AFF/TERRORISM/BIOTERRORISM

WE ARE UNPREPARED FOR A BIOTERRORISM ATTACK

AMERICA'S CITIES ARE TOTALLY UNPREPARED FOR A WMD INCIDENT

MICHAEL OSTERHOLM, School of Public Health, Univ. of Minnesota, 2000; LIVING TERRORS: What America needs to know to survive the coming bioterrorist catastrophe //VT2002acs p. 134-5

Ellen Gordon, director of' the Iowa Division of Emergency Management, testifying before Congress on behalf of the National Emergency Management Association in September 1999, warned that no local officials really feel prepared to face the consequences of an attack that uses weapons of mass destruction. "As a whole, the state directors of emergency management believe that most state public health systems are unprepared to respond to a WMD incident," she said. Gordon explained that there is wide range of capabilities at the local level, but warned that the national focus on America's biggest cities for equipment, personnel, and training has left the rest of the country unguarded. She also said that there is little coordination of information between the medical and law enforcement communities. Perhaps most important, she said, neither "public health services nor private hospitals are equipped to handle WMD issues related to decontamination, mass casualties, and mental health care for victims, first responders and the community at large."

IT WILL TAKE A LONG TIME FOR MEDICAL LABS TO DETERMINE A BIOWEAPONS ATTACK HAS EVEN TAKEN PLACE

MICHAEL OSTERHOLM, School of Public Health, Univ. of Minnesota, 2000; LIVING TERRORS: What America needs to know to survive the coming bioterrorist catastrophe //VT2002acs p. 135-6

Tara O'Toole, a senior fellow at the Johns Hopkins Center for Civilian Biodefense Studies, issued a similar warning at the September 1999 hearing. Pointing out that a bioterrorism attack would "require a response that is fundamentally different" from response to chemical or bomb attack, or even an earthquake or fire, she noted that "the speed and accuracy with which physicians and laboratories reach correct diagnoses and report their findings to public health authorities will directly affect the number of deaths, and-if the attack employs a contagious diseasethe ability to contain the epidemic." Yet, she noted, "few, if any, practicing clinicians have ever seen a case of smallpox or anthrax or plague. Only a handful of laboratories have the ability to identify definitively the pathogens of greatest concern." In other words, the hospital labs can find what they usually find -E. coli, strep, and the usual bugs that burden mankind. Only specialized government labs have the training and resources to do more-and getting samples to them could add to the delay in finding out what the disease causing the crisis is.

CURRENT PROTECTIONS AGAINST BIOLOGICAL WEAPONS ARE INADEQUATE

MICHAEL OSTERHOLM, School of Public Health, Univ. of Minnesota, 2000; LIVING TERRORS: What America needs to know to survive the coming bioterrorist catastrophe //VT2002acs p. XIX

Despite this chilling prospect -and the President's stated concern-the United States is not doing enough to prepare. Today's programs for combating terror by microbes are turning out to be more governmental public relations initiatives than workable policy. A classic Washington story, perhaps, but it's one with special urgency, given the dire results we could expect from an attack. Even if the current initiatives were run effectively at the international, federal, state, and local levels, we would still fall short of the facilities and therapies we need to protect private citizens around the world against biological agents like anthrax, smallpox, plague, Ebola virus, and other potential tools of a bioterrorist.

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Thomas V. Inglesby, MD May 12, 1999, JAMA, Vol 281, Anthrax as a Biological Weapon, Medical and Public Health Management http://jama.ama-assn.org/issues/v281n18/pdf/jst80027.pdf //VT2002acsln

To develop a maximally effective re-sponse to a bioterrorist incident involv-ing anthrax, the medical community will require new knowledge of the organ-ism, its genetics and pathogenesis, im-proved rapid diagnostic techniques, im-proved prophylactic and therapeutic regimens, and an improved second-generation vaccine.47 A recently pub-lished Russian study indicates that genes transferred from the related B cereus can act to enable B anthracis to evade the pro-tective effect of the live attenuated Rus-sian vaccine in a rodent model.73 Re-search is needed to determine the role of these genes with respect to virulence and ability to evade vaccine-induced im-munity. Furthermore, the relevance of this finding for the US vaccine needs to be established. An accelerated vaccine de-velopment effort is needed to allow the manufacture of an improved second-generation product that requires fewer doses. Finally, an expanded knowledge base is needed regarding possible maxi-mum incubation times after inhalation of spore-containing aerosols and opti-mal postexposure antibiotic regimens.

IN A BIOLOGICAL WEAPONS TERRORIST ATTACK TOO MUCH VALUABLE TIME WILL BE LOST TRYING TO IDENTIFY THE AGENT AT WORK

LAURIE GARRETT, Pulitzer Prize -- winning science and medical writer for Newsday January, 2001 / February, 2001 Foreign Affairs SECTION: CHALLENGES FOR THE NEXT PRESIDENT; Pg. 76 HEADLINE: The Nightmare of Bioterrorism //VT2002acsln

Once an outbreak is recognized, an epidemiologist would be dispatched to identify the cause. If the pathogen were fairly common, like Clostridium botulinum (the bacterium that causes botulism, a fatal food poisoning), local hospital laboratories could probably identify the culprit first. But if the microbe were rare, like those that cause anthrax, Q fever, Ebola, smallpox, or plague, local facilities would probably be unable to diagnose the problem. With precious time passing, people dying, and disease possibly spreading, local officials would then await word from the diagnostic labs at the CDC. If the suspected pathogen were highly deadly, like the smallpox virus, the analysis would be handled in the CDC'S Special Pathogens laboratory, which is normally staffed by fewer than a dozen highly specialized scientists. And during a crisis, it would be difficult to find qualified supplementary staff to scale up operations. During the 1995 Ebola outbreak in Zaire, for example, the lab was staffed by a mere six scientists who toiled around the clock trying to identify the presence of the lethal virus in some 30,000 tissue, blood, plant, insect, and animal samples. In the case of a bioterrorist attack, valuable time -- and lives -- might be lost during such an arduous process.

THE CURRENT MILITARY-SECURITY FOCUS ON THE FIGHT AGAINST BIOTERRORISM DOOMS IT TO FAILURE

In a historic speech in Atlanta during the winter of 1998, D. A. Henderson, head of Johns Hopkins University's Working Group on Civilian Biodefense, beckoned public health officials to jump on board a train already in motion, conducted by the law enforcement and defense communities. Less than a year later, public health had boarded the train, but only as a passenger. The train was fueled by an $ 8.4 billion budget in fiscal year 2000, yet public health was allotted a mere 3.7 percent of those funds, according to a recent study by the Stimson Center in Washington, D.C. With such comparatively paltry funding, it is no wonder that public health found itself sitting at the back of the train, watching the scenery race by as other government players steered the locomotive's course. Unless this changes, the train is going to crash.

THE WORLD IS TOTALLY VULNERABLE TO A SMALLPOX VIRUS ATTACK

The world is thus completely vulnerable to a smallpox attack. The last time a mass emergency vaccination took place in the United States was 1947, when a traveler from Mexico spread smallpox to New York City. Vaccines were then readily available, and 6.35 million New Yorkers were immunized in less than four weeks. In 1961, a similar vaccination campaign was administered following a smallpox outbreak in England: 5.5 million people were immunized in a month's time. A decade later, smallpox cases in Yugoslavia prompted the rapid vaccination of 20 million people in that country. Were a smallpox crisis to emerge today, none of these efforts could be repeated.

EVEN IF VACCINE IS AVAILABLE, SMALLPPOX VIRUS ATTACK WILL HAVE HUGE IMPACTS

EVEN IF large stockpiles of the smallpox vaccine could be collected immediately, they would be of limited value for two reasons: only several days after infection would individuals develop recognizable symptoms, by which time thousands -- even millions -- would have been exposed; and only several days or weeks after vaccination would individuals develop sufficient antibodies to stave off infection.

For other diseases preventable by vaccine, such as anthrax, the lag time between inoculation and the development of powerful antibodies could be far longer -- up to a year, even with boosters. And of course, immunization efforts would be useless against vaccine-resistant pathogens, such as those created by Soviet scientists working on anthrax weapons. Furthermore, a determined bioterrorist could simply try a succession of microbial weapons -- or use a cocktail at the outset -- defying even the best-organized vaccination programs.

IT IS DIFFICULT TO EVEN RECOGNIZE THAT A BIOLOGICAL WEAPONS TERRORIST ATTACK HAS TAKEN PLACE

But even if cities were well equipped for a bioterrorist attack, they would still have a difficult time recognizing that such an attack had occurred. Local authorities "probably aren't going to be able to recognize it has happened . . . until the incubation period is over," says Clark Staten, executive director of the Emergency Response and Research Institute in Chicago. "And by then, you've got it spread over a wide area. And it may take longer to recognize there's a pattern going on."

FAKE BIOLOGICAL ATTACKS HAVE ALREADY SHOWN HOW UNPREPARED WE ARE

Already, local public health departments were having a hard time responding to fake bioterrorist attacks. Claiming to have dropped off or shipped an anthrax-containing device suddenly became chic at the turn of the millennium. Terrorism expert Jessica Stern counted 47 such hoaxes in the United States since 1992. In all 47 cases, local fire and police authorities reacted seriously, decontaminating thousands of people and appearing on the scenes dressed in full-body protection suits. And Stern's list was by no means comprehensive.