Monday, February 17, 2014

How 3D Bioprinting would change a Wargame: Atlantic Storm

   Influenza virus Credit: Dr Paul Digard, Department of Pathology

Author's note: In 2007 I was invited to speak at a NATO instillation near Warsaw. I delivered a talk on variola major the causative agent of smallpox and highly pathogenic disease containment. At that time, the US Strategic National Stockpile was rapidly increasing its procurement of a number of vaccines and medical counter measures, including vaccine to prevent smallpox. The US strategic stockpile was comprised of vaccine from Acambis and Bavarian Nordic. As I noted in my discussion, NATO held only a virtual stockpile and one had wonder how a real response could be mounted by NATO, not just allocated to the Member States, holding their national stockpiles, but by NATO command, when they only had a virtual stockpile. Atlantic Storm, following on from Dark Winter, was in my view a conservative and realistic table top exercise. Below is the basic introduction to Atlantic Storm,  but what would happen if instead of strategic stockpiles we could use centrally located 3Dbioprinters? What if NATO had  3D bioprinters for example or even the World Health Organization? How would that change how we counter highly pathogenic and possibly deliberate outbreaks of disease? I do make a distinction between deliberate and  natural outbreaks, as a deliberate outbreak is likely to increase mortality rates. So here are the basics of Atlantic Storm:  
Atlantic Storm was a simulated bioterrorist attack which demonstrated the weakness of international public health and security systems when dealing with a sudden outbreak of highly infectious diseases. On 14 January 2005, ten heads of government from Europe and North America and the Director General of the World Health Organization (WHO; Geneva, Switzerland) were scheduled to meet for a ‘Transatlantic Security Summit' in Washington, DC, USA, to discuss the threat of international terrorism. On the eve of the meeting, news broke that citizens from several European countries appeared to have become ill with smallpox; shortly thereafter suspected smallpox cases appeared in the USA. Although the assembled leaders did not know it at the time, a radical terrorist group had obtained seed strains of Variola major—the virus causing smallpox—and deliberately released the virus in a number of main transport hubs and sites of commerce throughout Europe and North America. On 14 January, the heads of states who gathered in Washington were confronted with one of the worst nightmares imaginable: the use of contagious and deadly disease as a weapon. Full citation see:

Just as Atlantic Storm began, the scientific journal Nature published a paper describing a new technology that allows the rapid and accurate synthesis of long DNA segments using standard laboratory chemicals (). In October 2005, scientists at the Centers for Disease Control and Prevention (Atlanta, GA, USA) published the reconstruction of the ‘Spanish' influenza virus, which killed at least 25 million people during the winter of 1918/19 (). These and other discoveries provide researchers with better tools and knowledge to develop new medicines and vaccines against infectious diseases. However, they also make the synthesis and modification of viruses and bacteria for criminal purposes more likely. Hundreds of biological laboratories around the world already have the technical capacity to synthesize or manipulate small viruses such as polio or flu. Smallpox, with its genome of approximately 200 kb, is technically more challenging, but within the next few years, technology will undoubtedly advance to the stage where the synthesis of Variola major—based on sequence information freely available on the worldwide web—will be possible. The age of engineered biological weapons is neither science fiction nor suspense thriller—it is here today ().
For decades, NATO and other security alliances have planned their response to all kinds of military crises. Planning with that degree of rigor and strategic and operational detail is also needed to cope with potential biological threats of international consequence. Such transatlantic cooperation is also at the core of many non-proliferation programmes, such as the US Department of Defense's Cooperative Threat Reduction Program or the G8 Global Partnership. These programmes seek to reduce the threat posed by weapons of mass destruction (WMD) by detecting, deterring and interdicting illegal trafficking in such items; improving the physical security of facilities and WMD materials; destroying chemical weapons agents; preventing radiological contamination by decommissioned Russian nuclear submarines; and providing former WMD programme personnel with a decent living so they will not seek to profit from selling their knowledge to terrorist organizations or states trying to acquire WMD. However, biosecurity has often been an orphan of such programmes and must be given both higher priority and more resources commensurate to the challenge (; Dalgaard-Nielsen & Hamilton 2005). “We live in a time of new threats… What we now see is that health and security go together, so we have to combine them, and I think the lesson we should draw from this…is that we don't have the organizational structures to deal with the new threats,” commented Jan Eliasson, who acted as the Swedish Prime Minister in Atlantic Storm. Similarly, Sir Nigel Broomfield (Fig 3), who played the British Prime Minister, said after the exercise, “we have a globalized economy and globalized society, but we don't yet have globalized effective institutions to deal with the questions that come out of the globalization process.”

If we consider not only the time it takes to deploy a vaccine, and the US CDC estimates the time at about twelve hours, and we consider international travel, this time frame becomes critical. This photo below illustrates one aspect of what is involved in deploying medical countermeasures. If however, a state or institution such as NATO or WHO could manufacture vaccines on site, something akin to having fire hydrants strategically located throughout a city for putting out fires and easily accessible to all, containing disease would be far more efficient and effective. 

Click photo for screen-resolution image

Air Force Senior Airman Jacob Lloyd, a member of the 153rd Logistics Readiness Squadron, moves simulated vaccines onto a C-130 Hercules as part of the Strategic National Stockpile exercise in Wyoming. May 14, 2012. Airmen assigned to the Wyoming Air National Guard worked with multiple state agencies to test state health officials' abilities to receive, deliver and distribute medical supplies to various parts of the state. (Air National Guard, photo by 1st Lt. Rusty Ridley)

While it is prudent to understand that such technology can potentially be used to manufacture biological warfare agents, I believe the benefits far outweigh this possibility. In terms of Atlantic Storm, 3D bioprinting would remove policy decision making on vaccination/containment strategy, logistical issues involved in deploying a stockpile, remove transnational issues related to supply and rapidly increase our ability to respond at the first instance. One of the issues particularly with regard to smallpox vaccine availability within EU/NATO states is inconsistent stockpiles. One can imagine if there were an outbreak of smallpox in Africa, given lengthy incubation periods,  flights arriving into Schipol or Zaventem would not raise any alarm until the first cases started emerging. By this time, Belgium which holds only slightly over a 15% coverage would see citizens possibly trying to cross the boarder to the Netherlands where they hold a 100% so 1:1 stockpile. 3D bioprinting could theoretically remove all these issues possibly making bio-terrorism and warfare a less attractive option. 
Dragon voice recognition

For an interactive view see:

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