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A decade after the 'Amerithrax' attacks, is the nation better prepared?

This article first appeared in the St. Louis Beacon, Oct. 10, 2011 - WASHINGTON - Moon-suited investigators swab for spores in vacated suites of a U.S. Senate building. A Florida photographer, two postal workers in the nation's capital, and two women in the Northeast perish from inhalation anthrax. Speculation about the origins of the deadly pathogen leads to "white powder scares" across the country.

Ten years ago this month, the first major bioterror attack in U.S. history -- the "Amerithrax" anthrax mailings, striking just weeks after the horror of the 9/11 attacks -- caused nationwide hysteria and spurred the most expensive and extensive (in terms of hours) criminal investigation in the annals of American law enforcement.

Today, after $67 billion in government spending on "biosecurity" and related initiatives over the past decade, is the nation better prepared for the possibility of another such attack? Would the BioWatch sensors in St. Louis and other cities accurately detect deadly pathogens, and would the public health system be able to deal with an attack that could be far more extensive than the handful of anthrax-laden envelopes mailed in 2001?

Interviews with biosecurity experts, public health officials, scientists and authors indicate that, while major steps have been taken to improve the nation's overall preparation to detect and respond to a bioterror attack, cutbacks in public health budgets could undermine those advances, while scientific and geopolitical trends may pose new threats.

"The threat is only getting worse," said Randall J. Larsen, former executive director of the Congressional Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. As a result of advances in biotechnology, he said, "things that only superpowers could do back in the 1960s and '70s can now be done by small teams" with the right equipment.

Next week, the nonprofit research group that Larsen directs, the Bipartisan WMD Terrorism Research Center-- which is co-chaired by former U.S. Sens. Jim Talent, R-Mo. and Bob Graham, a Florida Democrat -- will issue a 70-page "Bio-Response Report Card" that will outline weaknesses in preparations to fend off and respond to a bioterror attack.

One area of concern to experts is rapid detection of an attack and diagnosis of its victims. "We still don't have rapid diagnostics" for certain diseases, said Eric Toner of the Center for Biosecurity of the University of Pittsburgh Medical Center. "We still don't have countermeasures for many of the [bioterror] agents. So there are still some big gaps."

While Toner cites major advances over the last decade in preparing the public-health responses to a bioterror attack -- including the stockpiling of millions of doses of 60-day treatment courses for many of the feared pathogens -- he worries that cutbacks in funding to federal, state and local public health programs might erode that capability.

"We're doing better in the area of disease surveillance -- and we could do better still. We have surveillance systems to track disease outbreaks and find out where the cases are and be able to make projections about what needs to be done," Toner told the Beacon. "But that progress is really imperiled by the very dramatic funding cutbacks that are being made now in public health."

Others worry that the massive federal spending on "hot" laboratories and research projects that focus on "select agents" -- as potential bioterror pathogens such as anthrax are called -- is making it more likely that an attack could originate from "insiders." The prime example: The FBI's seven-year investigation concluded in 2008 that U.S. biodefense scientist Bruce E. Ivinswas solely responsible for the Amerithrax attacks.

"We've grown all these laboratories around the country and we're bringing in thousands of new scientists to work on these pathogens, without commensurate controls that would give us confidence that we don't have another potential 'insider' problem," said investigative journalist and author David Willman.

Willman, who won a Pulitzer Prize for his Los Angeles Times exposes of unsafe prescription drugs and the impact of drug-company funds on researchers, spent more than two years researching Ivins and the FBI Amerithrax investigation for his book, "The Mirage Man: Bruce Ivins, the Anthrax Attacks and America's Rush to War."

In 2007, the government reported that more than 630 labs across the U.S. are registered to handle select agents, and a separate survey estimated that the labs that can safely handle those pathogens -- known as BSL-3 (or even safer BSL-4) labs -- are found at about 280 research facilities that employ thousands of scientists. While the government keeps close watch on the pathogens, it is sometimes difficult to monitor or control how the microbes are distributed for research purposes.

"So we've grown the 'insider' threat exponentially, and we're sort of betting on the come as to whether all this additional research is going to yield counter-measures that could make us safer," Willman told the Beacon. "As for the latter, could be. But right now, on the former, we know that we've really grown the risk."

Bolstering Public Health Response to a Bioterror Attack

In the months after 9/11 and the Amerithrax attacks, epidemiologist Michael Osterholm -- then an adviser to Health and Human Services Department secretary Tommy Thompson -- recalls "expressing great concern that, should there ever be a smallpox attack, we then had really no vaccine supply to respond. That would only add to the fear and panic" if smallpox were used as a terror agent.

Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota School of Public Health and School of Medicine, said he is heartened by the biodefense initiatives taken after Amerithrax, especially the strategic national stockpile that now includes vaccines against smallpox and anthrax.

"I feel confident today that, should smallpox ever return, we're in a much better condition to handle it," Osterholm said. "And the stockpile for anthrax [vaccine] is clearly in much better shape that it was then. We could now move quickly to a large metropolitan area if there were an aerosol anthrax attack."

The stockpile also includes tons of antibiotics that are used to treat infections from select agents -- such as Cipro and doxycycline, which are effective if deployed early against inhaled anthrax -- as well as experimental treatments for clearing toxins that certain pathogens might generate in an infected person.

"We have lots of those antibiotics in the stockpile," said Toner. "The [Centers for Disease Control and Prevention] can ship them out, but we still are having trouble in demonstrating the ability to get the pills into the palms of people as fast as we would like to. There's been progress made, but a lot more needs to be done."

An Institute of Medicine report released this month found that plans for rapidly delivering antibiotics to a large number of people in the event of an anthrax attack "have been significantly enhanced over the last decade." But also warned that "many public health authorities and policy experts fear that the nation's current systems and plans are insufficient to respond to the most challenging scenarios, such as a very large-scale anthrax attack or an attack on multiple cities."

The study found that a major, aerosolized release of anthrax spores over a large city could place "hundreds of thousands of people" at risk unless they had quick access to certain antibiotics. "Inhalational anthrax is considered the most severe bioterrorism threat because the spores can travel significant distances through the air, and it has the highest mortality rate -- approaching 100 percent if untreated," the report said.

Of the estimated $67 billion that the U.S. has ploughed into biosecurity infrastructure and research since 2001, the billions that were not spent on biodefense initiatives -- such as research into detecting anthrax -- helped pay for broader health programs that are also important in dealing with natural outbreaks such as influenza or SARS.

But that system has many gaps and weaknesses, as the film "Contagion" vividly shows in dramatizing how the nation would likely respond to a virulent flu pandemic.

"There are a lot of issues," said Larsen, with one of the most important being a better warning system that would depend on improved detection of bioweapons.

"If we know that there is a release in St. Louis of anthrax, plague or tularemia -- three of the most common bacterial agents that can be weaponized -- and you can distribute antibiotics, people would probably be OK," said Larsen. "But we've got to be able to detect that. And we've got a long way to go in detection." He added: "The problem is that we're probably not going to know in time to save many of the people who have been exposed."

Both Larsen and Osterholm cited the BioWatch program -- a 24/7 air sampling program in St. Louis and at least 30 other cities that sniffs for dangerous pathogens -- as potentially important to provide early warnings. BioWatch relies on monitors, often situated at public places such as subway stops or train stations that analyze air samples and electronically report the presence of any unusual pathogens.

While many details of BioWatch are kept under wraps, a report by the Congressional Research Service found critics who worried about "its lack of ability to detect smaller outdoor releases, its potential for false positives, and its capabilities in an urban environment."

But Osterholm, who concedes that BioWatch "still has a ways to go," sees great potential. "I believe it is going to give us the best chance of recognizing a widespread aerosol release in a major metropolitan area," he said. "That technology would give us the lead time, which is so important in getting people treated quickly and giving prophylaxis and vaccine to those who might have been exposed."

In general, Osterholm said, "we've done a tremendous amount to really improve state and local preparedness -- and St. Louis is a good example of that. There's a very different awareness and level of [public health] infrastructure available to respond."

But funding cuts may threaten that system. "The problem with it is that it's not like a bridge or a building that lets you build it and tends to operate OK even if you forget to maintain it for a few years," he said. In contrast, "you basically have to maintain" public health infrastructure aimed at bioterrorism. "I worry that we're going to be back to almost the 1999 levels in a couple of years, which means we're back to Square One."

An extensive analysis of the public health response to the anthrax attacks is in a report, "Remembering 9/11 and Anthrax: Public Health's Vital Role in National Defense," produced by the Trust for America's Health and the Robert Wood Johnson Foundation.

Has Technology Made an Attack More Likely?

Imagine a terrorist, financed by a foreign government, who has enough training in bacteriology to set up a basement laboratory to grow the anthrax bacterium a few miles from the White House. He then sends a co-conspirator to St. Louis to rent an apartment, set up another primitive lab and propagate more of the pathogen to be used for sabotage.

It might seem far-fetched, but that actually happened. The year was 1916, the germ warfare expert was a German spy, and the targets of the anthrax were horses and Missouri mules that the then-neutral United States was shipping by the tens of thousands to aid the Allied war effort in Europe in World War I.

The biosaboteurs weren't very effective -- deploying the anthrax by injection rather than by spreading its spores through the air -- but the incident sheds light on the difficulty of detecting and tracing a biological attack. In those days, the U.S. authorities didn't even find out about the biosabotage until a decade later -- and that was by accident.

What worries Larsen is that today's potential terrorists, knowing that the deadliest way to use the anthrax bacterium is to distribute its spores through the air (aerosolization), would have a much easier time of it. Aerosolizing pathogens such as anthrax could be achieved now using "commercial, off-the-shelf technology," Larsen said.

Making a similar point was former Sen. Jim Talent, who told a House panel this summer that bioterrorism is more feasible now than ever before. "Today, terrorists have ready access to pathogens, the capability to weaponize them, and the means to effectively dispense a biological weapon. There is no question on intent."

Talent said that if the FBI is correct in asserting that Ivins "was the sole perpetrator of the 2001 anthrax letter attacks, then a single individual with no training or experience in weaponizing pathogens, and using equipment readily available for purchase on the internet, was capable of producing high-quality, dry-powdered anthrax."

Added Talent: "The only difference between producing enough material for several envelopes and enough material to attack a city is just a matter of a few months production work in a laboratory, rather than the few hours of [Ivins'] late night work cited by the FBI investigation."

Talent, a St. Louis Republican, co-chaired the bipartisan WMD commission that issued a 2008 report, called World at Risk, warning that the U.S. government needed to bolster its preparations to thwart bioterror attacks. A followup "report card" in early 2010 gave the government an 'F' grade in "rapid and effective response" to a bioterror threat.

Even though it is only one of numerous pathogens listed as likely "select agents" of bioterror, anthrax has held special interest for bioweapon and biodefense programs since the 1930s.

The anthrax bacterium, Bacillus anthracis, which a scientist once described as "a soil bug gone bad," infects cattle, sheep and other mammals in nature. If inhaled, it can also kill people, although antibiotics can blunt the infection.

It was not until the 1930s and '40s that scientists -- led by the Japanese, then followed by U.S., British and Soviet programs -- developed deadly ways to use anthrax as a weapon of war. Before President Richard Nixon ordered an end to the development and production of offensive biological weapons in 1969, the U.S. program -- officially started in 1943 -- was headquartered at Fort Detrick in Maryland.

Over a quarter century, researchers there had developed seven biological weapons that were ready to be deployed: the agents that cause anthrax, tularemia, Q-fever, brucellosis, encephalitis and botulism. They had also done research into weaponizing about 20 other agents. A parallel program in the Soviet Union was even larger.

Nixon's presidential order -- followed by U.S. participation in the 1975 Biological Weapons Convention -- restricted any research to what is called biodefense; that is, preparing to defend against germ warfare, rather than developing biological weapons. That allowed Ft. Detrick scientists to continue working with anthrax and other "select agents" to develop vaccines, detection kits or other defenses.

That is how the FBI's suspect in the Amerithrax attacks, Ivins, happened to be working on anthrax -- in his cases, focusing on a next-generation vaccine -- in 2001.

Since then, there have been no documented bioterror attacks in this country. But there have been thousands of hoax "anthrax" attacks -- most of them involving white powders in envelopes or packages -- across the country in the last decade. An FBI official quoted by the the Los Angeles Times said the agency had investigated about 1,000 "white powder events" as possible terrorist events between 2007 and 2009 alone.

Among the targets of such "white powder" attacks have been most governors' offices; many U.S. embassies; ticket booths at Disneyland; Mormon temples in Salt Lake City; and dozens of banks and news organizations.

The Challenge of Contaminated Buildings

When the anthrax mail attacks struck in 2001, the U.S. government, the Postal Service and insurance companies ended up spending more than $1 billion to clear buildings of the deadly and elusive anthrax spores -- fumigating most of them with chlorine dioxide gas.

What if such spores had been spread via aerosol over part of a city?

Robert P. Kadlec, a former senior director for biodefense of the Homeland Security Council and a White House special assistant, testified this summer that he is "afraid [that] not enough consideration has been given to the cost of cleanup."

"As witnessed during the 2001 anthrax letter attacks, cleaning a couple of buildings cost over a billion dollars," Kadlec said. "The cost of cleaning a city or subway system following a large-scale anthrax release is mind boggling. It is not clear that we know the costs of environmental cleanup or even how to do it."


According to an FBI report, the seven Amerithrax envelopes contaminated 35 postal facilities -- forcing the closing of the D.C. mail-sorting center for two years -- and parts of seven buildings on Capitol Hill. More than 1.8 million letters, packages, magazines, catalogs and other mailed items were quarantined at postal facilities -- and, to this day, all letters sent to congressional and some federal agencies offices are irradiated before they are delivered to kill any spores.

And the extent of that contamination is regarded as small compared to what could be expected following a large-scale anthrax attack. At a biosecurity conference last year by the Center for Biopreparedness, participants pointed out that no federal standard defines how "clean" a formerly contaminated building has to be before it can be reoccupied.

They called for more research on how biological contaminants move in the air, how the extent of contamination can be accurately assessed, and the best ways to decontaminate buildings that have been exposed to deadly pathogens.

But former Sen. Graham, pointed out that there is very little funding for such research. "We have not made the effort to understand and prepare for environmental cleanup that's required," he said. In fact, the Marine Corps "will spend twice as much [in 2011] on its marching bands" and the federal government spends on contamination research.

Beacon Washington correspondent Robert Koenig is also the author of "The Fourth Horseman: One Man's Mission to Wage the Great War in America," which tells the story of the first use of anthrax as a weapon of sabotage in the 20th century.