Despite the horrendous scale of the Deep Water Horizon oil disaster, America is indeed fortunate to have Admiral Thad Allen at the helm as the National Incident Commander. His decades of service in the U.S Coast Guard provide him the technical knowledge and leadership skills to manage the “unity of effort” required to coordinate this complex operation that includes federal, state and local government assets plus private-sector and NGO efforts. Additionally, his demeanor and communication skills make him an outstanding spokesperson for the national response. I trust what he says.
One advantage in this response scenario is that we, unfortunately, have a lot of experience with oil spills—never on this scale, but national plans and organizational structures have been developed, tested, and improved for decades. Such is not the case for a response to bioterrorism.
Today there are more than two-dozen Presidentially-appointed, Senate-confirmed individuals with some responsibilities for biodefense, but not one has it for a full-time job, and no one is in charge. Who would be in charge of coordinating a response to an act of bioterrorism, using a contagious pathogen, that was detected in multiple states, counties, and cities?
We would most certainly need someone with Thad Allen’s character, expertise, and leadership and management skills, but that alone would not be enough if the proper organizational structure was not available. As General Eisenhower said, “The right organization will not guarantee success, but the wrong organization will guarantee failure.”
For response to an act of bioterrorism, is America organized for failure?
Biosecurity Blog 
Right on! My only question is whether Thad Allen actually has as much overall authority as is really needed as well as requisite staff to assure that what is being promised is actually delivered. I sense that there are important areas with respect to dispensing of funds and organization of community support that need considerable strengthening.
D.A. Henderson
I have never been much taken with the “who’s in charge” problem for bio writ large – preventing/mitigating/countering/responding to/recovering from a biological attack necessarily crosses so many professional communities and jurisdictions that one has to deal with the world as it is; it isn’t worth spending a lot of time wishing that the universe or the issue were organized in some way that makes a single decisionmaker possible. Anyone in charge has to have a very light touch in ordering around others who also have essential roles.
If you slice various parts of the problem away, however, you can get down to a core for which having someone in “charge” is not unreasonable. First of all, let’s just look at response; leave prevention aside. Within response, most of the equities are state/local, so a federal official can’t technically be “in charge,” but we also know that the states and localities can’t and won’t be able to deal with a problem having 1) sufficient scale; 2) extended geographic scope; and 3) unfamiliar technical attributes. State and local authorities will look to a federal official even if that official doesn’t have legal authority over them, and it is important that the federal government not sit around waiting to be asked to help.
Restricting the issue to the federal component (including support to state and local authorities) of the response to a terrorist attack, one is starting to get close to where having a predesignated person or agency “in charge” might be helpful.
Picking one, however, will have to be an arbitrary call. You can’t say that a bioterrorist attack is not a health incident, so HHS is essential. You can’t say it isn’t a terrorist attack or a disaster, so DHS is essential. You can’t say it isn’t a problem of investigation, interdiction, and preventing a repeat, so FBI is essential. And for a biological attack of sufficient magnitude, DoD and the military are going to get called in (and now they know it and are training, staffing, and equipping for it, unlike 5 or so years ago). All these agencies have distinct responsibilities, all of which (for the purposes of responding to a biological attack) at least partially overlap. So to have someone be “in charge” means making an arbitrary call and making sure that everyone else remains involved too. There isn’t any right approach to this; we just have to pick one and move on.
If I had to pick one, I’d pick HHS, because now that they have an explicit security mission and organization, I think they can cover that space more readily than any of the other candidates can cover health. But most people, I suspect, will pick their choice for “who’s in charge” not on agency roles and missions, but on personalities and judgements about organizational experience, maturity, and competence.
Gerald Epstein
In a big bio event, it is unlikely that the response will be just medical in nature. Rather, I can easily envision the need for a “whole of government/whole of society” response which addresses issues that go far beyond the medical realm. For example, if the event involved a contagious agent, ensuring that essential services (e.g., electric generation and distribution, food production and distribution, etc.) continued might be required. I don’t question the appropriateness of having health professionals run the medical side of the response but I do question whether or not HHS is the most appropriate entity to be “in charge” of that overall response.
The “who’s in charge” issue, in my experince, frequently gets wrapped around an all too common but naive mental image of a monolithic response run out of a single command center. This notion is wrong. If you look at a military theatre of operations, there will be a single apex command center but there will be numerous subordinate command centers and command posts executing various slices of the overall operation. What quides the overall operation is a single concpet of the operation and a single “Commander’s Intent,” under which subordinate elements deal with their assigned tasking, which can be broken down by either or both geographic boundaries and specialized functions. Medicine would be one, but only one, of the specialized functions that would have to be incorporated into a response to a big bio event.
If you prefer a different, less militarized analogy, think of a symphony. Each musician plays his or her instrument, but only according to a master concept (i.e., Commander’s Intent) set down by the composer and executed under the direction of the conductor (who is sometimes also the composer). Medicine might be the string section, but you still need the brasses (security), the woodwinds (logistics), the percussionists (public affairs) and others to have an orchestra. Of course, you also need a staff to clean and maintain the building (critical services). Done right, you have a whole which is far greater than the sum of its parts. Done wrong…well, we don’t want to go there.
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