Efforts to prevent bioterror attacks intensify

While the investigation into last year's anthrax attacks has so far had little success, the United States has begun an intensive effort to be better prepared for a future possible attack.

In January, three months after the attack, U.S. officials increased efforts to develop the National Pharmaceutical Stockpile-supplies of treatments and vaccines stored throughout the country to counter biological agents. Funding for the stockpile jumped this year to $644 million, up from the $50 million spent annually since it was created in 1999.

In June, President Bush signed into a law a bioterrorism bill to provide $4.6 billion for improvements to U.S. defenses. The bill included $640 million to develop a stockpile of smallpox vaccine and $1.6 billion to help states improve hospital systems. Last month, the Centers for Disease Control and Prevention began distributing more than $900 million in grants to state and local public health departments to help improve readiness for a biological attack.

"That money is helping to build better laboratories and better systems for detecting a potential terrorist attack as well as expanded communications systems to get information to public health workers and clinicians quickly," CDC Director Julie Gerberding said in September. "These investments will not only pay off in terms of terrorism preparedness, but public health in general will also benefit."

The increased funding in biological defense research and public health preparedness probably would not have occurred without the anthrax attacks, according to experts. The attacks were "quite a wake up call," said Mohammad Akhter, executive director of the American Public Health Association.

The anthrax incidents and the Sept. 11 attacks have demonstrated that terrorists are interested in causing mass casualties and in using weapons of mass destruction-which has led to the increased spending, said Mike Powers, a research associate at the Chemical and Biological Arms Control Institute.

The attacks have led to "unprecedented" biotechnology research including new detection devices and safer vaccines, Akhter said. The increased biological defense spending has been well focused, addressing areas of concern as well as potential new threats, he added.

Barbara Hatch Rosenberg, a biologist at State University of New York who has often publicized her views on the anthrax investigation, has claimed, however, that the United States has rushed to increase funding into research on potential biological weapons agents that might be ineffective and lead to security problems.

"Because of the rush to 'do something,' large amounts of government money are being thrown, without sufficient forethought, at research involving potential biological weapons agents," she wrote in a Sept. 22 commentary for the Los Angeles Times. "Scientists go where the money is, and we're now seeing a crowd of biologists lacking in relevant experience trooping to the trough."

Increased research on biological agents could make it even more difficult to impose regulations and oversight, Rosenberg wrote. Some have speculated that the anthrax used in the attacks originated from a U.S. research facility.

Instead of increasing funds for biological defense, the United States should fund improvements in the U.S. public health system to be able to respond to a wide range of naturally occurring diseases, Rosenberg wrote.

"Natural outbreaks of disease, including rapidly emerging new diseases for which we are unprepared, are a far more likely hazard for most people," she wrote. "Improving the public health system's ability to respond would help combat these diseases as well as biological attacks."

The increased biological defense funding has not appeared to take away from public health spending, according to Akhter and Powers. Even with the small number of casualties caused by the anthrax attacks, the increased funding is justified, Powers said. Terrorism has both a physical and psychological effect, he said, noting that the disruptive effect of the attacks has been "quite substantial." The appearance of preparedness, through the increased funding and research, can help to reduce the psychological effects of a future attack, Powers said.

Powers did agree that the United States still has "a long way to go" in developing a basic public health capacity. There is a tendency to focus research efforts on improving response capabilities such as developing a new smallpox vaccine, he said. The "front-end" public health system, however, provides detection and assessment capabilities in the event of a biological attack, without which it would be hard to determine how to allocate response capabilities, he said.

There is also still a tendency to focus planning and research on high end attacks-ones that could cause mass casualties such as the use of smallpox, Powers said. While it is important to be prepared for such attacks, an exclusive focus on them could leave the United States unprepared to combat other biological weapons agents, he said.

There are two U.S. public health areas that still need to be improved, according to Akhter. One is better public preparedness, such as the distribution of treatments and vaccines to the public in the event of an attack. For example, more research needs to be done on new vaccine delivery methods, he said. The recently released U.S. smallpox vaccination plan calls for the vaccine to be administered in the same way as it was 30 years ago, Akhter said.

"We don't do anything the way we did 30 years ago," he said.

Vaccines and treatments to be distributed to other countries also need more development, Akhter said. "People over there are basically sitting ducks." A global strategy is needed to combat biological terrorism, he said.

"We've asked out allies about a war on Iraq" but have not sought their help in combating biological terrorism, he said.

Could It Happen Again?

The possibility of another attack is based largely on the supply of anthrax still in the hands of those responsible for last fall's attacks, Pena said. If a non-U.S. terrorist group is behind last fall's attacks, the chances for a future attack are lower because "real terrorists" tend to alter their methods to retain an element of surprise, he said.

If the person responsible fits the mold of a "Unabomber"-type terrorist, however, the chances of future attacks increases, according to Pena. These types of terrorists tend to repeat attack methods to taunt authorities-a "catch me if you can" mentality, he said.

Whether or not the anthrax culprit is found, the CDC has said it is now better prepared to respond to any future acts of biological terrorism in the United States.

"The process of preparing for a terrorist attack is a continual one with no real endpoint, but even today CDC's level of preparedness is very high," Gerberding said in September. "We have the plans, the policies, the people, the products, and now we have the practice to make sure we are ready to respond."