The Threat Changed So Must We
By Richard Schoske, PhD, Defense Threat Reduction Agency, Chief Detection and Diagnostics Division
In 2001, the United States was griped in the fear from an attack with Bacillus anthracis, the causative agent of anthrax. Letters laced with the deadly pathogen were sent to members of Congress and people were fearful of getting packages in the mail. As a young Captain in the Air Force, I was tasked to assist with testing samples suspected to contain B. anthracis at the Armed Forces Institute of Pathology (AFIP) in Washington D.C. In the Division of Microbiology, scientists were working with a relatively new technology, namely the Polymerase Chain Reaction (PCR) to test for the presence of the genetic material of B. anthracis. While rather common place today, PCR was considered a newer technology, with it first being published by Kary Mullis in 1987.
In the lab, we worked day and night, testing powders, letters, uniforms, and many other different items that were suspected to contain B. anthracis. We were learning on the fly as to what the ideal testing parameters should be.
This included the assay’s limits of detection, and its false positive and negative rates. In partnership with industry, this technology was eventually fielded as part of the Joint Biological Agent Identification and Diagnostic System (JBAIDS) to the entire US Department of Defense. For the first time, the DoD had one standardized and validated approach to detect and identify a biological agent. Fast forward to today and PCR remains the standard bearer for what I call pathogen directed identification. But what if we don’t know what the next threat is? What if it is a threat we were not anticipating? What if PCR doesn’t work well for some reason? In other words, the threat is changing and so must our approach to identify it. The goal should be to push beyond the boundaries of the traditional threats such as B. anthracis, and Yersinia pestis (causative agent of the plague) to address the unknown and emerging biological threats, whether natural or man-made.
There is no bigger emerging biological threat than the current COVID-19 pandemic. Today, as we did in 2001, PCR is the preferred technology of choice for its identification. Many companies such as Cepheid, Johnson and Johnson, and bioMerieux have fielded technology in support of testing efforts around the globe. Their technology is tried and true, but still doesn’t answer the questions I outlined above. Our mindset needs to change. We need to be able to adapt to emerging biological threats and better prepare for surprise. The next outbreak will surprise us, but the key is leveraging technology to mitigate its effects.
In order to do this, we must continue to break new ground in the area of detection and diagnostics. The technologies should leverage novel approaches to not only characterize the pathogen but also identify the host response. We need to standardize our sequencing approaches, much in the way we did with B. anthracis testing in the early 2000’s. Furthermore, we need to simplify our bioinformatics analysis so the user can analyze and interpret the data without having to be a PhD level bioinformatician. We should continue to evaluate not only the genetic information but also the proteomic and metabolomic signatures of pathogens. This “multiomic” approach could allow us to not only identify the presence of the pathogen but predict such things as its pathogenicity and virulence.
Finally, by investigating host response we should look for concepts that not only identify the presence of the agent but predict how sick the person will get. In military medicine, in a combat situation, military doctors often triage patients in order to better provide care. What if we could do that with an infectious disease like COVID-19? Imagine being able to tell a person that they will experience mild symptoms or they need to be immediately admitted to a hospital and administered lifesaving therapy. Not only could this allow for better treatment, but it would be a way to better manage limited medical supplies.
All of these approaches share a comment element. They are not only unique pathogen directed identification approaches, but they allow us to better predict how the threat will manifest itself and how it could affect people. As the biological threat evolves our approaches must change with it. The afore mentioned concepts are just a couple ways to do this. I challenge you to come up with the next revolutionary concept and/or technology to better prepare us for the next emerging biological threat.
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Dr. Richard Schoske – Serves as Chief, Diagnostics, and Detection Division for the United States of America Defense Threat Reduction Agency (DTRA), Research and Development Directorate, Chemical Biological Technologies Department (RD-CB). In this capacity Dr. Schoske overseas and manages an $80 million Research and Development Portfolio. This portfolio includes projects in the areas of medical diagnostics, and chemical and biological agent detection.
His educational background is in Biochemistry, Chemistry and Clinical Laboratory Sciences. He has applied this knowledge in operational work experiences involving the development and deployment of novel medical diagnostic systems for the United States Air Force. Dr. Schoske has an extensive background in counter Chemical-Biological Consequence Management Planning. Prior to joining the DTRA, Dr. Schoske served in the United States Air Force for 21 years and is a retired Lieutenant Colonel.
During his time on active duty he served in numerous capacities including Chief, of a Medical Laboratory, Assistant Professor of Chemistry at the United States Air Force Academy, Principal Investigator in Diagnostic R&D, and Emergency Medical Planning. He was selected as a Senior Air Force Laboratory Fellow for Science and Technology and is an American Society of Clinical Pathologists Certified Medical Technologist. He earned a Master’s of Arts in Biochemistry from the University of Scranton, and a PhD in Chemistry from American University in Washington DC.