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27 Dec 2002

Source: Washington Post, July 14, 2002.

A First Step on U.S. Biodefense

Plans Include $400 Million to Make D.C. Area a National Model

By Guy Gugliotta, Washington Post Staff Writer

Nine months after the most serious outbreak of biological warfare in U.S. history, the United States has taken its first tentative steps toward biodefense readiness, but experts say it will take years for the nation to build a robust system after decades of neglect.

The first post-Sept. 11 trickle of federal funds devoted strictly to biological warfare defense began last month, when the Department of Health and Human Services started distributing $1.1 billion to states and some cities to upgrade community public health preparedness.

It is a startup program, aimed at attacking the basic weakness of U.S. biodefenses by requiring communities to begin developing infrastructure, including chains of command, response patterns, and communications, a condition of receiving their share of the payout.

"This is only the first year, and in this context, it's going to take maybe five years to build the systems and capacity," said Thomas Milne, executive director of the National Association of County and City Health Officials. "What we'll get this year is an increment of improvement, not preparedness. Not yet."

Besides the HHS money, the centerpieces of national biodefense include a plan to shift $1.9 billion in research funds from the National Institutes of Health to a new Department of Homeland Security, and a new $420 million program to transform four urban areas -- including metropolitan Washington -- into state-of-the-art showcases for the best in biodefense.

The NIH plan in particular is controversial, and the fate of all the programs depends on both the 2003 budget that Congress eventually passes and the way bureaucratic lines of authority are redrawn in the proposed Department of Homeland Security.

President Bush in February announced a $5.9 billion biological warfare defense budget for 2003, on top of $2.5 billion in new money made available in an emergency spending bill passed by Congress in January.

But nine months after the mail-borne anthrax attacks killed five people, officials in most parts of the country are only beginning to grapple with a threat that until recently was regarded as little more than a highly hypothetical what-if.

"We have practice with explosions or chemical spills," said epidemiologist Donald A. Henderson, principal science adviser for public health preparedness at HHS. "The biological has been more difficult because of the misapprehension that you could deal with it the same way as a chemical incident, when, in fact, these events could not be any more dissimilar."

In ramping up the nation's biodefenses, no part of the country has gotten more attention than metropolitan Washington. Besides its share of the HHS money, the region in January received a $292 million congressional appropriation to upgrade emergency preparedness, and is slated to get $85 million more in 2003. In all, greater Washington could receive about $400 million in federal emergency preparedness and biodefense funds in 2002 and 2003.

"There are lots of downsides to being the national capital," said Margaret Kellems, deputy mayor for public safety and justice, who is in charge of biodefense for the District. "The upside is that when you're in the spotlight, you get the best treatment. We think the District is a bull's eye."

By reason of its privileged status, however, the region has also become a closely watched laboratory as it tries to parlay federal largess into a seamless biodefense infrastructure that can work across 17 jurisdictions.

"The federal government is not in the habit of funneling money to local governments to accomplish a federal priority; there was no plan that could be tweaked," said Robert Malson, chairman of the Metropolitan Washington Council of Governments' Bioterrorism Task Force. "We had to do it from scratch, and that challenge can't be overstated."

Of the $292 million the region got in January, the District's share was $154 million destined for 14 municipal departments. Much of the money can be used to handle different types of disasters, but there was a clear recognition of the region's biodefense shortcomings.

"After September 11th, if we did nothing else, we needed to communicate better," Kellems said, so the city invested $46 million in a new wireless radio system, with attendant technologies and improved land-line security.

Kellems today also has seven ways to stay in touch, among them a special card to get priority dial tones, two different two-way pagers and dedicated circuits and tie lines: "I like toys, but this was a good excuse," Kellems said. "We've become quite the experts."

Other city priorities included new protective gear, traffic light upgrades, video camera technology for managing traffic flow, pathogen testing equipment and a mobile laboratory. The Fire Department bought a new hazardous materials unit equipped to handle biological, chemical and radiological events. The District had not had its own hazmat capability since 1998.

Across the region, communities were funding similar priorities, and now that that job seems to be nearing completion, the goal "is, to the fullest extent possible, to have a stitching together of the individual jurisdiction plans," Malson said.

"Each has its own police force, its own fire department and public health structure, as well as privately owned hospitals, physicians and health care providers with their own way of doing things," Malson said. "We want an arrangement so all these entities can respond together. There are a lot of pieces to this."

But even as the region tries to get comfortable with this first set of innovations, it is getting ready to receive the additional $85 million earmarked for the as-yet vaguely defined biodefense upgrade to be administered by the new Department of Homeland Security.

The program started out in the Bush 2003 budget as a $420 million Defense Department initiative called the National Bioweapons Defense Analysis Center, with $120 million to be used to build a facility to study bioterrorism, and the other $300 million going to four urban areas -- beginning with greater Washington -- to create biodefense models that can be used as national templates.

Anna Johnson-Winegar, deputy assistant to the secretary of defense for chemical and biological defense, said the urban areas program seeks "to demonstrate how much we can do in one year" in selected areas.

Washington was chosen because of obvious target potential and because it has already received considerable money, she said. The second site is Albuquerque, which has a well-developed radiological accident response system. The other two sites have not yet been chosen.

The aim is to create what the Defense Department called a "system of systems," Johnson-Winegar said. "It would include biodetection, using information from medical surveillance systems and environmental sensors and integrating the data into one comprehensive system."

Johnson-Winegar said the District program will get the best available off-the-shelf equipment, while the other "test beds" will use more experimental technologies. Although the Pentagon will not control the program, Gordon Johndroe, spokesman for the White House's Office of Homeland Security, said its goals would remain the same under Homeland Security.

To help smooth all these changes, Malson said the District is using part of its $11.9 million share of the HHS money to hire a physician to serve as medical director for bioterrorism response coordination for the D.C. Hospital Association. Malson is the association's executive director.

Hiring the physician -- who will help coordinate regional biodefense -- was part of the District's response to an HHS requirement that states and cities, before receiving their share of the $1.1 billion, comply with 16 "Benchmarks for Bioterrorism Preparedness Planning," among them designation of a "senior health official" as a state coordinator for biodefense.

Other benchmarks included development of communications systems to link hospitals, public health offices and law enforcement, and preparation of hospital emergency plans to accommodate a "surge" of up to 500 gravely ill patients.

Besides the benchmarks, states were urged to come up with their own innovations. The District decided to make its coordinator a physician. Oregon is hiring a mental health expert to cope with "demoralization" caused by a bioterror attack. Wyoming developed a plan to counter a terrorism-related outbreak of livestock disease.

"I've been really gratified at how much has been done," said HHS's Henderson, who is coordinating the program. "People are taking this very seriously, and are spending not only the money we've given them, but state money as well."

Other federal biodefense programs will remain somewhat vague, at least until the 2003 budget is passed and the Department of Homeland Security comes into focus. Only then would the new department take charge of NIH's proposed $1.9 billion in bioterrorism research.

"We will provide the money and inform the scientists of the threat we want to examine," Johndroe said. "They do the research, and disburse the money with their oversight."

Several experts suggested that the White House's desire to split this responsibility could fragment biodefense research rather than consolidate it, a danger that could be further enhanced because the Bush plan does not give the new department any authority over $1.07 billion in Defense Department biodefense programs, many of which have important civilian applications.

"You really have to be careful not to disconnect some of these programs from where the expertise is," said Peggy Hamburg, a vice president at NTI, a nonprofit organization that studies weapons of mass destruction. "You can't just carve out pieces of a department, label them 'bioterrorism' and expect to get the same results."