials to take action.
• increased inspections: livestock and food preparation inspections must be increased and greater resources - human and financial - need to be diverted towards guaranteeing the safety of the food chain. Moreover, inspectors need to have the authority to halt production, issue recalls and demand improvements to ensure health standards.
• bars on importing contraband and exotic animals: the monkeypox outbreak in the US was traced back to exotic pet imports. More and more, animals that previously lived in the wild free from human contact are being delivered to the marketplace. This must stop; if it is not halted completely, the trade at least needs to be regulated and quarantine periods imposed to ensure the pets of tomorrow are not also disease vectors today.

It is also essential to crack down on the importation of so-called ‘bush meat’ - the exotic foodstuffs carried back in airline luggage. These regional delicacies are often prized by immigrant communities but their unregulated importation in less than sanitary conditions has the potential to bring with it more than just a taste from home. A recent Guardian report stated that there are only two canine detectors for the entire UK that focus on detecting bush meat. More resources need to be devoted to ending this practice and greater public awareness campaigns on the problems associated with such activities should be implanted in a bid to curtail this practice.

• higher penalties: unfortunately, this may one of the only ways to get people to comply with public health measures, and abandon unsafe practices - such as illegal importation of wild animals and exotic foodstuffs.
• increased medical stockpiles and ‘push-packs’: to deal with possible outbreaks, the public needs to be put at ease that medical supplies are available, and will be delivered in a time of emergency. The shortage of vaccines in the US does not instil confidence in the public health system. As the American ‘Dark Winter’ bioterror exercise demonstrated in 2003, during a biological event logistical and delivery systems breakdown. This must be rectified.
• greater international co-operation and communication: more healthcare workers, public health officials, and first responders need to be vaccinated against pathogens they may encounter from foreign source. They should also be exposed to their counterparts in other countries so that, should the need arise, relationships are already in place, and colleagues can communicate with colleagues in a safe, academic environment.
• an end to state secrecy: this may prove to be the greatest challenge. Governments are naturally reluctant to discuss such matters - however, disease does not respect borders. The inclination to treat outbreaks as a matter of national security must be tempered with the greater concerns for public health.
• greater transparency in industrialised farming. As the world’s foodstuffs increasingly come from large-scale industrialised facilities, it is vital to ensure that health standards are maintained at the highest levels. Outbreaks of mad cow disease, avian flu and less exotic contaminates such as e.coli can be reduced if not halted through greater transparency and increased governmental oversight and inspections.

The measures outlined above are not a panacea for halting the spread of disease and pathogens. Such a development is not within our reach at present; it is hoped that they can lessen they incidents of such events. These public health measures can help protect the civilian population from exposure to potentially deadly agents, and increasingly homeland security and national resilience officials can draw on these protocols to prevent the spread of an international terrorist biological agent.

Christopher Boucek is the editor of RUSI/Jane’s Homeland Security and Resilience Monitor