Author: Vora Sadhna
Date: September 2005
September 11, 2001 has etched a mark on the hearts of Americans. Decades from now, we will shudder as we recall the events of that tragic morning, etched forever in our memories. We will remember, also, the threat of bioterrorism ominously revealing itself afterward as a white powder interlaced in a few letters, which shocked our sheltered society.
Though the tensions with Afghanistan have since calmed down, one wonders whether the U.S. responded appropriately to the danger of bioterrorism. The future security of our country depends on leaders who can take efficacious steps to protect against biological weapons. The defenses that the government has made thus far against bioterrorism offer only a temporary solution to the microbial weapons of the 21st century.
To assess the U.S. response to the current threat of bioterrorism, we must examine the early episodes of anthrax exposure. After the first exposure, which occurred at a newspaper office in Florida, public health officials incorrectly assumed that the only people in danger of anthrax infection were those who actually opened infected letters. The deaths of two Washington, D.C. postal workers shattered that assumption. On December 19, the administration did what it should have done back in October: It made anthrax vaccines available to thousands of Capitol Hill workers and postal employees, along with follow-up medication. While better late than never, the U.S. should have been swift to enact this policy. Instead, it took no action to protect postal workers until two months after the first anthrax exposure.
Admittedly, hindsight is 20-20, and the administration did not act earlier in part because it did not have solid information in regards to the danger represented by anthrax. However, now that we have experience on our side, we should make informed and cautious decisions.
Perhaps it was this logic that has led to the U.S.'s strategy concerning smallpox. Last month, Health Secretary Tommy Thompson purchased 155 million doses of smallpox vaccine for $428 million (Check 2001). That brings the U.S. stock to 286 million doses, the majority of which will be stockpiled. However, a recently published paper that appeared in Emerging Infectious Diseases (Melzer 2001) stated that only 40 million doses would be necessary to protect the country against a terrorist attack. However, the results of this study are under scrutiny. In any event, while there might be excess vaccine, this expenditure should not necessarily be considered a waste because it provides valuable reassurance to the public. To err on the side of caution is indeed an effective political strategy.
However, one must wonder if the U.S.'s plan to simply stockpile this vast store of vaccine is prudent. After all, the purchase did exhaust a significant portion of the country's public-health resources. On the other hand, vaccination of the entire U.S. population would cause hundreds of thousands of deaths caused by the vaccine's side-effects. To address such concerns, the U.S. should support a policy of voluntary smallpox vaccination, reserving a fraction of the total stockpile for an emergency situation.
Voluntary vaccination would bring several important benefits. A partially vaccinated population would naturally limit the injury caused by an outbreak. Furthermore, giving people the option of vaccination would provide a measure of reassurance. People would be able to assess their individual risks, taking into account such factors as their profession and geographic location. Additionally, people with weakened immune systems could choose to be vaccinated when they could best monitor their own conditions. For example, women could choose to be vaccinated at a time when no pregnancy is planned. Withholding vaccines until the occasion of an outbreak does not allow for this type of consideration.
It can be argued that voluntary vaccination would deplete reserves that are best stored for the future. Although voluntary vaccination would reduce our supply of smallpox vaccine, it would also ward off the threat of a bioterrorist attack, making a stockpile unnecessary. As mentioned above, a partially vaccinated population makes an outbreak more containable, thereby reducing the terrorists' incentive to launch an attack. Rather than stockpiling our doses of vaccine, and hoping that we can mobilize them rapidly enough to contain an outbreak, we should put them to this more strategic use.
While the current approach toward the smallpox vaccines is not perfect, other more worrisome decisions have been made. In early December, Democrats in the Senate backed away from a $15 billion anti-terrorism proposal, half of which would have gone toward security and combating bioterrorism. This money would be in addition to the $3 billion that were part of President Bush's $40 billion emergency spending plan (Dewar 2001). The president had warned he would veto any bill exceeding the allotted amount, and Congress took heed. According to The Washington Post, White House officials opposed the $15 billion bill not solely on the basis of fiscal soundness, but rather to illustrate that the administration would take the lead in the war effort (Morgan 2001).
The trouble with this partisan power struggle is that it ignores the present threat. As Sen. Robert Byrd (D-W.Va), one proponent of the bill, noted, "For this country to be in a state of emergency . and then be told we ought to wait until next spring [for the added funds] is mind-boggling." (Morgan 2001). The bill would have provided much needed funds for improvement of public health facilities, training of health professionals, and building of laboratories.
A portion of the money would also have been used to inspect imported foods. Public health experts fear that the nation's food supply may become the target of the next terrorist attack. By contaminating a shipment of imported food, terrorists could succeed in issuing nationwide panic or dealing a heavy blow to U.S. livestock or crops. What's more, the U.S. Food and Drug Administration is sorely understaffed and ill-prepared to meet the threat of bioterrorism. Their inspectors are able to inspect only less than 1 percent of the shipments of imported produce each year (Dingell 2001), making the U.S. food supply susceptible to biological warfare. The defeated bill would have enacted strong regulations on imported foods and would have increased the number of food inspectors who oversee imports.
However, the defeat of this bill was partially recompensed by the victory of other, albeit smaller, anti-terrorism bills in both the Senate and the House. The Frist-Kennedy bill in the Senate and the Tauzin bill in the House both represent an attempt to address bioterrorism threats while staying within the $20 billion cap determined by President Bush (Committee on Energy and Commerce, 2001; Kaiser Network 2001). The two bills resemble each other, each one proposing roughly $3 billion to be allocated for the fight against bioterrorism. The bills dictate that just over a billion dollars be given to the states to increase preparedness. Included in the bills are funds to increase the national stockpile of antibiotics and vaccines as well as to renovate CDC facilities, although they differ in the amounts dedicated to each cause. Furthermore, each bill places regulations on imported foods, dictating that imports suspected of contamination be detained and that food distributors maintain regulators detailing the source and distribution of food.
The major downfall in both of these bills is that neither includes a mandate for essential pathogen research. Blunders such as those made by officials when anthrax cases appeared can only be avoided in the future with the aid of the scientific community. To stimulate research on vaccines, diagnoses, and treatments, government funding is necessary. The risk is too high for the private sector to see such research as a profitable enterprise, for the political atmosphere changes more rapidly than scientific research can be conducted. For example, a safe vaccine for smallpox may take several years to develop, and by the time it can be made publicly available, the political situation may have changed so that there is no longer a market for it. Treatments for conditions that affect large numbers of people and promise to do so long into the future prove to be a more lucrative investment for the private sector. However, as a matter of national security, vaccines and antibiotics are needed as a defense against bioterrorism. The government must pick up the tab for research in this area because the private sector will be reluctant to do so. Unfortunately, the lessons of the recent anthrax episodes have fallen on deaf ears, for Congress has not taken on this duty.
While the proposals in the House and Senate ignore research and are limited by financial constraints, it must be acknowledged that they are a step in the right direction. The U.S. government has taken other important measures by purchasing smallpox vaccines, as was previously mentioned, and by establishing a data network to alert and coordinate federal and local health officials of bioterrorist activities. Indeed, the improvements to the public health infrastructure that these measures demand will benefit the nation regardless of whether the threat of terrorism exists, for they update health systems, improve organization, and foster communication within the health sector. In the event of a terrorist attack, they will provide a degree of reassurance until more substantive measures can be taken. Though the measures embraced by these bills cannot be a permanent solution, they at least demonstrate that the government is not ignoring the possibility of bioterrorist attacks. This is the first step toward ensuring that history will not remember the U.S. response to Sept. 11 as too little, too late.
Check, Erica. "Need for Vaccine Stocks Questioned." Nature. 414:(2001) 667.
Committee on Energy and Commerce. "Tauzin Hails House Passage of Sweeping Bioterrorism Bill." Dec. 12, 2001. http://energycommerce.house.gov/107/news/12122001_454.htm
Dewar, Helen. "Bush, GOP Prevail on Anti-Terror Spending." The Washington Post 8 Dec. 2001, p. A1.
Dingell, J.D. "H. R. 3075, " "Imported Food Safety Act of 2001", Extension of Remarks by the Honorable John D. Dingell" Statement. 10 Oct. 2001. Democratic Members of the Committee on Energy and Commerce Website. 2 February 2001. http://www.house.gov/commerce_democrats/foodsafety/107-fs-extremarks.htm
Kaiser Network. "Frist, Kennedy to Formally Introduce $3.2B Bioterrorism Bill." Kaiser Daily Health Policy Reports, Dec. 5, 2001. http://www.kaisernetwork.org/Daily_reports/rep_hpolicy_recent_rep.cfm?dr_cat=3&show=yes&dr_DateTime=12-05-01#8391
Melzer, M, I. Damon I, J.W. LeDuc et al. "Modeling Potential Responses to Smallpox as a bioterrorist Weapon." Emerging Infectious Diseases 7(6)(2001): 959-969.
Morgan, D. "Senate, White House Tussle over Homeland Spending." The Washington Post. 6 Dec. 2001, p. A24.