When it comes to US biodefense and bioterrorism response, the critical question may be whether government agencies at all levels are prepared and aligned to operate beyond epidemiology to effective crisis management and containment.

A Harris School Center for Policy Practice (CPP) briefing and panel discussion on these issues revealed that the fundamental dialogue between the public and government agencies at all levels suffers from inarticulate policy—lacking accurate scientific and statistical input—and conflicting information. As Dean Susan E. Mayer noted, “the intersection of science and public policy” must be evident in the government’s overall terrorism strategy.

This was the second briefing in a three-part series on health and security issues cosponsored by the CPP and the Great Lakes Regional Center of Excellence for Biodefense and Emerging Infectious Diseases Research (GLRCE) at the University of Chicago.

Moderated by Olaf Schneewind, Director of GLRCE, the panel included William Bicknell, Professor of International Health at Boston University’s School of Public Health; Harvey Drucker, Associate Laboratory Director for Energy and Environmental Science and Technology at Argonne National Laboratory; and Monica Schoch-Spana, Senior Associate at the Center for Biosecurity at the University of Pittsburgh Medical Center.

“We need to make an investment in ‘boiling down’ governance, so the public connects with the agencies” in a crisis, said Schoch-Spana. As a medical anthropologist, she studies communications efforts by government agencies to define what she calls “the people’s role in biodefense.” She believes public confidence in government could be undermined by its lack of communication. “People need a feeling of peer communication,” she added, “so that they feel others like themselves share an understanding of the government’s actions in the event of a disaster.”

What’s worse, according to Drucker, is that “no one is really sure who’s in charge.” Through his research with so-called “first responders”—fire and police officers, physicians, nurses, and others—he learned that coordinating efforts of even such basic services as ambulances (private and public) up to treatment in hospitals (private and public) in a crisis will raise conflicts of regulation and liability that will inevitably affect the care given.

Bicknell pointed to awareness of the threat of smallpox as an example of the confusion. “The vaccine safety against smallpox is underrepresented while at the same time there is a lack of understanding about the endurance of [immunization].” He cited the US military forces’ comprehensive vaccination for troops in Iraq as a model of preventive planning and asked, “Do we immunize first responders? Why not have [citizens] stock Cipro (an antibiotic prescription for smallpox)?”

Questions and comments from the audience raised some criticism of current biodefense policies—not backed by thorough science and analysis, they said—and a perceived lack of coherent communication to the public. “Right now,” said Bicknell, “the public feels vulnerable because the policy isn’t clear.”

That comment prompted others to call for a policy and process of biodefense including a chain of command articulated down to the local level—starting with the National Security Agency. Schneewind pulled together several comments to say such a policy should be coupled with a funding strategy that allocates resources according to probable risk and potential threat. In turn, “that policy must be informed by basic scientific and statistical research,” said Drucker. “The public,” he concluded, “would have more confidence in the Department of Homeland Security’s communications” if the agency could show that its policies and planning are designed to respond effectively and are quick to implement in a bioterrorism crisis.

Ronald Litke

Inaugurated in 2003, the CPP is dedicated to facilitating programs that connect the classroom to the community and provide students with hands-on policy practice. In addition to the Health and Security Policy Briefing Series, CPP’s programs include group internships, practica, the mentor program, public lectures, and a major speaker series. For more information, visit harrisschool.uchicago.edu/centers/cpp.