Biological Defense and Public Policy

Here's a good working example of public policy in action, using the ever-popular topic of bioterrorism versus natural public health threats - which to fund? The Republican senators of the Health, Education, Labor and Pensions Committee, led by Senator Richard Burr (R-NC), have approved the Biodefense and Pandemic Vaccine and Drug Development Act of 2005, which will go to the Senate floor for full vote. Burr is the chair of the Bioterrorism and Public Health Preparedness Subcommittee. What is this wonderous act, you ask?

The bill creates a Biomedical Advanced Research and Development Agency (BARDA) within Health and Human Services (DHHS). This agency would lead in the development of new medical countermeasures against bioterrorism and natural disease outbreaks, but in particular, oversee the research to support industry's investment into developing more drugs and vaccines for bioterrorism. The Repubs do not believe the current BioShield acts do enough, since the big pharma firms aren't diving into the business of making more bioterrorism countermeasures. Ergo, create a new federal agency. That will, in the words of Senator Mike Enzi (R-WO), ensure "that we as a nation are prepared for a variety of threats..." Of course it will, senator. Just like having FEMA ensured we were ready for Katrina...

But wait! The bill does more. It allows DHHS to sign exclusive contracts with particular firms and forbids government purchases of generics. It provides the companies with complete liability protection from being sued unless the DHHS secretary believes that they are liable. It offers grants and rebates to said firms and limited antitrust exemptions, while exempting BARDA from FOIA and FACA requirements, essentially shielding the agency from any public or federal cost oversight. In short, this bill is to Big Pharma what the recently passed energy bill was to Big Oil - good times.

But might this bill do any good (other than lining Big Pharma's pockets)? Maybe. From a public policy perspective, does it make sense to create such an agency and provide these benefits toward bioterrorism measures instead of reforming and fixing the public health system? Hilzoy says no, and I tend to agree with his argument. He notes:

Infectious disease surveillance and control protect us against things that can kill us just as surely as any bomb, in many cases without our having done anything whatsoever to bring death or disease on ourselves. . . . Despite that fact, we have been cutting public health funding, except for specific bioterror programs. This is a mistake even if we're only thinking about bioterror, not about public health more generally: having a decent system of infectious disease surveillance and control is essential to detecting and coping with bioterror attacks, and funding for specific bioterror programs needs to supplement, not replace, funding for public health more generally.

Now I'm not one to suggest that investing in the public health infrastructure alone will promise improvements to federal/state response to a bioterrorism act. The funds and resources required to fix the U.S. public health infrastructure is probably a big number. We need to focus some funds and resources on the possibility (as remote as it is) that a bioterrorism act could occur in this country, and if it is contagious, it could be bad. The funds to address bioterrorism is going to be smaller than the funds for the public health system, and because of that, it's easier for these senators to focus on that - it's cheaper and still gets headlines. Diverting all medical bioterrorism funding into public health will not make things better for both issues. But certainly bioterrorism funds are getting too much of the limelight and money these days. There needs to be a better balance in addressing both challenges.

This bill won't make public health better, it may promote some good bioterrorism countermeasures, but it's loaded with bad language. Maybe that's intentional - maybe the Repubs deliberately wrote this to make Dems vote against it, in the hopes that it can become a campaign issue. Who knows? A more bipartisan and logical approach to this issue might be to suggest that the public health infrastructure does need addressing, in light of the threat of avian flu and other diseases; that there does need to be a program for focusing medical bioterrorism response; and that the path to doing both might be done in the same process of legislation.

In the meantime, there's always the Centers for Disease Control and Prevention - let them do their job. I'm in favor of killing BioShield and BioWatch and spending the money more wisely, but we need experts to map out a better course of action - quickly. Without question, natural diseases kill more Americans every year than bioterrorists, but the federal government has a responsibility to address both. We just need some seriousness on both sides of the congressional aisle to stop politiking and get to work.

Thanks to nadezhda for the tip!

UPDATE: Bad post link corrected.

Comments

[Saheli]

Over on my blog we were having a somewhat esoteric and abstract discussion on the ability of humanity to coalesce and attack a problem without needing some other group to dehumanize and fight as other, and my friend Scott, who works in disaster preparation and disaster relief on a grassroots level every day, left this">http://www.haloscan.com/comments/ssrdatta/112979410752023136/#117709">this comment:

I won't claim to have figured it out, but I submit that a good test case for sustaining momentum against a nonhuman "them" will be how much we as a country continue to prepare for natural disasters. Especially if you compare it to our response in the last few years to deliberate-human-caused disasters, which fits PN's mold of a convenient "them" much better.

Sadly, I think he's right--as your post seems to prove. We've got so much natural disease to fight, day in and day out, for which we so often shrug and say no. When I went to hearings on the second anniversary of 9/11 near ground zero, the overwhelming theme was "Please, at least invest more in public health."

[J Thomas]

Probably one of the reasons for this is the widespread concept of danegild.

If some human group does bad things and nobody stops them, they're likely to do it on a larger scale and a shorter timetable.

But if we're weak on earthquake relief it won't cause more earthquakes.