The bioterrorism threat to America’s children

A month after the Christmas Day underwear bomber suspect revealed a gravely ineffectual air travel terrorism prevention system, a new report was released giving the federal government an “F” for its failure to prepare for the nation’s most urgent threat: bioterrorism.

This was a breathtaking assessment from the bipartisan Commission on the Prevention of Weapons of Mass Destruction, Proliferation and Terrorism. Even more alarming was that the report focused almost exclusively on our ability to protect adults. In other words, a quarter of the population — children — weren’t even on the commission’s radar. In fact, federal agencies have been aware of this gaping hole in our bioterrorism response system but have done little to change it.

Consider this: Children are at a greater risk for death from nerve agents than are adults. These agents stay low to the ground, where young children can be found; children inhale them faster than adults do; young children’s skin is more permeable to them; and they sicken and kill children faster than they kill adults. But nerve agent antidotes have been tested only on adults, and automatic anti-toxin kits (similar to EpiPens) are approved by the Food and Drug Administration only for adults.

That means that if a nerve agent were released somewhere in the United States, health care workers would be able to treat adults rapidly, while children would be vulnerable to seizure and death. The only approved medications for children have to be manually and individually drawn up from vials, while the health care providers are in chemical protective gear.

Pediatric medications and their delivery mechanisms tend to be more difficult and expensive to test, develop and acquire compared with those for adults — and there’s not as much of a place in the market for them.

The root problem is that the necessary testing is unlikely to ever occur; there are not adequate incentives or a large enough profit margin to encourage pharmaceutical companies to invest in the production of these kits.

In its interim report delivered to the president and Congress just four months ago, the National Commission on Children and Disasters called for sweeping reforms:

• Dedicate more research dollars and revamp industry incentives to speed the development and purchase of medical countermeasures specifically for children.

• Call on leaders of the FDA to resolve long-standing calls from the pediatric community to approve the use of auto-injectors specifically designed for children and approve for use in children certain additional medical countermeasures approved for adults, which may be the very best preventive, diagnostic or therapeutic options available.

• Create a standing advisory committee of federal and external experts to advise Health and Human Services Secretary Kathleen Sebelius on issues pertaining to pediatric emergency medical countermeasures.

• Include a pediatric voice throughout decision-making bodies in the federal government.

There has never been a more important moment, in need as well as potential for catastrophic consequences, to secure an appropriate place for children’s issues in the national disaster preparedness agenda.

The Obama administration and Congress should act on these two separate, though not mutually exclusive, commission reports to generate a turning point in the way the federal government, academia and industry take responsibility for protecting our children during catastrophic events.

Mark Shriver is chairman of the National Commission on Children and Disasters.