The Space Race and Biodefense

Abstract

The events that followed the launch of Sputnik on Oct 4, 1957, provide a metaphor for the events that are following the first bioterroristic case of pulmonary anthrax in the United States. This paper uses that metaphor to elucidate the nature of the task ahead and to suggest questions such as, Can the goals of the biodefense effort be formulated as concisely and concretely as the goal of the space program? Can we measure success in biodefense as we did for the space project? What are the existing resources that are the equivalents of propulsion systems and rocket engineers that can be applied to the problems of biodefense?

History changed on October 4, 1957, when the Soviet Union successfully launched Sputnik I. The world's first artificial satellite was about the size of a basketball, weighed only 183 pounds, and took about 98 minutes to orbit the Earth on its elliptical path. That launch ushered in new political, military, technological, and scientific developments. While the Sputnik launch was a single event, it marked the start of the space age and the U.S.–U.S.S.R space race.¹

History also changed on Oct 4, 2001, 44 years to the day later, when health officials announced that a 63-year-old Florida man had contracted pulmonary anthrax and had been hospitalized with the infection.² This event, too, is ushering in an era of new political, technologic, and scientific developments, with a substantial, if not predominant, focus on the fields of medical care and public health. As a result, medicine is already experiencing fundamental changes, such as the demise of the time-honored practice of “watchful waiting” when a patient has symptoms of early viral illness.

Public health is experiencing even greater changes. Techniques of disease control such as sanitation, vaccination, and water treatment that have produced dramatic improvements in health and longevity over the past century are no longer sufficient for the protection of the public health. Traditional disease transmission cycles memorized by generations of students will henceforth include hundreds of new pathways, such as biowarfare plant > foreign agent > terrorist cell > mail handling facility > infected human along side the familiar infected human > mosquito > infected human.

Disease control now involves participation by national security agencies in the detection of terrorists with the motivation and capabilities to conduct such attacks, detection of biowarfare production capabilities, detection of plans to disseminate such material, and detection of actual covert transfers of material. Electron beam irradiation of the mail is an early example of changes in the methods of disease control that could ultimately grow to include the widespread deployment of environmental or even personal portable sensing devices. The broadening of the techniques and organizations involved in the protection of the public health is such that some are speaking of a new field called biodefense.

It is in the area of public health surveillance that the analogy between the space race and biodefense is perhaps closest. To mitigate a medium or large-scale surreptitious release of Bacillus anthracis will require breathtaking improvements in the rapidity of detection and of response decision-making in public health. Improvements of even an hour over current capabilities may reduce economic impact by hundreds of millions of dollars.³ To attain such capabilities, however, the nation must develop electronic public health surveillance systems that process clinical and other types of data looking for the earliest possible clues of an outbreak in real time on a national or even international scale. Here, the breadth of technologic advances required and the scale of their deployment undoubtedly warrant the label Big Science.

The field of medical informatics, which is the study of the roles and uses of information and information technology in biomedicine, has made foundational contributions in the fields of medical care and public health. These contributions are being leveraged to build new public health surveillance systems. They include highly visible products such as electronic medical records and immunization registries as well as less visible but arguably more influential products such as technical contributions in the key areas of representation, inference, decision-making under uncertainty, and standards for exchange of biomedical data. Indeed, many of these results have influenced and been incorporated into the specifications for the National Electronic Disease Surveillance System being promulgated by the Centers for Disease Control and Prevention.⁴

Rapid detection and response will also depend on tight coupling between the activities of public-health workers and the activities of individual clinicians. This coupling can be accomplished best through the embedding of decision support and disease reporting capabilities in clinical information systems. Such an infrastructure will help clinicians adhere to the rapidly changing population-based guidelines needed to manage optimally individual cases, and it will provide public health officials with aggregate information about disease activity needed for public health surveillance.

Those researchers in medical informatics who have witnessed the nation's slow progress toward ubiquitous clinical computing over the past four decades may wonder about the nation's capacity for such a breathtaking advance in disease surveillance, especially in light of the present state of deliberations in Congress. The early halting steps of the nation and Congress, however, should not be interpreted as the only and final reactions of the country. The early history of the space race suggests otherwise:

Immediately after the Sputnik I launch in October, the U.S. Defense Department responded to the political furor by approving funding for another U.S. satellite project. Werner von Braun and his Army Redstone Arsenal team began work on the Explorer project. On January 31, 1958, the tide changed, when the United States successfully launched Explorer I. This satellite carried a small scientific payload that eventually discovered the magnetic radiation belts around the Earth, named after principal investigator James Van Allen. The Sputnik launch also led directly to the creation of National Aeronautics and Space Administration (NASA). In July 1958, Congress passed the National Aeronautics and Space Act (commonly called the “Space Act”), which created NASA as of October 1, 1958, from the National Committee for Aeronautics (NACA) and other government agencies.¹

It may be reassuring to us now to recognize that President Eisenhower and Congress, under a less dire threat, were nonetheless able to come together to take immediate action in the form of the Explorer I program. Nine months later, they followed with definitive action—consolidation of multiple, small, overlapping efforts into a single dedicated agency. This consolidating of resources under NASA is even more noteworthy given that, at the time, the Army had the most advanced rocket propulsion system (the Jupiter C) and the von Braun team, which subsequently became a key asset of the NASA team. The analogy raises the question of whether the country needs a NASA-like reorganization and consolidation of diverse federal efforts in biodefense.

NASA from its inception was managed by rocket engineers who were (largely) undistracted by objectives other than the single-minded goal of winning the space race. A question for the nation is, Who are the rocket engineers for the field of biodefense? The answer may be that they are the experts in medical informatics. For the past several years, researchers in medical informatics have developed and fielded electronic public health surveillance systems and have provided direction to projects such as those described in a separate article in this issue of the Journal.⁵ As in the field of rocketry prior to the space race, the nation has available a body of knowledge, parts, and existing teams of researchers working on actual fielded systems.

The analogy between the space race and biodefense can provide additional insights and guidance to the country. It is widely acknowledged that President Kennedy's promise to land men on the moon and return them safely by the end of the decade inspired Congress and the nation through its simplicity and clarity. This clear goal statement was a source of guidance to legislators, managers, scientists, engineers, and construction workers throughout the world as they made the millions of individual decisions that led to our success in the space race.

It is an interesting question whether the goals of the biodefense effort can be formulated as concisely and concretely as the goal of NASA. Similar goal statements for biodefense might be to, within a year, reduce detection and response time by two days over current levels and, within five years, to detect and respond, within a day of their release, to any biological agents that threaten the health of our citizens.

The Sputnik launch revealed deficiencies in training and education in the sciences that were ameliorated by massive changes in the educational system. A parallel exists in the area of training of the public health workforce in information technology. The analogy also suggests the question of whether the expected technologic spin-offs in the areas of large-scale computing, simulation, and mitigation of naturally occurring epidemics will equal the spin-offs of NASA in the areas of materials, computers, communications, and electronics. The analogy may also reveal differences. Biodefense may fundamentally be best accomplished by regional deployments under central coordination and support, rather than a single national effort.

The development of early warning capability for biological events is Big Science. The nation should draw on lessons learned from the space race^6,7 and other historical challenges, including the Manhattan Project, to ensure success in meeting the present challenge. These lessons include the value of a clear call to action, identification of existing resources, consolidation of the resources, and in highly technical areas such as early warning systems for biodefense, assignment of responsibility and authority to scientists and engineers in fields that are already working on the problem.