The 1999 West Nile virus warning signal revisited

ABSTRACT

The 1999 unprecedented emergence of West Nile virus in the western hemisphere represented a health security warning intelligence failure. This paper reviews the timeline of warning signal recognition and associated missed opportunities to bridge strategic and tactical assessments. The complexity of signal evolution involving multiple public and private institutions and professional disciplines, coupled to inherent biases and shortfalls in interpretation, resulted in significant delays in warning communication and lost opportunity for preparedness and emergency response.

Acknowledgements

The authors gratefully acknowledge the manuscript reviewers for their comments.

Disclosure statement

Dr. Wilson is employed by M2 Medical Intelligence.

Notes

1. Centers for Disease Control and Prevention, “West Nile Virus.”

2. Centers for Disease Control and Prevention, “Provisional Surveillance Summary.”

3. Crosby, “Virgin Soil Epidemics.”

4. U.S. Government Accountability Office, “West Nile Virus Outbreak.”

5. Ibid.

6. Newspapers.com.

7. PubMed.gov.

8. Bureau of Transportation Statistics, “Air Carriers.”

9. Tsai et al., “West Nile Encephalitis.”

10. Hubálek and Halouzka, “West Nile fever”; Hubálek, Halouzka, and Juricová, “West Nile fever”; and Giladi et al., “West Nile Encephalitis.”

11. Malkinson et al., “Introduction of West Nile.”

12. Drexler, Secret Agents, 32.

13. See note 5 above.

14. Ibid; and Drexler, Secret Agents, 20.

15. See note 5 above.

16. Drexler, Secret Agents, 20.

17. See note 5 above.

18. Drexler, Secret Agents, 56.

19. See note 5 above.

20. Ibid.

21. Ibid.

22. See note 7 above.

23. See note 9 above.

24. Giladi et al., “West Nile Encephalitis.”

25. Ibid.

26. See note 5 above.

Additional information

Notes on contributors

James M. Wilson

James M. Wilson is the CEO of M2 Medical Intelligence, Inc. Dr. Wilson is a board-certified, practicing pediatrician who specializes in operational health security intelligence, with a focus on the anticipation, detection, and warning of infectious disease crises. Dr. Wilson led the private intelligence teams that provided tracking of H5N1 avian influenza as it spread from Asia to Europe and Africa, detection of vaccine drifted H3N2 influenza in 2007, warning of the 2009 H1N1 influenza pandemic, discovery of the United Nations as the source of the 2010 cholera disaster in Haiti, and several investigations of alleged and confirmed laboratory accidents and biological weapon deployments. Dr. Wilson is a strong advocate for effective and accountable global health security intelligence and the need for credible and balanced threat assessments.

Tracey McNamara

Tracey McNamara, D.V.M., Diplomate, A.C.V.P., NAPf is a veterinary pathologist and a Professor of Pathology at Western University of Health Sciences College of Veterinary Medicine in Pomona, CA. Dr. McNamara specializes in the recognition and understanding of the diseases of captive and free-ranging wildlife and is best known for her work on West Nile virus. Dr. McNamara served as a consultant to the National Biosurveillance Advisory Subcommittee and continues to be actively involved in the development of the Nation’s biosurveillance strategy. She served as lead on a project with Russian colleagues on the ‘Human-Animal Interface’ by the Nuclear Threat Initiative’s Global Health and Biosecurity program in Wash. DC. She recently gave a TEDxUCLA talk entitled ‘Canaries in the Coalmine’ about continued gaps in biosurveillance for emerging biological threats. She is a founding member of the Global Health Security Alliance (GloHSA) group established by the German government in 2017. Most recently, she participated in Ending Pandemics ‘Finding Outbreaks Faster – Metrics for One Health Surveillance’ at the Salzburg Global Seminar in Austria and is now a Salzburg Global Seminar Fellow. She is actively involved in the One Health movement and advocates for a species neutral approach to the detection of pandemic threats.