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The Battle Against Bioterrorism
by Molly M. Peterson
Federal, state and local public health officials say they are better equipped to protect the nation from a bioterrorist attack today than they were a year ago because of lessons learned from last year's terrorist attacks and anthrax mailings. But they say the still have much work to do to build a seamless, secure, nationwide network that would enable government agencies, healthcare providers and medical laboratories to prevent, detect and respond to bioterrorist threats.
"In a bioterrorist event, speed is of the essence, accuracy is of the essence, and communication is paramount," David Bickel, information assurance coordinator for Maryland's Department of Health and Mental Hygiene, said last week during an E-Gov homeland security conference. "Dialogue is essential in deciding what you're going to do, and how."
But many state and local "first responders" to potential bioterrorist attacks lack adequate technologies and processes to ensure that type of real-time communication, according to Amy Smithson, who directs the Henry L. Stimson Center's Chemical and Biological Weapons Nonproliferation Project.
"In every response, one of the key problems is communications," said Smithson, who has researched responders' capabilities in more than 50 U.S. cities since Sept. 11, 2001. "Right now, most of the hospitals in our major metropolitan areas aren't talking to each other."
'The Lesson Of Communications'
The Centers for Disease Control and Prevention (CDC) is trying to improve "overall knowledge management" capabilities for bioterrorist attacks and other public health emergencies, according to CDC director Julie Gerberding, who spoke at the E-Gov conference.
Gerberding said the most important lesson CDC officials learned from last year's anthrax attacks was "the lesson of communications." "No matter how good we are in responding to any crisis ... if we don't get the communications right, we've failed," she said.
Gerberding recalled that during the anthrax crisis, CDC officials were able to establish an emergency command center -- with effective internal communications -- in just a couple of days because of the agency's in-house technical capabilities. But she said connecting those systems with other federal, state and local agencies has proven to be more complicated.
"Integration of the [CDC's] communications capacity externally was something that didn't happen overnight, and it's something we're still working on today," Gerberding said.
James Seligman, the CDC's chief information officer, said the agency is making progress in connecting its systems to those of other public health agencies. A key reason for that progress, he said, is that "there's a strong movement [in the public health sector] toward a greater degree of standardization of healthcare data ... as well as near-universal Internet connectivity."
But so far, that standardization has not spread to the clinical sector, according to Seligman. He said many emergency-room doctors and other healthcare professionals -- who probably would be the first responders to a bioterrorist attack -- are relying on "fragmented, heterogeneous technologies" that do not share data efficiently or consistently with government health agencies.
"The current public health information cycle is too long, and it frequently involves the manual exchange of information," Seligman said. He added that there is a "very critical need" for government and private-sector collaboration to enable clinical care facilities and medical labs to exchange standards-based data with public health agencies.
Bankrolling Bioterrorism Preparedness
Legislation enacted earlier in June aims to address many of those communications problems. The law authorizes $1.6 billion in grants to states to enhance bioterrorism preparedness and $520 million to improve hospital preparedness.
"Too many communities are still under-prepared for bioterrorism," Massachusetts Democrat Edward Kennedy said before the Senate's final approval of the legislation. "Too many hospitals, crippled by savage cutbacks in their funding under Medicare and Medicaid, cannot make the investments needed to prepare for bioterrorism. Too many Americans are still at risk."
The bioterrorism law also requires the Health and Human Services Department (HHS) to establish an integrated system of public health communications and surveillance networks. The system would link federal, state and local health agencies, public and private hospitals, medical laboratories and other healthcare organizations. "The [legislation] will accelerate development of new methods for disease surveillance, using modern information technology to provide real-time reporting of disease outbreaks," Kennedy said.
In compliance with the bioterrorism law, the CDC -- which is part of HHS -- is building an interoperable, high-speed, Internet-based Public Health Information Network that would enable public health officials and clinical professionals to continuously monitor, analyze and communicate data.
But rather than constructing the network from scratch, Gerberding said CDC officials are transforming existing, largely separate systems into a connected, standards-based network. "It is the glue that brings all of the other [communications] preparedness efforts together," Gerberding said, adding that the network has grown more quickly -- in both size and sophistication -- than CDC officials had anticipated a year ago.
The CDC also is providing states with financial assistance to upgrade their information systems and ensure that their communications networks will be compatible with the new network. Seligman noted that the CDC allocated $918 million in bioterrorism funds to states in fiscal 2002, and states used $150 million for information technology and communications improvements. Seligman said CDC technology assistance represented a 500 percent increase over fiscal 2001, when states only used $30 million in CDC funds for IT improvements.
The CDC also is funding regional projects that eventually could be implemented nationwide. A $1.2 billion project by the Massachusetts-based Harvard Consortium, for example, is developing a computer system that would look for clusters of illnesses in certain geographic areas. "This system will be able to locate pockets of illness that might represent an intentional attack of terrorism and will give us an early warning of such an attack," HHS Secretary Tommy Thompson said when announcing the project in October.
An Assist From The Private Sector
First responders also are looking beyond government-funded projects to boost their bioterrorism communications capabilities.
For example, in response to requests from many healthcare professionals, Johns Hopkins University's Center for Civilian Biodefense Strategies is developing a Clinicians Biodefense Network that would provide doctors with real-time, clinical information for combating bioterrorist threats.
"The Clinicians Biodefense Network is being built to complement the activities of the public health community," said Lew Radanovich, the project's team leader. "We plan to use the network to connect the practicing clinicians with each other and with biodefense experts around the country, in the event of a bioterrorism attack."
Radanovich said the Blum-Kovler Foundation, a private Chicago-based group that provides financial support for social services, is funding the free, subscriber-based network, which will consist of a secure Web site and an e-mail service. "We have about 1,000 people who have requested this type of information, and we hope the list will grow from there," Radanovich said. "We would like it to be at least 20,000 or so clinicians."
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