Front and Center: Security at Boston's Infectious Disease Research Lab

When controversy hit, Kevin Tuohey became the public face of a high-profile plan to study deadly diseases in Boston. To succeed, the security director would have to become part diplomat, part great communicator.

Kevin Tuohey is the executive director of operations and safety at Boston University Medical Center, a job that includes security responsibilities and, he declares, "anything to do with risk." That includes expected tasks like access control and surveillance, managed from an operations center on the BU Medical Center campus. Through bulletproof glass, the ops center looks across Albany Street at the hospital, where Tuohey takes care of triply redundant utilities that keep critical medical systems online. On one side of the ops center sits security staff. On the other side, separated by a glass wall, sits the safety team. On a campus with a busy hospital and research facilities, safety and public health risks are on par with security risks. A public health risk he deals with is the potential release from research labs of infectious agents such as Francisella tularensis.

One micron long, F. tularensis is a small bacterium. But it can survive months in below-freezing temperatures, and 10 microbes will infect humans with a disease called tularemia. Historically, outbreaks were associated with rodent hunters who got sick from carcasses of their prey, giving tularemia its familiar name: rabbit fever.

The most virulent rabbit fever strain, pneumatic tularemia, is capable of airborne transmission. Antibiotics suppress the fever, but left untreated, it can kill. (Because early symptoms are flulike, some people will try to tough out what feels like a nasty cold.)

Outbreaks occur sporadically across the Northern Hemisphere. One took place on the Massachusetts island Martha's Vineyard in 2000, when landscapers mowed over an infected rabbit and aerosolized the bacteria, giving 15 people the fever, one of whom didn't seek treatment right away. He later died.

The Centers for Disease Control and Prevention classifies pneumatic tularemia as a "Category A" infectious agent&mdash:a potential biological weapon that the government monitors and that universities research to prevent wider epidemics.

At Boston University Medical Center, Dr. Peter Rice was researching a vaccine for tularemia. In May 2004, one researcher in his lab went to the doctor's office with a fever, cough and headache. Two days later, a second researcher from the lab felt similar but more severe symptoms and was hospitalized overnight. Both were diagnosed with the flu, given antibiotics and recovered. In September, a third researcher from the same lab landed in the hospital for several days with more severe flulike symptoms. This time, someone put one and one and one together. For the vaccine research, all three had worked with what was supposed to be a harmless strain of F. tularensis.

By the end of October, scientists determined that the bacteria strains delivered to Rice's lab, thought to be inert, were actually virulent. Over the next two weeks, the medical center's Institutional Biosafety Committee, where Tuohey's manager of emergency planning holds a seat, shuttered Dr. Rice's lab, notified the Massachusetts Department of Public Health, the Boston Public Health Commission and the mayor of Boston, and finally confirmed with blood tests that the researchers had contracted pneumonic tularemia.

It was Nov. 12, 2004, almost six months after the first researcher contracted rabbit fever. The information had been kept confidential because the local health officials and BU Medical Center determined there was no threat to public health. Now the public would find out. And for Tuohey, the timing couldn't have been worse.

That's because the medical center was in the process of getting approval to build a new infectious disease research lab on campus. In 2003, the National Institute of Allergy and Infectious Diseases (NIAID) awarded a $128 million grant to build the lab, which if approved by state and federal environmental agencies, would bring billions in grants and attract top scientists.

But the new facility would also be classified a Biosafety Level 4 lab, one of only seven in the United States. In lab safety terms, level 4 means the biologics handled at that facility have no known vaccine or therapy. No cure. Ebola. Smallpox. Anthrax. (Level 3 biologics can cause disease if inhaled, but there are treatments available. Level 2 agents can cause disease but are not transmitted in a lab. Level 1 is not harmful.)

The live strains of F. tularensis that infected BU Medical Center researchers are Biosafety Level 3 agents. Those who opposed building the biolab seized on the rabbit fever cases as Exhibit A in their grassroots fight to stop the project, evidence that the center was incapable of protecting the surrounding neighborhoods from potentially deadly outbreaks.

A CSO Steps Front and Center

As an operations director, Tuohey initially had a limited role when a public controversy struck his organization's most important project. All he could do was explain the building design, systems and processes that BU Medical Center would use&mdash:most mandated by regulators&mdash:to prevent failures at the new lab. He also could point to his team's operations center, and the redundant systems and all of the new high-end security controls like advanced surveillance and biometrics that would protect the facility.

Tuohey did all that. But soon he did more. Tuohey knew it would fall to him to defend the new lab and quell a chorus of dissent coming from a well-organized alliance of citizens and scientists who categorically opposed the lab. Despite the tularemia episode, Tuohey had to tell them that the security and safety risks associated with this new lab were fringe risks, and manageable. And tell them he did. By the time the news of the three rabbit fever infections reached the public, Tuohey was making himself a public face for BU Medical Center. Ever since the center won the federal grant to build the bioresearch lab, Tuohey had moved beyond his normal focus as strategic security and safety director. He had testified at public hearings, briefed politicians, talked to the media and met regularly with community groups. His role became a community outreach and communications job too.

It's a leadership role more security executives are playing as issues of risk migrate to a central place in our politics and culture. Security leaders will find themselves in Tuohey's position, tackling outward-facing roles, meeting with key constituents, testifying in hearings and speaking to the media.

Hemanshu Nigam, for example, was named CSO at in April partly to assuage parents unsettled by media reports of online predators associated with the site. Nigam's background was in consumer security outreach. And during the recent controversy over a Dubai-based company taking over management of some U.S. ports, analysis that shaped public opinion came from security experts like Stephen E. Flynn, a Council on Foreign Relations fellow, Graham Kee of the Vancouver Port Authority and Dennis Treece of Massport.

At BU Medical Center, the response to the rabbit fever outbreak had the medical center leaning on Tuohey to fulfill this new kind of role. "This will be a huge blow," Tuohey remembers thinking as he anticipated the public's response to the rabbit fever cases. "It will take a lot of time and effort to explain factually. I was prepared for a lot of, See! See! We told you!"

The medical center wanted him right in front of it all. "Early on, we didn't always bring Kevin with us to meetings," says Ellen Berlin, BU Medical Center's director of corporate communications. "But we found the issues that gave people angst were Kevin's issues. And he is a natural. In many ways, Kevin is the face of the project."

The Site of a New Lab

A chain-link fence wrapped with green fabric surrounds the site on Albany Street, between Boston's South End and Roxbury neighborhoods, where the Biosafety Level 4 lab will rise. Tuohey stops at a gap in the fence and, opening his arms to the controversial plot, says, "Here it is."

His tone borders on apology, for the site on this brisk April morning is just an old vacant parking lot. It's an unremarkable urban blot, a typo in the neighborhood sentence.

But the site itself isn't the point. It's the process for picking this place to build a biolab. Biosafety Level 4s are like nuclear power plants. They are rare, most people at least can understand an argument for their existence and necessity, but no one wants them nearby because of their risks.

This site's backyard is Boston's gentrifying South End and, farther down, the Roxbury section. More than 50,000 people work and live within a few square miles, and a million people are within 10 square miles. Some residents live just yards away, across Albany Street, in rows of rejuvenated brownstones. To the site's south is a county jail and a half-built parking garage. The sprawling Boston Flower Exchange cooperative of wholesale florists borders on the east. Beyond that runs the Southeast Expressway, one of the busiest highways in the United States.

Remarkably, the notion that bringing anthrax and other incurable biologics into this bustling, densely populated setting might upset the neighbors initially seemed to escape BU Medical Center officials, who assumed it would rise on their campus, in "BioSquare" with existing research facilities and the hospital nearby. Federal officials "believed like us that these are safe facilities no matter where they are," Tuohey says, recalling the two-year-plus application process, when BU officials were focused much more on the science that would go on inside the facility than they were on the risks the building brought to the neighborhood. "Location is just one of many criteria that go into the application process. If you want the grant you have to meet National Institutes for Health standards on everything, including security and siting." From a security and safety perspective, the Albany Street site has advantages, Tuohey says. "People didn't put together that an infectious disease outbreak response will come here"&mdash:he points toward the hospital&mdash:"no matter where it originates. It's good to be close."

The Plan's Awful Debut

An air of inevitability surrounded the biolab. Besides the federal grant, state and city elected leaders backed the project for the jobs it would bring to Boston. Then came the first community meeting about the facility, held in January 2003 at the hospital and led by one of the lab's champions, a microbiologist named Dr. Mark Klempner. He began explaining, with some enthusiasm, the scientific research that would be done in the new facility and what he hoped that would produce&mdash:vaccines and therapies to combat natural epidemics and used as defenses against bioweapons. (It is illegal under international treaty to do bioweapons research, but not biodefense research.)

But a significant klatch of attendees from surrounding neighborhoods grew restless and irritated listening to Klempner. They wound up challenging him. They accused him of being patronizing and out of touch with their concerns. They demanded to know why they weren't involved earlier in the approval process for such a facility. They asked how Boston University could assume everyone would be OK with a "bioterror" lab in their neighborhood. The international Sars epidemic, having crested six months earlier, was no doubt fresh in their minds, and the anthrax attacks of 2001 probably weren't forgotten either. Questions about a "weapons factory" came up.

Officials for BU Medical Center appeared surprised by the tenor of these responses. They saw the biolab as a boon, producing construction and research jobs, and a dose of national prestige. Instead, according to a Boston Globe story, Klempner was seen as "condescending" and "evasive."

Tuohey's comments about this public relations disaster suggest that he understood the reactions. "They said, basically, Stop talking down to us. We don't care about the science. Make it safe.' We were focused on the potential outcomes from this lab; they were focused on potential risks. It was then I realized our perceived concerns were much, much different than theirs."

BU Medical Center clearly needed a new front man. Enter Tuohey. He was approachable, human. He maintained eye contact without staring. His voice was calm but strong, and he responded to the harshest attacks with polite replies. But most of all, as director of "anything to do with risk," Tuohey could address citizens' most urgent concerns. And so BU Medical Center, and those opposing this big lab project, looked to him to do that.

Tuohey Gets Going

In the 90 days following that initial community gathering, Tuohey held about 100 meetings with citizen groups, politicians and scientists. Meetings usually had a couple dozen attendees. He had a presentation outlining the basic security and safety issues at hand, but for the most part, his job was to listen. After a while, it seemed like every question had been asked, including, Tuohey recalls, if there would be snipers on the roof (no), if the lab was designed to withstand an earthquake (yes) and if the building would be fortress-ugly (no). When he didn't know the answer, he said so. "I said, I'm not going to tell you I'm the smartest guy, but I will research it. I will use all the resources I can to find an answer.'"

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