Randy, a friend of this blog, has an illustrious and varied career in the military, homeland security and communications. Most recently, he was the Executive Director of the Commission on the Prevention of Weapons of Mass Destruction and has, along with co-chairs Bob Graham and Jim Talent, formed the Bipartisan WMD Terrorism Research Center. They will be working to implement the Commission’s extensive recommendations. (The Biosecurity Blog’s subhead is: “Improving America’s Capability To Respond to Bio-Threats.”)

Randy is author of Our Own Worst Enemy: Asking the Right Questions About Security to Protect You, Your Family, and America (Grand Central Publications, 2007) and was the co-host of one of my favorite radio shows, “Homeland Security Inside & Out”.

I recommend following the Biosecurity Blog.

And you thought people with cosmetically frozen facial expressions were scary. Writing in the latest Scientific American, two bio-terror experts, Ken Coleman and Raymond A. Zilinskas, warn about the proliferation of international counterfeiters of the wrinkle-smoothing drug Botox. The worry is that through the counterfeiters, terrorists will be able to obtain or make lethal forms of the drug’s active ingredient, botulinum neurotoxin.

The stuff isn’t such a concern in a typical cosmetic Botox dose — its presence is so minuscule it would take hundreds of vials to kill a person — but it wouldn’t take much to wreak widespread havoc, the two say.

Foreign Policy summarizes their work:

… Botulinum neurotoxin, in its pure form, is ‘the deadliest substance known to science,’ according to Coleman and Zilinskas. It is grouped with the world’s most lethal potential biological weapons agents, sharing ’select agent’ status with the pathogens that cause smallpox, anthrax and plague. How potent is it? One gram could be lethal to 14,285 people if ingested, 1.25 million people if inhaled, and 8.3 million people if injected. The toxin particles block receptors on nerve endings, silencing the nerves and paralyzing surrounding muscles.

Coleman and Zilinskas fear that terrorists may make the connection between the cosmetic uses and the deadly toxin, and find a way to produce or buy the dangerous stuff on the Internet. ‘As security analysts, we undertook two years ago to explore the size and nature of this illicit global trade,’ they write, ‘and have come away gravely concerned that a deadly, but once relatively inaccessible, weapons agent is now becoming as easy to get or to make as a roadside bomb.’

The most important overlooked story of the past few weeks was overlooked because it was not surprising. Also because no one really wants to notice it. The weight of 9/11 and all its implications is so much on our minds that it’s never on our mind.

I speak of the report from the Inspector General of the Justice Department, issued in late May, saying the department is not prepared to ensure public safety in the days or weeks after a terrorist attack in which nuclear, biological or chemical weapons are used…

Noonan notes that the Justice IG was not alone in noting the lack of WMD readiness:

The report was not the first of its kind. Six months ago, the bipartisan Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism gave both the Obama administration and Congress failing grades on preparedness for biological attack…

After the Inspector General’s report, Paul McHale, a former Democratic congressman from Pennsylvania who also served as an assistant secretary of defense under George W. Bush, told the Los Angeles Times: “There is a sense of complacency that has settled in nearly a decade after Sept. 11.” The paper also quoted Randall Larsen, the former executive director of the commission that gave the government low marks in January: “They just don’t see the WMD scenario as most likely,” he said.

They don’t? They must be idiots. They must not be reading all the government reports of the past eight years, declaring terrorist attacks on U.S. soil not only likely but virtually certain…No one wants to think about it. I don’t want to think about it. But you have to make plans. You have to imagine, you have to think about the worst case, and then you have to plan for it—literally…

Noonan says that the success in preventing another major attack has been a double edged sword in part by presenting a misimpression about the nation’s preparedness and response abilities:

Our eye is off the ball. The public, in spite of what it knows in the day to day, assumes the government is on the case. And certainly the government is on the case with regard to prevention: Not being hit again since 2001 means something, and our antiterrorism professionals, intelligence and law-enforcement agents, do impressive work. In New York the past week they picked up two apparent would-be terrorists who won’t be playing jihad anytime soon. But public awareness of prevention success gives the impression the government is similarly capable in terms of readiness and response…

On 9/11 we were rocked but held together. In a second and more devasting attack, public safety and public unity would be infinitely more stressed. The event, having had a precursor, would be infinitely more painful. You’d think this would focus the government’s mind.

We may be witnessing again a failure of imagination, the famous phrase used after 9/11 to capture why the U.S. government was caught so flatfooted and was so stunned that such a terrible thing could occur. They neglected to think of the worst thing that could happen, and so of course they did not plan for it. If agencies within the government now are having a second failure of imagination, it is not forgivable. We’re not being asked to imagine a place we’ve never been, after all, we’re only being asked to imagine where we’ve been, and how it could be worse, and plan for it.

Though Noonan was a speechwriter for Republican presidents Reagan and Bush, her general theme about the need to engage the public on WMD response was echoed by a current top DHS official Tara O’Toole in a speech this week.

Those provisions are part of comprehensivelegislation addressing the WMD threat which is based largely on the recommendations of the Commission on the Prevention of WMD Proliferation and Terrorism’s final report, “World At Risk.”

Of most interest to this blog, the bill has several provisions that deal specifically with public information, a significant focus of the WMD Commission report and its chairman Bob Graham.

The House legislation, sponsored by Rep. William Pascrell (D-NJ) and Rep. Peter King (R-NY), joins a Senate WMD bill. Both aim to codify many of the WMD Commission recommendations. This bill’s submission comes two days after a top DHS official said in a speech that the U.S. has “to start thinking very seriously about what we would actually do the day after [a nuclear or biological] attack”.

The public information provisions, according to the bill’s summary, are:

SEC. 2121. Communication of Threat Information and Alerts. This subsection directs the Secretary of Homeland Security, in coordination with appropriate Federal agencies, to ensure that homeland security information concerning terrorist threats deemed to be credible is provided to State, local, and tribal authorities and to the public within the United States, as appropriate. (ADDRESSES WORLD AT RISK RECOMMENDATION 13.)

SEC. 2122. Individual and Community Preparedness for WMD. This subsection requires the Secretary of Homeland Security, acting through the Administrator of the Federal Emergency Management Agency (FEMA), to assist State, local, and tribal governments in improving and promoting individual and community preparedness and collective response to WMD and terrorist attacks against the nation. The FEMA Administrator shall develop and disseminate guidelines and checklists of recommended actions, compile and distribute best practices, provide training materials, and conduct outreach efforts for individual and community prevention and preparedness. (ADDRESSES WORLD AT RISK RECOMMENDATIONS 1-5 AND 13.)

SEC. 210. Communications Planning for WMD Information Dissemination. This section requires the Secretary, acting through the FEMA Administrator, in consultation with State, local, and tribal governments and in coordination with the heads of other appropriate Federal Departments and agencies, to develop a communications plan for providing information to the public related to preventing, preparing for, and responding to attacks with WMD and acts of terrorism. The FEMA Administrator shall incorporate this plan into FEMA operational plans. This section also directs the FEMA Administrator to develop and disseminate pre-scripted messages and message templates to State, local, and tribal officials so that they can incorporate them into emergency plans, and quickly disseminate critical information to the public in anticipation or in the immediate aftermath of a WMD attack or terrorist incident. (ADDRESSES WORLD AT RISK RECOMMENDATION 13.)

Another important aspect of the bill with direct relevance to the public is the question of how “countermeasures” would be distributed to citizens after (or possibly) before an attack. The bill requires the Administration to come up with a strategy on that question:

SEC. 301. National Medical Countermeasure Dispensing Strategy. This section requires the Secretary of Health and Human Services, in coordination with the Secretary of Homeland Security, the Secretary of Agriculture, and the heads of other appropriate Federal Departments and agencies, to develop and implement a National Medical Countermeasure Dispensing Strategy to enhance preparedness and collective response to an attack on humans or animals with a chemical, biological, radiological, or nuclear agent. (ADDRESSES WORLD AT RISK RECOMMENDATION 1-5.)

The speech was reported in an article by Martin Matishak on the Global Security Newswire:

While preventing a strike involving an unconventional weapon is “absolutely to be preferred, we do have to start thinking very seriously about what we would actually do the day after an attack,” Tara O’Toole, the department’s undersecretary for science and technology, said during an event at the University of California’s Washington campus.

“We could recover from an improvised nuclear device attack but to mitigate the death and suffering and the economic and social consequences we have to … start equating the American public with the notion we could recover,” she told the audience. Advance preparation “is something that we have to take seriously and is a very difficult point to sell to Congress, particularly in these highly pressured economic times,” according to O’Toole. ”God knows these preparations must be affordable,” she added.

A bipartisan group of members of the U.S. House Homeland Security Committee will introduce a bill tomorrow to implement the recommendations of the WMD Commission. The legislation will aim to improve U.S. efforts to prevent, deter, detect, and respond to a WMD attack. In its final report, the Commission emphasized the need to educate the public on these threats along the lines that O’Toole mentioned in her speech.

The article continues:

Today, the government’s responses to a nuclear or biological attack contain many similar elements. They call for the federal government to be in charge of the response and include immediate measures like medical attention for the sick and injured and detection of the source of the attack to properly training first responders to operate within a contaminated area. Longer-term issues include decontamination of the impacted zone….

Earlier this year, the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism gave the Obama administration an “F” grade for bioterrorism defense, saying the United States does not have the capability to rapidly recognize, respond to and recover from a disease-based attack (see GSN, Jan. 26). Last week, the Justice Department inspector general reported that the the agency’s WMD response efforts are severely lacking.

O’Toole said the government has a “better shot” at preventing a nuclear attack than its disease-spreading counterpart.”The difficulty of detecting, interdicting and attributing biological attacks is very, very serious and we have to, particularly in the realm of biological weapons, be prepared to respond to these attacks,” she said, referring to pursuing the perpetrators of a possible strike….

O’Toole said there are several myths in Washington about biological terrorism, including that it is too hard to prepare for; that an attack would be similar in scope to the 2001 anthrax mailings; and that infection could be countered using the antibiotic ciprofloxacin.

The Commission concluded its work as a congressionally-mandated organization on February 26, 2010. The chair was former Senator Bob Graham (recently chosen to co-chair the presidential commission on the Gulf oil spill), the vice chair was former Senator Jim Talent, and the executive director was Col. Randy Larsen. The trio have formed The Bipartisan WMD Terrorism Research Center to continue work on these issues

“We All Have A Role” is a concrete result of the WMD Commission’s public outreach effort, which was central to the group’s mission. Senator Graham told me last year in an interview that informing the public on weapons of mass destruction was an “urgent” priority. And the Commission dedicated the final chapter of its report to the “Role of the Citizen.”

What I think is particularly special about “We Have A Role” is that it not only offers advice to the public on personal preparedness and response. But it also gives them guidance on how to take a leadership role as citizens to determine if their community is prepared for weapons of mass destruction, and if not, how to get it ready.

“We Have A Role” concludes with suggested questions “specifically for nuclear and biological attacks.” To me, that underscores a point I’ve made previously on the blog that the term “WMD” should be clarified for the public with the catastrophic nuclear and biological weapons in one category and serious but lesser weapons (also normally placed within the WMD rubric) such as chemical and radiological, placed in another.

The two-minute video (below) and resources are available at www.FasterVaccines.org. It is part of the Commission’s effort to engage citizens on issues of bioterrorism and weapons of mass destruction.

“WHY WEREN’T H1N1 VACCINES AVAILABLE FOR CHILDREN BEFORE SCHOOL STARTED?” VIDEO (ABOVE)

“Whether the threat is from naturally occurring disease or bioterrorism, the United States needs to be able to produce vaccines and other medicines faster and less expensively. We had six months of advance warning for the H1N1 pandemic. A bioterrorism attack will have no advance warning,” said former senator Graham, chairman of the Commission. “Creating the infrastructure for rapid development of large quantities of safe vaccines and medicine is a win-win for public health and national security.”

According to Graham, the United States—unlike the European Union and China—continues to use a 60-year old production method, using chicken eggs, to make H1N1 and other important vaccines. Modern methods will shave months off the typical six-to-nine months that current processes require. These newer methods can produce more vaccine and be quickly scaled-up, on demand.

“We want the public to know there are better options,” said Commission vice chairman Talent, “and encourage policymakers to have the foresight to invest in them.”

Lieberman and ranking member Sen. Susan Collins (R-ME) introduced a bill that would implement many of the extensive recommendations of the commission’s report, World at Risk. “The mental images of mushroom clouds and nuclear blasts are powerful and frightening,” Lieberman said. “But as the Graham -Talent Commission rightly notes, the more likely terrorist threat is from a biological weapon,”

While there is some debate among experts on which weapon of mass destruction, biological or nuclear, is more likely (and which is the more serious threat), there is general agreement that both would be very serious and  would probably be much worse than the other two threats — chemical and radiological — that are usually included in the term’ WMD’ (including by the Commission itself). Yet, as the Commission itself reports, the latter two are not weapons of mass destruction in the same category as the first two. It’s not that chemical or radiological attacks would not kill ‘mass’ numbers of people, but the potential magnitude is much different.

The question of ‘WMD’ nomenclature came up yesterday with the indictment of Najibullah Zazi for conspiring to use “weapons of mass destruction” in connection with a terror plot, news reports say, to set off explosives here in New York City along the lines of the July 2005 bus attacks on London’s subway and bus system. Those bombings were horrific; 56 people were killed and many more people could have died. But the scope of casualties from a ‘traditional’ explosives is likely not be at the level of what potentially could happen in a biological or nuclear incident. I would guess that there was probably some confusion among the public upon hearing Zazi’s bombing plot being characterized in the indictment as a “weapon of mass destruction.”

In a post after the WMD Commission released its report, I argued that the term ‘WMD’ should be redefined and why I think it matters and isn’t just semantics. An excerpt is below:

In its report, the WMD Commission argues that the incoming Administration should make an effort to inform and engage the public on the subject of WMD’s. I agree. And, I suggest officials consider starting that process by defining (or redefining) what a WMD actually is. At present, it is most common to define a WMD for the public as a chemical, biological, radiological, and nuclear (or “CBRN”) weapon.

The Commission report, however, focuses primarily on the dangers of biological and nuclear terrorism, both of which could be absolutely catastrophic. By contrast, a chemical or radiological (better known as a ‘dirty bomb’) weapon could be very serious but would likely not cause as much lasting damage. In fact, both a chemical and radiological attack would likely be a one-shot event seriously impacting those directly near the event, closer in result to a ‘traditional’ terrorist bombing. A nuclear bomb or biological incident, however, could have wide and long-lasting ‘mass destruction’ impact to humans, property and the society itself.

As the report’s Executive Summary explains:

“While the mandate of the Commission was to examine the full sweep of the challenges posed by the nexus of terrorist activity and the proliferation of all forms of WMD-chemical, biological, radiological, and nuclear-we concluded early in our deliberations that this report should focus solely on the two types of WMD categories that have the greatest potential to kill in the most massive numbers: biological and nuclear weapons.”

When I speak to experts, they tend to divide nuclear and biological from chemical and radiological. I believe they should be communicating that dichotomy to the public. In fact, I believe that a vital part of educating and engaging citizenry on terrorism is giving them a more precise sense of potential terror weapons. It turns out that some of those threats are actually not as scary the more you know about them. But the time to tell people is before an incident not during it. That’s important because it allows policymakers and responders to focus time, money and public attention on the most dangerous threats.

The Obama Administration has taken the advice of the Commission and will appoint a WMD Czar, Gary Samore. I would hope that one aspect of his job is public education — and that defining (or redefining) what exactly WMD’s are is part of that effort.

Obviously, what we call these weapons is far less important than to preventing their use. But words do matter particularly on these sensitive, serious matters. And, therefore, I do think that better defining WMD’s for the public is something worth taking up.

The City has currently signed up 500 “patients” so far, according to Anne Rinchiuso from the Health Department’s Bureau of Emergency Management, but she says they could use up to 2000 volunteers. “The more people in the drill the more practice and data we get.” During the drill, the volunteer patients will go through a POD, a mass dispensing site opened for the distribution of antibiotics or other medications in response to a public health emergency or outbreak.

Rinchiuso says the exercise was designed a year ago specifically for an anthrax response. However, it will also provide lessons for officials in case there is a need for a mass H1N1 vaccination program this Fall.

If you are interested in participating on Saturday, go to the Health Department’s Exercise website at www.nyc.gov/health/podexercise to fill out the short registration form. The drill will take place at a school on Manhattan’s Lower East Side and will run from approximately 1-5 pm. It is open to New Yorkers over 18 years old. More information will be provided once you register.

Although CERT team members are often asked to participate in emergency responder drills (and are doing so again on Saturday), this exercise is open to all New Yorkers. Rinchiuso notes that this an opportunity for individual members of the public to play a very helpful role in the City’s emergency preparedness planning. (On a personal note, I have participated in a number of these drills. I — and I think most of the other participants — have found them interesting, community-building and even fun events. You really do feel as if you are helping out your city in an unusual but important way. And maybe you’ll even make some new friends on the line for ‘medicine’.)

One of the papers is titled, ”Expanding The Public’s Role In Health Emergency Policy”, written by Monica Schoch-Spana, Brooke Courtney and Ann Norwood. It offers a series of important ideas to increase citizen involvement including:

􏰀The Administration should work with Congress to fund public preparedness and community resilience at levels commensurate with their official status as core features of public health security.

ô°€CDC should help augment state and local health departments’ capacity to build partnerships with community and faith-based organizations and local businesses.

􏰀CDC should enable community- and faith-based organizations, especially those who represent vulnerable populations, to collaborate more easily with health and disaster agencies.

􏰀The Administration should urge Congress to authorize legal protections for nonprofit and business entities that act in good faith during a public health emergency. 

􏰀CDC should equip more state and local health agencies with the skills to engage the public in health emergency management policy decisions.

􏰀�The Administration should increase volunteer opportunities for Americans to protect the health, safety, and security of their hometowns.

More details can be found in the memo here.

“The economic crisis could result in a serious rollback of the progress we’ve made since September 11, 2001 and Hurricane Katrina to better prepare the nation for emergencies,” said Jeff Levi, PhD, Executive Director of TFAH. “The 25 percent cut in federal support to protect Americans from diseases, disasters, and bioterrorism is already hurting state response capabilities. The cuts to state budgets in the next few years could lead to a disaster for the nation’s disaster preparedness.”

The report also offers a series of recommendations for improving preparedness, including:

*Restoring Full Funding. At a minimum, federal, state, and local funding for public health emergency preparedness capabilities should be restored to FY 2005 levels.

*Strengthening Leadership and Accountability. The next administration must clarify the public health emergency preparedness roles and responsibilities at the U.S. Department of Health and Human Services and U.S. Department of Homeland Security.

*Enhancing Surge Capacity and the Public Health Workforce. Federal, state, and local governments and health care providers must better address altered standards of care, alternative care sites, legal concerns to protect community assistance, and surge workforce issues.

*Modernizing Technology and Equipment. Communications and surveillance systems and laboratories need increased resources for modernization.

*Improving Community Engagement. Additional measures must be taken to engage communities in emergency planning and to improve protections for at-risk communities.

*Incorporating Preparedness into Health Care Reform and Creating an Emergency Health Benefit. This is needed to contain the spread of disease by providing care to the uninsured and underinsured Americans during major disasters and disease outbreaks.

“The new Biosecurity Briefing will present opening excerpts from and a link to the original source for important and/or informative items from national and international news outlets, public- and private-sector reports, scholarly publications, and the occasional op-ed piece or blog.”

The Center is a leader in the field of biosecurity, and I have learned a great deal from its experts, including Monica Schoch-Spana, who is as knowledgeable in citizen preparedness as anyone and Randy Larsen, the co-host of the informative Homeland Security Inside & Out radio show. Both Monica and Randy were kind enough to participate in this blog’s “What Should We Tell The Public?” video series.

The co-editors-in-chief of Biosecurity Briefing are the Center’s director Tara O’Toole and deputy director Thomas Inglesby. If you are interested in signing up for a free daily email subscription, click here.

The Centers for Disease Control and Prevention has directed 72 major American cities to devise plans to distribute anthrax antibiotics to all their residents within 48 hours of receiving them. So far, few of these cities are able to meet that goal. The traditional approach to dispensing medical supplies to a large population is to place the medicines in schools and other public places and instruct people to pick them up. The main shortcoming of this “PODs” approach (for “points of dispensing”) is labor: there are not enough public health workers to distribute the antibiotics quickly, and cities would have to rely largely on volunteers to perform unfamiliar (albeit simple) tasks in unfamiliar settings.

A better way is to let residents stay home and have mail carriers, escorted by police officers, go door to door delivering antibiotics. This can be done within eight hours, trials in Seattle, Boston and Philadelphia have shown. While the mail carriers (who have already taken antibiotics) distribute pills, public health workers can make bulk deliveries to special populations like universities, nursing homes, detention centers, homeless shelters and large hotels.

After the mail carriers have finished their routes, the next police shift can be assigned to PODs, opened up to serve anyone who may have fallen through the cracks and to supply additional antibiotics so that each citizen can ultimately be given enough for the full 60-day course of treatment.

Besides being faster, the postal approach can reach those people who, surveys suggest, might refuse to go to a dispensing point. It would also require fewer workers, and it would be much better executed – mail carriers cover their routes six days a week through rain, sleet and snow. And the elderly, the handicapped and those without cars could obtain their pills more easily.

The issue of preparing the public for a bioterrorism attack has been a focus on this blog. I am also interested as a CERT team member as we might be asked to help distribute medicine to citizenry after a bioterrorism incident. Whether or not mail carriers are the optimal method of distribution (I am also very interested in the use of in-home ‘Med Kits’ which is now being tested as well), I think it is important that the public knows more about this issue, and Wein’s article — and its prominent positioning on the Times Op-Ed Page — helps accomplish that.

In my interviews with policymakers and first responders, I have found that the public’s role in preparing and responding to bioterrorism is a major concern of them. Yet, it is something that most citizens have little idea about. So, I think it’s very important that the government start a dialogue on this topic which should include: a) asking and beginning to answer what we expect our government to be able to do to respond to the range of terror threats and b) a higher profile effort to familiarize Americans what they might need to do in such a situation. To me, the goal should not be that every citizen knows everything about every possible terror weapon, but that the first time every citizen hears about these weapons and what to do is not after an emergency occurs.

This is an issue that is not on the public’s radar, but is very much a front and center concern among the federal, state and local officials I have spoken to. The challenge was highlighted well during the workshop by Dr. Gerald Parker from the U.S. Department of Health and Human Services, as summarized in the report:

Parker noted that the United States is just about to reach the goal of having stockpiled sufficient antibiotics to provide post-exposure prophylaxis for 60 million people for 60 days in the event of an anthrax attack. However Parker continued, if we do not have the mechanisms to get these lifesaving medicines in the hands of Americans after such as attack or multiple attacks within a very short timeframe, we have squandered an opportunity to save lives. 

Parker noted that an analogy can be found in the school buses that ended up underwater in New Orleans after Hurricane Katrina. Those school buses, if harnessed early, could have been used to evacuate thousands of New Orleans citizens out of harm’s way. Instead, this valuable resources was rendered useless. We must ensure that the same does not happen to the resources in our stockpile, said Parker.

Kathy Nguyen, 61, worked at the Manhattan Eye, Ear & Throat Hospital where she was exposed to Anthrax. The hospital is directly across the street where my family and I lived. Such proximity, coming just six weeks after 9/11’s death, caused my wife to ask me “What should we be doing” as a family to prepare ourselves for the next terror attack? it turned out not to be a simple, straightforward answer. But my research on emergency preparedness as well as this blog is focused on trying to help my wife and other Americans help work towards finding it. And maybe it’s at least something positive that comes out of the terrible deaths of Kathy Nguyen and the other four victims.

That’s why I hope (though I’m not overly optimistic) government officials, the media and we citizens use today’s news as an opportunity to ask if we are more prepared for anthrax (or any other biological) attack than we were in October of 2001. From a governmental perspective, though there is still a long ways to go I believe the answer is ‘yes’. There are more resources, more training, more research and more overall preparation and attention. Work continues on developing logistics for stockpiling and distributing vaccines and other medicines if necessary. Agencies such as the Centers of Disease Control have done exhaustive after action reports critiquing their performance with each other and the public, and then making adjustments. 

However, I would argue that the public itself is not really any more prepared than we were. There has been very little citizen education on bioterrorism. It is rarely discussed by government officials or the media. And it’s not as if we ourselves are raising the question to our political leaders in “You Tube” debates or town meetings. That will be a problem the next time anthrax is used as a weapon.