Looking Ahead
Kenneth I. Shine, M.D.
Director, RAND Center for Domestic
and International Health Security
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Criminal Acts Intended To Coerce Governments
and Populations To Change Policies
• New faces of terrorism
• The range of threats
• Importance of dual use
• Community health security systems
• Challenges for the future
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New Faces Of Terrorism
• Ideology vs. poverty
• Middle class vs. uneducated
• Mass casualties vs. messages
• Non-state vs. state origin
• Domestic vs. foreign
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Lessons From 9/11
• Hospital responses
• Respiratory effects
• Psychological effects
• Communications problems
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Lessons From Anthrax
• Communications failure
• Understanding of risk
• Overwhelming of laboratory and investigatory capacity
• Lack of rapid diagnostics
• Lack of vaccine
• Overuse of antibiotics
• Postal workers vs. Hill staff
• Natural history not known
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Range of Terrorist Acts
• Radiological
• Chemical
• Nuclear
• Biological
• Conventional explosives
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Uniqueness of Biological Events
• Slow to evolve
• Progressive nature
• Occult presentations
• Distinguishing natural from man-made
• Focus on surveillance and response
• Vaccines and antibiotics
• Fear!!!
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Importance of Dual Use
• Cost effectiveness
• New and emerging infections
• Antibiotic resistance
• Involvement of medical people and institutions
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Community Health Security Systems
• Public Health
• Medical
• EMS
• Public Safety
• Media
• Community organizations
• Disaster organizations
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When do we know we have won?
Humility in the face of the microbes!!
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Public Health Approaches
• Prevention
• Surveillance
• Response
• Recover
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Federal, State and Local Responses
• Federal funds
• State organizations
• Local responses
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Challenges
• Maintenance of interest and effort
• Coordination
• Who is in charge
• Law enforcement vs. health
• Communications
• Media
• Spokespersons
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Challenges
• Research needs- vaccines, antibiotic resistance
• Surveillance techniques e.g. syndromic approaches
• Cost effectiveness (people, beds, and funds)
• Ethical and civil liberties
• Academic openness vs. security
• National vaccine strategy
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Challenges
• Local
• State
• Regional
• Federal interactions
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The Intelligence-Health Interface
• National Intelligence Fusion Center
• Privacy
• HIPAA
• Security Clearances
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Looking Ahead
• Living with risk
• Maintaining our values
• Strengthening our security
• Maintaining our perspective
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How do we know we are ready?
Exercise. Exercise. Exercise.
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