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A4494a-1 03/03 / IGCC Characterizing of Biological Threats to Security Sam A Bozzette, MD, PhD UC Institute on Global Conflict and Collaboration & RAND.

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Presentation on theme: "A4494a-1 03/03 / IGCC Characterizing of Biological Threats to Security Sam A Bozzette, MD, PhD UC Institute on Global Conflict and Collaboration & RAND."— Presentation transcript:

1 A4494a-1 03/03 / IGCC Characterizing of Biological Threats to Security Sam A Bozzette, MD, PhD UC Institute on Global Conflict and Collaboration & RAND Health & RAND Health

2 A4494a-2 03/03 / IGCC Public Policy and Biological Threats 2-3 week residential bootcamp at UCSD –Intent to enroll up to 18 fellows –Primary target UC system grad stds /post-docs –also sought are UC Jr faculty, PRGS Students, Professionals from US and abroad Immersion into policy aspects of biothreats Utilize many topical expert speakers (1-3 per session) Arrange out of session contacts as feasible

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9 A4494a-9 03/03 / IGCC Broad Range of Threats Intentional threats a small element in the total picture –Nature is scarier than nations or terrorists (think SARS, West Nile, Hantavirus, Ebola, HIV). –New Diseases –New variants of old diseases –New territories for old diseases –Human, animal, plants vulnerabilities all considerations

10 A4494a-10 03/03 / IGCC Emerging and Reemerging IDs

11 A4494a-11 03/03 / IGCC Global HIV

12 A4494a-12 03/03 / IGCC Intentional threats Familiar (Salmonella in salad bars) Ancient (Smallpox) Arcane (Wool sorters disease, aka inhalation anthrax) Exotic (Meliodosis, hemorrhagic fevers)

13 A4494a-13 03/03 / IGCC Select Agents and Toxins

14 A4494a-14 03/03 / IGCC Intentional Threat Complexity Varies Materials: –Easily obtainable (lab techs) –High Tech (milled anthrax spores) Delivery systems: –Simple (direct contamination) –Advanced (aerosolization) Operations –Isolated –Coordinated Attacks are unlikely to be obvious

15 A4494a-15 03/03 / IGCC Key Prevention and Response Technologies Primary prevention Treaties / Control Regimes Information / technology control Environmental monitoring Surveillance / Monitoring Public health responses

16 A4494a-16 03/03 / IGCC Response Technologies Heavily dependent on: Dual use systems & facilities Poorly configured public sector –Public health infrastructure badly decayed Personnel Diagnostic, isolation, other facilities –Little tradition of directed public research Reluctant Private sector activities/investments –Actions / decisions of providers & health care systems –Regulatory concerns –Pharmaceutical industry incentives

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18 A4494a-18 03/03 / IGCC The Case of Smallpox Vaccination Infectious, contagious, disfiguring viral disease of humans Vaccine = live vaccinia virus –Successful vaccination >95% protected ~5yrs –Complications: ~50/million; Deaths: 1-3/million U.S. extremely vunerable –Universal vaccination stopped in 1971 –Heath system unprepared for vaccination or care –Health care workers at high risk

19 A4494a-19 03/03 / IGCC Generating A Recommendation for National Security Policy on Smallpox Develop plausible attack/response scenarios Identified Policy options Perform systematic literature review Model outcomes based on scenarios Relate outcomes to policy options

20 A4494a-20 03/03 / IGCC Deaths: 3 Attacks and 3 Policies Airportlow success Prior vaccination of HCW and public Prior vaccination of HCW No prior action Deaths Hoax Building

21 A4494a-21 03/03 / IGCC Should We Vaccinate Now? Expected gains should exceed expected losses –Probability(gains) losses (losses gains) –Probability (outbreak) (lives lost if no outbreak) [(lives lost if no outbreak) (lives saved if outbreak)]

22 A4494a-22 03/03 / IGCC Should We Vaccinate Now? Example: vaccination prior to building attack –Vaccination of health workers causes 25 deaths but can avert 100 –Policy is favored when risk of attack [25 (25 100)] ~20% Expected gains should exceed expected losses –Probability(gains) losses (losses gains) –Probability (outbreak) (lives lost if no outbreak) [(lives lost if no outbreak) (lives saved if outbreak)]

23 A4494a-23 03/03 / IGCC Threshold Probabilities: When Should We Vaccinate? No prior vaccination Prior vaccination of health care workers Prior vaccination of health care workers and public 60% 0% 20% 40% Lab release Human vectors Building Probability of attack Airport low Airport high

24 A4494a-24 03/03 / IGCC December 2002 Presidential announcement: –Vaccination of health workers to resume –Vaccination of public may be allowed later Phased program –50,000 initial responders –500,000 addition health care worker –up to 10M health and safety workers The Policy

25 A4494a-25 03/03 / IGCC The Outcome Only 50% of hospitals participated Less than 50,000 vaccinated –Known complications low –Possible cardiac complications dominated news Emphasis shifted to preparation for public health emergency

26 A4494a-26 03/03 / IGCC A National Security Program Goal: protect public by raising population immunity Decisionmaking based on aggregate issues Losses expected and accepted

27 A4494a-27 03/03 / IGCC A Public Health/Clinical Program Goal: optimize public health by preparing the system Decisonmaking based on clinical/individual considerations Losses unacceptable (do not harm)

28 A4494a-28 03/03 / IGCC Comparison of Best Strategy from Each Investment Portfolio

29 A4494a-29 03/03 / IGCC Large Airport Attack – Prob of Attack =.05

30 A4494a-30 03/03 / IGCC Large Airport Attack: Best Options For Costliness and Probability Regimens (Current Prohibited) 89 - MVA1 Pre-HCW: NYCBH : NYCBH : NYCBH : MVA1 90 – MVA1 Pre-HCW: NYCBH : NYCBH : MVA1 : MVA MVA1Post-HCW: NYCBH : NYCBH : NYCBH : MVA MVA1Post-HCW: NYCBH : NYCBH : MVA1 : MVA1

31 A4494a-31 03/03 / IGCC Recommendations NIAID: Complete development of MVA, including explorations of single dose MVA HHS: Purchase approximately 10M courses of MVA to cover: All immunocompromized in mass vaccination (100% acceptance) OR All immunocompromized (and possibly those with relative contraindications) in ring vaccination response plus health care workers in mass response

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33 A4494a-33 03/03 / IGCC Expected Per-Person Costs - USD Administration costs are absolutely and relatively higher in mass (100%) compared to smaller (10%) vaccination campaign, where fixed costs dominate


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