Bioterrorism Concerns Heightened

Be prepared. That was essentially the take-home message of a mid-February conference on bioterrorism held in Crystal City, Va., and sponsored by the Johns Hopkins Center for Civilian Biodefense, the U.S. Department of Health and Human Services, the Infectious Diseases Society of America, and the American Society for Microbiology. Conference speakers addressed the following: Could a bioterrorist attack occur in the United States? The answer: absolutely--in fact, the chances are pretty good, given the availability and ease of production of several biologic agents including smallpox and anthrax, generally believed to be the best candidates.1 The more pertinent questions are when and to what degree. "It's not for lack of capability that we have seen limited deployment of biological weapons," warned symposium speaker Joshua Lederberg, president emeritus of Rockefeller University. He adds that the limitations have more to do with the experience and motivations of terrorists, both of which have been evolving in recent years. The next concern: Are we prepared to deal with a large-scale attack? Answer: certainly not. An attack affecting thousands would put a severe strain on the public health infrastructure as it currently stands. These grim prospects prompted President Bill Clinton earlier this year to ask Congress for $1.4 billion for safety measures meant to guard against chemical and biological attacks, part of the $10 billion he's proposing for antiterrorism efforts. The money would create new local emergency medical teams, buy and employ portable detection units for identifying hazards, join regional laboratories together, and accelerate research and development for new vaccines, medicines, and diagnostic tools. Donald A. Henderson Secretary of Energy Bill Richardson followed the president's call for action on March 2 with the announcement of several measures that the Department of Energy (DOE) plans to take to counter nuclear, chemical, and biological weapons of mass destruction. Richardson has requested $32 million for fiscal year 2000, a 70 percent funding increase, for chemical and biological defense. Projects will include an array of detectors: The DOE has, according to Richardson, just developed a suitcase-sized instrument that can detect a biological agent within hours by analyzing its DNA. Richardson also foresees the development of hand-held detectors for emergency personnel and a biological detection system, designed for public arenas such as subway systems and sports stadiums. He expects the detectors to be available within the next few years--at least in time for the 2002 Olympics in Salt Lake City. Bioterrorism issues could also be formally discussed at the international level as part of a proposed North Atlantic Treaty Organization (NATO) meeting currently under consideration. According to Erhard Geissler, a professor of genetics at the Max Delbruck Center for Molecular Medicine in Berlin and one of the scientists heading up the meeting proposal, participants would discuss viable bioterrorist agents, the level of the bioterrorist threat from different national standpoints (and the rationale for those evaluations), and ways to eliminate any loopholes in the 1972 Biological Weapons Convention (especially in light of the Iraqi threat and the possibility of uncontrolled biological weapon stores in the former Soviet Union). While few European countries acknowledge any significant threat for a biological attack on their own people, Geissler points out that since biological agents don't recognize geographic borders, a NATO meeting could be a necessary forum for discussing how countries might coordinate efforts in terms of manpower, vaccine stockpiles, and facilities. Indeed, an expert panel assembled in April 1998 by the National Security Council to advise the president on the bioterrorism threat suggested as a top priority the negotiation of an international treaty to reduce the illicit use of dangerous pathogens. The verdict on funding for the NATO meeting should be announced by this April. Research has shown that, as a defense against bioweapons, molecular replication inhibitors can prevent a virus from permeating throughout the body. But clearly a great danger lies within American borders, where conventional attacks are unlikely and a stealthy biological strike engineered by a small terrorist group may the best bet for wreaking havoc. According to Donald A. Henderson, conference speaker, smallpox expert, and director of the Johns Hopkins Center for Civilian Biodefense, the president's funding initiative is on the right track. Henderson endorses, in particular, the establishment of a first-response unit at the state and local levels, a program already in place in the case of chemical weapons. "One billion dollars is not an egregious sum," he says of funding such an endeavor. Henderson would also like to see a half dozen new centers like his own, and a national conference at least once a year. And in a February Science,2 he calls on the private sector, on federal, state, and local governments, and on medical and public health authorities to provide resources for training emergency room doctors and nurses, and to achieve better health care delivery guidelines related to bioterrorism. One organization, the Association for Professionals in Infection Control and Epidemiology (APIC), has in fact already attempted to improve procedures for health care professionals who might be faced with the weaponization of anthrax, smallpox, or botulism toxin. The "APIC Biological Warfare Readiness Plan" is scheduled to be available today for a fee via the Web (www.apic.org). "The real concern is that an attack probably wouldn't be obvious for days or weeks, depending on the incubation period of the disease," remarks APIC President Janet Franck. "The number of hoaxes that have been reported in the media has heightened the awareness in the health care environment [of its] need to be prepared should a terrorist attack occur." Anthrax hoaxes have been especially frequent in recent months. Many public health officials are also intent on replenishing severely depleted stores of smallpox vaccine with a new and improved second-generation version--an estimated 36-month undertaking. "If this meeting does nothing to protect the nation's health, it's going to be making sure that we get an adequate supply of smallpox vaccine as soon as possible," panelist Michael T. Osterholm said to an audience of nearly 1,000 scientists and public and private health care officials at the February meeting; many responded with applause. Osterholm, the chief of the acute disease epidemiology section at the Minnesota Department of Health, was among the symposium participants who discussed a hypothetical worst-case smallpox scenario. Scientists, as well as public health and state government officials, were asked to comment on each stage of a fictional attack in which thousands of people are exposed to smallpox at a political rally. The end result: 4,000 deaths as well as months if not years of economic, political, and public health turmoil. While few would doubt the bioterrorist threat, there is some question as to the likelihood of such a large-scale siege, and some uncertainty as to the amount of funding needed. Conference speaker Jessica Stern, a fellow at the Council on Foreign Relations and a former staff member at the National Security Council, encouraged preparation but suggested that "low-technology, large-scale efforts," such as food or water contamination, are far more likely than major attacks. Mark Wheelis "The consequences of terrorist use of biological agents have been grossly exaggerated by many analysts," maintains Mark Wheelis, a microbiologist at the University of California, Davis, who's focused his research on bioweapons for the last 12 years. "It would be an enormous challenge for even a state-sponsored terrorist to develop a delivery mechanism that would in fact wipe out a large city or ... even cause a significant number of casualties." Wheelis contends that although the risk of a biological attack is quite high and should be guarded against, such an attack would cause many fewer casualties than a chemical or conventional assault. He further speculates that terrorists might lose whatever infatuation they have with biological weapons once they realize that they can get equal or better results with more traditional means. For instance, the Japanese Aum Shinrikyo cult responsible for the 1995 Tokyo subway attack reportedly made 10 failed attempts using biological agents before successfully injuring 3,796 people and killing 12 using a nerve gas called sarin. "I think we shouldn't panic and we shouldn't waste huge amounts of money trying to prepare for an impossible scenario," says Wheelis. Proponents of big-time funding suggest that there's more to it than just a "better safe than sorry" mentality. Henderson points out that even if major attacks are extremely rare or nonexistent, newly trained first-response teams at state and local levels would not, for instance, be sitting idly by; they would be actively investigating new and emerging infectious diseases. Wheelis agrees that there could be added benefits. "The best defense against either deliberate or natural outbreaks is effective public health infrastructure," he remarks. "And to the extent that the antiterrorism programs focus on strengthening the capacity to respond to public health emergencies ... there is then definitely a carry-over." R. Lewis, "Bioweapons research proliferates," The Scientist, 12[9]:1, April 27, 1998. D.A. Henderson, "The looming threat of bioterrorism," Science, 283:1279-1282, Feb. 26, 1999. MedicCom.org has numerous links and Listservs related to disaster management and terrorism www.medicom.org Department of Health and Human Services Emergency Preparedness oep-ndms.dhhs.gov Domestic preparedness site meant to enhance the capabilities of federal, state, and local emergency

Bioterrorism Concerns Heightened

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