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TR: These are long-term solutions that will obviously take years. What can we do more immediately to prepare the nation?

Peters: We need to get diagnostics out to the emergency room level for all the biowarfare agents, so we can diagnose people directly-not at CDC headquarters in Atlanta a week later when someone thinks about it and mails a sample to Atlanta. That way we can test anybody who looks sick with something that is hard to explain. Right now we don’t have that capability. The technology exists. In many cases it could be done, but we don’t have the actual machine that can do it for us. We need to develop that platform and get it out into the emergency rooms.

TR: What about smallpox vaccinations? Do you think parents should vaccinate their children against smallpox?
Peters: No, I would not suggest they do that. The vaccine is overall a good vaccine. But as with all vaccines, some people will be hurt. So we should not vaccinate the general population until the threat is higher.

We’re actually getting close to being ready on smallpox. We’ve got enough vaccine. We have some plans as to how to give it. We now have a decision to go ahead and vaccinate medical staff most likely to see the first cases. And we could respond to an outbreak right now. Maybe not as well as we’d like to. We’re a year away from being in as good a position as the currently perceived threat suggests we should be. But today, we’re still in a pretty good position.

We’re not ready for every scenario, of course. The old Soviet plan was to use tons of smallpox delivered by missiles and cluster bombs and literally saturate urban areas with smallpox. So you’d have lots of direct infections followed by the contagion. We’re not ready for a massive attack of that nature. But I don’t think we’re concerned about the former Soviet states mounting it. And I don’t think other state actors have that kind of capability.

TR: Are we ready for a genetically engineered superstrain of a bioweapon such as vaccine-resistant smallpox?
Peters: I don’t think engineered smallpox is a real consideration right now. Genetically modifying viruses and knowing what’s really going to happen when they’re modified-whether it’s really going to work-that’s a lot harder than making antibiotic-resistant bacteria.

But I don’t think it will always be that way. The future will be more dangerous if current trends continue. We’re going to have to be thinking that people will be trying different things, looking for ways to get around vaccines or drugs. And we have to be thinking about how they might do it; how we can counter it. Above all, we have to have the intelligence out there to find out about it.

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Tagged: Biomedicine

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