Big Round Numbers

From radiation treatment to smallpox vaccines to port security, do agencies really know how much is enough?

Half a million-that's the number of soldiers who would be vaccinated against smallpox, along with 440,000 public health workers, President Bush announced in 2004. But concerns about the safety of the vaccine stalled the effort at about 50,000 vaccinations, and the administration stopped pushing for more. Where did that half a million number come from? How many doses really were needed?

The government's homeland security efforts certainly have weathered their share of criticism, with agencies told in some cases that the amount spent on one threat is too little or that the dollar figure allocated for a different threat is too high. But some critics see a pattern: The numbers coming out of government agencies are big and round, and outsiders sometimes can't figure out where they came from. Bush's fiscal 2003 supplemental budget request asked for $2 billion in grants to states and localities for terrorism preparedness. Stephen Flynn, an author and Council on Foreign Relations fellow, says his understanding is that the amount came from adding up pre-Sept. 11 requests from states and local governments for terrorism preparedness. Administration officials then tripled or quadrupled the sum, and the total came to just under $2 billion.

Since then, attention has focused on the different entities vying for larger pieces of the pie, not why the pie is that size to begin with, according to Flynn. "All the stories are about the food fight . . . not where they came up with the number and is that number adequate and what we are trying to achieve with it," he says.

One big round homeland security number that has caused consternation is 100,000-that's the number of doses of radiation poisoning treatment the Health and Human Services Department requested in September 2005. Acute radiation syndrome is a collection of illnesses that come from exposure to high doses of radiation in situations such as the fallout from a nuclear bomb blast. The solicitation said HHS could buy another 100,000 doses later.

Some say that number seems low, especially compared with HHS' procurement of a next-generation anthrax vaccine, for example. The agency's November 2004 contract with Brisbane, Calif.-based VaxGen called for 75 million doses. That contract has since been canceled, and the department has put out a new notice seeking sources for 25 million doses of next-generation anthrax vaccination. (It has an option for another 40 million doses, which, along with the 10 million doses of current generation vaccine the department bought, would put the stockpile at 75 million doses.) Either way, compared with therapies potentially used after a nuclear blast, some say that's a lot of vaccine, especially for a disease that cannot spread directly from human to human.

"You would have to spread anthrax in high enough concentration to infect people from Boston to Richmond, Va., all at once," says Michael J. Hopmeier, president of the consulting firm Unconventional Concepts Inc. of Mary Esther, Fla. The population of the entire New York City metropolitan area, he notes, is only about 18 million people.

Critics have other qualms about the 100,000 figure. In February 2006, the department separately bought 450,000 doses of two anti-radiation therapies-so-called chelating agents that attach themselves to radiation particles in the body, which helps the victim expel radiation poison through urination. The treatments would work only for certain kinds of dirty bombs and not for nuclear blasts, and they would not help a person who already had developed radiation sickness. The contract gives the department the option to buy another 500,000 doses.

HHS seeks 100,000 doses of one anti-radiation treatment, and 450,000 to 1 million doses of another. Where do those numbers come from? Department officials say they are based on the Homeland Security Department's threat assessment and the interagency Weapons of Mass Destruction Medical Countermeasures Subcommittee's evaluation of the medical consequences of a radiological or nuclear incident. According to a study in the June 2004 issue of the Annals of Internal Medicine, the detonation of a 1-kiloton nuclear bomb in a city of 2 million residents would put 136,500 people in need of hospital care-303,300 in the case of a 10-kiloton bomb.

Sometimes you see the numbers in money not spent. DHS is developing systems to be mounted on civilian airliners that would defend against shoulder-fired missiles. The department requires the systems' cost beat the threshold of $1 million per plane in units of 1,000. Both contractors say its price tag will be below that mark. But where did that $1 million figure come from?

Flynn says the big round numbers obscure larger truths.

"The administration has not worked to help people understand just what exactly they have been spending money on and also developing a discussion in the country," he says. "Every year's press release just gives you the big numbers for port security and you go, 'OK, I guess we're doing a lot for port security because those are big numbers.' "

Flynn says that instead, the government should convene experts to determine the appropriate level of protection for each sector, figure out how much that would cost, and then debate who will pay for it and how. But he says the federal government has a disincentive to establish such benchmarks.

"If they established what that level [of necessary security] is, there'd be real pushback by states and locals saying, 'Where's the money?' " Flynn says. "If the feds set minimum standards requiring this [amount] be spent, it's an unfunded mandate."

The government isn't the only source of big round numbers. The American Chemistry Council, which represents the companies whose plants have become the subject of a fierce debate over mandatory government security standards, likes to say its members voluntarily have spent $3.5 billion on security improvements since 2001. But if you break down that number over six years and 2,000 facilities, you are left with $291,000 annually per plant. Flynn says based on the cost of a 24-hour security shift-including benefits-that amount would fund an additional six to 10 guards per facility. That is a lot more understandable-and less impressive, Flynn says-than the $3.5 billion figure.

"When you actually roll it back and do that kind of arithmetic," he says, "you realize we're not talking huge investments here."

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