Sept. 21, 2001 -- It took only box cutters -- and minds bent on evil -- to turn passenger aircraft into missiles. Using germs as weapons of mass destruction requires higher-level technology. It already may be in the wrong hands.
"Dedicated but evil people will find new ways to attack us," Joseph F. Waeckerle, MD, tells WebMD. "Biological weapons are the real threat to America, and we are not prepared."
Bioterrorism is the deliberate release of disease-causing germs with the intent of killing large numbers of people -- and of panicking many more. Some of these germs -- like smallpox and plague -- could set off worldwide epidemics. Others, like anthrax, aren't spread from person-to-person, but still can be made extremely deadly by putting them in an ultra-fine powder and spraying it over a wide area. Very small amounts can kill millions.
Waeckerle teaches emergency medicine at the University of Missouri, Kansas City, School of Medicine. He heads the American College of Emergency Physicians' taskforce on preparedness for nuclear, biological, and chemical incidents. Two years ago, he warned a congressional subcommittee on national security that the U.S. was ill-prepared for an attack with weapons of mass destruction.
The result? "Nothing has changed," Waeckerle says. "What we have to understand is we can change things for the future, and we have to become committed to that as a country. We have to do this collaboratively with hospitals and doctors. It is not only time for the government to unify but also for all the rest of us in healthcare to unify. We have to get our act together."
This may now be happening, says Ken Bloem, MPH, a senior fellow at the Johns Hopkins Center for Civilian Biodefense. Bloem has served as CEO of Georgetown and Stanford university hospitals.
"The events of Sept. 11 constitute a wake-up call," Bloem tells WebMD. "In the absence of a crisis, bioterror falls into a long list of other issues. Hospitals are dealing with lots of very, very pressing concerns. Before Sept. 11, the threat of bioterrorism was only another issue on the list, with a very low probability associated with it. To get prepared for a biological event of any sort takes resources. Hospital CEOs say, "Why should I be funding scarce resources to something of low probability that I cannot get reimbursed for?'"
Waeckerle and Bloem say that unlike other types of disaster, a biological attack places doctors, nurses, and paramedics on the very front line. They literally are the first people who will know something is going on. The entire response effort hinges on how soon they can find out an attack is under way.
"Other disasters are announced with an explosion of horrific injuries, but a bioterror event is a different beast -- an epidemic," Bloem says. "They are quiet. They are silent. They have to be detected."
"The one avenue we have for an immediate strategy is to educate the clinical people and say, 'These are the signs and symptoms of a potential biological agent -- if you see this, pick up the phone,'" Waeckerle says. "That is where we need to spend money right now." He adds that our ability to protect ourselves over the three to five years it will take to develop better detection technology will depend on human expertise.
Bloem says that hospitals need these four things to happen in order to prepare for bioterror attacks:
- Hospitals must add the capacity to handle large numbers of people and must beef up their staffs and equipment. "In this era of managed care, hospitals have learned to manage quite well with a philosophy of 'just in time and just enough,'" he says. "In the process, we have lost sight of the hospital as a community resource that is always available in case of a disease outbreak."
- Government must provide financial incentives for hospitals to get prepared. "Fighting bioterror is a common good," Bloem says, and without a mandate to act and the funding needed to do so, it is illogical to expect hospitals to be prepared.
- Build networks of collaborating institutions. "An effective response to bioterror will have to include public-health laboratories, state departments of health, voluntary organizations like the Red Cross, and links to police and the media," Bloem says. "I am unaware of any real progress there."
- Legal and policy issues must be addressed.
The U.S. already has made plans for a new smallpox vaccine. Clinical trials are scheduled for early next year, with product rollout expected in about three years. Anthrax vaccines exist but only in quantities sufficient for military needs. Neither currently is available to civilian physicians. The U.S. is also planning to stockpile the antibiotics needed to treat the diseases most likely to be used in bioterror attack. This process has just begun.
Can we really afford all this?
"I believe it will cost every individual in America something, and it will cost healthcare professionals even more," Waeckerle says. "But it is worth it. It is an investment in our children and our life and our future. It must be done. We must be resolute in our commitment to this end."