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Fools Rush In
by Lola Vollen

With $7.8 billion authorized by President Bush for 2003 alone, the biodefense program of the United States has been launched. The military has embarked upon a major research and development program, the private sector is producing vaccines and antibiotics for stockpiling, academic institutions are funding biopreparedness learning centers, first responders are being trained and equipped, and public health departments nationwide are consumed by preparations to counter a biological attack.

The momentum created by this massive increase in bioterrorism-related funding has swallowed all agencies downstream of it. However, the rush to mobilize monetary resources in the aftermath of 9/11 and the anthrax attacks — the events upon which the war on bioterrorism is leveraged — during a time in which traditional public policy processes are being
sacrificed, provides no motivation and little opportunity to examine plans for a robust bioterrorism program. As a result, the fundamental question about these efforts has not been asked, much less answered: Is the Bush administration’s war on bioterrorism in the best interests of the public’s health?

Military Strategies

Biodefensive strategies against weapons of mass destruction include prevention, preemption, and deterrence. However, unlike nuclear and chemical weaponry, where the greatest number of casualties occur instantaneously, there is a latency — of days to weeks — between the time a biological agent is released and when it begins to wreak its massive havoc. Therefore, early and effective medical intervention in the form of early detection, diagnosis and treatment — collectively referred to as biopreparedness — is a core tactic for mitigating the consequences of biological weaponry. The need for biopreparedness, though, stems from the failure of more effective tactics.

The opportunity to prevent the development of biological weaponry — the only true form of primary prevention — has been essentially eliminated by the United States’ decision to opt out of enforcement of the Biological Weapons Convention (BWC) by rejecting the protocols designed to enforce it. Although ratified by the U.S. in 1975, President Bush in 2001 rejected a comprehensive plan of inspections and spot checks to verify compliance with the BWC. He complained that the verification agreements would be overly intrusive and impinge upon the commercial interests of industry, scrapping the product of seven years of multilateral negotiations by 56 nations to develop a “legally binding protocol that would increase the transparency of treaty-relevant biological facilities and activities and thereby help to deter violations of the BWC.” These protocols spelled out the working method for the prevention of biological warfare — but the pharmaceutical and biotechnology industries, intent on protecting trade secrets, lobbied hard against the protocols, insisting that inspections would jeopardize the secrecy which is so crucial to their profits. Other countries, however, were willing to sign, maintaining that the proposed protocols struck a reasonable balance between commercial privacy and enforcement of the BWC. Tibor Toth, chair of the multinational committee that developed the protocols, did not see the point of voting on them if the world’s largest biotechnology industries — those in the U.S. — were opposed. Negotiations on the protocols were therefore suspended.

The U.S. biodefense program joined the biotechnology industry in opposition to the proposed protocols. In September 2001, the Pentagon announced that it intended to develop an antibiotic-resistant anthrax strain that could also resist conventional vaccines. This program, like the one begun in 1997 to build a bomb capable of delivering anthrax , contravenes the BWC. By refusing to adopt the enforcement strategy for the BWC, the U.S. can continue to operate under a double standard: one that is applied permissivelyy at home and stringently elsewhere — most recently, to Iraq.

Without a functioning way to support the only credible prevention strategy, the U.S. has succeeded in justifying its own policy of preemption by arguing that proliferation of bioweapons by other countries is inevitable. But it is unrealistic to expect that preemptive strategies will help manage the risk of a biological weapons attack.

Unlike nuclear weaponry, the key ingredients for germ-based warfare are everywhere — in the soil, in commercial and research labs, and at military bases. The technology to weaponize germs is tricky but has been available for the past twenty years. Genetic engineering has already been used to enhance the potency of anthrax as a weapon and could be used to create designer germs for which there is no medical recourse. Such technology is not confined to secret laboratories. It is commercially available. Reporters from the London Sunday Times ordered the DNA strands for making Ebola
virus from a biotechnology company.

The pre-emptive model is designed to use the military to eliminate a presumed enemy’s capacity for deploying their threatening weaponry. But the critical determinant of biological weapons capacity may be — and certainly will become — simply the number of people trying to develop them. While germs are fickle and the technology to weaponize them is complex, the manufacture of an effective biological weapon will require no more than skilled and enterprising groups. By the United States’ own admission, its efforts to root out individual terrorists have not worked so far. Nor have they worked elsewhere. Israel, with its stellar intelligence agency and security forces, and its focus on a relatively small group residing in discrete and accessible regions, has not been successful at reducing suicide bombings. Furthermore, every alleged terrorist they eliminate may only serve to increase the pool of suicide bombers.

Some U.S. policies may indeed enhance the threat of biological attack. Biodefensive strategies are virtually indistinguishable from offensive weapons programs. While the intention of the United States may be defensive, its international stance is threatening, and thus an inducement to a global arms race. The Soviet Union’s claim that the U.S. was producing biological weapons motivated Soviet scientists to vigorously develop them. An inflammatory foreign policy, such as that of the U.S. in the Middle East, may increase the number people ready to participate in terrorist activities, just as Israeli policies have done during the current intifada.

A vigorous U.S. biodefense program may be breeding not only the expertise to launch biological weapons, but the very germs that will come back to haunt us, whether by accident or intent. An accidental release of anthrax in a Russian weapons plant in 1979 resulted in the death of 75 employees. Smallpox, once believed to exist at only two locations, is now believed to have spread, as a consequence of the Soviet Union’s dissolution and the downsizing of its weapons industry. Unemployed Soviet scientists have left their posts with highly sensitive knowledge and, there is reason to believe, biological material.

Homegrown germs have not backfired on Russia alone. It is certain that the germ used in the post-9/11 anthrax attacks was derived from germs created by the U.S. military. The biological material and technical expertise to produce the anthrax could have come from several U.S. labs, whose carelessness and lack of security have been well-documented. Universities and commercial enterprises also have the potential to create wandering germs — some of which have been acquired by less than reputable buyers.
The United States’ program against biological weapons has spawned a thriving biodefense industry. Within that industry, the U.S. will recruit, employ, and train biodefense workers, providing technical expertise of value to a bioterrorist operation. The biodefense enterprise will thus produce a whole new generation of well-trained bioengineers prepared to develop more effective biotechnologies that, like all technologies, are ultimately beyond the control of the United States.

Many aspects of the biodefense program seem ideally suited to enhance the risk of bioterrorism — both real and perceived. Yet not all biodefense strategies are equally poised to backfire. Early detection technology, for example, may be useful in providing a critical window of opportunity for
intervention and is certainly not an offensive weapon in defensive clothing.

How do those holding the federal purse strings evaluate and determine appropriate strategies? The primary marketing tool for increased biodefense spending is simulated attacks — doomsday scenarios that quickly overwhelm existing resources. These exercises attract high-level decision makers. Playing on the worst fears of politicians and the public — such as a catastrophe that could have been averted — these pseudo-apocalyptic events are, in the opinion of those who prophecy them, extremely successful in getting politicians to put their money where their fears are.

Public Health Strategies

The recent increases in public health funding have not been justified by a specific threat. However, it is easy to follow the logic that the United States’ failure to adopt a primary prevention program, coupled with the impossibility of a successful preemption program, magnifies the need to develop an elaborate safety net designed to reduce the potential toll of a biological attack.

In 1985, in an effort to affect voter turnout, the Rajneesh cult poisoned salad bars, causing 757 Oregonians to become ill. The attack went undetected for five months and unsolved for a year — but not for lack of resources. Initially, agencies were not considering the deliberate deployment of germs. Once they did, communication, decision making, and investigative actions were poorly coordinated. The lessons learned from the only other contemporary biological attack on U.S. soil — the post-9/11 anthrax letters — are not so different. The Center for Disease Control (CDC) was specifically criticized for being slow to test postal workers and alert physicians, while the lack of coordination among the CDC, Department of Health and Human Services, and the FBI created a serious leadership void. Resources were already in place to detect germ warfare, but the planning to optimize their use was not.

It is the aftermath of a successful bioweapons attack, however, that most preoccupies America’s public health system today. Hospitals are being readied, biological attacks simulated, vaccines and antidotes stockpiled, health powers legislation passed, and the smallpox vaccine administered. What has emerged is an extraordinary, if somewhat frenzied, effort by public health systems nationwide to use the massive influx of biopreparedness funds. Unfortunately, the most important decisions have already been made by the time the money reaches public health agencies. And the burdensome responsibilities of enacting directives occupy time that could better be spent examining and contributing to our public health policies in a post 9/11 context.

A bioweapons attack may result in large numbers of patients requiring life-supporting interventions, but also generate many more people who anxiously flock to medical facilities in fear that they may be infected. The public will be ordered to stay home for days, relying on the pantry for food and bottled liquids. To effectively manage a real apocalyptic scenario would require not only enough available hospital beds, but a cooperative public willing to wait and worry while their personal liberties are curtailed by effective public health leadership. In other words, a real catastrophe would require the inversion of the usual American way: putting the community’s health first. Unfortunately, the U.S. health care system stopped putting the public’s health first long ago. Oriented toward the paying customer, existing systems and their patrons are unprepared for an event that must be managed using long-standing public health principles and resources.

While epidemiologists and other experts are busily examining the theoretical impact of surveillance, early detection, vaccinations and antibiotics, it is the public’s compliance with these and other emergency measures that will ultimately determine the success of the measures intended to counter biowarfare.

What are the determinants of compliance? While the success of any behavioral health intervention depends on an array of factors, there is general agreement that there are some essentials: comprehension of the nature of the threat; appreciation of the intended intervention; trust in the source of advice; and ability to exercise some personal control to reduce the likelihood of death. While smallpox has become the poster germ for biowarfare, there are many bacterial and viral candidates, little known to the public, that have different modes of transmission and medical consequences While first responders will be suited up in protective gear, no thought has been given to providing the public with simple facial masks that can effectively filter out most biological agents. And the lukewarm reception of health care providers to the smallpox vaccination program is hardly suited to inspire trust in federally sponsored programs.

The basis for a biopreparedness program is need. The public health community has not been given evidence that even remotely substantiates the need for the vigorous biodefence program underway. In the absence of adequate justification, public health officials rationalize the large expenditures with the trickle-down theory — suggesting that their top-heavy programs, even if unjustified, will yield useful improvements in infrastructure, training, diagnostics, and other valuable resources. But even if this were the case — and there is much dispute as to the validity of trickle-down — it would still not justify the massive emphasis on biodefense. The substance of a successful biopreparedness plan — like any other plan to manage a public health crisis — is public trust, comprehension, and individual preparedness. Vaccines and antidotes are the filler.

Public Policy

It is difficult to fathom the logic behind the U.S. biodefense strategy, but easier to understand why the logic is flawed. While 9/11 has compelled a focus on bioterrorism, the plans have been hatched by an administration that is trying to gain support for their plans to invade Iraq by perpetuating
a heightened sense of anxiety and fear. The Gingrich revolution’s abolishing of the Office of Technology Assessment in 1995 had already removed the technical and analytical tools Congress needs to independently assess bioterrorism; the war on bioterrorism has further short-circuited the oversight mechanisms so vital to the public interest. Effective public health leadership — principled, visionary, and cohesive — is conspicuously absent.

The public seems relieved to think their vulnerability is being addressed, and is unlikely to scrutinize the situation, especially since so much relevant information is beyond their reach. A rapidly developing biodefense industry, dependent on the war on bioterrorism, has dissuaded many who have the necessary knowledge from bringing clarity to our biodefense strategy for fear of undermining their own funding.

Indeed, existing dissent within governmental agencies has been actively discouraged. My colleagues in public health, who insist on remaining nameless, roll their eyes at the notion of rationalizing today’s war on bioterrorism on the basis of public health principles. They know that they face unmet needs while resources are allocated to programs that might be of no benefit, or to events that might never occur. However, they also are part of institutions now fed by this “war” — institutions where public debate is tightly controlled. Moreover, they are individuals with careers and hopes, who are not about to buck a trend that literally redefines their horizons.

While civil libertarians have been vigilant on issues of legal representation and freedom of speech for suspects detained without charges or access to lawyers, no equivalent watchdog organizations speak out about the post-9/11 policies and practices that may put the public’s health at risk.

Because our nation recognizes the conflict of interest between a company’s profit motive and the public’s health, federal agencies like the FDA, USDA, and CPSC regulate what the commercial sector can provide and say to the public. It hardly seems sensible for the government to create a biopreparedness program without a regulatory agency that can adequately scrutinize it. Public policy cannot be divorced from politics, even when it concerns itself with scientific matters. Reagan’s Star Wars was based on data produced by the military that, upon analysis by Congressional agencies, did not support the impressive claims used to justify the program. Public policies created from a pluralistic process and inclusive of
a multiplicity of values are more likely to support the public’s interest and less likely to serve private interests alone. Public health officials should encourage a public policy debate and not compartmentalize their “personal” opinions of the war on bioterrorism from their public responsibilities. At the very least, public health should apply the same standards for accepting funds as they do for requesting them. Congress and other government bodies should subject bioterrorism policy to the independent analysis it deserves.

Our public policies, including the biodefense program, are — if nothing else — a testament to U.S. sensibilities. To spend billions of dollars on a war against biological diseases that are imagined while millions die of actual and preventable diseases is self-serving, irrational, and offensive to any society decimated by the biological consequences of poverty — tuberculosis, malaria, and AIDS. The September 11 attacks do not exempt us from a morality that would judge our expenditures harshly. While post-9/11 fear may feel like a new and heavy affliction in the United States, many other countries would consider our obsession an indulgence. Ironically, this view may be shared by the Bush administration, which has
capitalized on the fear they steadfastly nurture. This irony is one of the few simple transparencies in our foreign policy, readily recognizable from the outside, and it strips the war on bioterrorism of any pretext of rationality.

The U.S. biodefense policy has not been justified, its programs may backfire, and its biopreparedness strategies fail to address the core determinants of success. When examined from the perspective of those whose suffering is remediable but unaddressed, the policy brings into focus the hypocrisy and self-indulgence that much of the world sees as the dark side of the United States.

Laurie Vollen is a Visiting Scholar at the University of California, Berkeley, Institute for International Studies. At Berkeley, Laurie is Director of the DNA Identification Technology and Human Rights Center and is currently working to develop a public health framework for biodefense strategy assessment.

There is not space here to do justice to Laurie’s extensive background in public health and international justice. In recent years, she has developed health care systems for Save the Children in Somalia; worked with Physicians for Human Rights in former Yugoslavia; conducted an International Commission of Jurists-sponsored assessment of the Jenin Refugee Camp in the aftermath of the Israeli Defense Force’s April 2002 incursion; and worked with the Life After Exoneration Project, helping the exonerated establish lives outside of prison.