Prepare for Pandemics or CBRN Threats? We must do both.

In our fight against the growing threat of manmade weapons and natural born agents, we no longer have the luxury of focusing on one at the expense of the other. It’s time for the preparedness community to walk and chew gum at the same time.

Beyond the aforementioned threats and strategies, the U.S. Government has clearly articulated the growing concerns in multiple Department of State reports. The first of which is that the People’s Republic of China (PRC) and the Russian Federation, in addition to their vast and growing nuclear capabilities, possess or have possessed chemical and biological weapons. Further, North Korea has offensive CBRN capabilities and Iran continues to develop a nuclear program while financially supporting global terrorism. The 2023 Annual Threat Assessment from the Office of Director of National Intelligence emphasizes another acute threat, the pharmaceutical based agent fentanyl, which kills more than 100,00 Americans annually by product produced in Mexico from Chinese precursors. While fentanyl is not officially a WMD it could be effectively weaponized and increase the death toll by killing more Americans via counterfeit pills and other drugs.

We have also learned a hard lesson from the recent global pandemic of SARS-COV2 or COVID.  The world, and our nation specifically, discovered that our domestic supply chain of medical supplies and pharmaceuticals is limited at best. These domestic supply limitations have been apparent for years.  We cannot hope to successfully defend our national health security with fragile supply chains unless we make robust investments to prepare for probable threats in advance. Efforts to prepare for pandemic influenza in the early 2000’s were not maintained by appropriations from the Congress after the H1N1 pandemic in 2009.  This is a large part of why there were less stockpiled respiratory protective products when we were faced with COVID.  In short, we ceased working toward preparedness for pandemics and focused on preparedness for CBRN events.

Before the next pandemic, the US Government must continue investment in domestic manufacturing and stockpiling pharmaceuticals and other critical medical supplies.  These investments can help ensure that material is available for pandemic events.  Stockpiling and rotation of essential products is mandatory; however, stockpiling is only a part of the preparedness solution.  Continued investment in expanding and supporting domestic capability is imperative. Manufacturing support must go beyond investing in greater production capability to securing a market for those products in routine healthcare.

The failure to invest in pandemic preparedness creates a new risk that must be addressed.  As our nation invests in health security against new emerging infectious diseases (EID) there is a great risk that we will fail to continue investment in being prepared for CBRN events.  It is a fact that CBRN medical countermeasures (MCM) have a limited market and are generally only purchased by the government to protect the warfighter and the general population. There always exists a possibility, however, that investment in CBRN products may fill gaps in preparedness against EID. A prime example is the global response to monkeypox.  The reason pharmaceuticals were available to address this disease was due to US Government investment in preparing for a smallpox event.  Now, we must continue to maintain our capability to produce vaccines and anti-virals for such orthopox virus events domestically.

Aside from the potential use for emerging infectious diseases we cannot fail to invest in MCM for CBRN threats. It is not possible to manufacture many of these products at the time of need.  It is not unusual for manufacturing cycles for biologic or large molecule drugs to require lead times from raw material acquisition to filled and finished products of more than 18 months. In order to continue to assure availability of these vital products the government must continue to invest in manufacturing to include not only the products themselves, but also in specialized contract drug manufacturing organizations (CDMOs) to produce these critical drugs.

We have addressed biological events in this article, but we also cannot divert attention from preparedness for Chemical, Radiological and Nuclear events at the same time.  We often speak of CBRN preparedness but then focus primarily on the B—Biological.  Chemical attacks have been conducted by nation-states at a mass casualty level and against individuals.  We know the chemical agents are being produced, stockpiled, and used. Many nations have access to and capability to make use of nuclear weapons and radiation dispersal devices (RDD). In the event of RDD use, it would be horrific for there to be no existing response capability. Worse yet, a nuclear detonation would be catastrophic.

We urge the preparedness community to continue to plan for future pandemic events while simultaneously continuing preparedness efforts for CBRN events.  Adequate preparedness requires Congress to make policy and actual appropriations to investment in research and development, manufacturing, and stockpiling all these vital materials domestically.  We cannot find ourselves in another situation like COVID where we had stopped investing to respond to EID events in favor of CBRN events. It is essential that we be ready for both. The American people deserve nothing less.   

Greg Burel is the former Director of the Strategic National Stockpile.

David Lasseter is the former Deputy Assistant Secretary of Defense for Countering Weapons of Mass Destruction.