By Chris Chadwick, Specialist, Public Health Preparedness and Response, Tyler Wolford, Specialist, LRN, and Kara MacKeil, Associate Specialist, Public Health Preparedness and Response
Many of us in public health have become familiar with the US Army Medical Research Institute of Infectious Diseases (USAMRIID) and its role in scientific research and biodefense. However, what we don’t see in the movies is its long-term and far-reaching involvement in the overall preparedness of our nation. APHL’s Public Health Preparedness and Response (PHPR) team recently visited USAMRIID at Fort Detrick, MD, as part of the Laboratory Response Network’s (LRN) Operational Workgroup, and we were fortunate to spend some time touring the facilities and learning more about USAMRIID’s history.
Officially created in 1969 when the existing US Army Medical Unit (USAMU) was renamed, USAMRIID’s stated mission is: “We conduct research on current and emerging biodefense threats, resulting in medical solutions to protect the warfighter.” The benefits of the facility’s research aren’t limited to the armed forces though. USAMRIID’s work includes vaccine and treatment research, and their scientists offer expert consultation and training for medical personnel. During our tour we also learned that one of the first ever laboratory gloveboxes was put together in the Fort Detrick machine shops in the 1940s.
There are more interesting things than gloveboxes in Fort Detrick and USAMRIID’s history though. One of the most thought-provoking things we observed on our tour was USAMRIID’s famous Eight Ball, a piece of US history that’s protected under the National Register of Historic Places. This one million liter metal sphere is currently tucked away behind a service building, but at one point it was the epicenter of Operation Whitecoat, the US Cold War biodefense program. From the 1950s through the ‘70s, researchers developing treatments for biological agents released small amounts of these selected agents into the eight ball, allowed them to disperse, and then exposed volunteers to this contaminated air via specially rigged gas masks. By treating the volunteers (who signed consent forms) with their newly developed vaccines and therapies, scientists were able to develop effective methods to respond to biological warfare. Whitecoat volunteers were exposed to agents that cause diseases such as rabbit fever (tularemia), Q fever, yellow fever, and plague.
Operation Whitecoat and the eight ball experiments may seem shocking to modern readers, but the volunteers were scrupulously screened and educated on the risks and gory details before agreeing to participate. They received the best medical attention possible at the time, and they were free to end their participation at any point. Although work in the eight ball was discontinued in the mid 70s, many still return to USAMRIID for annual get-togethers commemorating their work.
Of course, the work didn’t end with Operation Whitecoat. National laboratories like USAMRIID are the pinnacle of the Laboratory Response Network (LRN), and are responsible for specialized strain characterizations, bioforensics, and handling highly infectious biological agents. These activities require significant planning and state of the art facilities to ensure the safety and security of scientists and that the right results are obtained.
Although most LRN testing at USAMRIID is done in Biosafety Level 3 (BSL-3) equipped laboratories, it is one of a few laboratories in the United States that has BSL-4 facilities. Biosafety level is the level of biocontainment required to work with specific biological agents based on the risk posed by the agent and the activities required for testing. Each level requires a unique set of safety equipment, facility designs, and practices that reduce the risk of laboratory-acquired infections. BSL-4 laboratories are equipped to handle the most dangerous organisms, such as Marburg, Ebola and Smallpox viruses that are highly infectious and potentially lack countermeasures (prevention and treatment).
The most noticeable difference in BSL-4 laboratories is the use of full-body pressurized suits, often referred to as “space suits.” For reference, imagine the movie scene from E.T. the Extraterrestrial where the space garbed scientists ominously invade a home searching for the alien. These suits are the highest form of personal protective equipment and are required for work in BSL-4 labs. BSL-4 also requires scientists to take chemical showers, enter vacuum rooms, and be exposed to UV light in order to destroy any trace amounts of the organisms after testing.
USAMRIID is a vital resource for definitive testing of emerging high-risk biological threats. For an interesting read, check out The Hot Zone written by Richard Preston, which highlights USAMRIID’s involvement in the 1989 discovery of Reston virus, a mutated strain of Ebola virus that surfaced near the nation’s capital.
USAMRIID is also heavily involved in the training of first responders across the world, including hazardous materials teams and National Guard Civil Support Teams (CSTs), tactical response teams, emergency communications, and others. These trainings have gained significant respect in the public health and public safety communities. In addition to their high quality, the trainings are standardized, so a team from Washington will receive the same training and competencies as a team in Maryland. These courses have also benefitted from partnership with other LRN members over the years, allowing USAMRIID to truly integrate all players involved in a typical threat response. For example, we learned of several instances where public safety (law enforcement and fire) was integrated with one of APHL’s own member laboratories to provide on-scene screening and then confirmatory analysis via the LRN.
USAMRIID’s Field Operations and Training Branch (FO&T) provides two courses to first responders: the Biological Agent Identification and Counterterrorism Training (BAIT) and the Field Identification of Biological Warfare Agents (FIBWA) Course. BAIT provides first responders with one- or two-day realistic bioterrorism scenarios that require an integrated response, emergency communications, rapid decision making, analysis of biological threat agents, and an after action review once the exercise is complete. During APHL’s visit to USAMRIID, we had the opportunity to tour the onsite facilities that FO&T utilizes for these training scenarios. The facilities are actual trailers that have been rigged to serve as mock clandestine laboratories. As part of the scenarios, supposed terrorists have a DIY setup for weaponizing agents (e.g., making anthrax-like powders to stuff into envelopes and packages). To test the first responders, there are clues throughout the trailer (think quirky living arrangements, basic chemistry textbooks, and large plastic containers…the kind of stuff you probably saw in Breaking Bad) that suggest the presence of a clandestine lab. Another scenario involves searching a packed storage unit (a replica from an episode of Hoarders, probably) for suspicious powders; participants especially dislike this one because they’re required to remove and test every piece of equipment even though the powder is rather easy to find. The BAIT program is nationally recognized as a premier course for all first responders, and therefore, FO&T is constantly training a variety of groups from all over.
FO&T’s other course, FIBWA, provides first responders with an intensive four-week syllabus on conducting laboratory operations under field conditions. Participants become very familiar with agent detection assays over the four weeks as they work to extract nucleic acid, perform polymerase chain reaction (PCR), and practice electrochemiluminescence (ECL) to detect threat agents and toxins. FO&T has several mobile laboratories at their disposal, so the trainees must adapt to tighter, more consolidated spaces. FO&T can host the trainings at Ft. Detrick, but the mobile labs do travel well so trainings can come to you.
USAMRIID is truly instrumental in national biodefense history, response, research, and training, and has outstanding resources for APHL’s membership.