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Last Updated

19 Mar 2003

Source: Wall Street Journal, March 19, 2003


Are States Prepared For a Bioterror Attack?


On the morning of Feb. 4, a tractor-trailer swung onto the county fairground in Tallahassee, Fla., with a six-ton shipment of fake antibiotics and other medical supplies.

The delivery came from the Strategic National Stockpile, the emergency-medicine supply maintained by the federal Centers for Disease Control and Prevention, and it was part of an exercise testing Florida's readiness to treat victims of a terrorist attack spreading the pneumonic plague.

Emergency teams quickly unloaded the cargo, dividing it among smaller trucks for distribution to clinics in eight counties. Afterward, Florida officials proclaimed the six-hour drill a success.

"We know we can handle this," said Robert McDaniel, training and exercise officer with Florida's emergency operations office.

Yet as concern about a bioterror attack rises on the home front, not all states can make that claim. The CDC's stockpile can deliver 50-ton packages of drugs and medical supplies anywhere in the country within 12 hours. But while every state and major city has a plan on paper enabling it to take delivery and make distributions, the CDC says live drills with the stockpile's practice package have been held in just five states: Arizona, Oklahoma, Kentucky and Nevada, in addition to Florida.

"It doesn't matter what you have in your medicine cabinet if you can't move it out to the people who need it," says Monica Schoch-Spana, a senior fellow at the Johns Hopkins Center for Civilian Biodefense Strategies. "Distribution capacity at the state and local public-health level is a system problem that continues."

Steve Adams, the stockpile's deputy director, says the CDC doesn't have the authority to require states to conduct live exercises. But he says such drills are "a very good thing to do" because the distribution of a stockpile delivery is a major logistical challenge.

Local planners say at least 5,000 square feet of space are required just to accommodate a single prepackaged 50-ton shipment, which typically fills a 747 aircraft. "That's a huge thing," says Tim McAndrew, the emergency manager for Las Vegas.

"When it comes down to 'can we really do it?' there's nothing like pushing those containers around to know you've planned the right amount of space and allocated the right amount of resources to make it move," says Steve Englender, Kentucky's state epidemiologist.

The degree of readiness varies by state. Georgia, the CDC's home state, says it aims to schedule a live stockpile drill in September. Alabama plans one in October. Maryland says it's prepared, even without a live drill: The state has trained hundreds of pharmacists who have volunteered to dispense medication in an emergency.

Jerome Hauer, acting assistant secretary for public health preparedness at the Department of Health and Human Services, the CDC's parent agency, concedes that some states "are more ready than others." But in an emergency, he says, the federal government -- which already sends a team of pharmaceutical and logistics experts with each stockpile -- could supply extra personnel to help deliveries run smoothly.

In addition to the live exercises, Mr. Hauer notes, some states have had drills to test their capabilities without using an actual stockpile. In addition, 200 people from all 50 states have practiced with the stockpile at a federal training site in Anniston, Ala., says a CDC spokesman, and demonstration sessions have been held in Mobile, Ala., and Memphis, Tenn.

Mr. Hauer also says that giving smallpox shots to health-care workers and planning for mass inoculations in the event of an actual smallpox outbreak are a major part of the government's bioterrorism plan. He argues that organizing mass vaccinations inevitably boosts preparations for other scenarios, such as an anthrax attack, which would call for mass distribution of antibiotics from the stockpile.

But some local planners respond that the smallpox shots have kept them so busy that testing plans for a stockpile shipment haven't received priority. Stockpile "exercises have been put on a back burner," says Laurene Mascola, whose department oversees bioterrorism preparations for Los Angeles County.

Formerly known as the National Pharmaceutical Stockpile, the program was established in 1999 with a $51 million budget. After Sept. 11, the government expanded it with an infusion of $600 million. President Bush's budget for the stockpile this year is $300 million, the CDC says.

At any given time, there are 12 "push packs," as the huge loads of antibiotics and medical supplies are called, at 10 locations around the country, up from eight originally. The packs contain drugs to treat the diseases that the CDC thinks are most likely to be used in a bioterror attack, including anthrax , plague and tularemia, plus medical gear such as syringes, airway tubes and intravenous supplies.

The stockpile also has antidotes that can be used in other situations, such as nerve-gas attacks. But because such drugs generally have to be given within minutes or hours to be effective, the stockpile would be most useful if there were a second-wave attack in such cases.

The CDC can tailor additional deliveries from its inventories if a specific threat is identified. The stockpile program maintains the nation's supply of smallpox vaccine, for example, which would be distributed separately if a case of the disease were confirmed.

Originally, the program stored drugs in bulk, requiring pill-counting machines to sort out individual doses once the pack was delivered. Now, the stockpile keeps most medications in "patient ready" doses, Mr. Adams says.