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Years After Anthrax Attacks, Bioterrorism Threat Still Looms

August 7, 2008 at 6:15 PM EST
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As the probe into the 2001 anthrax attacks comes to a close, the country still faces challenges preventing and responding to bioterrorism attacks. Experts assess U.S. preparedness.
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JEFFREY TAYLOR, U.S. Attorney for the District of Columbia: We are confident that Dr. Ivins was the only person responsible for these attacks.

JEFFREY BROWN: The U.S. government effectively closed its investigation into the 2001 anthrax attacks yesterday, when federal prosecutors declared that Bruce Ivins, who committed suicide last week, was the sole perpetrator.

JEFFREY TAYLOR: We have a flask that’s effectively the murder weapon from which those spores were taken that was controlled by Dr. Ivins. The anthrax in that flask was created by Dr. Ivins.

JEFFREY BROWN: The anthrax mailings killed five people, sickened 17 others, and rattled a nation already on edge after the 9/11 attacks.

CITIZEN: I don’t know. It’s hard to avoid things, because you don’t know what — you know, do you not eat food? Do you not open your mail? I mean, not open our bills and, you know, and send them back? What do you do?

JEFFREY BROWN: Tommy Thompson was then secretary of health and human services.

FORMER GOV. TOMMY THOMPSON (R), Wisconsin: I know some critics are charging that our public health system is not prepared to respond to a major bioterrorism attack.

JEFFREY BROWN: The administration and Congress quickly approved spending tens of billions of dollars.

GEORGE W. BUSH, President of the United States: It’s important that we confront these real threats to our country and prepare for future emergencies. Protecting our citizens against bioterrorism is an urgent duty of American — American governments.

JEFFREY BROWN: Readiness drills were held in communities and hospitals around the country.

DOCTOR: Were you on the Metro yesterday when the symptoms happened?

PATIENT: Yes, that’s how I get home from work.

JEFFREY BROWN: Chemical and biological sensors were installed in major cities, including Washington, D.C.’s, Metro system.

TOM WOLSKO, Argonne National Laboratory: Once we know or can predict where the plume will go in a certain time frame, then we can take corrective actions in the subway systems to either shut down the trains, close ventilation systems.

JEFFREY BROWN: The government also began programs for new vaccines and stockpiling of drugs. In 2003, President Bush announced Project BioShield.

GEORGE W. BUSH: I have proposed that our government spend nearly $6 billion over the next 10 years to speed the research, production, and availability of effective vaccines and treatments against smallpox and anthrax, botulinum toxin, Ebola plague and other possible agents of bioterror.

JEFFREY BROWN: Since the anthrax attacks, the federal government has spent roughly $50 billion to protect against bioterror threats.

But with this week’s determination by the government that the perpetrator was a longtime Army scientist, the case is raising questions anew about the source of any threats and whether the country is, in fact, better prepared than it was in 2001.

Preparation against bioterror

Tara O'Toole
University of Pittsburgh Medical Center
I think hospitals are much better prepared to deal with what I'd call normal disasters. They're still not ready to deal with massive numbers of casualties, such as would occur in a big bioterrorist attack.

JEFFREY BROWN: And to help answer some of those questions, we turn to two experts in this field. Both have advised the government in the past, and both have also independently assessed its response.

Tara O'Toole is the director of the Center for Biosecurity at the University of Pittsburgh Medical Center. Amy Smithson is a senior fellow who specializes in chemical, biological, and homeland security issues at the Center for Nonproliferation Studies.

Well, Tara O'Toole, I want to start with you. As a general proposition, are we safer today after this big effort in bioterror response?

TARA O'TOOLE, University of Pittsburgh Medical Center: I think the nation is definitely better prepared, although progress has been modest in some places and has gone more slowly than was originally hoped, largely because the problem has proved harder than we anticipated. And it is the case that there is widely varying levels of preparedness from one location to another across the country.

JEFFREY BROWN: What kind of successes do you see?

TARA O'TOOLE: I think hospitals are much better prepared to deal with what I'd call normal disasters. They're still not ready to deal with massive numbers of casualties, such as would occur in a big bioterrorist attack. But they're working together and with public health, I think, in a much better manner than was the case in 2001.

We have a national stockpile of drugs and vaccines that would be very handy in an anthrax attack, for example, although progress and getting new drugs and new vaccines into the stockpile has been slow.

And I think public health is in better shape than it was in 2001, but it still has a long way to go.

I think in biosurveillance, we've spent a lot of money that with hindsight could have been better spent. But I think we're on the verge of being able to put together a good strategy for biosurveillance.

JEFFREY BROWN: Let me ask Amy Smithson, how do you weigh the benefits and problems still here, especially to the extent that it is about money? Has this been money well-spent?

AMY SMITHSON, Center for Nonproliferation Studies: We do have finite resources. And I would agree with Tara that some of our best investments have been in the improvement of public health capacity and also hospital preparedness.

When you go out on the front lines and work with America's emergency responders, I think they would argue that they'd like more money for drills to test their capabilities.

If there is a disease disaster in this country, they're going to be dealing with things that they haven't seen before. And the scale of the situation will far exceed their previous experience.

JEFFREY BROWN: You mean, if we have...

AMY SMITHSON: And so allowing them to test their skills and run major drills is a major part of the preparedness picture.

How far have we come?

Amy Smithson
Center for Nonproliferation Studies
It's difficult to get a uniform level of preparedness across this country when we don't have institutionalized standards for what first responders are supposed to be able to do in these types of contingencies.

JEFFREY BROWN: But this was there seven years ago, this idea that, if thousands of people at one time were harmed in some kind of bioterror attack, would the system -- would there be good communications and would the system be able to handle it? Have we come -- how far have we come since then?

AMY SMITHSON: I think, in some cities, they're better off. And in other cities, they still have a way to go.

It's difficult to get a uniform level of preparedness across this country when we don't have institutionalized standards for what first responders are supposed to be able to do in these types of contingencies.

And also, when our emergency management system, as demonstrated by the response to Hurricane Katrina, the glue that holds it all together needs to be re-addressed, too.

JEFFREY BROWN: Tara O'Toole, how do you respond to that, that sense of, if there is something that hits thousands of people at the same time, how much better off are we?

TARA O'TOOLE: Somewhat. It's going to depend a lot on where it happens, as Amy said.

You know, those states and those cities that have experienced disasters up close and personal have taken preparedness very seriously and come a long, long way.

New York City is much better prepared than it was in 2001. North Carolina has come a long way, largely because of its experience with floods and hurricanes.

So it's going to depend on what part of the country you're in, in terms of how good the response is.

JEFFREY BROWN: Amy Smithson, what about vaccine programs? I mentioned in the set-up the BioShield project that President Bush announced. Now, there have been some pluses and minuses in that, right?

AMY SMITHSON: There have been pluses and minuses. Some would question whether or not this program has been framed, because, as of yet -- framed well, because as of yet we don't have some of our larger pharmaceutical companies engaging in these programs, in large part because the amount being invested is far, far short of what it takes to bring a new vaccine or drug to market. And so you have the smaller biotech companies engaging in this.

So maybe we ought to reconsider the framework for BioShield. But also, should we be directing our research into things that are called multivalent, vaccines or treatments that go across multiple diseases, not just against the diseases that are possibly weaponized, like anthrax or smallpox?

Reducing U.S. vulnerabilities

Tara O'Toole
University of Pittsburgh Medical Center
We're not going to be able to develop the medicines and vaccines we need against bioterrorism or other diseases unless we do laboratory work. We obviously have to take safety and laboratories very seriously.

JEFFREY BROWN: Let me start with you. I want to ask about the Ivins case and what new questions that raises. For example, one of the things now on the table is, are we more vulnerable, in a sense, precisely because we have more labs and more scientists with access to this kind of material?

AMY SMITHSON: Well, there were rules put in place and strengthened after the anthrax letter attacks that are supposed to govern facilities' ability to work with these materials, including the access of personnel to work with these materials.

And in some areas, these rules -- called select agent rules -- are very, very prescriptive, they're very tightly worded. But in others, particularly issues of mental health and substance abuse, they're kind of vague.

And so the implementation is uneven. And I think what we know from the Ivins case is that, you know, he was seeing a mental health professional in February of 2000. And so we need to re-look at how these rules are being framed and implemented so that we really have the security gain there.

We don't want a situation where workers are afraid to admit they have a problem because they'll lose their job, but we do want to assure that we have, you know, people working on these agents that are mentally stable and not drunk, quite frankly.

JEFFREY BROWN: Tara O'Toole, what would you add to that? Have we, in a sense, put ourselves in a more vulnerable position, precisely by having more of these labs and people working?

TARA O'TOOLE: No, I don't think so. I think, as Amy said, the rules that were put in place after 2001 are quite sound. And there's a new bill that was introduced before the FBI investigation concluded that would look at those rules to make sure they're sufficiently stringent.

You have to keep in mind that anthrax and other bioweapons agents exist in nature. They're not, for the most part, locked up in labs. They're out in the world.

And if you really want to get a hold of anthrax, you can, even if you don't have access to these large labs. Furthermore, we're not going to be able to develop the medicines and vaccines we need against bioterrorism or other diseases unless we do laboratory work. We obviously have to take safety and laboratories very seriously.

And I think, you know, it's well worth looking at that to make sure everything is as secure as it ought to be. But lots of nations are doing work on these materials and just securing U.S. labs will not mean we're safe.

The psychology of fear

Amy Smithson
Center for Nonproliferation Studies
These details that are coming out about the Ivins case should get policymakers and scientists to re-examine the select agent rules and other initiatives that were put in place to see how they can be strengthened.

JEFFREY BROWN: I want to ask you both, finally, about the psychology of all this. We all remember the duct tape, and the evacuation plans, and, you know, the fear of opening letters.

To what extent -- I'll start with you, Amy Smithson -- to what extent did the psychology of fear shape what has happened over the last few years for better or for worse?

AMY SMITHSON: A number of the programs and policies that were put in place, I think, were perhaps driven by fear. I mean, this is a scary situation.

People can't see the diseases. They may fear that they don't have access to treatments. And that's why we do need research and development of the type that is done in laboratories like those at Fort Detrick.

JEFFREY BROWN: But driven by fear in a way that sent us down some wrong roads, as well?

AMY SMITHSON: I think we have gone down some wrong roads. And these details that are coming out about the Ivins case should get policymakers and scientists to re-examine the select agent rules and other initiatives that were put in place to see how they can be strengthened.

Which ones are truly better investments than others? A number of things were done. Were they all a security payoff, a safety payoff? I would argue no.

JEFFREY BROWN: Tara O'Toole, what would you argue about the psychology? And where are we today, in terms of the public awareness, apathy, if that's the right word for what's going on? How do you assess the psychology?

TARA O'TOOLE: Well, I think there's always a damager to overreacting to the last war, the last battle, or the last event. And there's no question that people were scared after 9/11.

It's important to remember that the major bioterrorism programs were begun in the Clinton administration in recognition of this growing threat.

You know, we're more prepared today than we were in 2001. At the same time, we're in the midst of a biological revolution. The science that allowed the FBI to conclude its investigation is marching on at an extraordinary pace.

And as we go forward, it will be easier and easier to make new and more potent biological weapons. And access to that technology will inevitably grow, regardless of what we do in our labs.

So biodefense is going to be an absolutely essential component of national security. We have to do it smart. We have finite resources, as Amy said. And we have to be prudent in our choices, but we're going to have to have a robust biodefense.

JEFFREY BROWN: All right, Tara O'Toole and Amy Smithson, thank you both very much.