2001.08.16: (Fact Sheet) HHS Initiative Prepares for Possible Bioterrorism Threat

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August 16, 2001

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HHS Press Office
(202) 690-6343

HHS INITIATIVE PREPARES FOR POSSIBLE BIOTERRORISM THREAT

Overview: While the exact risks are unknown, the use of biological weapons by terrorists potentially could result in life-threatening illness on a large scale. Even a lone terrorist could cause a major disease outbreak in the population - and, in the case of communicable disease, the outbreak could spread in successive waves of infection.
Unlike explosions or chemical releases, a bioterrorist attack could be surreptitious and thus difficult and time-consuming to detect. Symptoms might not occur among victims for days or weeks, and those initially presenting themselves to physicians and clinics might be geographically dispersed. A strong public health network would be needed to piece together early reports and quickly determine what had happened. Once detected, the situation could overwhelm local health systems that are faced not only with the tasks of caring for mass casualties but also with the demands of even larger numbers of people requiring preventive care.
President Bush has named the Federal Emergency Management Agency to coordinate federal response efforts in the event of chemical, biological or nuclear terrorism. In a bioterrorism event, HHS would have special responsibilities, including detecting the disease, investigating the outbreak, and providing stockpiled drugs and emergency supplies in the large amounts needed. On July 10, 2001, Secretary Thompson named Scott Lillibridge, a physician who has coordinated the Centers for Disease Control and Prevention's bioterrorism response efforts, as his special advisor to lead the department's coordinated bioterrorism initiative.

In fiscal year 2001, HHS will invest $297 million in anti-bioterrorism efforts. President Bush's fiscal year 2002 budget proposes an investment in the HHS anti-bioterrorism initiative of $350 million, an 18 percent increase over fiscal year 2001 funding. HHS efforts are focused on five areas:

improving the nation's public health surveillance network, to quickly detect and identify the biological agent that has been released;
strengthening the capacities for medical response, especially at the local level;
expanding the stockpile of pharmaceuticals for use if needed;
expanding research on the disease agents that might be released, rapid methods for identifying biological agents, and improved treatments and vaccines; and
preventing bioterrorism by regulation of the shipment of hazardous biological agents or toxins.

Background

There is little experience, especially in the United States, with the deliberate release of biological agents to cause major disease outbreaks. However, events of recent years have focused attention on the increasing possibility of such incidents, particularly 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), as well as smallpox, pneumonic plague, tularemia, viral hemorrhagic fevers and botulism. While there generally are vaccines or treatments for these diseases, they do not exist in the quantities that would be needed and therefore must be stockpiled. Smallpox, while eliminated as a naturally occurring disease, could cause a chain reaction of person-to-person infection if ever released as a terrorist weapon. The existing smallpox vaccine supply is limited, and only supportive care would be available to those with the disease.

Challenges for Bioterrorism

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

Silent Attack and the Need for Improved Public Health Network. Unlike explosives or chemical releases, an attack involving biological agents could go undetected for days. Only when individuals present themselves to physicians or clinics with symptoms would any evidence of the attack appear, and even then the initial symptoms might not be recognized and accurately diagnosed. Furthermore, those presenting themselves with symptoms could be at great distances from the original site of exposure by the time symptoms occurred. In order to enhance our preparedness for and response to a bioterrorist attack, 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 communities. Yet many of the special needs in responding to a bioterrorist attack (from the capacity to identify the problem to the availability of appropriate drugs) generally exceed the capacities of local systems. National response resources need to be prepared for use in cooperation with local and state officials and health personnel. Training for such unusual situations also needs to be developed and carried out with federal assistance. New working partnerships between public health, medical, public safety and intelligence agencies are needed.
Potential for Widespread Public Health Consequences. Large numbers of people might be directly exposed to an agent released in a dense urban environment, and in some cases further spread of disease could occur person-to-person. In dealing with the consequences, appropriate measures for treatment and follow-up may need to be carried out on a massive scale, as would the distribution of drugs and emergency supplies from the stockpile, decontamination procedures and even the provision of appropriate mortuary services.

Current HHS Actions

HHS' five-year plan for combating bioterrorism includes a range of activities to strengthen and enhance the nation's preparedness for possible terrorist acts. The plan relies heavily on cooperation with state and local health agencies as well as local emergency medical response units. It also provides for an unprecedented vaccine and therapeutics "stockpile," including assurance of the effectiveness of such vaccines, antibiotics and emergency medical equipment. A "surge" production capacity has been developed in cooperation with drug manufacturers to address the needs for larger quantities of stockpiled materials. The plan also outlines accelerated research on the diseases, diagnostics, vaccines and treatments needed to help address the potential threat.

In his fiscal year 2002 budget, the President has requested $350 million for HHS to prepare for and respond to the medical and public health consequences of a bioterrorist attack. Of this amount, $182 million is for the Centers for Disease Control and Prevention (CDC), $51 million is for the Office of Emergency Preparedness, and $93 million is for research.

Disease Surveillance and Public Health Network: To better detect and respond to a wide range of infectious disease threats, including possible bioterrorist incidents, CDC is upgrading the nation's public health laboratory and epidemiological capacity. It is also expanding training and communications resources for state and local health agencies. This includes the capacity to detect outbreaks of illness that might have been caused by terrorists, improved laboratory identification and characterization of causal agents for disease outbreaks, and improved electronic communications among public health and other officials regarding outbreaks and responses to them.

Medical Consequence Management: HHS, through its Office of Emergency Preparedness (OEP), is expanding its efforts to develop medical response capabilities at local and national levels. In particular, OEP will increase the number of Metropolitan Medical Response Systems. So far, systems have been supported in 97 communities. Another 25 will be initiated in fiscal year 2002.

National Pharmaceutical Stockpile: The role of National Pharmaceutical Stockpile Program 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 program 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. The stockpile includes pharmaceuticals, intravenous supplies, airway supplies, emergency medications and bandages and dressings. Materials are intended to be available within 12 hours of an authorization to deploy from the national stockpiles. Pharmaceutical manufacturers may also be called upon to release inventories committed under prior agreement to the federal government

Research and Development: HHS is increasing 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 threats -- 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. In addition, NIH will support intensive work on a new smallpox vaccine.

Deterrence: HHS has the responsibility to track and monitor 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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