9. Rapid ID and Tracing = Improved Deterrence & Safety
10. Clean Up The Sources

Point #9 relates back to the molecular fingerprinting lab, which helps buy valuable time via faster diagnosis and also improves deterrence by making bioweapons more traceable. Other methods that also help us achieve these goals should absolutely be explored.

Point #10 relates both to Lady Thatcher's point about pre-emption of rogue states, and to the need for effective aid programs and subsidies that keep scientists in places like Akademgorodok, Sverdlovsk, Kirov, Stepnogorsk et. al. gainfully employed in other pursuits. This "offensive" component to our strategy is a necessary counterpart to the "defensive" components above.

The proactive subsidies in particular would surely lessen the tempatation for ex-Soviet scientists in particular to sell their bio-warfare knowledge to terrorists or rogue states, thus slowing proliferation. If all these scientists were also put to work translating and extending Soviet-era works on phage therapy, they could even perform a tremendous service to medicine in return for their subsidy.

Alas, America's record in this area to date has been so poor that it not only forgoes these benefits, it poses a clear and present danger. All the more tragic in that the danger is so avoidable. And where the hell is the EU? Sleeping or insouciant, as usual.

JULY 2005 UPDATE: The original Thresher article is gone, as is the site itself. I'm posting Michael T. Osterhold & John Schwartz full article here, therefore, in order to preserve this important document:

8 Point Platform for Change
Preparing for Bioterrorism with Michael T. Osterhold & John Schwartz

1. STOP TALKING ABOUT "WEAPONS OF MASS DESTRUCTION"

We're not talking about conveniently erasing these weapons out of our everyday world, though it would be a miracle if such magic actually existed. No. We simply mean it's time to stop lumping all weapons that can kill large numbers of people under the single rubric of "WMD." The difference in responding to bioterrorism, as opposed to a chemical or nuclear attack, is like the difference between flying a plane and driving a Formula One car. Both are moving vehicles, but very different skills are required for each one. The overuse of the term "weapons of mass destruction" has done a great deal to stunt the necessary attention to the looming threat of biological terrorism. It has allowed policy makers to throw money at the broader problem, short-change this narrower one, and still claim to be solving the problem. As we've seen, in contrast to other forms of WMD, bioterrorism response is not primarily a military and law enforcement effort. It's a public health and medical system effort. That means our budgets at the federal, state, and local levels have to show proper funding for bioterrorism planning, training, monitoring, and stockpiling. In 1999, the Center for Disease Control and Prevention (CDC) supported funding of $41 million for all fifty states and three large metropolitan areas-a miniscule amount in light of the $10 billion spent on terrorism. Yet those public health and medical programs are our first, second, and third lines of defense against and in response to a biological weapons attack. To put it bluntly, our priorities are really screwed up. Removing the WMD bias is most important in the area that policy makers call "consequence management"-running the show in the aftermath of an attack. We hope we have made the point that responding to a biological attack requires an entirely different structure and management system than responding to a chemical or bomb attack. At the moment, coordination of response to WMD attacks falls to the Department of Justice and Department of Defense. To be sure, that is the right management team for a blast or chemical release; the cops and soldiers should remain the go-to guys in that kind of crisis. But you don't want them running the show during a biological attack, any more than you would expect them to coordinate the response to an outbreak of listeriosis at a hot dog plant, Legionaires' disease from a cooling tower, or even West Nile Virus in New York City. These crises require special skills, special knowledge, and special people-all already present within the public health system. The CDC has been late to recognize its potential role in biological terrorism response, and its leadership may have room for improvement, but since 1999 it has become a more active participant in the process and should be placed in charge of civilian biodefense.

2. BUILD THE STOCKPILE

Until we have a large and usable stockpile of the right antibiotics and vaccines for the most likely agents to be used in a biological attack, weÕre dead. Nothing can move forward until we have created this fundamental buffer between us and the abyss. Experts have been pushing for a new smallpox vaccine for three years, and seem little closer to having one than when they started. Both the administration and Congress must accept blame for a situation that has shown the worst of the federal bureaucracy.

3: BUILD MORE "SURGE CAPACITY"

At the moment, hospitals, pharmaceutical companies, and insurers squeeze every excess penny out of health care, performing at the limits of their capacity. It's time to open the debate over how much we're going to let economics be the single compass for directing our medical system. We need, as a nation, to build a little more slack into the system. The added capacity would have the side benefit of better preparing our health care networks for natural disasters and the still-possible pandemic of influenza like the one that carried off so many millions of people worldwide at the beginning of this century. It also will be expensive-but then, so are fire departments at airports. When was the last time the fire department at your nearest metropolitan airport responded to a plane crash? Still, we would never operate those airports without fire fighters on duty twenty-four hours a day, every day of the year. History shows us that we pay for what we think we need, and when we understand how much we need this, I'm confident we will pay for it. If we donÕt, we'll really pay for it. We desperately need doctors, particularly infectious-disease experts, and nurses to participate in local and regional planning activities for bioterrorism. But they almost never show up. Why? In large part, they are stretched in their capacity of providing more patient care with less resources. They have no "financial freedom" to spend time at an all-day meeting without some reimbursement to their hospital or managed care organization. Our failure to address this is penny-wise and pound-foolish. Part of our surge capacity process will involve assembling medical teams to supplement the staffs of local hospitals and treatment centers wherever outbreaks may occur. Prior to any attacks, these professionals, who would come from the ranks of trained medical personnel nation-wide, would voluntarily receive the vaccinations they need to be able to go safely into the nation's new hot zones.

4. SHORE UP THE PUBLIC HEALTH INFRASTRUCTURE TO BE READY FOR QUICK RESPONSE TO OUTBREAKS

This point is related to the third item, but goes further and deeper. Along with helping the people who will treat patients on the front lines, we have to strengthen the broader public health system that supports their efforts. The first major phase of the nation's new infectious disease detection program - a nine-site network of monitoring and diagnostic centers now receiving only $12 million of annual funding-must grow. The $41 million for the CDC's first grants to 53 state and local public health programs must also grow quickly. Current levels provide only very limited resources for any one state or large city, given the potential need. With our public health infrastructure in its current shape, trying to detect and respond to a bioterrorism attack is comparable to running O'Hare Airport's air traffic control system with tin cans and strings. Building an adequate stockpile of vaccines and antibiotics won't mean much if the cache is locked in a vault in Atlanta and nobody can get it to the citizens who need it. Having to scramble to get antibiotics and vaccines to a large population isn't as rare as you might think. After a meningitis outbreak, our team was stretched to the breaking point with a need to distribute vaccines and antibiotics to only thirty thousand people. It occurred under the watch of one of the best health departments in the country-and it stretched us to the very limits of our ability. Now imagine needing to vaccinate millions of people!

5. CLEAR UP THE ROLES OF FEDERAL, STATE, AND LOCAL GOVERNMENTS.

Just as we need to define the roles of the various agencies across the federal government, we need to drill down through the layers, of bureaucracy and clarify the roles and responsibilities on the state and local levels. Our efforts to turn around the lagging preparedness issues at the top don't automatically ensure that the same problems will be resolved at the other levels. Local police and medical teams don't have any better understanding of each other than the federal Departments of Justice and Health and Human Services does, but the federal government can help by setting a better example. Heads of federal agencies can improve matters by treating the funding of biological terrorism as less of an opportunity for pork-barrel grantsmanship and more of an opportunity to help the nation head off catastrophe.

6. CLEAN UP THE COVERAGE

Most of the press coverage of biological terrorism has been made up of scare stories, give-'em-the-gross-details writing we like to call gorenography, and gee-whiz pieces detailing the high tech schemes that various agencies are funding. That's a shame, because thoughtful news coverage could help keep lawmakers and agencies focused on the problems at hand-and keep them honest besides. Reporters and editors also need to prepare themselves for writing about these outbreaks by learning what they can about the diseases that might be used. Reporting inaccurately that anthrax is a communicable disease like smallpox could worsen the panic in the midst of an attack. Journalists aren't agents of the government, and shouldn't be. But journalism, at it's best, does serve the public interest.

7. WE'LL UNDERSTAND IT IF WE ACTUALLY PRACTICE

Most everyone can recall seeing a picture in the newspaper or video footage of the classic WMD exercise. Typically, a number of HAZMAT professionals are seen in spacesuits walking out of some building carrying a container. We all feel comforted to know that the government has made an impressive effort for terrorism. The painful irony is that these exercises do nothing to prepare us for the eventual bioterrorist attack. As we noted before, we have fooled ourselves into believing weÕre prepared to deal with bioterrorism because we have perfected our response to an event such as an explosion or release of a chemical agent. In real life, none of these players, including the FBI or other law enforcement officials, will be on the front lines when we recognize the results of the intentional release of a biologic agent. Moreover, that recognition will occur not over minutes-to-hours, but rather over days to weeks. In the end, it will be the emergency rooms, doctors' offices, and public health departments that will be the smoke alarms going off alerting us to the impending raging fires. Despite this, we continue to avoid preparing for bioterrorism through such activities as meaningful live drills and tabletop exercises (a type of make believe exercise usually conducted in a single room). Why? Frankly, to unfold a bioterrorism exercise that is realistic means days to weeks of challenging health care workers, persons working in clinical laboratories, and public health officials with bits of information that appear to be unrelated. And it wonÕt happen in a single clinic, hospital, or even geographic region. Most of all, no one will ever know it happened. That's different from responding to a recognized crisis, For those reasons, very few communities have attempted to play out realistic scenarios involving the release of a biologic agent. The threat of bioterrorism raises many difficult questions for hospitals. So far, the most ambitious attempt to address these issues is presented in Bioterrorism Readiness Plan: A Template for Healthcare Facilities, a report prepared by the Association for Professionals in Infection Control and Epidemiology (APIC) and the Bioterrorism Working Group in the CDC. The report, which runs thirty-four manuscript pages, provides general recommendations for responding to a suspected bioterrorism event for a hospital. While noting that hospitals need to prepare their plans in collaboration with local and state health departments, the report has been criticized for not elaborating on the need for regional planning to coordinate actions by multiple health care facilities and other agencies in response to a major biological attack. We believe that no health care facility should consider itself an island in planning for things such as outbreak detection, patient placement and transport, discharge management, and post-mortem care.

8. WE'RE ON OUR OWN - TOGETHER.

What does this leave for individuals to do? Plenty, actually. Citizens need to keep informed about what is being done in their names and to think about whether the things that are being done truly serve their interests. Then they need to take that knowledge and use it to pressure our elected representatives to do the right thing, fund the right programs, and make sound choices for the future. Each of us has to demand more accountability of our elected officials-and not confuse performances on Nightline with performance of their duties. You might expect us to advise you to get vaccinated against the most likely diseases to be used in biological terrorism. We won't though -because it's the wrong thing to do. Yes, we'll need the vaccines and antibiotics for the outbreaks, but not as a part of a routine program. It goes against the simple realities of statistics. No individual in America is highly likely to be infected by a biological terrorism attack, which after all will affect only those directly exposed-or, in the case of contagious diseases, those who come into contact with the initial victims. I worry that disease hustlers will begin encouraging people to pay top dollar to be vaccinated against anthrax and smallpox as moneymaking schemes, pitching their wares to the worried well. Marketers say that sex sells, but sex doesn't have anything on fear. Don't give in to the hype. The appropriate use of these vaccines will be in association with an outbreak, or in advance for a limited number of volunteer public health and health care workers, police, and other personnel needed to maintain our basic infrastructure support during the crisis. Ultimately, the lesson of this book is that we can't take bugs for granted anymore. Terrorists are acting as intermediaries to bring the problem to us, but we've been reminded again and again, with outbreaks like antibiotic resistant TB, HIV, E.Coli o157:H7, and West Nile virus, we're not just talking about biological terrorism. We are fighting a much bigger war: the eternal evolutionary battle between man and germ. The bugs were here before we were here and the bugs will be here after we're gone. But we have to learn the ways of the adversary: fight on his terms and survive.

By John Schwartz and Michael Osterholm, copyright © 2000