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75–040 DTP 2001

S. HRG. 107–124

THE THREAT OF BIOTERRORISM AND THE

SPREAD OF INFECTIOUS DISEASES

HEARING

BEFORE THE

COMMITTEE ON FOREIGN RELATIONS

UNITED STATES SENATE

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

SEPTEMBER 5, 2001

Printed for the use of the Committee on Foreign Relations

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/senate

COMMITTEE ON FOREIGN RELATIONS

JOSEPH R. BIDEN, JR., Delaware, Chairman

PAUL S. SARBANES, Maryland

CHRISTOPHER J. DODD, Connecticut

JOHN F. KERRY, Massachusetts

RUSSELL D. FEINGOLD, Wisconsin

PAUL D. WELLSTONE, Minnesota

BARBARA BOXER, California

ROBERT G. TORRICELLI, New Jersey

BILL NELSON, Florida

JOHN D. ROCKEFELLER IV, West Virginia

JESSE HELMS, North Carolina

RICHARD G. LUGAR, Indiana

CHUCK HAGEL, Nebraska

GORDON H. SMITH, Oregon

BILL FRIST, Tennessee

LINCOLN D. CHAFEE, Rhode Island

GEORGE ALLEN, Virginia

SAM BROWNBACK, Kansas

MICHAEL B. ENZI, Wyoming

EDWIN K. HALL, Staff Director

PATRICIA A. MCNERNEY, Republican Staff Director

(II)

CONTENTS

Page

Cilluffo, Frank J., senior policy analyst, Center for Strategic and International Studies, Washington, DC ...................................................................... 86

Prepared statement .......................................................................................... 89

Henderson, Donald A., MD, MPH, director, Center for Civilian Biodefense

Studies, Johns Hopkins University, Baltimore, MD ......................................... 62

Prepared statement .......................................................................................... 65

Heymann, David. L., MD, executive director, Communicable Diseases, World

Health Organization, Geneva, Switzerland ....................................................... 70

Prepared statement .......................................................................................... 73

Ikle ́, Dr. Fred C., distinguished scholar, Center for Strategic and International Studies, Washington, DC ...................................................................... 59

Prepared statement .......................................................................................... 61

Nunn, Hon. Sam, co-chair and chief executive officer, Nuclear Threat Initiative, Washington, DC ........................................................................................... 13

Prepared statement .......................................................................................... 19

Woolsey, Hon. R. James, former Director of Central Intelligence, and partner,

Shea & Gardner, Washington, DC ..................................................................... 26

Prepared statement .......................................................................................... 30

(III)

(1)

THE THREAT OF BIOTERRORISM AND THE

SPREAD OF INFECTIOUS DISEASES

WEDNESDAY, SEPTEMBER 5, 2001

U.S. SENATE,

COMMITTEE ON FOREIGN RELATIONS,

Washington, DC.

The committee met, pursuant to notice at 10:00 a.m., in room

SD–419, Dirksen Senate Office Building, Hon. Joseph R. Biden, Jr.,

(chairman of the committee) presiding.

Present: Senators Biden, Boxer, Bill Nelson, Rockefeller, Helms

and Lugar.

The CHAIRMAN. The hearing will come to order.

National security, to state the obvious, is the first obligation of

every government. And the test of how well we meet that obligation is whether whatever action we take makes us more or less secure in the end.

There are some very difficult decisions with hard choices relating

to strategic doctrine, foreign policy, threat assessment and economic constraints that every President and every government has

to face.

And just as we would all agree that we would provide for the

health care of all if we had unlimited funds, when there are not

unlimited funds we have to make difficult choices. We have to

make the same kinds of decisions in terms of our national security.

One aspect of our sacred responsibility to our fellow citizens, to

provide for the physical security of our Armed Forces and to protect

our homeland, is how we go about this process.

This is the first in a series of hearings on what have been termed ‘‘Homeland Defense and Protecting U.S. Military Forces,’’ where we

will focus on the threats to our homeland and attempt to assess

what those threats are and prioritize them to be able to make rational recommendations to our colleagues.

These hearings have taken on an added sense of urgency in my

view for two reasons: The most ominous reason is there appears to

be an overwhelming focus, I would subjectively characterize as a

myopic focus, on national missile defense by the Bush administration.

We appear to be about to jettison 50 years of strategic doctrine

grounded on three basic principles: One, reduce the number of nuclear weapons in the world and prevent proliferation to other countries; Two, stop all nuclear weapons testing, because only with new

testing can new weapons of mass destruction be developed. And the

United States is far ahead of the game.

2

And, Three, diminish or eliminate the reliance on those nuclear

weapons which are most vulnerable and therefore the least stable

because they are most likely to be used on short warning. These

have been at least three of the basic principles of our strategic doctrine for the last five decades.

But, for example on August 16, Secretary Rumsfeld told the

‘‘Lehrer News Hour’’ that he didn’t care if other countries responded to a U.S. missile defense by MIRV’ing or re-MIRV’ing their

ICBMs. He added, ‘‘What really counts is the total number of weapons.’’

In doing so, the Secretary threw out decades of rightful concern

over crisis stability which lead to the landmark efforts by the

Reagan and Bush administrations to get the Soviet Union to give

up MIRVed ICBMs. In the interest of missile defense, Secretary

Rumsfeld reduced our nuclear strategy to a simple numbers game.

Later last month, Under Secretary of State Bolton suggested that

we might withdraw from the ABM Treaty if President Putin does

not agree by November to scrap the treaty.

Russian officials had publicly declared their willingness to amend

the ABM Treaty. But obviously an amendment does nothing.

The administration and Mr. Bolton then tried to walk back his

comments. Maybe they realized the United States won’t win any

friends by rejecting Russian proposals when we have none of our

own, especially on offensive force reductions, which President Bush

and President Putin agreed were tied to the issue of missile defense.

But I have yet to hear any serious U.S. proposals or any rational

explanation of why we cannot amend the ABM Treaty to permit

the testing that the administration wants conducted. And just this

weekend there was a bit of a flap in the press—a number of national press people questioned me, and I’m sure the rest of my colleagues, on press reports the administration is willing to let China

MIRV its ICBMs and let it resume nuclear testing in response to

a missile defense deployment.

The Chinese build-up may, in my view, spark a new arms race

involving India and Pakistan. But our withdrawal from the ABM

Treaty, the end of the START process and renewed nuclear testing

seems to be something that the administration may be willing to

pay in order to be able to move forward with an untested,

undeclared national missile defense.

A few months ago, and I don’t want to get in the middle of this

but there is a former famous Senator who may testify today who

warned against making missile defense an issue of theology. Looking at recent administration actions, I’m beginning to wonder

whether we run into theology or technology.

The second reason for a sense of urgency of these hearings is the

state of the budget. We are not where we were 15 months ago with

a large surplus. The loss of the surplus and the lack of funding

have created new impairments.

It was at least theoretically possible 18 months ago to meet all

our defense needs. But because of the state of the economy and arguably some action taken to reduce the surplus, that is no longer

possible. So we have to now prioritize.

3

And we still have no reliable estimates on the full cost of national missile defense, but we know that they range from $60 billion to hundreds of billions of dollars to develop the systems contemplated by the Bush administration and the last administration.

Obviously, we don’t have enough money to do everything. The estimates for the 10-year cost for modernizing our conventional forces

range from $250 to $650 billion over 10 years. So these are the two

reasons for the urgency of these hearings.

Hopefully, when we finish our hearings we’ll have a much clearer

understanding of the needs we face and which we should address

first.

Today’s hearing will focus on the threat of bioterrorism and the

holes in our homeland defense policy when it comes to combating

this threat. We begin with two expert panels on two closely linked

issues: Bioterrorism and the spread of infectious disease.

Our globalized world, where people and goods constantly move

across borders, is a perfect breeding ground for the spread of disease, whether from natural epidemics or bioterrorism. It would

seem to me, and I’m sure the testimony we will hear today will address this, that any steps we take against the threat of biological

terrorism could reap benefits in medical efforts to slow future infectious disease epidemics and vice versa.

An improved public health system in the United States would

help address this great national security threat as well. But make

no mistake, a biological weapon smuggled across a border and the

spread of infectious disease are very real threats.

This hearing will give us insight into how well prepared we are

to engage those threats and what we need to do if we are not fully

prepared, and hopefully we’ll have some estimate of the costs of

doing all this.

Our first panel will focus on the truly harrowing consequences

that a bioterrorist attack would have on our people and indeed on

our democratic political system. Former Senator Sam Nunn and

former Director of Central Intelligence Jim Woolsey have participated in a chilling simulated exercise called ‘‘Dark Winter.’’

I wish we had the time, and maybe we will see parts of the CD–

ROM they produced from that exercise. As I’m sure both Senator

Nunn and Mr. Woolsey will emphasize, ‘‘Dark Winter’’ was a nightmare scenario exposing serious flaws in our public health infrastructure’s ability to deal with a major disease, whether it be a

smallpox attack or a flu epidemic.

I reviewed that scenario last night, and I can tell you that it is

harrowing. It was frightening not just for the many, many people

around the world who could be felled by a biological weapons attack. Perhaps even more frightening was the risk that if we do not

prepare rationally for such an awful event, we may put our democracy at risk.

Our witnesses are: Dr. D.A. Henderson, director of Johns Hopkins Center for Civilian Biodefense Studies; Dr. David Heymann,

executive director of Communicable Diseases at the World Health

Organization; and the Honorable Fred Ikle ́, former Director of the

U.S. Arms Control and Disarmament Agency, who is now a distinguished scholar at the Center for Strategic and International StudVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 75040 SFRELA2 PsN: SFRELA2
4

ies; and Frank Cilluffo, senior policy analyst at the Center for Strategic and International Studies.

Before hearing our first panel, I would like to make part of the

record two letters to the committee, one by Dr. Joshua Lederberg,

a Nobel Laureate and noted expert in infectious disease, and the

other by Dr. John Mekalanos, chairman of the Department of

Microbiology and Molecular Genetics at Harvard University.

These two scientists are among the most accomplished microbiologists and infectious disease experts in the world. Dr.

Lederberg’s letter is actually a primmer on what he calls, ‘‘a matter

of transcendent importance to our security and to global human

welfare.’’

He warns that biological weapons are ‘‘Probably the most perplexing and gravest security challenge we face.’’ But he approaches

that challenge with both clarity and wisdom. Listen to his description of the dilemma dealing with a biological weapons attack. ‘‘The

organization of government to deal with mass contingencies is a

vexing and still poorly attended problem. It entails the coordination

of local, state and Federal assets and jurisdictions; the intersection

of law enforcement, national security and public health; and a time

of crisis is not the best venue for quarrels over responsibility and

authority, over who will pay for it.

‘‘Our main bulwark against direct large-scale attack is a combination of civic harmony and firm retaliation against egregious

transgressors.‘‘

Dr. Lederberg also discusses the role that primary prevention, including strengthening of our intelligence capabilities, should play

in any response.

Dr. Mekalanos presents his findings on the emergence of new infectious agents in nature and the import of the advances in microbiology on the threat posed by bioterrorism.

If, God forbid, America should ever be attacked by biological

weapons, it will be the scientists and the public health professionals on the front lines, not just our men and women in uniform.

And it’s the scientists and public health officials, as well as state

and local governments and public services, who will have to be

fully prepared to engage the enemy, whomever it is and whatever

it is.

On the other hand, U.S. military must have the ability to detect,

survive, and maintain operations during biological attack. It must

also be prepared to assist at home in ways that buttress, rather

than undermine, the authority of state and local officials.

I said that God forbid we should ever be attacked in this manner.

But the truth is that such an attack is more likely today than it

ever had been in the past, and that the comparable natural epidemic is all too possible in the decades to come.

In my view, the threat from anonymously delivered biological

weapons and from emerging infectious disease simply dwarfs the

threat that we will be attacked by a Third World ICBM with a return address. I’m not suggesting anyone else agrees with me on

that. That is just my view.

Whether you agree or disagree with that judgment, however, it

is clear that bioterrorism and infectious diseases are real threats

5

that demand our attention now. Because there are steps that we

can realistically take now to contain them.

If we can come to grips today with the implications of that reality, then this may be the most important hearing we hold this

year.

In ending my statement, let me exercise a point of personal privilege, actually, two. When Senator Nunn was the Chairman of the

Armed Services Committee, he and I put together a little piece of

legislation on antiterrorism. And I can just remember, Sam, the

difficulty we had and the inability we had, notwithstanding the

consensus we thought we had, to deal with the little thing called

posse comitatus and how we were going to deal with weapons of

mass destruction, the role of the military in dealing with them in

a domestic attack that was a terrorist attack.

If I just think of that one debate, that one debate, the concerns

you have all raised in ‘‘Dark Winter’’ make that one concern pale

by comparison.

[The letters referred to by Chairman Biden follow:]

JOSHUA LEDERBERG, University Professor-Emeritus,

THE ROCKEFELLER UNIVERSITY,

1230 YORK AVE., NEW YORK, NY, August 30, 2001.

Hon. JOSEPH R. BIDEN, JR.

Chairman, Committee on Foreign Relations,

221 Russell Senate Office Building,

Washington, DC.

DEAR SENATOR BIDEN:

I am honored to have the opportunity to address you and your committee by

means of this letter, on a matter of transcendent importance to our security, and

to global human welfare. I refer to the threat of use and proliferation of

(micro)biological weapons, which will be almost irresistible temptations to malignant

persons and states, who would otherwise be intimidated by the U.S. preeminence

in wealth and military technology.

To structure your perusal, my outline will be as follows.

• definition, historical note, and assessment of scope of the BW threat

• Countermeasures: diplomatic

• defensive preparations

• deterrence and intelligence

• primary prevention; our clean hands

• inspiring global convergence on health as human aim

• Definition, historical note, and assessment of scope of the BW threat

I will define biological warfare as the use of agents of disease for hostile purposes.

This embraces attacks on human health and survival, but extends also to plant and

animal crops. Far from vague speculation, BW was the focus of billion dollar investments, both by the U.S. and the USSR until President Nixon’s unilateral abjuration

in 1969. This was followed by the negotiation, ratification and coming into force (in

1975) of the Biological Weapons Convention (BWC). This is a categorical ban of the

development, production or use of BW.

The cardinal features of BW are outlined in attached Table 1.

Most important are:

low cost and ease of access

difficulty of detection, even after use, until disease has advanced

unreliable but open-ended scale of predictable casualties

per kilogram of weapon the potential lives lost match nuclear

but would need far less costly and sophisticated technology

clandestine stockpiles and delivery systems—the proverbial suitcase

perhaps concealed in a bale of marijuana.

6

Published citations to intelligence estimates would place up to a dozen countries

in the camp of BW-developers. Considerable harm could be done (on the scale of,

say, a thousand casualties) by rank amateurs. Terrorist groups, privately or statesponsored, with funds up to $1 million, could mount massive attacks of 10 or 100

times that scale. Important to keep in mind: if the ultimate casualty roster is 1000,

there will have been 100,000 or 1,000,000 people at risk in the target zone, legitimately demanding prophylactic attention, and in turn a draconian triage. Several

exercises have given dramatic testimony to how difficult would be governmental

management of such incidents, and the stresses on civil order that would follow

from inevitable inequities in that management.

The short bottom line is that, in the current world where major states sustain

some equilibrium through mutual deterrence, and positive shared interests, BW offers opportunity for grave harm on the part of lesser actors. Relative to the assets

and doctrinal insights available, BW is probably the most perplexing and gravest

security challenge we face.

• Countermeasures: diplomatic

President Nixon’s abjuration of BW as a U.S. military weapon, in 1969, set in motion the most important diplomatic and legal steps towards the eradication of BW

globally, laying the groundwork for the BWC treaty. The BWC lacks robust

verification machinery, mainly for reasons intrinsic to the technology, and as well

that certain parties to the BWC have no intention of complying with it. But BW

verification is not the foundation of our own no-BW stance; the U.S. has long since

abandoned the idea that it need or would respond in kind to BW attack. Were it

not for the BWC we would have seen a gradually escalating technology race, amplifying even further BW’s threat to human existence. The BWC does set a consensually, or at least rhetorically, agreed standard of behavior: namely, it has become

institutionalized into international law, and infractions open the door to enforcement. Further verification provisions would do little to enhance our actual knowledge of those infractions: they would nevertheless have important symbolic value in

reaffirming international attachment to the principles of the BWC. At minimum it

behooves us to exercise creative leadership in developing alternative means of bolstering that reaffirmation.

The real problem with the BWC is less verification than it is enforcement. We

have all but certain knowledge that Saddam Hussein has continued Iraq’s (grudgingly admitted) BW development program, the main sore point in his squabbles with

the UN. (We can hardly be certain that his nuclear program has not been revitalized, though that would be more difficult, and from his perspective possibly redundant.) We have failed to convince our allies, much less the diffident ‘‘neutrals’’ and

potential adversaries, that halting Iraq’s BW is worth turning their back on his oil

contracts. To convince them of what is at stake we may have to start with elevating

the priority we give to the BW threat generally. We must also become more knowledgeable about the local political and cultural terrain, and more ingenious in the

design of punitive and compellent sanctions that will persuade Saddam of his errors

without undue hardship to the Iraqi population that he also victimizes! That would

carry us further with the international consortia in which we have to invest political

capital (and not waste it in other tangents) to be sure this major threat is quenched.

If Saddam does develop and effectively use BW even in a purely regional context

(the most likely), that will not only be a humanistic catastrophe; it is unlikely we

will ever restore the principle of mutual forbearance in resorting to BW.

Our public diplomacy is predicated on the stated proposition that the use of BW

is an offense to civilized mankind. That is a major accomplishment of the BWC. It

needs to be reaffirmed as well in the attention we give to our own defense, as well

as to our stern responses to significant infractions in any quarter.

• Defensive preparations

BW threat mitigation is indispensable, so as not to present irresistible temptations to mischief makers, for whom interstate deterrence is irrelevant. Unlike the

aftermath of a nuclear or high explosive bombardment, BW attack is amenable to

interventions for some hours or days after the event, depending on the agent used.

With the best popularized BW agent, anthrax, at feasible dose levels the administration of appropriate antibiotics can protect the majority of those exposed. The other

side of the coin is the urgency of recognizing the syndrome within hours of the earliest symptoms. Biosensors are being developed that can be used to confirm suspicions of anthrax. For some decades, we will have to rely on early diagnosis of the

first human (or animal) cases to have the basis for focussing those sensors. As a

wide list of diseases are in the picture, this entails nothing more nor less than reinvigorating our overall public health infrastructure. In contrast to the explosive rise

7

of health care expenditures—with universal access to ever more technically sophisticated health care—public health has been allowed to languish, boosted only very recently by public arousal about emerging infections and about bioterrorism. That

boost entails people and organizational structures, but improvement also comes

down to money—new money, as well as the relabelling of established programs.

Besides the diagnostics, we need organizational and operational doctrines that can

confront unprecedented emergencies, we need trained people on call, we need physical assets for logistics, isolation, decontamination and care. We also need stockpiles

of antibiotics and vaccines appropriate to the risk—and before that, more careful

analysis of what kinds and how much we need. We need research on treatment modalities—how we manage the care of inhalational anthrax with possibly limited supplies of antibiotics (and which kinds?) is not that well understood. And still more

fundamental research could give us sharper tools for diagnosis, and more usable

ranges of antibacterial and antiviral remedies.

The organization of government to deal with mass contingencies is a vexing and

still poorly attended problem. It entails the coordination of local, state, and federal

assets and jurisdictions; the intersection of law enforcement, national security and

public health; and a time of crisis is not the best venue for quarrels over responsibility and authority, over who will pay for it.

• Deterrence, intelligence and preemption

Our main bulwark against direct large scale attack is the combination of a civic

harmony, and firm retaliation against egregious transgressors. It is sometimes said,

we should not worry about BW attacks, ‘‘we’ll just ‘nuke the perps’ ’’ if they dare.

Lacking the clear provenience of a missile track to finger the aggressor, that puts

us at the mercy either of bafflement, or worse of calculated disinformation as to the

source. Good, I have to say better intelligence is the key to retaliation, apprehension, and penal containment and sanctions. This is technically unfamiliar territory

for most of the intelligence community; it has nevertheless taken many positive

steps, but it still has a long way to go, and once again is resource-constrained compared to what goes on in the collection and analysis against other more familiar

threats.

A related vein of opportunity is found in the realm of cooperative threat reduction.

Since BW facilities can be so readily reconstituted, it is less important in the long

run to destroy production facilities, even stockpiles, than it is to get toxic technical

knowledge diverted to constructive purposes. Former weapons scientists in Russia

need financial as well as moral encouragement to ply a new trade in vaccine development and other constructive pursuits. This could benefit Russia, and its circle of

less developed countries directly, and thus enhance security globally. The alternative is for some few of of the ex-biowarriors to sell their knowledge, and who

knows what range of horrific bio-strains, to the highest bidders among the rogues.

We do have very modest programs in place: they should be expanded, not put at

risk for flimsy excuses as seems to be happening.

• Primary prevention; our clean hands

I have already alluded to public diplomacy (starting with firm conviction at home)

about the priority needed to be applied to averting any successful BW attack. We

have to be careful to behave ourselves fully consistently with abhorrence at the idea

of using disease as a weapon. Such attributions will be lodged against the U.S. as

part of general America-bashing (witness the ongoing rumor campaign in Africa that

the U.S. government had somehow ‘‘invented AIDS’’). They will also be excuses for

continued simmering of the BW pot in other venues.

A particular dilemma is how to study the BW threats in detail, how to develop

vaccines and other countermeasures, without attracting such accusations. I believe

the executive and legislative branches could develop models of entrusted transparency for oversight of such necessary studies, both for assurance to global publics,

and to be certain there are no careless projects oblivious to the reputational or physical harm they could inflict on our polity.

• Inspiring global convergence on health as human aim

The central premise of the BWC is that infectious disease is the common enemy

of all humankind; and it is a treasonable act to join with that enemy.

Those motives clearly inspired adherence to the BWC, even on the part of (smaller, poorer) countries who might otherwise exploit BW to level a playing field as

against a superpower. Having set aside BW as giving small advantage and numerous migraines for our own military power, we should count it fortunate that we

share those interests and conclusions. They can only be bolstered if we internalize

that ideology, and participate ever more fully in global campaigns for health. The

new funds for the scourges of AIDS, malaria, and tuberculosis are right on the

8

mark! Their levels to date are just tokens—yes compare them to military hardware!—but certainly in the right direction, and it’s just about time we assumed

leadership of that vector among the nations cooperating with the WHO to bolster

global systems of surveillance of disease and coping with outbreaks that promise to

threaten all of us.

Besides the global humanitarian, political and economic virtues of this newfound

direction, there are good selfish motives as well. What would it pay for us to invest

to reduce the likelihood that another AIDS will emerge from a distant continent,

and cross the oceans to vex us at home. There will be no stopping the birds, nor

the frequent flyers, from disseminating ever more novel risks needing that global

surveillance. I do not count West Nile virus as a likely major scourge, but it is just

one more exemplary warning!

TABLE 1—GERMS AS ARMS: BASIC ISSUES

BW vs. CW: living germs vs. chemicals

might spread; unstable; self-amplify

Underlying science is unalterably dual use

licit defensive exploration

targetted against natural disease

Likewise production up to point of weaponization

vaccines vs. BW agents?

Facilities moderate scale; few external signatures

easily concealed or masked by licit programs

Weapons: potent, but unfamiliar and unreliable in military context

Tactical defense is easy: physical barriers (masks, suits)

Latent period up to 36 hours. Disease may be treatable

Hence focus on civil health preparedness

Hardly understood until now, these are strategic weapons.

. . . At same time, accessible to small powers . . . or groups

Seen as answer to a Superpower self confident about the ‘‘revolution in military

affairs’’.

Capabilities can scarcely be denied

remedial and intelligence focus on intentions

STATEMENT SUBMITTED BY JOHN J. MEKALANOS, PH.D.

Dear Honorable Committee Members:

Thank you for inviting me to comment on the related issues of biological terrorism

and the threat of emerging infectious diseases to the security of the United States.

I feel qualified to speak on these topics because of my scientific background. In brief,

I have over 27 years of experience in infectious disease research and currently serve

as Professor and Chairman of the Department of Microbiology and Molecular Genetics at Harvard Medical School. Our Department consists of a group of outstanding

investigators dedicated to understanding and controlling bacterial and viral diseases.

Although awareness of the dangers posed by biological warfare (BW) has increased significantly in recent years, it is my belief that we are still far from prepared to contend with a biological weapons attack. There are many reasons for this,

and numerous analyses over the past few years have examined the issues carefully.

This letter is intended to provide a brief overview of the scientific aspects of biological weapons development, as perceived from the point of view of microbiological research. I also want to emphasize that many of my comments about BW threats also

apply broadly to threats that we face from nature. We have seen numerous examples of this recently: a new highly lethal strain of flu virus, a mysterious prion,

multidrug-resistant tuberculosis, HIV, and malaria. Obviously, we are and will continue to be under constant assault by emerging microbes whose origin may be natural but whose spread to the U.S. will take full advantage of modern modes of travel, new human activities, and increased population density.

To begin with, biological weapons are comparatively inexpensive and simple to

manufacture. They are therefore accessible and attractive to those that lack sufficient means to pursue costlier weapons programs. One estimate suggests that a significant biological arsenal could be produced with as little as $10,000 worth of

9

equipment, though other studies have questioned the potential lethality of material

produced by such rudimentary operations. Construction of the most sophisticated

BW agents would indeed require significant scientific skills and equipment. However, the fact remains that the production of biological weapons is not as limited

by technical expertise as that of other weapons. For example, it is fairly easy to introduce new antibiotic resistance genes into bacteria. This does not require extensive technical training, and the relevant methods and materials are widely available

from even commercial vendors. Because the medical community is already struggling with the appearance of multi-antibiotic resistant, clinically important microbes, even a simple genetic manipulation such as transferring a single critical antibiotic resistance gene into a single pathogen could have extremely serious consequences.

As far as initial acquisition of pathogens by unscrupulous parties is concerned, it

would not be exceptionally difficult to obtain pathogenic strains. Microbial samples

are transferred between labs on a daily basis in the normal course of biomedical or

pharmaceutical research. It is fortunately not so simple for unauthorized personnel

to acquire highly pathogenic strains, as traffic in these is regulated carefully, but

it is certainly possible for determined individuals to acquire less virulent strains by

fraudulent means or theft. These strains could then be genetically modified to increase their pathogenicity, though this would probably require a higher level of scientific training as well as a longer period of development. Efforts along these lines

were vigorously pursued in the former Soviet Union, and since its dissolution, their

experts have likely been recruited to a variety of rogue states that openly threaten

the U.S. and its allies.

Biological research activity is currently growing at a tremendous rate, and although the potential contribution to human welfare is enormous, it is simultaneously providing additional tools that could be used for the construction and delivery of more powerful pathogens. Much of the information that is being generated

by biological researchers is publicly available, either in print or via the Internet.

The ease with which any individual can access data relevant to the genetic engineering of pathogenic organisms can only be expected to increase in the future.

Although the Biological and Toxin Weapons Convention of 1972 was ratified by

140 countries, there is no real mechanism for verifying compliance. Monitoring is

particularly difficult since many of the components of a biological weapons program

can also be used in fully legitimate pursuits. Apparatus employed in the manufacture of food products such as yogurt or beer could be used to grow pathogenic cultures, and yet it hardly seems practical to apply the same stringent restrictions to

beer fermenting equipment as to material that is of demonstrable military sensitivity (e.g., explosives or nuclear technology). It is useful in this situation to recall

the much-discussed bombing of a baby milk factory in Iraq during the 1990-91 Gulf

War. The facility was destroyed because it was suspected of producing biological

weapons. I personally am not able to judge whether this facility made baby formula

or biological weapons components at any point in time, but this illustrates the potential for confusion.

The conclusion is that it is certainly possible for small nations or terrorist groups

secretly to amass sufficient material to present a biological threat, although the seriousness of the threat would depend on the exact circumstances.

I think it is important at this time to point out that the results of biological manipulation are sometimes difficult to predict, even for highly trained professional scientists. Less than a year ago, Australian researchers seeking to develop a biological

contraceptive to combat rodent infestation, inadvertently created a strain of

mousepox that was more virulent than the original parent strain. Considering that

this occurred in the context of perfectly well-intentioned research that was intended

to benefit humans, we would do well to remember that the law of unintended consequences also applies to malefactors. The chances of unwittingly creating a ‘‘superpathogen’’ will only be increased by deliberate attempts to enhance an organism’s

pathogenic potential, and there is no assurance whatsoever that even the producers

of such an agent would be able to control it.

Next, I will mention briefly what can be done to combat biological warfare. Measures necessary for countering biological attacks can be divided into several categories: surveillance and early warning systems, treatment, and prevention. In this

letter, discussion of prevention will deal only with biological considerations such as

vaccine development and usage, since military concerns do not lie within my area

of expertise. I will also leave aside consideration of pathogens that target agriculture, focusing instead on those that affect humans directly.

Clinical surveillance and early warning measures are critical not only because

timely treatment of affected individuals often means the difference between life and

death, but also because infection must be prevented from spreading to other individVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6621 75040 SFRELA2 PsN: SFRELA2
10

uals and regions. Depending on the actual agent employed, the impact of a biological weapon can extend far beyond the initial point of attack. This is especially true

with highly communicable agents (e.g., smallpox), but it applies to all infectious

agents that demonstrate a delayed onset of symptoms. Victims may not know that

they are infected and so not seek treatment or take precautions against spreading

the disease to others. Unfortunately, it may be extremely difficult to detect an attack. Unlike nuclear or chemical weapons, the delivery of biological agents need not

be accompanied by telltale explosions and could be quite stealthy. The initial symptoms of bioweapons infections are often nonspecific, and anthrax and smallpox are

so rare in the U.S. that the majority of physicians might not recognize even the

characteristic symptoms of these diseases. In addition, current systems for reporting

cases of infectious disease would likely not uncover the presence of a covert attack

before significant damage had occurred.

Treatment of BW victims typically consists of antibiotic or vaccine therapy and

supportive care. Obviously, this requires an adequate supply of effective drugs and

appropriate clinical facilities. In this respect also, the U.S. is poorly prepared. Not

only are there serious logistical questions regarding distribution of drugs and supplies in a crisis situation, but studies of U.S. hospital facilities have concluded that

there is significant pressure with regard to space and staff. While this may not result in serious problems under typical conditions, hospitals clearly cannot cope with

epidemics.

Of all possible treatment strategies, preventive vaccines often offer the most advantages. Since they can be administered in advance of infection, and immunity

may be long-lived, vaccines can to a great extent alleviate the need for rapid diagnosis and administration of therapeutic agents. Vaccines have certifiably saved millions of lives and account for some of our greatest medical successes. Nevertheless,

preventive vaccines are not available for all diseases, and those that are available

may suffer from a variety of problems. For example, the current anthrax vaccine

must be administered in 6 doses over 18 months, with annual boosters for prolonged

protection. In this case, development of immunity is slow and logistically complex.

In addition, there are insufficient quantities of existing vaccines. Recent reports

have described the rapid diminution of U.S. anthrax vaccine stocks, as well as the

delays and difficulties associated with obtaining more. It has been estimated that

the worldwide supply of smallpox vaccine is only 60 million doses, and there is currently no facility for smallpox vaccine production.

For these reasons, my opinion is that the U.S. medical infrastructure is regrettably inadequate for dealing with biological warfare.

Finally, I would like to call attention to the fact that the legitimate development

of therapies against biological agents is extremely time-consuming. With any new

medical treatment, exacting rules are required to ensure safety and efficacy. This

is absolutely necessary and desirable, but those who intend to use biological weapons offensively are of course not similarly constrained. This is not in any way to

argue against existing or future regulations regarding research, but merely to emphasize the fact that offensive strategies are simpler to develop than therapeutic or

preventive ones. While exciting new therapeutic approaches for treating infection by

some of the more important BW agents have been recently described, funding for

their development has been inadequate. This is in part because the usual incentives

that motivate the pharmaceutical industry are in many cases lacking for such products. We have therefore all the more reason to press forward on all fronts to provide

adequate funding and resources for all types of defensive measures against biological warfare and infectious disease threats.

It is always far easier to cause harm than to prevent or treat it. This is particularly well illustrated by the issues at hand. Throughout human history, some of our

finest and most impassioned efforts have been devoted to the eradication of infectious disease. We have had many brilliant successes, and yet infectious disease still

accounts for millions of deaths worldwide. Many of these occur in wealthy, industrialized nations that possess the most advanced medical infrastructures ever developed. Due to multi-drug resistance and the emergence of new pathogens, plus the

logistics of clinical treatment, we are already facing difficult problems whose existence is attributable solely to natural processes. How much more frightening is it to

contemplate the situations that may arise if conscious effort is directed towards

using infectious agents, which we have spent centuries combating, for the dark purposes of mass destruction? Our hard-won understanding of pathogens is helping us

to meet the challenges of infectious disease, but it can easily be overwhelmed under

circumstances that are alarmingly possible. We must always be vigilant regarding

all aspects of biological weapons development and the threat posed by infectious diseases, or we will certainly be punished by the direst of consequences.

11

The CHAIRMAN. In another point of personal privilege, and I’ll

have more to say at an appropriate time, but I want to say a brief

word about an announcement made by Senator Helms just last

month.

Jesse, I know I speak for the members of this committee and all

whom have ever worked with you that we know there’s another 15

months fortunately we are going to get to work together, but that

assuming, and I am speaking only for myself and I’m back here,

and that’s not at all certain whether my constituency will decide

that that is going to happen, it will be a very different place, a less

friendly place, and a less accommodating place without you being

here.

I have truly enjoyed working with you. I think it’s been to the

surprise and to some chagrin of your supporters and mine that we

have such a close personal friendship. I remember telling the press

when I chose to take over the ranking position on this committee

for the Democratic Party and leaving Judiciary in that position,

that you and I will get along very well.

And the press, both national and local, were incredulous. They

thought that was not possible. Not only did we know it was possible, we had done it for 26 years prior to that. And I’m happy of

one thing, Jesse, and that is all those who follow politics can see

that we can disagree in this place without being disagreeable. You

have been one of my close friends. You continue to be.

And I’m truly going to miss, assuming that I am back, I’m truly

going to miss having you as a colleague.

Senator HELMS. Mr. Chairman, thank you. And I feel the same

way about you. And I just take a note there are three members of

the Class of 1972 here today: You and Sam Nunn and I. We are

glad to see you, Sam.

Well, anybody who might draw the foolish conclusion that this is

a routine hearing maybe got a wake-up call with an item hidden

on page umpteen of the paper the other day about Russia developing a new anthrax virus for possible delivery to other nations.

Mr. Chairman, I’m grateful, therefore, for your having scheduled

this hearing this morning. It’s very important; because the threat

of bioterrorism is very real, and it is growing as is evident by the

things we have seen almost every day.

This threat is driven by the increasing capabilities and the violent intentions of rogue states and terrorist groups seeking to harm

the United States or to make themselves able to do so.

Now, the sooner this very real peril is recognized, the sooner we

can begin to deal with it in a more direct and deliberate way.

These issues are of enormous importance.

How the United States prepares to deal with the consequences

of an attack employing deadly viruses and toxins would impact

countless thousands and possibly millions of lives. And planning for

such catastrophe is obviously an essential government responsibility.

However, I would much prefer to prevent and defend against the

threat in the first place rather than to have to deal with the chaos

and the death and destruction after the fact. And I know that is

a common feeling among all of us.

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A bioterrorism attack can be prevented, but it requires strong export control and nonproliferation regimes. Both are essential to ensure that terrorist groups and rogue states cannot acquire the technology and the know-how to build and deliver these horrible weapons so dangerous to the United States.

For that reason I am disappointed that the Senate is now considering the Export Administration Act, legislation designed to liberalize our national security export controls. That will obviously do

great harm to our national security by assisting countries like

Communist China to modernize their military, improve their strategic capabilities, and facilitate the dangerous proliferation of ballistic missile and other weapons of mass destruction technologies to

rogue nations be it Iraq, Iran, North Korea or whomever.

It is important that we never lose sight of the fact that the

United States and our allies can prevent a bioterrorism attack with

a robust missile defense system. I may be a voice crying in the political wilderness about this, but I firmly believe it.

A missile defense system can provide three benefits. No. 1, it can

deter rogue nations from building ballistic missiles capable of delivering weapons of mass destruction; No. 2, it can prevent rogue nations from threatening the United States and/or our allies; and, No.

3, it can shoot down these missiles if they are ever used against

the United States or our allies.

Iran, Iraq and North Korea are among many others that are

building long-range missiles. A report this past January by the National Intelligence Council indicated that these same nations are

also actively pursuing biological warfare capabilities.

Some have already weaponized these deadly pathogens and

placed them in missile warheads. They are doing all of this to

threaten and to blackmail and to intimidate the United States and

our allies by exploiting our greatest vulnerability—which is our

lack of ballistic missile defense.

Now, Mr. Chairman and members of the committee and those listening elsewhere, we must avoid the false choices that are so often

presented to policymakers, for example that some of these threats

are more likely than others and therefore that they demand the

lion’s share of resources. I disagree with that.

When it comes to America’s security, we must be prepared to

deal with all threats. We must not continue to spend nearly $10

billion a year to combat terrorism and defend against weapons of

mass destruction while we are spending far less annually on a national missile defense.

To this end I’m convinced that the Bush administration’s decision

to spend more on missile defense is the right decision and that

Congress should unhesitatingly support this decision. The American people I think expect no less and would surely ask embarrassing questions in the aftermath of an attack, if the people were

to discover that their government had had the means in the first

place to defend them but did not choose to do so.

I’m grateful to our witnesses for being here today. And I look forward to their testimony. Thank you, Mr. Chairman.

The CHAIRMAN. Thank you very much. What we’ll do is we’ll

start off. Hopefully we’ll be able to have more than one quick round

but with 7-minute rounds see if we can get through everyone first

13

and ask questions. Because everyone is anxious to hear what you

have to say.

Senator Nunn, the floor is yours, and welcome back.

STATEMENT OF HON. SAM NUNN, CO-CHAIR AND CHIEF EXECUTIVE OFFICER, NUCLEAR THREAT INITIATIVE, WASHINGTON, DC

Senator NUNN. Thank you very much, Mr. Chairman. Senator

Helms, let me join Senator Biden in thanking you for your service

to the United States Senate and to our country. It was a great

pleasure for me to be elected at the same time as you and Senator

Biden were, and when I look around the committee and I see relative newcomers, like Senator Dick Lugar, it reminds me of the

Class of 1972.

In a matter of interest, Jim Woolsey, my companion here at the

table was the General Counsel of the Armed Services Committee

when I arrived. So really we have four of us here that were there

at that stage. Of course it’s a great pleasure for me to be before

this committee and come back to an institution that I truly love

and have spent a great deal of my life in.

So to you and Senator Biden and Senator Lugar and Senator

Hagel and Senator Boxer, thank you for having us and thank you

for focusing on this very important subject.

The CHAIRMAN. I don’t understand why you didn’t thank Senator

Rockefeller. He’s in a different county down there.

Senator NUNN. I see him. He’s down at the end. A man with that

much wisdom I thought would be closer to the front of the table.

But Senator Helms, I know how hard it is to decide to leave voluntarily. I’m sure that you have been through a lot of your thinking. But my very best to you and your whole family.

Senator HELMS. Thank you, Senator.

Senator NUNN. Biological terrorism, Mr. Chairman, is one of our

greatest national security threats—one that cannot be addressed by

the Department of Defense standard operating procedures. The

specter of a biological weapons attack and the parallel peacetime

threat of a naturally occurring infectious disease outbreak—I want

to emphasize that these two go together.

The things we need to do to protect against bioterrorism are also

things we need to do with our public health system, even if we

never have a bioterrorist attack.

These are unique challenges and they deserve the time and focus

you are devoting to them today.

Mr. Chairman, Senator Helms, members of the committee, as

you may know this past June at Andrews Air Force Base I was a

participant in the exercise ‘‘Dark Winter’’ which simulated a biological weapons attack on the United States. It’s a lucky thing for

the United States that this was just a test and not a real emergency.

Mr. Chairman, members of the committee, our lack of preparation is a real emergency from my perspective. I think my colleague

Jim Woolsey will agree with that.

‘‘Dark Winter’’ simulated a series of national security meetings

dealing with a terrorist attack involving the covert release of smallpox in three American cities. The exercise was conducted by the

14

Center for Strategic and International Studies, the Johns Hopkins

Center for Civilian Biodefense Studies, and the ANSER Institute

for Homeland Defense, under the leadership of John Hamre, Tara

O’Toole and Randy Larsen, respectively.

Many of the participants in ‘‘Dark Winter’’ had served previous

Presidents in cabinet or sub-cabinet positions. And most knew how

the NSC, the National Security Council, worked. They were all individuals with considerable experience and perspective in either

the security field, law enforcement field or the health field or the

emergency field.

I will not take the committee’s time with charts. I planned to do

that at one time but then I started looking at the time and I know

we want the time to discuss the conclusions. I decided to just try

to briefly summarize this but the charts and CD–ROM are available. And I’ll just cover the highlights this morning.

In the opening minutes of ‘‘Dark Winter,’’ we learned from the

Secretary of Health and Human Services that cases of smallpox

had been diagnosed by the Center for Disease Control. Given the

infectious nature of the disease, we were facing the start of a

smallpox epidemic, an event with devastating, if not catastrophic

potential.

Like all of you, I received a smallpox vaccination when I was a

child. But I had forgotten the horror of the disease. In the 20th

century, more than 300 million people died from smallpox; more

than those killed in all the wars of the century combined, which

is an astounding figure.

Thanks to a massive and highly collaborative international

health campaign, smallpox as a naturally occurring disease was

eradicated. But once eradicated, the consequences of an outbreak

of smallpox today are more dangerous because each passing year

brings generations of unvaccinated citizens and also citizens who

have been vaccinated whose vaccinations have worn off, which

would probably include all of us. So the potency of the previous

vaccinations have diminished with time.

Unfortunately, we know that smallpox was made into a weapon

by the Soviet Union. What we don’t know is whether other nations

or groups either derived some smallpox from the Soviet Union or

whether they have pursued a similar goal with success. And this

should be a matter of keen intelligence focused by this committee

as well as other committees.

Over a 24-hour period at Andrews Air Force Base, our National

Security Council ‘‘war gamers’’ dealt with 3 weeks of simulated

shock, stress and horror. I was given the role of President of the

United States, and I wouldn’t describe it in this case as being an

honor.

Jim Woolsey was my Director of Central Intelligence. I’m sure he

was frustrated too. I said to Jim several times that what I got from

him in that 18-hour period was an awful lot of opinion and not one

damn bit of intelligence. Nevertheless, he did the best he could

with the circumstances we had.

We learned that on December 9, 2002, some dozen patients reported to the Oklahoma City Hospital with a strange illness confirmed quickly by the CDC to be smallpox. While we only knew

about the Oklahoma cases the first day, we later learned the scope

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of the initial infections and the sites of three simultaneous attacks

in shopping centers in Oklahoma, Georgia, as well as Pennsylvania.

The initial infection quickly spread to five states and three thousand victims, although most infected individuals had not displayed

symptoms or gone to the hospital in the first few days. And we did

not know at that time how many had been infected.

We didn’t know how many. We didn’t know how, how many there

were. We didn’t know where they were. We didn’t know who they

were. We did know that probably many people had been infected.

We quickly learned we had only two tools available to deal with

a smallpox attack: vaccination and isolation. And we had only

enough vaccine for 1 out of every 23 Americans, which is the state

today.

At the very beginning of the National Security Council meeting,

I denied the Secretary of Defense’s adamant demand that all 2.3

million U.S. military personnel be immediately vaccinated wherever they were in the world.

Instead, we administered the vaccine to U.S. military, including

the National Guard and security and medical personnel who were

on the front lines locally, and who also were in areas of the world

where a smallpox attack was most likely to occur.

We could not allow all the vaccine to go to the military right off

the bat, or at least 2.3 million which would be probably one fourth,

one third of the total supply, because the front line shifted. It

wasn’t the battlefield. It was back home.

The troops that were engaged were most of all medical personnel

whether they were local or whether they were military or whether

they were shipped in on emergency from around the country or the

world.

Our initial decision was to use our limited supply of vaccine to

protect health care workers, local police and fire officials, National

Guard on the scene and local, state and federal officials who were

in the line of fire.

We also devised a strategy to try and put a firewall around the

infections that were being reported. But that strategy was largely

ineffective because of the rapid spread of the disease. Because we

didn’t know where it had spread, where they were, and because we

had a very limited supply of vaccine. If you had enough vaccine,

you could put fire breaks around every suspicious area.

The CHAIRMAN. Senator, would you for the record indicate if you

can how the disease is spread?

Senator NUNN. It’s spread from person to person.

The CHAIRMAN. Physical contact?

Senator NUNN. The health experts tell me that you basically—

through breathing. Doesn’t have to be direct contact, in close proximity. And the health officials tell me that until you actually show

some signs, you can’t really spread the disease. But showing signs,

a lot of people confuse it with other things so they don’t know they

have got it to begin with.

The CHAIRMAN. Thank you.

Senator NUNN. On the first night of decisionmaking, Mr. Chairman, we designed a vaccination strategy. And we ordered accelerated production of new stock. We ordered it on an emergency basis.

16

We asked the Secretary of State to call his counterparts around

the globe and try to find supplies in other countries and began to

feel other countries out about whether they would engage with us

in trying to stop the disease before it spread all over the world.

I will skip the agonizing details now and get on to the conclusions. On day 6 of the crisis, we had very little vaccine left. We

quickly faced the only alternative, forced isolation, with large numbers of exposed citizens whose locations and identities remained

guesswork. We were down to really tough questions.

Do we force whole communities and cities to stay in their homes?

How? With force? How much force? Does it include lethal force? Do

we physically prevent citizens in high risk areas from fleeing their

communities with their children even though they themselves may

already be infected?

Who provides food and care for those in forced isolation, particularly when we can no longer provide vaccine to the essential providers? Who’s going to make the health care people show up when

you don’t have any vaccine for them and for their families?

On day 12 when our war game ended and my brief tenure as

President concluded, we were beginning the next stage of the epidemic, those who caught smallpox from the original 3,000 people

who were infected in the initial terrorist attack. Our health experts

told us that every 2 to 3 weeks the number of cases would increase

ten-fold.

To give you a glimpse of how the exercise ended, here are a few

highlights from a simulated CNN broadcast quoting that.

On day 12 of the worst public health crisis in America’s

history, demonstrations for more vaccine in hard-hit communities disintegrated into riots and looting around the

nation. Interstate commerce has stopped in several regions

of the nation. A suspension of trading on America’s stock

exchanges takes effect tomorrow. International commerce

with the United States has virtually ceased. The Centers

for Disease Control reports that efforts to stem the smallpox epidemic have depleted America’s inventory of smallpox vaccine. While the CDC may be out of vaccine, at least

45 Internet Web sites are offering what they claim are

safe, effective vaccines from previously forgotten stocks.

These claims have not, repeat not, been independently

verified, and authorities urge serious caution.

At least 25 more states and 10 foreign countries are reporting smallpox infections. At the United Nations, China

has sponsored a resolution to censure the United States,

blaming America for reintroducing smallpox to the world.

It is demanding that the United States supply the world

with vaccine.

I could go on and on, Mr. Chairman, but that I think captures

the essence of what we were faced with. In summary, I determined

from that experience that public health has become a national security issue and that we are unprepared.

We were out of vaccine. We were discussing martial law. Interstate commerce was eroding rapidly. The members of our simulated

NSC, as well as state and local officials, were desperate.

17

We came to realize too late that our country had not produced

sufficient vaccine; had not prepared top officials to cope with this

new type of security crisis; had not invested adequately in the

planning and exercises absolutely necessary for coordinated response; had not ensured that the public health infrastructure was

adequate, with built-in surge capacity; had not educated the American people on developed strategies to constructively engage the

media in educating the public about what was happening and what

they could do to protect their families; had not practiced what few

plans there were in place; had not ranked biological terrorism or

infectious diseases as high national priorities.

Before I detail the lessons learned in this particular exercise, we

should keep in mind that the results of biological effect would vary

greatly according to the specific agent used. Technology and training for early recognition of the type of pathogen, that kind of training and technology is absolutely essential and must be a high priority.

This exercise gave us valuable lessons about a possible smallpox

attack. The circumstances would be very different in the case of an

anthrax attack. In the event of an attack using anthrax, vaccination and isolation would not be the tools, but antibiotics would need

to be administered on the scene and in large quantities immediately.

For the participants, the ‘‘Dark Winter’’ exercise instilled in all

of us that there is much work to be done and needs to be done

quickly.

Number 1, clearly measures that will deter or prevent bioterrorism are the most cost-effective means to counter threats to public health and social order. We need to prevent the proliferation of

biological weapons in part by strengthening intelligence-gathering

against such threats, but also by providing peaceful research options to scientists in the former Soviet Union who know how to

make these pathogens and who have had plenty of experience making these pathogens but don’t know how they are going to feed

their children today with legitimate enterprises.

Two, we need to focus more attention, concern and resources on

the specific threat of bioterrorism, understanding that it is different from the other threats we face. Biological weapons must be

countered with new protocols for securing dangerous pathogens

with increased vigilance and surveillance, as well as with increased

supplies of medicines and vaccines and significantly increased

training.

Three, we need to recognize the central role of public health and

medicine in this effort and engage those professionals fully as partners on the national security team. We must act on the understanding that public health is an important pillar in our national

security framework.

Four, we need to identify and put into practice the mechanisms

by which all levels of government will interact and work together.

It is critical that we understand our differing roles, responsibilities,

capabilities and authorities, and plan on how we will work together

before an act of terrorism occurs. I must add that Governor Frank

Keating of Oklahoma was part of this exercise. I think he will

18

strongly echo that from a state government and a local government

point of view. He made a very valuable contribution.

Five, we need to reexamine and modernize the legal framework

for epidemic control measures and the appropriate balance with

civil liberties. Mr. Chairman, your reminder on posse comitatus is

right down that line because there would be all sorts of questions

this society has not faced, at least in modern times.

Six, there should be a clear plan for providing the news media

with timely and accurate information to help save lives and prevent panic.

Seven, we need to increase the core capabilities of our public

health system to detect, track and contain epidemics by providing

resources for effective surveillance systems, diagnostic laboratory

facilities, and communication links to other elements of the response effort here and abroad.

Eight, the national pharmaceutical stockpile must be built to capacity, including extra production capability for drugs and vaccines,

with heightened security at various dispersal sites. We must not

fall victim to a twin attack that releases a bioagent and simultaneously destroys our key drugs and vaccine supplies.

Nine, we need to develop plans for a surge of patients in the nation’s hospitals to make the best use of existing resources in the

event of an emergency.

Ten, we need to increase funding for biomedical research to develop new vaccines, new therapeutic drugs and new rapid diagnostic tests for bioweapon agents.

Eleven, we need to encourage the scientific community to confront the sinister potential of modern biological research, and help

them devise systems and practices that ensure the safe, secure

storage of and access to dangerous pathogens.

Twelve, officials at highest levels of the Federal, state, and local

government need to participate in exercises like this one to understand the importance of advanced not only planning but preparation. Plans must be exercised, evaluated and understood by decisionmakers if they are to prove useful in a time of crisis.

Mr. Chairman, finally, I have a new role now that relates to

what we call the Nuclear Threat Initiative (NTI). It’s a new foundation funded by Ted Turner very generously and headed by a

board of experienced people including Senator Lugar among others.

We are trying to encourage and help our government to deter,

prevent and defend against biological terrorism. That’s a central

part of our mission as well as the nuclear side of it and the chemical side of it.

We are dedicated to reducing the global threat from biological,

nuclear, and chemical weapons by increasing public awareness, encouraging dialogue, catalyzing action, promoting new thinking

about these dangers in this country and around the globe.

We fully recognize that only our government can provide the

leadership and resources to achieve our security and health priorities. But within that context, NTI is seeking ways to reduce the

threat from biological weapons and their consequences; exploring

ways to increase education, awareness and communication among

public health experts, medical professions, and scientists, as well as

among policymakers and elected officials.

19

We are considering ways to improve infectious disease surveillance around the globe, including rapid and effective detection, investigation, and response.

This is a fundamental defense against any infectious disease

threat, whether it occurs naturally or is released deliberately, stimulating and supporting the scientific community in its efforts to

limit inappropriate access to dangerous pathogens and to establish

standards that will help prevent the development and spread of biological agents as weapons.

NTI is searching for ways to help our Government and the Russian Government to facilitate the conversion of Russian bioweapons

facilities and know-how to peaceful purposes, and to improve security of dangerous pathogens worldwide. And I know that my colleague and partner Senator Lugar can well identify with that because he has been right out in front in that effort.

Finally, Mr. Chairman, in concluding, enemies don’t normally attack us where we are strong; they target us where we are weak.

Enemies of the United States are not eager to engage us militarily.

They saw what happened in Desert Storm and other conflicts in recent years, and they know the awesome capabilities we have.

They will, however, attack us where they believe we are vulnerable. Today, we are vulnerable to biological terrorism. Those who

perpetuate such an act are not likely to be quickly identified or

leave a return address. I emphasize that. That makes a huge difference in terms of the incentives of the game.

It is critical that we prepare with all possible speed; because if

an attack occurs and succeeds, there will be others. Preparing is

deterring. Our first priority, as Senator Helms mentioned, must be

prevention.

Whether the enemy achieves its objectives in an attack that may

take place depends to a large extent on how the American people

respond. Panic in our citizens would be just as great a danger as

the disease itself.

Some citizens will respond like saints, doing whatever they can

to meet the needs of their family as well as consider the community. Others will respond with panic, perhaps even using violence

to obtain vaccines and drugs or try to protect themselves or their

loved ones at the expense of others.

How most of our citizens will respond will depend largely on

what they hear from the President and their elected leaders, and

how they see our Government respond. This means we must be

prepared.

Thank you.

[The prepared statement of Senator Nunn follows:]

PREPARED STATEMENT OF HON. SAM NUNN

Chairman Biden and members of the committee, it is a privilege and honor for

me to come back to the United States Senate where I spent so much of my life. I

thank you for dedicating the first of these hearings to the threats of bioterrorism

and the spread of infectious diseases. Biological terrorism is one of our greatest national security threats, and one that cannot be addressed by Department of Defense

standard operating procedures. The specter of a biological weapons attack—and the

parallel peacetime threat of a naturally occurring infectious disease outbreak—are

unique, and they deserve the time and focus you are devoting to them today.

Mr. Chairman and members of the committee, as you may know, this past June

at Andrews Air Force Base, I was a participant in the exercise Dark Winter—which

20

simulated a biological weapons attack on the United States. It’s a lucky thing for

the United States that this was just a test and not a real emergency. But, Mr.

Chairman and members of the committee, our lack of preparation is a real emergency.

During my 24 years on the Senate Armed Services Committee, I saw scenarios

and satellite photos and Pentagon plans for most any category of threat you can

imagine. But a biological weapons attack on the United States fits no existing category of security threats. Psychologist Abraham Maslow once wrote: ‘‘When all you

have is a hammer, everything starts to look like a nail.’’ This is not a nail; it’s different from other security threats; and to fight it, we need a different set of tools

than the ones we’ve been using.

Our exercise involved an intentional release of smallpox. Experts today believe

that a single case of smallpox anywhere in the world would constitute a global medical emergency. As Members of this committee know, a wave of smallpox was

touched off in Yugoslavia in 1972 by a single infected individual. The epidemic was

stopped in its fourth wave by quarantines, aggressive police and military measures,

and 18 million emergency vaccinations to protect a population of 21 million that was

already highly vaccinated.

Mr. Chairman, we have effectively only 12 million doses of vaccine in America to

protect a highly vulnerable population of 275 million that is essentially not vaccinated. The Yugoslavia crisis mushroomed from one case; our Dark Winter exercise

began with 20 confirmed cases in Oklahoma City, 30 suspected cases spread out in

Oklahoma, Georgia, and Pennsylvania, and countless more cases of individuals who

were infected but didn’t know it. We did not know the time, place or size of the release, so we had no way of judging the magnitude of the crisis. All we knew was

that we had a big problem and a small range of responses. One certainty was that

it would get worse before it would get better. Our medical experts told us that we

had only two strategies for effective smallpox containment: (1) isolating those who

are sick, and (2) vaccinating those who have been exposed. Isolation is difficult

when you’re not sure who has it; vaccination cannot stop the spread if you don’t

have enough of it.

DARK WINTER OVERVIEW

Dark Winter simulated a series of National Security Council (NSC) meetings dealing with a terrorist attack involving the covert release of smallpox in three American cities. The exercise was conducted by the Center for Strategic and International

Studies, the Johns Hopkins Center for Civilian Biodefense Studies, and the ANSER

Institute for Homeland Defense, under the leadership of John Hamre, Tara O’Toole

and Randy Larsen, respectively. Many of the participants in Dark Winter had

served previous Presidents in cabinet or sub-cabinet positions. Most knew how the

NSC worked, and they were all individuals with considerable expertise and perspective in the security, law enforcement and health fields.

I will not take the committee’s time with a complete replay of the events, but will

share with you the highlights.

In the opening minutes of Dark Winter, we learned from the Secretary of Health

and Human Services that cases of smallpox had just been diagnosed by the Centers

for Disease Control. Given the infectious nature of the disease, we were facing the

start of a smallpox epidemic—an event with devastating, if not catastrophic, potential.

Like all of you, I received a smallpox vaccination when I was a child, but I had

forgotten the honor of the disease. In the 20th century, more than 300 million people died from smallpox—more than those killed in all wars of the century combined.

Thanks to a massive and highly collaborative international campaign, smallpox as

a naturally occurring disease was eradicated. But once eradicated, the consequences

of a smallpox outbreak has become more dangerous with each passing year as new

generations of unvaccinated citizens are born and the potency of the previous vaccinations diminishes with time. Unfortunately, we know that smallpox was made

into a weapon by the Soviet Union; we do not know if any other nations or groups

have successfully pursued a similar goal, and this should be a matter of keen intelligence forces.

Over a 24-hour period at Andrews Air Force Base, our NSC ‘‘war gamers’’ dealt

with three weeks of simulated shock, stress and horror. I was given the role of

President of the United States, and Jim Woolsey was the Director of the Central

Intelligence Agency.

We learned that on December 9, 2002, some dozen patients reported to the Oklahoma City Hospital with a strange illness confirmed quickly by the CDC to be

smallpox. While we only knew about the Oklahoma cases the first day, we later

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learned the scope of the initial infections and the sites of three simultaneous attacks

in shopping centers in Oklahoma, Georgia and Pennsylvania. The initial infection

quickly spread to five states and 3,000 victims although most infected individuals

had not displayed symptoms or gone to the hospital in the first few days so we did

not know who they were or where they were.

We quickly learned that we had only two tools available to deal with a smallpox

attack—vaccination and isolation, and we had only enough vaccine for one out of

every 23 Americans.

I denied the Secretary of Defense’s demand that all 2.3 million of U.S. military

personnel be immediately vaccinated wherever they were in the world. Instead, we

administered vaccine to U.S. military, including the National Guard, and security

and medical service personnel who were on the front lines locally and also those

who were in areas of the world where a smallpox attack was more likely to occur.

Our initial decision was to use our limited vaccine supply to protect health care

workers, local police and fire officials, National Guard on the scene and local, state

and federal officials in the line of fire. We also devised a strategy to try and put

a firewall around the infections that were being reported, but that strategy was

largely ineffective because of the rapid spread of the disease and our limited supply

of vaccine.

So, on the first night of decision-making, we designed a vaccination strategy, and

we ordered accelerated production of new stock. We asked the Secretary of State to

try to find surplus stock from other countries. I will skip the agonizing details and

get to the conclusions.

On Day Six of the crisis, we had very little vaccine left. We quickly faced the only

alternative—forced isolation with large numbers of exposed citizens whose locations

and identities remained guesswork. We were down to the really tough questions. Do

we force whole communities and cities to stay in their homes? How? With force? Do

we physically prevent citizens in high-risk areas from fleeing their communities

when they themselves may already be infected? Who provides food and care for

those in forced isolation, particularly when we can no longer provide vaccine to essential providers?

On Day Twelve, when our war game ended and my brief tenure as President concluded, we were beginning the next stage of the epidemic—those who caught smallpox from the original 3,000 people who were infected in the initial terrorist attack.

Our health experts told us that every two to three weeks the number of cases would

increase ten-fold. To give you a glimpse of how the exercise ended, here are a few

highlights from a simulated CNN broadcast:

On Day Twelve of the worst public health crisis in America’s history,

demonstrations for more vaccine in hard-hit communities disintegrated into

riots and looting around the nation. Interstate commerce has stopped in

several regions of the nation. A suspension of trading on America’s stock

exchanges takes effect tomorrow. International commerce with the U.S. has

virtually ceased.

The Centers for Disease Control reports that efforts to stem the smallpox

epidemic have depleted America’s inventory of smallpox vaccine. While the

CDC may be out of vaccine, at least 45 Internet websites are offering what

they claim are safe, effective vaccines from previously forgotten stocks.

These claims have not—repeat not—been independently verified, and authorities urge caution.

At least 25 more states and 10 foreign countries are reporting smallpox

infections. At the United Nations, China has sponsored a resolution to censure the U.S., blaming America for reintroducing smallpox to the world. It

is demanding that the U.S. supply the world with vaccine.

In summary, Mr. Chairman, I determined from our war game that public health

has become a national security issue, but that we are unprepared. We were out of

vaccine. We were discussing martial law. Interstate commerce was eroding rapidly.

The members of our simulated NSC, as well as state and local officials, were desperate. We came to realize too late that our country:

• Had not produced sufficient vaccine.

• Had not prepared top officials to cope with this new type of security crisis.

• Had not invested adequately in the planning and exercises absolutely necessary

for coordinated response.

• Had not ensured that the public health infrastructure was adequate, with built

in surge capacity.

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• Had not educated the American people, or developed strategies to constructively

engage the media in educating the public, about what was happening and what

to do.

• Had not practiced what few plans there were in place.

• Had not ranked biological terrorism or infectious diseases as high national priorities.

DILEMMAS AND INSIGHTS

Most participants in our exercise would have been much more in their element

if we had been dealing with a terrorist bombing. The effects of a bomb are bounded

in time and place. After the explosion, the nation’s leadership knows the geography

and the extent of the damage. You know where to start, and how much it will take

to respond and rebuild. Smallpox, on the other hand, is a silent, ongoing, invisible

attack. It is highly contagious, and spreads in a flash—each smallpox victim can infect ten to twenty others. It incubates for two weeks before physically appearing—

it comes in waves.

The most insidious effect of a biological weapons attack is that it can turn Americans against Americans. Once smallpox is released, it is not the terrorists anymore

who are the threat; our neighbors and family members can become the threat. If

they’ve been exposed, they can kill you by talking to you. The scene could match

the horror of the Biblical description in Zechariah (8:10): ‘‘Neither was there any

peace to him that went out or came in . . . for I set all men every one against his

neighbour.’’

A biological weapons attack cuts across categories and mocks old strategies. For

more than two thousand years the most important rule of war has been to know

your enemy.

In military language, this means that when you face a battlefield scenario, you

draw up an order of battle—you estimate the number of enemy tanks and planes

and troops, their intelligence and logistics capabilities, and other resources. A biological weapon, however, is an invisible killer. An attack may go unrecognized for

days, only becoming evident after large numbers of people become sick. In the case

of a contagious disease, our own people would become the enemy’s weapons as they

transmit the disease to others, creating ever-widening circles of exposure.

Even after you know there has been an attack, there still are few reliable numbers—because you don’t know who initially released it, how much more they have,

or where they are. And the usual responses to an attack are impossible: ‘‘Engage

the enemy; open fire; stop their advance; bring out the wounded.’’ You can hardly

know who is wounded.

For the participants, this exercise was filled with many such horrible dilemmas

and unpleasant insights.

Number one: We have a fragmented and under-funded public health system—at

the local, state, and federal levels—that does not allow us to effectively detect and

track disease outbreaks in real time.

Two: Lab facilities needed to diagnose the disease are inadequately supported and

laboring with outdated technology.

Three: There is insufficient partnership and communication across federal agencies and among local, state, and federal governments.

Four: The only way to deal with smallpox is with isolation and vaccination, but

we don’t have enough vaccines, and we don’t have enough dedicated facilities, resources, or information for effective isolation.

Five: A biological weapons attack will be a local event with national implications,

and that guarantees tension between local, state and national interests. In our exercise, Governor Keating of Oklahoma asked for vaccine for every one of his citizens—

as he had to in the interests of his state. The President said no, as he had to in

the interests of the nation. Naturally, this demands a high degree of advanced planning and coordination, because of the diverging interests, and because key players

and partners are answerable to different leaders.

Six: Most hospitals run at or near full capacity all the time: a surge in patients

from smallpox, combined with the inevitable infections of hospital personnel, and

the flight of some fearful health care professionals, would create a catastrophic overload.

Seven: There will be a dearth of information on this kind of event. My staff and

cabinet could not tell me ten percent of what I wanted to know: ‘‘How many cases

are there right now? How many more cases can we expect? Will there be more attacks? When and where did the first infections take place? Who released it? What’s

the worst-case scenario? Is our vaccine supply secure and safe for use? Will other

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countries loan us emergency vaccine to keep the disease from spreading all over the

world?

There are many tradeoffs. One of the biggest: We have 12 million vaccines; that’s

enough for one out of every 23 Americans. How do we decide whom to vaccinate?

Do we take power from the Governors and federalize the National Guard? Do we

seize hotels and convert them into hospitals? Do we close borders and block all travel? What level of force do we use to keep someone sick with smallpox in isolation?

Do we keep people known or thought to be exposed quarantined in their homes? Do

we guarantee 2.3 million doses of vaccine to the military; or do we first cover all

health care providers? Do we take strong measures that protect health, but could

undermine public support or destroy the economy?

Finally: How do you talk to the public in a way that is candid, yet prevents

panic—knowing that panic itself can be a weapon of mass destruction? My staff had

two responses: ‘‘We don’t know’’ and ‘‘You’re late for your press conference.’’

I told people in the exercise: ‘‘I would never go before the press with this little

information,’’ and Governor Keating—who knows about dealing with disaster, said:

‘‘You have no choice.’’ And I went, even though I did not have answers for the

public’s most urgent questions: ‘‘How do you plan to protect our families?’’ ‘‘How rapidly and how far will it spread?’’ And ‘‘Why isn’t there enough vaccine?’’

Naturally, there are some skeptics anytime you describe a dire threat to the

United States. I want to tell the committee: I am convinced the threat of a biological

weapons attack on the United States is as urgent as it is real. As Secretary Rumsfeld said in his confirmation hearings: ‘‘I would rank bioterrorism quite high in

terms of threats . . . It does not take a genius to create agents that are enormously

powerful, and they can be done in mobile facilities, in small facilities.’’ An experiment some years ago showed that a scientist whose specialty was in another field

was able to weaponize anthrax on his first attempt for less than $250,000.

Hundreds of labs and repositories around the world sell biological agents for legitimate research—and the same substances used in legitimate research can be

turned into weapons research. In addition, the massive biological weapons program

of the former Soviet Union remains a threat, at least to the extent that materials

and know-how could flow to hostile forces. At its peak, the program employed 70,000

scientists and technicians and made twenty tons of smallpox. One Russian official

was quoted some years ago in The New Yorker saying: ‘‘There were plenty of opportunities for staff members to walk away with an ampule.’’ There still are.

According to a very prominent press report, former Soviet biological weapons scientists have been aggressively—and in some eases successfully—recruited by Iran.

And Ambassador Rolf Ekeus, who headed the United Nations special commission

that investigated Iraq’s arsenal after the Gulf War, and who we are lucky to have

on the Board of Directors of NTI, had testified before Congress that in 1991 Iraq

had 300 biological bombs.

So the ability of people to acquire or create biological weapons should be clear beyond any doubt. And no one should doubt how lethal biological weapons could be.

In 1979, a small amount of anthrax escaped from a Soviet biological weapons lab

in Sverdlovsk. Seventy-seven cases of human anthrax occurred in the city surrounding the lab. Sixty-six died, and new cases were appearing as late as 47 days

after the leak. All this resulted from only a tiny amount of anthrax being released—

on the order of ounces. It doesn’t take much imagination to envision the catastrophe

that would result if someone deliberately released a much larger quantity.

It is important not to overstate this threat. But it is not an overstatement to say

it is real, it is dangerous, and if it occurred today, it would catch us unprepared.

Michael Osterholm and John Schwartz, in their book Living Terrors, told about

the experience of one doctor who knew his state was one of the best-trained areas

of the country for a biological weapons attack. One day he conducted some unscientific research. He discovered that the total city stockpile for dealing with an anthrax

attack would not cover even 600 patients. He found that a doctor trained in biological weapons failed to diagnose anthrax when the classic symptoms were described;

a doctor in the radiology department failed to recognize inhalation anthrax when

shown an X-ray; and a voice mail message describing a bioterrorism concern went

unreturned by the state health department for three days.

NEXT STEPS

In fairness, we are making progress. The Clinton administration deserves credit

for recognizing that a biological weapons attack is different from warfare or other

terrorist threats and for targeting funds to address it. That initiative includes

strengthening the public health infrastructure, creating a pharmaceutical stockpile

for civilian use, a contract to develop and produce a new smallpox vaccine, research

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to develop new and improved diagnostics, drugs and vaccines, programs to train

first responders (police and fire departments as well as public health and medical

professionals) across the United States, and investments in new technologies to help

detect biological agents.

Under the Bush administration, these efforts are continuing and in some eases,

funding is increasing. It is also heartening that Secretary Thompson has named a

senior advisor on bioterrorism who previously directed the program on bioterrorism

at the Centers for Disease Control and Prevention. These are positive steps. Still,

we have to do more—and quickly.

Before detailing the issues that I believe deserve the greatest attention, we should

keep in mind that the results of biological attacks would vary according to the specific agent used. Technology and training for early recognition of the type of pathogen are essential. This exercise gave us valuable lessons about a possible smallpox

attack. The circumstances would be very different in the case of an anthrax attack,

for example. In the event of an attack using anthrax, vaccination and isolation

would be irrelevant, but antibiotics would need to be administered on the scene immediately.

For the participants, the Dark Winter exercise instilled in all of us that there is

much work to be done:

Number one: Clearly, measures that will deter or prevent bioterrorism are the

most cost effective means to counter threats to public health and social order. We

need to prevent the proliferation of biological weapons, in part by strengthening intelligence gathering against such threats, but also by providing peaceful research

options to scientists in the former Soviet Union. Efforts to fight proliferation require

a global approach, including finding a way to strengthen and enforce the Biological

Weapons Convention.

Two: We need to focus more attention, concern and resources on the specific

threat of bioterrorism—understanding that it is different from other threats we face.

Biological weapons must be countered with new protocols for securing dangerous

pathogens, with increased vigilance and surveillance, as well as with increased supplies of medicines and vaccines and significantly increased training.

Three: We need to recognize the central role of public health and medicine in this

effort and engage these professionals fully as partners on the national security

team. We must act on the understanding that public health is an important pillar

in our national security framework. In the event of a biological weapons attack—

millions of lives will depend on how quickly doctors diagnose the illness, communicate their findings, and bring forth a fast and effective response at the local and

federal level. This means, clearly, that public health and medical professionals must

be part of the national security team. Planning for an event like this is not the exclusive purview of the Department of Defense, the National Security Council, the

CIA and the Department of Energy. The Department of Health and Human Services

(CDC, FDA, NIH, etc.) must also be included.

This may seem obvious enough. But several years ago, when administration officials were meeting to discuss supplemental funding legislation for defense against

biological weapons—the presiding official from the Office of Management and Budget greeted the officials from the NSC, and FBI and CIA and DOD, then saw the

Assistant Secretary from Health and Human Services at the table, did a double-take

and said: ‘‘What are you doing here?’’ Health officials should not need to be given

directions to the White House Situation Room in an emergency.

Four: We need to identify and put into practice the mechanisms by which all levels of government will interact and work together. It is critical that we understand

our differing roles, responsibilities, capabilities, and authorities, and plan on how

we will work together before an act of terrorism occurs.

Five: We need to reexamine and modernize the legal framework for epidemic control measures and the appropriate balance with civil liberties—the laws that would

apply if we were to find ourselves managing the crisis that would come with a biological weapons attack. These laws vary from state to state and many are antiquated. We need to make sure that they are up-to-date, consistent with our current

social values and priorities, and we need to reacquaint high-level officials in all

areas of response with the specific authorities these laws provide, and how they can

implement them.

Six: There should be a clear plan for providing the news media with timely and

accurate information to help save lives and prevent panic.

Seven: We need to increase the core capacities of our public health system to detect, track and contain epidemics, by providing resources for effective surveillance

systems, diagnostic laboratory facilities, and communication links to other elements

of the response effort.

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Eight: The national pharmaceutical stockpile should be built to capacity, including

extra production capability for drugs and vaccines, with heightened security at the

various dispersal sites. We must not fall victim to a twin attack that releases a bioagent and simultaneously destroys our drugs and vaccines.

Nine: We need to develop plans for a surge of patients in the nation’s hospitals

to make the best use of existing resources in the event of an emergency. This will

require careful advance planning, including how to utilize ancillary facilities such

as gymnasiums or armories, since most hospitals are operating at or near capacity

right now.

Ten: We need to increase funding for biomedical research to develop new vaccines,

new therapeutic drugs, and new rapid diagnostic tests for bioweapon agents.

Eleven: We need to encourage the scientific community to confront the sinister potential of modern biological research, and help them devise systems and practices

that ensure the safe, secure storage of, and access to, dangerous pathogens.

Twelve: Officials at the highest levels of the federal, state, and local government

need to participate in exercises like Dark Winter to understand the importance of

advance preparation. Plans must be exercised, evaluated, and understood by decision-makers if they are to prove useful in a time of crisis.

I know how difficult it is to find funding for new initiatives, and public health

is often left behind. We need to think about supporting public health activities in

the same way we think about our national defense. Congress and the public should

understand that expanding disease surveillance, creating additional lab capacity

and enhancing vaccine production capabilities will benefit the United States not

only in responding to a biological weapons attack, but also by improving our responses to natural disease outbreaks. We have a chance to defend the nation

against its adversaries and improve the public health system with the same steps.

THE NUCLEAR THREAT INITIATIVE—A NEW FOUNDATION

Mr. Chairman and members of the Committee, encouraging and helping our government to deter, prevent, and defend against biological terrorism is a central part

of our mission at the Nuclear Threat Initiative (NTI)—the organization founded by

Ted Turner and guided by an experienced board that Ted and I co-chair. We are

dedicated to reducing the global threat from biological, nuclear, and chemical weapons by increasing public awareness, encouraging dialogue, catalyzing action, and

promoting new thinking about these dangers in this country and abroad.

We fully recognize that only our government can provide the leadership and resources to achieve our security and health priorities. But within that context, NTI

is:

• Seeking ways to reduce the threat from biological weapons and their consequences. • Exploring ways to increase education, awareness and communication among

public health experts, medical professionals, and scientists, as well as among

policy makers and elected officials—to make sure more and more people understand the nature and scope of the biological weapons threat. • Considering ways to improve infectious disease surveillance around the globe— including rapid and effective detection, investigation, and response. This is a

fundamental defense against any infectious disease threat, whether it occurs

naturally or is released deliberately. • Stimulating and supporting the scientific community in its efforts to limit inappropriate access to dangerous pathogens and to establish standards that will

help prevent the development and spread of biological agents as weapons. • And finally, NTI is searching for ways to help our government and the Russian

government to facilitate the conversion of Russian bioweapons facilities and

know-how to peaceful purposes, to secure biomaterials for legitimate use or destruction, and to improve security of dangerous pathogens worldwide.

CONCLUDING REMARKS

Mr. Chairman, enemies don’t normally attack us where we are strong; they target

us where we are weak. Enemies of the United States are not eager to engage us

militarily; they saw what happened in Desert Storm. They will attack us where they

believe we are vulnerable. Today, we are vulnerable to biological terrorism and

those who perpetuate such an act are not likely to be quickly identified or leave a

return address. It is critical that we prepare with all possible speed, because if an

attack occurs, and succeeds, there will be others. Preparing is deterring.

Our first priority must be prevention. Whether the enemy achieves its objectives

in an attack depends, to a large extent, on how the American people respond. Panic

is as great a danger as disease. Some will respond like saints—doing whatever they

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can, exhibiting brave and selfless patriotism—to meet the needs of family and community. Others will respond with panic, perhaps even using violence to obtain vaccines or drugs, or try to protect themselves or their loved ones from exposure. The

distance between these two is broad. How most of our citizens will respond will depend largely on what they hear from the President and their elected leaders, and

how they see our government respond. This means we must be prepared.

When America faced possible financial panic in March of 1933, President Roosevelt did three things immediately upon taking office: he ordered the banks to close

temporarily, he proposed emergency banking legislation, and he explained his plan

to the public in the first of his regular national radio broadcasts.

If he had not talked reassuringly to the American people, his plan might not have

worked. But if he had talked, and had no plan, his talk would not have been reassuring. In the event of a biological weapons attack, no President, no matter how

great his natural gifts, will be able to reassure the public and prevent panic unless

we are better prepared than we are right now.

If we are well prepared—with the ability to detect the disease quickly, report it

swiftly, and implement the appropriate infection control measures, including the

provision of necessary drugs or vaccines for all those who came in contact with it—

then the President of the United States will address the American people with

knowledge, with courage, and with confidence, and the people will respond in kind.

Whether this or a future President will exert this essential leadership will depend

in large part on how we all address this issue now.

I commend the Committee for tackling such a difficult but important matter. Our

country’s protection and safety depend on your leadership. Thank you.

The CHAIRMAN. Thank you very much, Senator.

Mr. Woolsey.

STATEMENT OF HON. R. JAMES WOOLSEY, FORMER DIRECTOR

OF CENTRAL INTELLIGENCE, AND PARTNER, SHEA & GARDNER, WASHINGTON, DC

Mr. WOOLSEY. Thank you, Mr. Chairman. I have a three-and-ahalf-page statement with some attachments. If it’s all right, I will

just submit it for the record.

The CHAIRMAN. Without objection. That will be placed in the

record.

Mr. WOOLSEY. I will just use it as notes to give a briefer summary. I will not attempt to duplicate Senator Nunn’s testimony regarding our ‘‘Dark Winter’’ exercise. I have three broad points to

make with respect to trying to avoid a disaster of the sort that we

faced in this game.

First, 5 years ago the CIA and the Energy Department via Lawrence Livermore Laboratory asked me to co-chair a review of the

country’s capacity to deal with terrorism using weapons of mass destruction.

Most of that review is classified, but Joe Nye, my co-chairman,

and I did write an op-ed, which I’ve attached, in which we stress

that we believe that it is the case that terrorism using weapons of

mass destruction—and we thought at the time and I think still biological is the most difficult of these—ought to be the very highest

priority in U.S. National Security Policy.

Biological weapons in terms of number of people killed could

match a nuclear attack. And in terms of simplicity, unfortunately,

it is far simpler to work with biological agents than even chemicals

in many cases, particularly as far as scope and volume of equipment is concerned.

Often you don’t need to smuggle anything. Anthrax grows in

many cow pastures of the world, and much of the equipment that

one would need to weaponize it is transportable. Some of it is little

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more complex than that for, say, a microbrewery attached to a restaurant, which in fact the equipment rather resembles in some

ways.

Happily, there are some very difficult parts of this process which

led Aum Shinrikyo to forsake biological weapons and move to

chemical weapons for their attack in Tokyo. But there are good reasons to believe that one of the reasons, for example, Iraq has been

able to hide almost all of its biological weapons, even when

UNSCOM was in the country operating somewhat effectively, was

because it was moving both biological agents and the equipment

around, perhaps with the Special Republican Guard that protects

Saddam. This should give you some idea of the mobility and size

of this type of equipment.

Second, I served on a National Terrorism Commission chaired by

Ambassador Jerry Bremmer that reported to the Congress of last

summer. And we said in that report that although consequence

management is of course vitally important, and that’s much of

what we dealt with in ‘‘Dark Winter,’’ intelligence really is not only

the first line of defense but the best weapon against many aspects

of terrorism. Because the consequences are so horrible trying to

contain them once an attack has occurred, as we showed in ‘‘Dark

Winter,’’ is extraordinarily difficult.

Now, one reason for example is that vaccines and antibiotics may

be made ineffective by genetic modification of the biological agents.

We know that the Russians were involved in doing this with anthrax. We learned about it in 1997. And for 4 years we have been

asking the Russian Government for samples of their genetically

modified anthrax. So far we have not received any. This may have

spawned some of the work late in the Clinton administration that

has been reported in the press recently to try to figure out how to

deal with a genetically modified biological agent used in a terrorist

attack.

Back in the cold war, we could keep pretty good track of some

of the major threats to our country, Soviet ICBMs and the like,

submarines, with satellite reconnaissance. That tends not to be the

case with something like biological agents, whether used by governments or by terrorists or by some combination.

As Senator Nunn pointed out, biological agents lend themselves

to deception. I would say if a terrorist attack using biological

agents against the United States occurred and it seemed at first as

if the Government of Iran or Shiite groups might be behind it, we

should look very closely at Iraq because it might be a false flag operation.

And conversely, if it seemed initially as if it might have come

from Iraq, we should perhaps look to Iran.

With respect to difficulties and problems with collecting intelligence, I want to highlight two that we stressed in our terrorism

Commission report last summer.

First of all, the CIA has in effect certain guidelines issued in late

1995, I hasten to say after I stepped down from the job in the

Agency, in response to a highly publicized case in Guatemala.

Those guidelines make it considerably more difficult than it needs

to be to recruit agents inside terrorist organizations because rather

cumbersome procedures apply to the recruitment of any spy who

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may have a violent background or any history of human rights violations.

Mr. Chairman, these rules may be defensible when one is recruiting spies inside governments. There are a lot of good people

trapped inside bad governments who have over the years volunteered to work for the CIA or other parts of Western intelligence.

But in my judgment and in the unanimous judgment of our Commission, these rules make absolutely no sense with respect to terrorist groups, because the only people that are in terrorist groups

are people who want to be terrorists. And that means they have a

background in violence and human rights violations.

If you make it difficult for a CIA case officer in, say, Beirut to

recruit spies with this sort of background, he’ll be able to do a

dandy job of telling you what’s going on inside, for example, the

churches and the Chamber of Commerce in Beirut. But we don’t

really care what’s going on there. He’ll have no idea, however,

what’s going on inside Hezbollah.

The CIA today says that they have turned down no recruitments

because of these guidelines. But with all due respect, that’s not the

problem. The problem, as we were told on the Commission by a

number of current and former intelligence officers, is the number

of approaches that are not made to recruit people inside terrorist

organizations because of the cumbersome nature of these guidelines.

The Commission also looked at the FBI guidelines for domestic

work. I use the word work because the FBI strictly speaking does

not conduct domestic intelligence operations. It’s not an intelligence

agency. It’s a law enforcement agency. It investigates individual

crimes.

Here I want to stress that we are dealing with the civil rights

of Americans, and I think we should all agree that special care is

needed in making any changes. But let me state the following hypothetical.

A conscience-stricken member of a militia group affiliated with

Christian Identity, as these groups call themselves—many people

just call them Identity groups, but they call themselves Christian

Identity—comes to an FBI office somewhere in the United States.

He says that at last night’s meeting of the group they were discussing the importance of preparing for Armageddon between the

Children of Adam, Aryans, in this group’s belief, and the Children

of the Devil, everybody else.

One member reportedly stood up and shouted, ‘‘Anthrax for Armageddon’’ and everybody began to take up the same chant. The

conscience-stricken member was worried that some of the group

might act on its enthusiasm.

I believe it would be surprising to most people to realize that in

this hypothetical case the FBI would not be permitted under current guidelines to open a full investigation or to apply to a Federal

court for warrants to conduct electronic surveillance or wiretaps,

nor would it be permitted to recruit new informants beyond the

conscience-stricken individual. It could only follow the matter as

best it could without using these tools.

And finally, Mr. Chairman, on this intelligence point, a particular bete noire of mine, often CIA case officers and FBI Special

29

Agents who work in the terrorism area in these litigious times are

forced to buy personal liability insurance for fear of being sued individually for steps taken pursuant to their authorized duties when

combating terrorism.

Under a recent statute, Federal agencies need reimburse only

one half of cost of this insurance. The rest of the premium is paid

by the Special Agents or case officers out of their pockets.

It would seem the very least we could do is pay the full cost for

premiums of liability insurance that FBI and CIA employees in the

front ranks of the war against terrorism have to take out in order

to have the privilege of protecting us without risking bankruptcy.

Third and final point, Mr. Chairman, I know this is not a hearing on ballistic missile defense, about which I testified before this

committee in late July, and I fully agree that this country’s more

likely to be subjected to attack using biological agents via terrorism, state-sponsored or otherwise, than via ballistic missiles.

But in my view that in no way diminishes the importance of

planning for and deploying ballistic missile defense, including particularly those that would deal effectively with missiles carrying biological weapons.

Dr. Richard Garwin, among others, has pointed out that a missile carrying sub-munition packages filled with biological agents

could defeat defensive missiles that intercept in mid-course because

the sub-munitions could be released early, immediately after the

missile’s boost phase and prior to interception. There would be too

many of them to be intercepted by mid-course defenses. This is one

of the reasons I’ve been particularly attracted to boost-phase intercept as an approach toward missile defense since it would intercept

attacking missiles before the deployment of decoys or such sub-munitions.

Of the five states with biological weapons programs, in addition

to Russia and China, that were listed in last January’s National Intelligence Council assessment of the biological warfare threat,

three, North Korea, Libya and Syria, are susceptible to having any

missile launched from their territory intercepted by sea-based

boost-phase intercept.

One, Iraq, would probably be susceptible to such a defense, although one might need a site in eastern Turkey; and only one,

Iran, would require a substantially innovative approach such as

boost-phase interceptors based in Russia or in space.

I think there are two reasons, Mr. Chairman, why this threat of

ballistic missiles armed with biological weapons should concern us.

One is blackmail. The threat that we would be deterred or that our

potential allies would be deterred from protecting the Kuwaits and

the South Koreas in the future if we or our allies were vulnerable

to attack from a rogue state such as Iraq or North Korea with ballistic missiles carrying biological weapons.

The second is a risk that, as he lost in a crisis and faced removal

from office or worse, a rogue state’s leader might opt for a

Gotterdammerung rather than graceful degradation. We know from

Russian memoirs that this was the mind-set of both Fidel Castro

and Che Guevara in 1962 when they urged Mikoyan to demand a

nuclear attack on the United States at the height of the Cuban

Missile Crisis.

30

And we know from many accounts of the incredibly destructive

orders that Hitler gave, that happily were not carried out, in May

of 1945.

We know of accounts of drug use by national leaders such as Mao

and Hitler, of reliance on soothsayers such as by Saddam today,

and on astrology by the former Chief of the Soviet Strategic Rocket

Forces.

These types of accounts are simply too numerous through history

for us to be confident that as the number of countries with ballistic

missiles and biological weapons continues to grow, we will always

be blessed with rational and reasonable adversaries.

We should not have been forced to decide in 1940 between having

effective local police and having a navy. England should not have

been forced to decide in 1587 between protecting itself against civil

insurrection and an Armada from Spain. And we should not be

forced, today, to choose between defending against terrorists and

against ballistic missiles. Both types of defenses in my view are

badly needed. Thank you, Mr. Chairman.

[The prepared statement of Mr. Woolsey follows:]

PREPARED STATEMENT OF HON. R. JAMES WOOLSEY

Mr. Chairman, members of the Committee, it is an honor to be here today to testify before you on the important subject of biological weapons and terrorism.

I will not duplicate Senator Nunn’s testimony regarding Dark Winter, wherein I

served as President Nunn’s Director of Central Intelligence. Let me address just

three additional points about the threat of biological weapons.

I. LIVERMORE STUDY

Five years ago the CIA and DOE, via Lawrence Livermore National Laboratory,

asked me to co-chair a review of U.S. preparations to deal with terrorism using

weapons of mass destruction. My co-chairman was Joseph Nye, the Dean of the

Kennedy School at Harvard, who had served as the Chairman of the National Intelligence Council when I was DCI in 1993-95. Our report was classified, but we published an op-ed (attached) that reflected the main points of our review. We put terrorism using weapons of mass destruction as the highest priority in U.S. national

security policy.

Generally we determined in the Livermore study that the biological weapons

threat was the most serious because destructiveness, at least in terms of people

killed, could match that of nuclear weapons but the technological and industrial

challenges to a terrorist were considerably less daunting. Happily, there are some

real difficulties in some parts of the weaponization process for biological agents, but

compared to fissionable material many biological agents are far more readily available—anthrax, e.g., grows in many cow pastures in the world. Further, the equipment for much of the process of producing biological weapons is transportable, as

are the biological agents themselves, and indeed the equipment is little more complex than that for a microbrewery, which it rather resembles. There is good reason

to believe, for example, that one of the reasons Iraq was able to hide almost all of

its biological weapons work from UNSCOM was that it was moving equipment and

biological agents around, quite possibly under the control of the Special Republican

Guard that protects Saddam.

II. NATIONAL COMMISSION ON TERRORISM

Second, I served on the National Commission on Terrorism (Chaired by Amb. L.

Paul Bremmer) that reported to the Congress last summer. Although consequence

management is a terribly important part of the national response to terrorism, as

we pointed out in that report good intelligence is not only the first line of defense

against terrorism, but the best weapon against it—because it is the best way to prevent a terrorist act from occurring. I have attached six pages from our report that

make several points I believe relevant to your deliberations today.

There are serious flaws, we found, in both the CIA guidelines for penetrating

terrotist groups abroad and in the FBI’s guidelines for dealing with terrorist groups

in this country.

31

CIA 1995 Guidelines

As far as the CIA is concerned, new guidelines issued in late 1995 in response

to a highly publicized case in Guatemala make it considerably more difficult than

it needs to be to recruit agents inside terrorist organizations because special cumbersome procedures apply to the recruitment of any spy who may have a violent

background or any history of human rights violations.

Mr. Chairman, these rules may be defensible when one is recruiting spies inside

governments—there are a lot of good people trapped inside bad governments who

volunteer to work for the CIA. But they make absolutely no sense at all with respect

to terrorist groups. The only people in terrorist groups are people who want to be

terrorists—hence they will virtually all have a history of violence and human rights

violations. If you make it difficult for a CIA case officer in, say, Beirut, to recruit

spies with this sort of background, he will be able to do a dandy job of telling you

what’s going on inside, e.g., the churches and the Chamber of Commerce there, as

if we cared, but he will have no idea what Hezbollah is planning.

The CIA today says that they have turned down no recruitment because of these

guidelines, but with all due respect that is not the problem. The problem, as we

heard from a number of current and former case officers who communicated with

the Commission, is the number of approaches that are not made to potentially useful agents inside terrorist organizations because of these guidelines. Our Commission recommended unanimously that these guidelines ‘‘no longer apply to recruiting

terrorist informants.’’

FBI Guidelines

The FBI guidelines, our Commission found, are lengthy, complex, and difficult for

FBI Agents in the field to understand (they were also difficult for Commission members to understand). They too have been heavily influenced by past controversies,

such as some of the lamentable excesses of the COINTELPRO program of many

years ago. Here we are dealing with the civil rights of Americans and I think we

would all agree that special care is needed. Still, take the following hypothetical

case:

A conscience-stricken member of a militia group affiliated with Christian

Identity (as they call themselves) comes to an FBI office somewhere in the

U.S. He says that at last night’s meeting of the group they were discussing

the importance of preparing for Armageddon between the Children of Adam

(Aryans, in the group’s belief) and the Children of the Devil (everyone else).

One member reportedly stood up and shouted ‘‘Anthrax for Armageddon,’’

at which point all began the same chant. The conscience-stricken member

was worried that some of the group might act on its enthusiasm.

It would be surprising to many, I believe, to realize that in this hypothetical case

the FBI would not be permitted, under current guidelines, to open a full investigation and apply to a federal court for warrants to conduct electronic surveillance or

wiretaps. Nor would it be permitted to recruit new informants beyond the conscience-stricken individual. It could only follow the matter as best it could without

using these tools.

Full Cost of Liability Insurance

One further small but illustrative point about the way we conduct the war against

terrorism: FBI Special Agents and CIA Case Officers in the field are, in these litigious times, often forced to buy personal liability insurance for fear of being sued

individually for steps taken pursuant to their authorized duties when they are combating terrorism. Under a recent statute federal agencies need reimburse only onehalf of the cost of this insurance. The rest of the premium is paid by the Special

Agents and Case Officers out of their pockets. It would seem that the very least we

could do is pay the full cost of the premiums for the liability insurance that FBI

and CIA employees in the front ranks of the war against terrorism have to take out

in order, without risking bankruptcy, to have the privilege of protecting us.

PRIORITIES

Mr. Chairman, I know that this is not a hearing on ballistic missile defense, about

which I testified before this Committee in late July. But just a word about priorities,

if I might. I fully agree that we are more likely to be subjected, in this country, to

an attack using biological agents via terrorists—state sponsored or otherwise—than

by ballistic missile. But in my view that in no way diminishes the importance of

planning for and deploying ballistic missile defenses, including particularly those

that would deal effectively with missiles carrying biological weapons.

32

Dr. Richard Garwin, among others, has pointed out that a missile carrying submunition packages filled with biological agents could defeat defensive missiles that

intercept in midcourse because these sub-munitions could be released early, immediately after the missile’s boost phase, and prior to interception. There would be too

many of them for the mid-course defensive system to deal with. This is one of the

reasons I have been particularly attracted to the boost-phase intercept approach toward missile defense, since it would intercept attacking missiles before the deployment of decoys or such sub-munitions. Of the five states with biological weapons

programs (in addition to Russia and China) listed in the National Intelligence Council’s assessment in January of this year, ‘‘The Biological Warfare Threat,’’ three

(North Korea, Libya, and Syria) are susceptible to having any missile launched from

their territory intercepted by sea-based boost-phase intercept. One (Iraq) could be

susceptible to such a defense if the intercepting missile were fast enough, although

augmentation from a land-based site in Eastern Turkey might be necessary. Only

one (Iran) would require a substantially innovative approach, such as boost-phase

interceptors based in Russia, or in space, to defend against attacks from its territory.

I think there are two reasons, Mr. Chairman, why this threat of ballistic missiles

armed with biological weapons should concern us.

One is blackmail—the threat that we would be deterred, or potential allies would

be, from protecting the Kuwaits and South Koreas in the future if we or our allies

were vulnerable to attack from a rogue state such as Iraq or North Korea with ballistic missiles carrying biological weapons.

The second is the risk that, as he lost in a crisis and faced removal from office

or worse, a rogue state’s leader might opt for Gotterdammerung rather than graceful degradation. We know from Russian memoirs that this was the mind-set of both

Fidel Castro and Che Guevera in 1962, when they urged Mikoyan to demand a nuclear attack on the U.S. at the height of the Cuban Missile Crisis, and from many

accounts of the incredibly destructive orders that Hitler gave in May 1945. And the

accounts of drug use (Mao and Hitler), of reliance on soothsayers (Saddam) and astrology (former Chief of the Soviet Strategic Rocket Forces) are simply too numerous

throughout history for us to be confident that—as the numbers of countries with

ballistic missiles and biological weapons continues to grow—we will always be

blessed with rational and reasonable adversaries.

We should not have been forced to decide, in 1940, between having effective local

police and having a Navy; England should not have been forced to decide, in 1587,

between protecting itself against civil insurrection and an Armada from Spain. And

we should not be forced, today, to choose between defending against terrorists and

against ballistic missiles. Both types of defenses, in my view, are needed badly.

[From the Los Angeles Times]

PERSPECTIVE ON TERRORISM

DEFEND AGAINST THE SHADOW ENEMY

(By Joseph S. Nye, Jr. and R. James Woolsey)

The destruction of the federal building in Oklahoma City and the bombing of the

World Trade Center in New York shocked Americans. But those tragedies would

have been far worse if nuclear, biological or chemical materials had been involved.

After co-chairing a year-long study for the government, we believe it is increasingly

likely they will be.

For 40 years Americans lived under the fear of Soviet nuclear attack. The end

of the cold war reduced the prospect of a nuclear holocaust, but ironically, prospects

of a nuclear explosion inside the United States probably have increased. And it is

not just the nuclear threat. Terrorists worldwide have better access to anthrax or

sarin than to nuclear materials. So far, we have been lucky. But we should not wait

for another Pearl Harbor to awaken us to the fact that there is no greater threat

to our security than terrorism involving weapons of mass destruction.

Skeptics may call us alarmists. Nuclear technology has been around for 50 years

and chemical and biological agents for nearly a century, yet terrorists have rarely

turned to them. Conventional high explosives are easier to obtain. Moreover, terrorists seeking to promote a cause run the risk of a moral and political backlash if the

destruction they wreak is disproportionate to their cause.

But recent years have seen the rise of a new type of terrorist less interested in

promoting a political cause and more focused on retribution or eradication of what

33

they define as evil. Their motives are often a distorted form of religion and their

imagined rewards are in the next world. For them, weapons of mass destruction,

if available, are a more efficient means to their ends.

Such devices are becoming more available. The breakup of the Soviet Union and

the rise of the mafias in Russia have increased the smuggling of nuclear materials.

Chemicals and biological agents can be produced by graduate students or lab technicians. General recipes are readily available on the Internet.

Our overriding recommendation is to give the threat of terrorism with weapons

of mass destruction the highest priority in U.S. national security policy. Of the

threats that could inflict major damage to the U.S., such terrorism is the threat for

which we are least prepared.

The nation needs a national response program, directed by the White House. The

program must be coordinated and integrated across the entire federal bureaucracy.

And end-to-end systematic strategy to encounter this threat must address all phases

of a potential terrorist attack, from detection and prevention to response. Such a

strategy must include and coordinate program initiatives by all involved departments and agencies.

To this end, we recommend that:

• Policy direction be clarified at the White House level by a committee chaired

by the Vice President.

• Interagency and interdepartmental coordination and integration be handled by

deputies of the involved organization.

• The program be supported by a long-term funding strategy.

• The program be managed by a single director and supported by a technical and

systems planning staff.

• An independent advisory board of outside experts be appointed by the President

to monitor and advise the program.

• A joint legislative oversight committee be appointed.

The very nature of U.S. society makes it difficult to prepare for this security problem. Within recent memory, we have not had to battle a foreign invading force on

U.S. soil. Because of our ‘‘Pearl Harbor’’ mind-set, we are unlikely to mount an adequate defense until we suffer an attack. Because the threat of terrorism with weapons of mass destruction is amorphous (rogue states, transnational groups, ad hoc

groups or individuals) and constantly changing, it is difficult to make predictions

and preparations. However, given the current geopolitical state of the world, there

is every indication that terrorism will be the most likely physical threat to the U.S.

homeland for at least the next decade.

Only if we go beyond business as usual and respond in a broader and more systematic manner do we stand a chance of dealing with this problem before the horror

of another Pearl Harbor.

Joseph S. Nye, Jr., was Assistant Secretary of Defense and R. James Woosley was

the CIA Director in the first Clinton administration.

GOOD INTELLIGENCE IS THE BEST WEAPON AGAINST INTERNATIONAL TERRORISM

Obtaining information about the identity, goals, plans, and vulnerabilities of terrorists is extremly difficult. Yet, no other single policy effort is more important for

preventing, preempting, and responding to attacks.

The Commission has identified significant obstacles to the collection and distribution of reliable information on terrorism to analysts and policymakers. These obstacles must be removed.

In addition, this information, often collected at great risk to agents and officers

in the field, must be safeguarded. Leaks of intelligence and law enforcement information reduce its value, endanger sources, alienate friendly nations and inhibit

their cooperation, and jeopardize the U.S. Government’s ability to obtain further information.

‘‘Nothing should be as favorably regarded as intelligence; nothing should be as

generously rewarded as intelligence; nothing should be as confidential as the work

of intelligence.’’ Sun Tzu

ELIMINATE BARRIERS TO AGGRESSIVE COLLECTION OF INFORMATION ON TERRORISTS

Complex bureaucratic procedures now in place send an unmistakable message to

Central Intelligence Agency (CIA) officers in the field that recruiting clandestine

sources of terrorist information is encouraged in theory but discouraged in practice.

34

Inside information is the key to preventing attacks by terrorists. The CIA must

aggressively recruit informants with unique access to terrorists plans. That sometimes requires recruiting those who have committed terrorist acts or related crimes,

just as domestic law enforcement agencies routinely recruit criminal informants in

order to pursue major criminal figures.

CIA has always had a process for assessing a potential informant’s reliability, access, and value. However, the CIA issued new guidelines in 1995 in response to concern about alleged serious acts of violence by Agency sources. The guidelines set up

complex procedures for seeking approval to recruit informants who may have been

involved in human rights violations. In practice, these procedures have deterred and

delayed vigorous efforts to recruit potentially useful informants. The CIA has created a climate that is overly risk averse. This has inhibited the recruitment of essential, if sometimes unsavory, terrorist informants and forced the United States to

rely too heavily on foreign intelligence services. The adaption of the guidelines contributed to a marked decline in Agency morale unparalleled since the 1970s, and

a significant number of case officers retired early or resigned.

Recruiting informants is not tantamount to condoning their prior crimes, nor does

it imply support for crimes they may yet commit. The long-standing process in place

before 1995 provided managers with adequate guidance to judge the risks of going

forward with any particular recruitment.

Recommendations:

• The Director of Central Intelligence should make it clear to the Central Intelligence Agency that the aggressive recruitment of human intelligence sources on

terrorism is one of the intelligence community’s highest priorities.

• The Director of Central Intelligence should issue a directive that the 1995

guidelines will no longer apply to recruiting terrorist informants. That directive

should notify officers in the field that the preexisting process of assessing such

informants will apply.

The Federal Bureau of Investigation (FBI), which is responsible for investigating

terrorism in the United States, also suffers from bureaucratic and cultural obstacles to obtaining terrorism information.

The World Trade Center bombers and the foreign nationals arrested before the

millennium sought to inflict mass casualties on the American people. These incidents highlight the importance of ensuring that the FBI’s investigations of international terrorism are as vigorous as the Constitution allows.

‘‘The FBI has a right, indeed a duty, to keep itself informed with respect to the

possible commission of crimes; it is not obliged to wear blinders until it may be too

late for prevention.’’

The FBI’s terrorism investgations are governed by two sets of Attorney General

guidelines. The guidelines for Foreign Intelligence Collection and Foreign Counterintelligence Investigations (FI guidelines), which are classified, cover the FBI’s investigations of international terrorism, defined as terrorism occurring outside the

United States or transcending national boundaries. Domestic terrorism governed by

the Attorney General guidelines on General Crimes, Racketeering Enterprise and

Domestic Security/Terrorism Investigations (domestic guidelines). The domestic

guidelines would apply, for example, to an investigation of a foreign terrorist group’s

activities in the United States if the FBI does not yet have information to make the

international connection required for the FI guidelines.

Both guidelines set forth the standards that must be met before the FBI can open

a preliminary inquiry or full investigation. The domestic guidelines authorize a preliminary inquiry where there is information or an allegation indicating possible

criminal activity. A full investigation may be opened where there is a reasonable

indication of a criminal violation, which is described as a standard ‘‘substantially

lower than probable cause.’’

The domestic and FI guidelines provide the FBI with sufficient legal authority to

conduct its investigations. In many situations, however, agents are unsure as to

whether the circumstances of a particular case allow the authority to be invoked.

This lack of clarity contributes to a risk-averse culture that causes some agents to

refrain from taking prompt action against suspected terrorists.

In 1995, largely in response to the Oklahoma City bombing and indications that

confusion was inhibiting investigations, the Department of Justice (DoJ) issued a

memorandum to the FBI field offices attempting to clarify the circumstances that

would merit opening a preliminary inquiry and full investigation under the domestic

guidelines. Nonetheless, there is still considerable confusion among the FBI field

35

1 Commissioner Kayyem did not concur with the content of this section.

agents about the application of the guidelines. Neither the DoJ nor the FBI has attempted to clarify the FI guidelines for international terrorism investigations.

Recommendation:

• The Attorney General and the Director of the Federal Bureau of Investigation

should develop guidance to clarify the application of both sets of guidelines.

This guidance should specify what facts and circumstances merit the opening

of a preliminary inquiry or full investigation and should direct agents in the

field to investigate terrorist activity vigorously, using the full extent of their authority.

The Department of Justice applies the statute governing electronic surveillance and

physical searches of international terrorists in a cumbersome and overly cautious manner.1

Pursuant to the Foreign Intelligence Surveillance Act (FISA), the FBI can obtain

a court order for electronic surveillance and physical searches of foreign powers, including groups engaged in international terrorism, and agents of foreign powers.

Applications from the FBI for FISA orders are first approved by the Office of Intelligence Policy and Review (OIPR) in the Department of Justice before being presented to a judge of the FISA Court for approval. OIPR has not traditionally viewed

its role as assisting the FBI to meet the standards for FISA applications in the same

way that the Criminal Division of DoJ assists the FBI investigator to meet the

standards for a wiretap. For instance, the Criminal Division works with the investigating agents to identify and develop ways to obtain the type of information needed to satisfy statutory requirements. OIPR has traditionally not been that proactive.

The Commission heard testimony that, under ordinary circumstances, the FISA

process can be slow and burdensome, requiring information beyond the minimum

required by the statute. For example, to obtain a FISA order, the statute requires

only probable cause to believe that someone who is not a citizen or legal permanent

resident of the United States is a member of an international terrorist organization.

In practice, however, OIPR requires evidence of wrongdoing or specific knowledge

of the group’s terrorist intentions in addition to the person’s membership in the organization before forwarding the application to the FISA Court. Also, OIPR does not

generally consider the past activities of the surveillance target relevant in determining whether the FISA probable cause test is met.

During the period leading up to the millennium, the FISA application process was

streamlined. Without lowering the FISA standards, applications were submitted to

the FISA Court by DoJ promptly and with enough information to establish probable

cause.

Recommendations:

• The Attorney General should direct that the Office of Intelligence Policy and

Review not require information in excess of that actually mandated by the probable cause standard in the Foreign Intelligence Surveillance Act statute.

• To ensure timely review of the Foreign Intelligence Surveillance Act applications, the Attorney General should substantially expand the Office of Intelligence Policy and Review staff and direct it to cooperate with the Federal Bureau of Investigation.

The risk of personal liability arising from actions taken in an official capacity discourages low enforcement and intelligence personnel from taking bold actions

to combat terrorism.

FBI special agents and CIA officers in the field should be encouraged to take reasonable risks to combat terrorism without fear of being sued individually for officially authorized activities, however, government representation is not always available to such agents and officers when they are sued. As a result, FBI special agents

and CIA officers are buying personal liability insurance, which provides for private

representation in such suits.

By recent statute, federal agencies must reimburse up to one half of the cost of

personal liability insurance to law enforcement officers and managers or supervisors.

Recommendation:

• Congress should amend the statute to mandate full reimbursement if the costs

of personal liability insurance for Federal Bureau of Investigation special agents

36

and Central Intelligence Agency officers in the field who are combating terrorism.

The CHAIRMAN. Thank you. Let me begin quickly by saying I was

in a couple of these conferences and groups with the former CIA

Director. I agreed with him in that I had the same attraction to,

as he knows, boost phase interceptors. And the reason is all the

countries you have named, to the extent they may gain the capacity to launch an intercontinental ballistic missile against the

United States, the likelihood of them doing it with a nuclear weapon is much lower because of the throw weight required than it is

for the biological weapon.

And I don’t know how—parenthetically, I don’t want to get in

this debate, I want to get off it—but I don’t know how a test bed

in Alaska has a damn thing to do with any of this, which I think

is foolhardy. But at any rate, that’s a different question. Let me go

straight to the issue of what was learned from your exercise, gentlemen.

In terms of prioritizing, it seems to me that what we are going

to have to do to do this intelligently, were we to run another exercise, were we to say to the same group that you assembled, and

that wouldn’t be a bad thing by the way, from my perspective, were

we to assemble the same group, and say there’s a different exercise; the exercise is we have x amount of dollars and we have the

following threats.

We want you all to prioritize for us how we should spend those

dollars. What is the most urgent threat? How much of the threat,

Sam, in real terms, I don’t know how you characterize it, but in

real terms, is this threat of biological weapons attack or use of

pathogens?

I mean, where does it rank in your mind as requiring our attention in relative terms? Leave missile defense out for a minute—I

don’t want to get into the middle of that. But give us a sense of

how big a deal this is. How much do we have to worry about this?

My dad, God help him, he’s 86 years old. And at the time I was

a kid, I can remember him saying, ‘‘Joey, if everything is equally

important to you, nothing is important to you. If everything is

equally important, nothing is important.’’ Everything can’t be equally important. Tell me about it. Talk to

me about it. Talk to us about it. How important is dealing with

your recommendations on this issue relative to, you know, moneys

we are going to have to spend for a joint strike fighter; those kinds

of practical decisions that you had to make when you sat here.

Senator NUNN. That’s the toughest of all questions. And that’s

the reason we likewise lead us to sort out these priorities. But I

would say that there needs to be a process by which this is done.

And I think the process starts with the intelligence assessment.

I believe the intelligence community has to be charged with some

sense of priority in terms of various threats, in terms of both likelihood and consequence. Because something is not likely to happen

and yet the consequences are just so horrendous you can’t even

contemplate them has to be given some weight against something

that is much more likely to happen but with less consequence.

There needs to be a process. This may be a time, Jim Woolsey

and I have both lived through several B teams, may be the time

37

for an intelligence assessment with a B team of outsiders that basically would parallel it or follow it.

Missile defense would be part of this, and not just missile defense but also what parts of missile defense. Are we going to try

to guard against the troops in the field? That’s to me the highest

priorities, the troops in the field. That’s the most likely kind of attack with a ballistic missile.

That’s a different counter system probably, although it could lead

to a system with National Missile Defense. If terms of biological,

as Jim Woolsey said, I think he said it well, the access of so many

people, so many would-be perpetrators of this kind of horrible act

to the materials is much higher.

The access is much higher because so many of them are in the

mails. They are in laboratories all over. They are used for legitimate purposes. You can basically borrow these kinds of materials

because of the commercial side of it. The information that is now

on the Internet on how to both secure materials as well as make

weapons, not just biological but also nuclear, that has gone way up.

The futility of many of our adversaries to believe they could really harm the United States in a conventional war has gone way up.

And that frustration and futility has gone up. The knowledge that

for instance I think we have to put this in the equation, the knowledge that if they did fire a missile at the United States, we know

where it came from and they would be committing suicide. That

has to be put into the equation whether it’s a biological missile or

whether it’s a nuclear missile—versus the knowledge that they

have a reasonable chance of getting away with it if they spray aerosol in three shopping centers with a smallpox vaccine. That’s 2 or

3 weeks before we even know it happened.

If you are a perpetrator and you are not suicidal, what’s your

most likely course of action. For all those reasons, I put biological

near the top of the list. I’m not sure whether it ought to be at the

top of the list, but it’s very close, if it’s not.

The consequences are so horrendous, not just in terms of loss of

life but loss of confidence, loss of confidence that an American people in that of their own government.

One of the most frustrating things, and Jim will attest to this,

we had some of our most esteemed and wise members of the news

media sat in on these exercises. And we were later having a news

conference. Talk about unfairness, they sat in on the NSC meeting.

And then I went out and faced them and they knew everything

that we did. They knew as much as I did.

But the most frustrating thing I had to deal with this as President was the fact that I knew that I had to retain the credibility

of the Federal Government. What we said had to be proven later.

You ruin your credibility in this sort of horrible situation, you really would cause chaos. And yet I did not have any answers.

I couldn’t tell how much material was out there. I couldn’t tell

where it came from. I couldn’t tell from law enforcement whether

we had a reasonable chance of apprehending the culprits. I couldn’t

tell whether they were launching other attacks simultaneously.

I had no way of knowing where the victims were. I had no way

of isolating them. I had no way of basically telling people frankly

that we were going to have enough vaccine. All of a sudden, one

38

of the things that played in here, Russia offered us a huge dose of

vaccine to help about the second week of the attack.

Immediately on one hand we were saying wonderful. That’s wonderful. On the other hand, we were saying is it safe. Can we test

it? Do we have time to test it? Can we afford to go out there and

put out this kind of vaccine in millions of people knowing not

whether it might itself kill them.

All those things led me to the conclusion that I could not accurately describe with honesty to the American people what was happening. So I feared the loss of the credibility of the United States

Government; not me as President, but of the whole Government.

And that was the most frustrating part of this.

The CHAIRMAN. I have some very detailed questions for the scientists who will be coming up after you, and I am sure my colleagues are going to cover some of the areas that I would like to

get into. But let me conclude by saying that our present intelligence director, CIA Director, indicates on a classified basis that

this is a very, very high concern, that this is more probable, this

kind of occurrence is more probable than most any other.

But I will get into that later. And I’m sure others will want to

speak to some of these issues. I yield to my friend.

Senator HELMS. Thank you, Mr. Chairman. Let me make a proposition to you. You be Sam Jones sitting there having made the testimony you just made. And you are Sam Nunn, Senator, still in the

Senate. What would you do as a result? What would you recommend to the Senate that we do specifically? What kind of legislation would you draw?

I have an idea, Senator, that a lot of people are frightened, and

justly so. And I appreciate you doing it by what you have just said.

Senator NUNN. Chairman Helms, I think I would start with an

inventory of what’s being done. I don’t have a good sense, I know

we are spending more money than we were, and if you read some

people are saying we are spending a higher rate on biological; it’s

growing faster than others; but it’s from such a low baseline. I

would try to see how we are spending the money now.

Because a lot of this is not being spent in my view in the most

high priority areas. And the second thing is I think that the public

health service has to be part of the national security team. And I

think you may not do that by legislation. Maybe you do that by getting the head of HHS up here with the head of Department of Defense, with the head of the CIA and have a poll on people that

show across the board. It’s going to take a whole team.

You have to ask the public health service out there, what is it

that would prevent you from dealing with this situation? Do you

have enough surge capability in the medical system?

We are trying to get more efficient in the medical system. The

more efficient we get, the less surge capability we are capable of

handling. And the third thing I would look for every overlap between infectious disease and biological terrorism. Because we’ve got

to make this a global issue. It can’t just be the United States.

We have got to involve the World Health Organization. We’ve got

to work with people around the globe. We’ve got to work with the

Russians. They have the biological scientists that could make this.

39

We’ve got to find a way to get those people employed. All of those

things relate to money more than they do specific law.

On the legal side, and particularly legislative changes, I think

you have to contemplate emergencies and how you would isolate

people. And look at your laws and see right now whether we can

anticipate those kind of steps or whether we would be trampling

all over everyone’s civil liberties and have a huge cry while we are

doing it.

Can we anticipate this and deal with it? As Joe Biden said, we

had a huge problem on the posse comitatus contact to allow military to come in, in a nuclear emergency or biological and chemical

emergency and deal with this. They do have that limited authority.

So there are certain safeguards you could put in place. Otherwise, when this happens people aren’t going to be concerned about

civil liberties that much. They are going to say whatever it takes,

do it. And I think we’ll lose a lot of control in that perspective.

That would be my higher priority, take an inventory of what we

are doing now, look at the resources, see if they are being defended,

and call some public health witnesses up here, some people who

really are experts.

I know we have some on the panel coming. This is not something

the Pentagon is accustomed to thinking about. One of the things

that Jim will recall in the middle of our exercise, two or three people who served in the Department of Defense said, ‘‘I don’t know

how to think about this. We’ve never thought about this.’’

Senator HELMS. That’s the point. We could just talk about it and

we could scare the hell out of each other with testimony. And you

have. And I thank you for doing it.

But Mr. Chairman, let’s suggest a bipartisan approach, you and

I, on behalf of the committee with the committee’s approval as to

how to proceed on this. Because I think that every day we delay

we are running a bad risk in this country. Thank you, Senator.

Senator NUNN. Early detection is one of the early things, and to

have the technology that would tell us what is this pathogen that’s

been released. Because if you don’t know that, you don’t have a

chance of dealing with it; and training of doctors and nurses so

they recognize it.

That right now is a new technique, not new, but it’s called a

symptom survey. So instead of waiting until a doctor comes to CDC

and says I’ve got smallpox, you have got the pharmacists around

the country alerted.

You have computer systems so that when they start seeing people come in for certain problems, whether it’s a series of chronic

headaches or whatever, that they don’t recognize, that there’s some

reporting system, some early alert system about symptoms.

Senator HELMS. Maybe some of the pharmaceutical companies

can make some recommendations about how to deal with some of

these things.

Mr. Woolsey, let me ask you something. The January 2001 National Intelligence Council report on biological warfare threats said

that there are 25 missile warheads with biological agents in Iraq

alone, and they are unaccounted for.

40

Now, do we have any idea about the possible targets of these

missiles, and is it possible for Iraq to develop similar warheads for

longer range missiles?

Mr. WOOLSEY. I believe it is possible for them to develop warheads for longer range missiles, Mr. Chairman. It is both, in terms

of weight and in terms of technology, rather simpler as the Chairman suggested than for nuclear weapons. I don’t believe we know

or have any samples of the biological agents that Saddam had

produced—— Senator HELMS. That would be my next question.

Mr. WOOLSEY [continuing]. Or of any of the warheads. The Iraqis

simply said these have been unilaterally destroyed, and UNSCOM

was not able to get hold of any of these. So we are really rather

crippled by the absence of UNSCOM, I think, from knowing a great

deal more about the Iraqi program than we do today.

And of course one great fear is that if Russian scientists were

working with the Iraqis, some of these biological agents that are

in the hands of Iraq, and could conceivably through Iraq be given

to bin Laden or other terrorist groups, may be genetically modified

so that standard vaccines and antibiotics would not operate against

them.

I mentioned earlier we know that the Russians genetically modified anthrax. And so if that were used and we don’t know exactly

how it was genetically modified, we conceivably could have lots of

vaccinated servicemen and women in the Mideast or vaccinated

people in the United States who would be no better off if they were

subjected to an attack from that type of genetically modified anthrax.

Senator HELMS. Thank you, Mr. Chairman.

The CHAIRMAN. Gentlemen, for the record, we will be spending

$182 million on bioterrorism preparedness, a $1 million increase.

So we all have a number, it’s $77 million for state and local preparedness; $52 million for a national pharmaceutical stockpile; $22

million for an upgrade capacity at CDC; and $18 million for continued evaluation of the anthrax vaccine.

We are going to spend $94 million with the World Health Orga- nization; $344 million for DOD and $8.3 billion for additional moneys for national missile defense.

According to the Hart-Rudman Commission, biological weapons

are the most likely choice of means for disaffected states or groups

in the 21st century. That may or may not be right but this is what

the assessment in the allocations is so far in dollars.

Senator HELMS. May I say, is that enough?

Senator NUNN. Well, I don’t think it’s anywhere near enough. I’m

not sure how we pay for all of it but somebody’s got to increase the

hospital capacity. Somebody’s got to train the doctors and nurses

to recognize this.

Somebody’s got to do the research and development. Problem is

the government is the only one on how you recognize these pathogens very quickly. Someone has to try to figure out a way to hire

the Russians who might otherwise end up in Iraq making these

weapons. There’s a lot to be done. I don’t think this is enough.

The CHAIRMAN. Thank you.

The Senator from California.

41

Senator BOXER. Thank you so much, Mr. Chairman, for holding

this hearing. I fully agree with Senator Helms that this has been

a wake-up call. I want to thank both of our wonderful panelists for

their contribution.

I want to say that, Senator Nunn, I thought your testimony is

so clear. I particularly feel on page 3 where you just come right

down to it as you tried to deal with this in this mock exercise you

found out certain things: One, we had not produced sufficient vaccine; we had not prepared top officials to cope with this new type

of security threat; we had not invested adequately in the planning

and exercises necessary for coordinated response.

We had not ensured the public health infrastructure was adequate, and so on. We had not educated the American people to it.

We had not practiced what few plans were in place. We had not

ranked bioterrorism or infectious diseases as high national priorities, which is of course is what Senator Biden’s message is to us.

So I think that you lay out here for us a road map to the deficiencies that need to be fixed. And I support the call for a bipartisan approach to this, Mr. Chairman, and our ranking member.

In my remaining couple of minutes, I wanted to talk about infectious diseases because I can’t stay because of a conflict for the next

panel. Because whether you get the disease through an act of terrorism or it happens because it’s just naturally occurring, it confronts both. And that’s why I’m glad you do have the second panel.

But I wanted to take this opportunity to talk about a particular

threat that Senator Gordon Smith and I have been working on in

a bipartisan way. MDR TB which is the multidrug resistant tuberculosis, far more difficult and hundreds of times more expensive to

treat than the standard TB and even in the United States kills half

of its victims.

It cost New York City a billion dollars to quell an epidemic of

this multidrug resistant TB in the early 1990s, Mr. Chairman. TB

is invisible. It’s transmitted through the air. If untreated, it disables and then kills a person.

Someone with active MDR TB in a developing country is estimated to infect ten to fifteen others in a year. TB rates have skyrocketed in regions with high AIDS burdens such as sub-Sahara in

Africa.

In regions like Russia where the incidence of MDR TB is so high,

as HIV rates also increase, their risk of an uncontrollable global

epidemic is very real.

So what I wanted to take advantage, if you will, in close of this

opportunity, Mr. Chairman, to call to the committee’s attention

that because of your help and Senator Helms’ help last year Senator Smith and I worked and we got triple the funding for TB programs. We got that funding up to $60 million.

It is still if I might say, too small a sum. And this year we are

looking at an increase up to $200 million. And I mention that because this is a situation where the best way to treat this, if you

will, is called D-O-T-S, DOTS, directly observed treatment short

course.

So that is expensive and has to be done. And I wanted to tell my

friends on this committee on both sides of the aisle that Gordon

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Smith and I will be talking to you about this because we are very

concerned.

Two questions, have you looked at this problem with TB in what

you did and also, Senator Nunn, when you say the most important

thing for us to do is to have a review, which I think we should do,

would you then say that we should then move to go to your points

where you just say we were not prepared, we did not do this, to

change the reality.

Because even though the funds might be there, as the chairman

pointed out we are expending dollars, it seems to me on my sense

out there we have a lot to do.

Senator NUNN. Senator Boxer, we did not get into any other diseases other than this hypothetical with smallpox. But each one

would be different. I would only make the point again that whatever we do to improve the public health system to deal with any

kind of infectious disease, we also help ourselves with biological

terrorism and vice versa and particularly surge capability, early

recognition, training of medical personnel; and in the case of bioweapons certainly vaccine and new methods of treatment.

Senator BOXER. And what about that second question? In other

words, after the review would you be willing to put yourself out

there a little further? If the review shows that we are spending an

adequate fund or maybe we need to spend a little more but getting

to your—you are dealing with an exercise where you are coming in

pretty strongly and saying we were just not ready. So it seems to

me even if we have the money there’s not a mindset there.

Senator NUNN. That’s right. There’s a thin line here. You have

to think real seriously as Senator Helms alluded to, do you cause

people to panic? Do you cause despair? Or do you basically point

out problems?

I don’t know any other way to deal in a democracy like ours

where thousands and thousands of people have to make decisions,

particularly in public health, to be able to bring these things to

their attention without getting vivid about it and talking in realistic terms. This is a democracy and that’s the way we act. But

what you don’t want to do is cause despair.

Senator BOXER. Right. Thank you.

The CHAIRMAN. Thank you very much.

Senator Lugar.

Senator LUGAR. Thank you very much, Mr. Chairman. I want to

join your comments and those of Senator Nunn about our colleague

Senator Helms. I appreciate the friendship you expressed and the

way in which this committee has been able to move with the two

of you as chairmen during this Congress.

Let me just say I despair with the fact that Sam Nunn is not

here as a Senator because I miss him as a partner. But fortunately

he is active around the world and with the Nuclear Threat Initiative.

Ten years ago a bipartisan group of Senators met for breakfast,

Ash Carter, who had come from Harvard, and Bill Perry from Stanford, began to help us fashion what became the Nunn-Lugar bill

and the Cooperative Threat Reduction program. We’ve been working on this effort for 10 years, haltingly at first because the people

did not really see how we could be effective with Russia.

43

But in due course we have seen increasingly effective. And at

this point 5,600 nuclear warheads have been separated from missiles. There are still many left, and there is still much work to do.

Chemical weapons, the second part has not moved as quickly.

And we still have work to do with our colleagues in the House Representatives this year to destroy really the first pound of the 40,000

metric tons of chemical weapons they have stored in seven depots

in Russia.

But there has been progress, and we should get a program going.

The Russian Duma now has also appropriated funds for this purpose. So we must get started.

In the biological arena, it was not until November 1998 that Sam

Nunn and Carl Levin and I were invited to meet with thirteen

Biopreparat laboratory directors who had been working on the

former Soviet biological weapons program, under the auspices of

the International Science Technology Center (ISTC).

At this meeting these directors revealed a lot to us. And later

Sam and I were able to go in November 1998 to Obelinsk which

to my knowledge is the first time Members of Congress entered one

of these former biological weapons facilities.

We visited an eight-story building at the Obelinsk complex. The

third story held the facility’s strain library, and it had anthrax in

it. The laboratory director told me they had many different strains

of anthrax. I viewed anthrax under a microscope. And I wouldn’t

know what I was looking at but nevertheless that’s as close as I

want to get to that dangerous pathogen.

Now, that visit was the first step in the process of opening the

facility to the outside world. Obelinsk today is having seminars for

scientists around the world. They have brochures of the peaceful

work they are working on and the guests they have invited into

this place. But at the time that we visited, the security had a little

bit of barbed wire and one guard. The first hour of our discussion

was on how the United States could secure the facility and safeguard the deadly pathogens.

In the last couple of years it has been my privilege to also visit

Pokrov and just a week ago Kazan. Now these are so-called agricultural facilities. And ostensibly the purpose of these are dual use.

They work on vaccines that can help protect livestock herds, and

that was the reported Russian’s purpose as they gave it to us. But

you could turn the facilities around and use them to develop weapons to eliminate somebody else’s herds.

They had gone as far as Africa for exotic pathogens. And when

I asked why, they assumed that we had done that and were prepared to poison their cattle or to go after them.

These facilities have large stocks of pathogens. They store it in

iceboxes that they have shown to us. Now, the reason we got into

the iceboxes or into Pokrov or Kazan was essentially because of the

Nunn-Lugar program. We have inserted ourselves into these facilities. And it’s been to the extent of it that Russian military and civilian people thought they needed help that they got us in there.

The problem is that ISTC has identified tens of thousands of

Russian scientists who may have been involved in these weapons

programs. The United States provides maybe 50 or 60 percent of

the money. There is also an international component.

44

These scientists trade e-mail with laboratories in the United

States as well as elsewhere around the world. It’s sort of a hearts

and minds project in many ways. But there are prospects they will

expand their work with us.

Now, why, because the dangers for Russians are profound from

all of this. In Pokrov there is a bunker. It’s a bunker because they

feared, according to their authorities, nuclear attack. Whatever was

happening there they felt was significant enough that they would

be targeted by the United States of America. And there are stores

there of whatever they produced there.

The desperation of the situation is seen all around, disheveled

buildings that are falling down. Electricity is sometimes questionable, as well as the sanctity of the infrastructure of these facilities.

And yet, at Polrov, the facility’s right on top of the bunker occupied

by a commercial firm called Green Mama Shampoo where shampoo

is being produced in the same vehicles that could be used for the

anthrax or for the other purpose.

Because they are desperate for the money. They are renting it

out to all comers. This is a situation which cries out for activity.

The Nunn-Lugar program has been most successful in establishing some ties with these people.

Now, Nunn-Lugar is not the solution to our whole problem. But

if you look at it in terms of addressing these threats at their source

whether it’s nuclear, chemical, biological, the best avenue is still a

relationship with Russians who have similar views as our own.

And I would just say at the highest levels they do.

Now, there’s a dispute in Russia. We did not get it in this trip

I just described into one place that I thought that I’d been promised by a Russian general because some of the military people still

are resistant to seeing Americans entering these facilities. And

there are some laboratories still receiving orders to keep producing

more while the scientists are producing less and looking for peaceful jobs and looking out for their own financial security.

But it’s a fertile ground to at least try to understand who has

done what and where it is.

Now, all of the work that Nunn-Lugar has been doing is only a

$17 million project. This doesn’t denigrate any of these efforts, and

I am a strong proponent of the Nunn-Lugar program as most of

you are. I also believe the Nunn-Lugar-Domenici program, which

has helped 120 cities in America understand what might hit them

if something does and assisting first responders with training and

table top exercises with policemen and sheriffs, hospital staff. So

if our cities are attacked with biological weapons we can respond

effectively.

These efforts are tremendously important to avert panic and

have credibility. But I just plead for a continued bipartisan quest

on this. It is not going to work if these issues are politicized. But

we all need to try to think through this by utilizing our country’s

best minds to determine what needs to be done and how we can

enlist Russians.

I just conclude by saying I suggested to Vice President Gore,

when they had the Gore-Chernomyrdin meetings, that we seriously

consider having some of our pharmaceutical companies or chemical

companies purchase these laboratories, actually incorporate them

45

with the scientists and all of the techniques and whatever else they

have in the vaults.

This is not a farfetched suggestion. But one reason it has not

been appealing to the companies that I’ve talked to is just simply

the general business conditions in Russia. The fact that they, really

their legal system cannot support the contracts that would be required, property rights, the rest of it.

So in a way we are hung up by the facts of real life in terms of

commerce even while we are talking about the deadliness of these

threats. But it’s to be seen what we can do down the trail.

It could very well be that we will come together in a commercial

sense long before we come together in a security one because of the

desires of these scientists, the assets they have.

So I appreciate this hearing very much, Mr. Chairman. It’s a profound subject upon which we can visit for days, because we are just

scratching the surface of something that’s terribly important. I

think that responsible people can make a difference and are doing

so really in this area, and I congratulate both Sam and Jim for

wonderful testimony.

Senator NUNN. Thank you very much. Mr. Chairman, if I could

just throw out a gratuitous thought here in response to Senator

Lugar’s comments which I agree with and subscribe to 100 percent.

Front page story of New York Times yesterday and Washington

Post in the last 2 or 3 days about the United States taking defensive steps to be able to guard against an attack by creating some

offensive possibly what may be interpreted as offensive weapons.

First of all, it’s a tricky field the line between offense and defense. It’s extremely difficult. And I do think we need to do some

defensive things. So you have to know what you are going to be

possibly hit by.

But radical thoughts, some might call creative, some might call

radical. We know we can’t deal with biological threat. Those of us

who have been to Russia know you can’t deal with it without the

cooperation of Russia.

They have got the scientists. They have got the know-how. They

probably know more about it than we do. They’ve developed the

weapons.

We also know that these scientists are in demand. We also know

they don’t have jobs. And we also know it’s going to be hard to do

it commercially, although we need to try.

If we are going to do this kind of biological defensive work that

some might suspect is offensive in other parts of the world, I think

erroneously so, but nevertheless they might, and if they were doing

it, we might, why not engage the Russians? Why not have President Bush say to President Putin, let’s put some of our biological

teams together and let’s determine what you know and what we

know. And let’s work together to develop defenses. And let’s employ

your scientists while we are doing it.

And then if that works, we could add allies and we could possibly

even add China at some point. We’ve got to understand this is

international and we are not going to solve it ourselves. And we’ve

got to engage the Russians. And they know more about it than we

do.

46

Some of the very experiments we are trying to conduct I suspect,

although I have not been briefed on this and I have not been provided except what I’ve read in the news reports—some of these

pathogens we are trying to develop the Russians probably already

have.

So radical thought but I would hope that your bipartisan-type

approach you might pose this and think about it. Because there to

me is a real need here that we could turn it into a real opportunity.

The CHAIRMAN. Senator, let me say and be just transparent

about this, one of the reasons why I wanted to do this series of

hearings after consulting with my colleagues on both sides of the

aisle was that absent an awareness of the extent of the danger,

there is the ability to continue to indulge ourselves on both sides

of the aisle in our ideological folly and remain unwilling to cooperate, unwilling to deal with the Russians or deciding that we are

going to focus only on one thing.

The second thing is that I hope what will flow from this, and we

have five of these hearings scheduled, and I want to thank you for

your advice. In the interest of full disclosure, I had asked you, front

end, unrelated to this hearing, how, if you were doing this, would

you approach this whole series of hearings. There’s a need for

transparency here.

One of the things that worries me the most, and I realize I’m a

broken record on it—I apologize to my colleagues for this intervention—is that the unintended message that we are arguably sending

to the rest of the world about our leadership in containing the

spread of weapons of mass destruction is at best right now mixed.

You can make very strong arguments against the ABM Treaty.

You can make very strong arguments against the Biological Weapons Treaty. You can make very strong arguments against the

Chemical Weapons Treaty. And they are all legitimate arguments.

But the culmination and the accumulated effect worldwide of us

focusing only on that part of the equation which we have been of

late, I think, is frightening. Because I think what it does is send

messages to other countries that say now our only alternative is to

move in the direction that’s counter intuitive and against our interest and their interest.

I think one of the reasons for this series of hearings is hopefully

people like both of you and others will come up with some far

reaching ideas and notions and maybe even some of us that we can

begin to change the atmospherics here. But they have got to be

changed rapidly.

The idea that we are only spending several million dollars or

tens of millions of dollars on the Nunn-Lugar initiatives to me is

mindless, absolutely mindless. And initially there was a cut in

what we were going to spend in this area. A cut.

Hopefully this will generate enough interest, take it out of the

totally political realm. The fact that the chairman is suggesting

that we do this in a bipartisan way we may be able to get some

traction here. At least that’s the hope. But anyway, no more editorial comment. I yield to my friend from Florida.

Senator NELSON. I’m going to defer to my colleague from West

Virginia, but let me just say, your radical suggestion, Senator

47

Nunn, is common sense. This is why we are here. I yield to the

gentleman.

The CHAIRMAN. Senator Rockefeller.

Senator ROCKEFELLER. Thank you, Mr. Chairman. I thought

that, Senator Nunn, your statement that they don’t go after where

they think you are strong but they go after where they think you

are weak is a point. And in fact I think that it’s nonclassified material from the intelligence organization sees at this point that there

is a likelihood of chemical and biological attacks by the year 2015

some think 2010.

I don’t think it’s in other words in the realm of we can’t talk

about it, which leads me to my second point which you also have

made. And that is in a democracy you can have your leadership,

you can have your Senate Foreign Relations Committee, Intelligence Committee, whatever, you can have them working on this.

You can have people trying to come up with public policy.

But until you have engaged the American people in as you call

it the thin line between what is a reality of what we are facing as

opposed to the problems of panic, I would tend to come down on

the side of the former, that in a democracy where you fail to inform

people of something which is likely to happen within a relatively

short period of time is an enormous failure of leadership in and of

itself.

Which leads me to a couple of thoughts, and then your responses

from both of you. There’s been a lot of talk about Russia, and for

good reason. But it was also true that when Aum Shinrikyo did

their number back in 1995, 1996, whichever it was, they ended up

using sarin. But it was not because they wanted to. They wanted

to do biological, but they couldn’t do it.

That was 6 years ago. I don’t know whether they could today.

You know the Japanese Government went in and took out some of

their stuff and they couldn’t blow sarin from high and all that they

wanted to do. But what they really wanted to do was biological.

Japan is the most ordered society in the world. That’s the opposite of everything we’ve been saying about Russia. Everything what

we haven’t been saying about what goes on when you have people

that feel that they have nothing to lose in life, that the prospects

of their future don’t exist. They become desperate. The whole sort

of little cells, the massive need for intelligence gathering that boggles the mind in and of itself, probably human intelligence.

How do you possibly do that? But that you could have that in the

most ordered society in the entire world and have them fail to do

it, what they really wanted to do. What they did was bad enough

but what they wanted to do they couldn’t do. But that was a long

time ago.

So what would happen? The question I would pose to you, and

I also can’t stay for the second panel which grieves me because

public health and the way we train doctors is an area of great interest of mine—the way we don’t train doctors is an area of great

interest of mine.

We don’t do geriatrics in half of our medical schools. We don’t do

compassionate care the last 6 months in half of our medical

schools. You talk about preparing people to do this. I mean, you are

really talking about a medical revolution in terms of their syllabus,

48

one which I’m not sure they are prepared to take at this point; one,

because they don’t know that this is out there.

I mean those who testified will, but that gets into the whole sort

of leadership of it, and at this point or other elitist leadership; relatively small group. Seems to me the problem or the challenge is

to get it out there to make it an attractive enough this lugubrious

approach but to make it attractive enough so that it becomes either

the subject of sitcoms or the subject of specials.

It becomes the subject of speeches by all of us as a matter of public duty. When our constituents look at us and say what in heavens

name are you talking about. When we are trying to get card of Hbill through the West Virginia eastern mountains to Washington,

DC when you are talking about this stuff. Well, it may be that we

not only have to do that but you also have to set up what you did

on a 50 state basis.

So there are 50 presidents. So they find out how they are not

prepared. Now they are all strapped for cash. In my state all the

cash that exists is going to flooding, and flooding in comparison to

the consequences of all this in West Virginia would seem to me to

be relatively small.

I think that my people have, as do yours, the people have perfectly good sense to understand that if presented with this potential, and it’s more than that, probability of this happening.

The concept of somehow engaging the American process, the public health process, the medical association of American medical

schools, the state governments in the same kind of scenario that

you went through so that local press as well as the national

press—which is loathe to cover things other than scandals—seems

to me to be a terribly important part.

We really don’t have the time. One of the questions I want to ask

you is how do you motivate people to create vaccines for needs

which don’t yet exist but will? Some you have said let’s work with

the Russians, and I agree with all of that.

But it seems to me that gauging the American people in the

probability of this happening and what it means to them and what

has to happen all the way from public health to rural health clinics

to National Guard and all the rest of it really strikes me as the

most important thing we can do at this time. I would be interested

in both your comments.

Senator NUNN. I believe that public information is absolutely essential, and I think that we have to engage the health community.

I agree with you completely. I think it has to be done by state by

state and local community by local community.

CSIS is thinking of ways now; John Hamre is not here today, but

he was one of the real leaders in this, and I’m sure Tara O’Toole

and the others are willing to work on this to take this war game

on the road with some modifications and let others at the state

level play this war game. Because it does bring home not only the

need for planning but the need for coordination in advance.

There’s no question about that. On Aum Shinrikyo, when I was

chairman of the Department of Investigations, we did 2 years of

work on that and sent people to Japan. One of the things that is

still a challenge is that we have great relationship with the JapaVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00052 Fmt 6633 Sfmt 6602 75040 SFRELA2 PsN: SFRELA2
49

nese military and with the foreign policy team in Japan, but we

don’t have very much communication with their police force.

The police force knew about Aum Shinrikyo. Their intelligence

and military people, if they knew, didn’t tell us.

Here you have a huge organization, something like a billion dollars in assets, having conducted experiments against sheep in Australia, on land in Australia, having sent people to Africa to try to

pick up the Ebola virus so they could use it; they had helicopters

in compounds; they had already carried out chemical attacks in

other parts of Tokyo; they had an office in New York City trying

to get U.S. technology.

All of that was going on. We had I don’t know how many thousand members of the Russian—and it had never, ever come to the

attention of our CIA or our FBI. You would think that would be

almost impossible, but it happened. And in a country as you observed that would be the least likely for it to have happened.

So we really got to focus on these things more. I think we are

in a new security environment but we haven’t gotten rid of some

of the old security environment. We can’t get rid of them. Some of

the challenges are still there. So we are straddling in between.

But we really have to focus more on these items. And it’s a different kind of definition of security now than it was when I came

to the United States Senate.

Mr. WOOLSEY. I agree with Sam Nunn’s answer substantially,

Senator Rockefeller. I think that your comparison between Russia

and Japan makes the main point. If something like Aum could happen in Japan, it’s so much more likely that you are going to have

leakage from these Russian laboratories to, let’s say, Mideast terrorist groups or to Government of Iraq than would have occurred

in this very ordered Japanese society.

That states the essence of the problem. I certainly also agree

that trying to get the Russians involved in offensive and defensive

cooperative work to my mind is an excellent suggestion; and it illustrates a difference, if I may say so, between this biological

threat and a lot of other areas that we are used to dealing with.

Just as a lot of the things that people do wrong in their lives are

not necessarily susceptible to legislation, not everything that goes

wrong in international affairs is susceptible to verifiable arms control agreements.

I’ve been an advisor, delegate or ambassador and chief negotiator

five times in negotiations with the Soviet Union and other countries on arms control during the cold war. But I’ve got to say I

think this biological weapons issue and the verification of it is an

extraordinarily difficult matter.

It may make more sense to focus our effort on things like what

Senator Nunn suggested in working with the Russians than on trying to split the hairs of how we could have some type of effective

verification for something that can be carried around in trucks by

Saddam’s guards. So I very much agree with the thrust of your

comments and also Senator Nunn’s answer.

The CHAIRMAN. Thank you.

Senator NELSON. Mr. Chairman, I’m ready to go to work. I’m sufficiently in the crisis mode as a result of what’s been said here, and

I guess this was brought home to me a couple weeks ago when I

50

got on the airplane to go to Johannesburg and all of a sudden the

flight attendants were walking up and down the aisle with spray

cans.

That hasn’t happened to me in a long time on a closed airplane.

It brought home some of the things that you have suggested. So

let’s start with something that we could try to do right now about

this.

The administration has requested $182 million for bioterrorism preparedness and another $94 million for the contribution of our

country to the World Health Organization.

What would you all recommend that that be boosted to? And

then, Mr. Chairman, let’s talk about how we go about getting that

into the appropriations bill.

Mr. WOOLSEY. Senator Nelson, I am not real up to speed on exactly what the funds are being used for, but I want to stress one

thing; there are some very important things to do that don’t take

much money. Changing the CIA guidelines that I described would

help us be able to penetrate the terrorist groups better; having a

hard look at the FBI guidelines; passing a statute which bans possession, not only transmittal of some of these biological agents; establishing relationships with industry in this country and overseas,

so that you learn whenever someone orders a fermentor of a particular type or something is ordered to go to a destination that is

new and different. What you really want to do is enlist the marketing and sales people of companies that deal in some of these

types of equipment as friendly colleagues of the United States Government, so when they get a strange order they call up and say,

‘‘you know, this one just doesn’t seem quite right to me.’’ And then

someone can look into it.

There are a number of steps like that that need to be taken that

don’t cost a lot. Some of them cost a bit, added people, but if you

are looking at major programs and increases for major programs,

I can’t think of any area that’s more important than the area that

Senator Nunn and Senator Lugar pioneered and which came out

of this colloquy earlier about dealing with Russian science.

Russia is a democracy. It’s a troubled democracy; but, so far at

least, it’s on this side of the line. It has an elected Duma; it has

an elected President, and it has the mother of all cold war arsenals

for weapons of mass destruction.

Everything in one way or another has been generated in its laboratories. Of course people like the North Koreans pick it up and

pass it on, and the Chinese, and so on. But Russia is the font of

most of the technology that we are worried about.

One needs, as was said in a different context some years ago, to

go to the source. One needs to start working as closely as possible

with President Putin and the Russian Government and spend the

money to do it in a lot of these areas of cooperation—keeping the

Russian scientists and Russian technology out of the channels

which they might otherwise tend toward, be it via organized crime

or otherwise, to supply to Iraq, to North Korea, to Iran and the

like.

To my mind that ought to be the focus of where the new money

goes. But that’s off the top of my head. I have not made a thorough

study of this.

51

Senator NUNN. I would agree with Jim Woolsey on that, Senator

Nelson. I would also add that I think the next panel will probably

have thought more about budgetary aspects than this panel.

But I do believe that one thing that’s probably not a Federal

Government budget but I think government could encourage it.

When we had Three Mile Island in this country, the nuclear industry came together and formed a group to do peer reviews on nothing but safety.

They themselves took the initiative, not government money.

When Chernoble happened, they formed a similar organization in

Moscow that is worldwide on the nuclear side, peer review safety.

To my knowledge there’s no such thing in the pharmaceutical

community around the globe. Now I’m sure that the initial reaction

would be to the pharmaceutical industry probably we don’t want it,

don’t need it, so forth, so on. But I’m talking about a voluntary association.

The first time we have a biological attack, people are going to be

demanding that government solve it. It would seem to me that our

friends in the pharmaceutical industry would be wise to have their

own organization now that deals with safety and peer review and

standards and best practices to deal with these pathogens. Because

there’s not that now.

It’s hit and miss. So that’s one area that doesn’t necessarily require government money. On the government money side, I think

public health. I think infectious disease problem is here.

My experts tell me that for 20 years infectious disease rates went

down in the United States. The last 15 years they have gone up

2, 3, 4 percent a year. I’m not sure of the statistics.

We’ve got this problem even beyond biological terrorism. I think

surge capability in hospitals, as we move toward more efficiency in

hospitals without any excess beds where we can avoid it, and that

makes sense economically, somebody has got to step in and say we

need surge capability.

The government’s probably going to have to pay for it to deal

with this kind of emergency or other kinds of emergencies. That’s

another probably big budget item.

We already are doing research on vaccines. We certainly need to

accelerate in every way possible the vaccine supply, the smallpox

vaccine supply as well as others. We need to make sure we have

the kind of stockpile that would allow us to deal with emergency.

And only the government can do that.

There are a whole list of things here that I think only the government can do. We need much better training, public health and

doctors and nurses and people in drugstores so that when they see

symptoms recurring, they report them. We need a communication

capability in this country to begin with so that we have somebody

who collects this data, knows when something goes wrong. Then we

need to plug it into the World Health Organization to make sure

WHO is doing their job around the globe and helping with resources where they are not.

We need to get other countries involved. All of those things to me

are on the must list.

Mr. WOOLSEY. Senator, also could I mention one more point that

I think is quite relevant here. A relatively low cost but very imporVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00055 Fmt 6633 Sfmt 6602 75040 SFRELA2 PsN: SFRELA2
52

tant thing to do is to get clear all of the legal authorities that the

Federal, state and local governments have so this is readily accessible to people.

Who can close airports? Who can do what with respect to quarantines and the like? Because the problem here is when things get

out of hand—and they did in ‘‘Dark Winter,’’ you had this feeling

that the country was panicking.

In spite of everything President Nunn could do with his ineffective advisors such as the Director of Central Intelligence,

nonetheless——

Senator NUNN. Let’s face it. We were failures.

Mr. WOOLSEY [continuing]. We were in bad shape. When people

panic they do really bad things. My favorite illustration of this is

what was probably the principal action by the Federal Government

in the 20th century that in retrospect was the greatest infringement on civil liberties of Americans—the incarceration of the

Nissei, the Japanese Americans, in 1942.

Three people who were very heavily responsible for that were

Franklin Delano Roosevelt, Earl Warren, then Attorney General of

California running for Governor, and Hugo Black, who wrote the

decision that upheld it. Those were probably the three greatest

names in supporting civil liberties in the 20th century in America.

Even people who are strong supporters of civil liberties, when

they get scared, can do some really bad things. If in advance we

can get clear what the legal authorities are, who can act, when

they can act, what added authority they need, the Constitution is

flexible enough to permit people, the President and others, to have

extraordinary powers in extraordinary circumstances.

But it needs to be thought through ahead of time. If you let it

get to the point where people panic, even good people can do some

really terrible things.

Senator NELSON. Mr. Chairman, following up to Senator Nunn’s

comments about the pharmaceutical companies, I was quite intrigued to hear Senator Lugar talk about the possibility of developing some kind of incentive program for American pharmaceutical

companies and working with our counterparts in Russia.

As we continue to deliberate on this, I would like to pick up on

Senator Lugar’s comments. And let’s examine that as well.

The CHAIRMAN. Thank you. Gentlemen, we have a thousand

questions for you. Let me just ask you a generic point, ask for your

help. I’d like to be able to—we’d like to be able to seek advice from

you as to who on the team that did ‘‘Dark Winter’’ can give us some

really nuts and bolts recommendations, for example, or outlining in

detail the problems for example on legal authority.

You know, if you can tell us who we can talk to, we can avoid

dropping all this on each of you. I am going to seek to have the

administration come and testify on this issue and others at the culmination of these hearings. Because quite frankly all that we

talked about, there needs to be leadership from the top here. I’m

not laying this on the administration. I’m not making that case.

But somewhere along the line, the Secretary of Defense, the Secretary of State, the National Security Advisor, the President of the

United States have to get a sense of and state the sense of there’s

53

a lot of urgency that exists here, and what they think should be

done.

We, Senator Lugar and I, I think they expected it from me and

they were shocked at Senator Lugar—how exercised he became— when administration witnesses were here and we looked at the

Nunn-Lugar figures in the budget. They didn’t pay much attention

to me but they paid very close attention to Senator Lugar very

quickly.

But there are numbers that we can put in here, without a whole

lot of additional thought, that cost a lot of money but that we know

from past experience are needed now.

We also know that there are needed changes as you say, Jim, on

guidelines. For example I introduced a bill last year, I don’t want

to turn this into who did what, but just to give you an idea like

posse comitatus debates, we found people we never thought were

going to be our major, you know, opposition.

We have a black helicopter crowd suddenly emerge. Well, I introduced a bill, I’m not joking. That was literally true. I introduced

a bill last year on pathogen control. And right now, I mean, I

thought it was a slam dunk.

I’ve been the chairman of the Judiciary Committee for years. I

introduced it, thought I’d get a hearing. Why wouldn’t I get a hearing? I’ve been here 28 years. I know this stuff pretty well.

Every major criminal justice piece of legislation I’ve either authored or co-authored for the last 15 years. Didn’t get a hearing.

The only law on the books deals with the development of possession of toxin agents for, quote, use as weapons, end quote. That’s

all.

So, I just had a little bill to amend the Federal Criminal Code

to make it unlawful to possess these biological agents, toxins or delivery systems, handling such items in a manner that would grossly deviate from accepted norms and knowing that communicating

false information, trying to get for example these various companies to say, hey, look, we’ve got these funny calls, these salesmen

saying I’ve got twelve calls from someplace in the middle of wherever and all of sudden, nothing happened.

It’s a little bit like that, I mean, all it did was create a maximum

penalty of 10 years. It wasn’t like this was rocket science, no pun

intended. So I think, and that’s why I came around to this whole

thing. I just warn everybody in the press and everybody in the

Congress, this committee is going to spend a lot of time talking

about this and similar issues. Because it seems there’s nowhere

else to raise the profile of good citizens and experts like all of you

who are out there doing these exercises and trying to get public

awareness. It seems to me we’ve got to get awareness here.

We’ve got to get awareness downtown. We’ve got to get awareness up here. Democrats and Republicans, by the way. This has

nothing to do with partisanship.

And so I’m going to be spending a lot of time because I can learn

a lot, I’m not being solicitous, from Senator Lugar as to what it is

that we should be trying to put in to the appropriation bills that

deal with what we know.

What we know right now are big holes that don’t require new

thinking, just require funding. And we are going to be having, God

54

willing, the creek not rising, the administration willing to come up

here and have the Secretary of Defense, I realize, Sam, you can’t

have the Secretary Defenses come before the Foreign Relations

Committee, but he’s going to come. We are going to ask him to

come. There’s going to be an embarrassing situation if he dosen’t

come.

Senator NUNN. It wouldn’t bother him as much now as it might

have years ago.

The CHAIRMAN. And I’m willing to do these jointly with the

Armed Service Committee. But the bottom line is you have continued to perform a great public service, both of you. And I will, from

time to time, more than you might want, be contacting you fellows.

And I’m sure, and we are going to try to do this jointly, so we don’t

make repetitive requests of you as to figure out how to just get this

up on the agenda.

Everybody knows it’s there. It’s like everything else in public life.

Until there’s a crisis, until something terrible happens—I don’t

know whether it’s conscious avoidance or subconscious avoidance— but we just don’t focus on it. And I think we are sending a message

to the rest of the world that all of a sudden this nation that has

been the leader for three decades, Democrat and Republican Presidents, in dealing with nonproliferation, dealing with all these

issues; we seem to, I think unintendedly, I think it’s unintended,

we seem to have walked away.

I mean the perception, I don’t know about you, Senator Lugar,

and you guys travel all over the world. I’m going to tell you, every

place I go from my recent trip to the Far East to Europe, first question that I get from my counterparts, allies and adversaries alike

is, ‘‘What’s going on?’’ What’s going on.

And I think the perception matters. Because it amazes me as you

both know how every other nation in the world thinks we don’t do

anything by accident. They think everything we do is calculated

and thought out. They think we are capable of things we don’t

think we are capable of.

And they ascribe motivations to what we are doing that I think

exceed what is intended, but they become self-fulfilling. So anyway.

Do you have any comments?

Senator LUGAR. Just a short comment of support, Mr. Chairman.

I appreciate your having this hearing and the ones you are going

to have. In defense partially of the administration, my impression

again and again is that they are still engaged in planning.

The quadrennial review or large strategic planning and therefore

have not been prepared to visit with us and answer our questions.

But I would certainly work with you to encourage them to do that.

Because I found this anecdotally, and I mention this because the

Russians have much the same problem.

I was invited by Secretary Rumsfeld, and I appreciated this, to

the luncheon for the Russian group discussing missile defense, led

by General Baluyevsky. We laid out the national missile defense

architecture and our view of the world and threats facing our country.

And the Russians took this in. And they took this in again when

Secretary Rumsfeld and Mr. Bolton visited Moscow. This was the

third round consultations. And they are prepared to do more.

55

But at the same time when I saw General Baluyevsky in Moscow

and I saw General Dvorkin, who’s retired but is well-known to all

of you, they said they are waiting to know how many nuclear warheads we are prepared to destroy. And this is an interesting issue

at least for them, because they want to reduce their nuclear weapons very substantially.

It means a lot more Nunn-Lugar activities and expenses, because

the cost of going from 6,000 warheads to 1,500 is huge. And it’s not

just pushing pencils over paper and strategic thinking. This gets to

the nitty-gritty efforts to physically remove warheads from missiles, disassembling the missiles, storing the material, keeping it

safe from whomever, and all the rest of this.

But the Russians are prepared to talk about that. Now, our country is not prepared for these discussions at this point. Our Department of Defense will report on this issue later this year.

So I would just say that in due course during this fall we will

be debating these issues, and this will be of immense interest to

the Senate as well as to the Russians. And I would just say finally,

General Dvorkin in a moment of candor after a long dinner was

even prepared to analyze the ABM Treaty and how you do boost

phased intercepts within the ABM Treaty.

Now this is a much more extensive proposal than I have heard

in the past. I don’t know if it’s possible. But the fact that General

Dvorkin who is advising Marshall Sergeyev who is advising Putin,

despite the fact that Marshall Sergeyev is no longer head of defense, he’s at the ear of the leader about this whole business.

It is interesting that Russia has done this degree of analysis, a

good bit more than we have in this committee or maybe even in

our Department of Defense has been doing. So I find this to be encouraging that there are people to talk to here and there.

I appreciate an opportunity for one more interlude with this, Mr.

Chairman. Your leadership in calling this together is much appreciated.

The CHAIRMAN. Well, as Director Woolsey may remember, I appeared before a group of which he’s a member and indicated that

I had been the contact with the Russians and I thought they were

interested in boost phase and they would actually entertain it if we

were serious. And the irony is here we are now beginning the negotiation that is contingent upon, agreed it is, contingent upon reduction of offensive forces as well as eliminating or amending the ABM

and we don’t have a number yet.

And we are now saying, unless they come up with an agreement

quickly, we are going to maybe have to act unilaterally. I just caution a little patience here, a little patience.

The Senator is correct. The review is on the way. I have not been

publicly critical of this administration, because I think it’s overwhelmingly difficult for them to try to assess where they are and

what they should do and what need be done.

What I am critical of is assertions made with such definitiveness

about what they are going to do before they have done their assessment. And so I just caution a little patience here, a little patience.

We shouldn’t be discarding or amending a doctrine that’s worked

relatively well for us unless we know a little bit about what we are

going to put in its place. So we should just tone this down just a

56

little bit. But anyway, you guys didn’t need to hear that editorial

comment, and I hope you’ll continue to not only editorialize but recommend to us what you think we should be doing.

We need help. We need help. And I think it’s the time for calm,

cool, collected surveillance of what’s out there and a decision on

how to approach it and the bipartisan attempt to deal with it. And

I can think of no two better guys. And, Sam, thanks for your overall help on this. I warn you I’ll be back on this. I need a lot more.

Thank you both.

Mr. WOOLSEY. Thank you.

Senator NUNN. Thank you, Mr. Chairman, Senator Lugar, for

your continued excellent leadership on behalf of our Nation and the

world. Both of you have been stalwarts for a long, long time. Mr.

Lugar is a relative newcomer but he has been here a few years.

Mr. WOOLSEY. I completely second all that except the business

about the newcomer.

The CHAIRMAN. Well, thank you both.

We now have the distinguished expert panel. A second panel will

discuss the strengthening of the domestic and international capability to prevent and defend against intentional and natural disease

outbreaks.

Our group of witnesses today include some of the foremost experts in bioterrorism, the threat of infectious disease and homeland

defense.

Dr. D.A. Henderson, director of the Center for Civilian Biodefense Studies at Johns Hopkins University, led the World Health

Organization campaign in the 1970s to achieve the virtual eradication of naturally occurring smallpox.

For that, Dr. Henderson deserves the heartfelt thanks of the entire world for stopping one of humanity’s greatest scourges. Today

he is focusing his energies on the growing threat of bioterrorism

and what we as a Nation can do to respond to that threat.

Dr. Fred Ikle ́, a distinguished scholar at the Center for Strategic

and International Studies, is a former Under Secretary of Defense

for Policy under President Reagan. He has also served as Director

of the Arms Control and Disarmament Agency.

Dr. Ikle ́ can and will discuss with the committee the challenge

of the homeland defense as they relate to tackling the threat of biological terrorism.

Dr. David L. Heymann is the Executive Director for Communicable Diseases in the World Health Organization and can share

with the committee comments on how the international community

can better mobilize the prevention and containment of natural

epidemics and infectious diseases. I’m sure Dr. Heymann will note

that the strategies that work against naturally occurring outbreaks

can also work against manmade epidemics.

And our final witness will be Dr. Frank Cilluffo, a senior policy

analyst with the Center for Strategic and International Studies,

who authored a very impressive report last year on combating nuclear and chemical and biological terrorism. The quality of our witnesses today should ensure a lively discussion on what steps the

United States should take in concert with the international community to combat the threat of bioterrorism and the natural spread

of infectious diseases.

57

Before we begin, allow me to make part of the hearing record the

statement of the Pan American Health Organization on the threat

posed right here in our own hemisphere by emerging infectious diseases, including cholera and the bubonic plague. This statement

also lays out the strategies needed for greater hemispheric cooperation.

[The statement referred to follows:]

PREPARED STATEMENT OF THE PAN AMERICAN HEALTH ORGANIZATION

The Pan American Health Organization (PAHO) would like to thank the members

of the United States Senate for allowing the Organization to submit a statement

today on emerging and reemerging infectious diseases surveillance and control.

The Pan American Health Organization is the oldest continuously operating

health agency in the world. It was founded in Washington, D.C. in 1902. It has 35

Member States from the Americas, three Participating Governments, and one Associate Member Government. The United States is an original founder. PAHO cooperates with Member States, individually and collectively, in designing and implementing measures to improve the health of their populations.

We would like to provide you with information about the present capacity of countries in this Region to prevent and control disease outbreaks and of strategies and

activities in place for improvement.

The ability to detect risks and diseases, and access and respond to data is an essential public health function for establishing a line of defense and response to infectious diseases. An effective public health infrastructure is required. For health

systems in the Region, especially in developing countries, with difficulties in implementing routine and sentinel disease surveillance, the challenge of detecting and responding to the emergence of new organisms, disease outbreaks, and anti-microbial

resistance is substantial.

The tremendous advance in communications technology is playing an increasingly

important role. Many more people are aware of disease outbreaks occurring all

around the world. The variety of sources of information increases the potential for

distortion of the situation and the misunderstanding of risks.

The globalization of infectious diseases is not a new phenomenon. However, increased population movements, whether through tourism or migration, or as a result of disasters, growth in international trade of food and biologicals, social and environmental changes linked with urbanization, deforestation and alterations in climate, and changes in methods of food processing, distribution and consumer habits

have made infectious disease events in one country a potential concern for the entire

world.

In the Americas, an adult pulmonary distress syndrome and its etiological agent,

the Sin nombre virus, later recognized as a hantavirus, provoked an outbreak in the

State of New Mexico, United States, which attracted great media attention. Other

hantaviruses causing disease and death have been identified in the Southern Cone.

These events are widely known to the public. However, other such threats remain

ignored. Since 1993, mass media outlets have provided the public all over the world

with information on new and old threats of disease: Ebola virus in Africa and plague

in India have dominated the news for several weeks. By comparison, a cholera epidemic in the Americas during that same year—some three years after cholera was

introduced to the Americas following an absence of a century—received little attention. Likewise, the press reported little on outbreaks of bubonic plague that have

affected Peru since 1992. In fact, the latter epidemic remained ignored by the media

as late as 1995, by which time there were already 2,000 cases with 90 deaths. In

the 1980s, Aedes aegypti, the mosquito vector of dengue, returned with a vengeance

and was responsible for an epidemic in Cuba that caused thousands of cases of dengue and hundreds of deaths from dengue hemorrhagic fever. Since then, over 2 million cases of dengue have been reported in the region, with countries such as El Salvador and Ecuador in 2000 and Venezuela in 2001 declaring national states of emergency.

Other significant emerging and reemerging conditions include Lyme disease, diarrhea caused by cryptosporidia, and illness caused by Escherichia coli O157:H7 in the

United States; yellow fever in Brazil; drug-resistant Plasmodium falciparum malaria in areas of the Amazon, and wide-spread antibiotic resistance in several species of bacteria.

Epidemics become urgent events of national and international public health importance as the result of a combination of factors, including insufficient national caVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00061 Fmt 6633 Sfmt 6621 75040 SFRELA2 PsN: SFRELA2
58

pacity to recognize disease events in a timely manner, to deploy trained personnel

to investigate and confirm suspected reports, to identify the causal pathogen in the

laboratory, and to contain the spread of the disease. Hence, the absence of correct

information, misinformation and inconsistency in the information available to the

public and other national governments result in overreaction to media coverage and

subsequent internal pressure on governments to respond. Moreover, fear of costly

repercussions if disease events are notified has hindered the opportunity for collaboration in addressing emergency situations efficiently.

Health sector reform and the political and administrative decentralization that accompanies it are under way in most countries of the Americas and is affecting the

response capacity of countries. This process profoundly alters the management, organization, provision and financing of the health services, redefining the functions

of the central, regional and local governments for both individual and collective

health care. This transition has exposed capacity weaknesses in regulatory and policy issues, and the quality control of services. It has also revealed management deficiencies at central and provincial levels and resulted in the non-replacement of

aging physical infrastructure, including laboratories and information/communication

systems.

Countries have recognized the need for creating early warning and rapid response

systems for acute communicable diseases of high epidemic potential. However, multiple factors of political, technical, and financial nature have resulted in limited

progress in countries’ capacity to detect, investigate, diagnose, and control those diseases. The repeated occurrence of outbreaks or epidemics caused by a multiplicity

of agents poses new challenges to the health services in the majority of the countries.

A core of technical competencies is needed for epidemic alert and response at

country level, which in turn strengthen regional and global surveillance mechanisms. The Pan American Health Organization is promoting a three-pronged approach to deal with the health threats of emerging infectious diseases: emerging disease/syndrome surveillance; outbreak detection and response; and antimicrobial resistance surveillance and prevention. Strengthening of public health laboratory infrastructure will provide support to this approach.

The strategies adopted foster horizontal cooperation and coordination, especially

among countries in the same subregion. Three subregional networks for surveillance

of emerging and reemerging infectious diseases have been established, one in the

Amazon region, one in the Southern Cone and another in Central America (including the Dominican Republic and Haiti). These are subregional initiatives, which

have been sponsored by the Organization in collaboration with the United States

Centers for Disease Control and Prevention (CDC). A fourth network specifically for

the surveillance of anti-microbial resistance is also operational.

At country level PAHO has proposed a strategy geared to strengthening national,

provincial and local institutions responsible for infectious diseases surveillance, and

response policy and practice. Fulfillment of this essential public health function requires in-country coordination among various services and health institutions responsible for epidemiology, laboratory, medical care, quality control of water, food

safety, disaster preparedness, human resources training, health information and social communication.

Countries are being stimulated and supported by PAHO and partner agencies to

assess the current capacity of their public health services for surveillance and response to epidemic situations and to prepare and implement national plans of action

to improve the performance of national public health systems to detect, investigate,

confirm, intervene and disseminate information.

The above mentioned assessments will serve as review of each country’s vulnerability to the occurrence of epidemics caused by the emerging and reemerging diseases, identifying areas and populations at risk and determining the strengths and

weaknesses for surveillance, prevention and control. This will lead to plans that address these identified deficiencies in the infrastructure of the clinical, epidemiological and laboratory services in terms of: a) norms and procedures (regulations and

guidelines); b) administrative management; c) coordination and communication; d)

training; and e) technology (information, diagnostic equipment and supplies).

As part of our work, the International Health Regulations (IHR), the legal framework for global surveillance and response, is being revised and updated, in accordance with the World Health Assembly (WHA) resolution of 1995, so it will be more

applicable to the epidemiology of communicable diseases and the scale of international traffic and trade in the 21st century, and go further to prevent the international concern and uncertainty which has occurred during the epidemics of cholera, yellow fever, plague, dengue hemorrhagic fever and avian flu. The new IHR will

contain functional and effective templates for national surveillance as well as reVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00062 Fmt 6633 Sfmt 6621 75040 SFRELA2 PsN: SFRELA2
59

sponse processes for international disease threats and the harmonization of control

measures. The IHR builds on the inexorable link between national and global surveillance for diseases. The WHA was fully aware that the strengthening of epidemiological and laboratory surveillance and of disease control activities at national

level (i.e., where diseases occur) is the main defense against the international

spread of communicable disease.

In confronting infectious diseases we must not fail to recognize that diseases formerly under control are reemerging because of complacency—dengue is one example—and a revival of others has been triggered by the collapse of public health systems because of economic and social crises. When we add the potential for disease

occurrence from such factors as ecological change, climate events such as the El

Nin ̃ o Southern Oscillation, natural disasters such as Hurricanes Mitch and Georges,

and the increased flow of refugees and displaced persons, the resurgence and emergence of infectious diseases is indeed a threat to us all. Only with a concerted, serious regional and global effort can we continue to build the structures we need to

identify, prevent and control these threats and work together to build a safer world

in the 21st century.

The CHAIRMAN. Now in the order of protocol, and because he’s

probably testified before this committee more than anyone on the

panel, the order should be Dr. Ikle ́, Dr. Henderson, Dr. Heymann

and then Mr. Cilluffo.

Dr. Ikle ́.

STATEMENT OF DR. FRED C. IKLE ́ , DISTINGUISHED SCHOLAR,

CENTER FOR STRATEGIC AND INTERNATIONAL STUDIES,

WASHINGTON, DC

Dr. IKLE ́. Thank you. Mr. Chairman, I can be very brief for two

reasons. It’s late in the hour but more importantly the previous testimony has made all the points I agree with. I think there’s so

much value in there that I can totally support what has been said

by Senator Nunn and Jim Woolsey. So I will mention just a few

selected points from my short opening statement which has been

submitted for the record.

One point, the difference between biological weapons and nuclear

weapons in this context. First, we know much more about the nuclear weapons effects than we know about the effects of biological

weapons. Some of us remember the thick handbooks on nuclear

weapons effects that were put out by the U.S. Government. Scientifically these effects are easier to predict. It’s more precise. And

there were many, many tests on nuclear weapon effects in the

1950s.

And also, second, once a nuclear detonation has started, there’s

nothing you can do to escape the deadly energy that escapes from

a detonation unless you are far away or deep underground. By contrast, as we discussed in the previous testimony, after the biological attack has started, there’s a great deal you can do, if you are

prepared for it, to mitigate the disaster.

Moreover—another distinction—it is easier to detect nuclear

weapons than biological ones, both in the manufacturing process

and development, and importantly if they should be smuggled. We

have good equipment, not enough of it but good equipment, to detect smuggled nuclear weapons. It’s almost impossible to do that

for biological agents.

Now let me shift to what can be done. A few points, and again

I support what has been said before, so I can be brief. We must

not expect much from arms control but we must not trash every

arms control treaty in this connection. I have argued against what

60

I consider a deeply mistaken attempt to make a Biological Weapons

Convention verifiable with the so-called Protocol, which the administration has now said that the United States would not proceed

on.

But I am prepared to argue the value, the limited value, of the

two treatises that do prohibit biological warfare. The 1925 treaty

which is one of the best arms control treatises, only half a page

long—the Geneva protocol that prohibits biological warfare as well

as prevents gas warfare. And then the 1972 treaty, the Biological

Weapons Convention.

I took that treaty to the—I submitted that treaty on behalf of the

Ford administration in 1974 to this committee, then chaired by

Senator Fulbright. The committee debated about it for 2 minutes.

And I did mention that it was not verifiable, but recommended

without qualification that it would be a useful treaty to have. I still

feel that is the correct point to make.

The other need is remedial measures. Many have been discussed

and the ideas are around; but action on it has been hesitant. I

think we should realize (a hint has been made to this effect) that

not much will happen till we have experienced a disaster of this

kind, that our country and our society has to take this in two

stages.

We try to do what we can do now, but we surely must be prepared that if something happens and we have the shock and then

the willpower, and also the experience what ought to have been

done before, to do more after the first, hopefully not so large attack. We must be ready to surge ahead immediately, prepared to

pick up on the things we knew we should be doing; but for some

reason couldn’t get the budget, couldn’t get the will power, or

couldn’t get the organization to do it.

So now if I talk to people in government on this issue I recommend a two-stage approach. Do what you can put together now,

but in particular work on the surge capability so you have taken

care of the long lead items and you can then respond at a time

when obviously public anxiety would be much greater but probably

also the danger would be greater because the fire break has been

crossed.

The last point I will make is on the question of legal authority,

posse comitatus, etc. I have a small piece of good news; CSIS had

a study going, and an excellent lawyer has worked on this. That

senior lawyer happens to have now a very senior position in the administration. I’m trying to get the publication finished in the next

few weeks. Given that it’s the thinking that is represented in the

administration and will be made public, I think it will have an impact.

I think it will once and for all dispose of this phony problem of

posse comitatus and related legal restrictions. The legal powers

that the U.S. Government has under the Constitution are sufficient

to cope with all the emergencies that have been discussed. So we’ll

have the publication to you as soon as possible.

Senator Biden, you had to step out.

The CHAIRMAN. I apologize.

Dr. IKLE ́. One piece of good news, we had the publication prepared by senior competent lawyers on the legal authority. And the

61

punchline is there’s enough legal authority existing under the Constitution to cope with all these situations. The posse comitatus

question is a phony argument.

[The prepared statement of Dr. Ikle ́ follows:]

PREPARED STATEMENT OF HON. FRED C. IKLE ́

COPING WITH THE THREAT OF BIOLOGICAL ATTACKS

Mr. Chairman, thank you for the opportunity to testify before your committee.

The previous witnesses have reminded us of the horrible suffering, deaths, and disease that might be inflicted with biological weapons. I will address how the United

States should cope with this threat, and I will focus on the danger of such attacks

on the territory of the United States, rather than on U.S. forces deployed overseas.

The threat to our military forces that are deployed overseas is a vital concern for

the Defense Department, and it has received more attention than the risk of biological attack somewhere within U.S. territory.

During the last ten years a great many studies about biological attacks have been

produced, Congressional committees have held hearings, and increased funding has

been provided to cope with this risk. Also, the Clinton administration has taken

some organizational steps. Doubtless, the present administration will seek to advance our preparedness further.

First, let me start with the problem of anticipating the effects of biological attacks—the medicinal, psychological and social effects. Exercises, like the one on

which you were briefed this morning, warn us of the horror and social chaos that

might result from such an attack. The difficulties of predicting these effects are

greater than for nuclear weapons. In the 1950s, our government published thick

handbooks on the effects of nuclear weapons, based on extensive tests and scientific

calculations. A nuclear detonation is a physical event of brute force with many predictable consequences. The dispersal of biological agents that might spread illness

or death among a population is much less predictable, in terms of the area into

which effective doses of the agent would spread, as well as in terms of the actual

medical effects. And very few scientific tests have been conducted that shed much

light on these gruesome possibilities.

Second, how can we know the capabilities for such attacks in potentially hostile

hands, can they be discovered by our intelligence community? We have learned from

the United Nations inspection effort in Iraq how difficult and unreliable the knowledge is likely to be about hostile bio-capabilities in a tightly controlled dictatorship.

And that UN inspection effort initially benefited from an unusual degree of access

within Iraq. No international inspection effort in North Korea was ever given that

much access. Furthermore, in the future, our intelligence assessments will probably

face growing uncertainties regarding new agents that could be bio-engineered to

cause even greater havoc than natural agents, such as anthrax or smallpox.

Third, what can be done to avert or to cope with this awesome danger? Basically,

our government has four types of tools: intelligence, the threat of retaliation to

deter, diplomacy (including arms control), and remedial measures to mitigate the

impact.

(A) Intelligence is, of course, critical, to intercept an attack that’s in progress and

to render it harmless. It helps if the enemy makes mistakes, by giving us advance

warning or by stumbling in the attempted execution of the attack. And some good

luck helps us, too, as was the case with the terrorist high explosive attacks that

had been planned to hit the celebrations for the new millennium, January 1, 2000.

(B) Deterrence cannot work, unless the perpetrators fear that our intelligence capabilities might succeed in identifying them, at least after the attack, if not before.

An unknown perpetrator cannot easily be destroyed. Also, if our intelligence leaves

too much room for doubt as to the ultimately responsible perpetrators, and if the

tentatively accused are not easy to reach, such uncertainties might dissuade us from

trying to retaliate. We all have heard much speculation about Osama bin Laden

who allegedly was responsible in recent years for nearly every foreign terrorist act

against U.S. interests. According to the last public reports, he is still alive and well

somewhere in Afghanistan.

(C) The usefulness of additional arms control measures is even more uncertain

than the success of deterrence. I say ‘‘additional’’ arms control because two treaties

are in force that ban biological warfare—the 1925 Geneva Protocol and the Biological Weapons Convention of 1972. The latter treaty, as you know, also prohibits the

development and stockpiling of such weapons. Both treaties have been violated repeatedly, always with total impunity. There has been no enforcement of these treaVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00065 Fmt 6633 Sfmt 6621 75040 SFRELA2 PsN: SFRELA2
62

ties, none at all, and the so-called ‘‘Protocol’’ to the Biological Weapons Convention

(that the previous administration supported) would have made matters worse. It

was prudent for the Bush administration to withdraw support for this misconstrued

enterprise.

(D) That leaves the fourth type of measures—the remedial measures—steps that

can usefully be taken after a biological attack has occurred. Obviously, to count on

remedial measures, our federal government has to set up an effective organization

beforehand and must prepare effective tools. The State and Federal public health

authorities, the hospitals, fire departments, and police, can’t be asked to fight a biological weapons attack with their bare hands. Increased funding is needed for work

on vaccines that could routinely and safely be administered to the whole population

(like the smallpox vaccinations of the past) and for other medical counter measures

that could help contain the disaster after an attack had begun.

Let us take note of a significant difference here between nuclear and biological

weapons. Once a nuclear detonation has been started within a bomb, there is nothing that can protect people from the immense energy that will instantly escape, except being at a safe distance or in a deep underground shelter. But biological agents,

once they have been released, might be vulnerable to sun light and other factors,

might be kept out of buildings by special air-conditioning filters or over-pressure

systems, be sufficiently diluted by simple face masks, and finally be made less

harmful (or even harmless) by medical interventions.

To close, I want to make an organizational recommendation that is of utmost importance. We need to recognize a spectrum of possibilities regarding biological

threats, from domestic terrorism, terrorist acts in the United States by a foreign organization, and attacks within the United States in time of war by enemy powers.

Until now, U.S. military planning has been based on the implicit assumption that

U.S. territory would remain a sanctuary (except in a large-scale nuclear war).

Hence, the Defense Department has stayed on the sidelines. While the Justice Department with the FBI are correctly designated as the lead agency for terrorism,

DOD will have to prepare to take the lead to defend U.S. territory against biological

attacks in a warlike situation.1

———————— 1To address this issue, the Center for International and Strategic Studies has published the

report: Defending the U.S. Homeland, Strategic and Legal Issues for DOD and the Armed Services (1999).

The CHAIRMAN. Thank you very much.

Dr. Henderson, thank you for being here.

STATEMENT OF DONALD A. HENDERSON, MD, MPH, DIRECTOR, CENTER FOR CIVILIAN BIODEFENSE STUDIES, JOHNS

HOPKINS UNIVERSITY, BALTIMORE, MD

Dr. HENDERSON. Thank you very much. In all, I spent 11 years

in eradicating smallpox and have some feel for the disease. I can

say that the scenario in ‘‘Dark Winter’’ which some have suggested

may have exaggerated the risk, is based on a rather conservative

set of estimates that were provided and a conservative set of assumptions—that, indeed, the tragedy of ‘‘Dark Winter’’ could be

every bit as bad as depicted and in fact far worse.

There are of course other organisms which we are concerned

about, anthrax, plague, many others. There is certainly a likelihood

of biological terrorism or use of biological weapons now that is different from what we were experiencing not 10 years ago or what

we were concerned about when I was in the White House as advisor to the President. We perceived it very differently then.

What I think is not appreciated at this time is that the 21st century, as we move into it, is a quite different era with regard to biology and our concern about the threat of microorganisms.

Fifty years ago the science of nuclear physics dominated. Now I

think everyone would agree that this is the era of biology, with a

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63

ment and prevention; but at the same time we are experiencing potentially some of the greatest international security threats that we

have ever known.

This is not yet understood. We are only beginning to get some

comprehension of this.

The fact is that the threat of new and emergent epidemics is very

real. Let us recall that AIDS was discovered only 20 years ago. It

is devastating Africa. It is a real threat globally of a magnitude we

have not experienced in a very long time.

In 1918 we had the swine-flu epidemic which killed somewhere

between 20 and 40 million people. The death rate for that flu was

approximately one to two percent. Just in the last few years we

have dealt twice with a strain of flu in Hong Kong called H5 and

N1 in which there were six deaths among the 18 infected—a death

rate of 33 percent and understandably a tremendous concern on

the part of all of us that this might spread beyond the bounds of

Hong Kong.

Drastic measures were taken to try to control it. We will see

many more new diseases, as this past year we have seen foot and

mouth disease.

But there’s another problem which is also complicated. With the

advancements that we have seen in biology, scientists are doing

many different things with many different organisms than they

have done before. And they are able to do it with a facility that we

had not appreciated before.

Only within the past month the Imperial College in London was

fined 50,000 pounds for combining hepatitis C virus genes with

those of Ebola virus and working with the product without any particular protection.

There are other activities of this sort going on in many places.

Why? Because in the course of trying to understand the pathogenesis of organisms—for example, how they infect—many experiments that are done for good, scientific reasons have a potential

dark side. At this time we have no mechanisms in place for looking

at this and monitoring it. We wonder what would happen if an organism escapes. That certainly is a real problem.

Senator Nunn has indicated very clearly where we are at this

point in time. Our Center is now some 3 years old. We’ve have

been working diligently, looking at a lot of problems. It’s quite clear

that the weakest points in our system are: No. 1, the public health

system which is greatly understaffed, very weak, very unprepared

(and the $77 million being provided by the Federal government

averages a little more than a million dollars a state—it isn’t even

a respectable Band-Aid, I’m sorry to say); and No. 2, our hospitals

have very little flexibility. One can’t appreciate how little flexibility

until you realize that in Baltimore our hospitals are on ambulance

bypass regularly now. It’s doubled this past year. The year before

it doubled again. And that is occurring——

The CHAIRMAN. For the record, Doctor, explain what ambulance

bypass means.

Dr. HENDERSON [continuing]. It means that the hospital is full

up. It cannot take any more patients, and if you have an emergency patient, you will need to bypass the hospital and go somewhere else.

64

The CHAIRMAN. In my little state of Delaware, in our largest city,

not a week has gone by that at least one major hospital has not

been on ambulance bypass; in some weeks, all the major hospitals

were on bypass at the same time.

Dr. HENDERSON. This is not generally understood by the public,

nor is there a plan to address this. We also looked at the question

of dealing with casualties in the city of Baltimore when we had the

recent problem with the tunnel, and pretty much concluded that 75

acute patient casualties would overwhelm the capacity of the city

of Baltimore, so short are we of beds and facilities.

This is true across the country. So these are two major areas

where we are not in a position to even cope with casualties should

they occur. To rectify this will require a major input of resources.

Senator Nunn has also spoken eloquently of the need to put money

into research and development. Certainly this is true.

If we have new organisms that appear, we want to be prepared

immediately to move quickly to develop vaccines and/or antibiotics.

We are not now prepared to move quickly.

In fact right now we are using an influenza vaccine production

method that is 30 years old. If we get a new strain today, it would

take us 9 months before we could produce a new vaccine. By that

time the epidemic would be over. We’ve got a lot of work to do.

Clearly the important thing is to identify new disease threats as

quickly as possible. The global surveillance system obviously would

make a great difference if we could make that much better. Efforts

are now being made and Dr. Heymann has certainly played an important role. There are elements in our own government who are

contributing to it. Again, though, very little is yet being done compared to what needs to be done.

It’s going to be very difficult from everything we’ve looked at to

determine how we can deal with biologic weapons. They are not nuclear. They are not chemical.

That which we learned from dealing with nuclear weapons seems

to have little if any applicability with regard to controlling the biological weapons. For production, for example, the technology is dual

use, so that one cannot monitor specialized production equipment.

You can’t see production facilities from the air. Monitoring is a real

problem.

One thing that we feel is important is a strong moral commitment on the part of the science community to condemn anyone and

any laboratory involved in offensive weapons development. We are

exploring with the American Medical Association and the World

Medical Association what can be done in terms of a very strong official statement. Is it going to be effective? Nothing is going to be

100 percent effective, but it is a step.

The bottom line is that we are in a new era dealing with biologic

threats of a very different character than we have dealt with in my

40 years in public health. We are not prepared for this. We haven’t

really thought about it very carefully.

As we’ve looked at bioterrorism, it illuminates the problems we

have with the new and emerging infections, the problems we are

going to face with scientists using different organisms as recombinants. In that sense the bioterrorism threat is helpful but we

65

really have to take it very seriously. And we have not done so as

yet. Thank you.

[The prepared statement of Dr. Henderson follows:]

PREPARED STATEMENT OF DONALD HENDERSON, MD, MPH

Mr. Chairman, distinguished Members of the Committee, thank you for the opportunity to appear before you today to discuss the realities of the threat posed by biological weapons, our capabilities to secure an early warning of an attack, our potential for response and, finally, measures that might be taken nationally and internationally to lessen the probability of an attack.

It is generally agreed that the 21st century brings with it a new era in the biological sciences with advances in molecular biology and biotechnology that promise

longer, healthier lives and the effective control, perhaps elimination of a host of

acute and chronic diseases. The prospects are bright but there is a dark side—the

possibility that infectious agents might be developed and produced as offensive

weapons; that new or emergent infections, like HIV/AIDS, might overwhelm available preventive and therapeutic measures or that laboratory scientists, perhaps inadvertently, might create and release a new and lethal agent. These concerns are

as relevant to Europe, to Africa, to Asia as they are to America, In today’s world

of rapid travel and large migrant populations, epidemic disease, wherever it occurs

and of whatever origin, threatens the security of all nations. We are, today, ill-prepared to deal with these challenges.

Throughout the 45 years of my professional career, my principal concern has been

the control of infectious diseases both in the United States and abroad. My experience has included 20 years with the Centers for Disease Control, including assignments as Chief of Surveillance and Chief of the Epidemic Intelligence Serve; 11

years with WHO as Director of the Smallpox Eradication Program; and 16 years as

Chairman of the Pan-American Health Organization’s Technical Advisory Group

which counseled PAHO experts on the design and development of the polio eradication program. Enormous strides in epidemic disease control have been made over

the past quarter century and more is promised. Four years ago, however, it became

apparent to me that these accomplishments and more were jeopardized by the growing threat of biological weapons as well as by new and emergent infections. This

led to our founding three years ago of the Hopkins Center for Civilian Biodefense

Studies. Our energies are directed ultimately toward preventing biological disasters

that potentially could become global in scope, such as epidemic smallpox could readily be and which AIDS is rapidly becoming.

The Threat from Biological Weapons

Nothing in the realm of natural catastrophes or man-made disasters rivals the

complex problems of response that would follow a bioweapons attack against a civilian population. The consequence of such an attack would be an epidemic and, in

this country, we have had little experience in coping with epidemics. In fact, no city

has had to deal with a truly serious epidemic accompanied by large numbers of

cases and deaths since the 1918 influenza epidemic, more than two generations ago.

Senators Hart and Rudman, chairs of the United States Commission on National

Security in the Twenty-first Century, singled out bioweapons as perhaps the greatest threat that the U.S. might face in the next century. Admiral Stansfield Turner

pointed out that, besides nuclear weapons, the only other weapons with the capacity

to take the nation past the ‘‘point of non-recovery’’ are the biological ones.

The Dark Winter scenario dramatizes the catastrophic potential of smallpox as a

weapon. It is, of course, not the only possible organism that might be used. In 1993,

the Office of Technology Assessment estimated that 100 grams of anthrax released

upwind of a large American city—the model being Washington, DC—could cause between 130,000 and 3 million deaths, depending on the weather and other variables.

This degree of carnage is in the same range as that forecast for a hydrogen bomb.

Although there is legitimate concern as well about the possible use of chemical

weapons, they are far less effective pound for pound and extremely difficult to deploy over large areas. Ten grams of anthrax can produce as many casualties as a

ton of a chemical nerve agent.

The insidious manner by which a biological attack would unfold is itself alarming.

The fact of an attack using an explosive or chemical weapon would be recognized

immediately and resources summoned quickly to deal with the consequences and to

begin to remediate the situation. A biological agent would, in all probability, be released clandestinely as an aerosol spray, odorless and invisible, which would drift

slowly throughout a building or across a city. Not until days to weeks later would

people begin to fall ill; new cases would continue to occur over a period of one to

66

several weeks. Some of those exposed, in all likelihood, would be hundreds of miles

away when they develop symptoms—in other cities, in other countries. Thus, the

consequence of the attack would extend well beyond the immediate area of release.

Biological weapons have not been used since WWII but this is not because of concern that they might not work. The U.S. program was abandoned in 1969 not for

technical but for political reasons. As Gradon Carter has pointed out, the utility of

bioweapons had been demonstrated by all possible means short of war. By the

1960s, the U.S. knew how to grow and process many microorganisms in a form usable for mass casualty biological weapons. Trials that modeled dispersion of simulant

agents as aerosols were conducted in many cities and scores of tests with live biological agents using animals as targets were performed at the Johnson Atoll from

1963 to 1969. There is now no doubt and there was then no doubt, of the capacity

of these weapons to cause widespread casualties. A World Health Organization

(WHO) analysis, now 30 years old, supported the belief that biological weapons are

strategic, population-destroying weapons. Since then, the technology needed to create and disperse these weapons has advanced significantly.

The year 1972 was a significant one in the history of bioweapons. That year, the

Biological Weapons Convention was agreed upon, calling for all signatory countries

to cease research on biological weapons and to destroy existing stocks. The Soviet

Union and Iraq were both parties to the Convention. The Soviet Union, however,

began immediately to greatly expand and modernize its existing biological weapons

program and to develop genetically engineered pathogens and other organisms that

could serve as strategic weapons. A new organization was created called

Biopreparat. Ostensibly a civilian operation, it recruited some of the most capable

of Russian biologists. At its peak, it employed over 30,000 persons. There was also

a military program of at least 15,000 people and an agricultural program making

crop pathogens that employed 10,000 people. The overall complement of staff was

equivalent in size to that of its nuclear program. Biopreparat’s agenda included the

manipulation of viruses and micro-organisms to render them capable of surviving

delivery on missile warheads; the development of particularly virulent strains of organisms that are resistant to vaccines and antibiotics; the creation of peptides that

could alter moods and heart biorhythms; and the manufacture of tons of anthrax,

as well as smallpox virus and antibiotic-resistant strains of plague.

Although the Soviet program was of prodigious size and sophistication, the infrastructure that is actually necessary to make a biological weapon is, in fact, comparatively simple and inexpensive, especially compared to that required to make a nuclear weapon. To make one kilogram of plutonium requires 100 tons of uranium ore;

a substantial quantity of specialized equipment; and an enormous facility readily

visible from the air. A biological weapon can be produced with the same equipment

one uses to produce an ordinary vaccine; it can be readily housed in a building the

size of a two-car garage; nothing on the exterior would identify its use. Moreover,

the room and the equipment could be sufficiently cleansed within 24 hours so that

no one, on inspection, would be able to determine whether it had been used to make

vaccines or biological weapons.

The intelligence agencies have estimated that at least a dozen states possess or

are actively seeking an offensive biological weapons capacity. Most of these states

are those named by the State Department as sponsors of terrorism. Expertise for

operating these facilities is readily available from now poorly funded laboratories of

the Russian biological weapons complex. For these countries, biological weapons

have a special appeal. They are inexpensive, they occupy little volume, they are

readily transportable from place to place and they are capable of being disseminated

covertly so that attribution may be impossible.

It is also important to appreciate that the technologies needed to build biological

weapons are available in the open literature and on the Internet. This is not knowledge that is limited to a few hundred scientists isolated in a laboratory in the western desert. There are many scientists who have this knowledge and are capable of

putting together a biological weapon. Some have argued that preparing a biological

weapon is complicated and have been mistakenly reassured by the failure of Aum

Shinrikyo’s efforts to aerosolize anthrax throughout Tokyo. In fact, although the sect

did include some with experience in microbiology, those who actually worked on the

project were not well-trained microbiologists. Nonetheless, they came very close to

succeeding.

Implications of Advances in Biotechnology

A key reason for being concerned about biological weapons is the remarkable

progress now being made in biotechnology and genomics research. Bioscience is

moving at a much faster pace than did physics in the 1950s, partly because of computers and the more ready accessibility of knowledge, and partly because of the

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money that is being invested by large corporations in the biological sciences. In

1998, the U.S. biotechnology industry employed 150,000 people and had a market

capitalization of $97 billion with product sales of $13.4 billion. Last April, the Harvard Business Review predicted that the ability to manipulate the genetic codes of

living things will dwarf the business transformation propelled by the Internet. Indeed, it is generally acknowledged that the life sciences will be the most important

technology of this century.

But, as the understanding of molecular biology increases and as we develop the

ability to manipulate cellular processes, we are also creating the tools and knowledge for building more powerful and more diverse weapons. When we discover why

a particular virus or bacteria is especially virulent or why it has become resistant

to antibiotics, we create an opening for building a new drug or a new vaccine. At

the same time, we facilitate the creation of tools needed to build more virulent

weapons.

The Effects of a Biological Weapons Attack

The consequences of a biological weapon attack would be an epidemic, most likely

following an unannounced attack. In all probability, we would know that something

had happened only when people started appearing in the emergency rooms and doctors’ offices with strange maladies. Depending on the biological agent and its incubation period, it could be days or weeks after release of the organism before people

first became ill. Identification of the cause could be problematical. American physicians today are not trained to diagnose illnesses due to the pathogens thought to

be the ones most likely to be used as bioweapons. Few physicians have ever seen

cases of anthrax or smallpox or pneumonic plague.

It is difficult to imagine how the public might respond in today’s world to a fastmoving lethal epidemic. In recent decades, there have been few such epidemics in

industrialized cities. One of the more recent occurred in India in 1994. Plague broke

out in the diamond-polishing district of Surat. It was reported by the media as a

deadly, mysterious fever, possibly plague. Within hours, panic reigned. People began

streaming from the city. Many in the medical community were among the first to

leave. Eventually half a million fled, leaving the city a ghost town. It is estimated

that India lost some two billion dollars in lost trade, embargoes, and production as

a consequence of this outbreak. How many actually died of plague is still not clear

but the total was not more than 50.

Epidemics have the potential to spread internationally as we have observed with

the HIV/AIDS epidemic. The disease is contagious but it is not easily transmitted

from one person to another. Nevertheless, it spread across the globe and is changing

the population demographics in some African countries to a degree comparable to

that caused by the Black Death of the 1300s, which killed a third of the European

population.

Addressing the Biological Weapons Threat

The status of national preparations to deal with bioterrorism is difficult to summarize. The diverse initiatives taken by different agencies of government are not

well coordinated, even within the agencies themselves and many have been designed

with little comprehension of what is implied for the civilian population when a biological weapon is used. Beginning in 1995, when the first Presidential Decision Directive was issued, preparations to respond to terrorism focussed almost exclusively

on training and equipping ‘‘first response’’ teams to counter the effects of a nuclear

or conventional explosive device or a chemical attack. Training programs in 120 cities were targeted to include police, fire and emergency rescue personnel in a ‘‘lights

and sirens’’ type of response and special full-time units of the National Guard were

constituted whose function is not clear but certainly have little to do with bioterrorism.

Not for several years was there a beginning comprehension that the consequences

of use of a biological weapon would be an epidemic and that those first detecting

its presence and those primarily responsible for controlling the disease would be

public health personnel and physicians. Accordingly, in most cities, public health,

medical and hospital personnel were not included either in planning or training. Finally, in FY 99, significant funds began to be made available to the Department of

Health and Human Services, primarily the Centers for Disease Control (CDC),

whose traditional responsibility, with state and local health departments, has been

the surveillance and control of infectious diseases. Some two years ago an Office

dealing with Bioterrorism was established at CDC; modest funds began to be made

available to the states for development of programs both for response and surveillance; stockpiles of antibiotics were procured; smallpox vaccine was ordered; and a

national network of laboratories was established that is capable of diagnosing the

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organisms of principal concern. Unfortunately, little has yet been done to provide

for the training of public health and medical professionals and hospitals remain

woefully unprepared.

Current Vulnerabilities

We are today ill-prepared to deal with an epidemic of any sort. There is, as yet,

no comprehensive national plan nor an agreed strategy for dealing with the problem

of biological weapons. There is little inter-agency coordination at the federal level

and nationally funded programs appear to be as often competitive as cooperative.

Particularly serious are the vulnerabilities in our medical health care system and

our public health infrastructure.

Hospitals

When Americans are seriously ill, they expect to be cared for in hospitals. If the

hospitals became overwhelmed and were paralyzed by chaos, it would have serious

implications for public morale and for the potential for containing an epidemic, let

alone treating those who were already sick. The likelihood of public anxiety rising

to civil disorder would rise substantially.

Hospitals are under serious pressure today. Of the 5000 hospitals in the U.S., 30%

are losing money; over the last decade, 1000 have closed because of financial reasons. They face a host of regulatory issues including those dealing with health insurance portability, safer needles, medical and medication error reduction, limits on

medical device reuse, ergonomic standards for employees, requirements for patient

restraints and seclusion, and many more. At the same time, the numbers of the uninsured are increasing and the population is aging and in need of more medical

services. The hospitals have struggled to become ever more efficient but, in their

quest to eliminate inefficiencies, they have basically wiped out their surge capacity.

Even minor increases in patient demand, such as that of the 1999 brief and mild

flu season strained most hospitals.

This lack of elasticity is also seen in the pharmaceutical field as companies have

focussed on just-in-time production and delivery. The result is that reserve supplies

are few and temporary problems in production are regularly manifested in countrywide spot shortages of such as antibiotics and other critical drugs.

There is an increasing shortage of emergency rooms what with the loss of a thousand hospitals in the past decade and a desire on the part of hospitals to close ERs,

if possible, because of their drain on resources. The amount of time that Baltimore’s hospitals have been on ‘‘diversion’’ of ambulances because of over crowding has doubled every year for the past three years. Ventilators to aid respiration are in short

supply. Baltimore, home to two major medical centers and medical schools, could not

handle an acute situation that produced as many as 50 casualties requiring ventilators. A handful of highly contagious patients would cause havoc, there being in the

Baltimore-Washington area, no more than 100 beds in negative pressure rooms that

could handle highly contagious patients.

However, the most intractable problem for hospitals is likely to be staffing. As we

have been told, only half of all nurses work in hospitals and the average age of a

nurse in America is 53. More are now retiring than are being recruited to the field.

Hospital administrators report that, even if they had more open beds, they doubt

that they would have staff to care for the patients.

The Public Health System

The public health system is in even worse shape. Public health is a long-neglected

stepchild to modern medicine. It is a sector that has been understaffed and under

funded for several decades.

It is believed that, in most states, there is ample authority for public health officials to respond aggressively and effectively to protect the public health. However,

many of the relevant laws were written between the time of the Civil War and the

1930s. A more critical problem is knowing what to do and how to do it. With sharp

reductions in the number of cases of the major infectious diseases, processes and

knowledge about when and how to use quarantine and isolation procedures, how to

organize large scale vaccination programs and how to communicate effectively with

a concerned public have been lost.

A major problem is that there really is no public health ‘‘system’’ for dealing with

infectious diseases in this country, but, rather, a fragmented pattern of activities.

The federal system, which for the most part is in the federal Centers for Disease

Control and Prevention is itself comprised of a number of Centers and activities that

are themselves independent fiefdoms. State and local health departments reflect a

similar pattern and there is a major disconnect between the public health and medicine. Doctors rarely communicate with local public health officials and often, when

they try to do so, they find no one with needed competence. In New York City, a

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city with one of the best public health departments in the country, the report of two

eases of encephalitis to the health department led to the unraveling of the West Nile

epidemic. This was a laudable and important response. However, it was later discovered that at the time the first two cases were reported, there were 20 other patients

already hospitalized with encephalitis, a clearly recognizable and legally reportable

disease.

In most areas, public health is not treated as an emergency service as are police,

fire and utilities. The concept of a 24 hour per day, 7 day per week ‘‘hot line’’ is

little known. Yet, public health officials will be the ones who will be obliged to organize a response to an epidemic, to communicate with the public and to orchestrate

a city and state’s response resources

Increasing Preparedness

What can be done to diminish our vulnerability to bioweapons.

First, we have got to better prepare our public health and medical care services

to respond to outbreaks and epidemics and to mass casualty situations whatever

their origin. They are at the core of any response and yet, only recently have they

even begun to be involved in the necessary planning and training activities. Significant resources will be required for this purpose, perhaps one billion dollars per year

or more. Although a large sum, this would represent less than 10% of government

expenditures for counter-terrorist activities. This investment, however, would serve

a far broader utility than bioterroism alone.

Second, we need to mount a robust research and development program for biodefense. It would seem logical for this to be a joint DOD-DHHS effort. We need to

engage the genius of the universities, the pharmaceutical firms and the biotechnology companies, few of whom are now involved. The bioscience community

does not have a history of engagement with defense projects and, by and large, they

have not been eager to work with government in this field. For this to happen will

require inventive structures and incentives. Three areas of research and development would be especially important: (1) More definitive, rapid, automated means of

diagnosing major pathogens, basically building microchips that could identify specific pathogens by deciphering the molecular genomes. (2) Mechanisms for being

able to rapidly develop and produce new antibiotics and antiviral drugs for new and

emergent diseases. (3) Mechanisms for enhancing the immune response generally,

so as to get beyond the one organism-one drug approach.

Third, public health has to identify those critical capacities that are needed to

fight epidemics of contagious disease. These include surveillance and reporting systems, particularly the ability to track an epidemic once it occurs. But what we must

do, even in normal times, is to track outbreaks once they arc identified. Communications systems that connect health care providers and the public health system are

critical.

Fourth, in cooperation with WHO and other countries, we need to strengthen

greatly our intelligence gathering capability. A focus on international surveillance

and on scientist-to-scientist communication will be necessary if we are to have an

early warning about the possible development and production of biological weapons

by rogue nations or groups and, likewise, to have the earliest possible warning and

longest possible lead time to develop drugs and vaccines to deal with new or emergent organisms.

Fifth, a concerted effort by the medical, public health and, broadly, the biological

sciences community to condemn participation in research or development of biological weapons is clearly indicated. Such a response would provide no certain guarantees that misbehavior would not occur but then, there is as yet no other satisfactory

deterrent to deal with these troublesome weapons.

Summary

Biological weapons are a significant threat, and because of the rapidly growing

power of biotechnology and biological knowledge, the urgency and the diversity of

this threat will only increase. The nature of biological weapons and the epidemics

that they could create is such that preventing them will be far more challenging

than preventing the catastrophic use of chemical or nuclear weapons. It is going to

be hard to detect biological weapons production facilities, it is going to be hard to

track the weapons before they are used, and it is going to be very hard to interdict

them before they are released.

If we do nothing more than strengthen the public health and medical care systems, we can significantly decrease the suffering and death that would follow a bioweapons attack. By being able to mitigate the consequences of such an attack, we

can make ourselves less attractive targets to would-be perpetrators. As important,

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we could improve the everyday functioning of the health care and the public health

system for the general good.

The CHAIRMAN. Thank you, doctor.

Dr. Heymann.

STATEMENT OF DAVID. L. HEYMANN, MD, EXECUTIVE DIRECTOR, COMMUNICABLE DISEASES, WORLD HEALTH ORGANIZATION, GENEVA, SWITZERLAND

Dr. HEYMANN. Thank you, Mr. Chairman. I have provided a written statement that I would appreciate being put in the record.

The CHAIRMAN. The entire statement will be placed into the

record. You are welcome to bring that all the way up here if you

would like, if that’s good, or wherever is convenient.

Dr. HEYMANN. As you said earlier, Mr. Chairman, and as Dr.

Henderson has just emphasized, naturally occurring outbreaks can

cause equal amounts of havoc as can intentionally caused outbreaks. We have seen this in outbreaks in India with plague and

with various other outbreaks throughout the world.

This map [see Figure 1 on page 81.] shows a selection of the over

800 outbreaks which have occurred between 1996 and 2001. They

occur on every continent. But what’s very important is that they

occur with such frequency that it’s almost impossible to keep the

map up to date.

In the United States, for example, here in August just last month

West Nile fever occurred in humans now in Florida and in Georgia.

And at the same time, Canada reported to WHO that they had just

isolated the West Nile virus from birds in that country.

Three days after we received the report from Canada we see the

report from Venezuela whose President announced a national

health emergency after confirmation of more than 24,000 cases of

dengue which is also a mosquito-borne virus.

So we can see that infectious diseases are a very important issue

today. And as you noted, their phenomenal increase is due to travel

and trade which is increasing in the world today.

These diseases spread in apparently healthy humans around the

globe. They spread in food, in animals, in cargo, or in insects

stowed away in cabins and luggage holds of jets.

Because of our world’s growing interconnectedness, outbreaks of

infectious diseases in any country today are a health security risk

for us all. This has been clearly said by Dr. Hughes from CDC

many times. It’s clear that this is the case.

One of the strategies to protect populations against the international spread of outbreaks is the WHO global network of alert

and response. This poster [See Figure 2 on page 82] illustrates the

geographical distribution of haemorrhagic fevers, that is Ebola,

Lassa and Marburg, just one of the category of diseases which are

watched over and reported through this network.

The Global Outbreak Alert and Response Network is actually a

network of 72 different networks that have spread throughout the

world and continuously report outbreaks to WHO. The laboratories

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and the regional surveillance networks of the Centers for Disease

Control and Prevention in Atlanta are major members of this network as is the U.S. Department of Defense Global Emerging Infections Surveillance and Response Network. A unique member in

this global network——

The CHAIRMAN. Excuse me. On that chart, does the red indicate

those states where the fever has been reported or are they the——

Dr. HEYMANN [continuing]. Reported.

The CHAIRMAN. Are they the members of the global surveillance

system?

Dr. HEYMANN. Those are countries from which the disease was

reported.

The CHAIRMAN. How many countries are members of this global

surveillance system?

Dr. HEYMANN. We estimate that most countries are in some way

involved because we have 141 WHO offices in countries. And those

offices sit in Ministries of Health and are a source of information

for us.

The CHAIRMAN. Thank you.

Dr. HEYMANN. In addition to the networks that are occurring

from industrialized countries, there are also WHO networks. But a

unique member of this network is the Global Public Health Intelligence Network, called GPHIN which has been developed by

Health Canada for WHO.

This network is constantly crawling the Web looking at all open

sites such as news wires, public health and e-mail services, electronic discussion groups including the U.S. based Pro-MED discussion group, and local on-line newspapers for information about outbreaks.

At the close of each day, Health Canada packages the information that they have obtained and sends it over to WHO in Geneva.

And in the morning that information is reviewed by the outbreak

verification team and verification on the ground is done through

the network of networks.

This system has been very effective. And as you can see on the

next poster [See Figure 3 on page 83] 56 percent of all the reports

to the WHO network are coming from in the GPHIN, the Global

Public Health Intelligence Network, while 27 percent come to WHO

through our usual country reporting mechanisms.

The verification done each day at WHO is therefore extremely

important, because improperly handled information can have disastrous economic consequences for tourism and trade.

An example of how information can be mishandled is shown in

an article in the Bangkok Post. A single death from a pulmonary

embolism on a tourist travelling from Thailand to Vienna was inaccurately reported in the press as due to an infectious disease.

It was only through verification through the network that we

were able to inform the press that this death was not due to an

infectious disease.

A more recent example of the importance of the network was

during the largest reported outbreak of Ebola which began in

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Uganda in October of last year. The WHO network was informed

as soon as the first suspected cases were detected by Uganda, and

the WHO coordinating containment team—of which CDC was a

predominant member—began to arrive within 24 hours to contain

the outbreak over the next 5 months.

The containment exercise in Uganda is just one of many such activities in the alert and response network since 1998. Others are

shown on the next poster [See Figure 4 on page 84] and occurred

in Afghanistan, Bangladesh, Egypt, Ethiopia, Kosovo, Saudi Arabia, Sierra Leone, Sudan and Yemen.

It’s very important on this map to note that although outbreaks

occur on every continent that you saw in the first map, and in

every country, it is those in Africa and southern Asia which require

an international response in most instances. As we speak today,

Mr. Chairman——

The CHAIRMAN. Why is that?

Dr. HEYMANN [continuing]. Because they have the weakest public

health infrastructure. As we speak today, WHO coordinated teams

are working to stop outbreaks in South Asia of a disease which has

not yet been identified (this is the second outbreak this year) an

outbreak of urban Yellow Fever in West Africa in Abidjan, and in

the Horn of Africa where another yet unidentified infectious disease is causing high mortality.

To facilitate and better coordinate the work of the network, WHO

has developed protocols for containing outbreaks of known and unknown cause, including protocols for the infections shown on the

next poster [See Figure 5 on page 85] that names the biological

agents of feared intentional use by terrorists or in warfare. These

names have been provided to us by the protocol group meeting in

Geneva on the Biological Weapons Convention.

These protocols are against diseases, and all the protocols have

been used in outbreaks recently. So far all such outbreaks that we

have investigated have been of natural cause. But these outbreaks

could be intentionally caused as well. The WHO network we feel

is clearly well placed as one of the global mechanisms for detection

and containment of intentionally caused outbreaks.

WHO will soon be issuing an updated edition of its standard

guidelines for health aspects of chemical and biological weapons

shown on this poster. In view of the devastating impact on the populations that such weapons could have, the guide urges governments to strengthen public health infrastructure and develop nationally response plans for a biological attack as an integral part

of existing national emergency plans.

With this in mind, WHO’s 191 member states adopted in May of

this year a consensus resolution on global health security.

During the debate that preceded the adoption of this resolution,

developing countries continually emphasized the weakness of their

public health systems and the need for more input to these systems. Mr. Chairman, the U.S. Government and many other agencies are valuable partners in helping us strengthen the infrastructure in developing countries.

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This of course is at the basis of good global surveillance and response. In addition to the annual assessed contribution to WHO

that the United States gives each year and which has been referred

to here, the United States also contributes to WHO in global surveillance and response through USAID, through CDC, through the

National Institutes of Health, the Departments of Defense and Agriculture, NASA Goddard Space Flight Center, and the many U.S.

universities from which we draw both technical and in some cases

financial support.

As you can see from this wide range of agencies, the world today

must draw on a broad base of agencies in order to support global

surveillance and response. Infectious diseases are a threat to our

national and global security. And the battle lines must include defense through strong public health in all countries. Thank you very

much.

[The prepared statement of Dr. Heymann follows:]

PREPARED STATEMENT OF DR. DAVID L. HEYMANN

STRENGTHENING GLOBAL PREPAREDNESS FOR DEFENSE AGAINST

INFECTIOUS DISEASE THREATS

By their very nature, infectious diseases have the potential to spread internationally. Throughout most of human history, isolation and quarantine were the only

measures available for protection. As a result, the course of human history was frequently altered by epidemics that swept unchecked across continents, claiming more

lives and creating more social devastation than wars.

With the development of vaccines and the discovery, during the previous century,

of potent classes of antimicrobial drugs, humanity could, for the first time in history,

prevent many infectious diseases and cure many others. The risk that epidemics

might again sweep across continents seemed remote. The defenses were in place, the

threat was considered under control, and the world relaxed its guard.

The Magnitude of the Problem

The microbial world is complex, dynamic, and constantly evolving. Microbes proliferate rapidly, mutate frequently, and adapt with relative ease to new environments and hosts. They will also eventually develop resistance to the drugs used to

treat them. Numerous factors, including those linked to human activities, can accelerate and amplify these natural phenomena, as has happened in recent years. Moreover, when a complacent world relaxes its vigilance and lets down its defenses, the

consequences can be dramatic as well as rapid. Microbes are quick to exploit new

opportunities to spread, adapt, and resist.

As a result of several recent trends, the world now finds itself in a situation

where epidemics are again spreading around the globe unchecked, but this time at

unprecedented speed. New or newly recognized diseases are being reported at the

rate of approximately one per year. AIDS emerged as an important infectious disease in the early 1980s and is now entrenched on a scale that threatens global security. Other emerging diseases, such as Ebola haemorrhagic fever and new variant

Creutzfeld-Jakob disease, illustrate the severe damage caused by lethal new agents

that cannot currently be curbed by vaccines or drugs. In 1997 and 1999, when influenza viruses previously confined, respectively, to birds and swine suddenly appeared

in humans, experts voiced fears of a pandemic on the scale of the deadly Spanish

Flu of 1918, which some believe was caused by an avian virus that first crossed the

species barrier to swine before jumping to humans. Altogether, over 30 new infectious diseases have emerged over the past 25 years.

The phenomenal recent increase in global travel and trade has given microbes

multiple opportunities to spread around the global in novel ways and with unprecedented speed. Microbes can incubate in apparently healthy travellers, hide in food,

animals, or cargo, or be carried by insects stowed away in the cabin and luggage

holds of jets or in the pots of exotic plants. In the UK alone, 1,128 cases of malaria

were imported into the country by travellers in 2000. Cases of ‘‘airport malaria,’’ in

persons who live or work near international airports yet have not travelled, are detected regularly in cities such as London, Paris, Brussels, Geneva, and Oslo as well

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as in the United States and Canada. In just the past two years, unexpected outbreaks of relatively new or previously rare diseases have taken populations on every

continent by surprise. Legionellosis and leptospirosis in Australia, Lassa fever, yellow fever, hantavirus, listeriosis, and new variant CJD in Europe, and yellow fever,

West Nile fever, cryptococcosis, and E. coli O157 in the U.S. are just some examples.

In the face of such highly mobile, microscopic, and easily disguised threats, national

borders are porous. An outbreak anywhere in the world must now be considered a

threat everywhere else.

Once an infectious disease, or the insects and animals that carry it, invades a new

country or continent, it can prove difficult—if not impossible—to control. This has

been the case with West Nile fever, which made its initial appearance on the American continent in 1999 and is now firmly entrenched and spreading, and with Rift

Valley fever, which crossed the Red Sea from East Africa to the Arabian peninsula

for the first time in 2000. The aggressive tiger mosquito, capable of spreading dengue, yellow fever, LaCrosse encephalitis, and other diseases, and able to breed in

any container large enough to hold water, entered the U.S. in a shipment of used

tires in 1985 and has since spread to 25 states.

Apart from the need to cope with the emergence and spread of new diseases, public health infrastructures are further burdened by the dramatic resurgence of older

epidemic-prone diseases such as malaria, dengue, tuberculosis, cholera, and yellow

fever. Cholera, for example, is now causing epidemics in parts of Latin America

where it had previously been quiescent for over 100 years. The global spread of dengue, which began in Southeast Asia in the 1950s, has intensified dramatically,

showing a four-fold increase with unprecedented numbers of its deadly

haemorrhagic form. On 23 August 2001, Venezuela’s President declared the country’s current dengue epidemic, with more than double the number of cases seen in

the previous year and over 600 cases of its potentially lethal form, a national emergency.

The costs can be enormous. In recent years. wealthy nations have been stunned

by outbreaks of foodborne disease causing economic losses in the billions of dollars.

Some experts place losses associated with the emergence of mad cow disease in Europe at close to $38 billion. In New York in the early 1990s, the emergence of

multidrug-resistant tuberculosis, with a death rate of up to 80%, incurred costs associated with the failure to prevent its spread estimated at over $1 billion. In the

Russian Federation, the re-emergence of tuberculosis, including multidrug-resistant

forms, is estimated to have cost over $4 billion in 1999 alone. Initial costs associated

with cases of West Nile fever in New York have been placed at almost $100 million.

The Spectre of a ‘‘Post-Antibiotic’’ Era

As yet another especially serious and costly problem, resistance to inexpensive

and effective antimicrobial drugs is emerging and spreading era at an alarming

rate. The bacterial infections which contribute most to human disease are also those

in which emerging resistance is of most concern: diarrhoeal diseases such as dysentery, respiratory tract infections, including common pneumonia and multidrug-resistant tuberculosis, sexually transmitted infections such as gonorrhoea, and a host

of hospital-acquired infections that are notoriously difficult and expensive to treat.

Among the other major infectious diseases, the development of resistance to drugs

commonly used to treat malaria is of particular concern, as is the emerging resistance to anti-HIV drugs.

The development of resistance is a natural phenomenon that occurs, sooner or

later, with every antimicrobial. In the past, medicine and science were able to stay

ahead through the discovery of potent new classes of antimicrobials, a process that

flourished from 1930–1970 and has since slowed markedly, partly because of misplaced confidence that infectious diseases had been conquered, at least in the industrialized world. In just the past few decades, the emergence of resistant microbes

has been greatly accelerated due to several concurrent trends. These have worked

to increase the number of infections and thus expand both the need for

antimicrobials and the opportunities for their misuse. Important trends include urbanization with its associated overcrowding and poor sanitation; pollution, environmental degradation and changing weather patterns, which can affect the incidence

and distribution of infectious diseases and the habitats of the insects and animals

that carry them; and a growing proportion of elderly people needing hospital-based

treatments and thus at risk of exposure to highly resistant pathogens found in hospitals.

Additional trends include the resurgence of malaria and tuberculosis, causing millions of infections each year, and the AIDS epidemic, which has greatly enlarged the

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population of immunocompromised patients at risk of opportunistic infections and

thus in need of treatment. Moreover, the enhanced food requirements of an expanding world population have led to the widespread routine use of antimicrobials as

growth promoters or preventive agents in food-producing animals and poultry flocks.

In North America and Europe, an estimated 50% in tonnage of all antimicrobial production is used for these purposes. Such practices have contributed to a rise in resistant microbes which can be transmitted from animals to humans.

The associated costs are high. For example, treatment costs for tuberculosis can

vary between $15 and $40 per person to achieve a complete cure, whereas treatment

costs for multidrug-resistant tuberculosis can be up to $3,000 per person. Most

alarming of all are microbes that have accumulated resistance genes to virtually all

currently available drugs and have the potential to cause untreatable infections,

thus raising the spectre of a post-antibiotic era. Even if the pharmaceutical industry

steps up efforts to develop new drugs immediately, current trends suggest that some

diseases may have no effective therapies within the next ten years. Moreover, if current trends continue, many important medical and surgical procedures, including

cancer chemotherapy, bone marrow and organ transplantation, and hip and other

joint replacements, could no longer be undertaken out of fear that the associated

compromise of immune function might place patients at risk of acquiring an untreatable and ultimately fatal infection. Opportunistic infections in AIDS patients

would likewise be untreatable.

The Need for Global Solutions

Antimicrobial resistance is a global problem requiring a global solution. No single

nation, however effective it is at containing resistance within its borders, can protect

itself from the importation of resistant pathogens. The enormous growth of global

trade and travel means that a resistant microbe can spread from its place of origin

to almost anywhere else in the world within 24 hours.

Taken together, the threats posed by emerging and re-emerging infectious diseases, and by the emergence and spread of antimicrobial resistance are serious,

steadily growing, and universally costly. Their nature is inherently global, with

causes related to the world’s growing interconnectedness, and with consequences

that must be addressed by global solutions, ideally aimed at prevention.

WHO’s Capacity for Alert and Response

As an international health agency with over 50 years of experience, and the World

Health Organization is well placed to gather global disease intelligence and coordinate the rapid, multifaceted response needed to contain outbreaks quickly and prevent their international spread.

• Privileged access. WHO staff, consultants, and expert advisers have privileged

access to all countries. This privilege allows WHO, in the interest of safeguarding

international health, to transcend the prevailing political reality in which access to

critical expertise might be denied because of one country’s political relationship with

others. On many occasions, the Organization’s ability to secure laissez-passer status

has proved decisive in getting CDC and other U.S. experts quickly and smoothly

into countries where, for diplomatic reasons, entrance might otherwise be delayed

if not denied. This ability to obtain privileged status is extended to all of the many

security-cleared partners who may be needed to mount an effective international response.

• Geographical resources. WHO has unique and permanently positioned geographical resources. These include six regional offices and an additional 141 country

offices, located within or in close proximity to ministries of health, and concentrated

in areas where epidemics are most frequent and new diseases are most likely to

emerge. Although the size of these offices varies according to the disease situation

in the country concerned, all offices are staffed with medical experts and often with

epidemiologists, and all have the essential logistic equipment, including vehicles

mid local communications, needed for the prompt on-the-scene investigation of a

suspected outbreak. When outbreaks occur, country offices facilitate the arrival of

international assistance by arranging flights, customs and immigration clearance,

and accommodations. All offices are now linked electronically to WHO and thus to

its global network of institutional resources and collaborators.

• Collaborating centres. WHO’s disease control activities are supported by a network of over 250 laboratories and institutions formally designated as WHO Collaborating Centres. These centres provide the expertise and facilities needed to conduct

field investigations, handle dangerous pathogens, test samples, identify unknown

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agents, and confirm the diagnosis of cases. Many additional laboratories and public

health institutes also collaborate with WHO on a regular basis. The ability to draw

assistance from top experts and facilities is vital given the fact that most previously

unknown and highly lethal diseases, including Ebola and other viral haemorrhagic

fevers, tend to emerge in those countries that lack the requisite laboratory and epidemiological capacity to detect an unusual disease event and identify its causative

agent. Apart from its close working relationships with CDC, which includes the direct secondment of staff, WHO draws considerable technical support from agencies

such as USAID and from overseas laboratories included in the U.S. Department of

Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS)

as well as their counterparts in other WHO member states. Such collaboration with

leading experts and institutes lends added authority to WHO’s efforts to identify

and track outbreaks accurately and keep the world reliably informed.

• Surveillance networks. WHO coordinates a large number of electronic ‘‘detective’’ systems and databases for keeping experts alert to changes in the volatile infectious disease situation. These networks, most of which now operate in real time,

keep watch over disease-related events ranging from new strains of influenza virus,

through outbreaks of salmonellosis and dengue, to the emergence of drug-resistant

pathogens. Most of these networks also include quality assurance and training components to ensure that data submitted from all parts of the world are comparable

and conform to established standards. The oldest of these, FluNet, was established

over 50 years ago and has served as the prototype for the design and implementation of subsequent systems. It now draws support from 110 collaborating laboratories in 84 countries. The sensitivity of FluNet has recently proved vital in the

early detection of cases where influenza virus strains have crossed the species barrier from animals, such as swine and poultry, to infect humans.

These surveillance networks all operate within the framework of the International

Health Regulations, which provide the only international legally-binding instrument, implemented by WHO, governing the reporting of epidemic-prone diseases

and the application of measures to prevent their spread.

• Welcomed assistance. WHO is politically neutral, and often greatly needed in

the developing world. Ministries of health in such countries have repeatedly gone

on record to state their reliance upon WHO as their single most important source

of authoritative advice and technical assistance, particularly in matters pertaining

to the control of infectious diseases. As a result, direct assistance from WHO to control infectious diseases is frequently requested and warmly welcomed with the best

support the country can offer.

• Deep experience. WHO has over 50 years of experience in coordinating the field

operations needed to control infectious diseases. Current campaigns, which include

global initiatives aimed at eradicating or eliminating eight diseases, build on the epidemiological approaches and logistic infrastructure that contributed to the successful global eradication of smallpox. These mechanisms, which have been refined over

time, have proved robust and effective even under difficult conditions. The successful containment of the largest recorded outbreak of Ebola, which began in Uganda

in October 2000, was coordinated by WHO and involved over 500 local staff and volunteers, supported by some 120 international staff from 22 institutions and agencies, including CDC. WHO coordinated the considerable efforts and logistics needed

for the identification and confirmation of 425 eases and the surveillance of approximately 5,600 contacts in an area in which 70% of the population was internally displaced because of civil disturbances. As part of the drive to eradicate polio, mass

immunization campaigns have been successfully conducted in the midst of complex

emergencies and considerable civil unrest, with CDC providing strong and needed

support.

THE FRAMEWORK FOR DISEASE SURVEILLANCE AND RESPONSE

A Three-Pronged Approach

As WHO maintains only a small number of staff at its headquarters in Geneva

and its six regional offices, the framework for global disease surveillance and response is based on the use of a large number of partners, including government

agencies, non-governmental organizations, the private sector, and industry. Such

partnerships allow WHO to magnify the impact of its efforts considerably.

The framework relies on a three-pronged approach, with different strategies for

combatting known risks and unexpected events, and for improving both global and

national preparedness.

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• Containing known risks. Epidemic-prone diseases, such as cholera, dengue, influenza, measles, meningitis, shigellosis, and yellow fever, and foodborne diseases

pose a constant threat to human populations. They are well adapted to transmission

in human populations either directly from person to person, through transmission

by insects and other disease vectors, or by contamination of the environment or

food. These diseases are generally well understood and, in most cases, effective

measures are available for their control.

WHO maintains numerous programmes for the monitoring and control of these

well-known and almost constant risks to public health. Disease-specific networks of

partners help WHO mount a rapid response when outbreaks occur, at times following a breakdown in standard public health control measures in the country concerned. Established protocols, based on extensive experience, facilitate prompt, coordinated action. For some of these infections, such as epidemic meningitis, influenza, and yellow fever, WHO also collaborates with researchers and industry to anticipate future outbreaks and ensure that adequate emergency vaccine supplies are

available when needed. Other known risks monitored by WHO include those caused

by foodborne diseases and the emergence and spread of drug resistance.

• Responding to the unexpected. Unexpected or unusual disease events can be

caused by previously unknown infectious agents, agents that have crossed the species barrier from animals to humans, agents appearing in a new geographical area,

and agents that may be deliberately engineered and introduced by acts of bioterrorism. Novel pathogens are usually poorly understood in terms of their source and

mechanisms of transmission, and many have the potential to cause large outbreaks.

Fortunately, some of these pathogens are not well adapted to human populations

and lack the potential for sustained, epidemic spread. As experiences with the AIDS

epidemic have demonstrated, however, sustained epidemic spread is a distinct possibility that can have a major impact on societies and economies as well as on the

life expectancies of countries. While novel pathogens may not always cause major

outbreaks, they are often associated with high death rates, as they are poorly understood as they emerge, and initial prevention or treatment strategies are absent or

ineffective. Examples include hantavirus infections, Ebola and, most recently, Nipah

virus.

WHO has recently established innovative mechanisms for responding to previously unknown diseases and unexpected or unusual disease events. These mechanisms take full advantage of the powerful new opportunities for heightened vigilance and rapid response that have been created by the widespread use of electronic

communications. To heighten vigilance, WHO takes advantage of a semi-automatic

electronic system, developed for WHO by Health Canada, that continuously and systematically crawls Web sites, news wires, public health e-mail services, electronic

discussion groups, including the US-based Pro-MED, and local online newspapers

for rumours of outbreaks. In this way, WHO is able to scan the world for informal

news that gives cause for suspecting an unusual disease event. A WHO team responsible for outbreak verification investigates suspicious reports each morning to

determine whether they pose a threat of international health concern. When appropriate, WHO uses its technical and geographical resources to verify the presence of

an outbreak. Since 1998, WHO has used this system to verify over 800 outbreaks

of potential international importance.

To ensure that heightened vigilance is accompanied by a rapid response, WHO enlarged and formalized its procedures for outbreak detection, verification, and response in April 2000, when the Global Outbreak Alert and Response Network was

formed. The Network draws together 72 existing networks, including several maintained by agencies such as CDC and DoD as well as those operating under WHO’s

responsibility. The Network reports and verifies information, on a daily basis, from

a wide range of formal sources, including ministries of health, national institutes

of public health, government and military health facilities and laboratories, and

nongovernmental organizations, such as the Red Cross, having a strong presence in

epidemic-prone countries. When an outbreak is judged to require international assistance, as agreed upon in confidential consultation with the affected country and

with experts in the Network, WHO uses the latest electronic communication tools

to coordinate quick and appropriate assistance. Since early 2000, the network has

launched effective international responses in Afghanistan, Bangladesh, Egypt, Ethiopia, Kosovo, Saudi Arabia, Sierra Leone, Sudan, Uganda, and Yemen.

The work of coordinating large-scale international assistance, which can involve

many agencies from many nations, is facilitated by operational protocols, developed

by WHO, which set out standardized procedures for the alert and verification process, communications, coordination of the response, emergency evacuation, research,

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evaluation, monitoring, and relations with the media. WHO has also issued guidelines for the behaviour of foreign nationals during and after field operations in the

host country. By setting out a chain of command, and imposing order on the containment response, such protocols help protect against the very real risk that samples of a lethal pathogen might be collected for later provision to a terrorist group.

• Improving preparedness. WHO conducts a number of activities aimed at helping

countries strengthen their laboratory and epidemiological capacity and take advantage of new tools such as HealthMap (an interactive information and mapping system), and remote sensing data from NASA and other satellites. In collaboration with

CDC, WHO formed the Training Programmes in Epidemiology and Public Health

Interventions network (TEPHINET), another global network utilized by the Global

Outbreak Alert and Response Network, which seeks, through shared resources and

expertise, to enhance the effectiveness of national training programmes. In February 2001, WHO opened a new office in Lyon, France, to provide two-year specialized training for epidemiologists and laboratory specialists from developing countries where the epidemic risk is greatest. The training, which includes a six-week

course in Lyon, is followed by specially tailored field work and support in the home

country, supervised by Lyon-based staff. In so doing, the new programme is working

to strengthen disease detection and response activities in those countries where

epidemics and unexpected disease events are most likely to occur.

As another example, a working group on long-term preparedness for outbreak response was recently established to help ensure that the energy and resources that

are provided to a country for the investigation and containment of an outbreak do

not vanish after containment, but are instead harnessed in the form of long-term

technical assistance. During 1998 and 1999 major epidemics, including outbreaks of

haemorrhagic fever, cholera, and meningitis, caused a significant increase in morbidity and mortality in southern Sudan and necessitated major international assistance. In 1999, a WHO-coordinated international team responding to an outbreak of

relapsing fever set up an Early Warning and Response Network (EWARN) in partnership with nongovernmental organizations present in the field. With support from

several sources, EWARN has been expanded to cover seven diseases and a wide geographical area, and now ensures that epidemics are rapidly detected and investigated while responses are launched quickly using prepositioned materials. This

international partnership in the field has already saved thousands of lives and is

sustained by systematic capacity building among the local communities.

Capacity building for national epidemic detection and response is far more costeffective than mounting an international response. During the Ebola outbreak in

Uganda, containment activities left behind permanent improvements in the form of

isolation wards at two hospitals in Gulu district, a community-based early warning

surveillance and response system for priority infectious diseases, and sustained improvements in civil administration through the establishment of a community registry of births and deaths. In June 2001, a new focus of three suspected cases of

haemorrhagic fever was detected by local staff within three days of onset, patients

were immediately isolated in the recently established ward, and specimens were

despatched for testing at the WHO Collaborating Centre in South Africa, where results fortunately proved negative, in this case, strengthened national capacity made

it possible to defend global health security through local vigilance, without the need

for costly international assistance.

Preparedness for a Bioterrorist Attack

WHO will soon be issuing an updated edition of its standard guide to health aspects of chemical and biological weapons, initially published in 1970. In view of the

devastating impact on civilian populations that use of such weapons could have, the

guide urges governments to prepare response plans as an integral part of existing

national emergency plans. The strengthening of public health infrastructure, particularly for surveillance and response, is singled out as a major contribution to preparedness. The establishment of routine, sensitive, and near real time disease surveillance systems enhances preparedness for deliberate as well as natural outbreaks. National systems are important as experience has shown that many regionwide and global systems are inadequately sensitive to pick up local outbreaks quickly.

National surveillance systems need to be in place well in advance of possible intentional use of a biological weapon, as adequate data on the prevalence of background diseases are needed to aid recognition of an unusual and possibly deliberately caused disease. Moreover, the epidemiological techniques needed to investigate deliberate and natural outbreaks are the same. Since many of the agents that

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can be used as bioweapons cause disease in animals, countries also need to establish

mechanisms for the routine exchange of information between the public health and

veterinary sectors.

Within the context of its outbreak alert and response activities, WHO has developed protocols for containing outbreaks of diseases, such as anthrax and viral

haemorrhagic fevers, which could result from the intentional use of biological

agents. As part of its official mandate for dealing with smallpox-related issues in

the post-eradication era, WHO is responsible for ensuring the security of the remaining stocks of smallpox virus and overseeing their final fate.

A More Proactive Role for WHO

Traditionally, one of the main factors undermining the effectiveness of infectious

disease surveillance has been the reluctance of countries to report outbreaks due to

fear of the negative impact this news would have on travel, trade, and tourism. This

traditional reluctance is now beginning to change. In line with the growth of electronic media, approximately 65% of the world’s first news about infectious disease

events during the past four years has come not from official country notifications

but from informal sources, including press reports and the Internet. Transparency

about outbreaks and prompt reporting have therefore become increasingly important: unverified rumours of an outbreak or unusual disease can have a negative impact on travel and trade in the country and its neighbours even though the rumour

may be totally unjustified or grossly exaggerated.

In May 2001, the World Health Assembly, the supreme governing body of WHO,

adopted by consensus a resolution on global health security that considerably

strengthens WHO’s capacity to act in response to outbreaks and epidemics. WHO

is now in a position to investigate and verify rumoured outbreaks even prior to receipt of an official notification from the government of the country concerned.

Though WHO continues to confer, in confidence, with governments and secure their

agreement to mount an international response, this strengthened capacity allows

WHO to act with unprecedented speed.

In the new order of the electronic era, countries are increasingly aware of the advantages of prompt outbreak reporting and official verification, accompanied by

prompt international aid when needed, and prompt advice from WHO to the international community concerning the associated risks and the realistic need for restrictions on travel and trade. For example, during the Ebola outbreak in Uganda,

WHO was informed as soon as the first suspected cases were detected, and a WHOcoordinated investigative team was on the spot within 24 hours. Throughout the

five-month long epidemic, WHO issued 42 updated reports on the epidemic via its

Web site. The country’s borders were never closed.

During the May debate that preceded adoption of the resolution on global health

security, delegations from developing countries repeatedly urged WHO to help them

strengthen the laboratory and epidemiological capacities needed to detect outbreaks

quickly, identify their cause, monitor their spread, and introduce containment measures. Both the need to act and the will to do so are present. The risks are known,

immediate, alarming, and relevant to every country in the world. WHO and its

many partners and member states know what needs to be done.

Mechanisms for monitoring and containing these risks exist, but need to be

strengthened. Above all, the multiple threats posed by infectious diseases—whether

well known or unexpected have global causes and consequences that can only be addressed through global solutions. Strengthening of national capacities and public

health infrastructures represents one of the surest, most sustainable, and most costeffective measures for preventing the international spread of diseases and thus defending global health security for the benefit of all.

U.S. Support

The U.S. government is a valuable partner for WHO in building up global alert

and response capabilities for combatting the threat posed by infectious diseases.

Various U.S. government agencies have contributed to this effort, in line with the

multifaceted nature of the threat. Most extensive is WHO’s long tradition of reliance

on the practical experience, technical expertise, and staff resources of CDC to conduct a range of fundamental activities needed to contain the international spread

of epidemics. This collaboration has become even closer and more vital as the number of outbreaks requiring an international response continues to escalate. At times,

such as during the simultaneous outbreaks of Ebola and Rift Valley fever in 2000,

the resources of both agencies have been stretched to the limit. As with the

strengthening of national capacities and infrastructure elsewhere, any U.S. decision

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to strengthen CDC benefits WHO as well as a large number of countries where populations and governments have been weakened by repeated outbreaks and

epidemics. Any decision to strengthen CDC would likewise count as a sure, sustainable, and cost-effective measure for defending world security against the mounting

threat of infectious diseases. The recent establishment of DoD-GEIS is another especially welcome resource for expanding essential laboratory capacity.

U.S. contributions extend to many other fronts. WHO draws support from USAID,

whose financial assistance contributed greatly to the development work and expert

consultations needed to reach consensus on the first Global Strategy for Containment of Antimicrobial Resistance, which will be officially launched on 11 September

2001. Ongoing efforts to uncover what triggers an Ebola outbreak, and thus help

anticipate future outbreaks, are being conducted in collaboration with the NASAGoddard Space Flight Center, the National Centers for Environmental Prediction,

DoD-GEIS, and other U.S. agencies. The National Institutes of Health, through its

Fogarty International Center, provides training aimed at helping laboratory scientists and public health workers, in developing countries and the U.S., conduct research on emerging and re-emerging infectious diseases and strategies for their prevention and control. Further NIH and CDC support comes in the form of grants to

WHO Collaborating Centres and other U.S. institutions included in the Global Outbreak Alert and Response Network.

As yet another notable example, the U.S. State Department’s Bureau of Population, Refugees and Migration (PRM) has funded WHO malaria control activities

in complex emergencies. PRM is considering expanding this support to cover additional diseases that can complicate the management of complex emergencies. The

establishment of strong mechanisms for the surveillance and control of infectious

diseases in countries affected by conflict is of particular importance, as such situations provide both ideal conditions for natural epidemics and a likely setting for

epidemics of deliberate origin.

Conclusions

The resurgence of infectious diseases and the emergence and spread of antimicrobial resistance have unleashed threats whose magnitude is almost certain to

grow. Epidemics are again sweeping across continents. The tools needed to control

emerging diseases are, in many cases, non-existent. The control of re-emerging and

epidemic-prone diseases likewise suffers from the spread of resistance to inexpensive first-choice drugs. Nonetheless, today’s world is better equipped to protect itself,

through preventive measures, than in the past, when isolation and quarantine comprised the sole measures for control. Aided by powerful electronic communication

tools, key defense strategies now include early alert, through sensitive global networks for realtime outbreak detection and verification, and rapid national and international responses once outbreaks are confirmed. The strengthening of infrastructure in epidemic-prone countries is vital to the successful and cost-effective implementation of both strategies.

In a world that is now closely interrelated in matters of health as well as in economics and trade, defense against the threats posed by infectious diseases requires

a collaborative, multifaceted, global response. WHO wishes to express its gratitude

for the support provided on so many fronts by the U.S. and its agencies as part of

this global response. WHO also wishes to express its strong desire to stay in close

dialogue with the U.S. as we continue to track the evolving infectious disease situation, sound the alarm when needed, share expertise, and mount the kind of response

needed to protect us all from the consequences of epidemics, whatever and wherever

their origin might be.

[The figures referred to in Dr. Heymann’s testimony follow:]

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Figure 1

82

Figure 2

83

Figure 3

84

Figure 4

85

Figure 5

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The CHAIRMAN. Thank you very much.

Mr. Cilluffo.

STATEMENT OF FRANK J. CILLUFFO, SENIOR POLICY ANALYST, CENTER FOR STRATEGIC AND INTERNATIONAL STUDIES, WASHINGTON, DC

Mr. CILLUFFO. Mr. Chairman, Senator Lugar, thank you for the

opportunity to appear before you today and to discuss such an important matter. A major terrorist incident inside our borders involving conventional explosives, chemical weapon, or most glaringly

biological warfare agents, would undoubtedly put our emergency

management response to the test at the local, state and Federal

levels.

There’s a real danger of being overwhelmed. Two simultaneous

bombings of the magnitude of Oklahoma City or a large-scale release of sarin or VX nerve gas, could strain our current system to

the point of bursting.

In both cases, however tragic, there would be an immediate explosion or toxic effect to respond to. As Senator Nunn brought up

earlier, not necessarily so for a covert attack in which biological

weapons were used.

In the case of a biological attack, the first responder, the very tip

of the spear, is likely to be your primary care physician, your veterinarian, your agricultural services inspector or perhaps even an

entomologist.

Given the unheralded nature of these silent killers, it would fall

upon the public health and medical communities to detect the attack, contain the incident, and ultimately treat the victims. Biological weapons can be delivered through several different means,

ranging from using people as carriers of the disease, covert dissemination such as aerosolization, or via missile.

As the recent ‘‘Dark Winter’’ exercise illustrated, a successful BW

attack of major consequences could be a transforming event. It potentially threatens our American way of life, tearing at the very

fabric of our society.

According to a recent report on biological warfare by the National

Intelligence Council, over a dozen states are known to possess or

are actively pursuing offensive BW capabilities. Perhaps not surprisingly, a majority of the rogue nations populate this list.

By way of example, during the gulf war, Iraq had warheads containing biological weapons produced and ready for use. I’m sure

we’ll be hearing a lot more about that from Judy Miller’s book

which will be coming out in the not-so-distant future.

Also according to a forthcoming book by arms control analyst,

Jonathan Tucker, the Soviet Union deploy warheads with smallpox

weapons on at least four ICBMs. These missiles as gruesome as it

may sound, were intended to kill off any remaining survivors after

a nuclear attack in the United States.

One cannot over generalize about the intentions and possible use

and of course delivery of BW capabilities which do differ from state

to state. And research and development vary greatly in terms of

pathogen type, associated virulence, toxicity, stability, resistance to

detection and/or treatment, quantity of agents, and of course the

sophistication of delivery.

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For states not inclined to cause mass casualties, and with more

discriminate aims, namely to wreak economic havoc, we must also

consider agro-terrorism against our Nation’s livestock and/or crops.

And I look to Senator Lugar and applaud his efforts in this area.

But just imagine the consequences in your home state if wheat,

corn, citrus fruit, potatoes, tobacco, livestock, just to name to a few,

were the target of a BW attack. As the recent European hoof and

mouth outbreak demonstrated, pathogens that target agriculture

not only cause massive losses to the cattle industry and to farmers,

but also disrupted tourism and the entire economy for that matter.

And certainly our borders are porous to bacteria, fungi, viruses,

and insects, all of which could be used to attack our food supply.

While bullets and bombs, not bugs and gas, will remain the

weapon of choice for most non-state actors, some, including Osama

bin Laden, had expressed interest in acquiring or developing a BW

capability.

And while it is more likely to be a crude device and means of delivery, non-state actors may not be overly concerned about retaliation, making them more likely to actually use biological agents.

After all, it’s hard to retaliate to a bomb actor with no address.

While the likelihood of a catastrophic BW attack on the U.S.

homeland, whether committed by state or non-state actors, whether

delivered covertly or by missile, remains relatively low in the foreseeable future, the consequences are simply too high to be ignored.

Though I say all of this in terms of threat and the like, that I

believe since the end of the cold war, political forecasting and

threat forecasting for that matter has made astrology look respectable.

While there is general consensus that we are inadequately prepared to deal with bioterrorism, we are not starting from scratch.

We now need to ask ourselves what policies, programs, and procedures have worked to date. What are the centers of excellence that

can be built upon and leveraged.

What has not worked. And what are the major gaps and shortfalls that have not been adequately addressed at all. This in turn

lays the groundwork to proceed to the next step of crafting an effective national strategy to defend against bioterrorism.

Although Federal, state and local governments have made some

impressive strides, regrettably the whole remains less than the

sum of its parts. Let me very briefly explain.

We are now at a crossroads. While credit must be given where

it is due, the time has come for cold-eyed assessment and evaluation to get to Mr. Helms’ point earlier. We must recognize that we

don’t have a comprehensive strategy for countering this threat or

the larger challenges of homeland defense. And I commend the

chairman for tackling this issue in its entirety.

As things presently stand, there is neither assurance that we

have a clear capital investment strategy nor a clearly defined endstate, let alone a clear sense of the requisite objectives needed to

reach this goal.

Notably, no single Federal agency owns this strategic mission

completely. For the moment, however, many agencies are acting

independently in what needs to be a coherent response. My vision

of a comprehensive strategy incorporates a full spectrum of activiVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00091 Fmt 6633 Sfmt 6602 75040 SFRELA2 PsN: SFRELA2
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ties from prevention and deterrence, our first objective should always be to get there before the bomb goes off, to interdiction and

prosecution, to domestic response preparedness and retribution.

All too often these elements of strategy are treated in isolation.

This is a cross-cutting issue, yet we are still organized along

vertical lines. This to me is the greatest challenge from the organizational standpoint.

Any strategy must incorporate both marshaling of domestic resources and the engagement of international allies and assets. It

requires monitoring and measuring the effectiveness or

benchmarking of the many programs that implement the strategy

so as to lead to common standards, practices, and procedures.

In short, our capabilities and organizations must be strengthened, streamlined, and then synergized so that effective prevention

will enhance domestic response preparedness and vice versa.

I’m not going to get into what the prevention side as I had

planned, because I think Mr. Woolsey addressed those issues very,

very well. But multi-disciplinary intelligence collection is crucial to

provide indications and warning of a possible attack, and also to

illuminate key vulnerabilities that can be exploited and leveraged

to disrupt an attack before they occur.

We need to be able to tap in, the IC, the intelligence community,

needs to be able to tap in to the scientific and biomedical research

communities, something they have been having some troubles with.

Indeed some of most critical intelligence related to bioterrorism

may be derived through organizations such as the WHO which

aren’t really though of as intelligence collectors.

Clearly our first line of defense should not be at our shores or

at our water’s edge which is why I’m happy this committee is taking on this issue. If you just look at the pre-empted bombings during the millennium celebrations by the Jordanians, endless American lives were saved. The discussion we’d be having today would

likely be very different if those bombings had succeeded.

Let me just turn briefly to domestic response preparedness. We

must expand the national security planning table to include the

medical, public health and human services communities. They

must have a front row seat at this table as this is both a matter

of national security and public health.

Yet to be blunt, as we have already heard, these communities are

under-equipped, under-informed and ill prepared for the threat.

And in our recent report we had a veritable laundry list of recommendations which I won’t bore you with, but I’m just going to

touch on three general priorities.

In these priorities as a backdrop I think it’s important to ensure

that we receive a national security return on investment, a

counterterrorism bang for our counterterrorism buck. It’s not just

throwing money at these issues but making sure there is an ROI.

First we must capitalize the public health structure. Core public

health functions, disease surveillance and laboratory capability will

be the foundation of detection, investigation, and response for bioterrorist threats. This targeted approach would also have secondary and tertiary benefits to the public health community as a

whole.

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Second, we must develop a national bioterrorism surveillance capacity. Surveillance is the touchstone of public health and organizes the other capacities within the public health sector that allows public health and emergency managers to monitor the general

health status of their population, to track outbreaks and serve as

an alerting vehicle for a bioterrorist attack.

Third, we need to expand the provisions on biological terrorism

in the Terrorism Annex of the Federal Response Plan. It is absolutely critical we lash up emergency management with public

health, most notably to build a strong FEMA-HHS partnership.

Further, and with specific regard to the private sector who I believe are at the leading edge of technology, we need to incentivize

them to pull them into this war.

Much of the forgoing discussion centers on the organization of

the Federal, state and local governments. It is applicable whether

a biological weapon is delivered covertly by terrorists or by missile.

Unfortunately, somewhere in the course of discussions, these two

distinct issues became mutually exclusive.

It is not an issue of either or, rather we can and I feel must defend against both. The U.S. cannot be like the proverbial ostrich

with its head in the sand and act surprised when we get kicked in

the most obvious place. Moreover, if we concentrate on only one

method of delivery at the expense of another, we merely displace

risk and may even encourage attack in those other areas.

I think it’s clear that President Bush has made this one of his

priorities. I think we need to give him and Vice President Cheney

time to come up with their plan as well as to see how the Office

of National Preparedness comes together.

But I think if we look at it backwards, the President must never

turn to the cupboard and find it bare. He should never be placed

in a position where he must step up to the podium and address the

American people to explain what he could have, should have, would

have, but did not because this or that inside the beltway debate.

And, yes, policy without resources is rhetoric. Despite the magnitude of the challenge, there is no doubt that our great country

can rise to it. But to do so requires not only vision but also political

will.

Presidential and congressional leadership and follow-through are

needed to marshal our wherewithal in order to turn concepts into

capabilities, to move from nouns to verbs, as you ably addressed

earlier, Mr. Chairman.

Developing and implementing and sustaining such a strategy

and plan must be one of the highest priorities for U.S. national security.

Thank you for the opportunity to share my thoughts with you

today. As a carrier of foot-in-mouth disease, I’ve rarely had an

unspoken thought. I’d be pleased to try to answer any questions

you may have at this point. Thank you.

[The prepared statement of Mr. Cilluffo follows:]

PREPARED STATEMENT OF FRANK J. CILLUFFO

Chairman Biden, Senator Helms, distinguished committee members, it is a privilege to appear before you today to discuss this important matter. I would like to

commend you for squarely facing this complex challenge.

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1 As many BW agents can be developed clandestinely, detection of BW programs and/or acquisition of BW capabilities is vexing. Furthermore, given the dual-use nature of biotechnology it

is possible to cloak offensive BW efforts to appear to be legitimate research. Nations engaging

in camouflage, concealment and deception programs could ramp up a BW capability with little

or no warning to U.S. intelligence collection efforts.

Although there is no way to predict with certainty the biological warfare threat

to the homeland in the short-term or the long-term, it is widely accepted that unmatched U.S. power (economic, cultural, diplomatic, and military) is likely to cause

America’s adversaries to favor ‘‘asymmetric’’ attacks over direct conventional military confrontations. These strategies and tactics aim to offset our strengths and exploit our weaknesses. Against this background, military superiority in itself is no

longer sufficient to ensure our nation’s security.

A major terrorist incident on U.S. soil involving chemical weapons, conventional

explosives or most glaringly, biological warfare (BW) agents, would put our emergency management response to the test at the local, state, and federal levels.

There is a real danger of being overwhelmed—two simultaneous bombings of the

magnitude of Oklahoma City or a large-scale release of sarin or VX nerve gas—

could strain our current system to the point of bursting. In both cases, if no advance

warning was available, local and state emergency responders such as firefighters,

police, and paramedics would arrive on the scene first. They would be followed by

federal assets hours or perhaps days later. It would be a race against time to turn

victims into patients. In the case of a chemical attack the window is likely small,

the so-called ‘‘golden hour,’’ to administer life saving antidotes. It may take months

to complete decontamination, recovery and reconstitution efforts, and decades for

the community to come to grips with the tragedy and begin healing. In both cases,

however tragic, there would be an immediate explosive or toxic effect to respond to,

not necessarily so for a covert attack in which biological weapons were used.

It could take days, or even weeks, for the symptoms of a biological agent to begin

to manifest themselves. In the case of a BW attack, the first responder, the very

tip of the spear, is likely to be a primary care physician, healthcare provider, veterinarian, agricultural services inspector, or perhaps an entomologist. Given the

unheralded nature of these silent killers, it would fall upon the public health and

medical communities to detect the attack, contain the incident, and treat the victims. The delayed onset of symptoms, coupled with the fact that it is difficult to discern a deliberate BW attack like smallpox from a naturally occurring infectious disease outbreak, makes attribution and identification of the perpetrators exceedingly

difficult. Moreover, this type of attack can wreak havoc with the public, which must

confront fear of the unknown.

Biological weapons can be delivered through several, different means, ranging

from using people as carriers of the disease (including person to person infections),

covert dissemination such as aerosolization, or via missile.

As the recent ‘‘Dark Winter’’ exercise illustrated, a successful BW attack on the

United States, could be a transforming event. Beyond the physical damage and the

loss of life, a major BW attack could shake the confidence of our citizens in our government to the core. It potentially threatens our American way of life, tearing at

the very fabric of our society. We must grapple with difficult issues such as whether

we are protecting America or Americans. Ideally, we are defending both, but no

matter how robust our defenses, we will never be able to protect everything, everywhere, all the time, from every potential adversary.

In a recent report on biological warfare by the National Intelligence Council, it

is stated that over a dozen states are known to possess or are actively pursuing offensive BW capabilities. Perhaps not surprisingly, a majority of the ‘‘rogue nations’’

populate this list.1 States have a variety of reasons for developing biological weapons: to augment conventional war fighting capabilities, for blackmail, for deterrence/

compellence, and/or for prestige.

By way of example, during the Gulf War, Iraq had warheads containing biological

and chemical agents produced and ready for use. Also, according to a forthcoming

book by arms control analyst Jonathan Tucker, the Soviet Union deployed warheads

with smallpox biological weapons on at least four ICBMs—the SS–11, SS–13, SS–

17, and SS–18. These missiles were intended to kill off any American survivors in

the aftermath of a nuclear attack.

One cannot over-generalize about state intentions and possible use and delivery

of offensive BW capabilities (research and development vary greatly in terms of

pathogen type and associated virulence, toxicity, stability, resistance to detection/

treatment, quantity of weaponized agents, and sophistication of means of delivery),

which differ from state to state. While the resources available to states to develop

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biological weapons are much greater than those available to non-state actors, they

remain constrained to an extent by the possibility of retribution and retaliation.

For states not inclined to cause mass human casualties and with more discriminate aims, namely to cause economic havoc, we must also consider agricultural bioterrorism (agroterrorism) against our nation’s livestock and/or crops.

Imagine the consequences in your home state if wheat, corn, citrus fruit, potatoes,

tobacco, or livestock (to list a few) were the target of a BW attack. As the recent

European hoof-and-mouth outbreak demonstrated, pathogens that target agriculture

not only cause massive losses to the cattle industry and farmers, but also impact

a nation’s ability to feed its citizens and disrupt the economy. In addition it upsets

free travel and tourism, which are secondary effects, but equally costly. Certainly

U.S. borders are porous to bacteria, fungi, viruses, and insects, all of which could

be used to attack the nation’s food supply.

While bullets and bombs, not bugs and gas, will remain the weapon of choice for

most non-state actors or terrorist organizations, some have expressed interest in

seeking to acquire from other states or develop their own offensive BW capability.

In my eyes, this represents more of an evolving threat, and although much has been

written on the subject, the scientific sophistication needed to sustain and deliver

BW agents, if not insurmountable, is substantial, nonetheless the fabrication of a

crude BW device and means of delivery, on the other hand is very realistic and difficult to detect or preempt at any time. Moreover, conventional explosives continue

to become more lethal and for the most part have been effective in achieving their

terrorist aims.

But unlike their state sponsored counterparts, non-state actors are much freer

from the constraints of retaliation, making them more likely to use biological agents.

After all it is hard to retaliate against an actor if there is no return address. Modern

terrorism trends also highlight a propensity toward indiscriminate violence and

greater casualties. For example, a hamas training manual expounds that it is foolish to hunt a tiger when there are plenty of sheep to be had. And Osama bin Laden

has publicly pronounced that acquiring weapons of mass destruction, chemical, biological, radiological, and nuclear (CBRN), is a religious duty. Whereas traditionally

terrorism was a political tactic, an attempt to get to the negotiating table, some of

today’s groups motivated by radical religious or nationalist beliefs, no longer seek

a seat at the table, but rather want to blow the table up altogether and build their

own in its place.

While the likelihood of a catastrophic BW attack on the U.S. homeland, whether

committed by state or non-state actors, whether delivered covertly or by missile, remains relatively low in the foreseeable future, the consequences are too high to be

ignored.

As a general matter, we need to approach this problem holistically. We must

strike the proper balance between protecting our citizens and preserving our liberties and must not destroy our way of life in an effort to save it. Achieving this

balance demands clearheaded prioritization of interests and resources, and thinking

the unthinkable while we have the time to work out the problems that may arise.

While there is general consensus that the United States is inadequately prepared

and under-equipped and resourced to deal with bioterrorism, we are not starting

from scratch. In determining how to proceed as a nation to defend against bioterrorism, we must ask ourselves what policies, programs, and procedures have worked

to date (what are the centers of excellence that can be built upon)? What has not

worked? And what are the major gaps and shortfalls that have not been adequately

addressed? This in turn, lays the groundwork to proceed to the next step of crafting

an effective national strategy for defending against bioterrorism.

Although federal, state, and local governments have made impressive strides to

prepare for bioterrorism, regrettably the whole remains far less than the sum of its

parts. Let me briefly explain.

The United States is now at a crossroads. While credit must be given where it

is due, the time has come for cold-eyed assessment and evaluation, and the recognition that we do not presently have—but are in genuine need of—a comprehensive

strategy for countering the threat of bioterrorism and the larger challenges of homeland defense. It is important to remember that defense against bioterrorism is but

one plate in our counterterrorism armor.

As things presently stand, however, there is neither assurance that we have a

clear capital investment strategy nor a clearly defined end-state, let alone a clear

sense of the requisite objectives to reach this goal.

Make no mistake, though. The dimensions of the challenge are enormous. The

threat of bioterrorism by states and non-state actors presents unprecedented planning challenges to American government and society.

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Notably, no single federal agency owns this strategic mission completely. For the

moment, however, many agencies are acting independently in what needs to be a

coherent response, a goal that is not out of reach.

To the contrary, we now possess the experience and knowledge for ascertaining

the contours of a comprehensive strategy, a coherent response, and a future year

program and budget to implement the strategy. It also bears mentioning that strategy must be a precursor to budget.

In my view, effective organization is the concept that not only lies at the very

heart of a comprehensive national counterterrorism strategy but also underpins it—

from start (meaning pre-event preventive, preemptive and preparedness measures),

to finish (meaning post-event crisis and consequence management, and response).

My vision of a comprehensive counterterrorism strategy incorporates a full spectrum of activities, from prevention and deterrence to retribution and prosecution to

domestic response preparedness. All too often, these elements of strategy are treated

in isolation. Any strategy must incorporate both the marshaling of domestic resources and the engagement of international allies and assets. And it requires monitoring and measuring the effectiveness (‘‘benchmarking’’) of the many programs that

implement this strategy so as to lead to common standards, practices, and procedures.

In a recent CSIS report on combating CBRN terrorism that was developed from

a panel I chaired, we set out a roadmap of near-term and long-term priorities for

senior federal officials to marshal federal, state, local, private sector, and non-governmental resources in order to counter the terrorist threat. Our findings and recommendations speak not only to ‘‘the usual suspects’’ at each level of government

but also to new actors, both public and private, that have taken on added salience

in the current security environment.

In our view, a complete CBRN counterterrorism strategy involves both (1) preventing an attack from occurring (our first priority should always be to get there

before the bomb goes off; or better yet, prevent it from being built in the first place),

which includes nonproliferation, counter-proliferation, preemption, and deterrence,

and (2) preparing federal, state, local, private sector and non-governmental capabilities to respond to an actual attack. In short, our counterterrorism capabilities and

organizations must be strengthened, streamlined, and then synergized so that effective prevention will enhance domestic response preparedness and vice versa.

With respect to prevention, a multifaceted strategy is in order. The common

thread underpinning all of these, however, is the need for a first rate intelligence

capability. The breadth, depth, and uncertainty of the terrorist threat demands significant investment, coordination, and retooling of the intelligence process across the

board for the pre-attack (warning), trans-attack (preemption), and post-attack

(‘‘whodunit’’) phases.

Several steps to strengthen the IC need urgent examination and may require significant changes to intelligence programs and budgets. These include:

• Investing in all-source intelligence capabilities. Multi-disciplinary intelligence

collection is crucial to provide indications and warning of a possible attack (including insights into the cultures and mindsets of terrorist organizations) and

to illuminate key vulnerabilities that can be exploited and leveraged to disrupt

terrorist activities before they occur.

To date, signals intelligence has provided decision makers with the lion’s share

of operational counterterrorism intelligence. National technical means cannot be allowed to atrophy further. While a robust technical intelligence capability is important, enhancing our human intelligence capability is even more so.

• Invest in intelligence analytical capabilities. The intelligence community, including the FBI, must invest in expertise—linguists, BW experts, and regional specialists—to buttress and synthesize its analytical ability to track terrorists considering using biological weapons. This also requires tightening coordination

among the non-proliferation, counter-proliferation and counterterrorism communities . . . not only interagency, but also intraagency.

• Tap the scientific and biomedical research communities. Develop relationships

between the IC and the scientific and biomedical research communities, whose

knowledge of emerging capabilities and of other information gleaned from the

open scientific literature, international scientific collaborations, and conferences

could prove invaluable to the IC with respect to the bioterrorism threat.

Indeed, some of the most critical intelligence related to bioterrorism may be derived through the ongoing and open-source practice of international public health

and surveillance activities, such as those run by the World Health Organization.

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In the same vein greater attention to nonproliferation and counterproliferation efforts provide the much-needed stitch in time. We need to think about ways to reassess arms control measures to limit the proliferation of BW agents, material, and

expertise. This cannot be monitored like a START agreement or via traditional

international conventions, but the United States should take the lead in building

international support for multinational activities, while maintaining, and perhaps

even codifying, the right to take action, including military action, against violators.

In so doing, though, it must be kept in mind that traditional arms control meas- ures—which assume large state efforts with detectable weapons production programs—are less effective in monitoring smaller proliferation efforts, or even large

efforts, as the development of BW capabilities lend themselves to covert production.

These will also be more effective vis-a-vis state-sponsors of terrorism than non-state

actors. However, by focusing on state actors, we may also capture non-state actors

swimming in their wake.

Along with some foreknowledge of the actions of hostile parties, the U.S. should

strengthen its partnerships with foreign countries. Bearing in mind the

transnational characteristic of the threat, the U.S. would be remiss in trying to address the problem alone.

Diplomacy plays a major role in combating terrorism. Considering the shift away

from political terrorism and towards ideologically based terrorism, many countries,

the U.S. included, find themselves more at risk. An international interest exists in

learning about and dealing with terrorism and there are many states that have already acquired a breadth of knowledge on the subject. The U.S. could draw on many

of these countries’ experiences, thereby flattening its learning curve.

Moreover, engagement with these nations is critical for antiterrorism and

counterterrorism endeavors, where cooperation and understanding provide the keys

to success. Most importantly, cooperation works. The Jordanian authorities saved

countless American lives during the millennium celebrations by preventing planned

attacks on American tourists in the region. Clearly our first line of defense should

not be on our shores at the water’s edge.

No matter how robust our intelligence capabilities and efforts, we cannot prevent

100 percent of the threat 100 percent of the time. Our emergency responders—those

first on the scene of a ‘‘no warning’’ event—are state and local personnel: police, firefighters, and medics—not federal workers. With that in mind, I want to focus on

domestic response preparedness because that is where the matter of effective organization figures most prominently.

Organization must come from the bottom up as well as from the top down. This

requires that policymakers address the current ‘‘crazy-quilt’’ of doctrine, legal authority, equipment, and training for emergency responders. Bridge-building also involves reaching out to relative newcomers to the national security field—in particular, the medical, public health, and human services communities—who need to

be integrated into our counterterrorist effort and our (comprehensive) national strategy. This is simultaneously a national security and a public health concern. In addition, the value of training and exercising must not be underestimated. Hopefully,

it will be the closest we get to the real thing. And if not, it allows us to make the

big mistakes on the practice field and not on Main Street, U.S.A.

The medical, public health, and human services communities are especially critical to bioterrorism preparedness and response, as they would play a prominent role

in detection, management, containment and medical treatment of victims. Here

again, however, the need for effective organization stands in marked contrast to the

present state of affairs, which is sub-optimal at best. Smart shoppers will want

more accountability along the lines of defined core public health capacities for bioterrorism preparedness that deliver functional capabilities. This activity should be

expanded and coordinated with other agencies involved in national preparedness.

Put bluntly, the biomedical, public health, and human services communities are

under-equipped, under-informed, and ill prepared for a biological attack and for infectious disease in general. Accordingly, our recommendations on the public health/

medical side read like a veritable ‘‘laundry list.’’

Even without reiterating our full complement of suggestions, the extensive and

sweeping character of what is needed is evident in but a partial list: capitalize the

public health structure; develop a national bioterrorism surveillance capacity (epidemiological monitoring capability); develop and distribute rapid and more reliable diagnostic capabilities and systems; develop a comprehensive strategy for assuring

surge capacity for healthcare; streamline national pharmaceutical stockpiling efforts; and increase research and development for new pharmaceuticals, vaccines and

antidotes.

First we must capitalize the public health structure. Core public health functions

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tion, investigation, and response for bioterrorist threats. In implementing these solutions, we should focus on the terrorist threat. We need to ensure that we receive

counterterrorism bang for our counterterrorism buck, and that we do not simply

throw money at the public health sector.

This targeted approach would have valuable secondary and tertiary benefits.

Strengthening the ability to deal with extraordinary, and especially catastrophic,

events provides tools and capabilities that are equally valuable in dealing with ‘‘or- dinary’’ situations, e.g; natural outbreaks. Thus preventive measures, designed for

the stuff of nightmares, also have utilitarian, day-to-day, functions and benefits.

Second, we must develop a national bioterrorism surveillance capacity. Surveillance is the touchstone of public health and organizes the other capacities within

the public health sector. An effective national bioterrorism surveillance system allows public health and emergency managers to monitor the general health status

of their population (human, livestock, and crops); track outbreaks, monitor health

service utilization; and serve as an alerting vehicle for a bioterrorist attack.

Third, we need to expand the provisions on biological terrorism in the Terrorism

Annex of the Federal Response Plan. The current U.S. plan for an organized response must be updated to include preparedness for a biological attack, which presents a host of unique and complicated challenges and requires a re-examination of

the lead agency roles and missions. For example, the National Disaster Medical System (NDMS), composed of FEMA, the Departments of Defense, Health and Human

Services, and Veterans Administration, has no strategy to rapidly augment medical

resources at the state and local levels in the event of a bioterrorist attack. The

NDMS has never been properly resourced, or properly focused on the issue of bioterrorism response.

To these (and other) ends, the medical, public health and human services communities must work in greater partnership with each other—and must coordinate more

effectively with the larger national security community. Instead, however, we currently have a series of ‘‘disconnects.’’ Within the federal government alone, for instance, we have yet to develop (for

counterterrorist purposes) smooth channels of inter-agency and intra-agency coordination and cooperation. Many agencies have had little past experience working together, such as the intelligence community and the Departments of Defense, Justice,

Health and Human Services, Agriculture, and Energy as well as the Federal Emergency Management Agency and the National Institutes of Health (NIH). Certainly,

we need to envisage a better FEMA-HHS partnership, one capable of galvanizing

the public health and medical sector in response to bioterrorism.

Indeed, the core capacity for public health and medical care needs to be greatly

enhanced with respect to detection and treatment of infectious disease. Further, and

with specific regard to the private sector, the expertise of the commercial pharmaceutical and biotechnology sectors has yet to be genuinely leveraged. This situation

must change, and new funding strategies must be explored to ‘‘incentivize’’ engagement of the private sector as a whole in the task of preparedness planning and capability-building.

The United States needs to develop integrated surge capability for the entire

health care system. We must first identify all existing assets and how they could

be mobilized. Next, we need working strategies to be able to balloon care-giving efforts, at both the regional and national levels.

Again, the United States also needs to look internationally. The United States

ought to work with the World Health Organization (WHO) to monitor global infectious disease trends and outbreaks of disease, strengthen international surveillance

efforts, and provide advance warning for a bioterrorist attack. Here too is an example of where immediate strengthening of resources for national and international security purposes would have immediate secondary and tertiary benefits.

Once clear recommendations are made and a national strategy exists, the Defense

Production Act of 1950 (DPA) provides policymakers with the means of marshaling

and mobilizing the resources that would be crucial in the event of a terrorist attack

with CBRN weapons. In addition to helping the United States prepare, the DPA

provides some necessary authority to implement policies and procedures.

The act’s two-fold objective is: to ensure the availability of national defense products, materials, and services that are required to maintain national defense and

emergency preparedness requirements, without overly disrupting the normal course

of business and to provide U.S. industry with the necessary structure and framework to provide an inclusive response to a national security emergency. Thus the

act facilitates both emergency and non-emergency preparation and planning.

It could provide the necessary tools to put programs and people in position to prevent disaster. While proper previous planning prevents poor performance, it may

also deter malfeasants, preempting their plans and providing greater security.

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However, the DPA must not be used to interfere with the free market and the

ebb and flow of commerce. While our nation’s security is of great importance to its

citizens, fundamental principles of openness and freedom from restraint supersede

even that. A dynamic balance exists between the need for defense preparedness and

unfettered capitalism. This balance needs to be scrutinized before the government

invokes the DPA to ensure that undue weight is not given to one side or the other,

and avoid destroying what we hold dear in an effort to protect it.

Much of the foregoing discussion centers on the organization of the federal, state,

and local governments. It is applicable whether the delivery of a biological weapon

is delivered covertly by terrorists or by missile. Unfortunately, somewhere in the

course of discussions these two distinct issues became mutually exclusive. The debate became a question of either defending against bioterrorism or missiles. We can

and must defend against both threats. The United States does not have the luxury

of treating these two threats as an either/or proposition. They must each be monitored, deterred, and defended against through different mechanisms. We cannot escape the reality that they both exist. The United States cannot be like the proverbial ostrich with its head in the sand, and be surprised when it is kicked in the

most obvious place. Moreover, if we concentrate only on one method of distribution

at the expense of another, we merely displace risk and may even encourage attack

in the other areas.

The President and Vice President’s laudable work in this area, creating the Office

of National Preparedness and working towards formulating a national strategy,

demonstrate that the administration understands the dangers and is actively working to lessen them. The President must never turn to the cupboard and find it bare.

He should never be placed in a position where he must step up to the podium and

address the American people to explain what he could have, should have, or would

have done, but did not because of this or that. After all, policy without resources

is mere rhetoric. Formulation of this strategy is a necessary first step in the process.

Despite the magnitude of the challenge, there is no doubt that our great country

can rise to it. To do so requires not only vision but also political will. Presidential

and Congressional leadership will therefore be needed to marshal our wherewithal

in order to turn concepts into capabilities. Developing, implementing, and sustaining

such a strategy and plan must be one of the highest priorities for U.S. national security.

Thank you for the opportunity to share my thoughts with you today. I would be

pleased to try and answer any questions that you might have.

The CHAIRMAN. Thank you. Thank you all for your testimony. I’m

going to try to be as pointed as I can here. Dr. Henderson, we’ve

discussed two problems. One is diseases that naturally occur, that

are not a consequence of some maniacal plot on the part of an individual or individuals.

But I’d like to focus on the biological threat as it relates to a conscious decision on the part of an individual, group, a nation state

or any subordinate thereof to generate this problem, whatever the

problem, smallpox or whatever.

As a scientist, what are those dangerous infectious diseases that

have the capacity to spread rapidly and do great damage that are

most easily able to be manufactured, produced, stored, and transmitted by bad actors? We heard about smallpox. We’ve heard about

anthrax.

I’d like you to speak to two things. What else is in that group

of biological weapons? And what is the degree of difficulty in manufacturing that substance and transporting it for the purposes intended?

Dr. HENDERSON. Thank you, Mr. Chairman. We actually were

very concerned about just this question as we formed the centers

some 3 years ago. In fact, one could use any organism that could

infect as a weapon. But in fact we really aren’t concerned about

many of them as major threats to the health of the community at

large.

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What we are really concerned about are organisms that could

threaten civil security and the integrity of the government. And we

came up with five and a group: smallpox; anthrax; plague; tularemia, or rabbit fever, as it’s called, which can spread in an aerosol

and cause quite a number of deaths; botulinum toxin which is a

poison usuallyproduced in food; and finally, the group of diseases

causing hemorrhagic fever—primarily the Lassa fever, Ebola,

Marburg—all of which would be treated in a similar manner.

It was our feeling that what we needed was to focus on a small

enough group that one could educate physicians about to look out

for, what specifically would be problems, because most physicians

have seen none of these diseases at all.

Second, what do we do in terms of a response in terms of vaccines, in terms of antibiotics. We focused on a relatively few organisms.

The CHAIRMAN. Now again, I want to make sure I understand.

The organisms you have focused on, you indicated why you focused

in that, as most physicians haven’t seen them, although you theoretically or practically have the ability to deal with them if you are

prepared by vaccine, et cetera.

I want to make sure that I understand that it also meets the

first criteria. If I am the terrorist, what is that disease, what is

that pathogen that is most easily accessible to me and most able

to be transported by me with the most devastating impact? Are

they the same diseases?

Dr. HENDERSON. No. They are not the same diseases. For example, anthrax is not spread from person to person but it’s really

quite readily available and rather easily produced in fairly large

quantity.

The CHAIRMAN. How is it spread?

Dr. HENDERSON. It is spread, well, let’s say in a biological terrorist event it would be by aerosol. You would dry it and distribute

it as a spray and let it drift over a community.

It’s found in soil and infects animals. It does not normally infect

man or, if it does, it infects him on the skin, but inhaled, it can

cause very serious problems and a very high death rate.

Now, in looking at this group, we are looking at several things;

one, the lethality, the fear of the public to such as plague or anthrax or Ebola. We know that panic is common when these diseases occur. We assessed how easily it would be to disseminate

these organisms. By taking all of these different things into account, we eventually reached the list I cited.

Far and away the worst of this group is smallpox, with anthrax

probably a cut below and the others coming along behind. But any

of them would be a real problem.

The CHAIRMAN. It seems to me that based on what I have been

exposed to, taught, listened to, proselytised about—Dr. Ikle ́ knows

a great deal about this—is that in order for a terrorist to implement policies, their purpose to be achieved, it has to be something

they can take credit for, incredibly take credit for generally speaking.

It is possible we have some group just deciding to do great damage to the United States or somewhere else and never take credit

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and make it appear as though it occurred naturally in the environment. But that’s usually not the way.

Osama bin Ladin and others, that would not be their modus operandi to do that. It’s possible that happened. So that’s why I asked

the question in terms of what the focus is here.

Dr. Ikle ́, what I wanted to ask you is in your report you speak

to a number of these concerns. What is it that you think is the

place if you were heading up, and I know this is not your form or

function, but I know you know a great deal about it, if you were

heading up the intelligence community what would you be looking

at and for? Where would you be focusing if your focus was biological threats?

Dr. IKLE ́. I would first start with the recommendations that Jim

Woolsey made about opening up the opportunities for collecting the

information.

The CHAIRMAN. I got that. What kind of pathogen would you be

focusing on?

Dr. IKLE ́. What kind of pathogens? One would have to be entirely

advised by the life scientists like Dr. Henderson. It gets you into

a delicate situation. I was thinking about that as we were talking

a few minutes ago.

If you explain all this in public, you may give guidance to the

perpetrators. If you go back to the Aum Shinrikyo story, they obviously didn’t invent all this themselves. They read about it and then

proceeded to produce these agents.

So there’s in this area a delicate boundary between secrecy and

public information. I’m basically always in favor of minimized secrecy, because it’s used to cover up mistakes.

But this ties in with your previous observation that the perpetrator would want to be known. I could imagine a situation where

we are at war overseas, in the Gulf region or what have you, and

that country’s doing rather badly against our tanks and our fighter

aircraft and so on. The enemy may at that point want to weaken

the United States with such an attack without being known as the

country that caused it for fear of retaliation. So we have to figure

in the possibility of clandestine attack.

The CHAIRMAN. I wasn’t suggesting that it wasn’t a possibility.

Dr. IKLE ́. Sure. I realize that.

The CHAIRMAN. It takes me back to the point made by Mr.

Cilluffo that none of these potential, if you will, delivery systems

should be viewed as mutually exclusive. I agree, except that we

have a problem up here, Mr. Cilluffo; and that gets down to money.

It gets down to prioritizing, it gets down to making judgments

about what is the most likely thing that is to happen. It is in the

best of all worlds we can spend—if you take a look at a layered

missile defense—you are talking somewhere between $100 billion and $.5 trillion depending how layered it’s going to be, maybe

more.

If you are talking about dealing with public health infrastructure

here, we can’t even pass a bill introduced by Senators Kennedy and

Frist $125 million. Instead, we arrived at the final result of $1 million for the public health infrastructure.

One of the things I’m going to need your help on as we go down

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portunity for the committee and we’ll thank you and goodbye. The

bad news is that it’s like contributing to a charity. We have your

number and we’ll be back.

But all kidding aside, one of the things I have to do if I do my

job properly as chairman here, and this committee has to do, excuse me for this digression but all committees are intended to do

the in-depth look at the policy questions that the entire Senate

can’t do and make recommendations to the Senate as a whole.

It seems to me part of my responsibility is as I’ve undertaken

this task, and I’m not sure it may be more than I should have undertaken but I’ve undertaken this task is I eventually have to attach numbers to these initiatives.

The World Health Organization and the global surveillance system to make it work as well as you would like, how much money

do you need? I know we say there’s a lot of things we can solve

without money. There are. But you can’t provide more emergency

rooms and hospital beds without more money.

You can’t deal with the problems that some of you have identified for the research without more money, and so on. So we are

going to have to attach some numbers along the line here that are

reasonable expectations of cost, which takes me to this.

When I hear—and I’d like any one of you to respond to this—

when I hear Senator Nunn say, and I’ve just explained the whole

second rate policymaker here. I’m not a scientist but I’ve been

doing this a long time. And I hear people say, like Senator Nunn

and the group that put on the exercise, that we didn’t have enough

vaccine as they went through this to deal with the crisis.

Well, a logical thing to say would be, OK, if that’s a real possibility, why don’t we stockpile the vaccine? The reason I asked you

the question, Dr. Henderson, that I did, as to what are the most

likely agents that if this were to occur would be the easiest and the

most devastating pathogens, do we stockpile vaccines or whatever

medical response would be required? Do we do that?

In order to do that, we have to identify what we are stockpiling

and for what purpose. I know it’s obvious why I asked the question.

Because eventually we have to get to the point beyond curtailing

the availability of those who have the technology and the scientific

background to produce these things from going on the free market

out there.

We have to begin to figure out how to get our arms around this

in terms of policy. And so my question is, does anyone have any

sense of what the cost is of what you would list as the first or second most important thing we should be doing?

If I said to each of you the good Lord Almighty came down and

sat in the middle here and said, OK, guys, each one of you get to

have fully implemented one or two of your recommendations, what

would it be that you recommend? Because that’s how this place

works.

I mean, we could be honest about it. We don’t have a holistic approach here. We don’t come up and sit down and go through this

for a year and say here’s the plan and we introduce the entire plan.

What is it? What are the first things each of you would do in order

to deal with either the intentional spread of or the natural spread

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of any of these serious diseases which can wreak havoc upon a society?

Maybe I’ll start with you, doctor. And I know that’s an unfair

question but that’s essentially what guys like me end up having to

do.

Dr. IKLE ́. It is a key question, Mr. Chairman. And my inclination

would be to look at this as a two-stage approach. And I think I

mentioned (just while you had to step out) we must work on long

lead items to have a surge capability after we had experienced a

triggering event that focuses the public and the political consensus

on it.

And to that end I would think most of the work would be in the

area of preparing vaccines and other pharmaceutical countermeasures, engaging the pharmaceutical industry. And to give you

a guess, you asked us properly for a guess of a number—$300 million, $500 million over a spread of the next few years.

The CHAIRMAN. Thank you. Mr. Cilluffo.

Mr. CILLUFFO. And this is not to duck the question, but I really

do think there’s a need to turn and to look to three criteria which

need to be met. And that’s authority, accountability coupled with

the resources.

Right now we don’t know what we are spending on. Right now

we don’t know how we could leverage other programs that are out

there that can be brought into this war.

So I think we really do need some fiscal accountability and responsibility. And it’s not only at the Federal level, it’s at the state

and local levels. And the NGOs and the private sector and then we

need to look abroad.

So I think it’s a challenge. This doesn’t fit in any particular agency’s line item. This cuts across everyone’s budget. I think intelligence is clearly in my eyes the first area of priority. But again,

it’s not just an issue of throwing money.

We all know terrorists don’t frequent the cocktail circuit. These

aren’t good people. But we need to have the will to be able to do

certain things. I would recommend though that the NDMS, the National Disaster Medical, that there are some capabilities that will

need to be brought to bear which need to be leveraged and need

to be capable in the time of an event.

This is where the lashing up of FEMA and HHS is crucial, because it’s better to make the mistakes through training and exercising on the practice field and not on Main Street, U.S.A.

I would also say in terms of our RDT&E efforts, we should look

at a 5-year RDT&E effort as DOD goes through. There’s not much,

again, accountability. Some of it is with DOD, some of it is here

and some of it is there. It’s scatter shot. We need to put our arms

around this.

The CHAIRMAN. As you have pointed out, and all of you may find

this at least interesting if not instructive, for the last 30 years,

once a year I get together all the volunteer and paid fire services

and emergency responders in my state for a conference.

It’s become an event that is taken very seriously throughout my

small state, able to get them all together, literally 150 or so people,

max. And you know what, they figured this out. They figured out

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that they are the ones that are going to be the ones that are going

to have to be dealing with this problem.

They are begging now, begging the state and Federal Government. These are mostly blue collar guys and women who are volunteer fire service people or paid fire service people who understand;

for example, they just had a little old fire at a place called Motiva

relating to sulfuric acid.

They weren’t equipped to deal with it. Then they had a little

problem with a trailer carrying medical waste material that was

very dangerous. They had no idea how to go about it; nobody to

call. They had no 911 number.

There’s no 911 number that will immediately be on the scene. So

it’s interesting that this is beginning to seep down to the place

where—practically speaking, as the old joke goes—the rubber

meets the road, down to these normal people. There’s not any sort

of celestial body up here of big time Federal folks that is going to

come down and say, here’s your answer.

But what would you do, Dr. Heymann? What would you have us

do if you sat in this seat?

Dr. HEYMANN. Maybe, Mr. Chairman, I could put in perspective

a little bit the need for vaccines and for other items which are important today for public health. Today out of Geneva we’ll announce that there’s an outbreak of urban Yellow Fever in Abidjan,

in Cote d’Ivoire.

The last outbreak of urban Yellow Fever occurred in Nigeria in

the 1970s and killed over 24,000 people. We have no money to buy

the vaccine necessary to vaccinate the 3.5 million people.

The CHAIRMAN. Is there a vaccine?

Dr. HEYMANN. There is a vaccine. It’s 17 cents a dose, and we

are right now going out to the usual extra budgetary WHO donors

to mobilize the money that’s necessary to buy these 3.5 million

doses of vaccine at the request of the government.

If you look at the major infectious diseases today, AIDS, TB and

malaria, there’s no vaccine that’s effective in any of these. So we

have to balance the needs today with the needs that might occur

from the intentional use which makes it an even more difficult

problem.

As we look over the situation though, there’s one thing that’s

clearly needed. And that is an investment in public health infrastructure. That means in public health laboratories, in epidemiology training, in various activities within countries. There are investments which will deal both with those diseases which are occurring today and the ones that might be caused intentionally.

If we were to look at what it would cost to strengthen the weakest countries that we have now by strengthening their public

health laboratory, by starting epidemiology training with their senior level health staff, and by coordinating this outbreak response

network until countries can do the job on their own, we estimate

about $15 million a year for the next 5 years.

The CHAIRMAN. Fifteen? One-five?

Dr. HEYMANN. Yes, no more than $75 million over 5 years. But

even that is very difficult to mobilize.

The CHAIRMAN. Dr. Henderson.

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Dr. HENDERSON. Just a parenthetical note that you may be unaware of, Mr. Chairman. There has been smallpox vaccine contracted for—some 40 million doses—by the Centers for Disease

Control. This will be delivered some 3 years hence. And there are

stocks of antibiotics which have now been provided for that would

be immediately available for use for certain of these other diseases.

There is research going on to develop anthrax vaccine which

would provide us perhaps a two-dose schedule for protection.

The thing that we are most concerned about, as we look at the

whole picture, is that we do not have a national strategy. There are

large amounts of money now being spent for programs I’m not

going to cite, which are not productive for this program at all.

I believe the national strategy issue is very critical and having

an accounting of appropriated funds and how they are being used.

If I were to look at selecting only one thing, with your criteria, I’d

go back to the public health piece again. The key is that we need

an alarm to get at the problem and we need it quickly.

We don’t have that now. I think if I were going to invest right

now, I would be putting a lot more resources into public health

both nationally and internationally in surveillance, in investigation, in laboratories so we get on top of these outbreaks.

The CHAIRMAN. I have many more questions. Unfortunately, I’m

supposed to be at a policy meeting at 1 o’clock; although, it’s not

as important as this. I would like to ask you if you are willing to

stay in contact with this committee. Because I have a number of

questions I would like to submit.

I’m not trying to make work. And if the questions we submit to

you you think aren’t worth answering, say so. You are the experts.

I’m not being facetious when I say that.

To the extent that you can give us additional guidance, if you

were sitting here, how would you proceed to do exactly what you

have just said, Dr. Henderson, how do we come up with a national

strategy? What should be the locus of that?

I don’t know how any of this ever happens without a specific initiative—no matter if it’s a Democratic, Republican or Presidential

initiative—moving these kinds of things. But how would you go

about it? What would you suggest we do?

For example, when we talked about the issue of chemical weapons, we had a Commission that you may—I know you are familiar

with, Dr. Ikle ́, you may have even participated in it. I’m embarrassed to say I don’t know.

But it’s headed by Senator Baker and Mr. Cutler, among many

others. They came back with this very concrete report full of recommendations. For example, with these loose weapons lying

around in Russia, they showed us pictures of a clapboard buildings—they looked like old outhouses—with padlocks on them, with

enough chemical material in there that if disbursed wouldn’t take

a missile or anything else to cause devastation to tens of thousands, hundreds of thousands of people.

They came back with a hard recommendation. They said we

should be investing $30 billion on very specific initiatives as to how

to begin dealing with this. Eventually, this Nation has to come up

with a strategy that is, in a sense, bite-sized, that can be transVerDate 11-MAY-2000 08:23 Oct 17, 2001 Jkt 000000 PO 00000 Frm 00105 Fmt 6633 Sfmt 6602 75040 SFRELA2 PsN: SFRELA2
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lated to policymakers and justified to our folks back home as to

why we just voted to spend $X million or billion to do this thing.

And so, we’ve got to figure out how to get some of this down to

that level. This is not the purpose of today’s hearing. The purpose

of today’s hearing is to investigate and to begin a cursory look at

what the potential threat is out there. We are going to be having

the intelligence community and others come up and tell us about

the likelihood of that threat based upon their assessments.

We are going to be having four more hearings relating to chemical and nuclear weapons and so on. So this is the beginning of the

process. I don’t want you to think that we are foolish enough to

think that this is where we are going to be able to come up with

a solution or an answer based upon this first hearing.

Part of this is to make my colleagues and myself, beginning with

myself, aware of the nature of the problem. Because unless we understand that first, we are not going to get our hands wet.

You all have forgotten more about these issues than we are going

to learn. My hope is that you can communicate enough to us and

your colleagues in other areas that we can begin to generate a consensus about the willingness to expend money.

The idea that we are unwilling in this environment to spend $125 million on beefing up the public health sector in a bipartisan

effort by two Senators, Kennedy and Frist, and we are only able

to get a consensus to spend $1 million on it, illustrates the degree

of the education that needs to be undertaken here.

So I want to thank you all very, very much, and warn you that,

like I said, it’s like contributing to a charity. We know where you

are. We’ve called on you Dr. Ikle ́ many, many times, and we will

continue to do so as long as you are willing.

But I would like very much to pursue some of this and the specific questions with the other three panelists as well. Thank you

all. Sorry to trespass on your time so late, but I appreciate it very

much.

Senator Feingold’s statement—he was unable to be here—will be

placed in the record, and Senator Frist’s statement as well.

We are adjourned.

[The statements referred to follow:]

PREPARED STATEMENT OF SENATOR RUSS FEINGOLD

I want to thank the Chairman for convening this important hearing, and all of

the witnesses for their time and their insights. Taking a serious look at the U.S.

capacity to prevent or respond to a bioterrorist attack is an important part of this

committee’s broader effort to take a sober look at the varied threats before us and

to identify rational policy priorities accordingly.

But as a longtime member and current Chairman of the Subcommittee on African

Affairs, I particularly appreciate the second phase of this hearing, which recognizes

that Americans’ epidemiological security is not guaranteed even in the absence of

malicious, deliberate biological threats. As populations shift and international travel

increases, people all over the globe are coming into contact with new microorganisms—and, sometimes, new diseases. In fact, according to the General Accounting

Office, over the past three decades, more than thirty previously unknown diseases

have been identified. I know that this committee will hold hearings focusing on the

HIV/AIDS pandemic in the weeks ahead. But whenever I meet with African leaders

I am reminded of the devastating effects of other infectious diseases, and of the potential for mutations and treatment-resistance to wreak havoc around the globe. A

recent GAO report, which I joined with Senators Frist, Leahy, and McConnell in requesting, reveals that existing international surveillance networks are ill-equipped

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to alert us to these emerging threats. These critically important issues that affect

a core element of national security—our national health.

U.S. policy choices and priorities should reflect that reality. International disease

prevention and control initiatives are important investments in Americans’ security,

and well-managed, responsible development assistance programs can help governments and civil societies abroad to prevent new outbreaks and conquer persistent

scourges. The GAO report indicates that laboratory capacity in the developing world

is inadequate, and that investment in infrastructure is desperately needed to help

overworked public health professionals function effectively.

This hearing will bring much-needed attention to these issues as the United

States considers how best to allocate scarce resources. I look forward to the testimony and to working with my colleagues to make sound investments in improving

global epidemiological security.

PREPARED STATEMENT OF SENATOR BILL FRIST

I want to thank Chairman Biden for calling this hearing today on one of the most

pressing and disturbing issues of our time—the threat of bioterrorism. I welcome

the testimony from our two panels.

Not only will the discussion today focus on steps that have been taken to improve

our response to bioterrorist threats, but it will also look at lessons learned from

‘‘Dark Winter,’’ an exercise designed to simulate a terrorist attack on the American

people with smallpox—a contagious virus that could devastate our country. This exercise taught us about the potential damage such an attack could have on the

health, economy and security of our cities, communities and country.

Any threat to the security of the people of the United States from a weapon of

mass destruction, even those with low probability of occurrence but high potential

consequence, including biological weapons, must be taken seriously through adequate preparation. As we all know, the Bush Administration is committed to a coordinated national effort to deal with terrorist threats. Furthermore, Vice President

Cheney will soon be reporting to Congress about the program needs to deal with

biological and other weapons of mass destruction. I eagerly await his recommendations.

Whether past or present, bioterrorism remains a significant threat to our country.

Exposed individuals will most likely show up in emergency rooms, physician offices,

or clinics, with nondescript symptoms or ones mimicking the common cold or flu.

Most likely, physicians and other health care providers will not attribute these

symptoms to a bioweapon. If the bioagent is communicable, such as smallpox, many

more people may be infected in the interim, including our health care workers. Experts say it may take as long as 24 to 48 hours after a bioterrorist attack occurs

before federal assistance can arrive, making it the critical time for preventing mass

casualties.

To better prepare America, I introduced the ‘‘Public Health Threats and Emergencies Act of 2000.’’ This critical legislation, which became law last November, provides a framework for coordinating efforts within the Department of Health and

Human Services (HHS) and the Department of Defense to examine our preparedness for a bioterrorist attack. It also requires HHS, the Federal Emergency Management Agency, and the United States Attorney General to review the medical consequences of an attack, and authorizes the National Institutes of Health (NIH) and

the Centers for Disease Control (CDC) to develop new vaccines for biological weapons. Funding is authorized to support public health agencies, hospitals, and health

care facilities to detect, diagnose, and respond to bioterrorism.

The second panel today will help place bioterrorism in the broader context of preparing for the spread of naturally occurring diseases, such as influenza and West

Nile, a flavivirus that primarily relies on migratory birds and mosquitoes for transmission to humans.

Arms control negotiators have used the term ‘‘dual use’’ to refer to biologic production facilities that have the potential to be used by some countries to produce vaccines for children one week and then produce bacteria or viruses for biologic weapons the next. But we can also use the term ‘‘dual use’’ differently: The same infrastructure investments used to prepare our public health communities, doctors and

federal agencies to detect, diagnose and respond to smallpox epidemic resulting from

a biologic attack can also be used to detect and respond to outbreaks of natural occurring diseases like West Nile.

In addition to strengthening our defenses against a bioterrorist event, the improved public health capacities resulting from preparation and planning will lead

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to substantial health benefits in dealing with inevitable natural occurrence of

emerging infectious diseases.

Last week the GAO released a report, ‘‘Challenges in Improving Infectious Disease Surveillance Systems,’’ requested by Senators Leahy, McConnell, Feingold, and

myself. It concludes that global disease surveillance, especially in developing countries, is woefully inadequate to provide advance warning about newly emerged diseases, including antibiotic-resistant tuberculosis, or the suspected use or testing of

dangerous organisms as bioweapons. Not only would improving international surveillance networks and capacities help poor countries meet their health care needs,

it is in our own security interest to know about emerging threats if we are to appropriately respomd quickly and effectively.

Just this week, a New York Times article provided a summary of a recent study

documenting strong evidence that HIV/AIDS was a zoonotic disease in chimps that

entered the human population around 1930. If we had had the appropriate international public health and surveillance infrastructure in place then, perhaps we

could have avoided the epidemic which currently results in 15,000 new cases each

day and a death from AIDS every six seconds.

Despite significant medical breakthroughs, our nation faces grave new health

threats that could imperil the great medical progress made in the past century.

Whether it’s biological weapons, microbes resistant to antibiotics, or emerging infectious diseases, a strong front line defense is critical to America’s public health infrastructure. By taking steps now to improve our basic capacities to address all public

health threats, we ensure our investment in a public health system that keeps our

nation safe. The ‘‘Public Health Threats and Emergencies Act of 2000’’ provides a

sound policy framework upon which additional measures can be built, and the legislation should be adequately funded.

Biological weapons are but one of the ‘‘weapons of mass destruction’’ for which we

must be prepared. And let me be clear, we must adequately fund programs to deter

and respond to each of these threats—be they biologic, chemical, or nuclear. All are

real. All deserve our attention, our best thinking, and preparation. We must be assured that we are doing all we can to prevent the use of weapons of mass destruction, stop their spread, prevent their delivery by whatever means, and ultimately

mitigate their impact should they be used.

The CHAIRMAN. We are adjourned.

[Whereupon, at 1:20 p.m., the committee adjourned, to reconvene

subject to the call of the Chair.]

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