Institute for Biosecurity

Saint Louis University, Saint Louis, MO, USA

Founded in 2001, the Institute for Biosecurity has pioneered the use of distance-learning technologies to train professionals in the fields of biosecurity and disaster preparedness. The Institute provides both course instruction and ongoing academic research in disaster preparedness and response, community resilience, worldwide terror threats and surveillance, and the ecological and social effects of bioterrorism. The Institute started by offering an online certificate program and later a hybrid Master of Science program in 2006 to meet the demand from employed professionals to obtain a master's degree in the rapidly expanding field of disaster preparedness. In 2009, a hybrid Master of Public Health (M.P.H.) in Biosecurity and Disaster Preparedness program was created to align this program with the other offerings of the then School of Public Health at Saint Louis University. Finally, a completely online version debuted in 2016. Today, the Institute operates out of the College for Public Health and Social Justice at the same institution. All of its programs are competency-based and CEPH-accredited. Current academic programs include hybrid MPH joint degrees with Epidemiology and Global Health, the original online and hybrid M.P.H. and certificate programs, and an accelerated program combining a Bachelor of Science and an M.P.H. Students can take classes on a full-time or part-time basis and are 100% online, allowing working professionals to advance their formal education without taking time off work or relocating to St. Louis. Alumni have found employment in less than 3 months following graduation and report very high satisfaction with their academic program and professional field, as well as very high salaries. A particular strength of the Institute is its faculty. Most of the instructors are experts currently working in the field, providing students with cutting-edge information, boots-on-the-ground experience, and passion for their teaching. For example, our current faculty counts an infectious disease physician, a director of communicable diseases for a local public health agency, an emergency preparedness manager, an emergency preparedness planner, and an emergency preparedness specialist for a major health care system. Institute faculty have national and international reputations for research, and combined have published more than 250 peer-reviewed journal articles, book chapters, policy documents, and other academic work. The Institute's faculty have also given more than 200 presentations at regional, national, and international professional conferences, and have held leadership and editorial board positions on a number of professional organizations within the discipline. So far, the Institute for Biosecurity has graduated ~400 students, who are now pursuing rewarding careers. Many Alumni work for federal agencies (Centers for Disease Control and Prevention, Department of Homeland Security, Federal Bureau of Investigation, Federal Emergency Management Agency, among others), with hospital and health care systems or local public health agencies in disaster planning and emergency management roles, with the military, as first responders for law enforcement agencies, or in business continuity roles for large corporations. As a one-of-a-kind credential in the U.S., the M.P.H. in Biosecurity and Disaster Preparedness has proven widely recognized and respected and has provided its graduates with many career opportunities, regardless of whether or not they choose to work in a traditional biosecurity field. For all of its achievements, the Institute for Biosecurity is struggling to expand its capacity to graduate more students to meet the demand: this year, applications to its programs have increased by almost 60 percent compared to the same time last year. It is not surprising, as the COVID-19 pandemic caused a reckoning regarding the state of global biosecurity. Despite the best efforts of the Global Health Security Agenda (GHSA), whose role is to facilitate implementation of the 2005 WHO International Health Regulations (I.H.R.), COVID-19 spread rapidly around the world and will likely linger in pockets of unvaccinated populations for years to come. Even this dire outcome is a best-case scenario hinged on the hope that no variants will emerge that can defeat available vaccines. Additionally, some estimate that the COVID-19 pandemic will have cost 16 trillion U.S. dollars, which is a far cry from a prior estimation of 6 trillion that pandemics would cost over the next century. The eventual fruition of such complex international efforts as the GHSA will require new generations of biosecurity policy experts and academic centers to perform research on best practices to aid in these efforts. The Institute for Biosecurity would be an ideal candidate for one of these centers since Saint Louis University also houses the top program nationally in Health Law studies.

Aside from expanding our academic offerings in biosecurity policy, increasing the expertise of our graduates in microbiology, synthetic biology, and dual-use research is essential. Prevention of biological attacks with man-made pathogens is more challenging than ever now that genes can be manufactured in the laboratory. Several countries have implemented voluntary programs to prevent the synthesis of pathogens, and many institutions have worked to instill a culture of responsibility among researchers. However, these encouraging measures are only effective if we can achieve an almost universal consensus. Our programs cover biosafety and biosecurity principles, but we believe that some of our students would benefit from elevating their understanding of biology to engage scientists effectively if they are to play a role in this type of education and advocacy. More biosecurity experts are also needed to help design a better syndromic surveillance system in the U.S. The only national system is the BioSense Program launched in 2003 as mandated by the Public Health Security and Bioterrorism Preparedness and Response Act of the previous year. The goal was to establish a nationwide integrated public health surveillance system for the early detection and assessment of potential bioterrorism-related illnesses. Nevertheless, the BioSense Program has struggled to meet its stated goal of providing real-time situational awareness. It failed to detect the H1N1 outbreak soon enough to institute prevention and control measures that might have slowed the spread of infection. It also failed to detect the SARS CoV-2 virus that causes COVID-19 disease, now believed to have been in the U.S. at the end of 2019. Currently, at least in Missouri, only hospitals and associated health centers report syndromic data, totaling only 116 facilities for 6 million individuals and leaving out many private urgent cares and community clinics. In contrast, in 2018, there were 1,548 family physicians in Missouri, and in 2020, there were 476 out of 522 school districts serving 800,000 children with access to a school nurse. Further, only certain types of individuals have access to the data in Missouri, namely public health practitioners and hospital staff, limiting conversations amongst relevant stakeholders and experts, which could generate helpful information for themselves and local public health agencies. Why do a few weeks matter? If the local or federal government had put in place social distancing practices only one week earlier, we could have saved ~36,000 lives. Two weeks earlier would have spared ~54,000 lives. Biosecurity experts understand that effective syndromic surveillance takes a multi-disciplinary approach, not just through One Health, which rightly advocates for the inclusion of animal health experts in any such system. The Joint External Evaluation of the U.S.A. performed as part of I.H.R. implementation in 2017 named "the lack of integration of human and animal health agencies for surveillance of zoonotic pathogens," one of the significant vulnerabilities in the U.S. emerging infection surveillance system. Of course, such integration with animal health in the U.S. would not have helped with COVID-19, but cross-disciplinary real-time collaboration among subject matter experts would have. While syndromic surveillance of "flu-like symptoms" in the middle of the flu season would have been useless, other, less common manifestations of the disease may have perhaps raised the alarm. For instance, skin rashes in young children at frequencies much higher than usual, as some preschool directors have reported anecdotally. An isolated skin rash in a young child is hardly an oddity, but what if 20 different preschool directors in the region had fed the information into a syndromic surveillance system, whose real-time data would also be accessible to them? They may have seen that others were making similar observations and that knowledge could have sparked conversations and phone calls to local public health agencies in December and January. We did not have access to COVID-19 tests at the time, and we did not know that skin rashes could be a manifestation of COVID-19. Still, we could have determined that these children's parents had traveled abroad recently and that they had been experiencing flu-like symptoms. Knowing this in the context of COVID-19 reports from abroad, we could have counseled them to self-isolate.

The COVID-19 pandemic also highlighted vulnerabilities regarding emergency preparedness, which will require new generations of professionals to address. Communications during the pandemic between emergency operation centers and local public health agencies were a challenge. Conclusions from after-action reports, still pending, may prompt changes to how the Incident Command System (I.C.S.) works in circumstances other than an acute disaster, how emergency operation centers function when professionals other than first responders have to take leading roles, and how I.C.S. training is designed for that crowd. Government emergency management may need to collaborate more closely with local public health agencies to write emergency plans and to increase resilience of communities, so they achieve a degree of self-sufficiency that will augment the positive impact of local, state, and federal interventions when faced with a disaster or crisis.

In conclusion, the biosecurity field has been growing exponentially over the past 10 – 20 years, even prior to the COVID-19 pandemic. The pandemic has highlighted the need for more and even better trained biosecurity and disaster preparedness professionals. Entities such as the Institute for Biosecurity can provide this training and can generate important knowledge and research for a more biosecure world. You can access information about the Institute for Biosecurity and their academic programs online here or at www.slu.edu and searching for “biosecurity”.

AUTHORS


Carole R. Baskin, DVM, MSc Director, Communicable Diseases Prevention Saint Louis County Department of Public Health

Terri Rebmann, PhD, RN, CIC, FAPIC Special Assistant to the President Director, Institute for Biosecurity Professor, Department of Epidemiology & Biostatistics College for Public Health & Social Justice Saint Louis University