Global Navigation Element.
 


Spring 2001 Vol. 1 No. 1



Next
Table of Contents
Previous




OPINION


A New Strategy for Fighting Biological Terrorism

BY DONALD A. HENDERSON


Photo courtesy of Johns Hopkins University When a terrorist cult released lethal sarin gas in the crowded Tokyo subway system in 1995 -- killing 12 people and injuring hundreds of others -- police, fire, and emergency rescue teams rushed to the scene to treat and evacuate those who were ill and to contain the threat. These immediate health effects made it apparent that a toxic substance had been released. But what would have happened if the terrorists had released a deadly organism such as that which causes smallpox or anthrax?

A microbe released into the atmosphere would be invisible, odorless, and tasteless. The attack probably would not be discovered until days or even weeks later, when sick people would begin arriving in emergency rooms and doctors' offices. Rather than being contained at the attack site, contagious diseases such as smallpox or plague could spread far beyond those who were originally exposed. Such biological weapons, in terms of their potential destructiveness and the panic and civil disorder that could ensue, are considered now to be equivalent to the large-scale threats once only posed by nuclear weapons.

And yet, to date, there is no agreed-upon national strategy in the United States for dealing with bioterrorism. Policy-makers have only begun to appreciate that the release of a biological agent would result in an epidemic and that the implications would be entirely different from those resulting from the release of a chemical agent or detonation of an explosive device. Unless bioterrorism is tackled with a much greater sense of urgency, the right practical expertise, and far more funding, the nation will continue to remain perilously vulnerable.

As demonstrated by the Tokyo attack, the first on the scene of an attack using a chemical agent is typically law enforcement and emergency medical teams. If an epidemic resulted from a biological agent, however, physicians, nurses, and public health officials would be the first to respond to the needs of acutely ill patients. They would be the ones to diagnose the disease, identify the origin of the epidemic, and organize control measures. But planning and research activities related to bioterrorism, until recently, have been heavily dominated by those with little knowledge of infectious diseases and no experience in epidemic control. Although well-intentioned, the planners have launched programs appropriate to the threats with which they are familiar -- chemical and nuclear weapons. It is now apparent that the challenge presented by biological terrorism is very different in all respects, including research, surveillance, arms-control initiatives, and intelligence gathering.

Federal funding for biological terrorism control efforts had gone almost entirely to the departments of Defense, Justice, and Energy, rather than to agencies equipped for handling public health threats and conducting biomedical research, such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health.

Now, in a partial mid-course correction, an effort is being made to recast domestic preparedness programs to also focus on biological threats. However, those directing the efforts are primarily emergency rescue, police, and fire personnel who have had no experience identifying or combating epidemics. Even more difficult to understand is the fact that little has been done to incorporate hospitals into the planning process. A recent meeting of hospital executives concluded, in fact, that no U.S. hospital is prepared today to deal with a large epidemic for a multitude of financial, legal, and staffing reasons.

The first tentative steps have been taken to develop a more focused and rational national strategy. In 1999, CDC received funding to strengthen state and local epidemic detection and control programs. The effort is designed to bolster our public health infrastructure and to re-establish effective working relationships between the public health and medical communities. The plan calls for developing appropriate state and local plans, educating primary caregivers and public health staff about agents that might be used, implementing surveillance systems for early detection of outbreaks, building a laboratory network capable of rapidly identifying biological agents, and stockpiling needed quantities of vaccines and drugs.

The threat of bioterrorism is not going to disappear. Indeed, as our knowledge of biological science advances, so will the opportunity to create more diverse and deadly weapons. Meanwhile, the nation also is threatened by a multitude of new and emerging infections, including West Nile encephalitis, Hanta virus pulmonary infection, new strains of influenza, and a growing number of antibiotic-resistant microbes. Regardless of whether the source is bioterrorism or a naturally occurring outbreak, similar resources are needed for the early detection and control of disease. Without the appropriate resources and expertise, the nation will remain ill-prepared to fight these very real enemies.


Donald A. Henderson is a professor of epidemiology and the director of the Center for Civilian Biodefense Studies at Johns Hopkins University, Baltimore.



The National Academies Op-Ed Service distributes accessible, compelling, and timely articles written by prominent scientists, engineers, physicians, and other experts. Visit the Service's Web site at <national-academies.org/op-ed> for a comprehensive collection of authoritative commentary on issues involving science, technology, and medicine.



Previous Table of Contents Next




Copyright 2001 by the National Academy of Sciences