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• improving the nation's public health surveillance network, to detect quickly, based on the appearance of disease symptoms, whether a biologic agent has been released;
• strengthening the capacities for medical response, especially at the local level;
• creating and maintaining a stockpile of pharmaceuticals for use if mass treatment is needed; and,
• expanding research into the disease agents that might be released, into rapid methods for diagnosing these diseases, and into improved treatments and vaccines.

Background

There is little experience, especially in the United States, with incidents of deliberate release of biological agents to cause mass disease. However, events of recent years have focused attention on the increasing possibility of such incidents, with special attention to the possibility of terrorist incidents aimed at the civilian population.

Concern about deliberate use of disease agents presently focuses on anthrax, which can be spread by inhaled spores, and pneumonic plague, tularemia, viral hemorrhagic fevers, smallpox and botulism toxin. While there are vaccines or treatments for these diseases, they do not exist in the quantities that could be needed and therefore must be stockpiled. Smallpox, while eliminated as a naturally occurring disease, would cause a chain reaction of person-to-person infection if ever released as a terrorist weapon.

Challenges

In preparing for the possibility of bioterrorist incidents, HHS faces new challenges:

• Silent Attack and the Need for Improved Public Health Network -- Unlike explosives or chemical releases, an attack involving biological agents could be unannounced. Only when individuals presented themselves to physicians or clinics with symptoms would any evidence of the attack appear, and even then the initial symptoms might not appear unusual. Furthermore, those presenting themselves with symptoms could have traveled great distances from the original site of exposure by the time symptoms occurred. In order to be able to translate the presentation of symptoms into the knowledge that exposure to a given disease has taken place, the United States needs an improved network of infectious disease surveillance, including improved communications, upgraded laboratory facilities, advanced diagnostic techniques and expanded training of health care personnel.

• Local Response Depends on National Leadership, Resources and Coordination -- The responsibility for responding to medical emergencies falls first and heaviest on local resources. Yet many of the special needs in responding to a bioterrorist attack (from the capacity to identify the problem to the availability of pharmaceutical products and the determination of the necessary medical procedures) generally exceed the capacities of local systems. National leadership and nationally-supported resources need to be prepared and on-hand for use in cooperation with local and state officials and health personnel, and training for such unusual situations also needs to be developed and carried out with federal assistance. Across the board, new working partnerships between public health, medical, public safety and intelligence agencies are needed.

• Unique Potential for Widespread Consequences -- Large numbers of people might be directly exposed from the release of an agent in a dense urban environment, and in some cases further spread of disease could occur person-to-person. In dealing with the consequences, the appropriate measures for treatment and follow-up may need to be carried out on a massive scale, as would the task of disposing of contaminated equipment and medical supplies, and even in carrying out appropriate mortuary services.

HHS Actions in Fiscal Year 2000

The HHS Operating Plan for the Anti-Bioterrorism Initiative outlines a range of activities to build a stronger base to be prepared for possible bioterrorist acts. The plan relies heavily on cooperation with state and local health agencies as well as local emergency medical response units. It also initiates an unprecedented vaccine and therapeutics "stockpile," including assurance of effectiveness of existing supplies, development and storage of new supplies, and development of "surge" production capacity in the private sector for needed pharmaceuticals. The plan also provides for accelerated research into the diseases, diagnostics, vaccines and treatments to help address the potential threat.

In his fiscal year 2001 budget, the President has requested $265 million for HHS to prepare for and respond to the medical and public health consequences of a bioterrorist attack. Of this amount, $149 million is for the Centers for Disease Control and Prevention (CDC), $30 million is for the Office of Emergency Preparedness, and $30 million is for research to continue our preparation for possible acts of bioterrorism.

Disease Surveillance and Public Health Network: To better detect and respond to a wide range of infectious disease threats, including possible bioterrorist incidents, CDC will intensify its efforts to upgrade the nation's public health lab and epidemiological capacity. It will also help expand training and communications capacities for state and local health agencies. Five areas will be featured: support for planning by state and local health departments; capacity to detect outbreaks of illness that might have been caused by terrorists; epidemiological analysis of outbreaks to identify the source and modes of transmission; laboratory identification and characterization of causal agents for disease outbreaks; and improved electronic communications among public health officials regarding occurrences of outbreaks and responses to them.

Medical Consequence Management: HHS, through its Office of Emergency Preparedness (OEP), will expand its efforts to develop complementary medical response capabilities at local and national levels. In particular, OEP will increase the number of Metropolitan Medical Response Systems. Twenty-seven of these systems were initiated in 1997. During this year, a total of 72 metropolitan areas will have started. Ultimately, 120 of these systems are to be created across the nation. OEP will continue to work closely with the Department of Justice, the Federal Emergency Management Agency, the Department of Defense, the Department of Veterans Affairs and other agencies toward ensuring that plans for managing the medical consequences of terrorist acts are well integrated with other emergency response systems.

National Pharmaceutical Stockpile: The role of National Pharmaceutical Stockpile Program (NPSP) is to maintain a national repository of life-saving pharmaceuticals and medical materiel that will be delivered to the site of a bioterrorism event in order to reduce morbidity and mortality in civilian populations.

The NPSP has responsibility to identify, purchase, store, and manage pharmaceuticals and medical supplies that will assist state and local jurisdictions in their response to a chemical or biological terrorism event. Additionally, NPSP materiel and technical advisors will respond rapidly to threatened, suspected or confirmed chemical and biological terrorism events at any United States location. The stockpile contents for fiscal years 1999 and 2000 include pharmaceuticals, intravenous supplies, airway supplies, emergency medications and bandages and dressings. While a small quantity of smallpox vaccine is also maintained by CDC, additional vaccines will be added as they become available.

The CDC encourages the integration of the NPSP into state and local biological and chemical terrorism contingency planning and will provide technical assistance as requested. During an actual bioterrorist incident, the technical advisors will be on-scene to ensure the transfer of NPSP assets to authorized state representatives and to provide assistance as needed.

Research and Development: HHS will expand support for research related to likely bioterrorism agents. An area of major emphasis at the National Institutes of Health will be the generation of genome sequence information on potential bioterrorism agents -- especially the organisms that cause anthrax, tularemia and plague. The results of such genomics research, coupled with other biochemical and microbiological information, are expected to help in the development of rapid diagnostic methods, new or improved antibacterial and antiviral therapies, and new vaccines.

Deterrence: HHS has the responsibility to regulate shipment of certain hazardous biological organisms and toxins. CDC will continue efforts toward ensuring that all laboratories that ship or receive these select agents are registered and in compliance with requirements.

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Note: For other HHS Press Releases and Fact Sheets pertaining to the subject of this announcement, please www.os.dhhs.gov/news/press/ .