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July 19, 2002

U.S. IMMUNIZATION NEWS

"Public Health Preparedness: The Best Defense Against Biological Weapons" Washington Quarterly (mitpress.mit.edu/WASH) (07/02) Vol. 25, No. 3, P. 69; Katz, Rebecca

TOPOFF, an emergency test conducted by the Federal Emergency Management Agency (FEMA) and the Department of Justice in May 2000, and Dark Winter, a test performed by CSIS in May 2001, probed at the United States' preparedness for a possible biological weapon attack.  The exercises showed that not only would a bioterrorist attack be devastating, but that the government is woefully unprepared for such an event, with the end result being hundreds of thousands of people sick or dead, full-scale panic, most likely a descent into widespread chaos, and civil liberties and rights usurped in exchange for controlling a disease's spread.  The attack simulations highlight the inability of typical first-responders, such as police and firefighters, and even secondary lines of defense to a conventional attack, such as the Department of Defense, to deal with biological warfare.  Instead, the public health system is better equipped to deal with disease and controlling illness, but has its own difficulties to bear.  Coordination among local, state, and federal agencies must be immediate and total to confront the effects of a bioterror attack, including maintaining public confidence in the government, distributing treatment for the disease in question, and quarantining areas if necessary. The detection of an outbreak, however, is nearly impossible for a short while after it has begun, as symptoms of most bioterror diseases are innocuous, and could be delayed by a week or more; the difference in a population of 100,000 people among whom several people have been infected with anthrax could be the deaths of 5,000 and loss of $128 million compared with the deaths of 33,000 and a loss of $26.3 billion.  For the system to protect perfectly, all levels of healthcare professionals, from hospitals to private doctors, from laboratory technicians to pharmacists, must be attuned to the prospect of a disease outbreak and report their suspicions immediately to authorities that can put together a larger picture of the events as they occur.  Even at the federal level, however, the Centers for Disease Control and Prevention operate some 100 small surveillance systems, the majority of which operate individually and have little coordination, though the creation of the Office of Homeland Defense could offer an opportunity for the more than 3,000 local health departments and myriad other groups to link their efforts under a single system that monitors the country for activity that signifies a bioterror attack.

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