Exercise Mataika: White Paper on response to a smallpox bioterrorism release in the Pacific

Authors

  • Chandini Raina MacIntyre University of New South Wales
  • David J Heslop University of New South Wales
  • Devina Nand Fiji Ministry of Health and Medical Services
  • Craig Schramm Joint Health Command, Australian Defence Forces.
  • Michael Butel United States Indo-Pacific Command (USINDOPACOM)
  • William Rawlinson NSW Health Pathology Randwick
  • Michael Baker University of Otago
  • Tomasz Kiedrzynski Ministry of Health
  • Cassidy Nelson University of Oxford
  • Alexander Rosewell University of New South Wales
  • Lauasa Fotualii Ministry of Health Samoa
  • Kevin Yeo Emergent Biosolutions
  • Jesper Elsgaard Bavarian Nordic A/S
  • Louise Fonua Ministry of Health Tonga
  • John Michael Lane Emory University

DOI:

https://doi.org/10.31646/gbio.10

Keywords:

Smallpox, orthopoxviruses, pandemic, epidemic, military, police, public health, disaster, first responder, health security, bioterrorism, terrorism, warfare, biological select agents, synthetic biology

Abstract

Smallpox was declared eradicated in 1980, with known seed stock retained in two high security Biosafety Level 4 laboratories in the United States and Russia. Experts agree the likelihood of theft from these laboratories is low, and that synthetic creation of smallpox is a theoretical possibility. Until 2017 it was believed that synthetic smallpox was technically too complex a task to be a serious threat. However, in 2017, Canadian scientists synthesised a closely related orthopoxvirus, horsepox, using mail order DNA and $100,000. Simultaneously, terrorist groups have declared intent to conduct biological attacks. In this context an exercise was held on August 16th 2018, with international and cross-sectoral stakeholders to review preparedness for a bioterrorism attack in the Asia-Pacific region and globally. The exercise was conducted by The National Health and Medical Research Council (NHMRC) Centre for Research Excellence, Integrated Systems for Epidemic Response, with contextual input from the Ministry of Health and Medical Services Fiji. The scenario involved a deliberate release in Fiji, followed by a larger release in a more populous Asian country. Mathematical modelling was used to underpin epidemic projections under different conditions. The exercise alternated between clinical, public health, emergency and societal responses, with participants making real-time decisions on cross-sectoral response across the region and the world. Key weak points which are influential in determining the final size and impact of the epidemic were identified (based on mathematical modelling of transmission in Fiji and globally). We identified potential gaps in preparedness for smallpox and factors which influence the severity of a smallpox epidemic. This included identifying which determinants of epidemic size are potentially within our control, and which are not. Influential factors within our control include: preventing an attack through intelligence, law enforcement and legislation; speed of diagnosis; speed and completeness of case finding and case isolation; speed and security of vaccination response, including stockpiling; speed and completeness of contact tracing; protecting critical infrastructure and business continuity; non-pharmaceutical interventions (social distancing, PPE, border control); protecting first responders; operational support and logistics; social mobilisation and risk communication. Based on discussion at the workshop between diverse stakeholders, recommendations were made to guide improved prevention, mitigation and rapid response, thus providing a holistic, cross-sectoral framework for prevention of a worst-case scenario smallpox pandemic.

Author Biographies

Chandini Raina MacIntyre, University of New South Wales

Professor Raina MacIntyre is Professor of Global Biosecurity at the Kirby Institute, UNSW Sydney. As Head of the Biosecurity Program, she leads research in epidemiology, vaccinology, bioterrorism prevention, mathematical modelling, public health and clinical trials in infectious diseases. Her research falls under 4 areas - personal protective equipment, vaccinology, epidemics of emerging infectious diseases and bioterrorism prevention. She is an expert in influenza epidemiology, adult vaccination, bioterrorism and rapid epidemic intelligence and has led the largest body of research internationally on face masks and respirators in health care workers. She has over 300 publications in peer-reviewed journals. Her research is underpinned by extensive field outbreak investigation experience. She is a graduate of the Australian Field Epidemiology Training program and has extensive experience in shoe-leather epidemiology of infectious diseases outbreaks. Her in-depth understanding of the science of outbreak investigation draws from this experience combined with her clinical training as a specialist physician and her academic training through a Masters and PhD in Epidemiology. Her passion for field epidemiology led her to co-found the ARM network for Australian field outbreak response. She also has an interest in the ethics of medicine, and specifically in dual-use research of concern in the fields of synthetic biology and genetic engineering, and the risk this poses to biosecurity.

David J Heslop, University of New South Wales

FAFOEM FRACGP MBBS PhD MPH BSc (Adv) Hons 1 I am an Associate Professor at the School of Public Health and Community Medicine at UNSW, and retains significant military responsibilities as Senior Medical Adviser for CBRNE to Special Operations Headquarters Australia and to Australian Defence Force (ADF) joint senior leadership. I am a practicing vocationally registered General Practitioner, and qualified Occupational Physician, and a fellowship candidate for the Academy of Wilderness Medicine. My doctoral research focussed on the central autonomic anatomy and integrative neurophysiology relating to the cardiovascular response to noxious inescapable physiological stimuli such as severe haemorrhage and visceral pain. Utilising my research background and subsequent clinical training, through the ADF I have been fortunate to have extensively deployed into a variety of complex and austere combat environments, and have gone on to undertake advanced training in Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) Medicine and Senior Medical Officer training. Consequently I was appointed as Senior Medical Officer for Special Operations Command for 2014, and was the Officer Commanding and Senior Medical Officer to the ADF CBRNE medical incident response element at Special Operations Engineer Regiment from 2012-2015. I have extensive experience in the conception, design, planning, delivery and operations of health support systems and capability in remote and austere contexts; incorporating the management of exotic or novel hazards and risks. Extensive actual experience in planning for and management of major disasters, mass casualty and multiple casualty situations. I also have extensive overseas and domestic operational experience in command, personnel management, force protection, health protection systems, resilient systems design and test and evaluation. Direct responsibility and experience with leading deployable expeditionary medical support. I am regularly consulted and participate in the development and review of national and international clinical and operational CBRNE policy and doctrine. I am additionally a peer reviewer for the journals Military Medicine (AMSUS) and Journal and Military and Veterans Health (AMMA). I also continue to conduct CBRNE medical, and general medical education and ADF GP Registar training within my military capacity, along with civilian instruction of the Major Incident Medical Management System (MIMMS) framework with MIMMS Australia. My interests lie in health and medical systems innovation and research. I retain linkages with key national civilian and military education, research and development organisations and retain an active involvement in a wide variety of projects and initiatives supporting national public health preparedness goals. My current research effort and interests touch on complexity science, agent based and deterministic modelling, emergent complex adaptive systems phenomena, test and evaluation of systems, policy research, epidemic modelling, exotic and emerging infections, disaster preparedness and response, organisational resilience in health care, development of robust socio-technical systems in health care, and the modelling, simulation and investigation of public health interventions and systems.

Devina Nand, Fiji Ministry of Health and Medical Services

Director, Epidemiology Department

Craig Schramm, Joint Health Command, Australian Defence Forces.

Director General Health Capability

Michael Butel, United States Indo-Pacific Command (USINDOPACOM)

Chief, Clinical Public Health and Epidemiology, Public Health Command-Pacific

Liaison to USINDOPACOM Command

William Rawlinson, NSW Health Pathology Randwick

Senior Medical Virologist, Director of Serology, Virology and OTDS Laboratories (SAViD)

Michael Baker, University of Otago

Department of Public Health/Te Tari Hauora Tūmatanui

Tomasz Kiedrzynski, Ministry of Health

Principal Advisor, Communicable Diseases, Public Health Group

Alexander Rosewell, University of New South Wales

School of Public Health and Community Medicine

Jesper Elsgaard, Bavarian Nordic A/S

Senior Director, Global Governmental Affairs

Louise Fonua, Ministry of Health Tonga

Communicable Diseases Section

John Michael Lane, Emory University

Emeritus Professor of Preventive Medicine and and Special Consultant to the World Healt Organization, Smallpox Eradication Programme.

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Published

2019-02-14

How to Cite

MacIntyre, C. R., Heslop, D. J., Nand, D., Schramm, C., Butel, M., Rawlinson, W., … Lane, J. M. (2019). Exercise Mataika: White Paper on response to a smallpox bioterrorism release in the Pacific. Global Biosecurity, 1(1). https://doi.org/10.31646/gbio.10

Issue

Section

Research Articles
Received 2018-11-09
Accepted 2018-12-19
Published 2019-02-14