Military global health is not the right answer

In 1990, I was informed of a chemical officer stationed at the Aberdeen Proving Ground, at that time I was informed that I was preparing for possible deployment to Saudi Arabia. It seems that there is a brewing conflict with an adversarial country with important chemical and biological weapons programs, and my skills are (changed) necessary. Expected deployment. Before the conflict broke out, I received two injections of anthrax vaccine. It wasn't until a few years later that I learned that the Ministry of Defense was struggling with a severe shortage of anthrax and botulinum toxin vaccines. In Lansing, Michigan, there is a small company that produces all US military vaccine stocks, but the total number is insufficient. The botulinum toxin vaccine is only available to special operations forces, although the air disaster program at Fort Derick has begun to produce more. The Army ’s medical research community does have a long track record in developing vaccines against natural infectious diseases. Compared with biological warfare agents, the number of service personnel affected each year is much greater. But for the Iraqi biological warfare agent in 1990, this was unprepared.

Now, thirty years later, the Pentagon is ready to make the same mistake. The U.S. public was recently notified of the "speed of action", and its ambitious goal is to provide "a large number of safe and effective vaccines" to 300 million Americans by January 2021. Responsible for the procedure. Unfortunately, whether you are an American who is worried about COVID-19 or if you want to be confident that the US military will be able to face future biological threats, this effort will not work. In the warning of the intelligence department, this threat is particularly prominent in the community.

By making the government expedite the militarization of vaccine production within six months, this effort has the potential to divert resources and attention away from the task of developing chemical and biological defense equipment for military use. In addition, by excluding institutions from the Ministry of Health and Human Services, the government ’s efforts have ignored the performance of traditional experts in formulating and implementing public health measures.

Engineering Warp Yarn

COVID-19 is a newly emerging infectious disease, a new type of coronavirus that causes more incapacitation and death than seasonal influenza. But this is a naturally occurring disease, and most people want to be vaccinated so that they can return to a certain degree of normal state before the crisis.

Let ’s start with the Federal Government ’s vision respond to the pandemic by design and by law.

Congress passed the Public Health Services Act and designated the Ministry of Health and Human Services to lead the federal response to public health emergencies. Under the jurisdiction of this department, the National Institutes of Health oversees the National Institute of Allergy and Infectious Diseases, which has developed a study on COVID-19. Strategic Plan. The Assistant Secretary of the Ministry of Health and Human Services responsible for preparation and response is also responsible for overseeing the Biomedical Advanced Research and Development Agency (BARDA). Since 2004, the agency has been responsible for formulating and purchasing medical countermeasures against public health threats, including emerging infectious diseases, and including them in the national strategic reserve. In addition, BARDA funded three advanced development and manufacturing innovation centers, whose purpose is to provide domestic infrastructure that can quickly generate medical countermeasures. Given that many, if not all, commercial vaccine development has been transferred overseas, these public-private partnerships are necessary. In the past few months, BARDA has been establishing new partnerships with the industry to develop diagnostics, medical vaccines and therapeutic agents for COVID-19.

This sounds like a great tool for developing a COVID vaccine, right?

President Donald Trump seems to disagree. He announced the Warp Speed ​​operation as a vaccine development project, comparable to the Manhattan project in its scope. Of course, since the Army General is responsible for the project, this must mean that the Army General must be responsible for the project. General Gustave Perna, commander of the U.S. Army Material Command, and venture capitalist Moncef Slaoui, a former British pharmaceutical company GlaxoSmithKline Together led the task force. Board of directors of multiple vaccine developers. Therefore, the Army ’s top procurement officer and the “large pharmaceutical company” are working together on a $ 10 billion treatment contest.

According to media reports, the project was co-chaired by the Secretary of the Ministry of Health and Human Services and the Ministry of Health. Ministry of Defence. The detailed project framework plans multiple teams organized by Warp Speed. It shows three leadership positions, all from the Ministry of Health and Human Services, and each leadership is responsible for developing vaccines, therapeutics, and diagnostics. The first two will be served by senior leaders of the Food and Drug Administration, and the last will be the director of the National Institute of Biomedical Imaging and Bioengineering (affiliated to the National Institutes of Health). The three health officials will lead five technical teams, all of which are from the Ministry of Defense.

The diagnostic team and treatment team will be led by the National Defense Health Agency, which is the military organization responsible for managing all US medical facilities. The state passed a budget of $ 31 billion. The task of leading production and distribution is given to the two assistant deputy defense ministers responsible for procurement (the new office under the deputy defense secretary responsible for procurement and maintenance) and two teams in the executive office of the Joint Program for Chemistry, Biology, Radiology and Chemistry. Nuclear defense is the procurement department of the chemical biological defense program. The latter two teams include a brand new vaccine development and acquisition office with the name "Making Biotechnology Viable", while a project called "Security and Assistance" requires a "Chief Intelligence Officer" to carry out natural disease projects.

Department of Health and Human Services?

BARDA and the National Institutes of Health still have billions of dollars in congressional grants, in addition to any tasks performed by these teams. But the Warp Speed ​​team did not have representatives from BARDA or the National Institute of Allergy and Infectious Diseases, nor did it come from the Centers for Disease Control and Prevention.

The Ministry of Defence is not a best practice [19659002] After failing to provide a sufficient number of vaccines for the Persian Gulf War, the Ministry of Defense requires the Army ’s medical research and development community The funds are used for biological warfare vaccines. The department established a Joint Office of Biodefense Programs in 1994 to quickly track the development of biodetectors (separate programs for the Army and Navy) and expand the scale of the anthrax vaccine program. The office became part of the "Joint Chemical and Biological Defense Program", which began developing joint chemical and biological defense equipment for the military in 1996. In the first 10 years, almost all of the plan produced anthrax vaccine and

a major project in the chemical biological defense plan stood out. The Transformational Medical Technology Program started in 2006, and its purpose is to develop broad-spectrum medicine through scientific and technological efforts, spending more than $ 1 billion in eight years. This means that military service personnel may only need one medicine to protect them from all dangerous bacteria, all hemorrhagic fevers or genetically modified diseases. Defense leaders are reluctant to provide funding for the project, so funds are transferred from existing traditional chemical and biological defense modernization programs.

The funds were distributed to more than 20 companies and government laboratories. After 10 years of research, the results were disappointing. at least. The only promising technology in the project is a platform that may allow the development of countermeasures against influenza-not biological warfare agents, but something that domestic suppliers are interested in. Another part of the plan has evolved to create products for a joint biological surveillance and response system, which the military has not requested. Neither product improves the military's biological defense capabilities. In addition, this is also a valuable experience for scientific and technical researchers.

Between 2009 and 2016, hundreds of millions of dollars in research and development funding continued to shift from traditional chemical and biological defense programs to projects in the global biological monitoring and medical diagnostics that lacked service sponsorship but were touted as solutions to national guidelines. This trend continues to delay important plans needed for service modernization. The chemical biological defense program has indeed made progress in some key biological warfare vaccines. Over the past 10 years, the program has vaccinated botulinum toxin, plague, Rift Valley fever and Venezuelan equine encephalitis. All of these are currently investigative new drug applications, which means that their efficacy in humans has not been tested. They have been used in animal models, and there are good reasons to believe that they will work. However, an exemption statement still needs to be signed, stating that people understand the risks of using vaccines as a pretreatment for exposure to biological warfare agents. Over the course of 20 years, after spending billions of dollars in defense costs, the US Department of Defense provided six vaccines for the (approximately) twelve dangerous pathogens listed on the CDC Class A priority list.

The chemical biological defense program also likes to point out its contribution to the Ebola vaccine. You may recall that the US military contributed to the large-scale US response to the Ebola outbreak in West Africa in 2014. Most of the work is done by the Department of Health and Human Services and the US Agency for International Development, but the military likes to remind people that it is there. The Ebola vaccine has been studied by the Chemical Biological Defense Program since 2001. After 2014, additional funds and energy were invested. It was not until the US Food and Drug Administration approved the Ervebo vaccine produced by the giant at the end of 2019 that this result was achieved by the successful pharmaceutical company Merck and Co. Ebola. Proven biological warfare agents, but the vaccine is licensed for natural disease outbreaks. After 18 years of work, and established a wide range of partnerships with BARDA, industry and the Canadian government, resulting in good products. But why is there such a record, and why would the American public believe that the US Department of Defense effectively implemented a multi-billion dollar defense procurement plan to deliver hundreds of millions of vaccines within six months? It violates logic. Moreover, do not even enter the general records of the Ministry of Defense to manage large defense procurement programs.

The Army Medical Research and Development Command in Fort Derrick, Maryland does have a military infectious disease research program (military-funded) and medical chemical biological defense research program (funded by the chemical biological defense program) for emerging infectious diseases ). The "Authorized Biotechnology" office created for "Warp Speed ​​Action" will be located in Fort Derick Rick, but it is unclear to what extent these existing teams will participate in the new work. At the very least, Fort Detrick's animal testing facility will be used to support clinical trials. The US Department of Defense Advanced Research Projects Agency also has a biotechnology office, which works in a similar manner, but is more inclined to invest in high-risk, high-reward projects related to the industry, and these projects are not expected to be released in the short term. None of these will be completed in a short time. Anything related to medical research can take years to complete, for good reason. You do not want to introduce ineffective or unsafe medical methods in communities where a large proportion of people do not trust vaccines.

Negative aspects of global health security

Public health and national security began about 20 years ago, when the security research community discovered that a pandemic actually did have an impact on society. This was sorted out in the Bush Administration ’s 2004 “Biological Defense in the 21st Century” presidential directive, which focused on advances in biotechnology and life sciences that could lead to new biological threats. The guidelines also address the threat of “potential sources of infection from our borders”, which will require a “safe and effective medical response” developed by the Ministry of Health and Human Services. The entire country continues to work to resist deliberate and natural biological threats, a process that has continued throughout the Obama administration and continued to the Trump administration. This puts the modernization of non-medical chemical and biological defense equipment urgently needed by the US military on hold for a long time.

On the other hand, the American public health community is very aware of the impact of natural disease outbreaks. I have worked on this issue for more than 100 years. Global health security may be new, but the impact of natural disease outbreaks on society and international relations is certainly not. There is a very practical cultural difference between the safety research community and the public health community because the safety research community views the crisis as a dog-like squirrel. When an infectious disease pops up in the United States, the national security community will be fully alert and begin to deal with the crisis until the threat passes. Then go to sleep until the next health crisis threatens your home.

The public health community understands that if people take global health issues seriously, they must respond to the broader challenge of human security. In this challenge, people need to make serious efforts to improve the health system, which will include building health foundations in poorer countries. Facilities, lower prices for medical and diagnostics, and address access to clean water, housing, and education. This is a long process, but it is more effective than the security "w-rat" method, in which the United States takes action only when a major disease outbreak crosses the US border. Take a look at US records-SARS in 2002, pandemic flu in 2009, Ebola in 2013, and now COVID-19. If in fact global health is considered a major national security issue, one hopes that there is a sound process now. In Africa and Asia, outbreaks of influenza, yellow fever, malaria, dengue fever and cholera are no longer a problem without reaching the United States.

Today, Pfizer Pharmaceuticals has made considerable progress towards the COVID-19 vaccine. It is collaborating with a German company, BioNTech, to prepare to start human trials of four candidate vaccines and may obtain approved vaccines by the end of this year. This does not involve the massive aid provided by the US government for distorting operations. More than 100 promising vaccine candidates are being tested worldwide. Potential candidates from Oxford University are preparing for the fall release. Moderna Therapeutics and Kaiser Pharmaceutical cooperate with the Food and Drug Administration and the Department of Health and Human Services to quickly find candidate vaccines. Why does the Ministry of Defense need to lead a vaccine development project?

Today, the prevailing view within the national security community is to reflect on how COVID-19 has changed national security priorities. This lesson is not to say that national security issues should be expanded to include public health threats. The public health community should obtain the resources and priorities needed to advance global health goals, which will ultimately benefit the United States. Global health needs to be decoupled from global security, not to deepen ties to ensure that long-term strategies are developed and relevant health policy issues are addressed. This will require extensive participation in the political process that determines all government efforts. Why not start with this crisis?

Al Mauroni is the director of the US Air Force Strategic Deterrence Research Center and the author of the book Evaluation of Anti-Weapons of Mass Destruction . The views, conclusions, and suggestions expressed or implied are the views of the author and do not necessarily reflect the views of the US Air Force University, the US Air Force, or the Department of Defense.

Picture: Marine Corps (Photo by Marine Corps (Photo by Vanessa Austin)

        
    

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