With 1,000 deaths attributed to swine flu in the United States and a virus that has spread to 46 states, President Obama has declared H1N1 a national emergency. But what would be happening if instead we were confronting an intentional release of a deadly and contagious pathogen, such as smallpox, by a group of terrorists?
Last year, the bipartisan Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism concluded it was more likely than not that "a weapon of mass destruction will be used in a terrorist attack somewhere in the world by the end of 2013." More recently, the commission issued an interim report, "The Clock Is Ticking" [.pdf], stating that "the threat of bioterrorism is real" and that "the United States must strengthen resilience by developing the capability to produce vaccines and therapeutics rapidly and inexpensively." Clearly, the current shortage of H1N1 vaccines demonstrates the public’s vulnerability to bioterrorism. While the WMD Commission’s prediction of a bio-attack by 2013 might be more dire than real, the commission is nonetheless correct on two counts: that we are unprepared and that the clock is ticking.
In June 2001 an exercise, Dark Winter, was conducted to understand the implications (not likelihood) of a bioterrorist attack using smallpox. Smallpox was considered eradicated in the 1970s (the last known case in the United States was in 1949), so people are no longer routinely vaccinated for the disease, which means the population is vulnerable if infected (much like swine flu now; since it is a completely new strain of flu, no one was vaccinated against it before its outbreak earlier this year). As a result, on day six of the Dark Winter exercise crisis there were 2,000 known cases of smallpox and 300 deaths. With only 12 million doses on hand, the reserve of smallpox vaccine was effectively used up on day six. By day 12 of the crisis, there were 3,000 cases and 1,000 dead in 25 states. With the vaccine supply exhausted, the smallpox virus was projected to explode as follows:
- After 3 weeks: 30,000 cases and 10,000 dead.
- After 5 weeks: 300,000 cases and 100,000 dead.
- After 7 weeks: 3 million cases and 1 million dead.
What Dark Winter demonstrated – and the swine flu pandemic confirms – is the difficulty of trying to respond to a bio threat after the fact. In the case of smallpox, a more effective approach than leaving the entire population at risk and responding only in the event of an actual smallpox attack would be to make the smallpox vaccine available to the public for voluntary vaccination. Even if only a fraction of the population chose to be vaccinated, there would be a community immunity effect that would lower the rate of transmission of the disease in the event of an outbreak or attack and significantly increase the effectiveness of post-infection vaccination, as well as therapeutics (if any are available) to combat the virus in those people who have already been infected.
So the WMD Commission’s "The Clock Is Ticking" recommendations for responding to the bio threat are well founded. Indeed, the better we are able to limit the consequences of a bio attack through vaccinations and therapeutics, the more likely it is that biological agents will no longer be considered a weapon of mass destruction. And making such an investment is certainly better than spending hundreds of millions, if not billions, of dollars on more illusory security measures that erode our liberties or invade our privacy.
But even if we are able to achieve the WMD Commission’s goal in a cost-effective manner, we must also recognize that doing so will not be a cure for the root causes of why people engage in terrorism – including possible bioterrorism – against America and Americans. Unfortunately, this is not an issue the WMD Commission addressed – nor has it been addressed by any other blue ribbon commission in the post-9/11 era, including the 9/11 Commission, which recognized the problem of U.S. foreign policy in motivating terrorism but rather than prescribing a change in policy concluded: "That does not mean U.S. choices have been wrong. It means these choices must be integrated with America’s message of opportunity to the Arab and Muslim world."
So even if the WMD Commission’s recommendations are heeded and we get better at protecting ourselves against and responding to terrorist attacks, without reexamining and changing those policies that motivate people to become terrorists, the clock will still be ticking and we won’t have reduced the threat.
