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May 1, 2009
Exclusive: Swine Flu – Black Death, False Alarm or Mother Nature’s Bioweapon? (Part Two of Two)
COUNTERMEASURE DEVELOPMENT
While government has wisely invested in vaccines and countermeasures research, there are times when patronage and inefficiency overrun common sense, leading us to the old adage – leave it to government to turn gold into lead. There have been effective and off the shelf interventions for WMD that could be included in the national stockpile that were inexpensive. Yet the government preferred to spend millions to investigate more expensive alternatives. Who is driving the car?
Nevertheless, the government’s support of novel vaccine and antimicrobial research is laudable and must continue. At a time when the public are vilifying vaccines as some autism weapon instead of valuing them as protectors from nasty diseases, we have forgotten the power of infections – infections from which the world continues to suffer. Measles remains one of the leading causes of preventable blindness in the world. Less than 60% of children in India are immunized against measles; in the U.S. it is over 95%! Dengue, malaria, tuberculosis and HIV are global, not national or regional but global threats, ones we go blithely unaware of or unconcerned about. Moreover, there isn’t a city in the U.S. that is as impoverished or crowded as so many are worldwide – Cairo, Mexico City, and Calcutta, for example.
The risks of overcrowding cannot be overstated – they facilitate the spread of disease, especially ones that can be transmitted person to person or animal to person. During flu season, an epidemic or pandemic, you definitely don’t want to be closer than six feet to people; unless you travel by Gulfstream, your daily commute or transcontinental flight is unlikely to provide such spatial protections from a potentially sick bystander. The World Health Organization states there are over 500,000 people who travel by air on a daily basis. Speak about the spread of disease! Is it any wonder that sick people in Mexico City can be in the U.S. and transmit disease? Or spring break kids can be in Mexico one part of the day and cough merrily along back home in the ‘States a few hours later? That said, avoid crowds. Most importantly, only go to the hospital if you are really feeling sick. Otherwise, see your private practice physician. And make sure they use some common sense social distancing – a back door or quick through put for patients with coughs and fevers, masks, waterless hand sanitizers and the like.
Here is a vulnerability that continues to be questioned by the media: why did we not limit travel from Mexico into the U.S.? Why the delay in enhanced border biosurveillance? What was rationale for State and CDC to not immediately issue a travel warning for U.S. citizens considering travels south of the border?
First – we can’t even close the border to illegals, so how can anyone expect the U.S. to shut it off to sick people? Perhaps in the midst of swine flu, DHS and the Administration can seriously look at the full range of vulnerabilities the border poses.
Second – the genie was out of the bottle. Mexico was slow on releasing information. By the time any actionable information was leaked or shared, the disease was out of Mexico. Had the Mexican authorities isolated the regions, provided medications to persons exposed or with mild illness and reached out to global health organizations earlier, we might have had a far different set of circumstances. But by the time isolating Mexico was even considered, people were in airports or at their destinations, coughing and merrily spreading an infection they didn’t even know they had.
Third – inexperienced leadership in Washington. While European health experts were issuing travel warnings to Mexico and the United States, we were slow on the uptake. This is indefensible given the timeline of the illness and the reality many Americans go to Mexico for spring break. A travel warning now is all well and good; CDC through DHS is passing out information to Americans traveling to Mexico.
As of now, our border patrol personnel are using surveillance that relies upon looking for those who appear sick and enlisting the cooperation of the traveling ill across the border or in airports for further investigation is the border and arrival approach for the moment. Some nations in the Pacific Rim, where SARS is still part of their consciousness, are considering dusting off some of their arms length technology – roughly put – thermal detectors to identify folks who might have a fever. The U.S. tested such technology in Miami but to date does not have or plan to utilize it on a widely deployed basis. Given virtually all arms length technology is a double edged sword….conferring benefit and suffering from limitations; such instruments are not to be viewed as a panacea. The Holy Grail indeed would be the ability to detect potentially contagious, ill people using technology that identifies such persons well before they enter jet ways, airports or clear customs.
IS DR. STRANGELOVE INVOLVED?
In the early days of the swine flu pandemic conspiracy theories started making their way onto the blogosphere, complete with assertions that this latest viral epidemic was part of a secret biological weapon program to kill Mexicans or it was created in a clandestine lab and somehow it got released, that a 24-esque “Starkwood” (a la Blackwater) corporation developed the bug, it was a military experiment gone wrong, or lots of other variations on the Dr. Strangelove theme.
And fact is often stranger than fiction. Given this virus is an assortment of components from human, swine and bird influenzas, on the surface one could seriously wonder why or how this “bug” could evolve so unexpectedly and show up sickening folks so quickly. This is fuel for the conspiracy fires. Except for the fact that these genetic swaps are exactly what influenza viruses do, and why those of us in preparedness have been concerned – extra concerned since the first avian influenza outbreaks occurred in the late 1990s. But as they say, just because you are paranoid, doesn’t mean they aren’t out to get you.
There is reason for conspiracy theorists and serious scientists or preparedness folks to worry when a novel pathogen rears its ugly head and sickens people. Given that there are numerous nations, state sponsored organizations and assorted entities that are actively engaged in biological weapons research, the opportunity for accidents, let alone intentional release or experimentation on the unwitting, is significant and more than commonly appreciated. One cannot lose sight of the fact SARS and avian influenza emerged from a region close to an active biological weapons research facility in China; Chinese denials notwithstanding. But given the proximity of people to animals and the incursion into previously unexplored regions, the opportunity for novel pathogens to emerge in that part of Asia also likely.
Swine flu – natural or manmade – does it matter? Not to the victims. And therein rests our responsibility – to the victims and those we intend to protect from becoming victims. This influenza outbreak is a test of our capabilities, our preparedness efforts and our resolve as a people. If past performance, even current events are any indicator of capacity – we still have a ways to go.
In the following article you will find a brief overview of influenza viruses and why they can be deadly, a discussion of our current level of vulnerabilities and state of readiness, as well as key preparedness issues and practices that the public should consider.
BIOLOGICAL THREATS BEYOND SWINE FLU
Consider the vulnerabilities we face in the biological weapons and pathogen research arena.
Several years ago, vials of an aggressive form of influenza were mistakenly shipped to various laboratories nationwide. The CDC’s approach was to send letters alerting the labs of the problem, requesting the labs destroy the vials, and asking for no further proof than sending a fax to CDC as confirmation the pathogens were disposed of. How safe do you feel? Damage control was initiated after the fact. It was too little too late. It certainly was not the first time pathogen swaps have occurred between labs. And these were not intentional diversions. Want to take a guess how many materials become back of the truck articles? The nature of the beast has been the excuse, but it needs to stop. Sure errors occur but, with deadly pathogens, can we allow this to continue? But it will. Especially with poor government even industry oversight, weak or nonexistent federal security policies, inadequate oversight of the anemic security edicts in effect, and lack of interest from the very agencies legally charged with safeguarding the public from accidental or intentional misuse of deadly pathogens.
At the end of 2008 the World at Risk Report Commission presented its findings on weapons of mass destruction (WMD) vulnerabilities in the U.S. and internationally. One of their critical concerns was the lack of security they discovered at some of our nations BSL 4 laboratories. Their work echoed that of the Government Accountability Office (GAO) which found several BSL 4 labs lacked the most fundamental of security provisions, including absence of patrols, perimeter barriers or other basic considerations for a high threat, high value facility. What is as worrisome is the tepid, almost indifferent response from Health and Human Services (HHS) the cabinet level government agency which houses the Centers for Disease Control and Prevention (CDC) – you know the civilian counterpart of our military infectious disease folks. CDC also does research on BSL 3 and 4 pathogens – oh, and have oversight of such facilities nationwide.
Why is this problematic? Biosafety labs (BSL) under the U.S. Bioterrorism Act are primarily regulated and must be registered with either the CDC or U.S. Department of Agriculture (USDA) under the Select Agent Regulations. “Select agents” is a benign sounding term for the broad categories of viruses, bacteria, fungi, prions, etc.; deadly pathogens – mostly nasty viruses and bacteria, although toxins and other items of interest are “studied” – many of which have been designated as potential biological weapons. BSL labs are designated 1 – 4, based upon the nature of the pathogen under investigation and the safety precautions required to handle those agents. BSL 1 contains the least dangerous organisms and requires basic safety precautions. BSL 3 labs work with pathogens that can cause death but that there may be effective treatments. Only BSL 4 labs are allowed to work with pathogens for which either no cure, treatment or vaccine currently exists. The work environment is dangerous; BSL 4 requires special storage as well as containment labs which are separated from the facility by airlocks and other safety features, and those who directly work with the organisms must wear level A biosuits (“moonsuits” – think the movie Outbreak) – the professional is fully encapsulated in a sealed suit with a dedicated air supply. BSL “select agents” are not things you want readily accessed by those who do not need to handle them.
In addition to the typical category A bioweapons – smallpox, anthrax, plague, for example – there are a whole host of organisms including the realm of influenza viruses under investigation. This includes research and engineering efforts concerning the influenza virus that caused the 1918 Spanish flu pandemic that resulted in 20 – 50 million deaths worldwide. Of note, there have been reports of other entities worldwide trying to isolate that pathogen as well. It is unlikely the interest is either humanitarian or medical; influenza can be an effective weapon if it is deadly enough. BSL 3 and 4 labs are doing important research that can help us better understand the biological threats we face and lead to important countermeasures. But they also pose a significant risk given the range of pathogens being studied therein.
The risks just from research labs are not insignificant. Nationwide there are lots of BSL 3 and 4 labs springing up – if there isn’t one already, there will probably be one near where you live. Some are federal facilities, others federally funded, while some use private or other funding. To date there are five operational BSL 4 labs in the United States; there are numerous BSL 3 labs functioning nationwide. The GAO was tasked to perform a systematic security assessment of key perimeter security controls – from a security professional perspective….basic stuff that every lab should have had in place. Only one lab earned an “A” or near 100% on the five categories. Two earned a “B” or hit most of the boxes in 4 of 5 categories. Two flunked. The GAO put it in nicer terms. I don’t know what you call getting three correct on a 15-question test, but if that was my grade in medical school, needless to say I’d be doing a different job. When a lab that contains some of the world’s deadliest pathogens is situated on US soil and cannot even implement basic perimeter security, unarmed guards, and an exterior window with access to the lab you have a problem. When the government agency tasked with oversight – CDC /HHS seems unconcerned – that is near treasonous. The GAO specifically recommended that the Director, CDC take action to remedy these weaknesses. The Assistant Secretary for Legislation of HHS responses to GAO is quite telling in terms of how far we need to go for an infusion of common sense, some security mindedness and ability to act in the public trust. HHS replied they “agreed perimeter security is an important deterrent against theft of select agents.” And they noted the difference in security among the 5 BSL 4 labs was based upon risk based planning, but did not comment on the specific vulnerabilities the GAO mentioned, including an unlocked door leading into a building with a BSL 4! HHS did suggest that they would coordinate with another agency and consider input from physical security experts and the scientific community.
The same “scientific community” that the World at Risk Report Commission on WMDs has expressed concern about in terms of needing more training in and diligence about security measures in their research? Speak about going round and round and round.
Worrisome is the fact that HHS needed anyone to state a profound grasp of the obvious – especially in a post 9/11 world – don’t leave deadly pathogens unguarded. Nearly eight years post 9/11 and only now hiring a security professional to teach HHS, CDC and BSL 4 labs how to lock the door doesn’t inspire confidence on the same agencies charged with keeping us safe in a pandemic or bioweapons release.
Never the less, the CDC and Department of Agriculture (think Plum Island) co share oversight of BSL 4 labs. Time to write your Congressman….and time to create legislation that creates a universal set of laws not guidelines on the types of security every BSL 3 and 4 lab must have regardless of where the money comes from, or what entity has oversight.
Of additional concern is the number of laboratories nationwide and worldwide that are conducting research on naturally occurring deadly pathogens, as well as genetically altered ones. These facilities, including BSL 3 facilities, are not nearly as well secured as they should be.
But the sobering reality is that while it takes resources and expertise to refine a naturally occurring pathogen for advanced or military bioweapon applications, a graduate student could develop an inelegant but effective weapon with the vast array of these microbes currently available. Recall in 1984 a cult in Oregon used salmonella – a very common pathogen that can cause gastrointestinal illness, even death, if obtained and processed properly. And so they did – using such “hi tech” equipment as tubing under their robes, cult members sprinkled their bug juice on salad bars. Net result of this poor mans bioweapons attack on civilians? Approximately 750 people were sickened. And it took law enforcement and public health almost a year to put the pieces together! Two things were fortunate – first the pathogen they selected was not a person to person respiratory illness, and second, no one died.
Bioterrorism is within the capability of any reasonably well financed group. The information necessary to create a bioweapons is in the public domain. Bioterrorism has been referred to as the poor man’s nuclear weapon. Affordable, available materials – there’s a BSL 4 lab that probably still hasn’t locked the loading dock door, scientists for hire, and populations upon which to test make it a possibility. The current events in swine flu remind us that Mother Nature or “man created disasters – bioweapons” (term used painfully) require similar preparedness capabilities, political will and resources.
Remember, sick people can become weapons in and of themselves if the disease is contagious. The SARS epidemic cost Canada, specifically Toronto, millions in lost conference and tourism revenue. That was not an intentional outbreak. Given our inability to secure the borders, and airport security is weak in terms of identifying biological or chemical threats – a terrorist extremist turned passenger with a passport, sick with plague or carrying a simple dispersal atomizer could cause a bit of angst.
Al Qaeda has made no secret about wanting biological and nuclear weapons. Other cults have experimented with bioweapons. And as the proliferation of these materials, the encroachment of remote lands with global expansion and easy travel between nations increases, so does the risk.
Our most important biological weapons research is conducted in, and the most knowledgeable bioweapons experts are found at, the United States Army Medical Research Institute Infections Diseases (USAMRIID) in Fort Detrick. Although they conduct research on virtually all biosafety level (BSL) category agents, their work on BSL 3 and 4 are their métier. Contained in their BSL 4 facilities are the most deadly and dangerous of naturally found and, dare I suggest, engineered pathogens in the world – Ebola virus, Hanta virus, smallpox, viral hemorrhagic fever viruses, possible hybrids (certainly Russia has dabbled in that arena) and other nasty bugs. Working there are professionals who are the best of the best; at least in the U.S. and quite possibly, the free world (we’ll discuss their Russian and Chinese counterparts in a future article).
That said, you’d think there’d be a better inventory control or safety procedure than a pen and paper, or that there would be internal security. The U.S. Army Criminal Investigation Division (CID) is about to conclude an investigation on the possibility of missing virus samples from USAMRIID. In February 2009, USAMRIID halted their work when Venezuelan Equine Encephalitis virus samples were discovered that were not listed in the inventory. In another report it seems some vials were missing. The scientists interviewed were not worried and could not understand the concern. Really? Hmm, you as scientists work with the deadliest pathogens and don’t get concerned when some goes missing or cannot be accounted for? This is the United States, right? Not some Russian research lab after the fall of the Soviet Union where for a few dollars and a bottle of decent vodka you could have a back of the truck sale with some of their biological samples. For USAMRIID to have even one section that succumbs to laxity is inexcusable for the premier biodefense facility in the free world.
Nevertheless, the probe by CID to assess the situation was relatively concluded. Think softball. USAMRIID is also redoing their processes on “select agents.” Recall USAMRIID has been at the heart of another investigation – the anthrax events of 2001 which led Dept. of Justice to investigate two scientists – Dr. Hatfill (later given an apology and several millions in damages) and Dr. Irvins accused of mailing anthrax, and who committed suicide before the case could be fully aired in court. Over the years, a number of bioweapons scientists have apparently committed suicide.
DISCUSSON
The swine flu outbreak is a pandemic. Whether this is the big one or not is still up to Mother Nature. But the question is less important than the concern – would we be able to handle it, or are we handling it as well as we should if this becomes the pandemic?
The good news is that the United States is abundantly blessed with dedicated medical professionals, emergency responders and advanced health care facilities so that we will survive either in spite of or because of government planning, federal agency resources or the current political leadership – or the lack thereof.
The bad news – there are serious challenges and vulnerabilities that face us. And, no surprise, politics is alive and well in the mix. Since preparedness, like homeland security should be above politics given the intent is to protect everyone within our borders – the majority and back benchers alike, one has to wonder why ideology and political agenda need to influence our emergency response actions. As a preparedness professional this is not arm chair quarterback time – this is quality improvement assessment time. We need to look at what we did wrong to date and remedy those policies before it is too late and the next infection is the big one.
Right now we caught a break in the pattern of illness swine flu is showing us in the US and other parts of the world compared to what is occurring in Mexico.
So have we been lucky or is this the norm for swine flu and the world just paid attention this time? As a result, we got a dramatic reminder that disease outbreaks can occur, and will occur, as long as people travel. An illness in South America can affect someone in North America, Europe, or Australia in the time it takes to disembark from an airliner or cruise ship.
The actual incidence of humans infected with or sickened by swine flu is unknown. As discussed earlier, the swine flu can present with two distinct clinical pictures. Typically, most people infected by swine flu have mild illness – sore throat, low grade fever, occasional diarrhea, which accounts for the relatively unnoticed disease. But occasionally the other presentation occurs – a clinical severe illness that resembles pneumonia and results in high fever, shortness of breath, rapidly progressive aggressive symptoms, even death.
It is too soon to run the post game wrap up. But when it is known back in March that outbreaks are occurring in Mexico, instead of issuing mere “pick pocket” alerts, perhaps a health warning should have been issued to U.S. citizens traveling South of the border? Given it should be no surprise to our federal officials that Mexico is a favorite destination for that annual rite of renewal called “spring break,” one has to wonder why it has taken until this week for any, repeat any mention of a travel alert from the CDC or State Department.
In mid March 2009, Mexican health authorities started noticing outbreaks of influenza like illnesses (ILI); by early April a young woman died of severe viral pneumonia – swine flu was determined as the cause. Authorities noticed that young, healthy adults were becoming affected and developing severe illness. Typically only the very old, very young or those with underlying health problems develop severe illness from influenza, especially seasonal flu. Whenever a pathogen (Ex/virus, bacteria) presents atypically, that is a change from the norm – either in terms of the types of victims, ease of person to person spread, severity of illness or different genetic makeup – it warrants special attention and can be problematic. This was clearly the case with prior pandemics such as avian influenza which was not supposed to kill people or produce widespread severe respiratory illness or death among birds. And it is the case with the current swine flu pandemic.
By mid April several people in the U.S. had become ill from swine flu. To date, there are over 40 confirmed cases in the U.S., with sporadic cases being reported in elsewhere around the world, including Spain and Scotland.
The Department of Homeland Security has declared the swine flu as a public health emergency. This is pro forma to allow the release of countermeasures and implement containment strategies.
It is important to recognize this outbreak of swine flu is not the first influenza or respiratory outbreak we’ve seen in the last few years. Recall the SARS epidemic of 2003 that affected thousands of people, with deadly effect on patients and regional economies. Then there have been sporadic avian influenza (bird flu) outbreaks since 1997; the most recent and devastating occurred in 2005-2006 when numerous people and hundreds of millions of birds fell victim to this emerging pathogen. It has not gone away! Although long out of media coverage, avian influenza continues to sicken and kill people. A few days ago a 4-year-old in Egypt was diagnosed; current antiviral medications remain effective and the child is in stable condition. It has not gone away. Nor is it likely to disappear any time soon.
Regardless, swine flu has raised the specter of a global pandemic. But in the process we are led to examine the continuum of threats and vulnerabilities viruses and other pathogens pose to us.
Dr. Lederberg was not wrong and his cautionary thoughts remind us that while there will be life after mankind, perhaps we should take his warning seriously and tend to the infectious threats we face – before our epitaph “the late great human race…an interesting group of organisms that could not adapt or survive!” Because of modern medicine and an abundance of vaccines, next generation antimicrobials and advanced health care we have been lulled into a feeling of false security. Yet it is ignorant to think we have won the war with contagious diseases merely because the leading causes of death in the United States – suicide with a fork and the couch potato syndrome, have replaced pathogens that none the less continue to infect much of the third world.
The current swine influenza outbreak reminds us just how fragile is the stalemate we tenuously hold with infectious diseases. There are critical questions that arise from this pandemic and ones we must address:
- Is it going to be a global killer tantamount to the SARS outbreak in 2003 or Spanish Flu pandemic of 1918?
- Did our government agencies hit the deck running? Was the response timely, effective?
- How long will we allow our preparedness entities to be political instead of practical? Should fundamentally sound medical and epidemiological decisions – strategies to contain or control risk – be supplanted by ideology and policy?
- Will this be the wakeup call to get our act together….. that we are “due” for a deadly pandemic as most preparedness and virology experts assert?
- Will we recognize that outbreaks and pandemics are more likely with global travel and change our episodic, crisis management, eleventh hour strategies and finally have a long term approach to preparedness that persists even in the “quiet” or apparently “safe” times?
- Will DHS, CDC, DOE, D-Ag and others collaborate closer before an event and coordinate their efforts more effectively?
- Will DHS, HHS and CDC finally address the security gaps in our BSL 4 labs?
- Might DoD be a bit more proactive in remedying vulnerabilities and internal security gaps at military biodefense labs working on the deadliest pathogens?
- Will Congress and the Administration have the wisdom to invest the necessary funds to improve bioweapons security, develop countermeasures against emerging pathogens and enhance local preparedness, as well as the political courage to implement outcomes measures and benchmarks of success associated with those funds? The days of throwing money at the problem like drunken sailors, with no expectation of actual work product must be over!
- Will some common sense as opposed to political persuasion become the standard from which we conduct research and preparedness for natural infections and biological weapons? Or will we continue to reward political allies by building BSL 4 labs in high population or tornado zones instead of geologically better suited areas?
In this series of articles on swine flu, pandemic preparedness, biological weapons and homeland security, we’ve discussed the threats we face, separating hype from science, identify some of the vulnerabilities we face as a nation, and then introduce some practical solutions that can be readily implemented.
PHYSICIAN HEAL THYSELF?
If you have the following, contact your physician…
Flu like symptoms:
Sore throat, cough, fatigue, muscle pain or general achiness. Diarrhea is possible, too.
Shortness of breath is always worrisome…don’t be a hero! Call the doctor or 911.
Remember, fever is always worth paying attention to. A fever over 100.2 degrees Fahrenheit, especially with flu-like symptoms, warrants a call to your clinician.
Don’t flood the ER with aches and pains or being the worried well. We have little surge capacity.
What Steps Should I Take?
As with any infectious disease, people should take everyday precautions:
Avoid close contact with those that are or appear sick.
Stay home if you are not feeling well.
If you develop respiratory symptoms, especially shortness of breath or rapidly rising fever with other quickly developing and/or severe symptoms - contact your health care professional.
Suggest or insist that your doctor’s office or health care facilities offer masks for the waiting room.
Don't forget your annual flu vaccine. It’s not too late to get one!
Cover your mouth and nose when coughing or sneezing.
Wash your hands often, especially after shaking hands or being away from home
Avoid touching your eyes, nose or mouth.
Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
Visit reputable websites like www.pandemicflu.gov, www.cdc.gov, or www.who.int to get status updates.
Monitor and heed the current government warning about traveling to Mexico.
CONCLUSION
Swine flu – is it the next black death? Not likely. But it is worth recognizing for what it is…another influenza virus that, like its relatives is capable of making you sick, or in some cases, dead. While we can criticize some of the early efforts among CDC, DHS and the White House – whether inexperience, political concerns or other reasons played a part in some of the decisions, their current response is appropriate – medications are released, tests are approved, public health is investigating and health care professionals are being updated. We have the means to work the problem. If the public work closely with our responders – today in terms of cooperation and in the future in terms of support for preparedness funding, we can get through this with minimal loss of life.
In the interim, avoid the temptation to get your friendly doctor to write you prescriptions of Tamiflu. Take precautions – eat right, sleep right and avoid crowds. Get the flu vaccine and wash your hands often. These should help you avoid sickness. But if you feel sick, don’t be a hero. See the doc!
Biological weapons or Mother Nature’s select pathogens are persistent threats that must be taken seriously – preparedness is an ongoing process, even in the times we think deadly infectious agents are gone or peace has been declared. With numerous nations and state sponsored entities actively engaged in bioweapons research, millions of people worldwide living among or close to livestock, poverty and global travel it is unrealistic to expect outbreaks won’t or aren’t occurring. Russia remains the top bioweapons country. But China, Syria, Iran and others aren’t far behind.
From a policy perspective there are low hanging fruit that continue to jeopardize our safety – BSL labs coming to a neighborhood near you and a lack of coherence in government policies to secure those facilities. USAMRIID and other labs that got careless.
But these can be repaired. Will we? Will we be so caught up in swine flu we forget what it reminds us of? That biologicals – natural or man made remain a threat. That Iran is actively engaged in bioweapons as well as nuclear weapons. We cannot afford to focus all our attention on one challenge alone – daunting though it may be.
Life after mankind! Swine Flu – Black Death, False Alarm or Mother Nature’s Bioweapon? True pandemic or wake up call for better preparedness? It’s a cautionary tale – deadly pathogens and biological weapons remain readily available.
FamilySecurityMatters.org Contributing Editor Dr. Robin McFee is a physician and medical toxicologist. An expert in WMD preparedness, she is a consultant to government agencies, corporations and the media. Dr. McFee is a member of the Global Terrorism, Political Instability and International Crime Council of ASIS International. She has authored numerous articles on terrorism, health care and preparedness, and coauthored two books: Toxico-Terrorism by McGraw Hill and The Handbook of Nuclear, Chemical and Biological Agents, published by Informa/CRC Press.
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