Between October 5th and November 21st, 2001, five people in the U. S. died from anthrax. Eighteen others became ill but survived after long hospital stays. Thirty or forty thousand people received preventive antibiotics because they might have been exposed. Millions panicked, seeking Cipro, the most popular antibiotic, and buying gas masks. The U.S. government spent millions to buy even more antibiotics. The healthcare system came close to a standstill, with exhausted and overworked microbiologists sleeping in their labs for weeks. Months later, no one yet knows whether the anthrax attack was launched by a lone mad scientist, by an international terrorist group, or by a rogue state. Nor do we know whether the anthrax attack was merely a test run for a larger event.

The anthrax scare, like the attacks of September 11th, shows how unprepared and vulnerable the U.S. is to international and domestic terrorism. Suddenly, it's not only the Marines or the National Guard but also people in white coats in the U.S. public health system who have become the nation's front line of defense. Whether future terrorist attacks-and many analysts unfortunately agree that they are expected-are biological, nuclear, chemical or radiological (as in a so-called "dirty" nuclear bomb containing radioactive material that could be dispersed by using conventional explosives), clearly the public health system urgently needs improvement and expansion. More money, better communications, more personnel, improved training, updated facilities, national direction and coordination-all these are on the list of requirements for bringing the system to a level where it can be effective in the event of a bioterrorism attack.

"It may prove impossible to prevent future bioweapons attacks from occurring, yet prior planning and preparation could greatly mitigate the death and suffering that would result. As a nation, we need comprehensive, integrated planning for how we will address the threat of bioterrorism, focusing both on prevention and response. We need to define the relative roles and responsibilities of the different agencies involved, and identify the mechanisms by which the various levels of government will interact and work together," said Dr. Margaret Hamburg, vice president for Biological Programs at the Nuclear Threat Initiative, in a speech to the New York Academy of Medicine. When she was New York City's health commissioner in the early 1990s, she engineered the city's successful response to its epidemic of multi-drug-resistant tuberculosis and to the first terrorist attack on the World Trade Center in 1993.

Although the 1993 attack caused six deaths and many injuries, Dr. Hamburg points out that, "The release of a bioweapon could have created even more havoc...thousands of people who were working in that building or visiting would have unknowingly been exposed to a biological agent, returned home and become ill within days or weeks. With worsening illness, these individuals would begin to come into emergency departments, walk-in clinics and physicians' offices, but they would be spread out in time and geographic location." Because healthcare providers probably would not recognize the infection, diagnosis would be delayed. If the disease were communicable from person to person-as smallpox is, but anthrax is not-then the circles of infection would widen, in an international ripple effect. The resulting devastation would probably be compounded by the lack of an organized and coordinated response on the part of local, state and federal public health systems. Indeed, says Jerome Hauer, former head of New York City's Office of Emergency Management (OEM), "Our public health infrastructure has fallen apart. Local health departments don't see themselves as emergency agencies. They're closed on weekends."

Because of the potential for calamity that bioterrorism represents, the International Peace and Security program of Carnegie Corporation of New York has added chemical and biological weapons to its nuclear weapons focus. Says David C. Speedie, the program chair, "Biological weapons are easier to develop and acquire," but their dispersal and impact would not be immediately apparent. "It's not impossible that a nuclear weapon could fall into the wrong hands or that terrorists could create a 'dirty bomb' that spreads radioactivity," he continues. "In a nuclear attack, there would be immediate shock, immense casualties and a huge psychological reaction." Chemical or nuclear attacks, while they might be far more devastating than the airplane attacks of September 11th, are also likely to be local. (See Sidebar: "What if the Attack is Chemical or Nuclear?")

Protection against bioterrorism is now a public health issue. President George W. Bush called for spending $11 billion over the next two years to improve the nation's ability to defend itself against biological warfare and to create an early warning system. Distribution of the first funds for state and local bioterrorism preparation began in mid-February 2002. The money is to go to hospitals, laboratories and first responders (such as paramedics and emergency medical technicians) for purchase of communications systems to link with the Centers for Disease Control and Prevention (CDC), as well as other agencies and networks.

Several times, U.S. public health experts have contemplated the effect of a terrorist attack with biological weapons and concluded the nation would fail to respond effectively. Carnegie Corporation grantees Amy E. Smithson and Leslie-Anne Levy of the Henry L. Stimson Center interviewed police officers, firefighters, paramedics, emergency managers, healthcare providers and public health officials in 33 cities throughout the U.S. in 1999 and 2000 for a report they called Ataxia, which means lack of order, confusion, or failure of muscle coordination. It's a fitting title: the scenarios they described closely resembled what happened in the anthrax scare and in several war games exercises.

Next page: Bugs for Sale

Page 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8

Copyright information | Masthead | Carnegie Corporation of New York web site