Nation largely unprepared for bioattack

By JOHN MINTZ and JOBY WARRICK of The Washington Post

The United States remains woefully unprepared to protect the public against terrorists wielding biological agents despite dramatic increases in biodefense spending by the Bush administration and considerable progress on many fronts, according to government officials and specialists in bioterrorism and public health.

While administration officials have spoken at times about bioterrorism's dangers, they are more alarmed than they have signaled publicly, U.S. officials said. As President Bill Clinton did, President George W. Bush and Vice President Dick Cheney have thrust themselves into the issue in depth.

“There's no area of homeland security in which the administration has made more progress than bioterrorism, and none where we have further to go,” said Richard Falkenrath, who until May was President Bush's deputy homeland security adviser and is now a fellow at the Brookings Institution.

Unlike many other areas of domestic defense, which are centralized in the Department of Homeland Security, responsibility for biodefense is spread across various agencies. It is coordinated by a little-known White House aide, Kenneth Bernard, whose power is relatively limited.

Biological and nuclear attack rank as officials' most feared types of terrorist attacks. Because of the technical difficulties in creating such weapons, they reckon the chances of a devastating attack are currently small. But the consequences of a big biological strike could be epochally catastrophic, and rapid advances in science are placing the creation of these weapons within the reach of even graduate students, they said.

Given the escalating risks, many public health and bioterror experts, members of Congress and some well-placed Bush administration officials express mounting unease about what they believe are weaknesses in the nation's biodefenses:

The great majority of U.S. hospitals and state and local public health agencies would be completely overwhelmed attempting to carry out mass vaccinations or distribute antidotes after a large biological attack. Hobbled by budget pressures and day-to-day crises, many health agencies say they can't comply with federal officials' urgent demands that they gear up for bioterrorism.

Overlapping jurisdiction among federal agencies working on biodefenses—including the departments of Homeland Security and Health and Human Services (HHS)—leads to confusion inside and outside government about who is in charge of preparations for, and response to, bioattacks.

In tabletop exercises, missteps by top administration officials reveal that more work is required to plan how the government should communicate with the public after an attack and manage the potential flight of perhaps millions of people from city centers.

Despite considerable pro-gress since the 2001 attacks, the National Institutes of Health, which has the lead role in researching biological warfare vaccines and antidotes, remains largely wedded to its traditional role of doing basic research and is not producing enough new drugs. Large drug firms with track records of developing medications have little interest in making bioterror vaccines and treatments.

Because of the scientific complexities, there is no technology to detect a biological attack as it occurs.

Under the most advanced current program, called Biowatch, technicians remove filters from air-sniffing units in about 30 cities once a day, and carry them to labs for computerized analysis in search of about 10 biological agents.

In this way, a bioattack could be discovered within a day. Without Biowatch, no one would know about a smallpox attack, for example, until the first symptoms appeared about 10 days later.

Though it clearly has far to go, the Bush administration has sharply stepped up biodefense efforts.

Spending has increased 18-fold since the Sept. 11, 2001, attacks, from $414 million in fiscal year 2001 to a proposed $7.6 billion this year, according to a study by the University of Pittsburgh Medical Center's Biosecurity Center.

Administration officials say that in each area where critics note weaknesses, they already have made great progress. “There is no comparison between where we are today and where we were before 9/11,” said Stewart Simonson, assistant HHS secretary for public health emergency preparedness. “On 9/11 we had 90,000 doses of smallpox vaccine ready to go. Today we have 300 million.”

The government “is on a wartime footing,” said Anthony Fauci, the NIH official who heads biodefense research. “People who say we haven't made progress are not well informed about what it takes to make vaccine,” he said, citing steps to develop vaccine for the ebola virus since 2001. “This is light speed…Usually vaccines can take many years or decades.”

The government also has launched other initiatives. One gives officials early warning of a biological attack by fusing pharmacy data about, for example, cough medicine sales with spikes in symptoms such as high fever and rashes observed at medical clinics. Another plan calls on mail carriers to deliver drugs after an attack.

Administration officials say most gaps in U.S. biological defenses result from the sheer enormity of the task ahead—radically transforming entire sectors of society in order to mount defenses. They cite the need to induce an intensely skeptical drug industry to invest in biowarfare research, and the challenge of redirecting cash-starved hospitals and local health agencies into the unfamiliar field of mass casualty response.

In this age of bioterror dangers, long-tolerated weaknesses in the U.S. health care system have become serious national security vulnerabilities.