U.S.: Bioterrorism Vulnerability Cited (Wash. Post)

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Headline: Bioterrorism Vulnerability Cited -- GAO Warns That Health Departments Are Ill-Equipped

Source: Ceci Connolly, Washington Post, 28 September 2001; Page A16

URL: http://www.washingtonpost.com/wp-dyn/articles/A37610-2001Sep27.html

The federal government's plan for responding to bioterrorism is a collection of poorly coordinated, often underfunded, projects that span 11 separate Cabinet-level agencies, according to the first comprehensive report on the subject since the Sept. 11 attacks.

Further, the study by the General Accounting Office warns that state and local health departments appear equally unprepared to deal with a biological assault, despite the fact they are likely to be the first to respond.

"Bioterrorism remains a low probability, but a growing probability, coupled with a high vulnerability for our nation," said Sen. Bill Frist (R-Tenn.), who, along with Sen. Edward M. Kennedy (D-Mass.) requested the report.

In this year's budget, the Bush administration has allocated $343 million for dealing with a biological attack, $113 million of which is for the Pentagon to protect soldiers in the field. The rest, which amounts to less than $1 per U.S. civilian, goes to projects as diverse as environmental assessments, pharmaceutical stockpiles and computer upgrades.

More money is being spent by the Defense Department and other federal agencies on prevention and detection, although Frist and Kennedy argue it is nowhere near enough. They have urged President Bush to spend an additional $1 billion to immediately upgrade public laboratories, train medical personnel, pursue new vaccines and therapies and secure overseas stocks of biological weapons.

"We hope you will bear in mind the special challenges posed by biological weapons," the pair wrote Bush. "A terrorist attack using a deadly infectious agent could kill or sicken millions of Americans."

In the past, many have dismissed the threat of bioterrorism as unlikely because it can be difficult to obtain, produce and deliver the deadly agents. However, the formulas "are readily available on the Internet, and the agents are relatively easy to conceal," the report notes.

"According to intelligence agencies, the possibility that terrorists may use chemical or biological materials may increase over the next decade."

Many of the gaps identified in the report -- lack of coordination, questions over jurisdiction -- are endemic to the broader challenges surrounding counterterrorism, said Jeffrey H. Smith, former counsel to the CIA and an expert on preparedness.

"But biological weapons have unique aspects," he said. "The first unique aspect is the fact that the response is largely a public health challenge. That adds a layer of complexity that the others do not have."

Yet as the Bush administration readies for war and prepares to fend off future attacks on U.S. soil, many in the health field argue it is time to elevate the issue of bioterrorism. "We are concerned that the grave medical and public health vulnerabilities in the nation will be missed in the very, very rapid push to shore up the nation's response to terrorism," said Thomas Inglesby, a senior fellow at the Hopkins Center for Civilian Biodefense at Johns Hopkins University.

Reading from the Defense Department's report to Congress, he said the Pentagon spent $264 billion to deter regional conflicts, $28 billion to protect against a "peer" nuclear attack and $3 billion on all other biological, chemical, cyber and nuclear assaults. Of that, he said, $250 million went to public health systems. "It would be a mistake not to change the funding patterns of the past," he said.

The GAO report, which is still in draft form, found that many of the federal bioterrorism programs are still in their infancy, with little more than start-up money.

The federal Centers for Disease Control and Prevention in Atlanta formally began a bioterrorism program in 1999, although the agency did not receive its first infusion of cash -- $9.2 million -- until this fiscal year. All told, the CDC budget includes $148 million for bioterrorism, though much of that money is spent on developing vaccines or purchasing medications for national stockpiles.

As of January 2001, not one of the National Guard's civil support teams, designed to deploy to a contaminated area within four hours of an attack, "had received necessary certification, and none were in use." The Pentagon received $93 million for the teams, which have a broader mandate of responding to attacks by all types of weapons of mass destruction.

Other critical agencies have been left out of the discussion or continue to spar among themselves, the GAO report indicated. The departments of Transportation and Agriculture were left out of the early planning entirely. "The FBI and CDC each have their own list of biological agents, and these lists only partially overlap," the report notes.

"For example, CDC considers smallpox to be a biological agent of concern, whereas the FBI does not include smallpox on its list of biological agents likely to be used in a terrorist attack."

And while some officials at the Department of Health and Human Services have argued with the Pentagon and the CIA over what medications should be stored in the National Pharmaceutical Stockpile, the Food and Drug Administration has not been consulted at all, "despite FDA's expertise with pharmaceuticals."

The study's authors also highlight fears that state and local agencies could not manage a biological assault.

-- Andre Weltman (aweltman@state.pa.us), September 28, 2001


The key to preparation for civilian bioattack is a robust medical and especially public health infrastructure.

See Laurie Garrett's excellent book _Betrayal of Trust_ about the mess public health is in, everywhere.

Further, deponent sayeth not.

-- Andre Weltman, M.D. (aweltman@state.pa.us), September 28, 2001.

Isn't the purpose of this new Homefront Agency to coordinate all this stuff?

-- QMan (qman@c-zone.net), September 28, 2001.

Good question. I'm not sure even the Homeland Defense office yet knows what it's really going to do.

None of the discussion I've heard has really clarified exactly how the new cabinet position will interact with all the players...and especially not as regards public health. I have learned that there *will* be more money -- tens of millions of dollars -- flowing down the pike for CDC, HHS, state health departments. But just exactly how this money will be used remains unclear.

This morning on the radio I caught some former senator -- it may have been Domenici, who was key in pushing federal BT preps to the states a few years ago -- asking difficult questions about the Homeland Defense function and chains of command.

There's nothing worse bureaucratically than having an unclear function and unclear authority to make it happen. Stay tuned.

-- Andre Weltman (aweltman@state.pa.us), September 28, 2001.

I must admit, I am still completely in the dark as to figuring out how this new Homeland Defense Agency is going to function. In order to properly coordinate all defensive information it would, it seems to me, have to have sweeping authority to comandeer all intelligence from every Federal agency, plus data gathered by all state and local policing authorities, in somewhat the same manner that Interpol operates, but on a voluntary basis.

And, because we anticipate that bioterrorism will be a big part of coming events, all health authories' inputs would have to be factored in, too.

All of this would be an amazing feat in order to be successful, when you consider that we live in a democracy which inherently includes all its bureaucratic turfs to defend.

-- Wellesley (wellesley@freeport.net), September 28, 2001.

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