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Presentation at the Seminar Sponsored By: The India Forum

BIOTERRORISM AND CONFLICT MANAGEMENT: Challenges and Consequences for India, Israel and the United States Dr. Venkat Rao. Presentation at the Seminar Sponsored By: The India Forum School of Public Policy, George Mason University The Conflict Resolution Research Group (Israel)

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Presentation at the Seminar Sponsored By: The India Forum

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  1. BIOTERRORISM AND CONFLICT MANAGEMENT:Challenges and Consequences for India, Israel and the United StatesDr. Venkat Rao Presentation at the Seminar Sponsored By: The India Forum School of Public Policy, George Mason University The Conflict Resolution Research Group (Israel) May 15, 2003George Mason UniversityArlington, VA

  2. KATEUA’S TRAP Year: 67 BC Stage: Trabzon (Black Sea coast, Turkey) Actors: Roman General Pompey versus King Mithridates of Pontus Weapon: “Mad Honey” Excessive salivation, vomiting, loss of coordination, tingling and burning sensations in the mouth and extremities, low blood pressure, decreased heart rate, muscular weakness, and sometimes convulsions. Although few attacks are fatal, even a small amount of mad honey can result in total incapacitation, which lasts for about twenty-four hours.

  3. TOPOFF 2 Year: 2003 AD Stage: Hypothetical—Seattle and Chicago At Noon in Seattle, a bomb explodes causing more then 100 casualties. Significant level of radioactivity detected at the site. Local officials and first responders conclude it is a “dirty bomb” Next day, some 2,000 miles east, in Chicago, people arrive at the local hospitals complaining “flu-like” symptoms. Next 24 hours, the number of “flu-like” reports increase dramatically, bringing CDC. CDC confirms a deadly biological agent. *DHS Drill, May 12, 2003.

  4. Threat is Global—Emerging Landscape • Global travel • Globalization of food supply and centralized processing of food • Population movement (urbanization) • Transportation system • Access to specialized technologies • Internet • Environmental Degradation

  5. WHY US, India and Israel? • Threat real, differentiated only by local environment • Difference in endemic disease profiles and geography exist • Levels of preparedness vastly different—Israel:US:India. • Promising S&T base • Opportunities for collaboration (pharmaceutical stockpiles, vaccine technologies, sensor systems, bioinformatics, to name a few)

  6. WHY US, India and Israel? • Anthrax in the mail in the US, India and Israel • Nov, 2001: Envelope containing a suspicious power received by Maharastra’s Deputy Chief Minister (Mr. Bhujbal). Anthrax test was positive (confirmed by Haffkin Institute and Molecular Diagnostic Research Center) • 2001: One person diagnosed with Anthrax (Karnataka) • 2001: Goa’s Secretariat received mail with suspicious power (inconclusive results) • 2001: Uttaranchal’s Chief Minister’s (Mr. Nityanand Swami) residence received mail with suspicious power (inconclusive results) • Anthrax endemic in Tamil Nadu, Karnataka, and Andhra Pradesh

  7. WHY US, India and Israel? • Anthrax in the mail in the US, India and Israel • October, 2001: Three parliamentary office received letters with suspicious powers leading to closure of section of the parliament building • October 2001: Parliamentary opposition leader Yossi Sarid, head of the Meretz party, received a similar letter. • Test results not available. • October 4 to November 23, 2001: 23 confirmed cases of anthrax in the US from exposure to spore-laden mail. 11 confirmed pulmonary anthrax and 12 confirmed/suspected Cutaneous anthrax.

  8. WHY US, India and Israel? • Opportunities to share capacity and expertise in preparedness and countermeasure areas: • India reported development of a new Anthrax vaccine (Panacea Biotechnology) • India offered 20 million Ciprofloxacin to US in the aftermath of October 2001 anthrax mail to meet shortage in stocks • Israel reported development of a new Anthrax vaccine (Nes Tziona Biological Center). One dose regimen. • Israel's Home Command and Medical Corps provided guidance document to US DOD on hospital preparedness, “incident” analysis and risk assessment • Information and intelligence on threat assessment

  9. 1 0.8 Advantage of Early Decision 0.6 Detection Detection Disease Detection 0.4 0.2 0 0 24 48 72 96 120 144 168 Incubation Period (Hours) Consequences of Traditional vs. Early Detection Monitoring Early Symptoms Disease-specific Symptoms * Adopted from Kaufman, AF, et al. 1997. Emerg. Infect. Dis. 3: 83-94.

  10. Technology as an “Enabler” • Ability to generate real-time reporting • Capacity to incorporate Chem-Bio Detection with clinical surveillance/report • Flexibility of open standards-based incidence reporting and tracking platform • Ease to include biosensor modules on existing environmental monitoring networks • Weakness in expert decision systems • Ability to integrate GIS in EMS

  11. Innovative Technologies and Solutions Emerging Public Health Threatsand Role of Enabling Technology eLEXNET • Laboratory electronic exchange network • Track and respond to outbreaks offood-borne illness • Promote collaboration/data exchange D, S EmergingPublic Health Threats BTADT D, S • Integrate intelligence data with medical and other inputs • Decision tool to detect BW event HIRTS • Integrated electronic network for NCBR incidence first response • Expandable decision logic for incidence analysis R TB Surveillance • Laboratory surveillance of Mtb/NTM worldwide • Detection of resistant forms of Mtb S Mitigation and Response Detection and Surveillance

  12. Bioterrorism—Multiple Source • Contamination of water supplies (eg. Girardiasis) • Agricultural produce • Packaged food • Ventilation system (Legionnaires disease) • Package/cargo (Anthrax mail) • Transportation network (B. Subtilis)

  13. Bioterrorism—First Responders • Public Health Officials • Epidemiologists • Physicians • Pharmacists • Microbiologists • Agriculturists • Package designers • Industrial engineers • Law enforcement Both Prevention and mitigation Prevention

  14. Bioterrorism Monitoring Component Systems • Biosensor system/suite • Data capture/analysis • Reporting and tracking system

  15. Incidence Reporting-Tracking Systems Model HIRTS*VirtualCommandCenter * CSC’s Hazard Incidence Response Tracking System

  16. Bioterrorism Preparedness and Response--USA • Implement the National Strategy • Enhance Infectious Disease response, coordination, and support (NEDSS) • Enhance local epidemiology and surveillance capability • Improve coordination, communications in public health and medical care (hospital preparedness) • Conduct detailed preparedness assessment (city/region) • Enhance CBRN countermeasures R&D Tech base • Improve Stockpiles (NPS, Vaccines etc.) • Invest in public health informatics

  17. Bioterrorism Preparedness and Response—India • Perform integrated threat assessment • Establish Rapid Response Laboratory network for detection/identification • Establish dedicated bioterrorism workforce at state level (Ministry of Health, Drug Control Dept.) • Develop coordinated state government departments planning (Ministries of Health, Agriculture, Home and Drug Control Dept.) • Animal vaccination program (eg: Anthrax) • Leverage telecommunication tools for rapid infusion of training • Coordination with international partners in information sharing and joint ventures • Explore ways to co-opt Private Sector

  18. Bioterrorism Preparedness and Response—Israel • Completed final phase of smallpox vaccination • Priority in first response to incidence • Improvements in water supply, food supply systems • Secure infrastructure for medical professionals to treat victims • Robust Medical Technology Sector • Improvements in interlinked hospital network • Need CBRN countermeasure products approval process compliant with US

  19. US-India-Israel Partnership Needs • Collaboration of Preparedness/Prevention Programs • Improve coordination, share information and responsibility • International strategy to guide implementation • National Strategy Initiative • Need baseline for performance goals and measures for preparedness • Collaborations with private sector and stakeholders • Training, equipments, communication

  20. Research Activities—Areas of Collaboration • Detection of Agents (Bioinformatics, Proteomics based systems) • Development of New and Improved Vaccines (Recombinant products, biotechnology) • Development of Antibiotics and Antiviral products (Pharmaceuticals) • Performance standards for emergency response equipments (IT tools, data collection and KM systems)

  21. Knowledge makes bioterrorism possible; Knowledge also provides a strong defense against it.

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