Preparing for and Preventing Bioterrorism
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Strengthening the U.S. public health infrastructure is the key to enhancing the nation’s safety.
The tragic events of September 11th, followed by the recent anthrax incidents, have made us
painfully aware of our nation’s vulnerability to terrorism, including bioterrorism. Although once
considered a remote concern, the possibility that a biological agent might be intentionally used to
cause widespread panic, disease, and death is now a common concern. Whether the event
involves an unsophisticated delivery system with a limited number of true cases, as we have seen
with the current anthrax scare, or a carefully orchestrated attack with mass casualties, the
prospects are frightening. As the United States mobilizes to address an array of overlapping
foreign policy, infectious disease, and national security threats, it must make sure that a
comprehensive program to counter and prevent bioterrorism ranks high on the priority list.
The threat of bioterrorism is fundamentally different from other threats we face, such as
conventional explosives or even a chemical or nuclear weapon. By its very nature, the
bioweapons threat, with its close links to naturally occurring infectious agents and disease,
requires a different strategy. Meaningful progress against this threat depends on understanding it
in the context of epidemic disease. It requires different investments and different partners.
Without this recognition, the nation’s preparedness programs will be inadequate, and we may
miss critical opportunities to prevent such an attack from occurring in the first place.
Biological terrorism is not a “lights and sirens” kind of attack. Unless the release is announced or
a fortuitous discovery occurs early on, there will be no discrete event to signal that an attack has
happened, and no site that can be cordoned off while authorities take care of the casualties,
search for clues, and eventually clean up and repair the damage. Instead, a bioterrorism event
would most likely unfold as a disease epidemic, spread out in time and place before authorities
even recognize that an attack has occurred. Recognition that an attack had occurred would
emerge only when people began appearing in their doctor’s office or an emergency room with
unusual symptoms or inexplicable disease. In fact, it may prove difficult to ever identify the
perpetrators or the site of release–or even to determine whether the disease outbreak was
intentional or naturally occurring.
The first responders to a bioterroism event would be public health officials and health care
workers. Unfortunately, in many scenarios, diagnosis of the problem may be delayed, because
medical providers and labs are not equipped to recognize and deal with the disease agents of
greatest concern. What is more, effective medical interventions may be limited, and where they
exist, the window of opportunity for successful intervention would be narrow. The outbreak is
likely to persist over a prolonged period–months to years– because of disease contagion or
continuing exposure. The speed of recognition and response to an attack will be pivotal in
reducing casualties and controlling disease.
Not only are biological weapons capable of causing extraordinary devastation, but they are
relatively easy to produce, inexpensive, and capable of causing significant damage even when
small quantities are delivered by simple means. In addition, information about how to obtain and
prepare bioweapons is increasingly available through the Internet, the open scientific literature,
and other sources. Opportunities for access to dangerous pathogens can be fairly routine; some of
these organisms are commonly found in nature or are the subject of legitmate study in
government, academic, and industry labs. Furthermore, bioweapons facilities can be hidden
within legitimate research laboratories or pharmaceutical manufacturing sites.
Developing a response
Although there are enormous challenges before us, many of the elements of a comprehensive
approach are relatively straightforward. Some of the necessary activities are already under way,
though they may need to be expanded or reconfigured; other programs and policies still need to
be developed and implemented.
Perhaps most fundamental to an effective response is the understanding that public health is an
important pillar in the national security framework and that public health professionals must be
full partners on the U.S. security team. In fact, the president should appoint a public health expert
to the National Security Council, and Governor Ridge must include public health experts among
his key staff in his new Office of Homeland Security.
Today, experts agree that there is an urgent need to increase the core capacities of the public
health system to detect, track, and contain infectious disease. State and local public health
