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

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 MySpace.com 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.'”

What he learned by listening made the project safer, Tuohey says. “We started with one risk to mitigate&mdash:a release from the building, the worst-case scenario,” Tuohey says. “The neighborhood said, Fine. But how do these things get to and from the lab? On our streets. By our houses.’ So we had to back up and look at transportation.”

The team developed a far more detailed policy around transportation, including the use of GPS and arming drivers taking biologics to the lab with a duress alarm connected to the hospital, local police and the Centers for Disease Control. Eventually, Tuohey’s one risk turned into five, all of which had full mitigation plans developed around them (see “Five Risks to Mitigate”). It was an attempt to erase that sense of inevitability that so outraged the community at the start.

A Political Animal

Tuohey is the son of American diplomats. He was born in 1961 in Frankfurt, and grew up in Vienna, Moscow, Bombay, Maryland, Berlin and, finally, Tel Aviv, where he graduated from high school. Then he came to Boston. He was 18. He wanted to be a cop, so he took criminal justice classes at Northeastern University and he also took a co-op with Boston University’s security department as a security officer. At 19, he didn’t want to be a cop anymore, but still finished his criminal justice credits. “My background really is political science, political theory and international relations.”

Twenty-five years after taking a job at BU during college, he’s still there. Behind his desk hangs ink sketches of pretty campus buildings. On the wall hangs a blueprint, the “Institutional Master Plan” for BioSquare, including the new lab site. On his desk one day last May sat a large jar of ibuprofen.

A couple of blocks from Tuohey’s office, on Washington Street, Ken Olken and his wife will be able to watch construction of the Biosafety Level 4 lab from their sixth-floor apartment’s window. Olken is a retired textiles worker. His daughter’s family lives a block away. “In textiles, we handled powdered dyes,” he says. “In many ways you control them the way you control airborne biologics, using negative air pressure.”

Olken attended dozens of Tuohey’s community meetings. Olken says he went originally out of curiosity, but kept attending to help himself form a decision on whether to support the biolab. He had two main questions: “First, what would be taking place there? I had heard a lot about weaponizing biologics. Then I wanted to know the mechanics of the systems that would be used to prevent this stuff from getting out.”

Recalling the sessions, Olken says, “The medical staff that does the work is at the highest risk. [Who] they contact&mdash:their families, friends and neighbors, regardless of distance from the facility&mdash:are at the second highest risk. Then the neighborhood.”

Olken sounds remarkably similar to Tuohey when, sitting at his desk with the ibuprofen, he laid out the risks the lab presented to various constituents. It was as if Olken had internalized what Tuohey had told him. “I found Kevin to be a very good communicator,” Olken says. “He listened, and answered all my questions.” Ultimately, Olken decided to support the lab.

Tuohey’s meetings were so effective the concept was expanded. The medical center team set up a Biosafety Lab Advisory Group, comprising 20 neighborhood people, both supporters and opponents. He also held “office hours” to answer questions, and he says he continues to meet with 22 interested citizens groups in the South End. All told, he has held more than 250 meetings with more than 5,000 attendees.

Risk Plays Out in Public

Not everyone agreed with Olken. Many others who attended Tuohey’s meetings remained steadfast opponents of the new lab. A Roxbury group called Safety Net was one of several community groups that had mobilized to stop the lab, which by April 2004 was called the National Emerging Infectious Diseases Laboratory, or NEIDL, unfortunately pronounced “needle.” Another group, called Alternatives for Community & Environment (ACE), used aggressive political tactics. “The strategy was to raise as much doubt at [NIAID] that this [lab] would be a hard facility to get built in Boston, because of the opposition,” Penn Loh, ACE’s executive director, told The Boston Globe Magazine. The group focused on what it suggested was an air of secrecy around the project. For example, the original proposal for the project was slow to be made public, and when it was, the RFP made available in April 2004 was redacted to block descriptions of research at the lab. ACE seized on this, writing on its website, “There will be secret research performed at the [NEIDL].” BU flatly denies this. Tuohey says it’s “completely untrue” and that all research done there will go through public review. But in a sense it doesn’t matter who’s right. ACE made the suggestion, and rumors of secret research coming to the NEIDL persist to this day, which Tuohey still must defend against in presentations and community meetings.

Also by April 2004, a large contingent of Boston’s academic community had allied itself with the community groups. Dr. David Ozonoff of BU’s School of Public Health and professor Daniel Goodenough of Harvard Medical School were outspoken. Ozonoff called “the whole bioterrorism initiative” a “catastrophe” for public health. Goodenough accused BU of “environmental racism.” “Putting something like this in the poor community with such a weak political voice, there’s no question if this were in Brookline, Newton or Wellesley”&mdash:tony suburbs&mdash:”this wouldn’t happen.”

The activists sent an open letter to the mayor, city council and BU trustees opposing the biolab, signed by 165 academics, public health officials, and ACE. “High-level safety and security procedures will be installed,” the letter conceded. “However, there can be no guarantees that there will be no accidents that might lead to the release of deadly, airborne pathogens through the failure of safety systems or when they are transported through city streets. The laboratory might also become a target for intentional acts of violence.”

What’s remarkable about this statement is that the risks cited come straight from Tuohey’s list of five risks to mitigate. Tuohey, in defending the lab, would say the same exact thing.

The difference between supporters and opponents is their interpretation of these risks. Opponents said whatever benefit the lab might provide cannot outweigh the risks it presents to the community. Tuohey found himself defending the project from attacks and from information disseminated by an aggressive opponent, information that he believed was misleading. (By this time, BU Medical Center had launched BostonBiosafety.com as a counter to ACE’s anti-lab campaign, and had begun advertising the project’s benefits on subway trains.)

And the criticisms he’s countering often go well beyond security and safety. So when opponents talk about the NEIDL being a biodefense project of little value or counterproductive to public health, it’s Tuohey who brings up the threat of an avian flu outbreak and the need to research it at a facility like the NEIDL. When detractors suggest the NEIDL’s siting is racist, it’s Tuohey who says that the kind of redundancy in utilities, power generation and other critical infrastructures that the new facility will demand already exist there for the hospital.

And when opponents outline risks the NEIDL poses, it’s

Tuohey who tells residents, politicians and the media that the opponents’ statements are correct. But he would go on: “A release is a scary scenario. I understand that. I’ve never said there’s no risk and I never will. But I can tell you we modeled that four times. We modeled dropping a test tube with more anthrax in it than we’ll ever use. We modeled HEPA [particle filter] failures. After the community came to us with concerns, we looked at how the infectious agents would be transported to the lab. In all our tests, none created a risk to the health of the community. Individuals being infected? Yes, that’s a risk. It’s not likely but it’s possible.”

A month after ACE and the scientists sent their letter, two lab researchers counting bacteria colonies would unknowingly inhale live strains of F. tularensis and contract rabbit fever.

A Bad Report Card

The four-month investigation by the Boston Public Health Commission that followed the rabbit fever outbreak resulted in a

14-page report in March 2005. It said BU Medical Center was far from blameless. “Researchers noted the lack of use of personal protective equipment when counting [bacteria] colonies on an open bench,” it said. And “despite stringent guidelines on receipt and storage of Select Agents, [BU] did not have a system of laboratory testing in place to verify that the organisms being used in research were those that had been requested.”

Practices and safety measures in the Biosafety Level 2 lab were “inadequate” to prevent infection. BU should have reported the cases earlier and “should have had stronger procedures in place to monitor laboratory personnel,” which may have prevented the third case of rabbit fever. The tularemia lab “failed to consistently utilize adequate precautions when handling and manipulating laboratory specimens.” And finally: “The BU Institutional Biosafety Committee was not able to ensure compliance with appropriate laboratory protocols and procedures.”

Opponents of the NEIDL took the momentum. They ticked off a litany of recent failures across the country with infectious agents, at labs and in the mail, culminating in the rabbit fever case. The opponents’ new talking point was something like, If it can happen with tularemia, it can happen with anthrax. They filed a federal lawsuit (still pending) against the NIH to stop the project.

It didn’t matter that the report also said that the rabbit fever cases posed no threat of infection to the community, or that a University of Nebraska lab errantly delivered Biosafety Level 3 live strains of F. tularensis instead of inert Biosafety Level 2 bacteria, or that, even if it was slow to connect the dots, BU Medical Center reported the cases days after it had connected them.

Tuohey called the assault on BU’s credibility unfair. He countered, partly by acknowledging the failures and communicating what’s being done about them. “What happened wouldn’t have happened in a Biosafety Level 3 or Biosafety Level 4 because of safety features in those kinds of labs,” which are more stringent than in the lab where this occurred, he says.

But, he adds, “it’s a controls issue. A procurement issue. A very important lesson about what comes in the mail, and trust. We’ve applied new controls across campus. We test every agent that comes in to make sure it is what it says it is. We have unannounced inspections,” and third parties look at lab procedures.

This is a tricky communications job Tuohey pulled off, at once saying it’s an unfair assault, but also that what happened caused policy changes. Even opponents of the lab acknowledged his capability. “He strikes me as a guy who believes in this and is totally sincere,” says Goodenough. “He’s definitely knowledgeable and he’s definitely following all of the rules and guidelines [for safety and security] to a T. He’s careful. But what he does not acknowledge is human error. I’d love to sit with him and say, Don’t you think they had the same checks and counterchecks on [space shuttle] Columbia? Isn’t there room for error, and if so, why are we taking this chance?”

A Quiet Ground Breaking

After a long environmental review, federal officials approved the NEIDL and its system of safeguards at the start of this year. Tuohey succeeded. But there would be no ground-breaking ceremony.

In April, the Biosafety Level 4 site was a parking lot; by May, that was being ripped up. A dozen or more trucks and cranes filled the site. Steel pilings stuck up in a few spots.

Walking to the site, Tuohey announces “what an opportunity for the city this lab is.” He crows about the estimated 660 jobs it will bring and the economic benefit, including affordable housing and job training programs, and mentions the need for an avian flu vaccine. After acknowledging a short-lived student sit-in protesting the NEIDL at the dean’s office, he adds, “Frankly we get fewer and fewer questions about the biolab and more about development on Mass. Ave.,” an important nearby thoroughfare.

Goodenough called Tuohey “careful.” Another word for careful is politic, and through the meetings, defending the project, dealing with a nasty information war, and finally, doing damage control after a potentially debilitating gaffe, Tuohey has evolved into a kind of political creature. He is a partisan for the lab interacting with his constituents. He talks about being part of the neighborhood and how that means he cares. Though once he had no hometown, he’s now worked and lived here for a quarter century and he says that his entrenchment helps him fulfill his role. “I have more breadth here than people”&mdash:he makes a tunnel with his hands and holds it up to his eyes&mdash:”who are responsible just for security.”

He means this literally. After the tularemia episode died down, and it was clear that the Biosafety Level 4 Biolab project would break ground, BU Medical Center reorganized. Corporate communications and community relations now report to Tuohey. ##