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CBRN. It’s not one of those catchy acronyms. Nothing lovable about it.  That’s because it’s a short list of horrors, the four categories of possible threats to public health: Chemical, Biological, Radiological, Nuclear. The only good news is that the acronym exists because there are smart folks working every day to figure out how to deal with the threats they represent. And, if you’re reading this, odds are you’re one of the people who figure into the plan to respond.

What got us thinking about nasty new threats was talking with Brad Goble, a consultant to organizations dealing with CBRN, including the Global Health Security Initiative.

BRAD GOBLE and

The day the world got smaller

Goble is Canadian, a graduate of the Canadian version of West Point, the Royal Military College, and served fifteen years in the military. He described how he came to be involved in the CBRN fight:

“I backed in. The General I had worked for was retiring and I was ready for a new career. So I’d gone back and gotten an MBA from Queens University, and I became one of the people working to create the Canadian version of the CDC. This was right before 9/11. After that happened, the world got smaller, and we became more focused on new and emerging threats. Not long after 9/11, Tommy Thompson, then Secretary of HHS, came to Canada to meet with our Minister of Health, and out of those meetings came the Global Health Security Initiative – bringing together the ministers of health from the G-7 countries, Mexico, the WHO and the European Commission.  I was one of the people assigned to figure out how the international community prioritized investments against threats.”

(Photo: Brad Goble outside the United Nations HQ in Geneva)

We have to assume crazy

“After 9/11, we were paying more attention to what the bad actors were doing,” Goble explained, “working to assess the new threats and to coordinate the work of defense departments and health organizations.” Included in that work was the development of plans to deal with terrorist attacks: “We couldn’t assume rational behavior – we have to assume crazy.” And with that came the “A-list pathogens,” the list of the most virulent agents.

Where local health departments and pharmacists come in

“Take smallpox, for example,” Goble said. “It was declared eradicated by the WHO in 1980 and so people haven’t been vaccinated against it since then. But there are plenty of doses of a smallpox vaccine and antivirals standing by, in case of a new outbreak. We have the countermeasures, but they are in the Strategic National Stockpile. If there’s a bio-terrorist attack, we can’t all go line up at the National Stockpile.” And that’s where health departments and pharmacists come in.

Goble explained: “We started by bringing defense departments and public health organizations together, but I’ve also been working to bridge the gap to industry and make them true partners. As we work to strengthen the line of defense, we know that health departments play a major role, but one thing we learned from Covid is how pharmacists have a big part to play. We need to strengthen that line of defense more and more. Here in Canada, we are seeing new government proclamations putting pharmacies at  the front lines for more equity of care, and we have an increasing need for conversations on how we can rely on pharmacists.”

The smallpox case study

In using smallpox as an example of the preparations for bad actors, we learned from Goble that… 

Smallpox has a 30% fatality rate and those who survive are often left blind or with significant scarring.

It’s an airborne virus and is spread via contaminated objects, such as clothing and blankets.

While smallpox was eradicated by 1980, the U.S. and Russia kept some virus for research purposes. Anyone who’s ever seen a spy movie knows the potential for evil, but the problem here is worse: it now seems likely that synthetic smallpox virus can be produced – it’s already been done with a related virus, horsepox – and so eradication may not be possible.

While we do have an effective vaccine, there’s a problem: symptoms of smallpox exposure take 10 to 14 days, while a vaccine must be given prior to exposure or within 3 to 7 days to be effective.  Thankfully, the US government has also invested in the development of a smallpox antiviral as an added level of defense against this threat.

With that as a background, several models have been developed to identify the true impact of a deliberate release of smallpox.  While the outputs from such modeling are frightening, they do provide some level of comfort knowing that the brightest minds in government and industry are working to mitigate such risks.

Thanks to Covid, we can envision the public health response that would ensue. And it’s good to know that, in this case, the vaccines and antivirals already exist and stockpiles are waiting, but also good to know that governments around the world are working on counter-measures and on preparations.

But smallpox is just one creepy example. Let’s take a quick look at the dangers represented by the other letters of CBRN.

CBRN… happening as you read this?

Brad Goble shared a photo from a  CBRN conference in Rotterdam, explaining that “The organizers brought in a Russian tank that was recovered from Kyiv,” adding, “We met some very impressive Ukrainians at that venue.”

While we all hope that no nation will resort to chemical weapons, the Ukrainians are reporting chemical weapons being used against them. There is also the continuing fear that a large nuclear facility will be weaponized.

As for the fear of nuclear radiation, Goble reports that while there is little treatment, there will soon be advanced diagnostics to test for exposure. This will be critical in the case of a dirty bomb or a release of radiation from a nuclear plant because it will enable medical personnel to test for exposure and thus limit hospital beds to those who most need them.

In summary

So let us also be grateful for all those working as anti-terrorists, not just those with military training but also the PhDs, the MBAs, the MPHs, the Pharm.Ds and all of those standing by, ready to answer the call.

And speaking of being ready, we should all be asking where our organizations stand. We put that to STChealth’s CEO, Mike Popovich, who responded, “Will we be ready? At STChealth we had the systems ready during the 9/11 anthrax bioterrorism event. We had the systems ready during the previous two pandemics, and we understand the future — with folks like Brad as a key Board Advisor to suggest worse-case scenarios, we know how our clients would be front and center once again.”

STATS OF THE MONTH:

When Will Happen When

Hyphenated 2nd Generation Baby Names

Meet Modern Information Systems?

By Bill Davenhall, Geomedicine Analyst

Interesting question, perhaps?  Well, it seems it’s something that needs watching and here is why: Recent data from the Pew Research Center’s “surname naming strategy” suggests a trend among American parents:  the hyphenated last name. In a recent 2022 survey,

  • Twenty percent (20%) of married women ages 18-49 say they kept their last name, compared to 9% of those ages 50 and older.
  • Those women with postgraduate degrees (especially professional degrees) are even more inclined to keep their “maiden” name: 26%, compared to only 13% of those with a bachelor’s degree or 11% with some college or less.
  • Then there’s the divide with political “leanings”: Democratic women are twice as likely as Republican women to keep their last name (20% vs. 10%) and women who self-identify as “liberal Democrats” are especially likely (25%).

Why would an immunization program care about this? For starters, keeping accurate immunization records often relies on first and last names correctly identified and associated with the right individuals. Many computer processes match records using a first and a last name. As the  surname “soup” continues to boil, so will be the need for better and smarter personal identification schemes for health records. Furthermore, simply having more space (longer lines) on data collection forms and screens is now a critical business imperative on many levels. Many forms that we all get to fill out in our health and wellness encounters don’t really provide enough space even for our unhyphenated names let alone names that might exceed 26 characters! Space to provide more accurate surnames is probably already inadequate for our in-a-hurry data submission society — paper or digital!

Let me be direct—accurately determining authenticity and “ownership” of immunization data as last names will keep getting more complex and require more characters and hyphens. The process will become tedious, and while the Pew Research Center is in the early phases of assessing the larger societal implications of this trend, let’s not back away from the need to find better ways to “identify” any person with a hyphenated surname. Just think about a newly married couple, both given hyphenated names at their own births, now having a child of their own that needs to report their parents’ full surnames on some type of form or digital application at school!

Using 2022 Natality (birth) data resources from the CDC’s  Wonder Program, the map below provides a possible glimpse of where the hyphenated naming trend identified by the Pew survey research may most impact various States. Using hyphenated surnames may have a greater impact on information processing systems than we presently think!  Yikes, I think I have a headache coming on!

As always, 2nd Opinions welcomed!

(We generated our State estimates of possible name tracking issues by using birth mother’s college education and marital status as proxy indicators.  We then compared each State to the national average of the likely hyphenated birth-name rate of 35% of all 3.8 million births in 2022. While Alaska and Hawaii are not depicted on the map – both States are below the national average and would be colored yellow.)