- The Washington Times - Monday, January 17, 2000

A single squirt of anthrax spores or smallpox germs from a perfume bottle in a crowded subway has the potential to bring a city to its knees.
A couple of pounds of powdered tularemia or plague delivered from a low flying crop duster could be equally catastrophic.
A deliberate attack with the Marburg or Ebola virus would leave doctors helpless as the internal organs liquefied in hundreds of thousands of victims.
Public health experts and infectious disease specialists say they are woefully unprepared should terrorists target a city in the United States with deadly biological toxins.
To prove the point, Dr. John Bartlett, chief of the infectious diseases unit at Johns Hopkins Hospital in Baltimore, ran a test one day last winter.
Afraid that his hospital was unprepared for bioterrorism the intentional release of deadly microbes Dr. Bartlett wrote up a medical chart for a fictitious patient with fever, malaise, fatigue and a cough, the first symptoms of anthrax. The disease usually kills if untreated.
"I went to the emergency room, and presented the case," Dr. Bartlett told the Infectious Diseases Society of America at a recent convention in Philadelphia. "They presumed influenza and sent the patient home."
If an alert emergency room physician had kept the patient and ordered an X-ray or lab tests, either would have shown the patient did not suffer from flu, Dr. Bartlett said.
An X-ray would visually reveal a medical condition known as "wide mediastinum," which indicates something far more serious that the common flu bug. A standard blood test would detect the presence of a bacillus-type germ in the same family as anthrax, tipping off doctors that further tests are needed.
The Hopkins specialists, considered some of the best in the world, missed the diagnosis, in part because they had not seen an anthrax case in at least 25 years.
Dr. Bartlett placed a call to the Maryland Department of Health and Hygiene after learning that it had designated someone to deal with bioterrorism, only to discover that nobody knew who the person was.
"If I called 911 and said there was a bioterrorism attack, they'd say, 'What are you talking about?' " he said. "Every 911 operator should have that number and the state should be able to contact doctors all over the state by e-mail. But there is no plan."
James Baker, directory of the University of Michigan's Center for Biologic Nanotechnology, said people are not the only ones in danger. U.S. agriculture, which accounts for more than $1 trillion a year in the U.S. economy, is also at risk.
Agricultural terrorism is easy, he said. "You go to Eastern Europe, rub your handkerchief on the nose of a cow with hoof and mouth disease, fly back to Iowa, rub the handkerchief on the nose of another cow, and within a week we are barbecuing 100,000 cows."
Michael Osterholm, former state epidemiologist for Minnesota and director of the Infectious Control Advisory Network in Minneapolis, agreed. He said that if there were a biological attack, no stockpile of vaccines would be available. In addition, companies that make antibiotics make only what is needed for "just-in-time" delivery.
Unprepared hospitals could become unwitting incubators that spread the disease to uninfected patients, Mr. Osterholm said.
"Imagine a large anthrax or smallpox outbreak. Only a nut would walk into a hospital without the proper vaccinations and antibiotics to protect them," he said.
The use of biological agents to wage war goes back thousands of years. In the sixth century B.C., the Assyrians poisoned their enemy's wells with rye fungus.
In 1346, during the siege of Kaffa (now Feodosiya, Ukraine), the Tatars hurled plague-infected corpses over the city walls. It created an epidemic and forced the city to surrender. Refugees from the diseased city boarded ships to Constantinople, Genoa and Venice and are thought to have contributed to the Black Death pandemic that spread throughout Europe.
In this country, a British officer, Jeffrey Amherst (for whom Amherst, Mass., is named) gave Indians blankets contaminated with smallpox during the 1754-67 French and Indian War.
More recently, the Japanese ran the notorious Unit 731 in Manchuria. It used live prisoners as guinea pigs to develop weapons of plague and anthrax and then tested the weapons on unsuspecting Chinese cities during World War II.
During the Vietnam War, the Viet Cong placed "pungi" sticks covered with feces in booby traps along jungle trails used by American soldiers.
The United States had an offensive biological weapons program at Fort Detrick, in Frederick, Md., until President Nixon canceled it in 1969.
In 1972, the United States and many other countries signed the Biological Weapons Convention, which prohibits the creation and stockpiling of offensive biological agents.
But today, with the end of the Cold War, there is a fear that rogue states with the capacity to produce biological weapons might sell them or give them to a small criminal or terrorist group willing to use them.
Another fear is that biotechnology and gene manipulation has advanced to the point where altered strains of biological agents may be created that are more virulent, as well as resistant to antibiotics and vaccines.
Moreover, cutting edge research is now combining biological agents with chemicals.
Military planners fear the United States, the world's lone superpower, is especially vulnerable to attacks by terrorists armed with chemical or biological agents.
"American military superiority actually increases the threat of nuclear, biological and chemical attack against us," said a 1997 Pentagon report.
The Pentagon has identified 12 nations capable of building biological weapons: Russia, China, Iran, Iraq, North Korea, India, Pakistan, Libya, Syria, and three former Soviet states Ukraine, Kazakhstan and Belarus.
Biological weapons were apparently not used by Saddam Hussein during the Persian Gulf war. But some evidence suggests that the mysterious Gulf war syndrome was caused by experimental immunizations and drugs given to American service personnel to protect against biological and chemical warfare.
Some experts also believe Saddam did include biological weapons in the 1988 nerve gas attack on the Kurdish village of Halabja.
Russia's biological program came to light with the 1992 defection of Dr. Ken Alibek, who ran the program. His book "Biohazard," published last summer, detailed the inner workings at the world's largest covert biological weapons complex.
The World Health Organization announced in 1980 that smallpox had been eradicated. But at the time, the Soviet Union was producing tons of smallpox in its biological weapons facilities.
"What other governments saw as a medical victory, the Kremlin perceived as a military opportunity," Dr. Alibek wrote. "A world no longer protected from smallpox was a world newly vulnerable to the disease."
In 1979, the accidental release of approximately one gram of anthrax into the atmosphere downwind from the Sverdlovsk microbiology plant in Russia killed at least 66 persons and additional livestock.
Today, that program, which is all but shuttered, is considered a source of scientific know-how to rogue states or terrorist groups. With Russia's offensive labs closed and its scientists no longer needed, there is fear that some may be willing to sell their expertise to the highest bidder. The buyers could include terrorists such as Osama bin Laden, who is sought in the 1998 bombings of two U.S. embassies in Africa.
The CDC says there were more than 200 anthrax hoaxes recorded in the United States in 1999.
But the only "bioterrorism" event on U.S. soil took place in The Dalles, Oregon, in 1984, when members of a sect led by Indian guru Bhagwan Shree Rajneesh spiked local restaurant salad bars with salmonella, infecting 751 persons and inducing severe stomach cramps and diarrhea. No one died, but by keeping people home sick in bed, the sect attempted to manipulate the outcome of a local election.
Bioterrorism experts said they are not terribly concerned about an outbreak of intentionally induced diarrhea, however, authorities should be alert for more serious threats.
"There is plenty of reason for concern," said Dr. Donald Henderson, a public health physician also at John Hopkins. "I'm not worried about some yahoo in Montana. What I am worried about is that Iraq has an extensive enterprise Russia, too."
He cited Dr. Alibek's revelations about Russia's biological weapons program, the defection of Saddam's son-in-law with details of Iraq's biological program and the 1995 chemical attack in Tokyo's subway by the Aum Shinri Kyo sect.
Each demonstrates Western vulnerability, Dr. Henderson said.
"It was a real shock. Together they revealed a sophistication far greater than anything we knew, showing how difficult it is to get good intelligence on bioweapons," he said.
The Deutch Commission, a bipartisan, congressionally funded panel led by former CIA Director John Deutch, studied the threat to the United States from weapons of mass destruction. Like others, it also concluded that the United States was unprepared for a coordinated response to a bioterrorist attack.
There are at least 90 offices and agencies within the federal government, including the FBI, Department of Defense, the Treasury and the State departments, with some responsibility for dealing with bioterrorism, according to the report. Each is interested in maintaining its portion of responsibility and funding, but there is no coordinating authority, and the Office of Management and Budget does not know how much is being spent on the problem overall, the report says.
"Ten years after the fall of the Berlin Wall … there has been a tremendous absence of leadership, no adult supervision," said Janne Nolan, a member of the Deutch Commission and a professor of national security at Georgetown University.
Milton Leitenburg, director of the Center for International Security at the University of Maryland, said that the public health infrastructure and the federal government may be unprepared for a major bioterrorism event. But he said people are asking the wrong questions. He regards much of the rhetoric as alarmist, noting there has never been a serious biological attack because it is exceedingly difficult to do.
"Are there people out there who can make these agents and disseminate them? … If there is one thing we learned from the Aum cult, it is that these agents cannot be made in the garage, in bathtubs, in home brew kits," said Mr. Leitenburg. "Aum had four years and tens of millions of dollars. They had Ph.Ds. and post-doctorate training, but they could not manage to make anthrax and distribute it."
Mr. Leitenburg said that while the public health system may be unprepared for bioterrorism, the chances of an attack are minimal.
"All the frightening scenarios people come up with are just that scenarios. They are all plausible and nobody can argue with them," he said. "But the only kind of person who can do this at home is someone who has done it in a lab for 15 years."
Others disagree.
"Just because Aum couldn't do it, doesn't mean we can rest easy in our beds," said David Siegrist of the Potomac Institute for Policy Studies and director of a newly published study on bioterrorism, titled "Hot Zone 99."
Dr. Scott Lillibridge, director of the CDC's bioterrorism response program, said that while there is only a small chance that the United States will have to deal with a bio-terrorism attack, health care professionals need to plan for the unthinkable. He added that money and planning in anticipation of a bioterrorism attack is "dual use" and will further strengthen the nation's public health system even if there never is an attack.
"We have to be building infrastructure," he said, in a speech to the Infectious Disease Society of America convention in Philadelphia.
In an effort to shore up the public health system, Congress appropriated $121 million for bio-terrorism preparedness for 1999.
Dr. Lillibridge said until a year ago the CDC did not even have an office and telephone dedicated to dealing with bioterrorism. With the office open, he anticipates that Congress will continue to fund the bioterrorism program at this level for another three to five years.
In the first year, a chunk of the federal money has gone to upgrade state laboratories, which in most places were only slightly more sophisticated than college labs.
The District of Columbia, Maryland, Virginia and most states received some of the funding.
Early last month, emergency planners in the District had their first interagency meeting ever to prepare for bioterrorism.
"We had to get past Y2K before we could start thinking about bioterrorism," said one participant, speaking on condition of anonymity.
Dr. Lillibridge said that networking and communications between overlapping agencies is the key to responding to a bioterrorism event. He said it is important to link laboratories with hospitals and public health offices with the CDC.
"There is a preponderance of activity going on from training the National Guard to local law enforcement. We have hardened our facilities against attacks, but we have done little to protect civilians," said Dr. Lillibridge. "Twenty percent of the country's public health offices can't even do basic Internet activity."

Researchers John Haydon and Clark Eberly contributed to this report.

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