Security, science and biological threats

March 02, 2000|By Stephen L. Cohen

THE UNITED STATES was recently reminded again that it is woefully ill-prepared to deal with the threat of biological terrorism.

The General Accounting Office, an investigative branch of Congress, charged that the government has failed to properly manage the medical stockpiles developed to protect the public from the scourge of potentially devastating biological weapons.

In its report, the GAO criticized multiple government agencies for managing the stockpiles so poorly that they might be unavailable in the event of attack. It found both shortages of vital drugs and deficiencies in the amount of emergency supplies supposed to be on hand.

The Chemical Biological Incident Response Force, a Marine Corps unit created in 1996 to treat civilian victims of a biological attack, was cited for glaring shortcomings: The GAO discovered that more than a quarter of the corps' stockpile was plagued by inventory discrepancies and record-keeping errors. The Department of Veterans Affairs was also cited for its failure to manage emergency supplies.

Such government ineptitude is no idle matter. If deadly microbes such as anthrax or smallpox were released into the general population, a prospect that experts say is plausible, federal stockpiles of medical supplies would be critical to saving lives. State and local authorities could be quickly overwhelmed by mounting casualties, and federal intervention would be urgently needed. No city in the country has the resources to handle a major attack on its own.

Yet, Washington has been dragging its heels in preparing for a potential crisis. The GAO report is only the latest evidence that the government's effort to prepare for a biological attack is alarmingly ineffective. The problem, quite simply, is that the nation has yet to take the steps that could ultimately save thousands, or even tens of thousands, of lives. Such steps include everything from enhancing our disease surveillance system to ensuring an adequate supply of lifesaving vaccines and antibiotics.

Inevitable questions

The government's failure to take these steps raises inevitable questions. With the stakes so high, why isn't Washington taking more aggressive action? If national-security and health officials agree that the threat is real, why aren't they working harder to mitigate the threat? The answer may lie in the challenges posed by the specter of bioterrorism.

Unlike a chemical or explosive attack, a biological attack will require the close collaboration of groups not accustomed to working together: the national-security and public-health establishments. It's an odd mix -- doctors and intelligence agents -- but for biological counterterrorism to work, they must join forces. Unfortunately, the National Security Council and other federal agencies have yet to fully integrate the medical community into their plans.

To succeed, they will have to correct this flaw, because the first responders to any bioweapons attack are likely to be doctors and local public-health authorities. If terrorists should ever unleash infectious agents on a city, the first evidence of the attack will almost certainly appear in hospital emergency rooms. At this point, a rapid response will be critical: If diagnosis and treatment are delayed, it could mean huge numbers of casualties. The very survival of health-care providers could be at stake.

But how well prepared are we to handle such a crisis? Few doctors have ever seen a case of smallpox, plague or anthrax. Few, if any, medical laboratories are equipped to diagnose such conditions. As the GAO noted, U.S. stockpiles of drugs and supplies are far from ideal.

There are other problems. The national counterterrorism effort, for example, has focused mainly on chemical and explosive weapons rather than on infectious agents. Perhaps this reflects the security establishment's familiarity with such weapons, since its efforts in this area have largely involved the enhancement of existing hazardous-material protocols. But what about the biological threat?

Medical experts point out that biological weapons are far more dangerous than either chemicals or explosives, since the devastation from this kind of attack can persist and even worsen over time, as new cases of disease arise. In contrast, stabilization and recovery from a chemical attack can begin almost immediately. Yet, despite this reality, preparations for a bioweapons attack have lagged far behind efforts to prepare for more traditional kinds of threats like explosives.

Transcending priorities

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