What Has Changed in the Biosecurity Threat Landscape?

Ashish Jha: 00:00:00

Hey, everybody. Ashish Jha here coming at you from Providence, Rhode Island on a sunny afternoon with a moment in health the podcast where we talk about one data point, discuss one study and answer one question. And I'm going to jump right in here with the data point. And the data point I want to talk about today is six is 6.8 million. 6.8 million. That's the number of veterans who get their care in any given year through the VA Healthcare System. About 7,000,006.8 now I want to talk a little bit about some VA numbers, and then tell you why I'm bringing it up this week. So about 16 million veterans in America. That number, by the way, has declined very substantially over the last decade. When I started first practicing in the VA, that number was well over 20 million, closer to 25 but what we have seen over the last decade, 15 years, is a rapid decline in the veteran population, largely driven by the aging population from World War Two and Korea and those veterans dying. It's really been a transformation of the VA S Health Care System towards a whole different generation of veterans. About 16 million veterans still out there. 9 million are enrolled in the VA and about 6.8 or 7 million get their care at any given point across the 13 180 healthcare facilities, 170 VA Medical Centers across the country. Pretty remarkable health system. And the reason I'm bringing it up is I'm back on clinical service this week, seeing patients at the Providence. VA, always a lot of fun to be back on clinical service and really taking care of veterans. So that's your data point of the week, 6.8 million veterans getting their health care through the VA Health Care System.

Ashish Jha: 00:01:56

All right, I'm now going to transition to talking about the study of the week, and staying with the theme of the VA, I want to talk about a study that came out, actually about two years ago in the in the Journal of general internal medicine called Veterans Health Administration, VA versus non VA health care quality a systematic review. So the motivation behind this study, done by a group of people at the RAND Corporation was to answer the question, how good is the VA compared to non VA healthcare? Now this is a question that has been on policy makers minds for, oh, at least 3040, years. It's been a perennial question to make sure that veterans are actually getting good care, not just access to care. And this is the latest iteration in a series of studies that Rand has done answering the question, how does the VA compare to non VA healthcare? This latest iteration looked at 37 recent studies that measured clinical quality patient safety in VA hospitals compared to non VA settings. And basically what they find is that across all of these studies, clinical quality and patient safety at VA is as good, and usually better than non VA care in most contexts. That's really looking across the whole gamut of stuff, from inpatient to outpatient, community based versus tertiary care, and it's a reminder that the VA has made remarkable strides in quality over the last 20 or so years, despite all of the political challenges, funding challenges that the VA has faced, it's made a lot of very big improvements, and this has been a very bipartisan effort. These improvements have happened under in many ways. They were launched, launched under the Clinton administration, happened substantially under the Bush administration, continued under Obama and then Trump and Biden as well. So the VA remains one of the bipartisan issues where everybody cares about getting good care to veterans, and that has continued for the last 20 some odd years. So that's your study of the week,

Ashish Jha: 00:03:51

Veterans Healthcare versus non VA healthcare quality a systematic review in The Journal of general internal medicine. April 19, 2023 you

Unknown: 00:04:00

all

Ashish Jha: 00:04:07

right, and now for the question of the week, and today, I'm down here in Washington, DC, with my friend and colleague, Beth. Cameron. Beth, thank you for

Unknown: 00:04:14

being here. Thank you so much for having me. Ashish. I'm delighted. So

Ashish Jha: 00:04:17

Beth is a senior advisor to the brown pandemic center, a professor of health services, policy and practice at Brown a remarkably distinguished career in global health security biodefense. Served under four presidents. I thought it was three. I learned today was four, President Bush, President Obama, President Biden, President Trump. First Trump administration, it's true. And led the Directorate, led the Office of Global Health Security and biodefense. And so the question I wanted to ask you, Beth, is, you have been thinking about biosecurity, biodefense for a long time, and yet it feels to me. E like, something has changed in the last few years that has substantially raised the stakes on these issues. And I guess the question for you said two parter. I know supposed to be a one part question, but it's a two parter is, first of all, do you agree with that characterization? If you do, what's changed?

Beth Cameron: 00:05:21

This is a great question. So first, I agree with your characterization, but maybe just backing up a little bit thinking about the question, what is biosec like? What do we mean by biosecurity? Yeah, so I characterize biosecurity as preventing a large scale biological event, something that affects multiple states or multiple countries, or every country like a pandemic, like covid, and that means looking at health emergencies and pandemics. It also means, in particular, for national security professionals, people like me who've spent most of their career doing national security, that we're looking at preventing deliberate and accidental risks in addition to naturally occurring disease threats. So when we look at that whole picture, I think people are becoming more interested in this issue, and I think there's a few reasons for that. Many of us have been pushing this rock up a hill for a long time. I think today there is a better understanding in the American public about what can happen in an event that is caused by biology, that affects everyone everywhere, all at once. And I think when we look at the covid 19 pandemic, it showed us that we don't really have any practical approaches that can be locally adapted to be ready for a biological threat. So that means getting out of lockdown fast, or preventing lockdown in the first place. And I think people realized that this could really impact their day to day lives. It also made people, I think, realize that we don't have the communication systems. I know this is something you've been focused on a lot. Ashish throughout your career, we didn't have a great way to explain to people when things changed, when vaccine recommendations change, when recommendations were on masks or testing change, testing changed, and that really decreased trust and fractured our society. And we sort of find ourselves in the place that we are now. So first, I think the general public has a better understanding

Beth Cameron: 00:07:04

of what prevention, detection and response really means in the context of bio. But I think second, when you talk to policy makers, people who are more wonky, like like me and other people who've spent their career in government, they looked at all of these things that we put in place, like the strategic national stockpile, our early warning system, our system for developing and distributing vaccines, tests and treatments. And while we did get some things right when we look at the whole totality of the covid pandemic, I think we realized, wait a second, if these things didn't work for covid, which is really a moderate pandemic, and not necessarily as bad as a deliberate attack or something with a modified or especially virulent or transmissible disease. We realized, if these things weren't good enough for covid, what do we have in place for something that might be worse? I think that brings me to the debate around covid origins, and I think the jury's still out on what caused covid 19 and where it came from, but I think reasonable people, including the American public, are asking questions about how we can build biosecurity, preventing deliberate misuse and biosafety, preventing accidental release into our technology development strategies. And I think most technology developers are looking at the good sides. They're looking at developing treatments and therapeutics. They're looking at healthcare and improving it, and this is all really good. We need those technologies. But at the same time, as they're racing ahead, as we look at things like artificial intelligence, that are really accelerating and rapidly accelerating our ability to do those things better, I think we can be looking more carefully inward at technology development and saying, How can we build into our design, build, test cycle, guardrails that prevent us from accidentally or deliberately developing the very thing that we're actually trying to prevent in the first

Ashish Jha: 00:08:54

place. Let me ask you a question. So we're talking about thinking about what has changed that has made this so much more prominent. One is covid pandemic, brought it to attention, taught us a bunch of stuff, made us realize what works and doesn't. But second, sounds like there's a huge role of how the new set of technologies that have come about in the last five, seven years both their promise but the potential downsides of those are also raising some alarm bells about we have to be, we have to be deliberate and careful about how we think about these issues. Is that fair?

Unknown: 00:09:25

Absolutely fair. I think, as we've looked, you know, over the last couple of decades, many of us have been saying that it's getting easier to do good things and bad things with biology. But I really think in the last couple of years, artificial intelligence and machine learning, high performance computing have made it possible to envision now within a computer all of the ways in which a pathogen could become more transmissible and more virulent. That helps us make good vaccines. But if we could translate that into making those potentially pandemic pathogens, that's that's a more scary proposition, and we have to be right. And prepared to prevent

Ashish Jha: 00:10:02

that final question. And I suppose your one question thing, but here, here we are. Do you think the national security community has an appropriate understanding of the new sets of biological threats? Do you think they are underestimating overestimating. Like, what's your best sense of the broader community, not that just the biosecurity people, but the broader security community. How well do you think they have calibrated for the threat that is coming from our ability to do new and innovative things with biology?

Unknown: 00:10:38

I think it waxes and wanes depending on what's happening. So during the covid pandemic, sitting in the White House as you were too Ashish, I think there was an understanding that biology could stop our economy. It could stick people at home for months on end. I think the national security community was looking at that as one of the highest priorities, including the potential that biology could in the future be misused for that purpose. I think as we come out of the pandemic, we're seeing a lot of political will really wane, and so I'm hearing a lot less people talk about biosecurity, and more people talking about other potentially existential risks. I think that's a perpetual problem. I think there's some good news. I think there's some platforms out there that are bringing the private sector and the public together, things like the International biosecurity and biosafety initiative for science, the NTI bio AI forum. A lot of great work for our national labs. I think you have Shankar, our friend and colleague, on here sometime this month as well, talking about those those capabilities. We also have some great work at the pandemic center, building biosecurity and biosafety. But overall, I think there is not a cohesive sense, especially amongst heads of state, leaders, national security professionals, that this threat is a threat that is essentially here, and we have a little bit of time, I think, to get the guardrails right, but not a lot

Ashish Jha: 00:12:00

well. Thank you for all the work you have done to both elevate this issue but also help us understand how we begin to respond to it. Beth Cameron, thank you so much for

Unknown: 00:12:07

being here. Thanks so much Ashish.

Ashish Jha: 00:12:15

And there you have it, another episode of a moment in health, the podcast where we talk about one data, point 6.8 million veterans getting their care through the VA Healthcare System. We talked about one study which looked at the quality of care in the VA versus non VA settings, a systematic review across 37 studies, finding that the VA was at least on par, but usually better than non VA health care. And then we had a very special guest this week. We had Beth Cameron, who is a colleague and friend here at the brown scope health, a real national leader in biosecurity. And couple of interesting points that Beth made that I think are worth highlighting. She talked about biosecurity as really any large scale biological event, whether it's a pandemic, whether it's a lab leak, naturally occurring or obviously a deliberate biological attack. And she brought up that the pandemic, the covid 19 pandemic, had revealed major weaknesses in our preparedness and our ability to respond, and then new emerging technologies. And you're going to hear more about this in the upcoming weeks and months, because we're going to have a series of speakers talking about biosecurity, but new emerging technologies from CRISPR, AI, synthetic biology, has made the man made the deliberate threat landscape substantially more dangerous, and yet, as a country, we still lack a sustained, cohesive approach on how we handle this and developing that strategy is critical. It's got to be done in a very timely fashion, and so one of my goals over the next few weeks is to talk to biosecurity experts about what we should be doing in this space, and you'll hear some of that in the upcoming weeks. So Beth Cameron really kind of sets us up for those conversations that will be coming. Thank you again for listening music by Katherine Beggs, as always. Thank you, Catherine. And this was another episode of a moment in health, and we'll be back next week with with another data point, another

Ashish Jha: 00:14:10

study and another question to answer. Have a good week, everybody.

Unknown: 00:14:22

You