about Epidemiology & the department

Epidemiology academic information

Epidemiology faculty

Epidemilogy resources

sites of interest to Epidemiology professionals

Last Updated

26 Dec 2002

Source: New York Times, September 9, 2002.


Many Worry That Nation Is Still Highly Vulnerable to Germ Attack


Although the Bush administration has invested hundreds of millions of dollars over the past year to strengthen the nation's defenses against a biological attack, experts say the United States remains highly vulnerable to bioterrorism, particularly strikes on the food supply.

The long-neglected public health system, which was stretched thin during the anthrax attacks of last fall, has received nearly $1 billion. States have used the money for plans to cope with a germ attack, and some are already hiring workers who can respond to intentional attacks or natural outbreaks of diseases like West Nile virus.

"Each day we are getting stronger," said Tommy G. Thompson, the secretary of health and human services. Even so, significant shortcomings remain.

Many experts, including Mr. Thompson, say the administration has not paid enough attention to protecting the plants and animals in the food supply from biological attacks. The Food and Drug Administration doubled the number of food inspectors, to 1,500, this year, but even so, Mr. Thompson said, the government is "woefully inadequate in this area." He called this his biggest concern.

Battles persist within the federal bureaucracy, particularly over the role of the new Department of Homeland Security in preparing for germ attacks. John J. Hamre, president of the Center for Strategic and International Studies, a research organization devoted to security, says the bioterrorism effort is still "years away" from being properly organized.

"We're better prepared as a society, but not necessarily as a government," said Mr. Hamre, a deputy secretary of defense in the Clinton administration.

Meanwhile, a deep philosophical divide has emerged between scientists and intelligence officials over whether to withhold scientific information in the name of national security. A case in point is a rift over a study on agricultural bioterrorism prepared by the National Research Council.

The report, a draft of which was obtained by The New York Times, says the government lacked a comprehensive plan to respond to agricultural bioterrorism. But it has yet to be published, its authors say, because of fears that it could aid potential terrorists.

"There's a possibility of it being literally classified," said Dr. Joshua Lederberg, a microbiologist and Nobel laureate who served on the committee that wrote the report. "Some people think it shouldn't be released."

So while government officials say considerable progress has been made against bioterrorism, they acknowledge that there is a long way to go.

"There are still some gaps," said Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention. "There is a kind of mosaic of capacity right now."

While public health agencies have received a big lift, hospitals have received far less money from the federal government, and many hospital executives say they cannot afford to prepare for bioterrorism on their own.

Although the budget of the National Institutes of Health has grown considerably to accommodate more research into new drugs and vaccines, the next generation of therapeutics is still years away.

"That just doesn't happen overnight," said David Franz, former commander of the Army's bioterrorism defense laboratory in Fort Detrick, Md.

Indeed, Dr. Franz and others say, the biggest change has been one of attitude.

Doctors and nurses who have never seen a case of smallpox -- a disease that was eradicated two decades ago -- are now learning how to identify its distinctive rash and how to administer the vaccine, which has not been routinely given to Americans since 1972.

Health officials pay closer attention to infectious disease. For example, Dr. Georges Benjamin, who runs the Maryland health department, now has his staff compile a monthly e-mail report of disease outbreaks overseas.

"We didn't feel threatened by that before," said Dr. Benjamin, who is also president of the Association of State and Territorial Health Officials. "The world has changed. Every time we get an outbreak at all, the first question we ask is, `Was this intentional?' "

The Agencies: Boom Times

As director of the Iowa public health laboratory, Mary J. Gilchrist has long worried about germ attacks, but long had trouble getting colleagues interested.

"People thought I was from outer space," Dr. Gilchrist said.

Last year, her bioterrorism preparedness budget was scant: $100,000, all of it from the Centers for Disease Control and Prevention.

This year, with $1.5 million in federal bioterrorism money, Dr. Gilchrist is hiring laboratory workers and buying equipment to enable her technicians to conduct rapid tests on infectious agents. She says she worries that she will be unable to fill new positions because other public health agencies are also hiring.

"There's going to be a brain drain," Dr. Gilchrist predicted.

Bioterrorism has brought boom times to public health agencies. In January, President Bush signed a bill authorizing $1.1 billion for bioterrorism preparedness, with the bulk of it, $930 million, designated to be parceled out among the states for improvements in public health.

The Office of Public Health Preparedness, created by Mr. Thompson, reviewed state plans and had disbursed nearly all the money by June, said Jerome M. Hauer, the office's director and an assistant secretary.

Now the states must carry out their plans.

In Massachusetts, for example, Nancy Ridley, assistant commissioner of the state's Department of Public Health, said it took several months just to get officials in 351 local health departments to agree on how to divide the state into regions so the federal dollars could be distributed. "Everybody wants a piece of the pie," she said.

In Texas, Dr. Eduardo Sanchez, the commissioner of health, is trying to determine how to handle an attack that would involve the state's neighbor, Mexico. Could Mexican hospitals care for American patients, and vice versa? Would Mexicans be eligible for smallpox vaccine from the United States stockpile?

Dr. Rex Archer, the director of health for Kansas City, Mo., said: "We as a nation have not defined how well we want to protect our public. We have not said that we need to be able to manage a major bioterrorism attack in, say, 50 states, and keep the number of casualties down to a certain level. Until you do that, you can't see how adequate your staffing is."

The Hospitals: Getting Ready

The nation's hospitals are not nearly as far along as public health agencies in preparing for a bioterrorist attack, Mr. Hauer says. They received an extra $135 million from the federal government, he said, but that is not enough. In his budget for 2003, President Bush has proposed $518 million for hospital preparedness.

A major concern is what experts call "surge capacity," the ability of hospitals to accommodate a sudden increase of patients. Mr. Thompson, the health secretary, says he wants each state to develop regional plans that would enable hospitals to handle an extra 500 patients on any given day this year, and 1,500 on any given day next year.

"Five hundred patients is feasible so long as people understand that not everybody is going to be in a hospital-style bed with all the accouterments," said James D. Bentley, a senior vice president at the American Hospital Association. "If we have to start using elementary schools or armories or other kinds of settings, that's what we will have to do."

Hospitals that ordinarily compete have begun joining forces. Dr. Paul Pepe, who runs the emergency department at Parkland Health and Hospital System in Dallas, said hospitals in the region were talking about "cross-credentialing" doctors so that they could treat patients anywhere.

"We're talking about buying in bulk, in economies of scale, with everybody participating," Dr. Pepe said. "Everybody is anteing up."

But, Mr. Bentley said: "There is a long way to go. It is going to probably take five years to get where we ought to be."

The Vaccines: Bolstering Supplies

As fear of anthrax swept the nation last fall, much of the public discussion about bioterrorism centered on the question of whether there would be enough drugs and vaccines to go around. Today, those worries have largely eased.

The biggest fear last fall was an insufficient supply of vaccine against smallpox. Mr. Thompson, the health secretary, signed contracts with two companies -- Acambis, a biotechnology concern, and Baxter, the pharmaceutical giant -- for a total of 209 million doses.

But in the interim, scientific studies have shown that the nation's existing stockpiles of smallpox vaccine could be diluted to provide 300 million doses, enough for every American to be inoculated, said Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Diseases, which did the work.

The existing vaccine is old -- some of it dates to 1952 -- so the government still intends to buy the new vaccine. But, Dr. Fauci said, "If we had an emergency tomorrow we'd be good to go."

Still unresolved is the question of whether the government should offer the vaccine to health care and emergency workers as a precaution against a bioterrorist attack. In June, a national advisory panel recommended vaccinating about 15,000 health care professionals.

The issue has proved a vexing and politically delicate one, because the vaccine is made from a live virus that itself can lead to fatal complications in people who receive it or come into contact with people who receive it. People with impaired immune systems are especially vulnerable. The decision now rests in the hands of the White House; Mr. Thompson said an announcement was expected by the end of the month. (The new vaccine is also made from a live virus, vaccinia, but under safer conditions. )

The Food Supply: Another Front

Many officials and scientists say bioterrorist threats to the nation's food supply have had too low a priority in the war against terrorism. Understandably, one administration official said, the government initially concentrated on countering threats to people, and the relative complacency about agriculture was partly a result of the nation's success in controlling disease.

"Most people take the programs for granted because we have been so well protected," Ann M. Veneman, the secretary of agriculture, said in an interview yesterday. But countering bioterrorist threats has the highest priority for her, she said. Since Sept. 11, with a $328 million budget appropriated by Congress, she has formed a homeland defense council to advise her and has taken other steps to reduce vulnerability, among them increasing border inspections and spending on research.

Critics say too little is still being done, partly because of bureaucratic inertia and a passion for secrecy at the top.

"There is a true crisis in agricultural biosecurity that stems in part from from hostility to the very notion of vulnerability at the top of the Department of Agriculture," said Thomas W. Frazier, president of GenCon, a nonprofit group that promotes scientific and educational projects affecting agriculture.

The issue is reflected in a dispute over the delayed release of the National Research Council's draft report, "Countering Agricultural Bioterrorism: A Framework for Action," commissioned by the government a year before the attacks but partly written after them.

The report warns that "gaps in biological and intelligence data on foreign-plant and foreign-animal pest and pathogens" and inadequate inspection at the nation's borders increase the chance that a terrorist armed with, say, foot-and-mouth virus or soybean rust could enter the country and deliberately spread diseases that could cripple the nation's livestock and plants.

It notes that only 1 percent of all private vehicles entering the country are inspected by the Agriculture Department. It concludes that the government has not developed "in-depth plans for defense against the intentional introduction of biological agents directed at agriculture."

Dr. E. William Colglazier, the executive director of the National Academy of Sciences, which conducted the study, said that lawyers for the Department of Agriculture and the White House's Office of Homeland Security had asked the the academy not to publish the report because it might give terrorists a "road map" to striking American agriculture.

Dr. Colglazier said the academy had been willing to omit from the published version of the study secret data or passages that could be harmful to national security, but the government had not identified such material. Scientists and other experts who worked on the study said it contained no secret information and the vulnerabilities it discusses could be found in publications on the Internet. He also said the academy planned to publish a version of the study, which it would edit.

Ms. Veneman said she had not read the report. But Alisa Harrison, an Agriculture Department spokeswoman, said her agency and the homeland security office had not requested that the report be suppressed.

At the same time, critics say, the government has been slow to spend money for initiatives like the creation of a new national laboratory network to detect infectious disease in animals.

Last year, Congress appropriated $23 million to plan the design of a new facility at Plum Island, off Long Island, the nation's only laboratory authorized to study and develop vaccines for such highly contagious animal diseases as foot and mouth. But nine months later, no design plans have been made. Agency officials say Congress has insisted that first a new study must be completed on whether a new, higher-security lab should be built on the island or the mainland.

Anne K. Vidaver, chairwoman of the department of plant pathology at the University of Nebraska, said that plant research in general, despite the recent increases, remained underfinanced, and that federal and state labs communicate poorly with one another. In addition, she said, the response to a blight might be delayed by the Agriculture Department's concern about the effect of such a discovery on trade.

"The United States is not unique in this respect," Dr. Vidaver said, "but if soybean rust shows up tomorrow, we might be ordered not to talk about it."

Gordon D. Johndroe, a spokesman for the Office of Homeland Security, noted that President Bush listed bioterrorism prevention as one of his top four priorities this year, and that the White House had requested $7 billion for it in next year's budget.

He counseled patience as the government mobilizes for a long-term campaign against germs directed at people, plants and animals. "We're much better prepared than we were last fall," Mr. Johndroe said, "and we'll be twice as prepared a year from now as we are today."

Forewarned and Forearmed?

Most public health and intelligence officials agree that no matter how much money is spent, and how many plans are drawn, the nation will never be fully prepared for or protected against a biological attack.

"Prepare for what?" Dr. Benjamin, the Maryland health director, asked. "We are better prepared today to identify smallpox and anthrax than we were a year ago. There is still a whole list of organisms that we are not as prepared for."

In the end, experts say, the most important achievement since last September has been raising the nation's consciousness.

"Our biggest success is not related to vaccines or drugs," said Dr. Franz, the former Fort Detrick commander. "It is related to awareness: Awareness among physicians to think about unusual diseases. Awareness among emergency responders, that if it looks like the flu, maybe it isn't the flu. Awareness among law enforcement, and the guys that walk around in those white shirts in airports. I don't think they would let a sick person, maybe with smallpox, sit in an airport and cough on people. That's the big difference, and that is all education and experience."