When a terrorist cult released lethal sarin gas in a crowded Tokyo subway in 1995--killing 12 people and making hundreds of others ill--police, fire, and emergency rescue teams rushed to the scene to treat and evacuate those who were ill and to contain the damage. In that case, it was apparent immediately that a toxic substance had been released. But what would have happened if the terrorists had released deadly organisms such as those that cause smallpox or anthrax?
A microbe released into the atmosphere would be invisible, odorless, and tasteless. The attack probably would not be discovered until days or even weeks later, when sick people would begin arriving in emergency rooms and doctors' offices. Rather than being contained at the attack site, diseases would spread far beyond those who were originally exposed. Such biological weapons, in terms of their potential destructiveness and the panic and civil disorder that could ensue, are considered now to be equivalent to the threats posed by nuclear weapons.
And yet, to date, there is no agreed-upon national strategy in the United States for dealing with bioterrorism. For far too long, policymakers have failed to understand that the release of a biological agent will result in an epidemic. Unless bioterrorism is tackled with a much greater sense of urgency, the right practical expertise, and far more funding, the nation will remain perilously vulnerable.
As demonstrated by the Tokyo attack, release of a chemical agent requires the "sirens and flashing lights" type of intervention. If an epidemic resulted from a biological agent, the first to respond would be physicians, nurses, and public health officials. They would diagnose the disease, identify the origin of the epidemic, and organize control measures. But planning and research activities related to bioterrorism have been dominated by those with little knowledge of infectious diseases and no experience in epidemic control. Although well- intentioned, the planners have launched programs appropriate to the threats with which they are familiar--chemical and nuclear weapons. Only recently has it become apparent that the biological challenge is very different in all respects, including research, surveillance, and arms-control initiatives.
Federal funding for biological terrorism control has gone almost entirely to the Departments of Defense, Justice, and Energy, rather than to agencies equipped to handle public health threats and conduct biomedical research, such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health. For example, legislation in 1996 required the U.S. Department of Defense to train so-called Metropolitan Medical Strike Teams. Trained and equipped to operate in each of 120 cities, the teams are fundamentally similar to the already numerous hazardous material teams that now deal routinely with accidental chemical spills and leaks.
Now, in a partial midcourse correction, an effort is being made to recast this exercise to incorporate initiatives pertaining to biological threats. However, those directing the efforts are primarily emergency rescue, police, and fire personnel who have had no experience with epidemics. Even more difficult to understand is the fact that no systematic effort has yet been made to incorporate hospitals into the planning process. A recent meeting of hospital executives concluded, in fact, that no U.S. hospital is prepared today to deal with communitywide disasters for a host of financial, legal, and staffing reasons.
The first tentative steps have been taken to develop a more focused and rational national strategy. Last year, CDC received funding to strengthen state and local epidemic detection and control programs. The effort is designed to bolster our public health infrastructure and to reestablish effective working relationships between the public health and medical communities. The plan calls for developing appropriate state and local plans, educating primary-care givers and public health staff about agents that might be used, implementing surveillance systems for early detection of outbreaks, building a laboratory network capable of rapidly identifying biological agents, and stockpiling needed quantities of vaccines and drugs.
The threat of bioterrorism is not going to disappear. What's more, the nation also is threatened by a host of new and emerging infections, including West Nile encephalitis, Hong Kong influenza, and a growing number of antibiotic-resistant microbes. Regardless of whether the source is bioterrorism or a naturally occurring outbreak, similar resources are needed for the early detection and control of disease. Without the appropriate resources and expertise, the nation will remain ill prepared to fight these very real enemies.
Donald A. Henderson is a professor of epidemiology and the director of the Center for Civilian Biodefense at Johns Hopkins University.