Federal biodefense organizations discuss CBRN response plans

A panel consisting of one member from each of three major federal biodefense-related organizations met to discuss their coordinated response in the case of a CBRN event at this week's 8th Annual Biodefense, Vaccines and Therapeutics Conference in Washington, D.C.

Each panelist of gave an account of their pre-planned procedures, creating an “end-to-end” look at how the government would react in an emergency situation.

Susan Monarez, the senior science advisor in the Chemical and Biological Division for Science and Technology at the Department of Homeland Security, said that her agency’s primary role is in determining the nature and extent of an emergency - what she called, “the landscape of the threat.”

According to Monarez, DHS examines whether the event is “sufficient to pose a threat to national security.” After a formal determination is made, the risk is classified and matched against “plausible high-consequence scenarios.” 

Factors that impact the threat assessment include the nature of the intelligence, the intended target, the bioagent utilized and exposure estimates. The Department of Health and Human Services then takes the information and performs medical countermeasure modeling in order to prepare a response.

“Modeling is a tool to do consequence assessment," Monique Mansoura, the director for medical countermeasure policy for the Office of the Assistant Secretary for Preparedness and Response at HHS, said. "What is the impact on people’s lives? And given that consequence assessment, we have come up with what we call ‘scenario-based requirements.’ You have to define the size and scope of what you are working with.”

“With that problem set that Susan has provided us, that Mother Nature has provided us, what do we do about it to mitigate that risk? If we have addressed the functional elements that before the event put us in a better preparedness posture, then ideally, in the event, we will have a better response posture.”

In establishing the requirements and planning for the use of medical countermeasures in health emergencies, HHS is, in effect, “setting national policy and strategy,” Monsoura said. “It is not only important for us to think federally, but nationally and internationally." 

“In almost every one of these steps along the way there is an incredible array of partners throughout,” Mansoura said. HHS works with the biomedical industry and other federal agencies, including the Centers for Disease Control and Prevention, in determining the capacity needed to deliver medical countermeasures effectively. 

The delivery side falls under the purview of those in charge of the national stockpile. 

“Our portfolio at present is about $4 billion worth of material in repositories around the country,” Steve Adams, the deputy director of the Strategic National Stockpile from the Office of Public Health Preparedness and Response for the CDC, said, referring to the national stockpile.

“Aside from maintaining the physical material itself, we have two important jobs - one is to work within the enterprise requirements generation process to help assure we’re stockpiling most appropriate countermeasures to begin with, the other is working with our colleagues at the state and local level who, for the scenarios for which we prepare, represent the primary response, or certainly the initial response,” Adams said.

Adams pointed to his operation’s limited ability take charge of a relief situation beyond the logistical challenge of delivering medical countermeasures, calling integration with state and local efforts “the key to the enterprise.” He also applauded his relationship with the CDC’s commercial partners, like UPS and FedEx, which “can cover an airfield anywhere in the country with medical countermeasures, and they do it rapidly.”

“Our job may seem like simplicity itself," Adams said. "We deliver critical countermeasures at the site of a national emergency, but unless you make the correct decisions and put in place the ability to respond to threat items, and unless you integrate those items into a response that is largely led by local leaders, at least initially, you have failed to accomplish much.”