Countering biological and chemical agents

Bioterrorism

The movement into the highly technical 21st century and especially the terrorist act of September 11, 2001 at the World Trade Center in New York City and the anthrax scare, have stimulated major concern for civilian vulnerability to the deliberate use of biological and chemical agents. As a result, significant national organizations, such as the Center for Disease Control (CDC), as well as local urban areas and smaller communities, have either begun to develop or have implemented strategic plans concerning what to do in the event of a bioterrorism attack. Success of such programs relies on integrating essential training, education and preparation readiness, as well as strong communication systems among the many emergency organizations involved. It also necessitates the involvement of everyone in a community.

Chemical warfare is the intentional use of toxic substances that result in death or injury. Biological warfare is the premeditated utilization of microorganisms for the same results. Some toxin kills just those with whom it comes in contact. Other weapons may spread and cause major epidemics.

The use or threat of chemical and biological weapons is deeply rooted in the history of warfare. Due to the experiences on the battlefields in the Western Front in World War I that resulted in thousands of deaths and the written descriptions of the effects of the agents, the concern is even greater (Douglass x). Elsewhere around the world, populations have been decimated or debilitated from these weapons.

In World War I, Germans introduced the blistering agent mustard gas, dichorethyl sulfide, which derives its name from the odor. It irritated the eyes and throats of the soldiers and caused blisters to form on their skin. It also led to blindness, vomiting and nausea that sometimes lasted for months. Further, it contaminated the soil and had to be removed before anyone could walk in the area where it was disseminated. Similarly, the blistering agent lewisite, which was used in the same war, was quick acting and caused eye damage within 15 minutes.

Unlike the poisonous blood agents used in WWI, nerve agents that are transmitted through the nerves and muscles are much more dangerous. They block nerve function when inhaled or absorbed through the skin and lead to death from paralysis of the respiratory system. Fatality can occur within one to ten minutes. Since not much of the gas is needed when airborne, thousands of civilians in cities can be killed or harmed very rapidly.

In their book Germs: Biological Weapons and America's Secret War, Miller, Engelberg and Broad relate future possibilities such as deadly germs sprayed in shopping malls, bomb letters sending out anthrax or other chemicals over cities, and tiny vials of plague scattered in highly populated areas as Times Square in New York City. These, the authors say, could be the poor man's hydrogen bombs, hideous weapons of mass destruction that can be made in a simple laboratory.

Following hundreds of interviews with scientists and senior officials in the Clinton Administration, including the president himself, as well as after reading declassified documents and on-site reporting from the former Soviet Union's sinister bio-weapons labs, Germs describes how bio-warriors could actually meet their objectives. This is without a doubt, say the authors, one of the country's biggest nightmares.

Could this truly be a concern in the United States? The anthrax scares and subsequent illnesses and deaths, although minor, show that it is possible. Situations as in Tokyo in 1995, do the same. On the morning of March 20, many Japanese were going to work. Five men boarded three separate subway trains in various parts of the city. The men, part of the group called "Aum Shinrikyo" or "Supreme Truth," carried plastic bags of toxins. They punched holes in them, and the commuters began gasping for breath. Panic set in, as people became dizzy or nauseous, collapsed or were choking. An older man in one of the subway cars soon died. A few who helped clean up the mess were also fatalities (Levine 8).

Scores of ambulances rushed to the subway stations and carried the victims to the hospitals. In total, the disaster killed 12 and injured over 5,000. Most recovered, but some were left with serious and permanent problems such as blindness (Levine 8). The situation could have been worse. The trains were not as crowded as usual because it was the day before a national holiday. Second, the chemical was in the form of liquid instead of gas. Third, the sarin, or nerve gas, was weakened by its impurities.

Although there is disagreement as to the degree of the threat of chemical or biological weapons on United States soil, some have decided to take the issue very seriously. In April 2000, the Center for Disease Control prepared a report "Biological and Chemical Terrorism: Strategic Plan for Preparedness and Response Recommendations of the CDC Strategic Planning Workgroup," which outlined steps for strengthening public health and health-care capacity to protect the United States against such dangers.

The report noted: "Terrorist incidents in the United States and elsewhere involving bacterial pathogens, nerve gas, and a lethal plant toxin, have demonstrated that the United States is vulnerable to biological and chemical threats as well as explosives." Recipes for preparing "homemade" agents are readily available, and rumors of arsenals of military bioweapons raise the possibility that terrorists might have access to highly dangerous agents, which have been engineered for mass dissemination as small-particle aerosols. Agents as the variola virus, the causative agent of smallpox, are highly contagious and often fatal. "Responding to large-scale outbreaks caused by these agents will require the rapid mobilization of public health workers, emergency responders, and private health-care providers. Large-scale outbreaks will also require rapid procurement and distribution of large quantities of drugs and vaccines, which must be available quickly," the report added.

In the case of emergency, "a comprehensive public health response to a biological or chemical terrorist event involves epidemiologic investigation, medical treatment and prophylaxis for affected persons, and the initiation of disease prevention or environmental decontamination measures." Widespread use of effective communication is also vital. People affected need to have access to up-to -- the minute emergency information. Effective communication with the public through the news media is essential to limit the terrorists' ability to induce public panic and disrupt daily life.

The Emergency Response and Research Institute (HERI) in Chicago has maintained for years that local fire, police and emergency services are not prepared collectively for a biological or chemical attack (Gay 54). One of the originators of HERI emphasized in 1997 that a "major consideration is the need for an effective pre-planning process." No one can possibly predict the specific site of a biological or chemical accident or attack. However, plans can be put into effect in case this horrible and deadly situation does occur. As he explains:

Logically, as in any crisis, the local police, fire departments and EMS agencies will be immediately responsible for an operation involving a chemical/biological release and mass casualties. But, depending on the circumstances of the incident, it may also be necessary to rapidly involve other state and federal agencies...[including] the nearest field office of the Federal Bureau of Investigation (the federally designated lead agency in a confirmed domestic terrorist event), the Secret Service, the Department of Alcohol, Tobacco, and Firearms, the disaster agencies, military units and specialized medical personnel units...excellent interagency cooperation and communication is a necessity (Gay 55).

An unexpected "run through" of an emergency incident occurred during a concert at the Centennial Olympic Park during the Olympic Games in Atlanta, Georgia. Although this did not happen to be chemical or biological weapons, a bomb exploding showed the necessity of being prepared. The response by multiple agencies was held up as a prototype. Within minutes after the explosion in the park, hundreds of local firefighters, police and medical personnel were on the scene. Within hours, FBI agents were at the site gathering soil samples from a crater produced by the bomb.

According to a report in Chemical and Engineering News on the Atlanta bombing, the Department of Defense Science and Technology Center (Sci-Tech) "brought together under one roof the best chemical and biological warfare agent analytical capability to be found within the federal government." The Army contributed its Army Materiel Command Treaty Laboratory for chemical warfare agent identification. The U.S. Navy offered its Biological Defense Research Program for biological warfare agent verification. The article added: "Counterterrorism is not the principal function of either lab. The Army's lab was set up to verify compliance with the Chemical Weapons Convention. The Navy lab, part of the Naval Medical Research Institute, conducts biological research."

Because of the Olympics with so many people in attendance, Atlanta had to be prepared in case of an emergency. Many other large cities would not have been as prepared Thus, the federal government has looked for ways to enhance readiness.

The Defense Authorization Bill, or Nunn-Lugar, Domenici II legislation, passed in 1996. Its purpose is providing funds to states and local training programs for effective responses to possible attacks. Then Secretary of Defense William S. Cohen said the program was "specifically designed so that the people we train become trainers themselves. This approach will greatly magnify our efforts to produce a core of qualified first responders across the nation." In March 1998, Cohen announced an additional Department of Defense support initiative -- the military's first-ever rapid assessment teams, RAID (rapid assessment, identification and detection). "These new RAID teams will quickly reach the scene of the incident in order to help local first responders figure out what kind of attack occurred, its extent, and the steps needed to minimize and manage the consequences." He added: "Getting prepared for such an attack is extremely complicated, given the wide range of possible threats and the many players at the local, state and federal levels (U.S. DOD).

However, a large number of cities do not have any plans to respond to a chemical or biological attack. According to Biodefense.org, an educational and reference library website on this topic, many news stories published across the U.S. during 2004 showed that many cities are not prepared for any type of major incidence.

Florida, however, has been ranked as one of the most prepared states in the country. Florida, a state all too familiar with emergency after four hurricanes battered it last year, presents a model for bioterror preparedness. Yet even its boosters caution that much still needs to be done to address areas of vulnerability. Both Florida and North Carolina passed the grade in nine of the 10 categories that the Trust for America's Health (TFAH), an independent research group in Washington, uses to assess each state's public-health readiness. In 2003, Florida scored seven out of 10. The state has scored so well largely because of the strong public-health infrastructure it has developed that maximizes resources. Among such achievements is the state's coveted "green" status relating to the Strategic National Stockpile of the Centers for Disease Control and Prevention. It means that Florida, the first of only five states to achieve such a grade, is deemed adequately prepared to distribute vaccines and antidotes in the event of a mass disease outbreak.

Last February, health personnel from each of the 67 Florida counties took part in a large-scale exercise that simulated air passengers with bubonic plague arriving at various places in the state. The distribution test was passed. Officials also point to the state's five-year public-health plan, which calls for additional resources to counter bioterror threats. For example, in the event of a biological, chemical, or radiological attack leading to mass casualties, Florida's hospitals will be able to manage emergency treatment for 500 people per one million of population, and they will be able to admit 50 patients per one million. In addition, each region will be able to isolate 10 patients showing symptoms of diseases like smallpox. Florida has almost 17 million residents. Maintaining a strong response capability in Florida's Public Health Department laboratories has also been a priority, and the state has upgraded much of its equipment. Only one-third of states were judged to have enough scientists to be able to cope with a bioterror attack.

Other states are not doing as well in preparing for different scenarios, according to a Trust for America's Health report. It found only six states, like Florida, are adequately prepared to distribute vaccines and antidotes in an emergency. "More than three years after 9/11 and the anthrax tragedies, we've only made baby steps toward better bioterrorism preparedness, rather than the giant leaps required to adequately protect the American people," said former Senator Lowell P. Weicker Jr., president of the Trust. The report concluded that basic bioterrorism detection, diagnosis and response capabilities are not in place, and the country has a long way to go to protect the American public from such an attack.

The most significant downfall among the states was the lack of adequate public health labs and laboratory scientists to handle serious outbreaks. The Trust report found only 16 states have enough labs and 21 have enough scientists. Another report, conducted by Milbank Memorial Fund, found "By and large, most state departments of health were grossly unprepared for September 11 and its aftermath." Georges Benjamin, previous director of the Maryland Department of Health and also president of the Association of State and Territorial Health Officials, noted in October 2001, just weeks after the attacks on the World Trade Center and the Pentagon, that "in a field where communication can save a life, some state health departments did not have an effective e-mail communication system with their local and county departments." The Atlanta Journal and Constitution, citing Benjamin, reported that "public health officials have been warning for years that the [public health] system is antiquated" (Markowitz).

Since 2001, the federal government has spent almost $3 billion developing strategies to prevent or at least prepare for bioterrorism attacks. Is the country better prepared now than four years ago? With the support of the Robert Wood Johnson Foundation, the Century Foundation Working Group on Bioterrorism Preparedness has studied how these funds have been used and assessed what has been done well, what gaps remain, and what should be done in the future. In the project's final report, "Breathing Easier? The Report of The Century Foundation Working Group on Bioterrorism Preparedness," a group of leading public health policy experts and practitioners concluded that the new federal funding has resulted in considerable improvements to the U.S. public health system, but that substantial vulnerabilities remain. The group found that without clearer definitions of what constitutes preparedness and standards for achieving it, the infusion of funds may not succeed in enabling the public health system to respond effectively to a future bioterrorist attack.

The Working Group developed a set of recommendations for how bioterrorism funding can strengthen the fabric of public health, rather than stretch it too thin. The organization's recommendations included the following:

The government should define public health preparedness more clearly and develop minimum national standards.

Federal and state public health officials, in cooperation with experts in public health, should define what local public health capabilities should be.

Laws governing how responses to public health emergencies and public health investigations are conducted must be modernized.

The public health workforce needs to be enlarged and its skills upgraded.

To sustain improvements in the public health system, the flow of federal and state funding must continue without interruption.

A balance must be struck between preparing for a biological attack and maintaining and expanding other vital functions of the public health system.

In the two years following the 9/11 attack, state departments of health throughout the country sought to determine their own state of preparedness and to define exactly what "preparedness" actually meant. According to Southern California's North County Times, one nationwide survey found, "90% of county governments were... unprepared for biological or chemical attacks" (Markowitz).

Such programs as noted above stress preparation and reaction. The other approach that has been recommended for dealing with the possibility of bioterrorism, especially due to budgetary problems with upgrading health departments, is promoting intelligence and motivational methods -- taking a proactive approach -- such as: Reforming and modernizing the U.S. intelligence community; improving international intelligence cooperation; increasing intelligence to detect small-scale nuclear/biological/chemical programs; increasing and improving monitoring of diseases to determine whether a biological attack has occurred and expanding Department of Defense efforts to train personnel who would respond to a large-scale biological or chemical attack (Falkenrath 249).