Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe

The threat of terrorist groups using weapons of mass destruction (WMD) in warfare against the United States is at the top of Washington's national security agenda. Consequently, the U.S. Government is devoting billions of dollars annually to federal, state, and local levels to organizationally prepare and respond to such a worst-case scenario. Extensive efforts are being made with U.S. allies to coordinate a response to such an incident. However, as pointed out by the well-argued, compact book by Michael Osterholm and John Schwartz, such response efforts are inherently flawed because they lump chemical, biological, radiological and nuclear (CBRN) terrorist warfare, under the WMD threat umbrella whereas each type of potential warfare requires a unique and very different set of threat assessments and policy responses. As a result, if lumped together, valuable resources would be wasted because they would not address the very differentiated nature of threats presented by each of the CBRN types of warfare. Thus, in the authors' view, the initial response to bioterrorism should be primarily centered on medical care and public health, not military and law enforcement-which might be more appropriate to the other types of terrorist warfare threats. Moreover, of the four components of CBRN, Osterholm (the book's primary author) considers bio-terrorism to be the most likely and imminent type of attack against the U.S. homeland, for a variety of reasons that the book very insightfully discusses. One reason this book is significant is that Osterholm was chief state epidemiologist in Minnesota and for the past two decades has been an internationally renowned expert in infectious diseases. He now serves as chair and CEO of ican, INC. He collaborated in writing this book with Schwartz, a Washington Post reporter who specializes in the impact of science and technology on society. Osterholm's primary argument is that biological terrorism is the most likely threat facing this country and that a unique set of responses is required to manage its consequences. He writes in the introduction, "I do not believe it is a question of whether a lone terrorist or terrorist group will use infectious disease agents to kill unsuspecting citizens; I'm convinced it's really just a question of when and where." The book proceeds to outline the scope of the potential threat, with each of the nine chapters preceded by a series of fictional scenarios. According to Osterholm, bioterrorism is imminent because of the coalescence of three factors: Terrorists who are motivated to carry out such attacks. The post-Cold War era has spawned a proliferation of extremist groups, "lone wolves," religious cults, and terrorists who are motivated by ideological extremism to use weapons that can cause catastrophic harm. Some of these terrorist groups also are allied with state sponsors, whose biological weapons programs could be used to carry out such attacks. Available infectious agents. In Osterholm's view, it would be relatively easy for terrorist groups (and their scientists) to procure and produce infectious agents. Likely agents of biological terrorism might include smallpox, anthrax, plague, botulinum toxin, tularemia, and hemorrhagic fevers, such as the Ebola virus (which is in the news because of an outbreak in Uganda). The ability to deliver agents to targets. Until recently, biological weapons were "battlefield weapons" that required the investment and technological expertise of "full-scale warfare," by means of high-tech missiles and bombs that were available only to nationally funded programs. However, today's terrorists are likely to use less expensive technologies that would exploit "recent benign uses of biomedical and aerosol technologies" to unleash the "incredible destructive power of the biologic agents." Pathogens could be released by low-tech outdoor means such as a plane or spray truck, or an indoor release of aerosol particles within an airplane, airport, or shopping mall, or a juice bottle, or a vial of dried anthrax spores to break and release the deadly agent, or even dispersing dry agents by means of over-the-counter pharmacy inhalers. Osterholm presents a total of nine fictional scenarios for a biological attack, such as an airplane dispersing microscopic anthrax spores over a football stadium, a former Soviet scientist who unleashes smallpox in a shopping mall during the Christmas rush, and a smallpox attack against a major city. He very ably describes the chaos that would follow, as hospitals with insufficient antibiotics or vaccines try to cope with tens of thousands of sick people. While Osterholm is scientifically correct in diagnosing the horrific impacts of bioterrorism, one of the weakest aspects of his argument is the lack of discussion of the numerous constraints that would drive most terrorist groups away from embarking on a biological attack, particularly in terms of a group's motivation, strategy, and internal and external hurdles that need to be overcome to acquire such a capability. Thus, while it is true that a biological attack might be an attractive option because it would be more likely to be undetected, most terrorists still prefer to carry out attacks that involve explosions by conventional devices. Thus, only a very small subset of the 29 worldwide terrorist groups officially designated by the U.S. Department of State would fit Osterholm's category of likely bioterrorists. One of the book's many strengths is its argument about the need for more efficient government coordination and spending to combat "microbial" terrorism. In a biological attack the first responders would be local medical and public health personnel, but no American municipality is fully prepared. If a biological attack were to occur, supplies of vaccine would be inadequate, so "even an accidental release of this virus into civilian populations would result in catastrophe." To improve the government's response effort, Osterholm proposes an "eight-point plan for change." The eight points are focusing on the individual components of WMD, as opposed to lumping them together; building the stockpile of the right antibiotics and vaccines for the most likely agents that would be used in a biological attack; upgrading the hospital and public health "surge capacity" to handle a catastrophic incident; shoring up the public health infrastructure to quickly respond to an outbreak; improving coordination between federal, state, and local governments; improving press coverage of the potential bioterrorist threat; more frequent and realistic drills and exercises by authorities that would be involved in managing the consequences of an incident; and bringing the government and the citizenry together to act responsibly on this issue.