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Bioterrorism and Food Safety: Developing an Effective National Response
November 12, 2001

University of Minnesota Academic Health Center Conveners:

• Center for Infectious Disease Research and Policy
• Center for Animal Health and Food Safety
• School of Public Health Division of Environmental and Occupational Health

Participants:

• Representatives from government, including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the US Department of Agriculture (USDA), and the Minnesota Department of Health (MDH) (see Appendix A)
• Representatives from food-system industries (see Appendix A)

This document is divided into the following sections:

Statement of the Problem
Needs Assessment for Addressing Problem Areas
Potential Action Steps
Appendix A: List of Participants

The material covered in Sections 1 through 3 was taken from prepared remarks presented by speakers and from discussions among group participants..

Statement of the Problem

Industries that comprise the US food system from farm to table are potential targets for bioterrorism and terrorist hoax situations. Terrorists could create harm through: (1) final product contamination using either chemicals or biological agents with the intent to kill or cause illness among consumers, (2) disruption of food distribution systems, (3) damaging the agricultural economy (which makes up roughly 17% of the gross domestic product) by introducing devastating crop pathogens or exotic animal diseases such as foot-and-mouth disease, or (4) hoaxes, which create anxiety and fear and which could severely impact an area of the food system.

Efforts to develop effective preparedness and response strategies for protecting the nation's food supply pose substantial challenges for a number of reasons, including the following:

• The food system encompasses many different industries.
• Security issues vary by industry.
• Agricultural and food production facilities are scattered throughout the country, making coordination of security responses difficult.
• The US food supply is global, with a wide range of imports continually entering the country from around the world.
• Chain restaurants, which have extensive and complex food-supply chains, comprise an important sector of food service in the United States.
• High turnover rates exist among food-system workers, creating challenges for monitoring personnel security.
• Many workers are immigrants, and systems to assure the authentication of such workers are not in place.
• A variety of potential bioterrorism and chemical agents could contaminate the food supply, and the possible scenarios for deliberate contamination events are essentially limitless.
• Information on potential targets and vectors is lacking.
• Protocols that address bioterrorism preparedness and response for the food system are lacking. Examples of issues where guidance is needed include surveillance methods for farms and production facilities, appropriate levels of farm or facility security, evacuation plans and procedures, crisis management, risk communication, and product-recall procedures.
• The potential for hoax situations is high; such situations utilize limited resources and strain existing response systems.
• Effective protection and decontamination strategies for the food system have not been developed and tested.
• The public health system is complex, and responsibilities for prevention and control may overlap or may fall in the gray area between authorities of different agencies.
• Public health resources to assist industry and to coordinate effective preparedness and response strategies at the local, state, and federal levels are limited.
• Concerns about government over-regulation and the proprietary nature of information within various food industries create barriers to effective sharing of information and coordination of emergency responses.
• Recognition of a foodborne bioterrorism attack may be delayed because of background levels of foodborne disease and potential wide distribution of a contaminated product or ingredient.
• Systems for coordinated emergency response/crisis management between industry and government may not be adequate to deal with a serious threat to the food system.
• Rapid diagnostic methods for identifying bioterrorism agents in food are not consistently available, and coordinated laboratory systems for detection are not fully operational.
• Rapid trace-back procedures for potentially contaminated products are not consistently in place.

Needs Assessment for Addressing Potential Problem Areas

The goals of national food and agriculture biosecurity include:

• Mechanisms to decrease the potential for contamination of or damage to the food supply from farm to table (ie, prevention activities)
• Systems to ensure early detection of deliberate food contamination at any point along the production pathway, including surveillance, rapid laboratory diagnostics, and communication systems
• Systems to ensure a rapid and thorough response if an attack occurs, including protection of workers, customers, and consumers (ie, emergency response, control, and mitigation activities)

To achieve adequate food and agricultural biosecurity, the activities described below are needed in the areas of prevention, detection, and response. In addition, appropriate areas for applied research need to be identified and a research agenda needs to be developed.

Prevention

• Education for food producers about which bioterrorism and chemical agents would likely contaminate food, where in the production process contamination would likely occur, and what food-processing steps can be taken to eliminate or inactivate potential agents and chemicals
• Guidance on how to assess plant or company vulnerability against a bioterrorist attack
• Guidance on how to reduce the likelihood of a bioterrorist attack

Detection

• Methods for identifying credible threats, so that incidents may be appropriately triaged and responded to according to level of risk
• Rapid and secure communication systems for sharing information on unusual events or occurrences within the industry; such systems may include "snap surveys" as necessary
• Enhanced laboratory capacity, including improved coordination, communication, and information sharing between the public and private sectors
• Primer for clinicians (including signs, symptoms, laboratory diagnosis, and treatment) on potential high-impact foodborne bioterrorism agents (eg, foodborne anthrax, botulism toxin, chemical agents) to aid in rapid recognition of outbreaks

Response

• Guidance on developing action plans for response, including information on which agencies to contact for which types of events
• Methods to increase government/industry coordination for investigating foodborne outbreaks, including issues of improving product traceability
• Improved coordination between animal health, public health, law enforcement, and industry for responding to bioterrorism events
• Guidance on developing streamlined systems for risk management communication (including public relations) throughout a product supply chain from farm to table in the event of a real bioterrorism attack or a hoax situation
• "Just-in-time training" that provides scientifically sound and accurate information in a timely manner to key industry leaders, employees, public health officials, and consumers in response to current events involving new or re-emerging disease threats

Potential Action Steps

A number of potential action steps to address possible problem areas were raised during group discussions:

Convene a working group to address issues of food biosecurity from farm to table. The working group would include representatives from food-system industries and government. The group would meet on an ongoing basis and would develop a strategic plan for food biosecurity, including development of a research agenda. The group also would serve as a mechanism to promote improved coordination between industry and various government agencies.

Develop a primer for food producers that would include information about which bioterrorism and chemical agents would likely contaminate food, where in the production process contamination would likely occur, and what food-processing steps could be taken to eliminate or inactivate potential agents and chemicals.

Develop a guidance document on how to assess plant or company vulnerability against a bioterrorist attack and steps to reduce the risk for such an attack.

Develop a protocol for assessing credible threats and methods for triaging them. This protocol also could address methods for dealing with hoaxes.

Explore the feasibility of developing a confidential, nonregulatory, rapid surveillance/communication system that would detect unusual occurrences throughout food industries and provide real-time communication regarding events that may be of importance to food biosecurity. Issues that need to be addressed when considering implementation of such a system include: (1) where the system would be housed, (2) how the system would be funded, (3) how data would be generated, (4) how data would be analyzed, summarized, and disseminated, and (4) how "snap surveys" could be utilized as part of the system.

Develop a primer for clinicians on high-impact foodborne bioterrorism agents (eg, foodborne anthrax, botulism toxin, chemical agents).

Review examples of existing action plans that have been developed by food-system companies and trade associations and develop a checklist of critical components that should be included in such plans.

Develop additional training materials on bioterrorism preparedness and response for the food industry, such as webcasts with experts in various fields.

Explore methods to increase the speed of investigating foodborne outbreaks through better coordination between government and industry, including issues of improving product traceability.

Investigate strategies for developing coordinated, streamlined risk management communication systems (both internal and external) throughout a product supply chain in response to bioterrorism attacks or hoax situations.

Support efforts to enhance national laboratory capacity and to establish standards for electronic communication of data between laboratories.

Appendix A: List of participants

Mark Becker, PhD Dean, School of Public Health University of Minnesota Larry Bell Chief Technical Officer Fresh Express Fresh Foods Jeff Bender, DVM, MS Diplomate, ACVPM Assistant Professor College of Veterinary Medicine Veterinary Public Health Dane Bernard Vice President Food Safety and Quality Assurance Keystone Foods LLC John Besser Clinical Laboratory Manager Minnesota Department of Health Shirley Bohm Director Dairy and Food Inspection Department of Agriculture Andy Bonanno Deputy Regional Food and Drug Director Chicago Field Office (Regional Office) Food and Drug Administration Phillip Brooks President Brooks Produce Frank Busta Professor Food Science and Nutrition Institute for Food Technologists Anita Colglazier Director of Quality Assurance Armour-Swift Eckrich Michael Cooper, PhD Office of Public Health Science Human Health Science Division United States Department of Agriculture Richard Danila, PhD Acute Disease Epidemiology Section Minnesota Department of Health Mark Dopp American Meat Institute Forrest Dryden, PhD Hormel Foods, LLC Chet England Senior Director Product Safety and Regulatory Chief Food Safety Officer Burger King Corporation Susan Ferenc, DVM, PhD Vice President Scientific and Regulatory Policy Grocery Manufacturers of America Bill Fry Vice President Quality Assurance and Environmental Affairs HEB Grocery Co., LP Donna Garren Vice President Scientific and Technical Affairs United Fresh Fruit and Vegetable Association Edith Garrett International Fresh-cut Produce Association Jim Gorny, PhD Technical Director International Fresh-cut Produce Association Craig Hedberg, PhD, MS Associate Professor Environmental and Occupational Health School of Public Health University of Minnesota Barbara Hines President & CEO Director, Crisis Preparedness and Response Group Big Think Marketing and Communications Corp William Hueston, PhD, DVM Director Center for Animal Health and Food Safety University of Minnesota William Krueger Director Laboratory Services Division Minnesota Department of Agriculture Mahesh Kumar, DVM, MS, PhD Diplomate ACPV Beth Lautner, DVM, MS Vice President, Science and Technology National Pork Board

Joseph Levitt, Esq Director, Center for Food Safety and Applied Nutrition Food and Drug Administration Sara Lilygren Senior Vice President Legislative and Public Affairs American Meat Institute Michael Loftis, RS Director of Quality Assurance Ruby Tuesday, Inc. Judy Mandy Executive Assistant Center for Infectious Disease Research and Policy University of Minnesota Ann Marie McNamara Vice President Food Safety and Technology Sara Lee Foods Graham Miller Director of Quality Assurance Buffets, Inc. Kris Moore MD, MPH Medical Director Center for Infectious Disease Research and Policy University of Minnesota Ellen Morrison Director Division of Emergency and Investigational Operations Food and Drug Administration Terry OBrien Legal Consul Center for Infectious Disease Research and Policy University of Minnesota Michael Osterholm, PhD, MPH Director Center for Infectious Disease Research and Policy University of Minnesota Julie Ostrowsky Program Director Center for Infectious Disease Research and Policy University of Minnesota Christine Roberts Interim Associate Director Center for Infectious Disease Research and Policy University of Minnesota Sara Thurin Rollin Director Corporate Policy Development Cargill, Inc. Michael Schommer Communications Director Office of the Commissioner Minnesota Department of Agriculture Jenny Scott Senior Director National Food Processors Association Food Safety Programs Dan Skrypec, PhD Scientific Relations Worldwide Toxicology Kraft Inc. Kirk Smith DVM, PhD State Public Health Veterinarian Acute Disease Investigation and Control Section Minnesota Department of Health Jeremy Sobel, MD Bioterrorism Activity, Foodborne and Diarrheal Diseases Division of Bacterial and Mycotic Diseases National Center for Infectious Diseases, Centers for Disease Control and Prevention Radivoje Spasojevic, DVM, MS, PhD Diplomate ACPV Technical Service Veterinarian Sparboe Companies William Sperber, PhD Senior Corporate Microbiologist Cargill Corporate Food Safety Mike Starkey Planning Director Minnesota Department of Agriculture Katherine Swanson, PhD Director Microbiology and Food Safety General Mills Robert Tauxe, MD, MPH Chief, Foodborne and Diarrheal Diseases Division of Bacterial and Mycotic Diseases National Center for Infectious Diseases, Centers for Disease Control and Prevention Donald Vesley, PhD Professor Environmental and Occupational Health School of Public Health University of Minnesota