C&EN Washington

It sounds like an urban myth. The President reads "The Cobra Event," a 1997 novel by Richard Preston about a bioterrorism attack on New York City. He gets exercised over the plot and has intelligence and infectious disease experts evaluate its plausibility. Then he gets energized: Top administrative officials are marshaled into action, national plans to prepare and defend against such a possibility are firmed up, and money never before available for bioterrorism study and response suddenly flows more freely to government agencies, think tanks, consultants, and academics.

Like all myths, this one has a kernel of truth. President Bill Clinton did read the novel. It did heighten his concerns about the likelihood of such an event occurring on American soil in the near future.

And because of the President's engagement, the issue of bioterrorism--once of interest only to a small cadre of obscure analysts--leapfrogged to the top of the action agendas of his key aides and Cabinet officials. In a surprisingly short period of time, nearly every federal agency got woven into the fabric of a response to a homefront bioterrorist attack.

Critics charge that no rational strategy underpins the complicated, fragmented, and seemingly uncoordinated plan that has unfolded swiftly. They argue that money is being thrown in too many--or in too many wrong--directions without a clear understanding of the dimensions of the problem or likelihood of a bioterrorism attack.

And even those analysts who believe that at least one bioterrorism incident is likely within a decade fault the planning effort for fundamentally misunderstanding the nature and ramifications of an attack by biological--as opposed to chemical or nuclear--weapons.

Critics say it serves no rational purpose to lump all unconventional weapons--chemical, biological, and nuclear-- that terrorists might resort to using under the rubric weapons of mass destruction (WMD). Or to speak of WMD terrorism as a discrete deed as the President, his Cabinet, and Congress are wont to do. And it impedes sensible planning and training for an effective response to a biological event to talk about chemical and biological terrorism "as if they were one entity: 'chembioterrorism,' " argues Donald A. Henderson, director of Johns Hopkins' Center for Civilian Biodefense Studies, who led the successful global effort to eradicate the virus that causes smallpox.

Terrorism incidents over the past decade, the tools of the new biology, and the ease of acquiring information on the Internet have led the President and other government officials to believe that a rogue nation, a terrorist group, or a disgruntled individual is likely to use bioweapons against the U.S. in the near future. Interestingly, W. Seth Carus, senior research professor at National Defense University, Washington, D.C., says analysts in the intelligence community are not as alarmist as is senior leadership.

Those policymakers are also convinced by the argument of asymmetrical warfare. As Carus explains, "Over the past couple of years, confidence in the notion that the U.S. is a sanctuary no adversary would target has disappeared." Given the U.S.'s overwhelming conventional and nuclear military capabilities, the argument goes, "an adversary will find ways to fight wars that get around our strengths." Enter bioterrorism.

Bioterrorism is a national security and law enforcement issue, albeit one with a strong scientific and medical/public health component. Yet some analysts believe that scientists of all stripes have had too little input and the public none in the decision to ramp up U.S. policies to combat bioterrorism.

Perhaps the primal fear bioterrorism evokes has precluded rational analysis of the likelihood and the magnitude of the threat, and of how best to allocate resources to defend against it. Instead of wide-ranging debate, the President has convened closed-door meetings and task forces, issued presidential directives, and proposed billions of dollars to defend against what he perceives to be a growing danger to U.S. citizens.

Sidebar: Defining terms

Most analysts believe terrorism by biological weapons is a low-probability event, but one with severe consequences. The first line of attack in reducing that threat is investment in better intelligence and appropriate law enforcement to try to prevent a bioterrorism event. But if that fails, "mitigate the consequences of those incidents that do occur," says Michael L. Moodie, president of the Alexandria, Va.-based Chemical & Biological Arms Control Institute (CBACI) and former assistant director for multilateral affairs at what was once called the Arms Control & Disarmament Agency.

"That's where the domestic preparedness plan comes in," explains Zachary A. Selden, research director for emerging threats for Business Executives for National Security (BENS). "But it's important to make it efficient and effective and scaled to the more likely sorts of events." BENS lobbied strenuously for ratification of the Chemical Weapons Convention.

A senior National Security Council (NSC) official tells C&EN: "The U.S. is preparing for a reasonable attack, one that is doable by a terrorist--but not a worst-case scenario." However, many analysts and some government officials contacted by C&EN have a different understanding.

They believe the U.S. response is geared more to a worst possible incident, one that would produce mass--up to the high hundreds--or even catastrophic--up to the tens and hundreds of thousands--casualties. And they argue that the Administration reasons that if the U.S. develops a system capable of responding to the worst possible WMD incident, it will be better able to respond to a lesser threat.

"The Clinton Administration is focused on a WMD response in ways that bear no relationship to reality," says Amy Sands, associate director of the Center for Nonproliferation Studies at the Monterey (California) Institute of International Studies. She made this remark at a recent seminar on the new terrorism sponsored by CBACI.

One reason the U.S. domestic preparedness plan to counter WMD terrorism has been faulted is that it was forged without a clear understanding of what might motivate some terrorist group to use an unconventional weapon. "We are protecting against what could be done rather than on what particular groups intend to do," says Jerrold M. Post, director of the political psychology program at George Washington University, Washington, D.C. "We are," he adds, "spending very little, if any, money on understanding the dimensions of the threat."

Jonathan B. Tucker, biological weapons expert at the Monterey Institute, agrees with Post. "Policy to date has been based almost entirely on the vulnerability of society rather than looking at specific groups that might be motivated to use these weapons and have the technology to develop them."

Most experts, like Jessica Stern, formerly on the NSC staff and author of "The Ultimate Terrorists," believe that a "doomsday terror attack" is unlikely unless a determined individual or a group gains access to a state-sponsored bioweapons program, like Russia's or Iraq's.

"Biological incidences in the future will be hoaxes or small-scale attacks, but the psychological impacts will be severe," predicts Sands. Indeed, public statements by senior policymakers, "sensational media coverage, Hollywood movies, best-selling novels, and a television series have already fueled a dramatic rise in hoaxes," she says. As she notes, there have been more than 200 anthrax hoaxes nationwide since October 1998.

Because defense against domestic bioterrorism is an issue that got worked from the very top down, the President's fiscal 2000 budget request for $10 billion to combat terrorism is not surprising or unexpected. And it's likely to be approved by a Congress equally as alarmed as the President.

While most of the requested funds are earmarked for programs to defend U.S. embassies against conventional (bomb) attacks, nearly $3 billion is set aside to counter what the White House terms "21st-century threats." And nearly half--about $1.4 billion--of the set-aside is slated to combat attacks by terrorists using chemical, biological, or nuclear weapons.

It's difficult to conceive of such a large program being put in place after the reading of one novel--and it wasn't, though the perception remains that it was. "I find it disturbing that the request for $1.4 billion . . . is based on science fiction," Tucker says.

The President has said he began to worry about unconventional threats to the U.S. shortly after he took office. Remember: It was in 1993 when Islamic radicals bombed New York City's World Trade Center, killing five people.

A year earlier, Russian President Boris Yeltsin had acknowledged the existence of the massive and sophisticated bioweapons program he inherited from the former Soviet Union. Though he ordered it shut down, Soviet defectors claim that has not happened.

As if Yeltsin's revelations weren't bad enough, the United Nations Special Commission on Iraq, years after the Persian Gulf War, began to unravel Iraq's secret biological weapons program. The commission was greatly aided in its discoveries by information supplied by Saddam Hussein's son-in-law.

Both countries continued illicitly to produce biological weapons after they ratified the 1972 Biological Weapons Convention (BWC) barring such activity--and the extent of that production went unnoticed by U.S. intelligence.

Of the two, Russia presents a particularly vexing problem today. Security at its former bioweapons labs is lax. Scientists at those facilities are poorly paid, when they are paid. The fear is that the mix of lax security and economic woes makes for mischief--opportunities to sell information and/or bioweapons to rogue nations or terrorist groups might become too enticing for some cash-strapped scientists to ignore.

Because the U.S. had never had a major terrorist incident on its soil before 1993, concern over the proliferation of unsecured Russian weapons had focused mainly on their spread to foreign, not domestic, terrorists. But that illusion of safety was profoundly shattered in May 1995 when homegrown terrorism became a reality. Then, two Americans using a fertilizer bomb destroyed a U.S. government building in Oklahoma City, killing 167. That calamity by conventional means demonstrated all too clearly that the American homeland was not immune to terrorism--even, possibly, biological terrorism.

The Oklahoma bombing was doubly shocking because it came one month after the nerve gas attack by a Japanese cult, Aum Shinrikyo, on the Tokyo subway system that killed 12 and injured about 5,000. Although the cult used a chemical, not a biological, weapon to kill and maim subway riders, the attack showed that long-standing barriers to using a weapon of mass destruction for terrorism had been breached.

"The Aum attack and the Oklahoma bombing fused in peoples' minds, and created a sense that the U.S. was not invulnerable to domestic terrorism, that terrorism could entail chemical and biological weapons, and that the U.S. was not prepared for it," explains Moodie.

Sidebar: Japanese cult tried but failed at bioterrorism

"That combination sparked congressional concerns, especially with former Sen. Sam Nunn (D-Ga.) and Sen. Richard G. Lugar (R-Ind.)," Moodie says. The senators believed there was a need for better trained and equipped first responders--police, firefighters, emergency medical personnel--and directed the Pentagon to set up such a program in 120 major U.S. cities. This program is now being transferred to the Federal Bureau of Investigation's National Domestic Preparedness Office. According to FBI Laboratory Division Director Donald M. Kerr, the bureau plans to "incrementally improve and refine the government's capability to deal with new threats" such as bioterrorism. "You can't immediately build capability against a perceived worst-case possible threat. You have to be guided by what you have seen, what you anticipate, and try to act with regard to that," Kerr says.

Since its audacious act, Aum Shinrikyo has become the poster child for the new face of terrorism. As a religious, apocalyptic group, Aum was willing to use unconventional means to kill as many people as it could to achieve its aspirations--control of Japan, then the world.

Contrasted with the more politically motivated terrorist groups of the past, the new terrorists, according to experts, are less political, are driven by vaguer motivations, are less cohesively organized, and are less beholden to public opinion. The latter characteristic is particularly true for the messianic and apocalyptic religious groups, such as Aum, and for ethnically oriented organizations. "These groups are more violent and don't face the same kind of political constraints that secular groups--like the Irish Republican Army--with more political objectives do," Stern explains.

Aum turned to chemical weapons only because it failed repeatedly to produce biological weapons that, when disseminated, infected people. But Aum's charismatic leader, Shoko Asahara, remained enamored with biological weapons. And rightly so from a terrorist point of view.

Table: Distinguishing features of chemical and biological terrorism

As Clinton has noted, a chemical attack would be horrible but finite, but a biological assault would be "like the gift that keeps on giving." An unannounced biological attack would likely go undetected and undiagnosed for days, maybe even weeks, enough time for infection and death to spread widely.

Mounting a response to a biological incident as opposed to a chemical assault "requires a very different set of capabilities and a coming together of groups--the public health and medical systems, law enforcement, and intelligence--that historically have not worked in partnership to any degree," explains Margaret A. (Peggy) Hamburg, Department of Health & Human Services (HHS) assistant secretary for planning and evaluation.

Hamburg, who before coming to HHS was health commissioner for New York City, points out that "a bioterrorism event will not unfold in the same way as a terrorism event with conventional weapons," or for that matter, one involving chemical or nuclear weapons. And "new and different investments are needed" to respond appropriately.

Fiscal 1999 was the first year HHS received any funding for counterterrorism activities, Hamburg notes. She applauds the hefty increase for HHS in the President's fiscal 2000 budget request, but says "investments remain grossly insufficient in the public health and medical arenas.

"We need to strengthen the public health infrastructure for rapid detection of and response to" a biological attack, Hamburg says. "We need to seriously think about augmenting the existing health care delivery system to respond to a mass-casualty situation, especially if it involves human-to-human infectious disease. And we need to educate health care providers--emergency room doctors and infectious disease specialists--to understand the new threat."

There is no disagreement between official Washington and terrorism experts that prudence dictates some level of preparedness against bioterrorism--an insurance policy, so to speak. It's the appropriate level of preparedness that sparks debate.

The U.S.'s open society, porous borders, and densely populated cities coupled with the accessibility of weapons make it vulnerable. "It isn't a question of if, but when and where bioweapons will be used," argues Yona Alexander, director of the Center for Counter Terrorism Studies at the Arlington, Va.-based Potomac Institute.

"On a scale of zero to 10, how likely do I see a major bioterrorism attack occurring within the next five years?" asks Jeffrey D. Simon, president of Political Risk Assessment, Santa Monica, Calif. "Nine," he answers. He defines major as the release of a biological organism that causes a very large number of casualties--from tens of hundreds to even hundreds of thousands if there is no rapid, effective medical response.

Calling bioterrorism "warfare in the shadow," Alexander says the U.S. had two choices: Prepare for bioterrorism or "close its eyes, sweep the issue under the carpet, and wait for a biological Pearl Harbor--and then the costs will be enormous."

Among those costs could be loss of constitutional rights. As Stern warns, "If the government is unprepared, in a time of crisis our leaders are likely to give into the temptation to diminish civil liberties."

Richard A. Falkenrath, a Harvard University assistant professor of public policy and coauthor of "America's Achilles Heel: Nuclear, Biological, and Chemical Terrorism and Covert Attack," echoes Stern's sentiments. One of the contingencies he worries about is "the very remote possibility that a major campaign of bioweapons attacks against the homeland would trigger a period of martial law."

But acting in prudence and acting wisely are not always the same thing. The U.S. has mobilized against the threat of high-tech terrorism without a comprehensive national strategy. And the absence of a threat and risk assessment makes it impossible to know if the steeply increasing sums being allocated to federal agencies to combat the perceived terrorism threat are being spent wisely.

"Are we spending smart or are the programs technological silver bullets chasing problems we don't really have?" asks John V. Parachini, senior associate in Monterey Institute's Washington, D.C., office. Intelligence analyses find that "conventional explosives and firearms continue to be the weapons of choice for terrorists," Henry L. Hinton Jr., General Accounting Office (GAO) assistant comptroller general, told a subcommittee of the House Committee on Government Reform last March.

Most of the mass casualty terrorist attacks have occurred since 1979, and all have used conventional explosives, according to the Rand-St.Andrews Chronology of International Terrorist Incidents, one of the most complete tabulations of its type in the public domain. Using this database, Bruce Hoffman, director of Rand Corp.'s Washington, D.C., office, says, "terrorists have become less active but more lethal, and religion is their driving force."

Just last month, GAO's director for national security preparedness issues, Mark E. Gebicke, elaborated on Hinton's statements about terrorists' choice of weapons. Testifying before the House Transportation & Infrastructure Committee, he said, "The possibility that [terrorists] may use chemical and biological materials may increase over the next decade, according to intelligence agencies."

But in 1996, Robert M. Blitzer, acting FBI section chief for domestic terrorism, testified before Congress that there was "no intelligence that state sponsors of terrorism, international terrorist groups, or domestic terrorist groups are currently planning to use these deadly weapons in the U.S." FBI spokesman Steven Berry says Blitzer's statement "still holds true today," but the agency is "always concerned about the intentions of the lone individual not associated with any known international or domestic terrorist group."

Acquiring the seed stocks for pathogenic organisms is not especially difficult. And someone with university science training and good laboratory techniques could culture, grow, and purify biowarfare organisms fairly cheaply. Disseminating the organisms as viable, lethal, respiratory aerosols capable of killing or injuring many is a technical hurdle most terrorists probably could not overcome, however.

Still, even a less efficiently delivered chemical or biological agent released in an enclosed environment like a high-rise building or subway system could kill and incapacitate hundreds. Even Aum Shinrikyo's impure and poorly dispensed nerve agent injured thousands in the subway, but its ineffectively aerosolized bioweapons delivered outdoors failed to harm anyone.

Aum is the only freelance group to successfully acquire and use a weapon of mass destruction. But more than four years have passed since the subway attack and no other group has tried to use these weapons--and no government analyst, Washington Beltway consultant, or academic pundit knows why.

If past is prelude, the likelihood of a future bioterrorism event is fairly low, but the social, economic, and psychological consequences of even a poorly executed small attack would be very grave. "As a nation, we are not accustomed to dealing with epidemics of disease," explains HHS's Hamburg. "HIV [the virus that causes AIDS] has had an impact, but the American people will be enormously unsettled even by a small [terrorist] incident," Hamburg predicts. The level of fear, panic, and confusion is likely to be very high.

Hence the domestic preparedness plan to defend against the possibility of terrorist attacks on the homeland.

But without the requisite assessments, federal programs are being funded in a vacuum. There is, Hinton says, no "governmentwide strategy that includes a defined end state; soundly established, defined, and prioritized program requirements; and crosscutting analyses of individual agencies' budget proposals to ensure that unnecessary duplication and waste are avoided and existing federal, state, and local capabilities are fully leveraged."

In other words, GAO, the Office of Management & Budget (OMB), and other analysts don't know if the U.S. is spending the correct amount of money on appropriate programs. "While we are spending a lot of money addressing vulnerabilities and after-event responses, maybe we need to pay more attention to understanding the motivations of those who might perpetrate these crises so we can interdict them before they occur," suggests Parachini.

Brian M. Jenkins, senior adviser to the president of Rand Corp., Santa Monica, Calif., offers his own succinct assessment: "Our willingness to allocate resources to response is matched only by the uncertainty about the threat."

According to Hinton, OMB officials have acknowledged that the lack of risk assessment makes it impossible to know whether enough--or too much--money is being spent, and whether the correct programs are being funded and apparent duplication of effort is necessary or not.

GAO has recommended that NSC in consultation with OMB and other relevant executive agencies set governmentwide priorities to combat terrorism, and that agency programs be vetted against these priorities. Additionally, GAO has suggested that funding be allocated based on these priorities and on a threat and risk assessment of the likelihood and magnitude of terrorist attacks. "NSC and OMB have not fully embraced or implemented our recommendations," Hinton told the committee.

Instead of analyses, Clinton opted for a brief meeting of handpicked experts. Shortly after reading "The Cobra Event," Clinton asked NSC to convene a White House roundtable discussion on genetic engineering and biological weapons.

For one-and-a-half hours on April 10, 1998, seven NSC-selected experts met to advise the President on breakthroughs in biotechnology and genetic engineering and their implications for combating and responding to a bioweapons threat. Also attending were top officials from the Departments of Justice, Defense, State, and HHS, and from the Central Intelligence Agency, the Office of Science & Technology Policy (OSTP), and NSC. Frank Young, a Presbyterian minister who formerly directed the Office of Emergency Preparedness in the Public Health Service and the Food & Drug Administration, moderated the panel's discussion.

Young tells C&EN that the Good Friday meeting focused on the current state of U.S. preparedness for bioterrorism, and offered the President recommendations to remedy gaps in three areas: research and development, civil defense, and ongoing negotiations to beef up the Biological Weapons Convention.

As Young explains, the genomic revolution has altered the playing field, making it easier in the distant future for terrorists to produce new, more lethal organisms that may evade existing vaccines and antibiotics. But this also offers "research opportunities to counteract these threats and to combat naturally emerging infectious diseases as well," he adds. Indeed, the White House panel underlined the dual-use nature of any funding for research and development.

Given that background, the panel recommended research to unravel the genes encoding for pathogenicity to allow for more rapid identification of the pathogen and, therefore, more rapid treatment. If successful, such research would result in a more effective U.S. response to either a terrorist attack or an emerging or reemerging infectious disease outbreak.

Many of the investments and capabilities are identical, whether the rationale is to combat bioterrorism or an emerging infectious disease, Hamburg contends. And Raymond A. Zilinskas, a policy analyst in Monterey Institute's Washington, D.C., office and former inspector for the UN Special Commission on Iraq, finds that fortuitous. "The threat of bioterrorism has been overblown and the U.S. has overreacted, but because of this, the real problem--natural threats like emerging infectious diseases--is largely being taken care of."

So even if the money is spent on research to combat bioterrorism, there would be spillovers for infectious disease control. It's an argument frequently heard among bioterrorism experts, but it has its detractors.

Matthew S. Meselson, a professor of biochemistry at Harvard University who was instrumental in getting former President Richard Nixon to renounce the U.S. biological warfare program in 1969, argues that "ordinary research in pathogenicity is quite different from research against biological warfare. The researchers involved would be different." Depending on where they worked--whether at or for the National Institutes of Health (NIH) or at or for defense agencies, for example--"they would have different motivations and values, and different rewards," he argues.

"The networks of influence would be shifted, and the durability of the programs would be short," Meselson continues. And to illustrate he cites the experience of the Centers for Disease Control & Prevention's (CDC) Epidemic Intelligence Service, which was created during the 1951-53 biological warfare scare. "It dwindled because there was no biological warfare, but if it had been created to control infectious disease it might have fared better," he believes.

Carus has some of the same concerns as Meselson. "What happens within a system if there is no event, and the system is beyond a sustainable level?" he asks. "You need to find a sustainable level of expenditures [and programs] that people will support even in the absence of an event--and I'm not sure we've found that level yet."

The White House panel didn't address the issue of sustainable expenditures, but it did suggest research on new vaccines, especially for smallpox, and on a new generation of antibiotics. There was much discussion on finding new, more generic methods for preventing the development of disease after exposure. The development of modulators is one possibility that would "bolster the immune system to do what it has to do," explains Hamburg, who represented HHS at the White House meeting.

In the area of civil defense, the panel pinpointed the lack of a comprehensive plan for a coordinated response to a bioterrorist attack as the U.S.'s most glaring deficit. Its recommendation--the development of an integrated plan for managing the crisis and consequences of such an event, with clearly spelled out lines of command and control at the national, state, and local levels--was acted on quickly.

The President, according to Young, directed the executive branch to expeditiously come up with plans and budgets to respond to the panel's recommendations. And in May, one month after the White House meeting, the President issued Presidential Decision Directive-62. PDD-62 designates a national coordinator for security, infrastructure protection, and counterterrorism to integrate the government's policies and programs on unconventional threats to the U.S. at home or abroad.

Clinton named Richard A. Clarke, senior NSC director for global issues and multilateral affairs, as his national coordinator--or counterterrorism czar, as he is more commonly called. Clarke is responsible for integrating the myriad federal programs into a seamless web and for advising the agencies on their counterterrorism budgets. He is not responsible for directing agencies' activities.

Clarke also is not expected to act as the on-site commander during a crisis. "He is the point man for coordinating federal efforts, but he is not the person on the ground during a crisis, making sure federal, state, and locals work in a coordinated manner," explains Selden.

The absence of "a single coordinator in an operational sense is a recipe for confusion and bureaucratic infighting," says Selden. "It is a very bad thing to leave open-ended in a time of crisis."

On-the-ground commanders are spelled out in PDD-39: The FBI commands the lead for crisis management; the Federal Emergency Management Agency (FEMA), for consequence management. Any disputes not resolvable on-site would be forwarded to Clarke in Washington, D.C., who would bring them to the attention of Cabinet heads or the President for swift resolution, an NSC spokesman explains.

A bioterrorism incident--a public health problem par excellence--would call on the skills of CDC, an Atlanta-based group that is part of HHS. Yet the domestic preparedness plan is virtually silent on whether CDC remains subservient to FEMA during a bioterrorism crisis, or if, when, or how it might assume a lead role.

Johns Hopkins' Henderson believes CDC by default will assume the lead in a crisis. But until recently, he says, "there was no organization in place in CDC" to act as control central "to orchestrate an effective response."

In January, CDC established its bioterrorism preparedness and response program, directed by Scott R. Lillibridge, within the National Center for Infectious Disease. The program "is geared toward enhancing state and local capabilities to deal with a potential bioterrorism event" in a timely and effective manner, explains Ali S. Khan, the program's deputy director.

Though Henderson acknowledges "a lot of fragmentation in the federal plan," he applauds the government's "effort to bring CDC in to handle the public health response." He is sanguine about the U.S. eventually being able to respond to a bioterrorism incident. "With plans developing and good scientific expertise to apply to the problem, things will get sorted out."

When the White House panel examined the U.S. public health structure for the President, it found a significantly deteriorated infrastructure that needed to be substantially rebuilt. Containment facilities and isolation rooms are few in number in any U.S. city, even in major ones. And there are precious few doctors who would recognize an anthrax or smallpox victim if they saw one, more likely attributing initial symptoms to the flu.

The panel also found severe problems in the nation's public health laboratories and offered recommendations to correct them. Under its current $121 million budget, CDC is striving to remedy the lab problems and, with the American Association of Public Health Labs, will soon set in place a bioterrorism lab network, says Khan. CDC is spending about $40 million, Khan says, to set up these labs and communications networks in some 25 states.

Another $51 million is going to ensure the availability of sufficient stocks of vaccines and antibiotics against anthrax, smallpox, plague, tularemia, and Q-fever--likely agents terrorists might use. This effort satisfies another of the White House panel's recommendations. But, as Khan explains, the stockpile will be "virtual." The vaccines and antibiotics won't be stored in CDC warehouses, but will "exist at drug firms" for delivery in 12 to 24 hours.

Most of the money CDC received this year is "operational in function," says Khan. "There is very little money directed for research" in fiscal 1999, he says, and that is not likely to change in CDC's fiscal 2000 budget.

Another suggestion of the White House panel was intensive training for medical first responders to deal with a massive outbreak of disease. In response, HHS has expanded its Metropolitan Medical Response Teams to 27 large cities, and is asking for funds in its fiscal 2000 budget to set up an additional 25. It also has set up four specialized National Medical Response Teams, three of which would be deployed in the event of a chemical or biological terrorist attack. And if all these teams aren't confusing enough, HHS already has in place 24 Disaster Medical Assistance Teams that provide medical support for any disaster, including terrorism.

To prevent bioterrorism attacks, the panel called for strengthening the BWC. The 1972 international agreement, ratified by 140 countries, bans the production and use of these weapons but has no teeth to ferret out and deal with cheaters. The Pharmaceutical Research & Manufacturers of America believes biological weapons represent an increasingly serious threat, and it is working to strengthen compliance and verification provisions of the treaty.

In May 1998, the White House panel sent Clinton a 10-page letter report replete with recommendations. "The outcome has been remarkable," Young exclaims. "About 75% of what the panel recommended for the first year has been funded. It's the fastest I've ever seen public policy developed and implemented."

Maybe too fast. Though Young believes "there was enough science input," another panel member, Barbara H. Rosenberg, director of the Federation of American Scientists' biological weapons programs, who attended the meeting to speak about the treaty and international efforts to address proliferation, believes otherwise. She says the U.S. "should assume an attack and prepare to a certain degree." But she also thinks the bioterrorist threat "is way overhyped--a means of feeding at the federal trough."

Rosenberg thought the short, one-day exercise "was a little facile. I would have thought something like the National Academy of Sciences process would have been more appropriate before the President acted. It would have been a more solid basis for action, more comprehensive, more carefully thought-out."

Henderson agrees that "there was not enough scientific input before the policy was put into place." No one thought the problem through, he says. What are the organisms of concern and why? What should be done about them and how to go about it? What are the justifications for the program? These are some of the questions Henderson says were not asked before policy was formulated.

John H. Gibbons, Clinton's science adviser during the period when the government's programs to combat terrorism were being put in place, says that "there was a substantial amount of scientific and technical input" in the formulation of the Administration's program. "Whether it was enough is another question."

Gibbons, who directed OSTP and who is now a senior fellow at the National Academy of Engineering, says "a lot of analysis was done, a lot of memos flowed" because of perennial concerns of the Department of Defense, NSC, and OSTP about "the reality of the new abilities to make mischief with bioterrorism."

The Administration's program didn't pop up full-blown "from just an overnight reading of 'The Cobra Event' by the President," Gibbons says. But, he admits, "the book was one of the vectors." A more stealth vector was Joshua Lederberg, a veteran government adviser and president emeritus of Rockefeller University and 1958 Nobel Laureate in Physiology or Medicine. Lederberg "raised his concerns about bioterrorism on every occasion he could," says Gibbons, including at the one-day White House meeting.

Kerri-Ann Jones, a molecular biophysicist and biochemist who until this January was associate OSTP director for national security and international affairs, says the book "may have been the catalyst, but there was an awful lot of other information out there raising the visibility of this issue."

Among less obvious sources was Clinton's likely reading of "Catastrophic Terrorism," a seminal article published in the November-December 1998 issue of Foreign Affairs. Written by three former national security officials, the article set the tone for ongoing debate in the Clinton Administration.

But events before the article's publication also influenced the debate. About three years ago, Jones notes, the defense authorization bill directed the Administration to look into the national security issues of biowarfare and bioterrorism. OSTP, as part of a White House task force, was already working on the flip side of the coin: emerging infectious diseases, a public health problem.

The same global surveillance network needed to monitor for emerging infectious diseases is also needed to track bioterrorism, Jones explains. After the White House task force made its recommendations on emerging infectious diseases to the President,it began to look into the issue of bioterrorism.

Jones, who also served as senior director for science and technology at NSC, says, "It was clear the President wanted to get a more comprehensive discussion on bioterrorism," and he called on NSC to convene the April 1998 White House meeting that Young moderated.

It was really after the April meeting that NSC began to focus on bioterrorism, Jones says. Before April, NSC had been reviewing issues dealing with the vulnerability of U.S. critical infrastructures to terrorism and was readying a new policy, which was issued last fall.

According to Jones, OSTP was also scrutinizing the fiscal 2000 budget request to ferret out R&D activities. The search revealed that only a small piece--about $400 million--of the $10 billion counterterrorism budget was earmarked for R&D.

More than $200 million of those R&D funds will support Energy Department research on methods to dispose of plutonium. The largest chunk of the remaining money will go to HHS to support such research as treatment and prevention of diseases caused by bioweapons.

Planning for the fiscal 2001 budget request is well under way. In an effort to guide the President's hand, an R&D subgroup of Clarke's weapons of mass destruction preparedness group is again scrutinizing research needed to address identified vulnerabilities.

As a private sector effort, Parachini, the Monterey Institute analyst, has taken on the arduous task of trying to identify agencies' funding levels for combating terrorism with a breakout of funding for combating WMD terrorism. His study on counterterrorism funding is posted on the Monterey Institute's web site (http://cns.miis.edu).

According to Parachini's tabulation, of the total $400 million R&D budget for combating terrorism by WMD weapons, five sectors will expend funds as follows: the Energy Department, $238 million; HHS, $73 million; the national security community, which includes the Central Intelligence Agency, $62 million; the Justice Department, $18 million; and the Treasury Department, $9 million. Among the projects to be funded are pathogen genome sequencing, vaccines and therapeutics, disease detection and diagnostics, biodetectors, personal and environmental decontamination, and modeling and simulation.

"Bioterrorism is a significant national security concern that justifies increased funding and a governmentwide effort to coordinate, prepare, and respond to a threat," Jones says. The threat of bioterrorism "is not an illusion to fill the void created by the end of the Cold War," she insists.

Nor is it entirely what Falkenrath has called "enemy deprivation syndrome." The "U.S. is an exceptionally secure country by any historical standard. There are only a few threats left that can directly impact the American homeland, and bioterrorism is clearly one of them," he says.

"Expert analysis has revealed that the U.S. is quite poorly prepared to cope with bioterrorism, and we are now embarking on a process of correcting these deficiencies," Falkenrath explains.

U.S. preparations "are highly fragmented," Falkenrath notes, "but they are loosely coordinated by Clarke and, increasingly, by the Department of Justice," more specifically the FBI. Domestic preparedness for bioterrorism does not lend itself to "tidy public policy" because the activities that have to be undertaken involve many "different agencies at several levels of government."

But successful defense against bioterrorism demands that all the moving parts in the system work together in a coordinated fashion. "A lot of people know what to do in a chemical event because there is a hazardous materials model to follow," says Carus. "But we don't have a model for a biological event yet."

And that is a concern of HHS's Hamburg as well. "We need to focus on bioterrorism as a discrete problem."

The efforts to date to train and equip first responders have focused mainly on a chemical attack. But Hamburg explains: "There's a real possibility that a biological event will be undeclared and the system of first responders would be the public health surveillance system and frontline medical responders. We need to focus our effort to ensure adequate support for that important sector of emergency preparedness and response."

The first Nunn-Lugar funds, in the Pentagon's 1997 spending bill, "set off a feeding frenzy in the government for a piece of the action," says Moodie. This may explain why so many federal agencies are involved in the U.S. program to counter domestic terrorism.

"I've seen a lot of independent contractors and organizations, as well as a lot of agencies getting in on this BW funding," says William C. Patrick, who directed bioweapons development for the U.S. before such activity was banned. "The first years of any program are always rather wasteful until those who know something about BW are heard from."

Meselson says he "is not an opponent of reasonable preparation," but sees only a "disjointed effort" at the moment. There is "no clear-cut rational plan that has calculated the costs and has put a limit on when enough is enough."

In his professorial fashion, Meselson begins this tutorial: "Are we vulnerable?" he asks. "Yes, of course," he answers. "Do we know of a definite threat? No, if we did we would take it out. Has it ever happened? No. Will it happen soon? Quite unlikely. Will it ever happen? Sure, it's possible. Is it an uncomfortable situation? Yes. Should we plan logically? Yes, for the possibility. What is the rational approach? Prioritize. Decide where to spend more money and what and whom to protect, because not everyone or everything can be protected."

And his final hope-filled words on bioterrorism: "If it never has happened successfully before, it's some indication that it is not likely to happen in the near future."

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