Frist: U.S. 'under-prepared' to deal with bioterrorism

By Kathy Helms-Hughes

   In 1984, members of the Oregon-based Rajneeshee cult used salmonella bacteria to contaminate 10 restaurant salad bars in an attempt to manipulate the outcome of a local election by making large numbers of voters too sick to go to the polls.
   After 751 people fell ill with food poisoning, public health investigators attributed the outbreak to natural causes. The true source did not emerge until a year later when a cult member confessed to the crime.
   Given the Sept. 11 terrorist attacks at the World Trade Center and Pentagon, terrorist bombings in New York City in 1993 and Oklahoma City in 1995, some experts predict that more domestic bioterrorist attacks are likely to occur.
   Biological agents such as viruses, bacteria or their toxins are easily concealed and potentially could affect large segments of the population. The agents can be released to the air in the form of aerosols, or in food, water, and even insects.
   In testimony presented Wednesday before the Senate Appropriations Committee, Tennessee Sen. Bill Frist, M.D., and Jonathan B. Tucker, Ph.D., director of the Chemical & Biological Weapons Nonproliferation Program Center at the Monterey Institute of International Studies in Washington, D.C. -- among other professionals -- outlined dangers presented by bioterrorism.
   "Now that we are all aware of this potential threat, we must concentrate on our response and invest approximately $1.4 billion specifically to fill the gaps in our current biodefense and surveillance system," Frist said. "We must take necessary actions to prevent the use of bioweapons, prepare our communities, and improve our capacity to respond."
   Frist said the Oregon incident is the only time bioterrorism has been successfully used in the United States and the method of delivery was food.
   "We have underinvested in food safety. Less than 1 percent of all food imports are properly inspected. We have fewer than a thousand food inspectors expected to oversee 56,000 food sites. Given that two of the major biochemical agents -- anthrax and tularemia -- as well as a large number of disease-producing organisms may be transmitted through the food supply, we absolutely must do more to ensure the safety of our food," Frist said.
   According to Tucker, the rising volume of tourism, trade, and imported agricultural goods associated with economic globalization has created new opportunities for the introduction of disease and pathogens into the United States from other parts of the world.
   "... Many studies have concluded that the threat of bioterrorism against the United States is growing and that the nation is not adequately prepared to handle even a medium-size biological attack. With a potential health emergency in the making, time is of the essence in reducing our vulnerability ...," Tucker said.
   The shift to privatized medicine and managed care has largely eliminated an effective early warning network for detecting and containing epidemics, he said.
   According to Frist, as a nation, with respect to biological weapons, "We remain highly vulnerable, not because we are unprepared, but because we are under-prepared."
   Hospitals are ill-prepared to deal with a surge in patients, he said.
   "Only one in five hospitals have developed a plan for such a calamity. We must ensure that local hospitals are equipped to provide appropriate crisis management structures by ensuring that every hospital not only has a plan for dealing with a bioterrorist attack but also has appropriate surge capacity, decontamination units, and necessary supplies for the immediate needs."
   According to the American Hospital Association, only about 25 percent of 6,000 U.S. hospitals are at some state of readiness.
   Tucker said a bioterrorist attack probably would involve the covert release of a microbial pathogen which would not be detected for several days.
   "For example, Bacillus anthracis, the bacterium that causes anthrax, has an incubation period of roughly six days. Individuals who have been exposed to an invisible aerosol cloud of anthrax spores would probably be unaware at the time that they had been infected. The first evidence of the attack would emerge days later when the infected individuals, by now widely dispersed, began to develop nonspecific, flu-like symptoms such as fever, fatigue, cough and chest discomfort.
   "A few days later, severe symptoms would set in, including pneumonia, sweating anoxia (causing the victim to turn blue), and death if the disease remained untreated."
   Anthrax is not transmissible from person to person, he said. Because the disease is generally fatal within 24 to 36 hours after the onset of severe symptoms, antibiotic therapy must begin as soon as possible to have any chance of success, making early identification essential.
   The release of plague bacteria or smallpox virus presents an even more challenging scenario, he said. Plague has an incubation period of one to six days while smallpox is roughly 12 to 14 days.
   "By the time the first cases of smallpox were diagnosed, the initial group of cases would probably have infected close contacts such as family and friends. In this case, it would be essential to launch an aggressive vaccination campaign to contain the epidemic before the infection spread through the general population ...," Tucker said.
   The threat is real, Frist said, and as a nation, "we remain highly vulnerable."
   Although the Department of Health and Human Services has made significant progress over the last three years, there are still large gaps in the current approach, Frist said. "Our goal should be to eliminate these gaps and reduce the risk to our nation and our people."
   Legislation introduced by Frist and Sen. Edward Kennedy, D-Mass., "provides the strategy and framework for a coherent national biodefense policy," Frist said. The Frist-Kennedy "Public Health Threats and Emergencies Act of 2000," addresses bioterrorism from three vantage points: prevention, maximizing preparedness, and response.
   "With this framework in place, we can identify shortcomings within our ability to prevent, to prepare, and to respond," he said, and recommended Congress work together with the administration to provide sufficient funding.
   Though the threat of a bioterrorist attack is remote, it is higher today for a variety of reasons, according to Frist.
   "First, Osama bin Laden has publicly pronounced that it is his religious duty to acquire weapons of mass destruction, including chemical and biological weapons. He has shown his disregard of human life, using weapons of mass destruction that we had never envisioned. Furthermore, he has the resources and motivation to use germ warfare."
   The threat also is increased due to recent scientific and technological advances in agent delivery (such as dispersing anthrax through an aerosol spray) and the willingness of unemployed scientists from the Soviet Union to solicit their expertise around the world, he said.
   Frist recommended the government focus on enhanced on-the-ground intelligence which would allow the United States to know who has access to and who is capable of deploying biochemical agents. He also recommended investment in research to develop anti-viral therapies for smallpox and newer, improved and more powerful versions of an anthrax vaccine.
   A General Accounting Office report on bioterrorism released last week stated that federal agencies have failed to come up with a coordinated plan to deal with a bioterrorist attack and that planning on state and local levels is even worse.
   "Local preparedness is severely lacking because it is inadequately funded," Frist said. "We have allowed our public health system -- the front line of our defense -- to deteriorate over the past 20 years."