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For those whose job it is to worry about the future,
the list of potential threats has always been a long
one, although dominated by the usual four apocalyptic
suspects—war, famine, pestilence and, of course,
death. Until recently, fears of pestilence focused only
on naturally occurring epidemics. Now, though, the
deliberate spread of infectious
disease—biological weapons and
bioterrorism—is considered an undeniable
strategic threat to the nation and the world, and a new
field of research has emerged to deal with it.
In the last decade, few institutions have played as critical a role in this
research, in developing an understanding of the bioweapon and bioterrorism
threats, as the Center for Biosecurity of the University of Pittsburgh
Medical Center. Among the most influential researchers in the field is the
center’s deputy director and chief operating officer, Thomas V.
Inglesby, who ranked at #3 among highly cited authors in Science
2009 survey of bioterrorism research (Inglesby’s co-director,
Tara O’Toole is currently ranked fourth.) In the last decade,
Inglesby has published 45 papers that have been collectively cited more
than 2,500 times, and he is a co-author on seven of the hottest papers in
the field: consensus statements, all with well over 100 citations each,
addressing the medical and public-health management of smallpox, anthrax,
tularemia, plague, botulinum toxin, and other agents as biological weapons.
Inglesby, 43, received his bachelor’s degree from Georgetown
University in 1988, and his M.D. from Columbia University’s School of
Physicians and Surgeons in 1992. He then relocated to Baltimore and the
Johns Hopkins School of Medicine, where he did his internship and a
fellowship in infectious disease, and then, in 1999, became an assistant
professor. In 2003, Inglesby became deputy director and COO of the Center
for Biosecurity of the UPMC (which was originally managed by Johns Hopkins
University and is still located in Baltimore). Since then, Inglesby has
become an associate professor of medicine at the University of Pittsburgh
School of Medicine and the University of Pittsburgh Graduate School of
Inglesby spoke to Science Watch from his
office in Baltimore.
You’ve been involved in two exercises to
explore the political and public health issues that would arise in the
event of a bioterrorist or bioweapons attack. The first, in 2001, was
called Dark Winter. Could you tell us what the motivation was for that
exercise and what you hoped to achieve from it?
Dark Winter was an exercise that had as its major purpose trying to inform
former government leaders—those still quite connected with sitting
leadership—about the character and potential consequences of a
biological attack on the country. It was our view at the time that there
was a profound misunderstanding about the consequences that could follow a
serious biological weapons attack. Most leaders had in mind the responses
that are required after some kind of chemical event: immediate
intervention, decontaminating victims, etc.—things that you can do
when you can delineate the boundaries of the event. What is actually the
case with biological weapons, as with naturally occurring infectious
diseases, is that it requires an almost entirely different set of responses
and responders. It would precipitate a series of political challenges and
choices that are quite different. So we had these leaders go through a
relatively brief exercise, where they had to make decisions and think about
the consequences of those decisions. We thought that this would make these
issues more clear to the leaders than if they had merely read about them in
a journal article or got a briefing on this. We decided to use a smallpox
scenario because of the concerns at the time regarding the security of the
smallpox vaccine in the former Soviet Union, and because we had a very
limited national supply of the vaccine for smallpox.
And what lessons came out of the exercise?
"The vision for the future of
biological threats, whether natural or
deliberate, should be to make the country
resilient to such threats," says Thomas
Inglesby of the Center for Biosecurity of the
University of Pittsburg Medical Center.
"This is what’s needed as a
It showed that even in a small outbreak, the political choices that would
confront leadership would be very serious, and that the time sequence of
these scenarios are very different from the kinds of events they were
familiar with. The stress on the health-care system would be serious. There
would be great differences in different parts of the country as to how they
would respond. Some might try quarantining groups of people. Others might
attempt to restrict the movement of people across state or national
borders. And the leaders had to be aware of these kinds of things so that
they could work out in advance how to avoid the most deleterious
consequences. The whole point of the exercise was to get people to think as
clearly as they could about these types of scenarios in the future and to
begin planning methodically and analytically how to deal with them.
Did you see any significant effects from the
The exercise took place in June of 2001. It was followed by a number of
briefings given by the participants, as well as Congressional hearings. Sam
Nunn spoke about what he learned, as did others. Then 9/11 happened,
followed by the anthrax events. One of the decisions the government made
that fall was to acquire a national reserve of smallpox vaccine and to move
with as much alacrity as possible in doing that. So what seemed like an
intractable problem only months before—a small and aging smallpox
vaccine supply—was actually one that was overcome with the will of
government leadership. By 2002, we had large supplies of smallpox vaccine
coming online, which could be stored for years and used only in an
How do you perceive the threat of biological
weapons and bioterrorism compared to nuclear weapons and nuclear
Both are very serious national security challenges for the U.S., although
for different reasons. The consequences of a nuclear detonation in America
would be quite extreme and would change history. Everything that can
feasibly be done to try to reduce that risk should be done. The
intelligence community has said that a biological weapons attack in the
U.S. is more likely than a nuclear terrorist attack for a number of
reasons. The first is the availability of pathogens around the world. They
can’t be locked up like fissile material can be. There are no
technological choke points in the development of biological weapons that
can be controlled, in the way that there are in the development of nuclear
weapons. Similarly, the knowledge required to make biological weapons
cannot be controlled. We have an area of science—life
sciences—that is very highly capitalized in the world, producing
phenomenal, beneficent changes worldwide. And all developed countries and
many developing countries are actively pursuing the fruits of this
explosive growth in the life sciences. So this field is highly capitalized,
quite global, and the knowledge is almost immediately available after
it’s learned. There’s no reliable or feasible mechanism to
control the knowledge, the technology, the people, or the outcomes in the
life sciences. This is why intelligence-community assessments and
commission report after commission report generally tend toward biological
weapons or bioterrorism attacks being more likely than nuclear. Of course,
we can’t predict exactly what will happen next. The consequences of a
nuclear weapon going off in America are as extreme as can be imagined. The
consequences of a biological weapons attack or bioterrorism could be
anything from small to extreme.
Are there definitive actions we can take to
minimize the chances of a biological weapons attack or bioterrorism,
or to minimize the consequences afterward?
Cited Papers by Thomas V. Inglesby and
Colleagues, Published Since
1999 (Ranked by total
D.A. Henderson, et al.,
"Smallpox as a biological weapon
– Medical and public health
management," JAMA-J. Am. Med.
Assoc., 281(22): 2127-37, 1999.
D.T. Dennis, et al.,
"Tularemia as a biological weapon
– Medical and public health
management," JAMA-J. Am. Med.
Assoc., 285(21): 2763-73, 2001.
T.V. Inglesby, et al.,
"Anthrax as a biological weapon –
Medical and public health management,"
JAMA-J. Am. Med. Assoc.,
281(18): 1735-45, 1999.
T.V. Inglesby, et al.,
"Anthrax as a biological weapon, 2002
– Updated recommendations for
management," JAMA-J. Am. Med.
Assoc., 287(17): 2236-52, 2002.
T.V. Inglesby, et al., "Plague
as a biological weapon – Medical
and public health management,"
JAMA-J. Am. Med. Assoc.,
283(17): 2281-90, 2000
Yes, and that’s the good news. There is a great deal we can do to
diminish the potential consequences of biological weapons. Over the longer
run, it’s conceivable that we would become so effective at responding
to biological threats that we would no longer need to consider biological
weapons to be weapons of mass destruction. If we can get to the point where
we can make vaccines and medicines rapidly and in great quantity, and if we
can diagnose illnesses more quickly, then the impact of biological weapons
and natural epidemics will drop dramatically over time.
Should this be our number-one priority in this
The vision for the future of biological threats, whether natural or
deliberate, should be to make the country resilient to such
threats—to make them into events that can be managed with limited
illness and limited disruption. This is what’s needed as a strategic
goal in this country. The Obama administration has moved in that direction.
One of the policy goals of the administration is to accelerate development
and the ability to make vaccines and medications for the world’s
worst infectious diseases. That is a very important goal.
What do you think we can do to deter the use of
We can do a number of things. And it’s good to compare and contrast
that with the nuclear model. In nuclear deterrence, we’ve lived now
for quite a while with the deterrence of having enough nuclear weapons to
achieve "mutually assured destruction." That, fortunately, is not the
strategy for biosecurity. The U.S., as have most countries in the world,
has foresworn the development of biological weapons. That’s a useful
tool in promoting transparency and in setting moral and behavioral norms
amongst countries. Another part is the education of the life-sciences
community generally about the potential misuse of research. That’s a
relatively new concept for some working in these fields. Getting people in
the life sciences to think about the fact that their work can be used both
for good or not-so-good can have a strong deterrent effect at the community
level. Improving our approach to microbial forensics to better identify the
signatures of pathogens could help us attribute future attacks.
You’ve spoken publicly about deterring
biological-weapons use by limiting the effects. Can you explain that
If we develop the ability to substantially blunt the effect of biological
weapons or natural epidemics, this would reduce the effects that such
weapons would have. If the U.S. has developed the ability to vaccinate
people quickly against a particular threat, it lowers the incentive to use
this kind of weapon. The country has become much more capable of dealing
with biological threats in just the last five to ten years, but obviously
there are limits to what can do. We have a long way to go in terms of
developing vaccines and anti-infective medications quickly. But
that’s the goal.
Has the pharmaceutical industry shown a willingness
to pursue this?
The interest has almost exclusively been on the part of smaller biotech
companies, trying to develop some of these anti-infective
medicines—antibiotics or vaccines or monoclonal antibodies. A few
years ago, the government made a very serious commitment to prepare for
pandemic influenza. That has created a strong industrial-pharmaceutical
commitment to flu medicines and vaccines. In the realm of emerging
infectious disease and biodefense, there has been substantial focus and
commitment to basic science. NIH has funded research in many areas related
to infectious-disease pathogenesis and immunology. There has only been
modest levels of support in the last couple of years to fund advanced
development of medications and vaccines for biodefense and ongoing
infectious disease. Xome companies are working with the government on
developing new medicines and vaccines, but compared to other kinds of
national-security investment, it’s quite small.
What is the government doing other than funding
The government has set a number of vaccine and medication requirements that
it believes must be fulfilled for the security of the country. These
include things like broad-spectrum antibiotics and antiviral treatments for
ebola and other infectious diseases. It’s a list of diseases the
government considers to be sufficiently threatening that there needs to be
a medication or vaccine developed against them. This is both on the Health
and Human Services side and the Department of Defense side. The government
is now continuing to flesh out a strategy of how to get those medications
and vaccines most efficiently and effectively.
Other than creating medicines and vaccines, what do
you see as the most pressing needs?
We have to look at the kinds of hospital responses we’ll need in a
crisis in a major city. We need to improve surveillance for new infectious
diseases. We need a public-health system that is prepared for emergencies.
And we should encourage more community-level preparedness for cities. We
need a highly competent government effort allied with a committed private
effort—by academics and public-health officials and the private
Is it easier or harder to get people to pay attention
now that we live in an era when there seems to be so much to worry
about—global warming, health care, the economy, etc.?
Both. The average person walking around doesn’t like to think about
preventing bad events from happening—it’s just not human nature
to do so. If it’s not actively part of your job, you don’t keep
it in mind for very long. There is "threat fatigue." I think we have to
expect that and build around it. It can’t be everyone’s job to
think about all threats all the time. That said, it needs to be the job of
some community of people. What we need are competent people in positions to
make a difference. What we’ve seen with the financial crisis and
climate change is that it’s important to have an effective federal
government, as well to have constructive international dialogue about these
types of problems. It can’t just be the U.S. or any single country
alone. We have to recognize that not everything will take care of itself,
and that we need talented people in the public sector. It seems to me that
there’s a new premium on having the right people doing the right
jobs, both in and outside of government. Hopefully that will carry over
into many of these challenges that confront us, including preparing for
biological threats and preparing to respond to epidemics, be they natural
KEYWORDS: THOMAS V. INGLESBY, CENTER FOR BIOSECURITY,
BIOLOGICAL WEAPONS, BIOWEAPONS, BIOTERROR, SMALLPOX, BIOSECURITY, DARK