Now is Not the Time for Funding Pauses, Cutting Ties With Health Organizations

Image credit: Cristian Rojas, Pexels

This is the first in a series looking at the intersection of the federal government and public health and how the former greatly influences the latter.

Until 2001, the only biocontainment unit in the country was located at the US Army Medical Research Institute for Infectious Diseases (USAMRIID) at Fort Detrick, Maryland. But then in 2001 2 seminal events led to the realization that the United States was woefully unprepared for a large biological event. The first occurred in June after a tabletop exercise conducted at the Johns Hopkins Center for Health Security called Operation Dark Winter. Involving active and former government personnel from all political viewpoints, the exercise simulated a fictional scenario involving a variola major (smallpox) attack in the US. The findings were presented to President George W. Bush, and it found that because there was no surge capability in any sector of the US healthcare system, a biologic attack could and would threaten national security.¹ Three months later and just 1 week after the terrorist attacks on September 11, letters laced with bacillus anthracis (anthrax) were mailed to several government and media offices, killing 5 and infecting 17 others.²

Emory University and the First Civilian Biocontainment Unit

But then, in 2002, Emory University opened the first civilian biocontainment unit in the US. It remains the only unit in the country certified by the World Health Organization (WHO) to care for patients infected with smallpox, and 1 of 2 in the world.³ And people questioned the utility of having a unit with no patients. But the team trained for 12 years much like the Roman army of antiquity, with “their drills bloodless battles, their battles bloody drills.”⁴ In 2014, 4 patients with Ebola virus disease were successfully cared for, with one ultimately readmitted. It was the first time a patient with a viral hemorrhagic fever had been placed on mechanical ventilation and survived; the first time renal replacement therapy had been utilized successfully.^5,6

The entire field of high consequence infectious diseases was advanced thanks to these achievements. Just late this past year, during the most recent Marburg Virus Disease outbreak in Rwanda, patients were placed on mechanical ventilation and survived, a first for the African continent. Because of the rapid deployment of international teams to that outbreak and the dissemination of recently developed medical countermeasures, the case fatality rate was approximately 23% (typical Marburg outbreak case fatality rates can reach upwards of 90%).⁷ Such sharing of resources, knowledge and operations is how a country, a citizenry leads.

A Continuation of Emerging Threats

In March 2021, the US Congress released the report Biodefense in Crisis, through a bipartisan commission on biodefense which noted: “the United States remains at catastrophic biological risk.”⁸ And this is 20 years after the start of a series of significant public health events including pandemics and outbreaks:

• H5N1
• SARS-CoV-1
• MERS-CoV
• West African Ebola virus
• SARS-CoV-2

Have we learned nothing?

The latest emerging threat is the highly pathogenic avian influenza (HPAI or H5N1). And due to lackluster public health guidance, poor investment in pre-emptive testing capacity, and delays in surveillance data, is on the verge of becoming a devastating outbreak in humans. In the country that has boasted of and prided itself in being the beacon for scientific advancement and achievement. But due to inadequate, reactionary funding in the face of disasters, that does not hold true. As I detailed recently in this article, while there is a network of institutions in the US and the world that have biocontainment units on 24 hour standby every day, the ultimate capacity is low relative to populations at risk.

Pathogens can be put out into the world in a variety of ways including a spillover from animals, misusage, lost or purposefully released and lead to worldwide epidemics in a matter of hours. It is essential that the United States, and those who continue to stand ready to protect our homeland and our communities be armed with the most accurate data, the most well-funded countermeasures to be prepared for any event that may occur, just like we were in 2014. Cutting off funding, communications with the WHO and other external partners will hamper any preparations and response when something occurs.

Tanzania is confronting another Marburg Virus Disease outbreak; there are reports of suspect cases of Ebola Virus Disease in the Boyenge health zone of the Democratic Republic of Congo, and due to the strife in the eastern part of that country, significant biosecurity concerns exist. Without the expertise and technical assistance of the Centers for Diseases Control and Prevention, the risks for the global community could be calamitous. People will die.

The United States has always proclaimed itself as a country that rises to the call, that responds to challenges—not one to abdicate responsibility and influence by retreating within false barriers and borders. There are two types of people in this world: those who run towards emergencies and those who run away. As our Chief Nursing Officer Susan Grant once said in this iconic article in 2014, when responding to criticism over the repatriation of American citizens with Ebola, “We can either let our actions be guided by misunderstandings, fear and self-interest, or we can lead by knowledge, science, and compassion. We can fear or we can care.”⁹

References

1. Dark Winter. Johns Hopkins Bloomberg School of Public Health Center for Health Security. Accessed 28 Jan 2025. https://centerforhealthsecurity.org/our-work/tabletop-exercises/dark-winter-a-training-tabletop-exercise#:~:text=The%20Dark%20Winter%20exercise%2C%20held,provided%20funding%20for%20Dark%20Winter

2. Amerithrax or Anthrax Investigation. United States Federal Bureau of Investigation. Accessed 28 Jan 2025. https://www.fbi.gov/history/famous-cases/amerithrax-or-anthrax-investigation

3. Serious Communicable Diseases Program. Emory University School of Medicine Department of Medicine. Accessed 28 Jan 2025. https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/

4. Josephus, Flavius. Chapter III: On the Wars of the Jews, trans William Whiston. In: The Works of Flavius Josephus. Wentworth Press 2016: 124.

5. Uyeki TM, Mehta AK, Davey RT, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374 (7):636-46.

6. Connor MJ, Kraft C, Mehta AK, et al. Successful delivery of RRT in ebola virus disease. J Am Soc Nephrol. 2014 Nov 14;26(1):31-37.

7. Marburg Virus Disease. World Health Organization. Accessed 28 Jan 2025. https://www.who.int/news-room/fact-sheets/detail/marburg-virus-disease#:~:text=Key%20facts,to%2088%25%20in%20past%20outbreaks

8. United States Bipartisan Commission on Biodefense. Biodefense in Crisis: Immediate Action Needed to Address National Vulnerabilities. March 2021. Accessed 28 Jan 2025. https://biodefensecommission.org/wp-content/uploads/2024/07/Biodefense-in-Crisis_070221.pdf

9. Grant, Susan. I’m the head nurse at Emory: This is why we wanted to bring the Ebola patients to the US. Washington Post. 6 August 2014. Accessed 28 Jan 2025. https://www.washingtonpost.com/posteverything/wp/2014/08/06/im-the-head-nurse-at-emory-this-is-why-we-wanted-to-bring-the-ebola-patients-to-the-u-s/