Photo Courtesy of Dr. Amesh Adalja

Dr. Amesh Adalja is a Senior Scholar at the Johns Hopkins University Center for Health Security. His work is focused on emerging infectious disease, pandemic preparedness, and biosecurity. Dr. Adalja has served on US government panels tasked with developing guidelines for the treatment of plague, botulism, and anthrax in mass casualty settings and the system of care for infectious disease emergencies, and as an external advisor to the New York City Health and Hospital Emergency Management Highly Infectious Disease training program, as well as on a FEMA working group on nuclear disaster recovery.

What are Global Catastrophic Biological Risks (GCBRs)?

GCBRs are a special category of pandemic biological risk that have capacity to overwhelm the response of national governments and the private sector causing severe disruption to civilization with loss of life in the millions. The 1918 influenza pandemic would be the only historical example.

What does bioterrorism preparedness look like?

Preparedness for bioterrorism has many facets that range from fortifying hospitals and local health departments with the resources required to detect and respond to such events to government stockpiles of key medical countermeasures such as vaccines, antivirals, and antibiotics. It is an activity that requires participation from all levels and branches of government as well as the healthcare industry and the private sector. It is something that must be done proactively and not just in response to an event.

Would you consider the United States prepared for both bioterrorism and emerging infectious diseases?

I think the US is the best prepared when compared to other nations however there are serious shortcomings, especially as it has been almost 20 years since the anthrax attacks of 2001 and commitments to preparedness have waned. The healthcare industry has little surge capacity and infectious disease expertise is spread very thin. Just one flu season ago we saw hospitals seriously burdened — imagine what would happen during a severe flu pandemic. The US Ebola cases in 2014 were an important wake-up call and revealed deficits in preparedness as well prompting the creation of a network to deal with high consequence infectious diseases. However, as time passes this — like bioterrorism preparedness in the face of anthrax — also fades in importance to the public and policy makers.

What are some tools for pandemics? If there were such a thing as a pandemic toolbox, what would be included?

The tools for pandemics are the basic tools used for infectious disease and include extensive surveillance of threats and a robust pipeline of diagnostics, antivirals, and antibiotics. These tools must be part of a comprehensive planning effort by governments and the private sector and be given a high and continual level of importance at the highest levels of government. International coordination is also a major component of pandemic response.

How does health security relate to emergency medicine?

Health security interfaces with all fields of medicine in some aspect or another. Emergency medicine is the front line specialty and most threats to health security will first present to the emergency department and it should be a major focus of preparedness activity.

Why are you so passionate about these areas of research?

Infectious diseases are the only class of disease that can be cataclysmic for society and pose the biggest challenges in medicine. Infections have altered the course of history and will continue to do so without robust and continual preparedness.

Follow Dr. Amesh Adalja on Twitter @AmeshAA