GAO

United States General Accounting Office

Testimony

Before the Committee on Veterans Affairs and the 

Subcommittee on Labor, Health and Human Services, 

Education and Related Agencies, Committee on 

Appropriations, U.S. Senate

For Release on Delivery

Expected at

9:30 a.m., EST

Tuesday, 

March 16, 1999

COMBATING TERRORISM

Observations on Biological 

Terrorism and Public 

Health Initiatives

Statement of Henry L. Hinton, Jr., Assistant Comptroller 

General, National Security and International Affairs 

Division

GAO/T-NSIAD-99-112

Page 1 GAO/T-NSIAD-99-112

Mr. Chairman and Members of the Committee and Subcommittee:

I am pleased to be here to discuss our ongoing work and preliminary 

observations on the biological terrorist threat and some aspects of the 

Department of Health and Human Services (HHS) bioterrorism initiative. 

As you know, our ongoing work was requested by you in your capacity as 

the Chairman and Senator Rockefeller as Ranking Minority Member of the 

Senate Veterans Affairs Committee; Congressman Shays as the Chairman 

of the House Government Reform Committee, Subcommittee on National 

Security, Veterans Affairs, and International Relations; and Congressman 

Skelton as Ranking Minority Member of the House Armed Services 

Committee. Over the past 3 years, we have studied and reported on a 

number of issues concerning federal agencies programs and activities to 

combat terrorism. A list of related GAO reports and testimonies is in 

appendix I.

It is frightening to think that a lone terrorist or terrorist group might be able 

to improvise a biological weapon or use other means to spread anthrax, 

smallpox, or other biological agents to cause mass casualties and 

overwhelm the health care system in the United States. There is no 

question that it would be unconscionable not to prepare to respond to, if 

not be able to prevent, such an incident. But some very important 

questions should be asked and answered as an integral part of any federal 

decision to invest in medical countermeasures or preparedness initiatives. 

This is one of those few areas in which national security and public health 

issues clearly intersect. It is also an area in which many disciplines of 

expertise must come together to perform the challenging tasks of assessing 

an emerging threat and focusing our investments on the most appropriate 

countermeasures and preparedness efforts.

My testimony will address four issues. First, I will briefly discuss 

intelligence agencies judgments about the threat of terrorism. Second, I 

will highlight the importance and benefits of threat and risk assessments to 

provide a sound basis for targeting the nations investments in combating 

terrorisma widely recognized sound business practice we have discussed 

in our reports and testimonies. 1

 Third, I will share some preliminary 

1See Combating Terrorism: Spending on Governmentwide Programs Requires Better Management and

Coordination (GAO/NSIAD-98-39, Dec. 1, 1997); Combating Terrorism: Threat and Risk Assessments

Can Help Prioritize and Target Program Investments (GAO/NSIAD-98-74, Apr. 9, 1998); and Combating

Terrorism: Observations on Federal Spending to Combat Terrorism (GAO/T-NSIAD/GGD-99-107, 

Mar. 11, 1999).

Letr
Page 2 GAO/T-NSIAD-99-112

observations from our ongoing work on the science behind the biological 

and chemical terrorist threat, with some focus on biological agents. 

Finally, I will provide some of our overall observations on public health 

initiatives that deal with a new national pharmaceutical stockpile and the 

basis for selecting items to research, produce, procure, and stockpile for 

civilian defense against terrorism. 

Summary The U.S. intelligence community continuously assesses both the 

foreign-origin and the domestic terrorist threat to the United States and 

notes that, overall, conventional explosives and firearms continue to be the 

weapons of choice for terrorists. Terrorists are less likely to use biological 

and chemical weapons than conventional explosives, at least partly 

because they are difficult to weaponize and the results are unpredictable. 

However, some groups and individuals of concern are showing interest in 

biological and chemical agents. The possibility that terrorists may use 

biological and chemical materials may increase over the next decade, 

according to intelligence agencies. While biological and chemical 

terrorism is still an emerging threat, many agencies have initiated programs 

and activitieswith Congress support and fundingto combat and 

prepare for this threat.

We have previously reported on the value of a new, post-Cold War approach 

of using sound threat and risk assessments performed by a 

multidisciplinary team of experts for focusing programs and investments to 

combat terrorism. Without such assessments using sound inputs and a 

multidisciplinary team of experts, there is little or no assurance that 

programs and spending are focused in the right areas in the right amounts.

We are looking into the scientific and practical feasibility of a terrorist or 

terrorist group improvising a biological weapon or device outside a 

state-run laboratory and program, successfully and effectively 

disseminating biological agents, and causing mass casualties. 2 Much of the 

information we have obtained is sensitive, classified, and in the early stages 

of evaluation. Overall, our work to date suggests that, for the most part, 

there are serious challenges at various stages of the process for a terrorist 

group or individual to successfully cause mass casualties with an 

2We recognize that some agents are communicable and could be spread without a weapon or device. 

Letr
Page 3 GAO/T-NSIAD-99-112

improvised biological or chemical weapon or device. More specifically, our 

preliminary observations are that 

 a terrorist group or individual generally would need a relatively high 

degree of sophistication to successfully and effectively process, 

improvise a device or weapon, and disseminate biological agents to 

cause mass casualties; 

 a weapon could be made with less sophistication, but it would not likely 

cause mass casualties; 

 some biological agents are very difficult to obtain and others are 

difficult to produce; and

 effective dissemination of biological agents can be disrupted by 

environmental (e.g., pollution) and meteorological (e.g., sun, rain, mist, 

and wind) conditions. 

For its part of domestic preparedness initiatives for combating terrorism, 

HHS received about $160 million in fiscal year 1999. These funds are 

intended for a variety of related preparedness efforts, including research 

and development and a new national stockpile for pharmaceuticals, 

millions of doses of vaccines for smallpox and anthrax, antidotes for 

chemical agents, and other items. For fiscal year 2000, HHS has requested 

$230 million for public health initiatives for dealing with bioterrorism. Our 

preliminary observations follow:

 HHS has not yet performed a documented, formal, methodologically 

sound threat and risk assessment with a multidisciplinary team of 

experts to derive, prioritize, or rankin accordance with the most likely 

threats the nation will facethe specific items it plans to have 

researched, developed, produced, and stockpiled. 

 Several of the items HHS plans to procure seem to be geared toward the 

worst-possible consequences from a public health perspective and do 

not match intelligence agencies judgments on the more likely biological 

and chemical agents a terrorist group or individual might use.

 It is unclear from the HHS fiscal year 1999 operating plan whether and 

to what extent the Department has fully considered the long-term costs, 

benefits, and return on investment of creating and sustaining the 

production and inventory infrastructure for such an initiative.
Page 4 GAO/T-NSIAD-99-112

The Foreign and 

Domestic Terrorism 

Threat in the United 

States

The bombings of the World Trade Center in 1993 and the federal building in 

Oklahoma City, Oklahoma, in 1995, along with the use of a nerve agent in 

the Tokyo subway in 1995, have elevated concerns about terrorism in the 

United Statesparticularly terrorists use of chemical and biological 

weapons. The U.S. intelligence community, which includes the Central 

Intelligence Agency, the Defense Intelligence Agency, the National Security 

Agency, the Federal Bureau of Investigation, and others, has continuously 

assessed the foreign-origin and domestic terrorist threats to the United 

States. According to intelligence agencies, conventional explosives and 

firearms continue to be the weapons of choice for terrorists. Terrorists are 

less likely to use chemical and biological weapons, at least partly because 

they are more difficult to weaponize and the results are unpredictable. 

However, some groups and individuals of concern are showing interest in 

chemical and biological weapons. According to the FBI, there were 

4 confirmed incidents of terrorism in the United States in 1992, compared 

with 12 in 1993, zero in 1994, 1 in 1995, 3 in 1996, and 2 in 1997. These 

incidents involved the use of conventional weapons.

Threat and Risk 

Assessments Can Help 

Define Requirements 

and Prioritize and 

Focus Program 

Investments

We have pointed out that sound threat and risk assessments can be used to 

define and prioritize requirements and properly focus programs and 

investments in combating terrorism. Soundly established requirements 

could help ensure that specific programs and initiatives and related 

expenditures are justified and targeted, given the threat and risk of 

validated terrorist attack scenarios as assessed by a multidisciplinary team 

of experts. 

Several public and private sector organizations use formal, qualitative 

threat and risk assessments to manage risk and identify and prioritize their 

requirements and expenditures. For example, the Defense Threat 

Reduction Agency, the Department of Energy, and the Federal Aviation 

Administration use such assessments in their programs. In addition, the 

Presidents Commission on Critical Infrastructure Protection 3

recommended in its final report that threat and risk assessments be 

performed on the nations critical infrastructures, such as 

telecommunications, electric power, and banking and finance systems. In 

fact, the Federal Emergency Management Agency strongly endorses the 

3The Commission, a government-private sector body established in 1996, was to develop a national 

strategy to protect the nations critical infrastructures from physical and computer-based threats.
Page 5 GAO/T-NSIAD-99-112

concept of risk assessment, as it is the key to predisaster hazard 

mitigationthe foundation of emergency management. Moreover, the 

Department of Energy has stated that domestic preparedness program 

equipment purchases should be delayed until a risk assessment is 

completed to ensure that appropriate equipment is obtained.

Threat and risk assessments are grounded in a new, post-Cold War 

approach to thinking about and dealing with security issues called risk 

management. Risk management is the deliberate process of understanding 

riskthe likelihood that a threat will harm an asset with some severity of 

consequencesand deciding on and implementing actions to reduce it. 

Risk management principles acknowledge that (1) while risk generally 

cannot be eliminated it can be reduced by enhancing protection from 

validated and credible threats and (2) although many threats are possible, 

some are more likely to occur than others. Threat and risk assessment is a 

deliberate, analytical approach that results in a prioritized list of risks (i.e., 

threat-asset-vulnerability combinations) that can be used to select 

countermeasures to create a certain level of protection or preparedness. 

Generally, because threats are dynamic and countermeasures may become 

outdated, it is sound practice to periodically reassess threat and risk.

The critical first step in a sound threat and risk assessment process is the 

threat analysis. The analysis should identify and evaluate each threat in 

terms of capability and intent to attack an asset, the likelihood of a 

successful attack, and its consequences. To perform a realistic threat 

assessment, a multidisciplinary team of experts would require valid foreign 

and domestic threat data from the intelligence community and law 

enforcement. The intelligence communitys threat reporting on 

foreign-origin terrorism is often general and, without clarification, could be 

difficult to use. However, a multidisciplinary team of experts can use the 

best available intelligence information on foreign-origin and domestic 

threats to develop threat scenarios. The intelligence community could then 

compare the threat scenarios to its threat reporting and validate or adjust 

the scenarios with respect to their realism and likelihood of occurrence as 

appropriate. 
Page 6 GAO/T-NSIAD-99-112

Our Ongoing Work 

Examining the 

Biological and 

Chemical Terrorist 

Threat

On the basis of information we obtained and analyzed to date, a terrorist 

group or individual4 would generally need a relatively high degree of 

sophistication to successfully and effectively process, improvise a device 

or weapon, and disseminate biological agents to cause mass casualties. 

John Lauder, Special Assistant to the Director of Central Intelligence for 

Nonproliferation, recently testified that the preparation and effective use 

of biological weapons by both potentially hostile states and by non-state 

actors, including terrorists, is harder than some popular literature seems to 

suggest.5

 Because we are in an open forum and our work is sensitive and 

preliminary in nature, my discussion will remain limited. 

Our ongoing synthesis of information and technical data from recognized 

experts suggests that some exotic biological agentssuch as smallpox

are difficult to obtain, and otherssuch as plagueare difficult to 

produce. Processing biological agents for effective dissemination to cause 

mass casualties requires specific, detailed knowledge and specialized 

equipment. Moreover, improvising a device or weapon that can effectively 

disseminate biological agents to cause mass casualties may require certain 

items that are not readily available. In addition, successful and effective 

dissemination of biological agents in the right form requires the proper 

environmental and meteorological conditions and appropriate energy 

sources.

That is not to say that casualties would not occur if less sophisticated 

means were used. For example, if an agent were dispersed in a less 

effective form using less effective equipment , some casualties might occur. 

However, under these circumstances, the potential incident would be less 

likely to cause mass casualties. What we have learned is that capability is a 

critical factor. Terrorists have to handle risk, overcome production 

difficulties, and effectively disseminate a biological agent to cause mass 

casualties.

We continue to gather and evaluate data on these matters and plan to 

report to our requesters this summer.

4For the purposes of our work, we define terrorist(s) as a non-state actor not provided with a 

state-developed weapon.

5Unclassified statement by Special Assistant to the Director of Central Intelligence for Nonproliferation 

on the Worldwide Biological Warfare Threat to the House Permanent Select Committee on Intelligence, 

March 3, 1999.
Page 7 GAO/T-NSIAD-99-112

Preliminary 

Observations on HHS 

Public Health 

Initiatives Related to 

Bioterrorism

On June 8, 1998, the President forwarded to Congress a fiscal year 1999 

budget amendment that included a proposal to (1) buildfor the first 

timea civilian stockpile of antidotes and vaccines to respond to a 

large-scale biological or chemical attack, (2) improve the public health 

surveillance system to detect biological or chemical agents rapidly and 

analyze resulting disease outbreaks, (3) provide specialized equipment and 

training to states and localities for responding to a biological or chemical 

incident, and (4) expand the National Institutes of Healths research into 

vaccines and therapies. The Omnibus Consolidated and Emergency 

Supplemental Appropriations Act (P.L. 105-277) included $51 million for the 

Centers for Disease Control and Prevention to begin developing a 

pharmaceutical and vaccine stockpile for civilian populations. The act also 

required that HHS submit an operating plan to the House and Senate 

Committees on Appropriations before obligating the funds. The fiscal year 

2000 request for HHS bioterrorism initiative is $230 million, including 

$52 million for the Centers for Disease Control and Prevention to continue 

procurement of a national stockpile.

Our preliminary work suggests that an ad hoc interagency health care 

group led by HHS has not yet performed a formal, documented threat and 

risk assessment to establish its list of biological and chemical terrorist 

threat agents against which it should stockpile. In fact, several of the items 

HHS plans to procure do not match intelligence agencies judgments, as 

explained to us, on the most likely chemical and biological agents a 

terrorist group or individual might use. According to HHS officials, the 

group identified its list through a process of evolutionary consensus among 

federal and nonfederal health experts. Because HHS did not document its 

process or methodology, we have difficulty evaluating its soundness and 

comprehensiveness.

According to HHS officials, the interagency participants identified the list 

based on

 agent characteristics such as transmissibility and stability,

 likely impact on population (i.e., can it cause mass casualties),

 availability of treatment, and

 whether the agent could be weaponized.

The group chose four biological agents for HHS stockpiling initiatives

inhalation anthrax, pneumonic plague, smallpox, and tularemia 
Page 8 GAO/T-NSIAD-99-112

(a bacteria)because of their ability to affect large numbers of people 

(create mass casualties) and tax the medical system. 

On the basis of our discussions with HHS officials, it is unclear to us 

whether and to what extent intelligence agencies official written threat 

analyses were used in their process. According to the Joint Security 

Commissions 1994 report on Redefining Security, without documented 

threat information, countermeasures are often based on worst-case 

scenarios. Valid, current, and documented threat information is crucial to 

ensuring that countermeasures or programs are not based solely on 

worst-case scenarios and are therefore out of balance with the threat. 

While HHS officials told us that they obtained information from various 

experts, including intelligence analysts, the ad hoc interagency group 

making the decisions comprised representatives only from the health and 

medical community. As a result, we have not seen any evidence that the 

groups process has incorporated the many disciplines of knowledge and 

expertise or divergent thinking that is warranted to establish sound 

requirements for such a complex and challenging threat and to focus on 

appropriate medical preparedness countermeasures.

As required in the appropriations act I mentioned earlier, HHS prepared an 

operating plan for its fiscal year 1999 bioterrorism initiative. The plan 

discusses numerous activities on which the fiscal year 1999 appropriations 

will be spent within four areas: 

 deterrence of biological terrorism,

 surveillance for unusual outbreaks of illness,

 medical and public health responses, and

 research and development.

We have reviewed the unclassified version of the operating plan. On the 

basis of our review of the plan, it is unclear whether and to what extent 

HHS has fully considered the long-term costs, benefits, and return on 

investment of establishing the production and inventory infrastructure for 

such an initiative. The reason I raise the issue of return on investment is 

that, until a valid threat and risk assessment is performed, we question 

whether stockpiling for the items on the current HHS list is the best 

approach for investing in medical preparedness. In addition, the HHS plan 

does not clearly address issues surrounding (1) the long-term costs of 

maintaining an inventory of items with a shelf life or (2) the safety and 

efficacy of expedited regulatory review of new drugs and vaccines.
Page 9 GAO/T-NSIAD-99-112

Conclusions We see many challenges ahead for HHS as it continues to decide how to 

target its investments for this emerging threat. Many frightening possible 

scenarios can be generated. But the daunting task before the nation is to 

assessto the best of its abilitythe emerging threat with the best 

available knowledge and expertise across the many disciplines involved. 

The United States cannot fund all the possibilities that have dire 

consequences. By focusing investments on worst-case possibilities, the 

government may be missing the more likely threats the country will face. 

With the right threat and risk assessment process, participants, inputs, and 

methodology, the nation can have greater confidence that it is investing in 

the right items in the right amounts. Even within the lower end of the 

threat spectrumwhere the biological and chemical terrorist threat 

currently liesthe threats can still be ranked and prioritized in terms of 

their likelihood and severity of consequences. A sound threat and risk 

assessment could provide a cohesive roadmap to justify and target 

spending for medical and other countermeasures to deal with a biological 

and/or chemical terrorist threat.

Mr. Chairman, Members of the Committee and Subcommittee, that 

concludes my prepared remarks. I would be happy to answer any 

questions you may have.

Letr
Page 10 GAO/T-NSIAD-99-112

Appendix I

Related GAO Products ApeInxdi

Combating Terrorism: Observations on Federal Spending to Combat

Terrorism (GAO/T-NSIAD/GGD-99-107, Mar. 11, 1999).

Combating Terrorism: FBI's Use of Federal Funds for

Counterterrorism-Related Activities (FYs 1995-98 ) (GAO/GGD-99-7, 

Nov. 20, 1998).

Combating Terrorism: Opportunities to Improve Domestic Preparedness

Program Focus and Efficiency (GAO/NSIAD-99-3, Nov. 12, 1998).

Combating Terrorism: Observations on the Nunn-Lugar-Domenici Domestic

Preparedness Program (GAO/T-NSIAD-99-16, Oct. 2, 1998).

Combating Terrorism: Observations on Crosscutting Issues

(GAO/T-NSIAD-98-164, Apr. 23, 1998).

Combating Terrorism: Threat and Risk Assessments Can Help Prioritize

and Target Program Investments (GAO/NSIAD-98-74, Apr. 9, 1998).

Combating Terrorism: Spending on Governmentwide Programs Requires

Better Management and Coordination (GAO/NSIAD-98-39, Dec. 1, 1997).

Combating Terrorism: Efforts to Protect U.S. Forces in Turkey and the

Middle East (GAO/T-NSIAD-98-44, Oct. 28, 1997).

Combating Terrorism: Federal Agencies' Efforts to Implement National

Policy and Strategy (GAO/NSIAD-97-254, Sept. 26, 1997).

Combating Terrorism: Status of DOD Efforts to Protect Its Forces

Overseas (GAO/NSIAD-97-207, July 21, 1997).

Chemical Weapons Stockpile: Changes Needed in the Management

Structure of Emergency Preparedness Program (GAO/NSIAD-97-91, 

June 11, 1997).

State Department: Efforts to Reduce Visa Fraud (GAO/T-NSIAD-97-167, 

May 20, 1997).

Aviation Security: FAA's Procurement of Explosives Detection Devices

(GAO/RCED-97-111R, May 1, 1997).
Appendix I

Related GAO Products

Page 11 GAO/T-NSIAD-99-112

Aviation Security: Commercially Available Advanced Explosives Detection

Devices (GAO/RCED-97-119R, Apr. 24, 1997).

Terrorism and Drug Trafficking: Responsibilities for Developing Explosives

and Narcotics Detection Technologies (GAO/NSIAD-97-95, Apr. 15, 1997).

Federal Law Enforcement: Investigative Authority and Personnel at

13 Agencies (GAO/GGD-96-154, Sept. 30, 1996).

Aviation Security: Urgent Issues Need to Be Addressed

(GAO/T-RCED/NSIAD-96-151, Sept. 11, 1996).

Terrorism and Drug Trafficking: Technologies for Detecting Explosives and

Narcotics (GAO/NSIAD/RCED-96-252, Sept. 4, 1996).

Aviation Security: Immediate Action Needed to Improve Security 

(GAO/T-RCED/NSIAD-96-237, Aug. 1, 1996).

Passports and Visas: Status of Efforts to Reduce Fraud (GAO/NSIAD-96-99, 

May 9, 1996).

Terrorism and Drug Trafficking: Threats and Roles of Explosives and

Narcotics Detection Technology (GAO/NSIAD/RCED-96-76BR, Mar. 27, 

1996).

Nuclear Nonproliferation: Status of U.S. Efforts to Improve Nuclear

Material Controls in Newly Independent States (GAO/NSIAD/RCED-96-89, 

Mar. 8, 1996).

Aviation Security: Additional Actions Needed to Meet Domestic and

International Challenges (GAO/RCED-94-38, Jan. 27, 1994).

Nuclear Security: Improving Correction of Security Deficiencies at DOE's

Weapons Facilities (GAO/RCED-93-10, Nov. 16, 1992).

Nuclear Security: Weak Internal Controls Hamper Oversight of DOE's

Security Program (GAO/RCED-92-146, June 29, 1992).

Electricity Supply: Efforts Underway to Improve Federal Electrical

Disruption Preparedness (GAO/RCED-92-125, Apr. 20, 1992).
Appendix I

Related GAO Products

Page 12 GAO/T-NSIAD-99-112

Economic Sanctions: Effectiveness as Tools of Foreign Policy

(GAO/NSIAD-92-106, Feb. 19, 1992).

State Department: Management Weaknesses in the Security Construction

Program (GAO/NSIAD-92-2, Nov. 29, 1991).

Chemical Weapons: Physical Security for the U.S. Chemical Stockpile

(GAO/NSIAD-91-200, May 15, 1991).

State Department: Status of the Diplomatic Security Construction Program

(GAO/NSIAD-91-143BR, Feb. 20, 1991).

(701167) Lret
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