Ten years after 9/11 and the anthrax attacks

Alexander Garza, MD

[Editor’s note: Assistant Secretary for Health Affairs and Chief Medical Officer Alexander G. Garza, MD, MPH, of the Department of Homeland Security, testified before the Senate Committee on Homeland Security and Governmental Affairs, on Oct. 18, 2011, and submitted the following statement, entitled, “Ten Years After 9/11 and the Anthrax Attacks: Protecting Against Biological Threats?”]

By Alexander G. Garza, MD

Chairman Lieberman, Ranking Member Collins, and distinguished members of the Committee: thank you for inviting me to testify before you today. Secretary Napolitano highlighted a number of Department of Homeland Security (DHS) activities related to efforts to prepare for and protect against biological attacks in the 2011 Progress Report reviewing DHS and partner efforts to build a country that is stronger, safer and more resilient. I welcome this opportunity to discuss how the Office of Health Affairs (OHA) contributes to this effort.

I would like to begin by providing an overview of OHA and our role within the Homeland Security Enterprise. OHA serves as DHS's principal authority for all medical and health issues. We look at health through the prism of national security, providing medical, public health, and scientific expertise in support of the DHS mission to prepare for, respond to, and recover from all threats. OHA's responsibilities include serving as the principal advisor to the Secretary and FEMA Administrator on medical and public health issues; coordinating DHS biological defense programs; providing medical expertise to support DHS preparedness and response efforts; and leading the Department's workforce health protection and medical support activities. OHA also serves as the primary DHS point of contact for state and local governments on medical and public health issues.

The threat of a biological attack is real and challenging. As you know, the Weapons of Mass Destruction (WMD) Commission reported that we must be vigilant in addressing several urgent threats, especially bioterrorism. Additionally, the Quadrennial Homeland Security Review (QHSR) identified high-consequence biological attacks as a priority threat.

A wide-area attack using aerosolized Bacillus anthracis, the bacteria that causes anthrax, is one of the most serious mass casualty threats facing the U.S. A successful anthrax attack could potentially expose hundreds of thousands of people, and cause illness, death, fear, societal disruption and economic damage. Even a small scale attack, such as the Amerithrax attacks of a decade ago, will result in deaths, panic, and economic losses, making this a weapon of mass disruption as well as destruction. The time between exposure and the administration of medical countermeasures (MCM) is the most critical parameter in determining the extent of how many lives are lost in a biological attack.

Since the anthrax attacks 10 years ago, the Department has made progress in protecting the nation from biological attacks, and preparing the nation to respond to such events. OHA lends our expertise to a number of initiatives across the Department that focus on the threat of a biological attack.

The federal government recognizes two critical capabilities must be in place to minimize the effects of a biological attack. First, we must be able to rapidly determine that an attack has occurred. Second, we must have the capability to quickly distribute MCM to the affected population before clinical symptoms appear. This timeline can be as short as one to two days. OHA manages a number of programs and activities designed to improve the government's capabilities in both of these areas.

Detection

One of OHA's primary responsibilities is to mitigate the consequences of biological incidents through early detection. Traditional epidemiological surveillance is too delayed to mitigate large scale attack consequences. Therefore early detection is a key tool to make the Nation more resilient against catastrophic health events. Prompt identification of a biological attack has the potential to increase the speed of delivery of medical countermeasures and save lives.

OHA's BioWatch program is a federally-managed, locally-operated, nationwide bio- monitoring system designed to detect the intentional release of aerosolized biological agents. This program deploys collection devices and analytical capability in more than thirty high-risk metropolitan areas throughout the nation. The intent of the BioWatch program is to provide public health experts with a warning of the presence of a biological agent before those who are exposed develop symptoms of illness. This "detect-to-treat" approach gives public health officials an opportunity to respond as quickly as possible in order to mitigate the potentially catastrophic impacts on the population. BioWatch uses risk information provided by the Bioterrorism Risk Assessment (BTRA) developed by the DHS Science and Technology Directorate to inform which agents to detect.

In addition to, and equally import as, providing critical early detection capabilities, the BioWatch program has built a collaborative capacity among the federal government, state and local public health, and emergency management communities that did not previously exist. This partnership is a model of interaction where a rapid, unified response is required.