Concerns over emerging pathogenic threats continue worldwide with the expanding Ebola outbreak and other public health threats such as Middle East Respiratory Syndrome and emerging novel influenza viruses. Such international threats quickly could become domestic in the global economy through international trade and travel.
However, preparedness continues to be required for emerging and possibly re-emerging domestic public health threats. Several recent domestic incidents involving dangerous pathogens in controlled environments demonstrate the potential threat moving closer to home. Whether preparing for a foreign or domestic biological hazard, a recent vital homeland security document – 2014 Quadrennial Homeland Security Review – provides strategic guidance and direction during the next four years for addressing public health concerns and pathogenic threats.
Unexpected Biosecurity Incidents
While cleaning a government storage room in July 2014, National Institutes of Health employees located vials that contained the smallpox virus. The vials subsequently were turned over to the Centers for Disease Control and Prevention (CDC) for testing and proper handling. This unexpected discovery challenged the commonly held understanding that the globally eradicated pathogen was well secured in only two high-security locations – one in the United States and one in Russia. Subsequent reporting indicated that other unexpected pathogens also were located with the smallpox virus in the storage room.
The CDC experienced its own incident in June 2014 when a possible exposure to live Bacillus anthracis (anthrax) occurred during its internal research operations. Reports found that anthrax samples distributed to other research facilities were not properly deactivated before distribution to those locations – a violation of existing biosecurity and biosafety operating procedures.
Another disclosure in July 2014 by the CDC revealed that a relatively benign sample of the H9N2 influenza virus was reportedly contaminated with the more serious H5N1 influenza virus before transfer to another facility. The U.S. Department of Agriculture reportedly identified the error after receiving the sample in May 2014 and advised the CDC.
These biosecurity incidents, along with previous ones, are relevant when considering the findings of a Government Accountability Office (GAO) report released in July 2014. The report on recent biosafety lapses at high-containment laboratories indicated that no federal agency is responsible for strategic planning and oversight of these essential research laboratories. The GAO report recognized the value of national standards and a government-wide strategy. A review of the related GAO products section for this report identified links to ten previous reports regarding this topic.
Emerging Domestic Pathogens
Of course, the majority of emerging or unexpected domestic pathogenic incidents and threats have not been in controlled settings, but naturally occurring. The pneumonic plague re-emerged in Colorado in a man and his dog. At least three additional people became ill from the plague after having contact with the dog. Even though this deadly bacterium is rare in the United States, it requires close observation due to its striking history.
The Heartland virus, a novel phlebovirus in the same genus as Rift Valley fever, emerged in Tennessee and Missouri. Likely transmitted by lone star ticks, the virus has required hospitalization for most of the infected persons. As with the recently encountered pneumonic plague, the Heartland virus occurrences have been limited and well monitored by medical and public health officials.
Emerging pathogenic concerns are not limited to humans. The porcine epidemic diarrhea virus (PEDv) is estimated to have killed millions of pigs since its U.S. appearance in April 2013. Since PEDv has a nearly 100-percent mortality rate in young piglets, the possible zoonotic threat is a credible concern for those outside the agriculture environment.
Bioterrorism Concerns & Strategic Priorities
Although research laboratory incidents involving smallpox, anthrax, and H5N1 influenza virus were controlled without documented expanded exposure, they provide another opportunity to assess the planning and preparedness levels for negative outcomes. Two of these pathogens – smallpox and anthrax – have long been considered for biological weapons and likely sought after by potential bioterrorists and unfriendly state or non-state actors.
Beyond bioterrorism or biological attack concerns, preparedness for such threats should include these vastly unanticipated domestic events. Such critical topics have been addressed in an updated national strategy document for homeland security planning and preparedness considerations.
In February 2010, the first-ever Quadrennial Homeland Security Review (2010 QHSR) was released pursuant to the Implementing Recommendations of the 9/11 Commission Act of 2007. The 2010 QHSR provides a broad vision of the strategic framework to guide homeland security activities to a common end. The report identifies biological weapons, pandemics, and disease outbreaks as threats viewed in conjunction with movement of people and goods across borders.
In June 2014, the 2014 Quadrennial Homeland Security Review (2014 QHSR) was released to provide updated national guidance and set priorities. According to the Secretary of Homeland Security, the report provides a strong analytic and strategic foundation to ensure that the U.S. Department of Homeland Security invests and operates in a cohesive and unified fashion. The 2014 QHSR addresses biological threats and bioterrorism in several sections of this high-level national strategy. The 2014 QHSR possesses a more robust discussion of public health, biological, and bioterrorism threats than the 2010 QHSR report.
When assessing the strategic environment, according to the 2014 QHSR, “of the naturally occurring events, a devastating pandemic remains the highest homeland security risk.” In addition, the likelihood and consequences of an emerging novel infectious disease are expected to increase in the future – possibly spreading quickly around the world. The current Ebola virus outbreak clearly demonstrates the seriousness of naturally occurring events and the ability to spread to other nations, regions, and continents.
A strategic priority of the 2014 QHSR report is countering biological threats and hazards, ranging from bioterrorism to naturally occurring pandemics. These threats are identified as a top homeland security risk due to their potential to significantly impact the health and well-being of citizens and the ability to execute essential functions. Below are the four priority biological threats and hazards that pose a particularly high risk to the nation:
- Pathogens posing particular bioterrorism concerns – for example, anthrax, plague, and smallpox – including enhanced and advanced pathogens;
- Emerging infectious diseases that are highly disruptive – for example, viruses that could cause human pandemic;
- Animal diseases and plant pathogens or pests that are highly disruptive – for example, foot and mouth disease; and
- Bioterrorist contamination of the food supply chain and water systems.
According to the 2014 QHSR, these types of biological threats and hazards may evade early detection and spread quickly across regions, countries, and continents causing severe consequences – including mass illnesses, fatalities, and widespread disruption of the U.S. society and economy.
The 2014 QHSR strategy for managing biological risk is to “prevent the occurrence of priority biological incidents, where possible, but, when unable to prevent, to stop priority biological incidents from overwhelming the capacity of our state, local, tribal, and territorial partners to manage and respond.” This strategy emphasizes the importance of a whole of community planning and preparedness approach for the threats.
Merger of Strategy & Threats
Interestingly, the recent high-containment laboratory incidents involved the same pathogens – smallpox and anthrax – identified in the 2014 QHSR priority above as posing particular concerns for bioterrorism. The naturally occurring plague in Colorado rounds out the specifically identified bioterrorism priority concerns. The list of pathogenic threats and concerns is obviously much broader than those discussed above. However, these recent events demonstrate the complexity of the public health threats and possibility of an unexpected emergence within domestic areas of responsibility.
None of this discussion has focused on the extremely serious threat of an intentional bioterrorism attack using any of the pathogens discussed so far. The impact of an intentional attack could be even greater due to the possible exposure in larger amounts and/or in multiple locations. The nation’s ability to identify, contain, and mitigate the biological threat may not be sufficient for this potential Black Swan event.
Whether foreign or domestic, naturally occurring or accidentally released from a controlled environment, biosecurity and bioterrorism issues continue to be priorities for national homeland security planning and preparedness. However, local jurisdictions may not be operationally prepared for a no-notice biological incident, so it is critical to include these issues as part of their strategic plans.
The opinions expressed herein are solely those of the author in his individual capacity, and do not necessarily represent the views of his agency, department or the U.S. government.