Unprepared for the Worst
Anthrax. Smallpox. A deadly flu virus. Every worst-case scenario in the world of biological weapons is now a possibility to the scientists, health professionals, security analysts, and law-enforcement agents working to assess the threat. They've tracked the stockpiles, run the numbers, and devised solutions, but are panicked U.S. officials listening to these experts?
By Laurie Garrett
Since September 11, those who study biological terrorism have been losing plenty of sleep over what-if questions. What if Osama bin Laden has an agreement with Saddam Hussein, allowing al-Qaeda access to Iraq's considerable biological-weapon stockpiles? What if scientists from the former Soviet Union, known to have worked on weaponizing smallpox viruses, have sold their expertise on the international armaments black market? What if the scattershot anthrax horrors the nation has witnessed since October 4 were writ large in a massive assault on a city? What if the unthinkable really happened: an epidemic on American soil, deliberately created by terrorists in order to sow chaos, hysteria, and mass casualties?
"All of a sudden we're fearful," says Brad Roberts, a bioterrorism expert with the Institute for Defense Analyses in Alexandria, Virginia. "The classic argument about terrorists is that they never have historically killed as many as they could have. The argument was that it was unnecessary and counterproductive; it would delegitimize their cause, prompt a government crackdown on their followers, and generate defectors."
On September 11, Roberts says, the terrorists blew that assumption away. "I think the attack was in some sense a failure," he says. "The ambition must have been to kill far more people. The ambition must have been to bring down the federal government. This isn't traditional terrorism. This is war."
The fact that the terrorists were on suicide missions, coupled with their deliberate targeting of civilians, "was very sobering," says Dr. Margaret Hamburg of the Washington, D.C.-based Nuclear Threat Initiative, a foundation funded by Ted Turner and run by former U.S. Senator Sam Nunn. "It removed any hopes that terrorist groups or others might have a threshold beyond which they wouldn't go in terms of causing damage and disease. People have puzzled why bioterrorism has never really been used before. And some have said it's a genie they didn't want to let out of the bottle. I think after September 11 that comfort is gone."
Both Roberts and Hamburg are part of an odd hodgepodge of American, Canadian, and European men and women who have attended small meetings for nearly a decade to toss around bioterrorism scenarios, debate preparedness priorities, and bemoan the general lack of concern in the government. This eclectic group comprises national-security experts, public-health bureaucrats, military strategists, policemen, F.B.I. agents, intelligence officers, and scientists who created death germs for the U.S. bioweapons program in the 1960s and the Soviet program in the 1980s. These people have always had a tough time communicating with one another, as each of their professions speaks a different patois and defines words in various ways. "Security," they learned, has a significantly different meaning to a police-man than it does to a global strategist or a scientist.
Recently, however, some group members began to find a common language and to settle on a list of priorities for government action because they felt a sea change was under way among terrorists. Jerome Hauer, who set up New York City's emergency-response system for Mayor Rudolph Giuliani and who now works for the security firm of Kroll Associates, says that during the 1960s terrorists went out of their way to avoid taking lives, preferring to hit symbolic targets in order to draw attention to their causes.
"The goal was always to try to make a statement without creating injuries," Hauer explains. During the 1980s in the Middle East, a new type of terrorist emerged, willing to commit suicide and kill significant numbers of people. But even such groups as Hamas and Hezbollah still tried to limit fatalities because they depended on outside political supporters for funds. If they went too far, they would lose their base of popular support, and the money would dry up.
In the last decade a third type of terrorist has appeared, Hauer continues, one who has access to enormous amounts of money and is not restrained by any need for popular support. This signaled to the Old Guard that there were now possibly people who believed that the deliberate creation of epidemics was a palatable tactic.
And then terrorists destroyed the World Trade Center.
"The unthinkable became reality on September 11, and as a result every worst-case scenario suddenly became a possibility," says Ronald Atlas, president-elect of the American Society for Microbiology and a longtime member of the band of bioterrorism thinkers. A resident of Louisville, Kentucky, he chaired his society's special committee on biological weapons. Now that a broader circle of people is addressing the issue, Atlas says, "everybody is running with the Armageddon scenarios. It wakes people up, but people are scrambling too fast."
By government standards the speed with which Congress, the White House, the federal bureaucracy, and state and local health authorities have mobilized around bioterrorism concerns is nothing short of breathtaking. But members of the Old Guard worry that, in the nation's rush to harden its bioterrorism defenses, hasty decisions are being made. The reality of the threat hasn't been properly assessed, they warn, and America's direst needs are being overlooked in favor of more immediate, reactive measures—such as spending more than a billion dollars on anthrax incidents while failing to put adequate resources into long-term improvements in the nation's ability to spot and respond to the full range of likely terrorist germ weapons.
In some ways the Bush administration created its own pressure cooker, fanning public hysteria, which in turn could be relieved only by showy displays of speedy government action. Two weeks after the September 11 attacks Attorney General John Ashcroft announced there were indications that members of the terrorist conspiracy had looked into renting crop dusters, and the Federal Aviation Administration ordered all such planes temporarily grounded nationwide. The next day Ashcroft revealed that suspected terrorists had obtained or tried to obtain driver's licenses for trucks that can carry large tankloads of dangerous materials, such as fuels, explosives, or deadly biological concoctions.
By September 26, six days before Sun photo editor Robert Stevens stumbled into a Palm Beach hospital, incoherent from anthrax-induced fever, doctors and pharmacists from the Hamptons to Honolulu were already reporting runs on stocks of the antibiotic ciprofloxacin, the preferred prophylaxis and treatment for anthrax infection. Gas-mask sales were vigorous, and by the end of the week most Internet distributors reported they were sold out. Some instant experts sprang out of the woodwork offering everything from alleged lifetime bioterrorism alerts (www.freegasmask.com) to air-conditioner filters that would keep one's home microbe-free. New York City television newscasters told viewers to seal up an airtight space in their homes, into which they could retreat in the event of a biological attack. Missing in all these lists of dubious advice was a fundamental facet of microbial attacks: invisibility. Nobody could know whether the air they breathed, food they ate, or water they drank was contaminated, so no one could possibly know when it was time to don a mask, ingest antibiotics, or sit in a sealed room. The only truly rational measures an individual can take are no measures at all.
This panic was coupled with a complete initial silence from government health officials. On September 11, at the Centers for Disease Control and Prevention in Atlanta, director Jeffrey Koplan and his top staff were rushed off to the DeKalb Peachtree Airport, where they awaited instructions inside a military transport that was fully fueled and ready to fly anywhere in America. Meanwhile, the C.D.C., the nation's prime repository of superlethal microbes, was evacuated. Behind the multi-layered high-security doors and air locks of the agency's Biohazard Level-4 Laboratory were freezers full of such microscopic killers as Ebola and assorted other hemorrhagic-fever viruses, smallpox, and dozens of additional lethal microbes, for which neither vaccines nor cures are readily available.
Though the evacuation order was probably a routine response in a high-alert situation, no one at the C.D.C. was allowed to release such words of comfort to the public. That's because the White House placed a gag order on all of the scientists, bureaucrats, and civil servants of the U.S. Department of Health and Human Services. Nobody at the C.D.C., the National Institutes of Health, the Food and Drug Administration, or any other H.H.S. agency was allowed to answer questions from the public or journalists without the permission of H.H.S. Secretary Tommy Thompson's office. The order not only cut the press off from vital information but also stymied local public-health authorities and physicians in their efforts to calm their communities and prepare for possible attacks.
"I've had people calling me. They can't get through to the C.D.C., because the C.D.C. isn't allowed to talk to anybody. They can't get through to H.H.S. And they're just terrified," Dr. James Curran, dean of the Rollins School of Public Health at Emory University in Atlanta, said in late September. "I think it's stupid. I think the C.D.C. ought to be responding."
"It's really bad," said a former top health official. "This is a time when they need to be providing leadership, a visual presence, the voice of the surgeon general assuring people."
Old Guard bioterrorism expert Amy Smithson of the Washington, D.C.-based Stimson Center think tank repeatedly tried to reach H.H.S.'s designated chief of bioterrorism response, Dr. Scott Lillibridge. "I tried to call to say, 'Are you aware of the panic in America?' I was told he could not be reached. I said, 'You must be kidding!'" Smithson recalls. "I'm losing a lot of respect for these people. One of government's responsibilities is to communicate accurate information to the public. But they've been silent. So the media has panicked the people."
Similarly, Dr. Steven Wolinsky, chief of infectious diseases for Northwestern University Medical School in Chicago, together with all the leading infectious-disease doctors in greater Chicago, was trying to prepare his area's medical system for the worst. "But we are meeting the same difficulties because we don't know who to deal with," Wolinsky said, noting that they also were unable to get vital information out of H.H.S.
Well behind the scenes, however, Secretary Thompson and his staff were lobbying for fundamental changes in the nation's public-health system, including the creation of a top position to coordinate federal agencies that would respond to a bioterrorist catastrophe.
"It's unlike anything I've seen in any major departmental activity," Lillibridge said in a September 28 interview. "From almost day one [in office] this bioterrorism issue was on Secretary Thompson's priority list."
In July, Thompson asked Lillibridge to move up from the C.D.C. to Washington, to act as a special assistant to the secretary for bioterrorism. Lillibridge was supposed to make the move on October 1. But on September 11, after his wife gave birth, he raced up to Washington. It would be 10 days before he again laid eyes on his newborn child.
While the general public's anxiety was rising, a vigorous, largely secret policy debate unfolded in Washington over how best to structure the newly created Office of Homeland Security, headed by director Tom Ridge. Before September 11, insiders say, the Justice Department—particularly the F.B.I.—was in charge of the law-enforcement investigation of domestic terrorism, while the Department of Defense headed up overseas issues. As the new office was formed, several agencies jockeyed for power and authority, chiefly the Departments of Defense and Justice, the Federal Emergency Management Agency, and H.H.S. Unseen by the general public, Thompson, Lillibridge, and the upper echelons of their department were putting in 12-hour days of meetings, secret briefings, and Capitol Hill lobbying. And that was before the anonymous letters containing anthrax spores were sent to news organizations, including NBC, CBS, and ABC News, and to Senate Majority Leader Tom Daschle's office, resulting in the House of Representatives being closed for three days and tens of thousands of people being tested for the disease. And before H.H.S. Secretary Thompson testified on October 3 to the Senate Appropriations Committee that his department had the situation under control, and was told by several of the nation's political leaders—from both sides of the aisle—that his assurances were not believed.
Whether level heads can prevail in such an atmosphere is a matter of grave concern, says Dr. D. A. Henderson, director of the Center for Civilian Biodefense Studies at Johns Hopkins University in Baltimore. Since 1977, after leading the successful global fight that eradicated smallpox, Henderson has been using his forceful presence in Washington and in public to push for greater preparedness against biological weapons. "I think it really is difficult, this new, elevated attention," says Henderson, who formally joined Thompson's advisors on October 3. "You're sort of walking along a knife-sharp ridge, trying to keep a balanced view of where we are. I don't know how we do it! We have a problem, there's no question. The knowledge of these weapons is out there. After September 11, I've had some very serious additional concerns."
A few members of the bioterrorism Old Guard, unable to assess how best to strike a balance between justifiable alarm and needless panic, now refuse to talk publicly at all. Several told V.F. that they fear anything they say about U.S. vulnerability will simply give horrible ideas to al-Qaeda and other terrorist organizations. One leading expert, who declined to speak for attribution, says simply, "We've just had another Pearl Harbor. After Pearl Harbor everything became top secret. And that's how things should be now."
Other members of the Old Guard, such as Dr. Michael Osterholm of the University of Minnesota, take the view that the American public needs urgently to know the scale of the threat, what ought to be done by government to protect the populace, and where individuals fit into the picture. Author of last year's Living Terrors, a primer on bioterrorism issues co-written with New York Times reporter John Schwartz, Osterholm insists that the only way to calm public panic is with mountains of accurate, balanced information.
The very writing of this article is, then, an arduous exercise in the ethics of truth, restraint, balance, and justifiable alarm. Only time will tell which government leaders, bioterrorism experts, and media have most responsibly informed and led an agitated American people. Key to calculating how afraid we actually ought to be are two things: assessing the real bioterrorism threat at this time and in the near future, and determining how ready government is to meet it.
For many years the Western intelligence community and F.B.I. lumped biological weapons into a category with nuclear and chemical threats called "W.M.D."—weapons of mass destruction. But, compared with the other two, biological weapons received little attention. That was because nuclear and chemical weapons were well understood, had been previously employed during wartime, and could be fairly easily tracked. Nuclear weapons are, after all, radioactive, so illegal shipments of fissionable substances can be detected with sensors located at many military bases, government buildings, airports, and other public facilities worldwide.
Chemical weapons are also easy to track, as the quantities necessary to inflict serious harm are usually massive—on the order of thousands of gallons or hundreds of tons. Even if a country or terrorist group wished to manufacture its own nerve-gas supplies, the purchase of tens of thousands of gallons of ingredients could not readily go unnoticed.
In addition, it has always been a fairly simple matter to figure out whether nuclear or chemical agents have been used. Even nuclear tests conducted deep underground are detected with seismographs, and United Nations inspectors believe that it is now impossible to inflict a serious chemical attack in even remote corners of the world without drawing attention.
In contrast, bioweapons emit no telltale signals and can be effective in microgram quantities, rather than tons. There is little global experience with their use to draw upon for intelligence clues. And every single aspect of their production can be convincingly described by someone trying to hide something as medical or pharmaceutical research. This "dual use" conundrum, as it is called, put Western intelligence communities at such a severe disadvantage that for years few bothered seriously to try tracking biological weapons.
Two dramatic events forced a rethinking of biologicals' lower-priority status in the W.M.D.-threat assessment: the Persian Gulf War and 1991 revelations about the Soviets' bioweapons program.
At the close of the Gulf War, Iraq was compelled under cease-fire resolution 687 of the United Nations Charter to submit to biological-weapons inspections. For a time, Australia's U.N. ambassador, Richard Butler, headed the U.N. Special Commission, or UNSCOM. "What Iraq did at the beginning is it entered an utterly false declaration," Butler recalls. "What Iraq did was say, 'What biological weapons? We have none.'" After four further confrontational years Iraq "then said, 'Whoops. We lied,'" Butler continues. "'We did have some bioweapons. But we put our hands on the Koran and say none of this is offensive. All of this is defensive bioweapons.'"
Despite dozens of Iraqi obfuscations, deceptions, and cover-ups, UNSCOM scientists were able to gather evidence of a massive bioweapons program, featuring production of 84,250 liters of anthrax spores—enough, if dried into a powder and properly disseminated, to kill every man, woman, and child in a city the size of New York many times over, based on calculations made in a 1994 report from the U.S. Office of Technology Assessment. Even more disturbing, there were labels found at some Iraqi sites that said "smallpox" in Arabic.
"We had evidence of human testing, possibly involving Iranian P.O.W.'s," Butler says. "Finally, [Iraqi foreign minister] Tariq Aziz opened his heart to me. I had become so sick and tired of the bully that when he asked me personally to have coffee, I said, 'Tell me, O Wise Man, what do you think of politics in the Middle East?'"
To Butler's amazement Aziz confessed that Iraq had indeed made not only the biological weapons that UNSCOM suspected but much, much more.
"Some of it was chilling," Butler says. "In private he said to me, 'We made it in order to deal with the Jews.' He also used ethnic names for the Iranis. He called them 'the Persians.'" (Mr. Aziz was unavailable for comment.)
Still, neither Aziz nor Saddam Hussein ever allowed full UNSCOM inspection, let alone destruction, of their bioweapons apparatus. Butler and dozens of scientists who assisted in UNSCOM inspections are convinced that Iraq's program was only briefly slowed by U.N. efforts, illustrating one of Butler's favorite points: "The order of difficulty here makes nuclear-arms control look like a piece of cake."
Even more frightening were those glimpses of the Soviet biological-warfare program that the West got after the 1991 fall of the Communist state. Because of the key defection two years earlier of Vladimir Pasechnik, director of a Soviet bioweapons laboratory in St. Petersburg, British intelligence knew that during the Brezhnev regime the Soviets had begun to develop a vast biological-weapons infrastructure called Biopreparat. At its peak just over a decade ago Biopreparat employed more than 50,000 scientists and technicians toiling in 52 labs and test sites, a major purpose of which was creating genetically modified superbugs with catastrophic kill ratios.
Professor Christopher Davis, who is both a neuroscientist and a physician, was part of the first team of outside scientists allowed to see a Biopreparat facility. Then working at the behest of British intelligence, Davis visited four Biopreparat sites in 1991 under an agreement forged among Prime Minister Margaret Thatcher, President George Bush, and Premier Mikhail Gorbachev.
"'W.M.D.' is a Soviet term dating back to the 1960s," says Davis, who now is developing epidemic-detection software for the Virginia-based Veridian Systems Division, Inc. "I will not use that term. Biolog-icals are not weapons of mass destruction. That's the whole point! They kill people. So true explosives and nukes are the weapons of mass destruction. Biologicals are something else."
By the mid-1990s active collaborations were under way between American and former Biopreparat scientists. The intention was to woo the weapons bioengineers from the forces of darkness into the arms of public-health science, putting their sophisticated skills to use for humanity's benefit. "These people produced tons of chimeric [i.e., genetically altered] agents," national-security analyst Smithson says. "The seeds of transformation of these institutions has begun, but certainly there's a long way to go."
The leading Biopreparat virus laboratory was VECTOR, located outside the Siberian city of Novosibirsk. By 1997, when I visited it, only a handful of scientists still worked in the vast complex of once secret buildings, hidden in the taiga. The place had an eerie post-apocalyptic feeling, as weeds were overtaking the concrete, and scientific workbenches, seemingly abandoned mid-experiment, were caked with dust. But still resting behind the locked doors were the most lethal pathogens humanity has ever known, in frozen hibernation: genetically modified forms of smallpox, Ebola, influenza, Lassa fever, Marburg, and dozens more viruses. Security was almost nonexistent.
And the overriding question, as one strolled through the VECTOR ghost town, was "Where did all the scientists go?"
Smithson authored a report two years ago entitled "Toxic Archipelago," in which she asserts that, "virtually overnight, tens of thousands of biological and chemical weaponeers found themselves without a concrete source of income, stripped of their elite status. . . . Before long, aspiring proliferators began to troll through the biological and chemical institutes, intent on persuading increasingly destitute scientists to divulge their weapons expertise and even put weapons materials up for sale."
Kanatjan Alibekov was a senior executive at VECTOR, and rose to the rank of first deputy director of Bio-preparat before defecting to the U.S. in 1992. Now a resident of Virginia, he has Americanized his Kazakhstani name to Ken Alibek. And he makes three claims that have shaken the intelligence community. First, Alibek says the Soviet scientists succeeded in fully weaponizing microbes—creating viruses and bacteria that could withstand missile launches and emission from jet planes. The scale of production, he says, was staggering: in 1987 anthrax alone could have been produced at the rate of two tons a day.
Alibek also claims knowledge of former Biopreparat scientists now living in Iraq, North Korea, Iran, China, and Cuba. Further, he says that during the 1980s his staff trained bioweapons-makers in several Eastern European countries, as well as in Libya, India, Cuba, Iran, and Iraq. Finally, Alibek insists that the Russian Ministry of Defense is still conducting bioweapons research today. Alibek's claims have grown grander the longer he has lived in America, and most of the Old Guard bioterrorism experts take his current comments, particularly regarding ongoing Russian military research and his insistence that VECTOR created chimeras of smallpox and Ebola, with a grain of salt. But intelligence sources say that most of the statements he made during his first, 1992 debriefing have been verified.
Beyond the Iraqi and former Soviet programs, intelligence about bioterrorism is weak, however. While insiders remain convinced that bioweapons programs exist in several other countries, including China, North Korea, and Pakistan, any links between stockpiles inside those nations and identified terrorist groups are either speculative or deeply classified. Nevertheless, most insiders rank such connections as possible, even probable.
Republican congressman Christopher Shays, chairman of the House Subcommittee on National Security, has said that Iran, Iraq, and Libya possess and are willing to share bioweapons. "I'm absolutely certain that terrorists, if they don't have access to biological agents now, will, and I'm absolutely certain that they'll use them. The expertise exists. The potential that it's being shared with the terrorists is almost a no-brainer," Shays said in late September on 60 Minutes.
Certainly the ability to buy expertise and bioweapons obviates the need to build laboratories, fermenters, and delivery devices. Skeptics among the Old Guard had long pooh-poohed the prospect that any individual or group could turn bioweapons production into a cottage industry.
"It's not like any bozo out there can manage such a thing," Smithson insists. "There's an orders-of-magnitude difference between learning how to pilot an aircraft and learning the technical details of producing biological weapons. This isn't the kind of thing a couple of guys in a garage are going to figure out."
The skeptics point to the Japanese religious cult Aum Shinrikyo, which in 1995 released sarin nerve gas in Tokyo's subway as part of an Armageddon scheme. The group had recruited scientists and built secret laboratories for bioweapons but never managed effectively to use them. It's unclear whether this failure was owing to an inability to overcome technical obstacles. Right-wing zealots in the U.S. have tried to purchase anthrax, and have published bioweapons cookbooks for use by such groups as Aryan Nations and Christian Identity. But in the end the most violent action executed by an American terrorist motivated by extremist principles was the low-tech, but hideously effective, bombing of the Alfred P. Murrah Federal Building in Oklahoma City.
So, says Harvard University national-security expert Jessica Stern, "if I were working in government, I would be thinking of low-tech bioweapons, low-tech chemicals, including industrial chemicals." Stern says terrorists are more likely to accomplish their ends with simple acts of food poisoning or by dispersing germs in a small room.
Anthrax expert Dr. Martin Hugh-Jones points out that there's plenty of low-tech damage to be done if the targeting is clever. Hugh-Jones does research at Louisiana State University in Baton Rouge and is one of the referees of the most popular Internet epidemic-intelligence site, ProMed. He has always felt that bio-weapons aimed at a country's economy, rather than populace, were cheap and as low-tech as one could imagine. Hugh-Jones and many veterinary and agricultural authorities explain that nonhuman pathogens, including foot-and-mouth disease, would devastate the American economy without posing any health risks to the terrorists. Four plant bacteria were, for example, developed as germ-warfare weapons by the U.S. Army during World War II. And Purdue University's agricultural extension program estimates that a release of the foot-and-mouth-disease virus into the U.S. livestock industry would cost the economy up to $24 billion.
"From what I've seen with foot-and-mouth, it is the best example of why agricultural biological weapons are far more effective than human ones," says Hugh-Jones.
Even human horrors could be caused in a remarkably low-tech manner, Ronald Atlas argues. "All you have to do is infect some of your people with smallpox, send them out, and you've got an epidemic. If you've got 40 or 50 people who are out there, committing suicide, you've got an epidemic," he says. "I don't have to get anthrax from a laboratory. I can just go to [Africa to] an elephant outbreak and get it from the carcasses. We can increase security, but all sorts of things are out there in nature."
"It's not exactly rocket science," says Dr. Stephen Morse, director of Columbia University's Center for Public Health Preparedness.
Tommy Thompson sought to reassure the American people in an appearance on 60 Minutes in late September. "We've got to make sure that people understand that they're safe, and that we're prepared to take care of any contingency, any consequence, that develops from any kind of bioterrorism attack," Thompson told newsman Mike Wallace. "We looked at it and we found that there were some shortcomings, and we have addressed those shortcomings, and we're still addressing those shortcomings."
But those "shortcomings" are substantial.
The medical response to the September 11 catastrophe consisted of a program planned during the second Clinton administration, mostly by Dr. Hamburg, who was then assistant secretary for planning and evaluation at H.H.S. "Push-packs" carrying tons of stockpiled pharmaceuticals and emergency medical supplies were rushed to New York City, as were teams of physicians, nurses, and mortuary experts. And more were placed on standby. The mobilization was accomplished in less than 36 hours.
But this was in response to an obvious, acute event—something broadcast internationally starting right after the first plane hit the World Trade Center. H.H.S. and the White House knew the tragedy had occurred within seconds, and a series of phone calls was all it took to mobilize emergency-response teams.
A large-scale biological event wouldn't be like that. It would look more like this:
At emergency rooms and clinics throughout a small city, population 100,000, doctors find themselves overwhelmed by a strange surge of what looks like flu cases. The patients come in with characteristic symptoms: fever, malaise, loss of appetite, chills, and muscle aches. But many of the afflicted are children under 10—a group rarely affected seriously by influenza.
Despite symptomatic treatment for the flu, the patients worsen and develop new symptoms: bone pain, dry cough, liver dysfunction, and meningitis. Some of the patients are so deranged that they run about naked, shouting incoherently. In the worst cases there are severe heart palpitations, causing the patients to writhe in agony and finally to die. The County Health Department becomes alarmed enough that it reports the situation to the C.D.C. in Atlanta, requesting assistance.
Not until two weeks after the start of the epidemic does the C.D.C. determine that the microbe responsible for what are by then 10 deaths and 200 cases of illness is Brucella melitensis, a bacterium which is usually found in sheep and goats, but which can be passed to humans. Since there are few, if any, sheep or goats in the area of the epidemic, the F.B.I. suspects bioterrorism. Local police discover an aerosolizing device in an office air-conditioning system that could have been used to release the brucella.
Cases spread to eight other states, as well as to Quebec, London, and Paris—carried by travelers. The World Health Organization issues an international alert. And the H.H.S. begins mobilizing millions of doses of the antibiotics doxycy-cline and rifampin, a combination of which will have to be taken for six weeks by every brucella-exposed man, woman, and child.
When the disaster is over and the numbers are tallied, the costs to the city are $285 for prophylaxis for each exposed person ($12.7 million); $5,587 for each hospitalized patient ($45 million); $1,418 per person for clinical tests for the "worried well" ($142 million). The total economic loss is estimated at more than $7.5 billion, not including an untold sum in lost productivity and mobilized state and federal personnel.
The human toll: 413 people of all ages and professions, united by only one thing—they happened to be in the wrong place at the wrong time.
This is the sort of scenario that C.D.C. economist Martin Meltzer spends his days contemplating. Working with C.D.C. biologists, he calculates the unthinkable.
"I'm not in the game to play absolute death numbers," Meltzer explains in a vaguely British accent, which turns out to be Zimbabwean. Self-described as "grouchy and nasty," he pushes government authorities to consider the potential horrors and to take steps, such as stockpiling antibiotics and vaccines, which according to his calculations would save billions of dollars—not to mention countless lives.
Were a brucellosis attack actually to occur, Meltzer and his colleagues might heave a sigh of relief. The disease, after all, is easily treated and prevented with cheap, readily available antibiotics. Even untreated victims usually survive—the death rate is only 5 percent.
The story would be far different if the terrorists used more lethal and more infectious microbes—for instance, inhalatory, weapons-grade, antibiotic-resistant anthrax. Its spores attack the victim's lungs, leaving him gagging for air. If treatment doesn't begin before symptoms occur, death follows within 36 hours in 60 percent of cases. Or tularemia, an illness commonly found in North American wildlife and sometimes passed to hikers and campers. Symptoms include high fever, prostration, and weight loss. In humans, tularemia is extremely difficult to diagnose, even in expert hands; the initial symptoms are vague and consistent with many other infections—many hospitals don't even know how to test for it; without antibiotic treatment, 5 percent of the infected die.
In every model Meltzer plays with, timing is crucial: the longer it takes to recognize that evil is afoot, identify the microbial culprit, and mass-medicate the populace, the higher the death toll, and the greater the cost.
How much worse would Melt-zer's models of disaster be if a major metropolis such as New York City or Washington, D.C., were involved? Or if the terrorist employed a more sophisticated method of dispersal, such as loading bioweapons on a crop duster?
"How much more difficult is it to aerosolize an agent to infect a population of 14 million?" Meltzer ponders. "Is it impossible? No. But there is some difficulty. If time isn't a factor, no problem." A couple of quick passes over a suburb might be sufficient to expose 100,000 people, whereas saturating New York City would require multiple flyovers during the course of many hours—or several planes working simultaneously.
"An appropriate crop duster holds only so many gallons of gas," Meltzer continues. "How much did he actually have to disperse in order to create an all-out panic? Remember, you generally don't have to kill a lot of people to be a successful terrorist." That was clearly demonstrated in early October, when the first anthrax death and several infections were sufficient to ignite anxiety worldwide.
But there are simple alternatives for large-scale attacks: mounting a dispersal device on the back of a taxicab. Or venting microbes through the U.S. Capitol's air-conditioning system. Or contaminating food in the I.R.S. cafeteria. Scratching his salt-and-pepper beard, Meltzer considers the possibilities: "Your definition of horror might vary from terrorist to terrorist. There might not be a release. You might get a phone call saying, 'Here it is,' and find a sealed bottle. Would that be enough to cause panic? Probably."
Enough to shut down Wall Street for a day, for instance.
Consider, for example, what happened in 1994 when the residents of Surat, India, heard on the BBC that a mystery virus was loose in the city: 450,000 residents reportedly fled by train in less than 48 hours. Even when the virus was identified as the highly treatable Yersinia pestis bacteria, the panic only got worse. Indeed, this naturally occurring outbreak threw the international community into hysteria, because the popular name for Yersinia pestis is plague. Infamous since the 14th century, when it eliminated a third of the population of Europe, the "Black Death," depending on the strain, causes hemorrhaging of the lungs, pustules on the skin, and a fever so high that it induces delirium and hallucinations. A picturesquely grim death ensues in 100 percent of untreated pneumonic cases, the result of respiratory shock and failure. Today, plague is easily treated with inexpensive, readily available antibiotics—tetracycline or doxycycline—but thanks to vivid historical accounts, it continues to inspire its own special horror.
"Assume a big red button," Meltzer warns. "When you hit it, what happens? What your experience in India tells us is you can't deal with the situation by going to a government leader and saying, 'We have a release—now what do we do?' You have to have a plan."
So far Meltzer has concentrated on scenarios involving bacteria. His mission is to persuade urban planners to conduct war games and establish a chain of command for emergency personnel. He is also trying to get medical schools to train doctors to diagnose exotic organisms the C.D.C. has named as likely biological-warfare agents.
Meltzer admits, however, that even he can't bear to plan for a bioterrorist attack involving smallpox.
But members of D. A. Henderson's staff at Johns Hopkins did. On June 22 and 23, 2001, they staged a role-playing war game with high-level government officials facing an outbreak of smallpox. The event was simulated for Oklahoma and involved Governor Frank Keating, along with federal officials, the Center for Strategic and International Studies, and other think tanks. Called "Dark Winter," the exercise found officials at a loss as the imaginary epidemic spun out of control. Their decisions would have caused a real epidemic to spread from a shopping mall to the entire nation. By the exercise's close it seemed a million people might die in the event of a real epidemic.
The fundamental lesson of Dark Winter was that officials were "reluctant to move quickly early on, when the epidemic was containable," says Dr. Tara O'Toole, who works with Henderson at the Center for Civilian Biodefense Studies. "Only after the epidemic was out of control they started talking about quarantine." Tough decisions must be made in a rapid, scientifically sound manner, she says. But in two such role-playing exercises, she has found, the lines of communication within government snarl, and then panic and terror ensue.
After labeling bioweapons as W.M.D. for so long, government planners have built response and preparedness plans that fail to recognize what the Old Guard bioterrorism experts, after years of debate, long ago concluded was the key: strengthening public health.
"I hope that we understand we're not going to deal with bioterrorism with the military," Henderson says. "Keep bioterrorism out of the hands of Defense and the F.B.I.," he argues—and put it where all epidemic responses go, into the hands of H.H.S., the C.D.C., and local public-health officials.
"Do the people in high places really understand?" Dr. Christopher Davis asks. Heaving a very deep sigh, Davis continues, "I wish I knew. Do they see what happens when a lot of people get influenza? By and large the police aren't involved. The military aren't involved."
Davis argues that the only way to prevent terrorists from trying to achieve their goal of creating epidemics is to "raise the bar," bolstering America's public-health infrastructure so significantly that terrorists see little chance that anthrax, smallpox, or any other disease would kill tens of thousands of people in such a well-prepared nation. According to Scott Lillibridge, that is the position shared by Secretary Thompson and the H.H.S. leadership. More significant, he says, it is also a point of view that is gaining support on Capitol Hill. In October, President Bush asked Congress for $1.5 billion in addition to the $40 billion it set aside for responses to the events of September 11, in order to fight bioterrorism and bolster America's sagging public-health infrastructure.
But giving booster shots to the severely weakened American public-health system will be no easy, or cheap, task. For more than three decades public health at the federal, state, and municipal levels has taken budget cuts, lost valuable personnel, seen its legal and political clout diminish, and witnessed the crippling of its allied profession, medicine. Nobody knows how much it would cost to repair the infrastructure, much less bring it up to a status where it would be able to react appropriately to an epidemic.
"As Americans we haven't had an epidemic to point to and say, 'See that? That's what we're going to face,'" says Northwestern University's Dr. Steven Wolinsky. "We haven't had an epidemic in our lifetime except AIDS, and we've had a hard time getting them to see that one."
"There are not many people involved in thinking and planning who have really been involved in an epidemic," says Margaret Hamburg. "There isn't as much expertise as one would like." One expert claims you could count on one hand the number of people at the C.D.C. who have ever been through an acute epidemic in the U.S.
In Geneva, at the headquarters of the World Health Organization, Dr. Guenael Rodier and his staff gather at a table every morning at nine to decide what the planet's microbes have been up to. "We sift through information from all over, all sorts of information. And we are not just passive about it—we really investigate," Rodier explains, demonstrating the elaborate computer systems and verification apparatus that W.H.O. has created.
Though Rodier's global disease-surveillance system was designed to spot naturally occurring outbreaks of deadly microbes, W.H.O. says it should also serve as a key safety net for detecting bioterrorist events.
In the last week of September the United Nations health agency rushed publication of its "Health Aspects of Biological and Chemical Weapons" report, originally scheduled for release in December. The 179-page document details the hazards and likely uses of biological weapons, the international treaties aimed at limiting their use, and preparedness needs. "A major contribution to preparedness against deliberate releases of biological or chemical agents in most countries can be achieved by strengthening public-health infrastructure, particularly for public-health surveillance and response," the W.H.O. report states.
Which is where Rodier's global surveillance system, currently operating on a shoestring budget of a few thousand dollars, comes in. For as little as $5 million a year, argues Rodier's boss, Dr. David Heymann, the network can spot any unusual outbreaks of disease in the world. Add $50 million a year to the pot, he says, and the system can be even stronger.
Rodier's system relies on a variety of sources, including official government reports, news accounts, rumors anonymously passed to W.H.O. sources, and tips from humanitarian relief organizations such as the Red Cross and from scientists working in remote areas. A computer program scans the Internet for news accounts in many languages.
But any system of surveillance is only as reliable as its grassroots base. And America's surveillance capacity has been eroding for years. Recently, Secretary Thompson asked for $800 million to bring local public-health departments nationwide into the computer age, so officials from Bangor to Fairbanks would have the ability to track disease trends in their communities and relay findings to the C.D.C. Washington insiders, however, say the Office of Management and Budget slashed this figure to $124 million.
Vaccine development and production are also in a sorry state. Last year C.D.C. investigators discovered that the US. smallpox-vaccine stockpile had severely degraded. Fewer than 15 million doses are considered active and safe. No U.S. company still manufactures either the vaccine or the bifurcated needles used to scratch it into the skin. And the nation no longer has adequate stores of the special immunoglobulin necessary to save the lives of the roughly 1 percent of smallpox-vaccine recipients who suffer adverse reactions. In September, Secretary Thompson ordered production of 40 million doses of smallpox vaccine from a British biotechnology company, scheduled for 2004 delivery. However, as urgency increased, Thompson stepped up the deadline to 2002 and sent an inquiry to 1,000 other drug manufacturers asking if any of them could assist with a goal of stockpiling 300 million doses. It won't be easy, experts say, because the methods of making the vaccine employed in the 1960s are now considered too dangerous.
Across the board the pharmaceutical options are slim. For many diseases the microbes are so lethal that the F.D.A. sees no way a drug or vaccine to combat them can be evaluated for safety and efficacy. Few companies are eager to get into the business of working with such lethal agents. And in the case of viruses, humanity has never had much success in battling the rapidly evolving microscopic killers.
There is no effective plague vaccine available. The anthrax vaccine used by the U.S. military isn't offered to civilians. If it were, it would take six shots spread out over 18 months plus annual booster shots to produce immunity. Even garden-variety vaccines are problematic right now. The nation has a shortage of tetanus vaccines, for example, a result of manufacturing problems. In September the C.D.C. announced that this year's batch of flu vaccines would be in short supply and the final shipment wouldn't reach doctors until early December, well after the traditional commencement of the flu season.
For all the talk of smallpox and anthrax, microbiologist Atlas thinks influenza would be the ultimate bioterrorist weapon. The highly contagious virus mutates constantly, and in its most virulent forms can be extremely deadly. In 1918, before the age of jet travel, flu killed some 22 million people worldwide, sickened 10 percent of the American workforce, and killed about 3 percent of those it infected.
"Flu has always been my personal fear," Atlas says. And his fear index jumped up a notch when a team of scientists discovered this summer that by simply altering one gene from a chicken-flu virus they could turn the microbe into one that would be highly lethal in humans.
Last January the Old Guard of the bioterrorism community was thrown into high anxiety by an accidental experimental finding made at Australian National University in Canberra. Drs. Ron Jackson and Ian Ramshaw were trying to make a contraceptive by performing experiments on mice using a virus called mousepox, a rodent form of the smallpox virus. They spliced a gene for an egg surface protein into it, along with an immune-regulator gene, accidentally producing a microbe so lethal that it killed virtually every mouse.
Stanford University biophysicist Steven Block was so stunned by this incident that he is leading a one-man crusade to wake up the nation's biology community. He thinks a similar experiment might produce a nearly 100 percent lethal smallpox.
What the Soviet Biopreparat scientists were trying to accomplish with comparatively crude technologies in the 1980s are now matters of relative ease. That's because scientists have sequenced the entire human genome and are now sequencing the genomes of the world's most worrisome pathogens. On October 4, British researchers from the Wellcome Trust Laboratories near Cambridge published the entire genetic sequence of Yersinia pestis, the bacterium that causes plague, noting which genes are responsible for the virulence and infectiousness of the deadly microbe. By matching virulence genes from pathogens with their targeted compounds in humans, researchers are coming up with medical breakthroughs that could lead to powerful drugs and vaccines. But in the process they are also creating a primer for designing bugs that could infect a wider range of cell types, spread in ways not typical of their microbial species, kill cells more efficiently, and resist antibiotics and vaccines.
Even before the advent of these new scientific tools, Biopreparat scientists succeeded in creating a new species of bacterium that combines elements of anthrax with a soil microbe. The resulting chimera is resistant to all antibiotics, infects a large range of human cells, and may be able to overwhelm vaccine-induced immune responses. Biopreparat also allegedly made a form of fully antibiotic-resistant plague.
Just in the last few years scientists have made astounding discoveries. They have mapped the activities of several bacterial toxins down to the smallest details. A Salk Institute scientist in California is working with an essential component of artificial chromosomes, and several teams are racing to be the first to construct a completely artificial microbe. Stanford researchers have developed a neat trick for rapidly finding the genes responsible for determining which types of cells a given microbe can infect. Similarly, a Harvard Medical School group has developed ways to quickly spot genes that give microbes their virulence. Many labs have found "quick change" genes, which microbes use naturally to evolve, or mutate, at a highly escalated pace. Finally, a California company has developed a technique it calls "DNA shuffling," which allows high-speed random mutations to occur by simply shuffling the order of DNA segments. The technique would allow a scientist to, in a matter of days, turn any given microbe into its most lethal form by simply shuffling the genetic deck until a royal flush was dealt.
'I think the bottom line here is we're looking at biology in the 21st century," Henderson says. "Ten years ago all of this was unknown. This is a new world! We haven't really thought about this."
Atlas agrees. He says all the elements have fallen into place during the last year, and "I could engineer the perfect pathogen, now that I have the human-genome sequence."
In the 1970s, a group of scientists led by Stanford University biochemist Paul Berg and Stanley Cohen, a Stanford geneticist, had an "uh-oh" moment. Should humanity conduct certain types of experiments in the then new field of molecular biology? they wondered. Is it safe? Is it right? Berg gathered the top biologists in the world at the seaside conference grounds of Asilomar in Pacific Grove, California. The outcome was a set of guidelines under which scientists agreed to police themselves, limiting their work in the field of genetic engineering within safe boundaries.
Now, Block and dozens of other bioterrorism insiders say, it is time for another Asilomar moment.
"Scientists are not in an age of innocence anymore," Columbia's Stephen Morse argues. "And they should be aware of the moral implications of what they're doing. We should be self-policing. We should know who we're sending samples to. . . . I think there should be internal controls, but I don't know how far it's possible to go."
Henderson is gung ho for an Asilomar-type gathering "because we have to have a hard look at what the implications are. And of course there are grave concerns about intruding in science and academic freedom. But the thing that's lacking is an appreciation by biologists themselves of the threat this poses to all of mankind."
Two weeks after the World Trade Center tragedy a memorandum quietly circulated among scientists working in one of New York City's most prestigious medical-research centers: "The devastating events of September 11, 2001 have raised questions concerning security and vulnerability of work areas here," the memo said. "Although this message is not intended to increase paranoia or alarmist behavior, we should be mindful that threats can come from any direction and take on many forms."
So, the memo in effect instructed, lock up your test tubes, be sure you know who is wandering through your laboratory, and don't mail off microbe samples to every Tom, Ivan, and Ahmed who writes to you, asking you to collegially share your work.
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