Book Excerpt: Bioterror

Our laws should be rewritten to recognize the distinction between responding to most weapons of mass destruction and responding to a bioterrorism attack. Terry O'Brien's analysis of the gaping holes in our legal system shows issues that must be addressed before a crisis, not during one. Otherwise, when we finally do have to authorize and carry out a quarantine, valuable time will be lost figuring out who is in charge and sorting out issues of legal authority. In a bioterrorist event, loss of such time will translate directly to loss of human lives; to prevent this, I believe that the administration and Congress should appoint a bipartisan national legal panel to draw up model legislation and enact it as quickly as possible.

Removing the WMD bias is most important in the area that policy makers call consequence managementrunning the show in the aftermath of an attack. I hope I have made the point that responding to a biological attack requires an entirely different structure and management system than responding to a chemical or bomb attack. At the moment, coordination of response to WMD attacks falls to the Department of Justice and the Department of Defense. To be sure, that is the right management team for a blast or chemical release: the cops and soldiers should remain the goto guys in that kind of crisis. But you don't want them running the show during a biological attack, any more than you would expect them to coordinate the response to an outbreak of listeriosis at a hot dog plant, Legionnaires' disease from a cooling tower, or even West Nile virus in New York City. Those crises require special skills, special knowledge, and special people all already present within the public health system. The Centers for Disease Control and Prevention has been late to recognize its potential role in biological terrorism response, and its leadership may have room for improvement, but since 1999 it has become a more active participant in the process and should be placed in charge of civilian biodefense.

2. Build the Stockpile.

Until we have a large and usable stockpile of the right antibiotics and vaccines for the most likely agents to be used in a biological attack, we're dead. Nothing can move forward until we have created this fundamental buffer between us and the abyss. Experts have been pushing for a new smallpox vaccine for three years, and seem little closer to having one than when they started. Both the administration and Congress must accept blame for a situation that has shown the worst of the federal bureaucracy. Yes, creating a stockpile involves a guessing game: a determined terrorist could well find out what agents the stockpile defends us against and hit us with an alternative. But if it means that we're able to respond quickly to an attack of anthrax or smallpox, it is well worth the effort. And yes, it will be expensive, but just a fraction of what we are currently wasting on other terrorism preparedness schemes today. It's part of the essential reordering of priorities that goes with rethinking "WMD": we must have fewer tricorder contracts and a lot more vaccines.

3. Build More "Surge Capacity."

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