The
proliferation of biotoxin threats, in all likelihood, will only grow with
time. Of all the areas of emergency response, the federal
government is least prepared to deal with catastrophic
bioterrorism.
Before the creation of the Department of
Homeland Security (DHS) in January 2002, numerous federal
departments and agencies bore responsibility for assisting state
and local governments in bioterrorism preparedness and response.
There was little coordination. Today, despite organizational
changes, much expertise and capacity remains beyond the department.
While the Secretary of Homeland Security is mandated to coordinate
the federal response, planning and coordination are still
inadequate, lines of operational control are unclear, and there is
no coherent national preparedness program.
To
address these shortfalls, further reforms are needed that cut
across a range of federal departments and initiatives.
Why Worry?
There is one simple reason why
bioterrorist strikes will be attempted against the United States in
the future: They can kill Americans on an unprecedented scale and
spread unimaginable fear, panic, and economic disruption. A gram or less of many
biotoxin weapons can kill or sicken tens of thousands. Weight for
weight, they can be hundreds to thousands of times more lethal than
the most deadly chemical agents and can, in some cases, be produced
at much less cost.
Some
biotoxin weapons are communicable and can be spread easily beyond
the initial target. They are less difficult to obtain than nuclear
arms and potentially more deadly than conventional explosives or
radiological and chemical weapons. a terrorist could use a
virulent, infectious biological agent to inflict catastrophic
damage.
The
technical procedures for biotoxin weapons production are available
in open-source, scientific literature. Over 100 states have the
capacity to manufacture biological weapons on a large scale. A
basic facility can be constructed and operated for less than $10
million.
Biotoxin weapons programs, however, are
not limited to state threats. Any non-state group might be capable
of performing some form of biological or toxin warfare. A terrorist
group, given a competent team of graduate students and a facility
no larger than a few hundred square feet, could field a small-scale
program for a few hundred thousand dollars or less. Individuals with some
graduate-level science education or medical training could produce
biotoxin weapons. In
some cases, biological attacks can be mounted without any
scientific skills or medical knowledge.
Moreover, the proliferation of biological
and toxin threats will only grow with time. Biotechnology is one of
the fastest growing commercial sectors in the world. The number of
biotechnology companies in the United States alone has tripled
since 1992.
These firms are also research-intensive,
bringing new methods and products to the marketplace every day, and
many of the benefits of this effort are dual-use, increasing the
possibility that knowledge, skills, and equipment could be adapted
to a biological agent program. The pharmaceutical industry, for
example, has invested enormous effort in making drugs more stable
for oral or aerosol delivery and thus, unintentionally, is
developing the tools for producing the next generation of easily
deliverable biological weapons. As the global biotechnology industry
expands, nonproliferation efforts will have a difficult time
keeping pace with the opportunities available to field a
bioweapon.
Equally troubling, the difficulties in
effectively delivering biotoxins can be overcome with some
forethought and ingenuity. For example, cruise missiles, unmanned
aerial vehicles, or aircraft could perform sprayer attacks, but
only if specialized spraying equipment was employed that ensured
proper dispersal and prevented particle clumping. Clumping of
agents can degrade the effectiveness of an attack. Large particles
quickly drop to the ground or, if inhaled, do not easily pass into
lung tissue, significantly lessening the potential for
infection.
Mechanical stresses in the spraying system
might also kill or inactivate a large percentage of particles--by
some estimates up to 99 percent. However, if an enemy had a large supply
(e.g., 50 kilograms of a virulent bioweapon) or was not terribly
concerned about achieving maximum effects, crude dispensers might
be adequate.
In
creating bioweapons, terrorists might be limited only by their
imagination. For example, a low-tech version of a bio-cruise
missile attack could be attempted with a system like the Autonomous
Helicopter, a 14-foot-long, pilotless, remote-controlled helicopter
built by Yamaha for crop dusting in Japan. The $100,000 aircraft
uses a GPS system and video camera to allow its flight route to be
preprogrammed and monitored.
Intentional contamination of food and
water is another possible form of biological attack. Product
tampering or contaminating food supplies is an ever-present
danger. For
instance, in 1984, the Rajneeshee cult contaminated local salad
bars in an Oregon town with salmonella, demonstrating the ease of
conducting small-scale, indiscriminate terrorist attacks.
Another means of bioattack is to spread
infectious diseases through humans, animals, or insects. Infectious
diseases are already the third leading cause of death in the United
States, and battling them is an ongoing health issue. Foreign
animal diseases also present a serious risk. Many diseases can
infect multiple hosts. Three-quarters of emerging human pathogens
are zoonotic--in other words, readily transmitted back and forth
among humans, domesticated animals, and wildlife.
Biological dangers can threaten plants and
animals as well as people. These are significant, even without the
threat of terrorist strikes. Crop and livestock losses from
contamination by mycotoxins (toxins produced by fungi), for
example, cost the United States an average of $932 million per
year.
Federal Bioterrorism Response:
Organization and Capabilities
Before the creation of the Department of
Homeland Security in January 2002, numerous federal departments and
agencies bore responsibility for bioterrorism preparedness and
response. Today, at least five federal departments still retain
significant responsibilities for responding to a bioterrorist
event.
The Department
of Homeland Security
The DHS has inherited some of the operational resources of
these agencies, including oversight of the Strategic National
Stockpile. Managed by the Centers for Disease Control and
Prevention (CDC) in the Department of Health and Human Services
(HHS), the Strategic National Stockpile provides for the storage
and deployment of pharmaceuticals, supplies, and equipment for
responding to a national health emergency or disaster.
The
DHS also oversees the Metropolitan Medical Response System and the National
Disaster Medical System, including national Disaster Medical
Assistance Teams, Veterinary Medical Assistance Teams, and Disaster
Mortuary Support Teams--formerly administered by the HHS. In
addition, the DHS has assumed the functions of the HHS's Office of
Emergency Preparedness, which manages and coordinates federal
health, medical, and health-related social services for major
emergencies and disasters.
The
DHS also took over the Department of Agriculture's Plum Island
Animal Disease Center, which conducts research and experiments on a
wide range of animal pathogens, and the Animal and Plant Health
Inspection Service, which conducts border inspections.
In
addition to assets directly related to biotoxin threats, the
responsibility for coordinating the federal response to any
terrorist attack or major disaster (including biotoxin strikes)
falls to the Federal Emergency Management Agency (FEMA) under the
oversight of the DHS Under Secretary for Emergency Preparedness and
Response. Formerly an independent agency but now part of the DHS,
FEMA manages national mitigation and disaster assistance programs,
including coordinating the types and levels of support provided by
all federal departments and agencies in the response to and
recovery from a terrorist strike.
Department of
Justice
Under the current na-tional response plan, the Federal
Bureau of Investigation (as executive agent for the Department of
Justice) retains its role as the lead agency for federal crisis
management at a terrorist scene for all types of attacks, including
bioterrorism.
Department of
Health and Human Services
The Food and Drug Administration (FDA) with its Office of
Crisis Management and the CDC, for example, could play important
roles in the federal response to bioterrorist threats. The FDA's
Office of Crisis Management works with state and local food safety
agencies to identify possible food supply contamination.
The
CDC oversees national biosurveillance ef-forts, and its Laboratory
Response Network provides specialized, rapid-detection capabilities
to state and local health agencies. Along with the Health and Human
Resources Administration, the CDC provides funding directly to
state and local health organizations to upgrade their overall
capabilities and conduct training exercises. Finally, the CDC
continues to manage the National Strategic Stockpile in
coordination with DHS through a memorandum of understanding agreed
to by the two departments.
In
addition, the Public Health Security and Bioterrorism Preparedness
and Response Act of 2002 established an Assistant Secretary for
Public Health Emergency Preparedness to serve as the DHS
Secretary's principal adviser on matters related to bioterrorism
and to coordinate interagency activities with other federal
agencies and the state and local officials responsible for
emergency preparedness. The legislation also expanded the disaster
planning responsibilities of HHS, calling for the HHS Secretary to
submit a National Preparedness Plan to Congress.
Section 505 of the Homeland Security Act
of 2002 reinforces HHS's responsibilities, directing the Secretary
to set priorities and preparedness goals and further develop a
coordinated strategy for such activities in collaboration with the
DHS. HHS was also directed to collaborate with the DHS in
developing specific benchmarks and outcome measurements for
evaluating progress in improving preparedness.
Department of
Defense
The Department of Defense (DOD) is also a cosponsor of the
National Disaster Medical System, and its hospitals are often used
to treat civilian disaster victims. In addition to hospital facilities, a
number of DOD assets might be deployed in response to a
catastrophic bioterrorist attack. In particular, the DOD is able to
provide technical and personnel support to the DHS and state
authorities during a declared biological or other terrorist
disaster. These include the U.S. Army's Medical Research Institute
for Infectious Diseases (USAMRIID) Aeromedical Isolation Team and
the U.S. Marine Corps' Chemical and Biological Incident Response
Force (CBIRF).
Additionally, Congress established an
Assistant Secretary of Defense for Homeland Defense to oversee
programs and policies providing military assistance to civilian
authorities (MACA). The Pentagon also established the U.S. Northern
Command (NORTHCOM), which has responsibilities for both MACA and
defense of the United States.
Department of
Veterans Affairs
The Department of Veterans Affairs Emergency Preparedness
Act of 2002 assigned preparedness and response functions to the
nationwide system of hospitals and clinics operated by the
Department of Veterans Affairs (VA). The act created an Assistant
Secretary of Operations, Preparedness, and Security to act as the
VA's liaison with the DHS, and it directs that all VA facilities be
made available for use during a declared national emergency.
The
VA's assistance during national emergencies is not new, but the act
allows for greater cooperation with the DHS. The VA is also
creating four regional emergency preparedness research centers to
aid in developing federal medical response strategies.
Why the Current System Is Inadequate
The
current federal response system is predicated on the thoughtful and
systematic application of resources. Local communities are expected
to deal with disasters and emergencies using their own resources.
When they lack adequate capacity, they call on the assets from the
state and neighboring jurisdictions. Federal resources are brought
to bear only after state and local governments find they lack
adequate capacity and request assistance from the federal
government. In turn, FEMA then has to determine the level of
required assistance and then coordinate the delivery of support
with HHS, the DOD, the VA, and other federal agencies.
The
current approach could well prove totally inadequate in the event
of a virulent biotoxin attack. Effectively negating threats in many
cases requires a rapid response capability, and operating on
compressed timelines leaves little room for delayed delivery of
support or miscues in coordination.
One
significant requirement, for example, is quickly emplacing an
incident response structure that can detect and assess threats and
mobilize appropriate resources. In particular, for a chemical or
biological attack, actions taken in the first hours to identify,
contain, and treat victims may significantly reduce the scope of
casualties and reduce the prospects for the outbreak of an
epidemic.
Complicating any medical response is the
plethora of federal, state, and local agencies that would play a
role in consequence management. Orchestrating their efforts could
be a major challenge. Some organizational chains of command are
maximized for responding to infectious diseases, some for natural
disasters, others for weapons of mass destruction incidents or
investigating crime scenes, and still others for chronic health
care issues or emergency or mass casualty treatment. A communicable
biotoxin attack, however, could resemble elements of all these
problems, requiring perhaps a more sophisticated and integrated
response than any other form of terrorist weapon.
Virtually every large-scale exercise or
response experiences problems in agency notification, mobilization,
information management, communication systems, and administrative
and logistical support. Emergency response operations are also
frequently plagued by a lack of information sharing and confusion
over responsibilities among policymakers, law enforcement,
emergency managers, first responders, public health workers,
physicians, nonprofit organizations, and federal agencies. The
necessity for speed can exacerbate the coordination challenge.
Responders will also have to deal with the
demanding conditions and requirements of any terrorist strike. One
major command and control challenge is the problem of convergence,
a phe-nomenon that occurs when people, goods, and services are
spontaneously mobilized and sent into a disaster-stricken area. Although convergence
may have beneficial effects, like rushing resources to the scene of
a crisis, it can also lead to congestion, create confusion, hinder
the delivery of aid, compromise security, and waste scarce
resources. In the case of bioterrorist attack, responders could
also become victims and unwittingly spread the contagion.
The
expense of further improving the response capabilities of state and
local governments and the private sector that might negate the need
for a robust federal response is also a significant issue. The cost
of general improvements in the state of health care systems,
maintaining infrastructure, trained personnel, and expanding
hospitals' surge capacity for acute care would be substantial. For
example, the Association of American Hospitals estimates that
preparing the nation's hospital facilities for biotoxin attacks
will cost over $11 billion. Enhancing the capacity to deal with
infectious diseases might require even more investment, since the
epidemiology of biotoxin (non-contagious) weapon strikes and
infectious disease attacks can be different and require different
clinical response and treatment strategies.
Improving the Federal Response
Preparing the federal government to deal
more effectively with catastrophic bioterrorism requires developing
a national system that can quickly move the right kind and level of
assistance to local communities. The Administration and Congress
need to take the following actions to streamline the current
system, reduce bottlenecks, ensure adequate national surge capacity
to respond to a catastrophic threat, and integrate and harmonize
operational capabilities before a crisis ensues.
Centralize
medical response capabilities in HHS
Bifurcating responsibility for medical response programs
such as the National Strategic Stockpile between HHS and DHS was a
mistake. Managing complex programs through interagency memoranda of
understanding is bureaucratic, inefficient, and unnecessary.
Clearly, efficiencies could be gained by transferring
responsibility and budgetary oversight of these efforts into one
department or the other.
The
DHS lacks the expertise and experience to oversee large medical
emergency response programs. Congress should amend the Homeland
Security Act of 2002 to move responsibility for overseeing the
National Strategic Stockpile, the Metropolitan Medical Response
System, and the National Disaster Medical System to HHS.
Create an
Assistant Secretary for Bioterrorism in DHS
To improve coordination of the national bioterrorism
response effort and ensure that key biomedical response programs
are seamlessly integrated into the overall national response
system, the DHS requires a level of management commensurate with
the assistant secretaries providing oversight for the DOD, VA, and
HHS.
Congress should establish an Assistant
Secretary for Bioterrorism and Infectious Disease Response in the
DHS Emergency Preparedness and Response Directorate. The Assistant
Secretary should have responsibility for ensuring that plans and
programs under development--including the National Re-sponse Plan,
National Incident Management System, and HHS national preparedness
plan--are consistent and provide for the rapid delivery of services
and support in the event of biomedical emergency.
Harmonize,
simplify, and focus DHS and HHS grant programs for state and local
governments
The DHS and HHS need to work closely together to ensure
that grant programs are operating as efficiently as possible to
expand the capabilities of local communities to deal with a health
disaster. Put simply, they need to ensure "the biggest bang for the
buck." The departments need a common performance-based grant system
that:
- Is based on national performance
standards,
- Focuses most resources on major
metropolitan areas and other critical high-risk targets,
- Simplifies the grant process so that
states and local governments have to provide only one assessment of
their needs and vulnerabilities,
- Encourages the development of regional
response capabilities and mutual-support agreements, and
- Evaluates how effectively grant funds are
being used to achieve the levels of performance set by the
agencies.
Congress needs to act now to establish a
framework for an effective national homeland security grant
program.
Focus federal
resources on developing national surge capacity
A significant portion of federal assistance (over
one-third)
contributes to developing local hospital surge capacity. This
funding supports a questionable strategy and is perhaps wasteful
spending. A fixed hospital-based national emergency response system
is not the answer. It can be assumed that local hospitals will
quickly be overwhelmed by a catastrophic bioterrorist attack. In
addition, encouraging hospitals to maintain excess capacity,
medical facilities, equipment, and staff that are not needed for
normal operations only places further and perhaps unnecessary
economic stresses on health care providers.
Federal aid should also strike the right
balance in ensuring that the national, state, and local governments
focus on their appropriate responsibilities. Assistance to the
state and local level should focus on medical surveillance, detection, identification, and
communication so that problems can be identified quickly and
regional and national resources can be rushed to the scene.
This
"national bioterrorism watch system" should include training and
effective information and incorporate health clinics, hospitals,
health care providers, public health officials, first responders,
veterinary clinics and hospitals, and food and commodity
distribution infrastructure. The Administration needs to develop an
integrated national preparedness program that focuses the lion's
share of assistance to state and local governments on helping to
contribute to the "national bioterrorism watch system," while the
federal government should focus on ensuring adequate regional and
national surge capacity.
Ensure
appropriate DOD support for bioterrorism response
Rather than building vast excess capacity in the national
health care system at great cost, the Administration should focus
on ensuring that the resources already available can be brought to
bear as efficiently and effectively as possible. Two key issues
that must be addressed are how quickly military capabilities can be
brought to bear if needed and how the need for the armed forces to
support homeland security and conduct missions overseas can be
balanced. Here, the newly established U.S. Northern Command
(NORTHCOM) could play a key role.
First, NORTHCOM should coordinate military
assistance to civilian authorities, even when a large federal
military presence is not required. This will allow the command to
establish solid working relationships with the other federal
agencies and state and local governments that would respond to a
large-scale disaster or terrorist attack.
Second, NORTHCOM needs to have the
contingency plans and force structure in place to respond to a
large-scale bioterrorist strike, and these needs must be balanced
with the Pentagon's other responsibilities. Through judicious
planning and force restructuring in the Reserves and National
Guard, the military can effectively support both "home" and "away"
games within existing force levels. The Department of Defense should take
another hard look at whether it has forces adequately prepared to
deal with a catastrophic disaster and ensure that NORTHCOM has both
the forces available and the contingency plans needed to meet the
needs of the National Disaster Medical System in the event of a
bioterrorist strike.
Enhance federal
expertise in emergency medical care
The federal government lacks an integrated approach to
emergency medicine, a key component for responding to a
bioterrorist attack. HHS, for example, does not have a National
Institute of Emergency Medicine. The Emergency Medical Services
Division, tasked with developing the federal contribution to
enhancing and guiding the emergency medical system, is a small
office within the Department of Transportation's National Highway
and Traffic Safety Administration, far removed from other key
elements of the federal emergency medical response system in HHS
and DHS.
Congress should amend the Public Health
Security and Bioterrorism Preparedness and Response Act and address
the shortfall in federal expertise in emergency medical services,
including moving Emergency Medical Services Division functions to
HHS and establishing an Institute for Emergency Medicine as part of
the National Institutes of Health, dedicated to spearheading
emergency medical research efforts. This institute should work
closely with the CDC to devise more comprehensive emergency medical
response strategies.
The Way Ahead
Bioterrorism is a growing threat, but
simply throwing more money at the problem or creating bigger and
more complex bureaucracies is not the answer. Providing sufficient
resources for bioterrorism preparedness is important, but without
the right organization, strategies, and programs, these efforts
will be inefficient and wasteful. Congress and the Administration
should move to ensure that the federal government is better
organized to meet the challenge.
Specifically, Congress should:
- Move
responsibility for overseeing the National Strategic Stockpile, the
Metropolitan Medical Response System, and the National Disaster
Medical System to HHS.
- Establish an Assistant Secretary for
Bioterrorism and Infectious Disease Response in the DHS Emergency
Preparedness and Response Directorate.
- Create
a framework for an effective national homeland security grant
program.
- Address
the shortfall in federal expertise in emergency medical services,
in part by moving the Emergency Medical Services Division functions
to the HHS and establishing an Institute for Emergency
Medicine.
The
Administration should:
- Focus
most assistance to state and local governments on establishing a
"national bioterrorism watch system" and direct the federal
government's main effort toward ensuring adequate regional and
national surge capacity.
- Ensure
that NORTHCOM has both the forces available and the contingency
plans needed to meet the needs of the National Disaster Medical
System in the event of a bioterrorist strike.
James Jay
Carafano, Ph.D., is Senior Research Fellow for National
Security and Homeland Security in the Kathryn and Shelby Cullom
Davis Institute for International Studies at The Heritage
Foundation.