Book Excerpt: Bioterror

ByABC News
October 12, 2001, 11:22 AM

Oct. 15 -- According to author Michael T. Osterholm, PhD., the question isn't whether we will face a terrorist attack with a deadly viral or bacterial weapon, but when and where and how devastating it will be. In the following excerpt from his book, Living Terrors, Osterholm presents his prescription for what the U.S. must do as a nation to secure its freedom.

Chapter Nine: MITIGATED DISASTER

Eight Point Plan: Preparing for Terror

Whatever we do, America will remain a uniquely compelling target for terrorists.

But our lack of preparedness doubtless heightens our vulnerability to bioterror attack. So far, most of what we have done has been to react to incidents; now it is time to act, to prepare. Although the law of diminishing returns understandably limits what actions we should take in the name of prevention, there are nevertheless a few things that must be done at the federal, state, and local levels, and by each of us to make a difference. We can take steps now that could both make it harder for terrorists to commit evil and keep the damage they do from growing out of control. And we can steer the outcome of an attack from the unmitigated disaster of the Chicago scenario to the "mitigated disaster" of Milwaukee.

Below, my eight-point plan for change:

1. Stop Talking About "Weapons of Mass Destruction."

I'm not talking about conveniently erasing these weapons out of our everyday world, though it would be a miracle if such magic actually existed. No, I simply mean it's time to stop lumping all weapons that can kill large numbers of people under the single rubric of WMD. The difference in responding to bioterrorism, as opposed to a chemical or nuclear attack, is like the difference between flying a plane and driving a Formula One car. Both are moving vehicles, but very different skills are required for each one. The overuse of the term "weapons of mass destruction" has done a great deal to stunt the necessary attention to the looming threat of biological terrorism. It has allowed policy makers to throw money at the broader problem, shortchange this narrower one, and still claim to be solving the problem. As we've seen, in contrast to other forms of WMD, bioterrorism response is not primarily a military and law enforcement effort. It's a public health and medical system effort.

I don't actually expect the phrase to go away, any more than I expect the weapons to. Buzzwords are like viruses, neither alive nor dead but moving from host to host, seemingly forever. But we should all insist that policy makers acknowledge that biological terrorism is different from terrorism that relies on chemical weapons or explosives, and deserves separate consideration. That means our budgets at the federal, state, and local levels have to show proper funding for bioterrorism planning, training, monitoring, and stockpiling. In 1999, the CDC supported funding of $41 million for all 50 states and three large metropolitan areasa minuscule amount in light of the $10 billion spent on terrorism. Yet those public health and medical programs are our first, second, and third lines of defense against and in response to a biological weapons attack. To put it bluntly, our priorities are really screwed up.

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.