In this part of my conversation with Prof. Dr. Manfred Wildner and Dr. Herbert Zöllner in Munich, we are discussing biothreat and pandemic preparedness in Germany.
Dr. Zöllner worked for the World Health Organization from 1971-2002, in a variety of roles. He was Regional Officer for Health Economics at WHO’s Regional Office for Europe in Copenhagen and later member of the executive management team in Strategic Planning and Coordination.
He was also a key member of the team developing the “Health for All” policy in Europe, which was adopted by all WHO member states. He has contributed to a wide range of WHO publications. Dr. Zöllner teaches courses on comparative systems and public health management at Ludwig-Maximilians-Universität in Munich and provides advice to Bavarian health authorities on new disease prevention and health promotion initiatives. He has a Ph.D. in Economics from the University of Colorado.
Professor Wildner is Director of the Health Division at the Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (Bavarian Health and Food Safety Authority). In close cooperation with the Institute for Medical Information Processing, Biometry and Epidemiology at Ludwig-Maximilians-Universität, an interdisciplinary professorship for Public Health Policy & Administration was created at the Pettenkofer School of Public Health, which is held by Professor Wildner. His current area of research is public health policy and administration. He studied medicine and worked as a doctor in Germany, the UK and in the US for several years. He also holds an MPH from the Harvard School of Public Health.
Dr. Zöllner and Professor Wildner are based in Munich, Germany.
Q: How well is Germany set up to defend itself against biothreats and pandemics? What measures are in place to safeguard against such dangers?
Prof. Wildner: You have to look at two aspects: the first is infrastructure, which is not specific to public health, the second is whether the right public health defense mechanisms are in place. Regarding infrastructure, ours is well-trained and very well developed, including with advanced technology, so we are doing fine on this front. Plus, we have a health care system which has enough capacity to respond to a pandemic. In terms of the Public Health Service, we have the International Health Regulations and we are compliant with them. I think our weakness is in research and development, not in practical aspects.
Dr. Zöllner: Just before retiring, I had a meeting at the WHO with chief medical officers of the Western European countries. It was just after 9/11 and the meeting was very simple. We wanted to know what terrorism threats might exist, whether the countries were prepared to handle them, and what their experiences were.
We started by considering terrorist threats that were already historically present in these countries, including in the Basque territory, in England and Northern Ireland, and in Chechnya. So, what is terrorism? It is any act designed to frighten people with a minimum of effort. It’s not about killing as many people as possible, but rather about attacking peoples’ spirit.
To speak on behalf of the victims, the head of the European victim organization from Paris told us how it felt to be a victim, which at that time in France primarily consisted of Jews and, occasionally, Muslims; how one had to be vigilant and work against the groundswell of right-wing movements.
The most important topics regarding terrorist threats at that time involved countries or terror organizations mutating viruses, dirty bombs, chemical, and nuclear threats.
Regarding viruses, our view was that only states would have laboratories capable of handling the most dangerous pathogens, but some already foresaw that labs would miniaturize. Chemical weapons were thought to be a threat but they cannot be used over large areas. You might deploy them in a subway, as happened in Japan, or in a movie theatre. Its effects would be limited, but they could still instill terror.
The devious part of 9/11: the terrorists used primitive means like hijacking together with very sophisticated technical knowledge of how to attack buildings. This increases also the threat of terror on nuclear plants. With regard to nuclear safety – and this was one of the lessons from Chernobyl – in the end the health consequences in Europe might depend on how the wind blows.
Q: What do you think is the main terror threat today?
Dr. Zöllner: A threat that is high on my list is digital terrorism. It’s very simple: the more networked systems get, the more vulnerable they are. In the future, terrorism won’t come from biological, chemical, nuclear, or explosive threats, it will come in digital form. Attacks, for instance, on communication networks, can be severe. For example, right after the 9/11 attacks, New York hospitals had major problems because communication broke down almost completely. They would have needed more burn specialists in the hospitals, for instance, but they could not get those people in and could not get less injured people out.
Regarding simulated response planning for attacks on communications infrastructure, two countries reported that they had already conducted such exercises. One reported that they carried out two exercises, but in both cases the city at issue was lost: it was London. The other country that had conducted such exercises was Switzerland. It was the only one that successfully completed its simulations, because for every eventuality, the Swiss knew exactly who was in command and what the chain of command was.
Of course, that was quite some time ago, so I would think everyone is better prepared today!