A Discussion of Findings and Their Possible Implications from a Workshop on Bioterrorism Threat Assessment and Risk Management

In November 2001, the Monterey Institute of International Studies convened a workshop on bioterrorism threat assessment and risk management. Risk assessment practitioners from various disciplines, but without specialized knowledge of terrorism, were brought together with security and intelligence threat analysts to stimulate an exchange that could be useful to both communities. This article, prepared by a subset of the participants, comments on the workshop's findings and their implications and makes three recommendations, two short term (use of threat assessment methodologies and vulnerability analysis) and one long term (application of quantitative risk assessment and modeling), regarding the practical application of risk assessment methods to bioterrorism issues.     

Risk Communication Planning for the Aftermath of a Plague Bioattack

We create an influence diagram of how a plague bioattack could unfold and then use it to identify factors shaping infection risks in many possible scenarios. The influence diagram and associated explanations provide a compact reference that allows risk communicators to identify key messages for pre‐event preparation and testing. It can also be used to answer specific questions in whatever unique situations arise, considering both the conditions of the attack and the properties of the attacked populations. The influence diagram allows a quick, visual check of the factors that must be covered when evaluating audience information needs. The documentation provides content for explaining the resultant advice. We show how these tools can help in preparing for crises and responding to them.     

Four publics of anti-bioterrorism information campaigns: A test of the situational theory

Applying the situational theory, this study examines the extent to which citizens recognize bioterrorism as a social issue, their level of involvement with it, and how their perceptions of it affect communication and protective behaviors. A national sample survey (N = 363) showed that problem recognition was positively related to information seeking and processing while constraints recognition was negatively related to information seeking and processing. Involvement was positively related to information seeking. Respondents were segmented into four public types based on media consumption habits, source trust evaluations and intentions to perform recommended behaviors.     

Intelligent Adversary Risk Analysis: A Bioterrorism Risk Management Model

The tragic events of 9/11 and the concerns about the potential for a terrorist or hostile state attack with weapons of mass destruction have led to an increased emphasis on risk analysis for homeland security. Uncertain hazards (natural and engineering) have been successfully analyzed using probabilistic risk analysis (PRA). Unlike uncertain hazards, terrorists and hostile states are intelligent adversaries who can observe our vulnerabilities and dynamically adapt their plans and actions to achieve their objectives. This article compares uncertain hazard risk analysis with intelligent adversary risk analysis, describes the intelligent adversary risk analysis challenges, and presents a probabilistic defender–attacker–defender model to evaluate the baseline risk and the potential risk reduction provided by defender investments. The model includes defender decisions prior to an attack; attacker decisions during the attack; defender actions after an attack; and the uncertainties of attack implementation, detection, and consequences. The risk management model is demonstrated with an illustrative bioterrorism problem with notional data.     

The Potential of Next-Generation Microbiological Diagnostics to Improve Bioterrorism Detection Speed

Emerging, rapid, multivalent, microbial diagnostic technologies can produce results in hours, as contrasted to the standard methods that require at least the better part of a week. Used in bioterrorism surveillance in medical settings, the new biodetectors could significantly reduce the time between a covert attack and its detection. By how much is determined by the intensity of sampling. If used to screen all patients reporting flu-like symptoms to their doctors, this basic level of "front-line" sampling would reduce life-threatening medical floundering and missteps and give responders 3-5 days of warning that they otherwise would not have had. Being miniaturized and amenable to mass production, these devices could reduce the cost of screening to a fraction of current costs and so it is tempting to imagine their use in more intensive bioterrorism screening programs aimed at the apparently healthy population, programs that could detect a covert attack even before the victims felt ill. This article examines the tradeoffs between surveillance effort and probability of detection for such programs. Dual-use deployment, where the biodetector provides some medically useful information in addition to bioterrorism surveillance, is discussed.     

Immediate Feedback on Accuracy and Performance: The Effects of Wireless Technology on Food Safety Tracking at a Distribution Center

The effects of wireless ring scanners, which provided immediate auditory and visual feedback, were evaluated to increase the performance and accuracy of order selectors at a meat distribution center. The scanners not only increased performance and accuracy compared to paper pick sheets, but were also instrumental in immediate and accurate data capture and tracking in compliance with the Public Health Security Bioterrorism Preparedness and Response Act (BTA) of 2002. The intervention, which required minimal training, successfully accelerated key operational processes and compliance with food safety mandates. The implications for Organizational Behavior Management practitioners are discussed.     

Setting Risk‐Informed Environmental Standards for Bacillus Anthracis Spores

In many cases, human health risk from biological agents is associated with aerosol exposures. Because air concentrations decline rapidly after a release, it may be necessary to use concentrations found in other environmental media to infer future or past aerosol exposures. This article presents an approach for linking environmental concentrations of Bacillus. anthracis (B. anthracis) spores on walls, floors, ventilation system filters, and in human nasal passages with human health risk from exposure to B. anthracis spores. This approach is then used to calculate example values of risk‐informed concentration standards for both retrospective risk mitigation (e.g., prophylactic antibiotics) and prospective risk mitigation (e.g., environmental clean up and reoccupancy). A large number of assumptions are required to calculate these values, and the resulting values have large uncertainties associated with them. The values calculated here suggest that documenting compliance with risks in the range of 10^?4 to 10^?6 would be challenging for small diameter (respirable) spore particles. For less stringent risk targets and for releases of larger diameter particles (which are less respirable and hence less hazardous), environmental sampling would be more promising.     

Modeling the Public Health System Response to a Terrorist Event in the Food Supply

We have developed a simulation model to quantify and characterize the response of the public health system and the impact of public health advisories in the event of an intentional contamination of the food supply. The model has three components: (1) definition of individual exposure over time and the outcomes of exposure, (2) definition of the geographical dispersal of exposures, and (3) response of the public health authorities to symptomatic individuals. The model explicitly considers the variation in the multiple interrelated facets of the response system, including differences among individuals' responses to exposure, variation between health care providers, and the subsequent processing of samples and confirmation of cases. To illustrate use of the model, case studies with  Escherichia coli  O157:H7 and  Salmonella  spp. in three categories of food vehicle were compared. The level of detail required to run the public health component of the model is not trivial. While some data may not be available for hazards of particular interest in potential bioterrorism events, the application of expert judgment permits comparisons between different agents, different system reactions, and other assumptions within the system. The model provides the capacity to study the impact of system changes, to compare scenarios and to quantify the benefits of improvement in terms of averted exposures and risk reduction, and constitutes a significant aid to understanding and managing these threats. Essentially, the model provides an explicit valuation of time saved in the identification and intervention in terrorist events in the food supply.     

Risks of Paralytic Disease Due to Wild or Vaccine-Derived Poliovirus After Eradication

After the global eradication of wild polioviruses, the risk of paralytic poliomyelitis from polioviruses will still exist and require active management. Possible reintroductions of poliovirus that can spread rapidly in unprotected populations present challenges to policymakers. For example, at least one outbreak will likely occur due to circulation of a neurovirulent vaccine-derived poliovirus after discontinuation of oral poliovirus vaccine and also could possibly result from the escape of poliovirus from a laboratory or vaccine production facility or from an intentional act. In addition, continued vaccination with oral poliovirus vaccines would result in the continued occurrence of vaccine-associated paralytic poliomyelitis. The likelihood and impacts of reintroductions in the form of poliomyelitis outbreaks depend on the policy decisions and on the size and characteristics of the vulnerable population, which change over time. A plan for managing these risks must begin with an attempt to characterize and quantify them as a function of time. This article attempts to comprehensively characterize the risks, synthesize the existing data available for modeling them, and present quantitative risk estimates that can provide a starting point for informing policy decisions.