GAO criticized Government

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Los Angeles Times

February 27, 2000

U.S. A Sitting Duck For Bioterrorism

By L. Cohen

NEW YORK--The United States was recently reminded again that it is woefully

ill-prepared to deal with the threat of biological terrorism. The General

Accounting Office, an investigative branch of Congress, charged that the

government has failed to properly manage the medical stockpiles developed to

protect the public from the scourge of potentially devastating biological

weapons.

In its report, the GAO criticized multiple government agencies for managing

the stockpiles so poorly that they might be unavailable in the event of

attack. It found both shortages of vital drugs and deficiencies in the

amount of emergency supplies supposed to be on hand.

The Chemical Biological Incident Response Force, a Marine Corps unit created

in 1996 to treat civilian victims of a biological attack, was cited for

glaring shortcomings: The GAO discovered that more than a quarter of the

Corps' stockpile was plagued by inventory discrepancies and record-keeping

errors. The Department of Veterans Affairs was also cited for its failure to

manage emergency supplies.

Such government ineptitude is no idle matter. If deadly microbes like

anthrax or smallpox were released into the general population, a prospect

that experts say is plausible, federal stockpiles of medical supplies would

be critical to saving lives. State and local authorities could be quickly

overwhelmed by mounting casualties, and federal intervention would be

urgently needed. No city in the country has the resources to handle a major

attack on its own.

Yet, Washington has been dragging its heels in preparing for a potential

crisis. The GAO report is only the latest evidence that the government's

effort to prepare for a biological attack is alarmingly ineffective. The

problem, quite simply, is that the nation has yet to take the steps that

could ultimately save thousands, or even tens of thousands, of lives. Such

steps include everything from enhancing our disease surveillance system to

ensuring an adequate supply of lifesaving vaccines and antibiotics.

The government's failure to take these steps raises inevitable questions.

With the stakes so high, why isn't Washington taking more aggressive action?

If national-security and health officials agree that the threat is real, why

aren't they working harder to mitigate the threat? The answer may lie in the

challenges posed by the specter of bioterrorism.

Unlike a chemical or explosive attack, a biological attack will require the

close collaboration of groups not accustomed to working together: the

national-security and public-health establishments. It's an odd mix--doctors

and intelligence agents--but for biological counterterrorism to work, they

must join forces. Unfortunately, the National Security Council and other

federal agencies have yet to fully integrate the medical community into

their plans.

To succeed, they will have to correct this flaw, because the first

responders to any bioweapons attack are likely to be doctors and local

public-health authorities. If terrorists should ever unleash infectious

agents on a city, the first evidence of the attack will almost certainly

appear in hospital emergency rooms. At this point, a rapid response will be

critical: If diagnosis and treatment are delayed, it could mean huge numbers

of casualties. The very survival of health-care providers could be at stake.

But how well-prepared are we to handle such a crisis? Few doctors have ever

seen a case of smallpox, plague or anthrax. Few, if any, medical

laboratories are equipped to diagnose such conditions. As the GAO noted,

U.S. stockpiles of drugs and supplies are far from ideal.

There are other problems. The national counterterrorism effort, for example,

has focused mainly on chemical and explosive weapons rather than on

infectious agents. Perhaps this reflects the security establishment's

familiarity with such weapons, since its efforts in this area have largely

involved the enhancement of existing hazardous-material protocols. But what

about the biological threat?

Medical experts point out that biological weapons are far more dangerous

than either chemicals or explosives, since the devastation from this kind of

attack can persist and even worsen over time, as new cases of disease arise.

In contrast, stabilization and recovery from a chemical attack can begin

almost immediately. Yet, despite this reality, preparations for a bioweapons

attack have lagged far behind efforts to prepare for more traditional kinds

of threats like explosives.

The problem is not just one of priorities. It's also a matter of expertise.

Our national-security apparatus, accustomed to dealing with military issues,

hasn't brought enough health experts into the nation's

emergency-preparedness program. According to the Center for Civilian

Biodefense Studies at s Hopkins University, the medical community has,

so far, received little funding or targeted attention from any preparedness

program, and few hospitals have participated in the bioterrorism-response

exercises sponsored by federal authorities.

This is a particularly illogical strategy, since planning for a possible

" man-made " epidemic is best handled by people who are specially trained for

this kind of occurrence: epidemiologists and infectious-disease specialists.

Preparing for bioterrorism without their active involvement is a bit like

preparing for war without the Department of Defense. It's time to correct

this oversight.

We also need to improve the communication between the medical and

law-enforcement communities. National-security efforts in the biological

arena simply will not work without the combined participation of both

communities. By planning ahead, we not only avoid unnecessary problems like

drug shortages, but we also minimize the chance that cultural differences

between the national-security and health establishments will hamper the

nation's response to a terrorist attack.

- - - L. Cohen Is a Physician and a Medical Journalist.

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