1. Emergency Medical Countermeasures Development and Acquisition BARDA’s Role and Biodosimetry Ronald G. Manning, Ph.D. Chief, Chemical, Radiological and Nuclear Medical Countermeasures Project BioShield Biomedical Advanced Research and Development Authority (BARDA)

2. ASPR HHS Assistant Secretary for Preparedness and Response (ASPR) Office of Preparedness & Emergency Operations Vision:A nation prepared to prevent, respond to and reduce the adverse health effects of public health emergencies and disasters. Mission:Lead the Nation in preventing, preparing for and responding to the adverse health effects of public health emergencies and disasters.

3. ASPR 2 BARDA: Roles and Responsibilities Coordinates an integrated, systematic approach to planning for, and executing research, development and acquisition of medical countermeasures for public health emergencies Supports the ASPR in leading the Public Health Emergency Medical Countermeasure Enterprise (PHEMCE) Drives medical countermeasure analysis and prioritization – HHS PHEMCE Strategy for CBRN Threats – HHS PHEMCE Implementation Plan for CBRN Threats Executes advanced development and acquisition of medical countermeasures for CBRN threats and pandemic influenza – Advanced development under BARDA – Acquisition under Project BioShield (CBRN material threats) – Acquisition with direct appropriations for pandemic influenza CBRN: chemical, biological, radiological, and nuclear

4. ASPR HHS Public Health Emergency Medical Countermeasures Enterprise BARDA NIH CDC CDC and OPEO Utilization Research and Development Advanced Development Acquisition Storage/ Maintenance Biosurveillance/ Detection PHEMCE COORDINATED PLANNING & EXECUTION BARDA and CDC National Biodefense Science Board Deployment CDC and DHS FDA

5. ASPR Purpose: To coordinate across the full spectrum of public health emergency preparedness activities for all intentional and naturally occurring threats Established by HHS in July 2006 HHS Public Health Emergency Medical Countermeasures Enterprise Interagency partners include: Department of Defense Department of Homeland Security Veterans Administration

6. ASPR Defining and Prioritizing Medical Countermeasure Development and Acquisition Programs Scoping the Mission Develop medical countermeasures that are deployable and readily dispensable Address a diverse set of threats: CBRN and Influenza Consider the needs of a large, diverse population Prioritize acquisition and advanced development programs with limited funding Face product development challenges: lengthy, risky, and expensive

7. ASPR Maximizing Opportunities for Collaboration Building a True Enterprise Bring together medical and public health assets more effectively Measurement is vital Build capacity to perform best practices Provide coordinated federal assistance to supplement state, tribal, and local resources in response to public health and medical care needs

8. ASPR Establishment of Medical Countermeasure Requirements HHS will establish concepts of operations (“conops”), including storage, maintenance, utilization policies and deployment plans for each medical countermeasure in the context of all available consequence mitigation strategies and capabilities. HHS will define specific medical countermeasure requirements, including product specifications consistent with US Government storage plans and operational capabilities for deployment and utilization by federal, state, and local authorities.

9. ASPR Plague Antibiotics Smallpox Smallpox vaccines (MVA and ACAM2000) Vaccinia Immune Globulin (VIG) Tularemia Antibiotics Anthrax AVA Vaccine Oral ciprofloxacin Doxycycline Amoxicillin Other IV antibiotics Human polyclonal antibody Botulism Antitoxins from legacy DOD program and legacy CDC/Cangene program Other monovalent and bivalent antitoxins Medical Countermeasure Preparedness for CBRN Threats BIOLOGICAL THREATS KI tablets and Pediatric KI Prussian Blue Cytokines Antibiotics Anti-emetics Blast and burn supplies Ca & Zn DTPA RADIOLOGICAL / NUCLEAR THREATS CHEMICAL THREATS CHEMPACKs

10. ASPR Radiological/Nuclear Threats Nuclear Detonation Radiologic dispersive devices (“dirty bombs”) Industrial and shipping accidents Power plant releases Food and medical irradiators Sealed sources

11. ASPR 10 adapted from: Blood, 15 June 2008, Vol. 111, No. 12, pp. 5440-5445. IND Models for a 10 KT event estimate 1.8 million affected 1 million may seek information on their personal risk (dosimetry), Hundreds of thousands estimated to receive > 2 Gy if event occurs in a large metropolitan area Radiation Exposure Events EventDescription Potential Numbers Affected Radioactive Source Accident Hospital irradiation source (Co-60) Industrial x-ray source (Ir-192) Example: Goiania (Cs-137 source) individuals to many Nuclear Reactor Accident Release of radioactive material Example: Chernobyl individuals to hundreds (can cover large geographical area) RDD – Radiological Dispersal Device, “Dirty Bomb,” or Exposure Device Improvised explosive device containing radioactive material May include food chain contamination Cs-137 or Ir-192 sources on a subway individuals to thousands Improvised Nuclear Device (IND) A true, or assembled, nuclear device capable of a nuclear detonation thousands to > 1 million

12. ASPR 11 NO mass casualty biodosimetry capabilities at this time 11 Triage and Patient Monitoring after an IND Event TRIAGE People requiring immediate medical intervention (burns, fractures, blood loss) People receiving radiation doses > 2 Gy (risk of hematological ARS) Concerned citizens Expectant (likely to die) Complications: Many inhomogeneous irradiations (partial body exposures) Correct triage and treatment depends on rapid and accurate radiation dose estimates Currently a multi-parametric approach is used to estimate radiation dose: Location relative to event Time from event to first emesis Peripheral blood lymphocyte counts & depletion kinetics (hours to days) The utility of these measures in response to an IND event is not clear.

13. ASPR 12 Current Biodosimetry Capacity Biodosimetry capability will be integral to triage, treatment, and medical management of radiation-exposed individuals. Dose evaluation based on clinical signs and symptoms can lead to a high level of false positives and lead to unneeded treatment. The "gold standard" for biodosimetry is chromosomal aberrations (i.e. dicentrics). Dicentric quantification o requires several days to perform; o is labor intense; o is only available in specialized centers (a Laboratory Response Network is in development). Immediate need: Rapid dose assessment tools or bioassays.

14. ASPR CBRN Dosimetry Objectives Pursue diagnostic capabilities for dose determination Physical dosimetry tools for exposure Rapid biodosimetry assays to estimate doses >2 Gy Rapid biodosimetry assays to determine dose 1 – 20 Gy Gold standard assays using novel biomarkers – i.e. organ-specific radiation injury/susceptibilities Rapid determination of radionuclide exposure and body burden 13

15. ASPR Contact Information: BARDA@hhs.gov www.hhs.gov/aspr/barda www.medicalcountermeasures.gov ANY QUESTIONS?????