In the past seven years, the federal government has spent more than $57 billion to shore up the nation's bioterrorism defenses, stockpiling drugs, ringing more than 30 American cities in a network of detectors and boosting preparedness at hospitals.The result: modest gains, at best, toward preventing another attack similar to the one in 2001, in which anthrax bacteria killed five people and sickened 17, experts and government officials agree.
"The threat of bioterrorism has not subsided," while the challenge of predicting or preventing a major biological attack remains "daunting," Robert Hooks, the Homeland Security Department's deputy assistant secretary for weapons of mass destruction and biodefense, told a House panel two weeks ago.
"The potential for something to happen is much greater now than it was in 2001, simply because of developments of technology and education," D.A. Henderson, who was principal science adviser for public health preparedness to then-Health and Human Services secretary Tommy G. Thompson, said in an interview.
The government has not developed a general-use anthrax vaccine. A new generation of sensors that would sniff out threats more quickly has been delayed. A coordinated plan to respond to a widespread outbreak still doesn't exist. And the rapid increase in the number of researchers registered to work with biological agents, now 15,000 people, has come without enough oversight.
"We may be putting dangerous pathogens in the hands of people who would deliberately cause harm. We may also be putting them in the hands of people who may inadvertently or unintentionally take steps to put large numbers of people at risk," said Elisa D. Harris, senior research scholar at the Center for International and Security Studies at the University of Maryland.
One cause is the government's difficulty organizing itself. Since 2003, for instance, management of both the stockpile of medications that would be used in a disaster and the National Disaster Medical System, the federal government's disaster health-care responders, has been shifted from HHS to DHS and back.
A significant bright spot, many agree, is the dramatic improvement in government preparations to respond to threats such as smallpox, botulism, plague and other biological agents. The Strategic National Stockpile, an emergency cache of critical pharmaceuticals that can be sent within 12 hours to counter outbreaks, has been greatly expanded, said Michael T. Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.
The stockpile, details of which are classified, has 60 million treatment courses of antibiotics for anthrax and pneumonic plague, according to a senior federal official with responsibility for bioterrorism response. About 300 million doses of smallpox vaccine can also be shipped.
"If smallpox returned today, we could contain it and minimize the danger very quickly. I could not have said that in 2001," Osterholm said. The anthrax attack "was a very important event in the world of bioterrorism preparedness," he added. "It did finally wake people up to what bioterrorism could do in this country and in the world."
The Bush administration has dedicated $57 billion for bioweapons, prevention and defense through fiscal 2009, according to the Center for Arms Control and Non-Proliferation. That includes a $9 billion increase next year for research and development of countermeasures such as vaccines.
The administration has tried to get its primary vaccine program, BioShield, back on track. The HHS in 2006 killed the two-year-old program's largest component, an $877.5 million contract to develop a new anthrax vaccine and last year canceled a project to develop radiation exposure drugs.
Officials say that the government is retooling efforts to encourage drug companies to invest in BioShield projects, and that the effort is paying off in new antitoxins for anthrax and botulism. Science is also being advanced by a dramatic expansion of federally funded university research, up from a handful of laboratories a decade ago to 400 today.
Still, the nation has seen few breakthroughs such as an anthrax vaccine that could safely inoculate Americans and end what many scientists consider a top-tier threat. Some analysts worry that the U.S. research effort is increasing the risk of abuse by a malevolent or unwitting insider, whether or not bioweapons expert Bruce E. Ivins turns out to among them.
The White House last fall refocused its years-long effort to meet the "big three" of bioterrorism preparedness needs: medical stockpiling, biosurveillance and mass casualty response.
On Oct. 18, the president signed a new homeland security directive to chart a fresh strategy for public health and medical preparedness, which included creating a panel at the U.S. Centers for Disease Control and Prevention to review biosurveillance efforts.
Early detection is critical because the impact of a bioweapons attack can spiral out of control in the hours or days it takes to discover it. Administration defenders have praised BioWatch, a five-year-old, $400 million effort to install sensors in more than 30 U.S. cities to detect the airborne release of biological warfare agents such as anthrax spores, plague bacteria and smallpox virus.
All 50 states now can receive urgent disease reports around-the-clock and conduct year-round surveillance for diseases such as influenza, according to the senior federal bioterrorism official. The number of state and local public health laboratories that can detect biological agents has increased from 83 to 110, and the number that can respond to chemical agents has climbed from zero to 47, said the official, speaking on the condition of anonymity because of the sensitivity of the FBI's anthrax investigation.
Critics say big gaps remain. BioWatch remains of limited use, because it takes 10 to 34 hours for samples taken by the machines to be analyzed. A new generation of sensors that can detect lethal agents within four to six hours was scheduled for pilot deployment in 2008 but now is not expected until 2010 or 2011.
Meanwhile, cities such as New York are pressing the federal government to spend tens of millions of dollars more on interim technology. Other analysts say it makes more sense to spend money to improve data collection and reporting by hospitals and clinics.
"There are a lot of fabulous new tools out there that could be turned to biosurveillance, but government hasn't figured out how to marshal them, who should control them or what to do," said Tara O'Toole, director of the Center for Biosecurity at the University of Pittsburgh Medical Center.
Washington also has sent more than $8 billion in grants to hospitals and public health agencies since 2002. The money reached more than 80 percent of 5,000 U.S. hospitals and funded 9,500 exercises in 2006 alone.
But the nation still lacks plans and an organized structure to respond to a massive disease outbreak with thousands of victims. "The system still isn't there," Osterholm said. Hospitals strain every day with overcrowded emergency rooms, while this summer's outbreak from salmonella infection underscores the challenges facing public health experts to trace outbreaks of even food-borne illness, he said.
It will do little good for the federal government to distribute stockpiled medications if health-care workers aren't there to dispense them, Osterholm said, or for the federal biosensor alarm system to ring if hospitals lack beds, nurses and tracking systems to manage patients.
"If we know the system is not going to work with everyone having a hospital bed, a nurse and all the modern medicines they need, then we better damned well prepare for that," he said.
At Congress's direction, DHS this year is developing a new National Biosurveillance Integration Center to coordinate federal efforts, but faces "big challenges" to being operational next month, Hooks said. Only six of 11 federal agencies have agreed to participate, and only one has completed a funding and staffing plan.
Henderson said such developments show that Washington is better prepared than it was in 2001 but is enmeshed in dangerous bureaucratic habits.
"There's a kind of complacency," he said. "You don't have the motivation now as they did right after 9/11 and the anthrax attack, and so, they can look at it now and say, 'Well, nothing has happened. We don't have to worry about it.' And they can sleep at night."
Article Appeared in the Washington Post
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