Just before September 11, 2001, I joined the newly formed BioEmergency Response Section at the Arizona State Public Health Laboratory. As a public health scientist, I was one of only a few people in this section, but we rallied together to tackle all the challenges — from location and space to staffing and supplies.
Prior to the first confirmed anthrax attack and in preparation for a potential bioterrorist attack, we had to ensure the BioEmergency Response Lab would be fully functional to serve the needs of Arizona. This was incredibly difficult as we had an older facility which made bringing on new programs a challenge. Before purchasing new equipment and instruments, we had to make sure the footprint of the equipment would actually fit in the lab. We looked at every inch of available space and used it as best we could.
At the outset of the anthrax response, we were basically operating out of a closet. We built a makeshift lab in an unoccupied office — this became our BioEmergency Response lab.
While our group was small, we had great support from staff in other sections of the lab. This was incredibly important as we watched our sample volume increase rapidly. In fact, we received over 1,000 samples in the six months that followed the attacks. We worked morning, noon and night, every day, including Thanksgiving, Christmas Eve and Christmas with three shifts every day. We tested everything from letters to full suitcases that had been rubbed against drywall— try getting those types of objects into a biosafety cabinet.
In addition, the resources we needed posed a significant challenge, especially since the testing demand was greater than anyone could have imagined. Further exacerbating the issue, real-time polymerase chain reaction and specific fluorometry tests were in their infancy in our public health laboratory. We had to perform all tests with culture or biochemical methods, which could take up to 72 hours before you could see growth of anthrax if it was present in the sample. We met the testing demand, but we would have faced difficulties if the samples kept flooding in at such significant numbers.
As we responded to the attacks, we began to work closely with the Emergency Preparedness and Response Bureau at the Arizona Department of Health Services, the Department of Public Safety, Federal Bureau of Investigation(FBI), local health departments and law enforcement agencies to develop protocols for bringing samples to the lab for testing, maintaining chain of custody requirements, and protecting those individuals handling and shipping the samples from any hazards.
In addition, we started coordinating at the national level with the Association of Public Health Laboratories (APHL) and Centers for Disease Control and Prevention (CDC) Laboratory Response Network (LRN). APHL became a great conduit for information exchange which helped us deal with questions and calls from the news media; something we had never had to deal with on this scale before. Samples were flooding in and phones were ringing off the hook.
In the decade since the anthrax attacks, things have changed dramatically. While we still perform the culture testing methods, we also use real-time polymerase chain reaction methods which provide preliminary results in a 4-6 hour timeframe. As a fledgling program, originally we could only test for anthrax and a few other select agents, now we can test for many more agents and toxins.
The anthrax attacks demonstrated a weakness in our Public Health Laboratory infrastructure in Arizona. We recognized the restrictions placed on us by the existing laboratory facility, which then was more than 30 years old. This laboratory severely lacked space and appropriate equipment to meet the surge in anthrax testing while maintaining other critical public health testing such as rabies, influenza and Tuberculosis. As a result of this desperate situation, the Arizona State Legislature approved close to $25 million in 2002 to construct a new laboratory facility. We now have a state of the art lab with 15 biosafety cabinets and 22 chemical fume hoods. Recognizing and responding to this weakness allowed us to put in place the necessary infrastructure with significantly more qualified trained personnel to respond effectively to the surge in sample testing volume during the 2009 H1N1 pandemic.
We have come a long way since the anthrax attacks10 years ago, with much improved communications between the lab and all parties involved in response to a Bioterrorism event. All of this could not have happened without the influx of funds from CDC and the state of Arizona. Are we better prepared today? Certainly we are, however six months from now my answer to this question might be different as we continue to see reductions in both federal and state funding. Still, make no mistake; it has been a dramatic improvement.
With federal funding for Biological Laboratories from the Public Health Emergency Preparedness grant gradually dwindling after hitting its apex in 2002, we’ve scaled back some capabilities, and given the current economic downturn, maintaining capabilities has become an even greater challenge.
In addition, we continue to struggle with the challenges of finding and hiring qualified laboratory staff. One way to cope with fewer people is to automate the testing process, and rather than manufacture lab testing supplies in-house, we now rely heavily on CDC and private companies to provide us with these supplies. While this may be more cost effective, it leaves us vulnerable. When you lose workforce skills for those basic lab necessities, you end up competing for the same source of lab testing supplies nationally if not internationally. This happened during the 2009 H1N1 pandemic and could also happen in the event of a large scale bioterror event across multiple states. To truly be prepared, we need to have qualified, trained staff and there needs to be dedicated funding for lab testing and reagent stockpiles.
There are still some weaknesses in our nation’s laboratory preparedness, particularly in regard to radiological testing capabilities. I fear this could be the case if we experience a radiological attack or nuclear event such as what happened in Japan in March. Across the nation, there aren’t enough radiological testing labs with response capabilities. But we should not build up radiological testing capacity at the expense of our current response capabilities in both Biological and Chemical testing areas. We’ve spent a lot of money to be prepared for another bioterrorist attack; those skills and capabilities cannot be replaced overnight if we let them lapse.
I believe we’ve come a long way in our state. We will handle any potential attack much better than we did a decade ago. The question is whether we’ll be able to maintain the important capabilities the public deserves. Currently it’s a legitimate fear that we may not be as prepared one, five or 10 years from now.
Victor Waddell, Ph.D., Bureau Chief, Arizona Public Health Laboratory, Arizona Department of Health Services
“In sharp contrast at one point we had to make sure the footprint of a new instrument would fit in the old lab, now the new lab is incredibly flexible preparing us for anything that might come our way.”