LEST WE FORGET:

A CRITICAL ANALYSIS OF BIOTERRORIST INCIDENTS, 

NATIONAL EXERCISES, 

AND U.S. PREVENTION, RESPONSE AND RECOVERY 

STRATEGIES

By

Lt Col Tasha L. Pravecek, USAF, BSC

The Counterproliferation Papers

Future Warfare Series No. 50

USAF Counterproliferation Center

Air University

Maxwell Air Force Base, Alabama
ii

LEST WE FORGET:

A CRITICAL ANALYSIS OF BIOTERRORIST INCIDENTS,

NATIONAL EXERCISES

AND U.S. PREVENTION, RESPONSE AND RECOVERY STRATEGIES

Lt Col Tasha L. Pravecek, USAF, BSC

April 2011

The Counterproliferation Papers Series was established by the USAF 

Counterproliferation Center to provide information and analysis to assist the 

understanding of the U.S. national security policy-makers and USAF officers to help 

them better prepare to counter the threat from weapons of mass destruction. Copies 

of No. 50 and previous papers in this series are available from the USAF 

Counterproliferation Center, 325 Chennault Circle, Maxwell AFB AL 36112-6427. 

The fax number is (334) 953-7530: phone (334) 953-7538.

Counterproliferation Paper No. 50

USAF Counterproliferation Center

Air University

Maxwell Air Force Base, Alabama 36112-6427

The Internet address for the USAF Counterproliferation Center is:

http://cpc.au.af.mil
iii

Contents

Page

DISCLAIMER.....................................................................v

THE AUTHOR.....................................................................vi

ABSTRACT.......................................................................vii

PREFACE.........................................................................viii

ILLUSTRATIONS.................................................................x

TABLE...............................................................................x

CHAPTER 1: INTRODUCTION..............................................1

CHAPTER 2: RECENT HISTORY OF TERRORIST BIOLOGICAL 

 ATTACKS AND NOTEWORTHY INCIDENTS.........................3

 Rajneesh Cult..................................................................................................4

Cult Overview .........................................................................................4

Biological Agent Acquisition and Dissemination.................................4

Items of Interest--Where our Prevention and Response 

Actions Failed....................................................................................5

Larry Wayne Harris.......................................................................................6

Harris Overview ......................................................................................6

Arrest Record...........................................................................................7

Items of Interest--Where our Prevention and Response 

Actions Failed....................................................................................8

Aum Shinrikyo...............................................................................................9

Cult Overview .........................................................................................9

Biological Agent Acquisition and Dissemination...............................10

Items of Interest--Where our Prevention Failed..................................11

Anthrax Letters ............................................................................................12

Event Description..................................................................................12

Items of Interest--Where our Prevention and Response 

Actions Failed..................................................................................14
iv

CHAPTER 3: NATIONAL EXERCISE PROGRAM AND LESSONS 

 LEARNED.....................................................................17

TOPOFF May 1, 2000, Denver, Colo. ................................................18

Exercise Description......................................................................18

Items of Interest--Lesson Learned.................................................18

TOPOFF May 2, 2003, Chicago, Ill. ...................................................21

Exercise Description......................................................................21

Items of Interest--Lesson Learned.................................................21

TOPOFF April 3, 2005, N.J. ...............................................................22

Exercise Description......................................................................22

Items of Interest--Lesson Learned.................................................22

Dark Winter, June 2001, Andrews AFB, Md......................................24

Exercise Description......................................................................24

Items of Interest--Lesson Learned.................................................25

CHAPTER 4: POINTS OF FOCUS TO PREVENT, RESPOND TO, 

 AND RECOVER FROM BIOLOGICAL ATTACK..........................27

CHAPTER 5: EVALUATION OF U.S. POLICY ...................................33

Current U.S. Policies and Initiatives ...................................................34

Provide Alternate Job Opportunities...................................................36

Encourage/Assist Regional Partners ...................................................37

Prevent Acquisition .....................................................................................38

Detect Attacks..............................................................................................40

Prepare, Respond, Recover and Gather Forensic Information............43

CHAPTER 6: SUMMARY, RECOMMENDATIONS, AND 

 CONCLUSIONS ................................................................................55

BIBLIOGRAPHY.................................................................62
v

DISCLAIMER

The views expressed in this academic research paper are those of the author 

and do not reflect the official policy or position of the U.S. Government or the 

Department of Defense. In accordance with Air Force Instruction 51-303, it 

is not copyrighted, but is the property of the United States Government.
vi

The Author

Lt Col Tasha L. Pravecek is the 5th Medical Support Squadron 

Commander at Minot AFB, ND. She wrote this publication while an Air 

Force Fellow, National Laboratory Technical Fellowship Program, 

Argonne National Laboratory, IL. Previously, Lt Col Pravecek served on 

staff at HQ Air Force Research Laboratory as Deputy Chief, Strategic 

Planning and Transformation Division, Wright-Patterson AFB, OH. Other 

positions included Deputy Chief Applied Biotechnology Branch, Air 

Force Research Laboratory, Wright-Patterson AFB, OH; Student, Air 

Command and Staff College, Maxwell AFB, AL; Chief of CBRNE 

Education, Research and Analysis at the USAF Counterproliferation 

Center, Maxwell AFB, AL; Chief, Bioenvironmental Engineering, Eielson 

AFB, AK; Chief, Chemistry and Toxicology Branch and Risk Assessment 

Consultant, Air Force Center for Environmental Excellence, Brooks AFB, 

TX; Instructor of Chemistry, USAF Academy, CO; Chief Cell and Tissue 

Culture Section and Research Toxicologist, Toxicology Division, 

Armstrong Laboratory, Wright-Patterson AFB, OH. Lt Col Pravecek has 

a Doctorate in Environmental Science and Engineering from the 

University of North Carolina at Chapel Hill and Masters degrees in 

Biological Chemistry from Wright State University and Military 

Operational Art and Science from Air Command and Staff College.
vii

Abstract

Current U.S. deterrence and prevention strategies are incapable of 

completely negating the multiple means a terrorist has to obtain and 

disseminate biological agents in order to create a catastrophic U.S. incident. 

However, a thorough analysis of previous biological attacks or incidents, and 

national bioterror exercises may provide insights to where most effective 

deterrence and prevention strategies should be focused to prevent or mitigate 

a highly successful, large-scale biological terrorist attack, or how to respond 

and recover should an attack occur. 

This paper reviews and analyzes biological incidents which have 

occurred over the past 30 years, including the Rajneesh Cult salmonella 

poisoning, Larry Wayne Harris’ purchase of plague bacteria, the Aum 

Shinrikyo cult anthrax dissemination and the Anthrax Letter attacks of 2001. 

Additionally, National Exercises which involve simulated bioterrorist 

events are analyzed: TOPOFF 1, 2, and 3, and Dark Winter. Next, current 

U.S. strategies and policies aimed to prevent a biological weapons attack are 

examined to determine the focus which will achieve the best effect in light of 

lessons learned from the recent biological incidents and exercises detailed. 

Based on examination of both real-world events and National 

Exercises, the following are key points of focus which the U.S. policy makers 

should consider more carefully: (1) improve the detection of bio-attacks, and 

(2) prepare against biological contingencies, respond effectively, recover 

quickly and capably, and gather biological-weapon forensics information so 

decision-makers may attribute the attack correctly.
viii

Preface

This paper grew from stray thoughts I had while working on BioDefense Now: 56 Suggestions for Immediate Improvements with Col (ret) 

Jim Davis. I wondered as we worked on the project in 2004 and 2005 at 

the USAF Counterproliferation Center, Maxwell Air Force Base, what 

lessons we had learned from the exercise and incidents we had 

experienced in the recent past. I had the opportunity while attending my 

Air Force Fellowship at Argonne National Laboratory to investigate in 

depth the National Exercises and bioterrorism incidents of recent history 

to determine any noteworthy lessons we could garner from our 

experience. 

I fear that often times, someone enacts guidance that a group must 

exercise some aspect of chemical, biological, or radiological response 

readiness, and we simply go through the motions of checking that block to 

complete said exercise without much thought into what benefit we can 

gain. I have seen through my Air Force career that we “play” in an 

exercise according to prescribed rules to pass an inspection; but then at 

times in real life we “play” a completely different way to get the job done 

more effectively. We have “hot-washes” following exercises or 

inspections to determine how to fix those areas we failed, but in my 

experience, those fixes do not always transfer to the most efficient actions 

in real-world events. Similarly, I found in researching the TOPOFF and 

Dark Winter exercises that we learned a great deal from them; but could 

not find in the literature that this valuable information was consistently 

passed to other states or responders. These National Exercises were 

simply a check in the block fulfilling guidance which said “you must 

conduct this exercise.” Nationwide changes were not made following the 

exercises as evidenced by the similar problems and shortfalls noted in the 

National Exercises year after year. 

I would not have been able to conduct this research without the 

support of many around me. I very much appreciate the support and 

excellent workspace provided by Dr. Harold Myron, the director of 

Argonne’s Division of Educational Program and my sponsor for the Air 

Force Fellows Program at Argonne. Next, thanks to Dr. Dan Schabacker 

who allowed me to work in his laboratory and learn in great detail the 

importance of microbial forensics in the attribution of a bioterror crime. 
ix

And finally, and most importantly, I give my most sincere appreciation to 

Dr. Barry Schneider, my advisor regarding this paper. He provided 

exceptional editorial comments and insight into the difference between 

deterrence and prevention, and generally made this paper clear and to the 

point. 

I am thankful to have been given the opportunity to participate in the 

USAF Fellows program and hope that you enjoy reading this paper. 
x

Illustrations

Page

Figure 1 Notional Progression of Biological Attack......................................28

Figure 2 Points of Focus...................................................................................31

Figure 3 Phases of Effective Response Actions.............................................44

Figure 4 The Preparedness Cycle....................................................................44

Figure 5 The Response Process.......................................................................49

Tables

Page

Table 1. Points of Focus in National and Military Strategies..........................35
Chapter 1

Introduction

Armed with a single vial of a biological agent...small 

groups of fanatics, or failing states, could gain the power to

threaten great nations, threaten the world peace. 

America, and the entire civilized world, will face this threat 

for decades to come. 

We must confront the danger with open eyes and unbending 

purpose.

─President George W. Bush 

Biological terrorism has occurred on U.S. soil. Most newsworthy was 

the 2001 anthrax letter mailings, which came to be known as “Amerithrax.” 

More significant events involve the 1984 salmonella poisoning by the 

Rajneesh Puram in Oregon and Larry Harris’ 1998 arrest for possession of 

plague bacteria in Chicago, addressed later in this paper. The United States is 

not immune to attack.

A large-scale biological weapons attack by a terrorist organization is 

probably not a matter of “if” but a matter of “when.” Terrorist groups in the 

past and present, for example Al Qaeda, have expressed interest or 

demonstrated steps in planning for a biological weapons attack. The National 

Strategy for Countering Biological Threats, published in November 2009, 

reports, “in 2001, while engaging the Taliban in Afghanistan, coalition 

forces came into possession of a significant body of evidence that Al 

Qaeda was seeking to develop the capability to conduct biological 

weapons attacks. Although Al Qaeda has lost many of the resources it had 
2

compiled prior to September 2001, it is prudent to assume its intent to 

pursue biological weapons still exists.”1

To facilitate this desire to use biological weapons, “how to” instructions 

are readily available. One book currently available for sale on Amazon.com 

is Silent Death written by Uncle Fester.2 In this book, the author details the 

means of production and dissemination of various plant poisons, botulism and 

ricin toxin.3

Current U.S. deterrence and prevention strategies are incapable of 

completely negating the multiple means a terrorist has to obtain and 

disseminate biological agents in order to create a catastrophic U.S. incident. 

However, a thorough analysis and assessment of previous successful or 

partially successful biological attacks and national bioterror exercises may 

provide valuable insights to where most effective deterrence and prevention 

strategies should be focused in order to prevent or mitigate a highly 

successful, large-scale biological terrorist attack, or respond and recover 

should an attack occur.

 Many other individuals and groups have published books and 

websites detailing how to effectively develop biological weapons, 

contributing to the ease of proliferation.

This paper reviews and analyzes biological incidents which have 

occurred over the past 30 years and national exercises which involve 

simulated bioterrorist events. Next, a brief summary of current U.S. 

deterrence and prevention strategies and policies to prevent a biological 

weapons attack is provided. Additionally, U.S. strategies and current 

programs are examined to determine the focus which will achieve the best 

effect in light of lessons learned from the recent biological incidents and 

exercises detailed. Finally, the paper provides some recommendations to 

bolster future biological weapons deterrence strategies.
3

Chapter 2

Recent History of Terrorist Biological Attacks and 

Noteworthy Incidents

Choosing the right poison for the job is like calling the right 

play in football. 

It requires knowledge of the subject and use of psychology to 

make the right choice.

−Uncle Fester

The proliferation and use of biological weapons are significant concerns 

to the United States. While biological terrorists have not attacked since 

World War II,4

This chapter will detail two partially successful biological agent attacks

on the United States: the Rajneesh cult dissemination of salmonella in 

Oregon and the anthrax letter mailings in 2001. Additionally, the events 

surrounding the arrest of Larry Harris will be described to demonstrate why 

and how the United States has taken some action to strengthen U.S. capability 

to deter a biological attack. Finally, the biological weapons program of the 

Japanese Aum Shinrikyo cult will be highlighted to demonstrate potential 

weaknesses in any country’s deterrence strategies.

three incidents in the United States and one attack on U.S. 

interests overseas, demonstrate attacks are not only possible, but can and do 

easily occur. Additionally, examination of these attacks and the response to 

them can provide indication of potential areas of improvement in deterrence 

strategy. It is important to note the similar shortcomings experienced in these 

events, such as the need for biological agent forensics, clear public 

communication, and training of first responders and healthcare workers. 
4

Rajneesh Cult

“For the first time ever, all of Mid-Columbia’s 125 beds were filled; 

some patients had to be kept in the corridors.”5 This sounds like the scene 

from a Hollywood film. In reality, this mass casualty event occurred in The 

Dalles, Ore., during September and October 1984. By the end of the attack, 

45 people were hospitalized and over 750 fell ill suffering from salmonella 

poisoning. This attack was the act of a religious cult residing in the United 

States.

Cult Overview

“In 1981, followers of the Bhagwan Shree Rajneesh had paid $5.75 

million for a remote 64,000-acre ranch in Wasco County, a two-hour drive 

from The Dalles, the county seat. Their plan was to build a ‘Buddhafield,’ an 

agricultural commune in which they could celebrate their “enlightened 

master’s” credo of beauty, love and guiltless sex.”6 Followers of the 

Bhagwan moved to the neighboring town of Antelope in 1982. They created 

a separate city within the ranch called Rajneeshpuram. Relations between the 

cult and the county officials deteriorated over time due to land-use issues and 

the cult’s desires to expand.7 The cult intended to use biological agents to 

win control of the county government by preventing non-cult voters from 

participating in the November 1984 elections.

Biological Agent Acquisition and Dissemination

The chief of the cult’s biological warfare program was 38-year-old Ma 

Anand Puja (aka Diane Ivonne Onang), an American nurse of Philippine 

origin. Puja joined the cult in 1979 in Poona, India.8 Under her direction, the 

Rajneesh cult experimented with poisons, chemicals and bacteria. The cult 

ordered and received many biological agents from the American Type 

Culture Collection (ATCC), including Salmonella typhi (causes typhoid 

fever), Fancisella tularensis (causes tularemia), Salmonella typhimurium

(causes gastrointestinal illness).9

 The cult’s Rajneeshee Medical Corporation 

and pharmacy also legally obtained biological agents, an incubator the size of 

an apartment refrigerator, and a quick-freeze dryer for agent preparation from 

medical-supply companies.10 In late 1983 or early 1984, Puja purchased a set 
5

of “bactrol disks” containing Salmonella typhimurium (ATCC 14028) from 

VWR Scientific, a medical supply company in Seattle, Wash.11

In the summer of 1983, two Wasco county commissioners conducted a 

mandatory inspection of the Rajneesh ranch prior to its annual summer 

festival. The Rajneeshees gave the two commissioners water laced with 

Salmonella typhimurium while they waited for their car’s mysteriously flat 

tire to be repaired. Eight hours later, both men became ill, and one was 

hospitalized. Both suspected the Rajneeshees had put something in the water, 

but neither had evidence, thus no charges were filed.12

Approximately one year later on Sept. 9, 1984, the famed salmonella 

attack of The Dalles began. This attack was suspected to be a practice run for 

the primary attack planned in November with the goal to affect participation 

by local voters in the county elections. In 10 restaurants and a grocery store, 

the cult members sprinkled salmonella over fruits and vegetables, milk, 

coffee creamers and blue-cheese dressing. The first reports of gastroenteritis 

to the Wasco-Sherman Public Health Department occurred on Sept. 17, 1984. 

By Sept. 21, the county was overwhelmed with sick and frightened people.13 

That same day, the Oregon State Public Health Laboratory in Portland 

confirmed the culprit was Salmonella typhimurium, only four days after the 

initial reported case.14

Two attacks apparently resulted in two waves of illness, Sept. 9-18 and 

Sept. 19-Oct. 10, 1984. The final reported count was 751 cases. However, 

the actual number of victims was likely higher due to the number of out-ofstate travelers who consumed contaminated food products.15

Despite the apparent success of the covert attack, the Rajneesh cult 

abandoned the planned attack in November. A year later the salmonella 

illnesses were discovered to be intentional. Oddly, the Bhagwan Shree 

himself, in accusing one of his followers who had defected, admitted to the 

cult’s role in the salmonella poisoning.16 Only two cult members, including 

Puja, were tried for these attacks. Both served less than four years in federal 

prison and fled to Europe upon release to avoid further prosecution by the 

state of Oregon.17

Items of Interest—Where our Prevention and Response Actions Failed

State public health officials and the Centers for Disease Control (CDC) 

investigated the salmonella outbreaks in The Dalles. They measured saladbar temperatures, inspected food-handling procedures, tested cows, raw milk, 
6

water, vegetables and food distributors, and found no contamination and no 

common source for the food.18 Despite the apparent randomness, both 

inspection agencies concluded there was no evidence of deliberate 

contamination. Instead, they blamed the food handlers at the 10 restaurants 

impacted by the bacterium. The most senior state epidemiologist went so far 

as to conclude the contamination “could have occurred where food handlers 

failed to wash their hands adequately after bowel movements and then 

touched raw foods.”19

In order to prevent future accidental or intentional outbreaks of 

salmonella contamination or to induce change to prevent such outbreaks, it is 

usual practice to publish an incident report. In this event, a report was not 

published. The public health officials realized how easily the Rajneeshees 

spread the disease and did not want to encourage copycats.

 In retrospect, this simultaneous coincidence in 10 

restaurants seems implausible and clearly demonstrates the lack of forensic 

detection capabilities or awareness.

20 A published 

report would have highlighted clues that a biological agent manufacture 

capability existed on the ranch, including an incubator and freeze dryer. 

Additionally, the report would have identified the need to register all medical 

laboratories in the state, regardless of the size. Finally, and most critically, 

the report would have underscored the ease with which Puja acquired 

pathogens from the ATCC and medical supply vendors. More than 10 years 

later, Larry Harris’ arrest prompted the CDC to take measures through the 

Select Agent Program to safeguard specific infectious agents and toxins.

Larry Wayne Harris

Larry Harris was a neo-Nazi sympathizer and trained microbiologist.21 

In 1998, Larry Harris bought three vials of plague bacteria from the ATCC 

for approximately $300. He pled guilty to wire fraud, the most serious charge 

possible at the time.22

Harris Overview

Harris says he first became interested in biological warfare while enlisted 

in the Army. He was a wheeled vehicle mechanic, but he claims to have 

spent time in a microbiology laboratory at Aberdeen Proving Ground, an 

assertion of which the Army has no record. He also asserts to have spent time 
7

working on biological weapon defenses in various laboratories, including 

Battelle and the Central Intelligence Agency (CIA), although no organization 

has record of his employment. In 1993, while attending Ohio State 

University to take microbiology courses, Harris alleges to have interacted 

with a woman by the name of Mariam Arif. Arif purportedly told Harris of 

small groups of Iraqi women who smuggle lethal biological agents into the 

United States with plans to disseminate them in the future. Harris informed 

the CIA, CDC and Federal Bureau of Investigation (FBI) of these Iraqi plans. 

“Since then, it has been Harris’ self-appointed mission to warn Americans 

about Iraq’s nefarious plans and to teach citizens how to protect themselves in 

the event of a biological attack.”23

Arrest Record

On May 3, 1995, Harris telephoned the ATCC to set up an account to 

order Yersinia pestis. He had previously told co-workers he wanted the pestis 

to carry out defensive research. He used a state laboratory license number of 

a scientific company where he worked and a homemade letterhead on which 

to print the request.24 On May 5, 1995, Harris ordered three vials of Yersinia 

pestis. On May 9, the vials were shipped. But on May 10, Harris grew 

impatient and called the ATCC. The astute technician at the ATCC sensed 

something unusual about Harris’ mannerisms and notified the CDC. The 

CDC contacted Harris who stated “he was conducting biomedical research 

using rats to counteract an imminent invasion from Iraq of supergermcarrying rats.”25 The ATCC contacted Ohio public health officials who 

contacted the police. Harris was arrested and the Yersinia pestis retrieved. 

Harris pled guilty to one count of wire fraud since no laws existed concerning 

illegal acquisition of biological agents at the time. While the maximum 

penalty was six months incarceration and a $25,000 fine, Judge Joseph 

Kinneary placed Harris on probation for 18 months, ordered to him complete 

200 hours community service and fined him $50.26

In February 1998, Harris’ probation officer granted him permission to 

take a trip to Las Vegas to promote his book and video. Harris also wanted to 

test a device purportedly capable of destroying bacteria and viruses in and 

outside of the human body made by another unorthodox researcher. Upon 

arrival, Harris told this researcher he intended to test the device using 

military-grade anthrax. The unorthodox researcher got uneasy and notified 

the FBI.

 

27 
8

On Feb. 18, 1998, federal agents arrested Harris because he claimed he 

had enough military-grade anthrax to wipe out all of Las Vegas. Further 

analysis determined the vaccine to be a harmless strain.28 A judge found 

probable cause that Harris threatened to possess a biological agent and 

misrepresented his credentials by claiming CIA affiliation. While Harris 

could have been sentenced to nine months in jail, Judge Kinneary was once 

again lenient and simply extended Harris’ probation by five months and 

added 50 hours community service. Harris repeated “his only purpose in both 

the 1995 and 1998 cases had been to protect America against the threat of 

biological terrorism.”29

Items of Interest—Where our Prevention and Response Actions Failed

Today many of our first responders have the capability and training to 

rapidly analyze certain biological agents on-site. However, in 1995 and 1998, 

this technology and training was not readily available. For example, in 

response to the 1995 Yersinia pestis incident: 

Public health officials involved in the case claim that it made them realize 

how poorly prepared they were for a bioterrorist incident. The Lancaster Fire 

Department had no equipment for dealing with hazardous materials, so the 

Columbus Fire Department had to be called in. Yet the firefighters were 

trained to deal only with industrial hazards, not terrorist incidents. Biological 

terrorism seemed so improbable at the time that one public health official had 

difficulty persuading a colleague that his call reporting the incident was not a 

joke.30

Additionally, during the Las Vegas incident caused by Harris, the Las Vegas 

Fire Department Hazardous Materials (HAZMAT) Team, and the FBI 

Weapons-of-Mass-Destruction team, the Nellis AFB Explosive Ordnance 

Disposal Unit, and the U.S. Army Biological Team from Dugway Proving 

Ground were all summoned to the scene. The mass of experts proceeded to 

secure all materials possibly containing suspected anthrax, including a 

Mercedes wrapped completely in saran wrap, and transport them to Nellis 

AFB where they were shipped to U.S. Army Medical Research Institute of 

Infectious Disease (USAMRIID), Fort Detrick, Md., for analysis.31 This 

incident demonstrates the dire need for training in appropriate HAZMAT 

response, forensic evidence collection, and the requirement for on-the-spot, 

immediate biological agent identification.
9

Due to the ease in which he acquired Yersinia pestis, Larry Wayne 

Harris was also the motivation behind establishment of the Select Agent 

Program to control the distribution of 24 infectious agents and 12 toxins. The 

details of this program are discussed further in Chapter Four of this paper.

Finally, Larry Harris’ arrests and subsequent lax punishments 

demonstrate the need for more severe laws to deter those who may consider 

such actions. The laxity in the legal system regarding biological agent 

possession was further strengthened by the Uniting and Strengthening 

America by Providing Appropriate Tools Required to Intercept and 

Obstruct Terrorism Act (USA PATRIOT Act) of 2001, which is also further 

described in Chapter Four of this paper. However, these Select Agent 

Program controls and USA PATRIOT Act legal penalties may not be as 

global as necessary to prevent acquisition and use of biological agents by 

groups who desire to harm our troops stationed overseas, as demonstrated by 

the Aum Shinrikyo and their attack on U.S. Navy installations at Yokohama 

and the headquarters of the Navy’s Seventh Fleet at Yokosuka.

Aum Shinrikyo

On March 20, 1995, the Aum Shinrikyo Japanese religious cult gained 

world recognition with its sarin gas attack on a Tokyo subway. The Tokyo 

attack killed 12 and caused over 5,000 to seek medical attention.32 Japanese 

authorities estimate of these 5,000 victims, 73.9 percent were “worried well,” 

showing no evidence of actual nerve exposure.33 Prior to this attack, the 

Aum Shinrikyo tried several unsuccessful attacks on several locations, 

including U.S. installations overseas, using biological agents.

Cult Overview

Shoko Asahara (aka, Chizuo Matsumoto), a Buddhist and selfproclaimed messiah, established the Aum Shinrikyo cult between 1984 and 

1987.34 The cult was founded on the belief Armageddon was inevitable and 

only devout believers in Aum Shinrikyo would survive.35 The cult grew to 

an organization of 40,000 people worldwide,36 with dozens in the United 

States, acquiring assets estimated by some at over one billion dollars.37 

While the cult sought multiple means to ultimately achieve Armageddon by 
10

prompting a war between the United States and Russia, one near-term goal 

was the disruption of the Japanese government. 

Recruitment of highly skilled, well educated people into the cult was not 

a difficult task. “Many of those attracted to Asahara’s promise of spiritual 

enlightenment were scientists, medical doctors and engineers from Japan’s 

top schools. A surprising number of highly educated young people were 

enthralled by Aum’s dramatic claims to supernatural power, its vision of an 

apocalyptic future, and its esoteric spiritualism.”38 Asahara also recruited 

heavily and obtained many of his weapons and scientific assistance from 

Russia.39 Thus, Asahara obtained the potential technical capability to 

manufacture both chemical and biological weapons for his terrorist activities.

Biological Agent Acquisition and Dissemination

Dr. Seiichi Endo was the lead Aum microbiologist and bioweapon 

specialist. At the age of 28, he left Kyoto University with a Ph.D. in 

molecular biology to join the Aum cult. He had considerable background in 

genetic engineering.40

Dr. Endo established the facilities and infrastructure needed to conduct 

in-depth research and development of biological weapons. He downloaded 

the entire Protein Data Bank from the Brookhaven National Laboratory in 

New York. This databank has information on more than 3,000 proteins, 

some useful in developing biological agents for weaponization.

 This man was the primary biological agent subject 

matter expert for Aum Shinrikyo. 

41 The cult 

also obtained much of its millions of dollars worth of equipment and supplies 

from the United States through a Silicon Valley shipping agent.42

Dr. Endo led the cult to obtain, develop and experiment with the 

dissemination of multiple agents, including anthrax, botulinum, Q-fever and 

Ebola. “A large Aum medical mission to Zaire in 1992, purportedly to help 

treat Ebola victims, led investigators to suspect the cult was attempting to 

obtain Ebola virus for culturing in Japan.”

 

43 Additionally, cult members 

prepared large quantities of Clostridium difficile bacterial spores they 

obtained through the mail from an advertisement in a Japanese medical 

journal.

44,45 This type of botulism produces a toxin which causes diarrhea 

and inflammation of the colon. The related Botulinus toxin A is a highly 

poisonous neurotoxin and can kill a person within 18-36 hours after sufficient 

exposure.46 
11

The cult also produced anthrax spores distributed by means of a steam 

generator at the top of the Aum Shinrikyo building in Tokyo in June 1993. 

The cult attempted 10 times between 1990 and 1995 to spread botulinum 

toxin and anthrax in Tokyo and Yokohama.47,48 These attacks included the 

U.S. Navy installation at Yokohama and the headquarters of the Navy’s 

Seventh Fleet at Yokosuka.49

Despite possessing the resources and apparent technical knowledge to 

produce deadly biological weapons, Aum Shinrikyo failed to sicken or kill 

thousands because the strains of agents used were non-lethal or their 

dissemination techniques were ineffective.

 

50 Botulinum toxins are extremely 

difficult to purify, are unstable in pure form, and degrade rapidly when 

exposed to air and sunlight. “These factors led scientists in the U.S. 

biological weapons program to discard botulinum toxins from their 

arsenal.”51 Additionally, Dr. Endo attempted to isolate his botulinum bacteria 

from soil. His training was as a molecular biologist, not a microbiologist, and 

thus he may not have understood the extreme difficulties in enriching an 

environmental sample of botulinum bacteria.52

The Aum’s attacks may have also failed due to inadequacy of 

dissemination methods and hostile atmospheric conditions. Dr. Endo settled 

on a liquid slurry to disseminate anthrax, versus a more difficult to obtain, yet 

potentially more stable, powder form. His ineffectiveness in distribution of 

the slurry may have been related to the material settling to the bottom of the 

sprayer. Additionally, sunlight may have destroyed the viable bacteria or 

degraded the toxin. Finally, wind conditions may have caused the aerosols to 

disintegrate or simply not disperse the biological material. Since many of the 

attacks occurred during Tokyo’s warm spring and summer months with 

strong sunlight, the environment may play some blame in the failure in Aum 

Shinrikyo’s attacks.

 

Items of Interest—Where our Prevention Failed

In April 1990, cult personnel used a vehicle equipped with a sprayer to 

disperse botulism toxin near the Yokosuka naval base and the headquarters of 

the U.S. Navy’s Seventh Fleet. According to open source literature, this 

attack was not detected. While it is likely the toxin degraded before contact 

and had no effect on the intended target, it is not published whether the Naval 

installations maintained stand-off detectors for perimeter monitoring of low 

levels of airborne toxins, chemicals or biological agents which may have 
12

impacted our overseas personnel. Nevertheless, this event highlights the need 

for perimeter monitoring, even in seemingly peaceful locations.

The experience of the Aum Shinrikyo cult demonstrates, despite 

excellent technical expertise, suitable laboratory equipment, and seemingly 

limitless funding, large scale biological weapon dissemination is not a simple 

task. However, dissemination of biological agents inside a closed space 

targeting smaller numbers of people can be achieved by even one well-trained 

individual, as was demonstrated by the 2001 anthrax letter attacks.

2001Anthrax Letters 

“Amerithrax”

The New York Times reported Oct. 5, 2001, “A 63-year-old Florida man 

has contracted pulmonary anthrax and has been hospitalized with the 

infection, health officials said yesterday. But, the officials said, there is no 

evidence that the man's disease was caused by a terrorist attack and there is 

no public health risk. ‘It is an isolated case...’”53 This man died on Oct. 6, 

2001, five days after being hospitalized for the disease. At the time, it was 

assumed he had been exposed to anthrax through natural causes. 

Event Description

In the initial attack on Sept. 18, 2001, letters are believed to have been 

mailed to four New York City addresses at ABC News, CBS News, NBC 

News, and the New York Post, as well as to the National Enquirer at 

American Media in Boca Raton, Fla. Only the letters sent to the New York 

Post and Tom Brokaw (NBC) were recovered. In the second attack on Oct. 

9, 2001, two additional letters were sent to Senators Tom Daschle and Patrick 

Leahy in Washington D.C. The Daschle and Leahy letters contained a more 

potent form of anthrax. The anthrax mailings contaminated the Hamilton, 

N.J., postal facility and the Brentwood postal facility in Washington D.C., the 

latter resulting in suspected contamination of many government offices. The 

anthrax letters caused 22 people to contract the disease and five deaths.54

Based on the properties of the anthrax, the FBI and others believed these 

spores to be of weapons grade. Anthrax prepared for weaponized 
13

dissemination is coated with silica to prevent clumping, enhance 

aerosolization and thus improve the efficiency of attack. “Homeland Security 

Director Tom Ridge in a White House press conference on Nov. 7, 2001, 

told reporters tests indicated a binding agent had been used in making the 

anthrax. Later, the FBI claimed a ‘lone individual’ could have weaponized 

anthrax spores for as little as $2,500, using a makeshift basement 

laboratory.”55

Dr. Paul Keim, a geneticist at Northern Arizona University, was called in 

by the FBI to produce a genetic fingerprint of the anthrax used in the attack, 

in an attempt to determine the origin. Dr. Keim examined short pieces of 

repetitive deoxyribonucleic acid (DNA) sequences to compare one strain of 

anthrax to another. He looked for variable-number tandem repeats (VNTRs) 

or regions in which a short stretch of DNA repeated, a sort of genetic 

fingerprint. Scientists then could classify anthrax strains into five different 

groups.56

The anthrax used in the letter attacks appeared to lack a uniform genetic 

makeup, complicating a match to one of the genetic “fingerprints.” Thus, 

further research over the years following the attack culminated in 2008, with 

the identification of four specific mutations in the original B. anthracis Ames 

strain found in the letters. Tests were developed to sample for these four, 

very specific mutations. Over 1,000 samples of B. anthracis collected from 

government and university laboratories across the United States, Canada, 

Sweden and the United Kingdom were run against these tests. Only eight 

samples showed all four mutations.

 

57 All eight of these samples “were 

directly related to a large flask of spores, identified as RMR-1029, which 

[Bruce] Ivins had created in 1997 and of which he was the sole custodian.”58

Bruce Ivins was a microbiologist at USAMRIID for 28 years. In 2000, 

production problems plagued the Army’s anthrax vaccine program, and thus 

Ivins began to experience high levels of stress. He became emotionally 

distraught and engaged in group counseling. Following the 2001 September 

11th attacks, he was reported to be “an absolute manic basket case” by coworkers.

 

59

Following the Anthrax letter attacks, the USAMRIID laboratory received 

a surge of resources. Ivins enthusiastically assisted the Army’s anthrax 

vaccine program to put back on track. And, as the investigation into the letter 

incident continued, Ivins provided samples and support as requested. 

 Laboratory records show that in September and October of 2001, 

Ivins worked much later than usual. 
14

On July 29, 2008, Bruce E. Ivins committed suicide. He had been 

notified federal authorities were preparing to file criminal charges against him 

in connection with the 2001 anthrax letter attacks. 60 Some suspect Ivins, 

who was a co-inventor and patent holder for an anthrax vaccine, would have 

realized significant financial gains with the rise in vaccinations and interest in 

anthrax research following the anthrax attacks.61

Items of Interest—Where our Prevention and Response Actions Failed

As the nation reacted to this event, people timidly retrieved mail from 

mailboxes, and frequently discarded it unopened or called fire departments 

and other emergency response teams fearing what may be inside. Hundreds 

of “suspicious letters” were painstakingly analyzed and found to be harmless. 

First responders and others spent countless hours and resources responding to 

the hysteria following these attacks, demonstrating the severe lack of 

transparent communication of the potential danger and sensitivity of the 

American people to terrorist action. The extensive and long-term 

consequence management activities which were undertaken in the months to 

years following the initial incident demonstrate both adequate and inadequate 

response, detection and decontamination capabilities. 

While hospital personnel were able to rapidly distribute treatment and 

prophylaxis and clean-up crews were able to successfully decontaminate 

buildings, it could be argued future response to a similar incident should 

realize dramatic improvement. The financial costs were very high, one FBI 

report estimating damages over $1 billion. The Brentwood facility alone cost 

$130 million and took 26 months to clean up, and many other government 

buildings required decontamination. It was over three years after the attack 

before the American Media building began decontamination activities.62

This event also demonstrates the dire need for enhanced forensic 

detection capabilities. It took almost seven years before evidence clearly 

pointed the finger at Bruce Ivins. However, some believe the real perpetrator 

of the 2001 Anthrax letter attacks is yet to be found. Dr. Ivins’ lawyer and 

others claim that the FBI’s constant harassment drove Ivins into a deep 

depression, which resulted in his suicide.

 

Despite these shortcomings, the Anthrax letter incident spurred additional 

emergency response training and the passage of the Project Bioshield Act to 

supply vaccine and drug treatment to protect against future bio-terrorist 

actions (discussed further in Chapter Five). 

63 It is also unclear why or how the 
15

FBI ruled out the other eight laboratories where the same anthrax was 

found.64

In 2005, the Washington Post stated, “The anthrax attacks killed five 

people, infected several others, paralyzed the United States with fear and 

shaped the nation’s bioterrorism policy.”

 Finally, the FBI failed to present any physical evidence directly 

implicating Bruce Ivins. Clearly, forensic techniques to determine the source 

of highly complex biological agents need to be enhanced if perpetrators of 

future biological agent attacks are to be quickly identified.

65 In order to determine what 

valuable insights were gained from these events, points of focus to influence 

prevention, recovery, and response strategies and policies will be examined in 

Chapter 5.
16
17

Chapter 3

National Exercise Program and Lessons Learned 

2000 - 2005

There are no failures—just experiences and your reactions to them.

Tom Krause

International Motivational Speaker

“I was honored to play the part of the President in the exercise Dark 

Winter... You often don’t know what you don’t know until you’ve been 

tested. And it’s a lucky thing for the United States that... ‘this is just a test, 

this is not a real emergency.’ But Mr. Chairman, our lack of preparation is a 

real emergency.” This is a quote from the Honorable Sam Nunn in his 

testimony before the House Government Reform Committee, Subcommittee 

on National Security, July 23, 2001, following his participation in Dark 

Winter, an exercise testing the national response to a simulated biological 

weapons attack.66

There have been five National Exercises since 2000, however only three 

of these exercises included a simulated release of a biological agent. These 

National Exercises are referred to as “Top Official” or “TOPOFF” exercises 

because they engage participation from all levels of government. In addition 

to these three National Exercises, Dark Winter was an exercise that tested 

strategic level responses. Dark Winter was not considered a National 

Exercise, but did test the predicted response of the National Security Council 

reaction to a smallpox attack on the United States.

 Exercises serve as a training venue, a test of local 

capabilities, and an opportunity to examine preparedness, status of 

appropriate resources and abilities of personnel. National exercises engage 

government officials and agencies, and test strategic level changes in our 

national emergency response structure and capability. 

The participants and observers of these National Exercises recorded 

lessons learned to enable everyone, including the top officials, the emergency 
18

management workers and the hospital employees, to gain information and 

improve future emergency response and consequence-management activities. 

It is important to note each of the four exercises elucidated similar 

shortcomings in the areas of treatment distribution plans, information storage 

and dissemination, public communication, and overwhelmed hospitals and 

emergency response staff. What follows in this chapter is a very brief 

description of the exercise followed by lessons learned from the response 

actions taken to each biological agent. 

TOPOFF 1

May 2000, Denver, Colo.

TOPOFF 1 was the first National Exercise which involved a response to 

a simulated chemical attack in Portsmouth, N.H., and a simulated biological 

attack in Denver, Colo. This exercise was conducted by the Department of 

Justice, the Department of State and the Federal Emergency Management 

Agency (note: the Department of Homeland Security did not exist at this 

time).67 

Exercise Description

The event began with a simulated aerosol release of Yersinia pestis, or 

plague bacteria, on the city of Denver, Colo., on May 17, 2000. Exercise play 

began on May 20, as 500 sick people inundated local hospitals. Players in 

this exercise included the state and county health agencies, the Centers for 

Disease Control (CDC), the Office of Emergency Preparedness, elements of 

the Public Health Service and three hospitals in the Denver area. By the end 

of the exercise on day four, hospitals are understaffed, there are insufficient 

antibiotics and beds for the demand, and there are an estimated 3,700 cases of 

pneumonic plague with 950 deaths.68

Items of Interest—Lessons Learned

Leadership and Role of Authorities. Leadership and roles during 

the exercise were uncertain. Because the Colorado governor did not actually 

participate, decisions were made by the governor’s Emergency Epidemic 

Response Committee. It was suspected some decisions made by the 

committee would have been different if political ramifications had been 

considered. For instance, the committee discussed closing the state borders 
19

and engaging quarantine without appropriate analysis of the consequences, 

like how to feed the quarantined population.69

First Meeting by Emergency Response Organizations. The exercise 

was the first venue of which many personnel met from emergency response 

organizations in Colorado. While it would have been optimal for these 

organizations to have had contact and planning meetings previously, the 

TOPOFF exercise at the very least provided an opportunity to meet and 

further demonstrated the need to meet frequently. The first time a real-world 

event occurs should not be the first time the lead of one organization meets 

the lead of another. During this TOPOFF exercise, “the roles, authorities, and 

even the identities of those participating in the calls, as well as the leadership 

of and agendas for the calls, were unclear.”70 Had prior meetings occurred 

during “peacetime,” many of these difficulties would have been resolved.

Poor Flow of Information. During the exercise, injects were provided 

detailing the number of sick and dead at each of the hospitals. It was widely 

agreed that with the databases and communication capability at the time, it 

was unlikely such efficient communication among hospitals and health 

departments would have been possible, especially tracking epidemiological 

information. “Without rapid access to this information and other data, 

decision-makers would have been even more ill positioned to make important 

decisions, such as how and when to distribute antibiotics, make 

recommendations for containment measures, or communicate public 

education messages.”71

Disease Identification. Laboratory diagnostics were not actually 

accomplished during the exercise. A photo of the plague bacilli was provided 

to a laboratory technician, who sent information to the state laboratory.72 

During the exercise, disease identification occurred much more rapidly and 

accurately than would likely have been the case in a real-world situation. 

Rapid and accurate disease identification is important with regards to 

treatment options and predicting the rate of spread of the disease.

Lack of Treatment Distribution Plan. This exercise demonstrated the 

need for a pre-established therapeutic priority and distribution plan. No plan 

to distribute limited medications, and no plan for who should get it first was 
20

in place, thus complicated decisions had to be made on the fly. Additionally, 

material from the National Pharmaceutical Stockpile (NPS, later called the 

Strategic National Stockpile) was requested and delivered. However, because 

the state had little prior experience with an NPS shipment, a single individual 

was given the responsibility for counting individual pills for each of the 

simulated 16 hospitals expecting antibiotics. Finally, after deciding to 

distribute antibiotics through “points of distribution” or PODs, the exercise 

participants quickly realized they had no logistical plans or sufficient 

personnel to support the PODs or means of tracking drug distribution. This 

inefficiency resulted in an abysmal rate of 140 people treated per hour... for a 

city of 1 million.73

Disease Containment and Quarantine. During the exercise, it was 

decided containment measures should be taken to control the spread of the 

disease. Initially only patient isolation, then travel restrictions were enacted. 

Later, the governor’s Emergency Epidemic Response Committee discussed 

closing the state borders and the Denver International Airport, and enacting 

quarantine. No consideration was made to the issue of feeding the 

population, nor how this quarantine would be enforced.74

Public Communication. Much time was spent during the exercise 

determining how to craft a message for the public. Discussions centered on 

what information should be provided concerning the disease, potential 

terrorist actions, and number of sick and dead. It was unclear to the 

participants the legal rights of the public, the impact public communication 

would have on inducing or reducing panic, or how clear communication 

would influence the control of the epidemic.75 This confusion demonstrates 

the need for prepared information, leaflets or handouts, concerning each 

major bioterrorist disease-causing agent, and a thorough discussion by top 

officials as to what should be communicated and when.
21

TOPOFF 2

May 2003, Chicago, Ill.

TOPOFF 2 was the first major exercise led by the newly formed 

Department of Homeland Security (DHS) following the events of Sept. 11, 

2001 and the Amerithrax attacks that followed. This exercise was the first 

opportunity for DHS to exercise the Homeland Security Advisory System 

(HSAS) and included a radiological dispersal device attack on Seattle and a 

plague release in Chicago.76 

Exercise Description

On May 12, 2003, Chicago hospitals reported an increase in common 

illness. During the exercise, 64 hospitals in Illinois participated, the largest 

mass casualty exercise ever undertaken. The exercise progressed for three 

days. In the end, exhausted and over-extended staff at hospitals and the State 

Department of Health demonstrated the limits on adequate functioning and 

ability to provide services over an extended period of time.77

Items of Interest—Lessons Learned

Lack of Treatment Distribution Plan. As noted in TOPOFF 1, there 

was no established prophylaxis distribution plan in place. Inconsistent 

information was provided to the public as to who should seek treatments, 

when and where.78 Additionally, there was confusion as to who had the 

authority in the state to request supplies from the Strategic National Stockpile 

(SNS) which resulted in a bureaucratic delay in vital medical supply 

delivery.79 

Communication Difficulties. The lack of a robust communications 

infrastructure was apparent during the exercise. At one location, the 

participants relied on HAM radio operators for connectivity.

Collection of Information to Common Database. “Information was 

often copied manually to a form. The form was then faxed (in some cases 

degrading its readability) to a collection point, where it was manually 

tabulated on another form, and then entered into an information system for 

transmission.”80 This exercise highlighted the need for a centralized database 

for rapid and accurate information collection.
22

Public Communication. Similar to TOPOFF 1, no consistent message 

was crafted prior to the exercise regarding terrorist dispersal of the plague 

bacteria. The exercise evaluators commented that a consistent message to the 

public from the command structure, public health and medical responders is 

critical to general public education.81 

TOPOFF 3

April 2005, New Jersey

TOPOFF 3 was the first test of the National Response Plan (NRP) and 

National Incident Management System (NIMS). This exercise included a 

chemical attack in Connecticut and a biological attack in New Jersey.82

Exercise Description

TOPOFF 3 was a totally scripted exercise in which the participants 

were alerted to the biological agent to be employed more than a week before 

the exercise began. Some criticize that this resulted in a “laser-like” reaction 

and response, and lacked a sense of true chaos.83 Nevertheless, in the 

scenario it was stated that a vehicle traveling through Union and Middlesex 

Counties released aerosolized pneumonic plague, and a few days later, 

hospitals were inundated with the sick. The primary test of this exercise was 

the operability of the Points of Dispensing (PODs) in three New Jersey 

counties: Middlesex, Monmouth and Union. The principle purpose of a POD 

was to dispense medications, educational materials, and to support the 

“worried well” and those who may actually have been infected. 

Items of Interest—Lessons Learned

Lack of Prior Planning for POD Activities. In general, activities in two 

of the PODs, Middlesex and Union, were not well thought-out. Issues such 

as what protective mask should be worn by workers, what security was 

needed, manpower requirements, and what records should be kept, plagued 

the operations of the PODs. The Union County POD could only distribute 

about 1,000 drugs dosages in a four-hour period, and Middlesex County, 

officials could treat only about 500 people. However, in Monmouth County, 

the POD was able to provide medications to 67,000 people, 10 percent of the 
23

county, in four hours. The Monmouth County POD adopted a “Point of 

Distribution” model in which it provided medication to a few people who 

then went out to redistribute these medications to others. It used a 

preprogrammed database to aid distribution activities. And, the team was 

well trained and well equipped for the exercise.84 This exercise was 

beneficial in providing clear proof that a Point of Distribution model of a 

POD is far more effective that a single Point of Dispensing. 

Inefficiency in Record Keeping. Exercise evaluators commented that 

attempts to maintain records at two PODs resulted in major inefficiencies and 

recommended records not be kept. However, at the Monmouth POD, most of 

the potential recipient’s information was preprogrammed in a computerized 

records system, resulting in highly efficient drug distribution. Evaluators 

criticized this preprogramming, stating “during a real event, this type of 

command and control would not be possible, unless there was a consistently 

updated list or lists of people who are in the computer database.”85 However, 

the results of this exercise demonstrated that, with some effort, it is possible 

to maintain a current database of residents. While this may appear to some as 

a “big brother watching us” sort of database, some of our privacy may have to 

be given up in order to ensure the most rapid distribution of treatment in the 

event of a bioterrorist incident. 

Pre-printed Information. Apparently, the week’s advanced notice 

gave volunteers at the PODs an opportunity to prepare information in a clear, 

concise and detailed manner. Exercise evaluators criticized the use of preprinted, professionally designed, information for public distribution. But, 

shouldn’t this be how we run real-world events? The military takes great 

pains to develop Concept Plans or Contingency Plans (CONPLAN) and puts 

them on the shelf, only to be brushed off in the event the specific contingency 

arises. Similarly, POD operators should have CONPLANs written with 

supporting documentation prepared, printed and shelved for the most likely 

bioterrorist or natural events which may occur in their jurisdiction. 

Public Communication—Giuliani Model. During the recovery in 

New York City following the Sept. 11, 2001, attacks, former Mayor Rudy 

Giuliani demonstrated what some say was heroic leadership. Mayor Giuliani 

was visible, composed and vocal during all of his frequent communication 
24

with the public. He was consistently reassuring and communicated specific 

plans for orderly and safe evacuation and recovery.86

During the TOPOFF 3 exercise, a Virtual News Network (VNN) 

provided public communication. The VNN simply provided interviews with 

VNN reporters in the field, with little sense of urgency or information 

regarding the crisis. “Providing timely, relevant and accurate information to 

the public can reduce confusion, provide good reasons for specific courses of 

action taken by the federal and state government, and provide the public with 

an explanation of the nature of the release, where to obtain needed 

medications and how to use them.”87 The exercise examiners recommended 

employing the “Giuliani model” of telling the public exactly what is 

happening, how bad the situation is, what the government is doing about it 

and what the public should do.88 Essentially, a more well-informed public is 

a more resilient public.

Dark Winter

June 2001, Andrews AFB, Md.

Dark Winter was a table-top exercise which involved a covert smallpox 

attack in three shopping malls in Oklahoma City, Philadelphia and Atlanta. 

The exercise aimed to examine the challenges faced by senior leaders in the 

event of a wide-spread bioterrorist incident.89 The senior leaders had to 

respond to a scenario which involved an initial infection of 3,000 people, 

followed by the subsequent infection of thousands of others.

Exercise Description

The Dark Winter exercise progressed as a series of power-point 

charts, incorporating decisions made into the evolving exercise. The 12 

participants portrayed members of the National Security Council, each of 

whom either currently serves or had served in a high-level government or 

military position. 
25

Items of Interest—Lessons Learned

Government Organizational Structure Ineffective. Exercise 

evaluators noted major “fault lines” among local, state, and federal 

government organizations which impeded situational awareness and 

emergency response actions.90 Additionally, senior leaders were unfamiliar 

with the character of biological agents, their policy options and the potential 

consequences of actions taken in response to the bioterrorist incident.91 

No Surge Capacity in Healthcare and Public Health System. 

Exercise evaluators predicted that the limited surge capability would result in

hospitals being overwhelmed quickly, reducing or causing them to become 

inoperable.92 Additionally, it was noted there is no capacity or plan to deal 

with the “worried well” who will inundate the hospitals.93 

No Surge Capacity in Pharmaceutical and Vaccine Industry. The 

ability to quickly respond to an epidemic and provide the necessary 

therapeutics is thought to limit the ability to respond and curb the spread of 

disease.94 Thus, other options in the pharmaceutical and vaccine industry 

should be examined to determine stop-gap measures in the event of a 

bioterrorist attack.

Lack of Treatment Distribution Plan. This lack of surge capacity also 

forces decisions to be made as to who gets vaccinated, and, more importantly, 

who does not. During the exercise, participants realized there was no 

treatment distribution plan appropriate for the event. This exercise confirmed 

the need for the federal government to develop clear guidelines as to how to 

balance local, state, military, and other national pharmaceutical and 

vaccination priorities.95

Collection of Information to a Common Database. Decision-makers 

required information to clarify uncertainties during the exercise... and found 

this information was not always immediately at hand. Information such as 

the location of attacks, predicted size of an epidemic, the number of people 

exposed and ill, and the number of people vaccinated was not readily 

available.96 The exercise demonstrated a centralized database is needed for 

improved information flow across states during a national bioterrorist event. 
26

Public Communication. “The president and other leaders in Dark 

Winter recognized the importance of persuading their constituents that there 

was a fairness in the distribution of vaccine and other scarce resources, that 

the disease-containment measures were for the general good of society.”97

Examination of the lessons learned from these National Exercises 

allows us to gain additional valuable insights into planning, preparation, 

response and recovery areas which should be addressed in biological weapon 

deterrence strategies.

 

As with the TOPPFF exercises, a pre-prepared, clear, concise message to be 

provided to the public is essential in maintaining trust and confidence during 

a chaotic event.
27

Chapter 4

Points of Focus to Prevent, Respond to, and Recover 

from Biological Attack

The beaten path is secure and logical, 

but most opportunities lie in the deep, dark woods.

─Unknown

Resources and time which can be focused on prevention, response and 

recovery from a biological attack are not infinite. How can we best assure 

our limited resources are used appropriately? Through reflection on lessons 

learned from past incidents and exercises, and consideration of the processes 

required to achieve a successful biological attack, the points of focus to deter 

a biological attack with the most “bang for our buck” can be elucidated.

Operational prevention, response and recovery strategies should include 

both long-term and short-term goals. The long-term goals include the 

ultimate objective—international prevention of aggressive biological agent 

use. The short-term goals include the “stop-gap” measures to reduce 

vulnerabilities and make American society more resilient, while steps are 

taken toward the long-term goal. Both long-term and short-term goals require 

national resolve, planning, resources and time to achieve their objectives.

There are multiple steps in the process to conduct a successful biological 

weapons attack. Figure 1 displays a notional and logical progression from the 

formation of a terrorist organization through the attack, including post-event 

effects or consequences. Between each step of this progression lies an arrow 

leading to the next step. At these arrows, efforts should be focused to prevent 

a terrorist from reaching the next step. 
28

 

Figure 1 Notional Progression of Biological Attack

For instance, in order to manufacture or cultivate and weaponize a 

biological agent, a terrorist organization must seek subject matter experts who 

have the knowledge and ability to select not only an appropriate facility to 

conduct operations, but also to choose a country that will accept and turn a 

blind eye to, or be oblivious to a covert biological weapon production 

activity. From the case studies in Chapter 2, it is apparent that the Rajneesh 

Cult found an effective subject matter expert in Puja, who was able to 

successfully culture and disseminate salmonella. Conversely, the Aum 

Shinrikyo cult was not able to attract an expert with the essential scientific 
29

training to achieve the ends. An effective U.S. prevention strategy might 

focus on preventing subject matter experts from being hired by the highest 

terrorist bidder by offering those experts alternate, more profitable, 

employment opportunities. 

Next, this subject matter expert must know where and how to obtain the 

necessary supplies, materials, protective equipment, vaccines, antibiotics and 

biological agents. In all of the case studies examined in Chapter 2, the 

principal biological agent engineer was able to easily acquire the equipment 

and supplies required. A preventive strategy might focus on identifying who 

is purchasing these materials and supplies, enact tighter international controls, 

and thereby help prevent terrorists from obtaining the capability to 

manufacture biological agents. 

It is not enough to have an agent to have an effective attack. Most 

biological agents are sensitive to environmental conditions and mistreatment, 

as demonstrated by the failures of the Aum Shinrikyo cult. In order to ensure 

viability and adequate dispersal, attention to the weaponization of the 

biological agent must be considered by the terrorist-hired expert. Again, a 

counter-terrorist strategy could target hiring these biological weapons experts 

for better uses while, at the same time, providing constant close supervision 

of all work done in national laboratories.

The arrow running along the left side of Figure 1 shows a “short-cut” to 

bypass the need for an expert, and enable the terrorist organization to obtain a 

fully weaponized, ready-to-install, biological warfare agent. For example, 

Larry Harris obtained Yersinia pestis and the Rajneeshees obtained a few 

other pathogens from the ATCC by means of a simple fax and phone call. 

Regardless of whether a subject matter expert is employed through the entire 

weapons development continuum or if an agent is acquired directly, 

preventive measures can be developed to detect and/or prevent acquisition of 

these agents by terrorist groups.

If a terrorist group is able to successfully acquire and culture a biological 

weapon, and disperse it with effective viability, the consequences of such an 

event can be dramatically reduced by early detection and quick responses. 

For instance, if the Aum Shinrikyo dispersal of an agent near naval facilities 

in Japan had been detected, even though non-viable, this would have 

provided a wake-up call, and subsequent Aum Shinrikyo experimentation and 

potential attacks perhaps could have been prevented. Additionally, if sensors 

had been placed in the Brentwood mail distribution facility and had detected 
30

low levels of anthrax spores in October 2001, the subsequent exposure to 

hundreds of people and the contamination of other buildings may have been 

prevented. Thus, early detection can mitigate or eliminate devastation due to 

an attack, and may also assist emergency responders engaged in consequence 

management activities by letting them know early what biological agent they 

are dealing with.

After the attack, there are two concerns. First, responders like firemen, 

police and special response teams will be involved in the initial recovery and 

potentially long-term consequence-management activities. Second, the 

terrorist organization must assess whether goals for the attack have been 

achieved. In both concerns, U.S. activities to prepare, respond and recover 

may act as a deterrent to terrorist organizations considering a biological 

weapons attack on the United States. If the attack is ineffective due to the 

superior preparedness and resilience of the American people to withstand 

such an attack, then the terrorist’s goals will not be met. Yet, in all of the case 

studies presented (Aum Shinrikyo, Rajneesh, and Larry Wayne Harris) and 

the TOPOFF 1, 2, 3, and Dark Winter exercises, planning, response and 

recovery lacked the robustness needed to be an effective prevention strategy.

Finally, effective forensic techniques can be especially beneficial if they 

could rapidly determine the perpetrator of an attack (attribution). Again, the 

recent case studies of biological incidents, especially the anthrax letters 

attacks, demonstrate the current absence and need for the development of 

adequate forensic techniques and capabilities concerning biological agents.

Figure 1 pictures a notional progression from the formation of a terrorist 

organization through execution of a biological attack. At a number of places 

in this progression, strategies to interrupt and prevent biological weapon 

acquisition and use by adversaries can be focused. Figure 2 displays a 

sampling of suggested points of focus. 

These suggested points of focus include methods to achieve both longterm and short-term goals. The first three points of focus on Figure 2 are 

activities which should be accomplished at the national level through 

international agreements and global strategies. Action in these three points of 

focus will move us toward achieving our long-term biological weapon 

prevention strategies. The second two points of focus must be guided by 

national strategy, but include actions the states and local communities must 

undertake in order to achieve the short-term goals. In the following chapter, 

the corresponding initiatives to both these long-term and short-term goals 
31

present in the national and military strategies and programs driven by these 

strategies will be discussed. 

Figure 2 Points of Focus
32
33

Chapter 5

Evaluation of U.S. Policy

The Obama administration's new strategy for countering 

biological threats—both natural and man-made—rests 

upon the main principle of the Biological Weapons 

Convention: that the use of biological weapons is 

“repugnant to the conscience of mankind.”

─ Undersecretary of State Ellen O. Tauscher

Since the attacks at the World Trade Center (1993), Khobar Towers 

(1996), U.S. Embassies in East Africa (1998), the USS Cole (2000) and the 

Pentagon and World Trade Centers (2001), the United States has 

progressively reshaped national security and national military strategies. The 

most current National Security Strategy (NSS) was published in March 2006. 

Supporting this strategy are the National Strategy for Homeland Security 

(October 2007), National Strategy to Combat Weapons of Mass Destruction 

(December 2002), National Strategy for Combating Terrorism (September 

2006) and the National Defense Strategy (June 2008). 

The National Defense Strategy, June 2008, describes the military support 

to accomplish the plans set forth in the various national strategies. The 

military, too, has developed strategies to complement the overarching defense 

strategy of 2008. The National Military Strategy, 2004, the National Military 

Strategy to Combat Weapons of Mass Destruction, Feb. 13, 2006, and the 

National Military Strategic Plan for the War on Terrorism, Feb. 1, 2006, 

detail the methods the military will use to enable the national security 

deterrence strategy.

Specifically related to bioterrorism, President George W. Bush signed 

the Biodefense for the 21st Century Presidential Directive (Homeland Security 

Presidential Directive (HSPD)-10) in 2004.98 “President Bush has made 

strengthening the nation's defenses against biological weapons a critical 

national priority from the outset of the administration -- investing over $10 
34

billion since 2001. While significant progress has been made to protect 

America, President Bush instructed federal departments and agencies to 

review their efforts and find new and better ways to secure America from 

bioattacks.”99

An examination of the biological incidents and attacks of the Rajneesh 

Cult, Aum Shinrikyo Cult, perpetrator of the anthrax letters and of Larry 

Wayne Harris may provide insight as to what aspects of the NSS and National 

Defense Strategy, and their supporting strategies, will provide as effective 

deterrents to prevent biological weapons attacks. The Figure 1 presented in 

Chapter 4 pictured a notional progression from the formation of a terrorist 

organization through execution of a biological attack. At a number of places 

in this progression deterrence strategies can be focused. Figure 2 also 

presented in Chapter 4 displayed a sampling of suggested points of focus. In 

this chapter, the initiatives presented in the national and military strategies 

related to each of the six points of focus will be discussed:

 Most recently, President Barack Obama published the 

National Strategy for Countering Biological Threats, November 2009, 

reaffirming the concern the government still holds toward this threat. Each of

these strategies provides a strategic plan for the United States to protect and 

defend against the nation’s enemies and attacks they may perpetrate against 

us.

1. Provide Alternate Job Opportunities

2. Encourage or Assist Regional Partners

3. Prevent or Detect Acquisition

4. Detect Attacks

5. Prepare, Respond, Recover and Gather Forensics Information 

Current U.S. Policies and Initiatives

The number of policies and initiatives regarding weapons of mass 

destruction and terrorism is vast. However, when considering only the 

biological agent aspect of these policies, the list of the deterrence measures 

narrows. Table 1 presents the location in each strategy document which 

addresses the suggested points of focus identified in Figure 2. Page numbers 

are provided for reference. The paragraphs following Table 1 address some 

of the current national and military strategies and related initiatives 

corresponding to each point of focus.
35

Table 1. Points of Focus in National and Military Strategies NSS 2006 NSHS 2007 NS CbtWMD 2002 NS Cbt Terror 2006 NS Vs Bio Threats 2009 NDS 2008 NMS 2004 NMSP 2006

NMS CbtWMD 2006

Provide 

Alternate Job 

Opportunities

8-9, 

19-20

Encourage/Assis

t Regional 

Partners

8, 

18-23

2

4 

6

9-11 6-7, 

19-20

10-11 

15-16

2, 20 23

24

6-7, 

21

Prevent 

Acquisition

12, 

18-23

15 2

5

13-14 13-14

16

14-15 10, 

20

7, 

23

16-19

23-24

Detect Attacks 12, 

18-23

6, 15, 

29

6 14 6, 11 15 10 7 20

Prepare, 

Respond, 

Recover & 

Gather Forensics 

Info

12, 

18-23

6, 

29-40

2

5

14-15 6-7, 

15-17 

7, 15 18 7 16-19

26

Abbreviations: NSS – National Security Strategy, NSHS – National 

Strategy for Homeland Security, NS CbtWMD – National Strategy to 

Combat Weapons of Mass Destruction, NS Cbt Terror – National Strategy 

for Combating Terrorism, NS Vs Bio Threats – National Strategy for 

Countering Biological Threats, NDS – National Defense Strategy, NMS –

National Military Strategy, NMSP – National Military Strategic Plan for the 

War on Terrorism, NMS CbtWMD – National Military Strategy for 

Combating Weapons of Mass Destruction.
36

Provide Alternate Job Opportunities

“Anecdotal reports persist of former Soviet scientists, especially those 

in Central Asia and the Caucasus, being approached by officials from 

proliferant states. Further, a 2003 survey of Russian scientists with 

weapons expertise found that 20 percent of respondents would consider 

working in North Korea, Syria, Iran or Iraq for a year or more.”100

In 2006, the U.S. Department of State and the U.S. Agency for 

International Development published their fiscal year summary, which 

addressed the challenge of redirecting former Weapons of Mass Destruction 

(WMD) scientists to more peaceful programs. The report highlighted 

activities in the Office of Cooperative Threat Reduction of the U.S. 

Department of State regarding Iraqi and Libyan scientists through what is 

currently called the “Iraq Scientist Engagement Program” and the “Libya 

Scientist Engagement Program.”

 In each 

of the four incidents described in Chapter 2, the lead subject matter expert 

was critical in the development of an attack plan, determining the biological 

agent to be used, obtaining the necessary supplies, and manufacturing the 

organism for dissemination. If the subject matter experts were enticed to take 

peaceful positions of employment, it would make it more difficult for 

terrorists to use biological agents as weapons. 

101 These programs enable the redirection of 

former WMD scientists to civilian activities through the enhancement of 

scientific and economic development.102

Currently, the Nonproliferation of WMD Expertise (NWMDE), which 

consists of the Science Centers program, the Bio-Chem Redirection program, 

and the Bio Industry Initiative, aim to redirect former WMD scientists in 

order to reduce or eliminate this aspect of the bioterrorist continuum. The 

Science Centers program supports two international science and technology 

centers: The International Science and Technology Center (ISTC) in 

Moscow

 

103 and the Science and Technology Center in Ukraine.104

The National Strategy for Countering Biological Threats recognizes the 

efforts to redirect former WMD scientists through cooperative international 

 Both 

centers provide peaceful and sustainable employment opportunities to 

Russian and Commonwealth of Independent States (CIS) scientists 

possessing WMD knowledge and skills. 
37

partnerships, re-affirming the level of importance at which the current 

administration holds these programs. However, to attempt to control or hire 

all of the individuals with appropriate knowledge to conduct a biological 

weapons attack would be impossible. It is unclear if the United States really 

knows how many scientists and related technical people from former Iraqi 

WMD programs it should be concerned about, much more nebulous are the 

numbers of WMD-related scientists from Russia and the other former Soviet 

states.105 Thus, although this is an attractive means to halt or prevent an 

attack, it is not the most likely or efficient means.

Encourage/Assist Regional Partners

The 2006 National Security Strategy states that “meeting WMD 

proliferation challenges also requires effective international action – and 

the international community is most engaged in such action when the 

United States leads.”106 According to unclassified sources, approximately 

20 countries have the capability to manufacture biological weapons, including 

North Korea, China, Russia, Iran, Syria, Libya, India, Pakistan and the United 

States.107

A keystone to this involvement centers on the Biological and Toxin 

Weapons Convention. Engagement in this convention is highlighted in the 

2002 National Strategy to Combat WMD.

 Because most equipment, technology and materials for biological 

agent production are dual-use, for peace and war purposes, it is difficult to 

distinguish between offensive weapons research and development, and more 

peaceful intentions. Biological weapon proliferation is a global issue. Thus, 

it is vital for the United States to engage with the international community 

to prevent terrorist activities, including those that involve biological 

agents. 

108 The 1972 Convention on the 

Prohibition of the Development, Production and Stockpiling of 

Bacteriological (Biological) and Toxin Weapons and on their Destruction, 

also known as the Biological and Toxin Weapons Convention, went into 

effect March 1975. It included 103 co-signing nations, and 140 nations have 

now signed and ratified the convention. However, it contains no provisions 

for verification or enforcement.109 The United States has many programs 

countering proliferation of weapons of mass destruction, in general. 

However, countering the proliferation of biological warfare agents is 

problematic.
38

The 2002 National Strategy for Combating WMD also highlights the 

need to enhance traditional nonproliferation measures, such as diplomacy, 

arms control, multilateral agreements, threat reduction assistance and export 

controls in order to reduce the threat of attack with WMD.110 Additionally, 

the 2006 National Military Strategy for Combating WMD details “Strategic 

Enablers,” including deterrence, intelligence, partnership capacity and 

strategic communication support, which enhance the effectiveness of military 

capabilities for combating WMD.111 “The United States alone cannot 

eliminate this threat, nor can any other single institution or sector. Defeating 

the threat will take a concerted, collaborative and integrated international 

approach involving allied governments; law enforcement; the military; and 

the academic, medical, and scientific communities.”112

Encouraging or assisting regional partners may help to deter adversary 

biological agent production. However it will not completely solve problems 

presented by the terrorist use of biological agents. While it is a challenge to 

entice a country to give up or never obtain a biological weapon capability, it 

is even more difficult to identify and prevent a terrorist group from 

developing the same capability on a smaller scale. The Rajneesh cult, Larry 

Harris and likely the perpetrator of the anthrax letters did not use U.S. 

regional partners to develop their biological weapons. Thus, a focus on 

regional partners and engagement to develop stronger nonproliferation 

relationships is an important deterrent in a strategic policy, but may not be the 

most effective at deterring a small-scale terrorist use of biological agents in 

the United States. However, it is possible to prevent some terrorist groups 

from acquiring materials and expertise to develop biological weapons through 

international programs to eliminate national WMD expertise, materials and 

arms.

Prevent Acquisition

After Larry Harris’ arrest, the CDC took measures to safeguard 24 

infectious agents and 12 toxins which pose a significant risk to human health. 

Prior to this incident, the Rajneesh cult obtained the agents on which it 

experimented, and Iraq obtained some of its lethal strains of anthrax, 

tularemia and Venezuelan equine encephalitis from the ATCC. Shippers and 

receivers of these identified agents must now register with the CDC.113 The 

safeguarding measures, known as the Select Agent Program, became law on 

June 12, 2002, when President Bush signed the “Public Health Security and 
39

Bioterrorism Preparedness Response Act of 2002.”114 The Select Agent 

Program requires registration of facilities including government agencies, 

universities, research institutions and commercial entities that possess 

biological agents or toxins deemed a threat to public, animal or plant 

health.115

When Larry Harris was arrested, the most severe punishment for his 

possession and expressed desire to use a biological agent as a weapon was 

wire fraud. The USA PATRIOT Act of 2001 was the first law to put 

restrictions on persons who possess select agents and provides criminal 

penalties for possessing such agents not justified for peaceful purposes. In 

addition, violation of the Public Health Security and Bioterrorism 

Preparedness Response Act can result in civil fines of $250,000 for individual 

or $500,000 for an entity and imprisonment of up to five years. 

 While this program makes agents more difficult to obtain, some 

may still seek them... and risk more severe penalties than in the past.

Further legal actions are addressed in the 2007 National Strategy for 

Homeland Security, the Intelligence Reform and Terrorism Prevention Act 

of 2004 and the Protect America Act of 2007 which promote security and 

implement portions of both the 9/11 Commission and the WMD 

Commission recommendations.116

Also, the National Security Strategy mentions the United States led 

the passage of the 2004 United Nations Security Council (UNSC) 

Resolution 1540, which requires nations to criminalize WMD proliferation 

and institute effective export controls.

 

117

The Select Agent Program has taken the necessary steps to eliminate the 

ease with which the Rajneesh cult, Iraq and Larry Harris obtained their 

biological agents, and the USA PATRIOT Act, and subsequent acts, have 

strengthened punishment against those who attempt to obtain biological 

materials for adverse acts. These two types of policy must be adopted by 

other countries in order to prevent and deter easy acquisition world-wide. 

However, if a terrorist group intends to use biological agents, many can be 

easily obtained and cultivated from natural sources. The growth and 

development of biological agents require specialized equipment and supplies 

and thus provide another indicator of an active biological program.

 Finally, the Military 

Commissions Act of 2006, allows captured terrorists to be tried for war 

crimes. The more severe penalties may prevent an individual or group from 

considering these agents as a weapon. 
40

The Aum Shinrikyo cult used a U.S. company to obtain and ship 

equipment and supplies. It was also assumed the cult had a chemical 

program based on the numbers of atropine injectors the cult had ordered.118

The nation’s nerve center for information sharing and domestic incident 

management is the Homeland Security Operations Center (HSOC). The 

HSOC collects and fuses information to deter, detect and prevent terrorist 

acts. The HSOC is divided into two halves: Intelligence and Law 

Enforcement. “The ‘Intelligence Side’ focuses on pieces of highly classified 

intelligence and how the information contributes to the current threat picture 

for any given area. The ‘Law Enforcement Side’ is dedicated to tracking the 

different enforcement activities across the country that may have a terrorist 

nexus.”

 

An integrated U.S. and international intelligence network which gathers data 

and tracks certain equipment and supply purchases may provide an early 

indication of the intentions of a terrorist group or cult. For instance, if a 

group or individual purchases a large amount of antibiotics or vaccines, 

intelligence efforts should have the capability to easily track and report these 

transactions for further examination.

119 The HSOC provides real-time situational awareness and 

monitoring, coordinates incident-response activities, and issues advisories and 

bulletins concerning threats to the United States120

Preventing acquisition and integrated intelligence are important foci of 

deterrence. While some critical steps have been taken in the United States to 

prevent acquisition of agents, more action should be taken worldwide. 

Additionally, more focus and funding should be provided to the intelligence 

agencies to enable them to better collect, integrate and interpret information 

to obtain a clear picture of biological weapon development and the intent of 

terrorist groups and others.

Detect Attacks

Detection of a bioterrorist attack should occur at the strategic and tactical 

levels. At the strategic level, detection of a terrorist organization’s plan and 

developing capability to use biological agents is a key to preventing such an 

event. At the tactical level, detection of the agent release is vital to rapid and 

effective response and consequence management activities.

On the strategic level, Argonne National Laboratory121 has developed 

two computer-based capabilities to aid in the identification of terrorist 

organizations and prediction of future actions. The Joint Threat Anticipation 
41

Center (JTAC) anticipates long-term threats to U.S. national security by 

integrating social science and technology. JTAC conducts research in areas 

of terrorist strategy and tactics, failed states, socio-cultural process and 

precursors to terrorism, and language studies.122

Complementary to the JTAC is NetBreaker. NetBreaker uses dynamic 

social network analysis and agent-based modeling with social network 

formation rules to find and model terrorist networks. Netbreaker’s simulation 

determines what a terrorist group can do, how it interacts and the probable 

threats from its network.

 

123

On the tactical level, detection of the release of an agent is critical to a 

rapid response to negate the harm done by a bioterrorist’s action. Aum 

Shinrikyo attempted biological attacks on Tokyo a number of times, yet these 

went undetected. If only one of these unsuccessful attacks had been detected, 

then appropriate antibiotics could have been administered (although in this 

case, they were not necessary) and actions could have been taken to prevent a 

future successful attack. Homeland Security Presidential Directive-21, Public 

Health and Medical Preparedness, states, “The United States must develop 

a nationwide, robust and integrated biosurveillance capability, with 

connections to international disease surveillance systems, in order to 

provide early warning and ongoing characterization of disease outbreaks 

in near real-time.”

 

124 In order to accomplish this edict, BioWatch is a 

Department of Homeland Security program, assisted by CDC and the 

Environmental Protection Agency (EPA), which performs 24x7 

environmental surveillance using the existing EPA and Department of Energy 

air quality monitoring systems. Air samples are tested as an early warning 

indicator of biological attacks.125 The BioWatch system has been 

successfully operating in more than 30 urban centers since early 2003.126

The Biological Warning and Incident Characterization (BWIC) is a 

support system integral to the DHS’ BioWatch program. BWIC integrates a 

number of diverse computer modeling programs and provides a common 

view of an event to emergency responders and critical agencies involved. 

BWIC includes Geographic Information System (GIS) maps, air dispersion 

models, population information, epidemiological tools, subway and facility 

models, and links to public health surveillance information. 127

The BioWatch system is an example of “detect to treat” defensive 

system. People have already been exposed to an agent when the system 

provides an alarm and triggers a response. A better capability is a “detect to 

 
42

warn” alarm system which would enable people to take shelter to avoid 

exposure. While many organizations conduct research in the area of 

biological detection, more attention should be focused on accurate and rapid 

detection. If an enemy cannot infect the desired target, there is no point to a 

biological attack—an effective deterrence-by-denial system.

However, if an enemy is successful in releasing an agent, enhanced 

situational awareness may be improved by another system under 

development at Argonne National Laboratory, the Integrated Chemical, 

Biological, Radiological, Nuclear and Explosives (ICBRNE) Detection 

System, is supported by the Department of Homeland Security’s Science and 

Technology Directorate. This integrates CBRNE sensor systems and 

supports regional capabilities to enable information sharing, enhance CBRNE 

detection, and improve situational awareness. The first phase of the program 

extends coverage to Chicago, Seattle, New York, Los Angeles and Boston.128

The 2006 National Security Strategy recognizes some bioterrorist events 

will not be detected through capabilities such as BioWatch, BWIC and 

ICBRNE; but instead may be discovered through epidemiological 

surveillance activities following people’s exposure to a biological agent. As 

the 2006 document states, “countering the spread of biological weapons 

requires a strategy focused on improving our capacity to detect and 

respond to biological attacks .... The United States is working with partner 

nations and institutions to strengthen global biosurveillance capabilities 

for early detection of suspicious outbreaks of disease.”

 

129

Also, in accordance with HSPD-21, Public Health and Medical 

Preparedness, the CDC BioSense System was established as an 

epidemiologic surveillance system for human health. This system allows 

for two-way information flow among federal, state, and local government 

public and clinical health care providers.

 To this end, the 

U.S. military utilizes the Electronic System for the Early Notification of 

Community-based Epidemics (ESSENCE). ESSENCE is a near-real-time 

global monitoring system to detect infectious disease outbreaks. 

ESSENCE monitors outpatient and pharmacy data on over 9.2 million 

military beneficiaries and reports alerts to local and state public health 

officials, the World Health Organization (WHO) and the CDC BioSense 

System. 

130 The CDC BioSense System 

tracks patients’ health complaints and symptoms to identify trends that 

may indicate an increase in disease rates, indicating a bioterrorist event. 
43

Emergency response personnel can then use the BioSense System to 

detect, track and respond more rapidly to disease outbreaks and enhance 

emergency response and consequence management activities.131 

However, this BioSense System has not yet been tested in a National 

Exercise to determine if it is capable of rapidly providing necessary 

information to decision-makers. Additionally no common database exists 

which can be shared within and across states to aid in response actions, 

drug distribution and public awareness.

Prepare, Respond, Recover and Gather Forensic Information

The 2006 National Security Strategy recognizes we may deter or 

dissuade terrorists from using biological agents if convinced they cannot 

achieve their goals. Thus, robust preparations to ensure a rapid and focused 

response may prevent any future need to use such a capability. With this in 

mind, the Department of Homeland Security was tasked by both the 2006 

National Strategy to Combating WMD and HSPD-5 to develop a plan to 

prepare, respond and recover from a WMD attack (Figure 3). Specifically, 

HSPD-5 directs the former Homeland Security Council to develop and 

administer a National Response Plan (NRP). “This plan shall integrate 

Federal Government domestic prevention, preparedness, response, and 

recovery plans into one all-discipline, all-hazards plan.”132

The National Response Plan was published in 2004 and revised in 

2006. In January 2008, the Department of Homeland Security published 

the National Response Framework (NRF) which supersedes the 

corresponding sections of the previously published National Response 

Plans.133 Chapter 3 of the NRF details specific response actions to 

respond to incidents, which includes three phases of effective response: 

prepare, respond and recover. This remainder of this section will describe 

these phases and discuss the additional need for forensics activities as they 

relate to the lessons learned from National Exercises and the four 

bioterrorist incidents described in Chapter 2 and 3 of this paper.
44

 

Figure 3 Phases of Effective Response Actions

Prepare. The NRF describes the six essential activities encompassing 

preparedness: plan, organize, train, equip, exercise, evaluate and 

improve.134

 

 These activities are displayed in the “Preparedness Cycle,” 

Figure 4.

Figure 4 The Preparedness Cycle135
45

Plan. The review of the TOPOFF exercises commented inadequate 

plans existed regarding distribution of limited medications. In TOPOFF 3, 

Points of Distribution (PODs) were established, however there were 

incomplete logistical or manpower plans for distribution of the 

medication. Planning “includes the collection and analysis of intelligence 

and information, as well as the development of policies, plans, procedures, 

mutual aid and assistance agreements, strategies, and other arrangements 

to perform missions and tasks. Planning also improves effectiveness by 

clearly defining required capabilities, shortening the time required to gain 

control of an incident and facilitating the rapid exchange of information 

about a situation.”136

Plans and the action of planning can be extremely complex 

undertakings. Thus, Argonne National Laboratory has developed a 

number of computer-based products to assist with the planning process. 

The first is the Synchronization Matrix Planning Process, a systems-based 

and problem-solving approach to emergency planning used to integrate 

emergency response plans across jurisdictions.

 The Integrated Planning System is the national 

system used to develop interagency and governmental plans. However, 

local emergency personnel must engage and develop plans which 

incorporate specific capabilities and resources to respond to a biological 

incident.

137

The second Argonne program to aid in the planning process is the 

Special Population Planner, or SPP.

 The Matrix is an 

interactive planning tool that allows the user to see a broad view of a 

response, visualizing the interactions that occur as the event progresses over 

time. The Matrix allows emergency managers to plan and practice 

interactions among agencies resulting in a more effective and coordinated 

emergency response. 

138

Planners should also consider the effects on the environment and 

potential alternate routes of biological agent distribution, such as drinking 

water distribution systems. Argonne’s Threat Ensemble Vulnerability 

 The SPP uses geographic 

information systems (GIS)-based software to aid in mapping communities, 

facilities and households where special-needs populations reside. Then the 

registry can be integrated in emergency response planning models to facilitate 

assistance of special needs individuals. The SPP is in use in six Alabama 

counties, enhancing emergency preparedness for 4,500 persons with special 

needs. 
46

Assessment (TEVA) simulates threats to drinking-water distribution 

infrastructure in order to analyze vulnerabilities, measure public health 

impacts, and aid in the design of threat-mitigation and emergency response 

strategies.139

Finally, Argonne’s Fort Future is a virtual installation which provides 

information to aid in the analysis of deployment requirements and the impact 

of disruptive events, such as a biological attack.

 

140 Fort Future integrates 

DTRA’s Hazard Prediction and Analysis Capability models to determine the 

contamination levels infiltrating buildings, thus enabling informed decisionmaking by commanders. Fort Future was developed for military 

applications; however it could be modified to model a local town or city to 

aid emergency managers in planning. 

Organize. “Organizing to execute response activities includes 

developing an overall organizational structure, strengthening leadership at 

each level, and assembling well-qualified teams of paid and volunteer staff 

for essential response and recovery tasks. The National Incident 

Management System (NIMS) provides standard command and 

management structures that apply to response. This common system 

enables responders from different jurisdictions and disciplines to work 

together to respond to incidents.”141 The concept of organizing is 

especially important when a prolonged situation causes healthcare workers 

and first responders to be over-extended. By considering the expected 

organization in a plan, potential shortages can be determined and plans 

modified accordingly.

Train. In 1995, when public health officials and fire department 

personnel responded to Larry Harris’ Yersinia pestis, few had trained or 

been educated regarding any biological agents. “Building essential 

response capabilities nationwide requires a systematic program to train 

individual teams and organizations – to include governmental, 

nongovernmental, private-sector, and voluntary organizations – to meet a 

common baseline of performance and certification standards.”142 Since 

Sept. 11, almost $3 billion in federal bioterrorism preparedness funding has 

been funneled to states.143 In 2002, the Department of Health and Human 

Services announced more than $1 billion in Federal bioterrorism 

preparedness grants. 144 These grants and funding opportunities, in 
47

combination with local and national exercises, have provided increased 

training and improved the skills of first responders and other hospital 

personnel.

Equip. After the covert attack conducted by Rajneesh cult members, 

Oregon hospitals were overwhelmed with sick and frightened people. A 

future terrorist may be even more successful in generating a mass casualty 

attack which taxes emergency responders, hospitals, and stockpiles of 

vaccines and antibiotics. “Effective preparedness requires jurisdictions to 

identify and have strategies to obtain and deploy major equipment, 

supplies, facilities and systems in sufficient quantities to perform assigned 

missions and tasks.”145

In 2004, President Bush signed legislation called Project BioShield as a 

new bioterrorism countermeasure. BioShield committed $5.593 billion over 

10 years.146 BioShield is a comprehensive effort to develop, stockpile and 

make available drugs and vaccines to protect against biological and chemical 

weapons attacks.147 The 2006 National Security Strategy and the 2007 

National Strategy for Homeland Security reaffirmed these initiatives to 

speed development of new vaccines and medical countermeasures against 

bioterrorist threats.148

In addition to vaccines and medical countermeasures, first responders 

also need protective gear, detection equipment and decontamination 

equipment in a quantity extensive enough for a predicted attack. These 

equipment requirements are called for in the 2007 National Strategy for 

Homeland Security.

 In short, BioShield provides incentives to 

pharmaceutical makers and biotechnology companies for development of 

medicines and vaccines to treat people exposed to bioterrorist agents. 

BioShield should strengthen research and development and enhance the 

ability to counter bioterrorism.

149 Additionally, HSPD-8, National Preparedness, 

requires caches of equipment be maintained at such levels as to meet the 

national preparedness goal.150 While it is of great benefit to possess these 

resources, they are of little use if personnel are not trained and 

experienced in their use. Exercises offer excellent opportunities to gain 

proficiency with novel bio-hazard response equipment.

Exercise. The 2007 National Strategy for Homeland Security

identified the establishment of the National Exercise Program to increase 
48

preparedness to respond to the consequences of terrorist attacks.151 

“Exercises provide opportunities to test plans and improve proficiency in a 

risk-free environment. Exercises assess and validate proficiency levels. 

They also clarify and familiarize personnel with roles and responsibilities. 

Well-designed exercises improve interagency coordination and 

communications, highlight capability gaps and identify opportunities for 

improvement.”152

The National Exercises detailed in Chapter 3 clearly show the 

capability gaps which exist, especially concerning the distribution of 

medical countermeasures. To assist Point of Dispensing operations in the 

future, the Community Vaccination and Mass Dispensing Model (CVMDM) 

developed by Argonne may prove useful in the execution of exercises to 

verify maturing plans. EpiPOD or CVMDM helps local public health 

agencies develop and test mass vaccination and prophylaxis dispensing plans. 

It is configured for response to a pandemic influenza outbreak; however it can 

be customized for other infectious diseases. EpiPOD is consistent with the 

National Incident Management System and Incident Command System 

(NIMS/ICS) standards.153

Evaluate and Improve. “Evaluation and continual process 

improvement are cornerstones of effective preparedness. Upon concluding 

an exercise, jurisdictions should evaluate performance against relevant 

capability objectives, identify deficits and institute corrective action plans. 

Improvement planning should develop specific recommendations for 

changes in practice, timelines for implementation and assignments for 

completion.”154 This aspect of the preparedness cycle is lacking at the 

national level in the United States. While there have been four National 

Exercises, there is little publicly available literature to indicate the 

exercise reviews completed were incorporated in future planning. This 

shortfall is also clearly shown by the consistently similar list of lessons 

learned from each of the National Exercises: lack of a treatment 

distribution plan, insufficient public communication, failure to adequately 

collect needed information and workers overwhelmed by the deluge of 

patients and problems.
49

 Respond. An adequate response involves the execution of emergency 

plans. An effective response should save lives, protect property and 

protect the environment. From the NRF, “Four key actions typically occur 

in support of a response: (1) gain and maintain situational awareness; (2) 

activate and deploy key resources and capabilities; (3) effectively 

coordinate response actions; then, as the situation permits, (4) 

demobilize.”155

 

 These response actions are shown in Figure 5.

Figure 5 The Response Process156

Situational Awareness. “Providing the right information at the right 

time.”157 As stated previously, HSPD-21 directed the establishment of the 

CDC BioSense System as an epidemiologic surveillance system for 

human health. This is one of many systems that enhances the common 

operating picture needed by officials directing response and recovery 

operations. However, as the National Exercises demonstrated, further 

development and training with the tools that enhance situational awareness 

is needed.

Deploy Resources. In each real-world incident described in Chapter 

2 and the National Exercises of Chapter 3, a “first responder” began initial 

actions to save lives and prevent further damage. First responders are 
50

defined in HSPD-8, National Preparedness, as “those individuals who in 

the early stages of an incident are responsible for the protection and 

preservation of life, property, evidence and the environment ... as well as 

emergency management, public health, clinical care, public works, and 

other skilled support personnel (such as equipment operators) that provide 

immediate support services during prevention, response and recovery 

operations.”158 During an incident response, first responders “assess the 

situation, identify and prioritize requirements, and activate available 

resources and capabilities to save lives, protect property and the 

environment, and meet basic human needs.”159

However, the National Exercises elucidated a shortfall in our hospital 

and POD staffing, which has also been noted in HSPD-21, Public Health 

and Medical Preparedness: 

 These actions are critical 

to ensuring success in a bioterrorist response. 

Mass Casualty Care: The structure and operating 

principles of our day-to-day public health and medical 

systems cannot meet the needs created by a catastrophic 

health event. Collectively, our Nation must develop a 

disaster medical capability that can immediately re-orient 

and coordinate existing resources within all sectors to 

satisfy the needs of the population during a catastrophic 

health event. Mass casualty care response must be (1) 

rapid, (2) flexible, (3) scalable, (4) sustainable, (5) 

exhaustive (drawing upon all national resources), (6) 

comprehensive (addressing needs from acute to chronic 

care and including mental health and special needs 

populations), (7) integrated and coordinated, and (8) 

appropriate (delivering the correct treatment in the most 

ethical manner with available capabilities).160

In order to affect this flexible and scalable response, the military is tasked 

with a major role in support to civil authorities. The 2008 National 

Defense Strategy requires the military to maintain the capacity to support 

civil authorities in times of national emergencies, such as a large-scale 

bioterrorist event. “The Department will continue to maintain

consequence management capabilities and plan for their use to support 

government agencies.”161
51

An additional aid to bioterrorism response is the Strategic National 

Stockpile (SNS), formerly known as the National Pharmaceutical Stockpile, 

which provides a re-supply of large quantities of essential medical materiel to 

states and communities during an emergency. The SNS is managed jointly 

by the DHS and Health and Human Services. The SNS is a repository of 

antibiotics, chemical antidotes, antitoxins, life-support medications, IVs, 

airway management supplies and medical/surgical items. The first line of 

support from the SNS arrives within 12 hours as “Push Packages.” The Push 

Packages are strategically pre-positioned in various locations in the United 

States to meet the 12-hour window.162 During TOPOFF 1 and 2, resources 

from the SNS were required. However, officials were unfamiliar with the 

administrative and logistical aspects of acquiring this support. Thus, 

deployment of these resources was delayed, reinforcing the need for further 

intense, hands-on training, experience and coordination with this SNS 

resource.

Coordinate. Specific response actions will be based on the incident, 

agent, priorities and resources available. The NRF describes coordination 

of emergency functions, actions, support, resources, and capabilities and 

information.163 Coordination depends primarily on complete situational 

awareness. As discussed previously, the National Exercises reiterate the 

need for a common database, with accurate information to enhance the 

flow of information.

 Recover. Recovery occurs, at times, simultaneous to response 

actions. “Once immediate lifesaving activities are complete, the focus 

shifts to assisting individuals, households, critical infrastructure and 

businesses in meeting basic needs and returning to self-sufficiency.”164 

The National Exercises ceased prior to recovery-type actions. However, 

the anthrax letters incidents and subsequent decontamination activities 

speak to the cost in time and resources for years following the bioterrorist 

incident. In a future, wide-scale incident, issues such as burial of 

contaminated remains; decontamination of hospitals, homes, and public 

meeting places; and dealing with and mitigating economic losses will be 

only a few of the major recovery concerns to be addressed.
52

Gather Forensic Information

The anthrax letters incidents draw attention to the gaping hole in our 

forensic detection capability. If the perpetrator of the letter attack desired, 

he could have periodically sent other anthrax contaminated letters in the 

mail to random recipients during the seven years it took investigators to 

gather enough evidence to point a finger. Imagine the impact to the mail 

system as the death toll continued to rise over the seven years. President 

Obama recognizes this shortfall in our deterrence in the 2009 National 

Strategy for Countering Biological Threats: “The primary objectives of 

any investigation into the alleged use, intended use or development of a 

biological weapon are to prevent casualties, protect the public health and 

attribute the activity to its perpetrator.”165 The strategy calls for 

establishing a national-level research and development strategy for 

microbial forensics. Additionally, the strategy reaffirms the need to 

maintain the National Biological Forensics Analysis Center as the lead 

federal facility for forensic analysis of biological material.166

The National Biological Forensics Analysis Center is part of the 

National Biodefense Analysis and Countermeasure Center (NBACC).

 

167 

NBACC is located on the new National Interagency Biodefense Campus 

at Fort Detrick, Md. The mission of the NBACC is to “support national 

security, law enforcement and medical communities by improving our 

understanding of potential bioterrorism pathogens that may be 

weaponized, transported and disseminated against U.S. targets for the 

purpose of improving our protection of human health and agriculture 

against biological terrorism, and sustaining homeland security through 

knowledge of the threat, prevention of surprise and attribution of use.”168 

The NBACC is expected to employ a staff of 150 with an annual 

operations budget of $50 million.169

In order to develop tools to aid biological agent forensics, scientists at 

Argonne National Laboratory, with Loyola University, have developed the 

use of a proteomic biochip for identifying biomarkers or signatures 

indicative of specific growth conditions for Bacillus anthracis. By 

growing anthrax under different conditions and observing changes in the 

protein and sugar content of the spore coat, a sort of fingerprint can be 

developed. This fingerprint, or detailed signature, may provide 

investigators of an attack clues to determine how an agent was produced, 

what equipment was employed, and the level of technical expertise of the 
53

operator. Thus, this information may aid investigators in a rapid 

identification of the perpetrator of an attack.

All of the programs and initiatives described in this chapter are a solid 

foundation toward building a credible prevention and response to a biological 

weapon attack. If the response to an attack is efficient and recovery happens 

quickly, then the attack may not have the consequences desired by the 

terrorists. If they realize this, they may choose not to strike with biological 

weapons. They may be deterred. In building a more resilient nation, we will 

continue to improve our ability to defend against and deter such a biological 

attack.
54
55

Chapter 6

Summary, Recommendations, and Conclusions

The greatest glory in living is not never failing, but rising every time you fall.

─Nelson Mandela

As the U.S. National Defense Strategy states , “Deterrence is key to 

preventing conflict and enhancing security. It requires influencing the 

political and military choices of an adversary, dissuading it from taking an 

action by making its leaders understand that either the cost of the action is 

too great, is of no use, or unnecessary. Deterrence also is based upon 

credibility: the ability to prevent attack, respond decisively to any attack 

so as to discourage even contemplating an attack upon us, and strike 

accurately when necessary.”170

This paper examined four recent international events concerning 

adversary acquisition and use of biological agents as weapons and four 

National Exercises testing U.S. consequence management capabilities 

following a simulated bioterrorist event. Several key points of focus were 

identified and examined in relation to current U.S. defense, deterrence, 

response and recovery initiatives. A few of these points of focus should be 

emphasized as critical steps in deterring or mitigating terrorist attacks with 

biological agents.

A terrorist attack involving a biological 

agent will have significant consequences. However, a well-defined and 

robust defense, deterrence and prevention program centered on the most 

critical steps in preventing a terrorist biological attack from either occurring 

or succeeding may mitigate or eliminate those consequences. Additionally, a 

well-planned and practiced response and recovery capability will lessen the 

adverse impact of an attack.

If the long-term goal of international prevention of aggressive biological 

agent use is the primary outcome desired from a deterrence action, then 

current programs and initiatives should be continued, regularly reviewed and 
56

improved as world events dictate. The specific areas of focus identified in 

this paper which will enable this long-term goal are: (1) provide alternate job 

opportunities to potential bio-weaponeers, (2) encourage and assist regional 

partners in preparing biodefenses, and (3) prevent acquisition of biological 

weapon agents and technology by potential rivals. While the programs and 

initiatives to accomplish these areas of focus are extremely important, more 

ground can be gained by focusing on the short-term goals of reducing 

vulnerabilities and establishing a more resilient American society.

To reach this short-term goal, focus should be primarily on actions which 

bolster the U.S. ability to detect an attack as early as possible in order to allow 

for the most rapid and effective of response and recovery operations. Based 

on examination of both real-world events and National Exercises, the 

following are key points of focus which the U.S. policy makers should 

consider more carefully: (1) improve the detection of bio-attacks, and (2) 

prepare against biological contingencies, respond effectively, recover quickly 

and capably and gather biological weapon forensics information to allow 

decision-makers to attribute the attack correctly to the initiators. In each of 

these areas, the previously discussed U.S. biological incidents and National 

Exercises highlight further specific areas of concern, which will be addressed 

next.

Detect Attacks

Attacks can be detected by both equipment and healthcare workers. 

In the event of a biological agent release, depending on the incubation time of 

the agent, it is possible that patients with symptoms will arrive in hospitals 

before samples are analyzed on equipment such as those found in the 

BioWatch sensors. This highlights the need for continual improvement in our 

stand-off detection equipment to be rapid and reach a more “real-time” 

reporting capability. Thus, continuous improvement of BioWatch sensors is 

important and will realize improvement in years to come. 

However, detection of an agent release by healthcare workers can be 

improved now with a few simple actions. Healthcare workers and first 

responders should be immediately trained on the epidemiological clues that 

indicate a bioterrorist event is unfolding or has occurred. From the Anthrax 

Letters and Rajneesh incidents, there were clear signs, epidemiological clues, 

which healthcare workers should have recognized to raise their suspicion of a 
57

potential attack. Below is a list of events that give strong indication of a 

bioterrorist event. This list was taken from select aspects of the American 

College of Physicians—American Society of Internal Medicine (ACP/ASIM) 

Guide to Bioterrorism Identification,171 Public Health Reports’ 

Epidemiologic Clues to Bioterrorism,172 Chapter 3 of Epidemiology of 

Biowarfare and Bioterrorism173 and the California Hospital Bioterrorism 

Response Planning Guide.174

1. Large epidemic, with large numbers of casualties (all National Exercises and 

Rajneesh);

 Parenthesis indicate the National Exercise or 

real-world event which demonstrates the usefulness of that epidemiological 

clue. 

2. Large epidemic in a discrete population, or point source outbreak (all 

TOPOFF exercises), or discrete population like people who went to a 

shopping mall (Dark Winter), or ate at a specific restaurant (Rajneesh) or who 

live, work or recreate in a common geographical area;

3. Single case of disease caused by an uncommon agent without adequate 

epidemiologic explanation (Anthrax Letters, first victim);

4. Multiple epidemics (Dark Winter and Aum Shinrikyo if they had been

successful);

5. A disease that is outside its normal transmission season, or is impossible to 

transmit naturally in the absence of its normal vector (Anthrax Letters, first 

victim; plague in TOPOFF exercises);

6. Uncommon disease, such as anthrax, pneumonic plague, or smallpox (all 

events and National Exercises);

7. A rapid increase in the number of previously healthy persons with similar 

symptoms (Rajneesh, Anthrax Letters, all National Exercises);

8. Direct evidence such as when a terrorist group announces an attack has 

occurred (Rajneesh, Harris)

Healthcare workers should be provided with examples of what these 

epidemiological clues would look like for each of the major bioterrorist agent 

threats we should expect. For instance, use of salmonella, anthrax and plague 

appeared in both the National Exercise scenarios and in actual incidents.
58

Prepare, Respond, Recover and Gather Forensics 

Information

Training and Recognition

Common in all incidents and events was the lack of education and 

training of first responders and healthcare workers to recognize and react to 

biological agent induced illnesses. In addition to understanding 

epidemiological clues to a bioterrorist event, emergency responders and 

healthcare workers should be trained on the real hazards of agents and be 

provided with quick reference guides on the most likely illnesses to be 

expected. Training concerning “real hazards” includes a clear understanding 

of the real transmissibility of disease. For instance, in the National Exercise, 

reviewers noted that the disease spread more rapidly and effectively than 

would normally occur in nature. While it is possible that a genetically 

engineered bio-weapon could enhance its transmissibility, it is more likely 

that normal Yersinia pestis bacteria will be used than one that is enhanced. 

By completely understanding the hazards of an agent and how to prevent 

transmission, fear can be eliminated and thus reactions will be quicker and 

more focused on the actual problem at hand.

To facilitate understanding or quickly refresh a worker’s memory of the 

training they received, there should be quick reference guides posted in all 

healthcare facilities, fire and police departments, to remind first responders 

what they should look for. Many examples of these quick reference guides 

are readily available on the internet. However, a standardized format should 

be adopted nationally to aid standardized training regarding the greatest 

potential bioterror threats. Examples of these guides are available at 

Appendix B.

Resources

As part of training and preparation for an incident, civilian healthcare 

managers should consider means to offer the flexible, scalable, sustainable 

and exhaustive mass casualty care capability demanded in HSPD-21. This 

surge capacity should come from a combination of the military, other nonaffected states and pre-established contracts with companies such as 

Walgreens and CVS pharmacy. 

As detailed in this paper, the military should serve a role in assisting a 

civil response, when necessary. However, during the National Exercises, 
59

when resources were clearly stressed, the players did not engage military 

resources for medical response or security in PODs. In future National 

Exercises, the military should be engaged and included in the exercise as they 

would in a real-world event. 

Non-affected states can also serve as additional resources. If a plague 

event is experienced in Colorado, it is likely that this plague will not 

immediately spread to more distant states, such as Alaska, Washington, 

Maine or Florida. Hence, healthcare workers could be “shipped in” to the 

affected state to assist. Interstate agreements should be established such that 

predicted aid is identified and included in response plans. Then, during 

National Exercises, these interstate agreements should be practiced, when 

possible.

Finally, local pharmacies can offer additional manpower during a 

national emergency. In many Walgreens and CVS drug stores, there are 

small clinics staffed by Family Nurse Practitioners and Physicians Assistants,

called “Take Care Clinics” or “Minute Clinics,” respectively. These clinics 

offer a wide range of healthcare services from minor cuts, to vaccines, to 

treatment for routine infections (bladder, eye, ear, etc.). States, regions or 

local hospitals could establish contracts with these pharmacies to provide 

similar services to those seen in Point of Dispensing operations during the 

TOPOFF exercises. With some minor training, and periodic refresher 

training, these skilled healthcare workers can serve as the “surge capacity” 

needed in the event of a bioterrorist emergency. Additionally, these drug 

stores have already established a partial database of local residents through 

their pharmacy customer lists. Wherever the additional personnel resources 

come from, it is vital that these intra- and inter-state agreements and contracts 

be exercised regularly.

Emergency Response Plans

The National Exercises highlighted the need for prepared treatment 

distribution plans tailored to each biological agent. Who should be the first to 

acquire treatment for each bio-threat agent? How should vaccines or 

therapeutics be distributed? Should a Point of Dispensing or Point of 

Distribution concept be adopted? Should Walgreens and CVS clinics be 

incorporated into these Point of Dispensing plans? Should a pre-prepared list 

or database of the people in the local community be maintained? These are 

only a few of the many questions that should be considered in each regional 
60

response plan. Again, once agent-specific plans are established, they should 

be exercised and practiced on a regular basis.

Within the emergency response plans should be the expected method of 

information exchange. A common, universally accessible database will 

enhance the flow of information and provide officials with a clear picture of 

the state of the response and extent of disease impact. It is essential that the 

database be populated with basic information concerning local residents; and 

personnel and time resources be allocated to ensure these are updated

annually. Additionally, this database should be used in every exercise so that 

first responders, emergency managers and healthcare workers are familiar 

with its operation and use. 

Public Communication

Public Communication is vital in building a resilient population. 

Understanding how to craft the message in order to get pertinent information 

to people, with multiple levels of education and understanding, while 

alleviating fear and providing a sense of empowerment is a highly complex 

task. However, time invested in crafting this public communication will 

dramatically reduce the number of worried-well who appear at clinics and 

hospitals. Additionally, a population who understands a disease and 

transmission may be more amenable to participating in quarantine, if required 

to stem the spread of a disease. 

Government officials should consider a public advertisement campaign 

in “peacetime” to make discussion of “what to do during a bioterrorist event” 

similar to the discussions we have regarding where you should go during a 

tornado or how to evacuate during a hurricane. While these events do not 

happen daily, people do not typically sit at home consumed with fear over 

what they will do when they hear the tornado siren. Because they have been 

educated regarding potential danger of a tornado, and have put some thought 

into where in their house is the safest location, their fear is alleviated... not 

eliminated, but put into its proper perspective. The resolve of a 

knowledgeable American people will offer the best deterrent. 

Evaluation and Continual Process Improvement

We must rise every time we fall. The National Exercises and recent 

incidents involving biological agents prove that the U.S. strategy, policies and 

initiatives should realize frequent evaluation and continual process 
61

improvement. While the United States has not experienced a mass casualty 

event due to a bioterrorist attack, the exceptional medical response to natural 

disasters such as hurricane Katrina or the earthquake in Haiti clearly 

demonstrate the capability to respond when forced to do so. But, we can do 

better. The Rajneesh, Aum Shinrikyo, Larry Harris and Anthrax Letters 

bioterror incidents and National Exercises should be thoroughly examined, a 

concise list of areas of improvement be developed, and a clear strategy to 

engage in continual process improvement should be enacted on nationally.

Current U.S. biodefense and deterrence strategies are an excellent 

beginning to an effective plan. However, because of the wide-spread 

proliferation and ease of production of biological agents, more work needs to 

be accomplished to strengthen such defense, deterrence and prevention. By 

focusing on the whole process of terrorist acquisition and use of biological 

agents, key steps can be targeted in hopes of preventing an attack altogether. 

If it becomes impossible or unprofitable to a terrorist to use biological agents, 

that threat perhaps can be avoided. But, as one Nobel-prize winning biologist 

has concluded, “It would seem to me both foolish and arrogant to assume that 

our goodwill alone, without concrete arrangements, will serve to forestall the 

further development, proliferation and possible eventual recourse to what 

surely is one of the most ghastly methods of warfare imaginable.”175
62

Notes

 1 National Strategy for Combating Terrorism, (September 2006), p. 2.

2 Silent Death and other works by “Uncle Fester” are available on 

www.amazon.com, http://www.amazon.com/Silent-Death-Second-UncleFester/dp/0970148534/ref=sr_1_5?ie=UTF8&s=books&qid=1264780400

&sr=8-5.

3 Uncle Fester, Silent Death, (Green Bay, Wis.: Festering 

Publications, 1997).

4 In 1932-1945, Japan conducted biological weapons research in 

China, infecting prisoners with biological agents. An estimated 3,000 to 

10,000 prisoners died. Additionally, the Japanese attacked at least eleven 

Chinese cities with aerosolized or waterborne agents and plague infected 

fleas. Diane J. Rodi, Biological Warfare, Bioterrorism, and Dual 

Research, Annual Refresher Training Course IBS1012009, Argonne 

National Laboratory, (2009).

5 Judith Miller, et al., Germs: Biological Weapons and America’s 

Secret War, (New York, Simon and Schuster, 2002), p. 19.

6 Ibid., p. 15.

7 Ibid., pp. 30-32.

8 W. Seth Carus, “The Rajneeshees (1984),” in Jonathan B. Tucker, 

ed., Toxic Terror: Assessing Terrorist Use of Chemical and Biological 

Weapons, (Cambridge Mass., MIT Press, 2001), p. 120.

9 Miller, Germs, p. 27.

10 Barry Kellman, Bioviolence: Preventing Biological Terror and 

Crime, (N.Y., Cambridge University Press, 2007), p. 81; and Carus, “The 

Rajneeshees,” p. 126.

11 Tucker, Toxic Terror, p. 127.

12 Tucker, Toxic Terror, p. 128; and Miller, Germs, pp. 21-22

13 Miller, Germs, pp. 18-24.

14 Tucker, Toxic Terror, p. 130

15 Ibid., p. 131.

16 Miller, Germs, pp. 23-24.

17 Ibid., p. 32.

18 Ibid., p. 21. 

19 Ibid., p. 23. 

20 Ibid., p. 32.
63

 21 Jessica Eva Stern, “Larry Wayne Harris (1998),” in Jonathan B. 

Tucker, ed., Toxic Terror: Assessing Terrorist Use of Chemical and 

Biological Weapons, (Cambridge Mass.: MIT Press, 2001), pp. 227-246.

22 Miller, Germs, p. 197.

23 Tucker, Toxic Terror, p. 232.

24 Miller, Germs, p. 197.

25 Tucker, Toxic Terror, p. 234. 

26 Ibid., p. 238.

27 Ibid., pp. 238-240.

28 Ibid., p. 234.

29 Ibid., p. 243.

30 Ibid., p. 235.

31 Ibid., p. 241. 

32 Frederick R. Sidell, et al., eds, Medical Aspects of Chemical and 

Biological Warfare, (Washington, D.C.: Office of The Surgeon General at 

TMM Publications, 1997), p. 4.

33 David E. Kaplan, “Aum Shinrikyo (1995),” in Jonathan B. Tucker, 

ed., Toxic Terror: Assessing Terrorist Use of Chemical and Biological 

Weapons, (Cambridge Mass., MIT Press, 2001), p. 219.

34 David E. Kaplan and Andrew Marshall, The Cult at the End of the 

World, (New York, N.Y., Crown Publishers, Inc., 1996), p. 7. William 

Rosenau, “Aum Shinrikyo’s Biological Weapons Program: Why Did it 

Fail?” Studies in Conflict and Terrorism, vol. 24, (2001), pp. 289-301. 

35 Eric Croddy and James J. Wirtz, ed., Weapons of Mass Destruction: 

An Encyclopedia of Worldwide Policy, Technology and History, (Denver, 

Colo., ABC CLIO, Inc., 2005), p. 30.

36 Tucker, Toxic Terror, p. 209. 

37 Rosenau, “Aum Shinrikyo’s Biological Weapons Program,” pp. 

289-301; Tucker, Toxic Terror, p. 209.

38 Jessica Stern, “Terrorist Motivations and Unconventional 

Weapons;” Peter R. Lavoy, Scott D. Sagan, and James J. Wirtz, eds., 

Planning the Unthinkable, (Ithaca, N.Y., Cornell University Press, 2000), 

p. 206.

39 Ibid., p. 207

40 Croddy, Weapons of Mass Destruction, p. 28; and Kaplan, The Cult 

at the End of the World, p. 28; and David E. Kaplan, “Aum Shinrikyo,” 
64

 

(1995);” Jonathan B. Tucker, ed., Toxic Terror: Assessing Terrorist Use of 

Chemical and Biological Weapons, (Cambridge Mass., MIT Press, 2001), 

p. 213.

41 Kaplan, The Cult at the End of the World, p. 102.

42 Ibid., p. 102.

43 Tucker, Toxic Terror, p. 213. 

44 Sidell, Medical Aspects of Chemical and Biological Warfare, p. 

463.

45 David E. Kaplan and Andrew Marshall, The Cult at the End of the 

World, (New York, N.Y., Crown Publishers, Inc., 1996), p. 56.

46Ibid., p. 53.

47 Ken Alibek and Stephen Handelman, Biohazard, (New York, N.Y., 

Random House, 1999), p. 278.

48 Tucker, Toxic Terror, p. 221. 

49 Tom Mangold and Jeff Goldberg, Plague Wars, (New York, N.Y., 

St. Martin’s Press, 1999), p. 341.

50 Kaplan, The Cult at the End of the World, pp 95-96; and Stern, 

“Terrorist Motivations,” p. 208.

51 Rosenau, “Aum Shinrikyo’s Biological Weapons Program,” pp. 

289-301.

52 Ibid., pp. 289-301.

53 Gina Kolata, “Florida Man Is Hospitalized With Pulmonary 

Anthrax,” The New York Times, (October 5, 2001); 

http://select.nytimes.com/gst/abstract.html?res=F50F14FC3C 

580C768CDDA90994D9404482, (May 3, 2006).

54 Council on Foreign Relations, “The Anthrax Letters,” (May 3, 

2006), http://www.cfr.org/publication/ 9555/. 

55 Wikpedia, “2001 anthrax attacks,” (May 3, 2006), 

http://en.wikipedia.org/wiki/2001_anthrax_attacks# A_.22person_of_ 

interest.22.

56 Martin Enserink, “Taking Anthrax’s Genetic Fingerprints,” Science, 

vol. 294, 1810-1812, (Nov. 30, 2001), www.sciencemag.org. 57 Martin Enserink, “Full-Genome Sequencing Paved the Way from 

Spores to a Suspect,” Science, vol. 321, 898-899, (Aug. 15, 2008), 

www.sciencemag.org. 58 Ibid.
65

 59 Amada Ripley, “The Anthrax Files,” Time, (Aug. 7, 2008).

60 Amada Ripley, “The Anthrax Mystery Deepens,” Time, (Aug. 2, 

2008).

61 Ripley, “The Anthrax Mystery Deepens.” 

62 Allan Lengel, “Little Progress in FBI Probe of Anthrax Attacks,” The 

Washington Post, (Sept. 16, 2005).

63 Ripley, “The Anthrax Files.”

64 Enserink, “Full-Genome Sequencing.” 

65 “Case not Closed,” Nature, vol. 454, (Aug. 21, 2008).

66 Honorable Sam Nunn, testimony before the House Government 

Reform Committee, Subcommittee on National Security, (July 23, 2001), 

www.upmc-biosecruity.org/website/events/2001_darkwinter/index.html, 

(Jan. 29, 2010).

67 Department of Homeland Security (DHS), “National Exercise 

Program,” www.dhs.gov/files/training/gc_1179350946764.shtm.

68 Thomas V. Inglesby, Rita Grossman, and Tara O’Toole, “A Plague 

on Your City: Observations from TOPOFF,” Clinical Infectious Diseases, 

(February 2001), vol. 32, pp. 436-445.

69 Ibid., pp. 436-445. 70 Ibid., pp. 436-445.

71 Ibid., pp. 436-445.

72 Ibid., pp. 436-445.

73 Ibid., pp. 436-445.

74 Ibid., pp. 436-445.

75 Ibid., pp. 436-445.

76 DHS, “National Exercise Program.”

77 Department of Homeland Security (DHS), “Top Officials 

(TOPOFF) Exercise Series: TOPOFF2, After Action Summary Report,” 

(Dec. 19, 2003).

78 Ibid. 

79 Susan May, “TOPOFF Exercise Offers Lessons for Preparedness,” 

Northwest Public Health, (fall/winter 2003), pp. 22-23.

80 Department of Homeland Security (DHS), “Top Officials 

(TOPOFF) Exercise Series.” 

81 Ibid.

82 DHS, “National Exercise Program.” 
66

 83 New Jersey Universities Consortium for Homeland Security 

Research, “TOPOFF 3 Comments and Recommendations,” 

http://dimacs.rutgers.edu/People/Staff/froberts/ topoffsubmission5-18-

06.pdf.

84 Ibid.

85 Ibid. 

86 Jeff Janssen, “9/11 Leadership Lessons,” 

http://www.teamcaptainsnetwork.com/public/ 230.cfm.

87 Ibid. 

88 Ibid.

89 Tara O’Toole, Michael Mair, and Thomas V. Inglesby, “Shining 

Light on ‘Dark Winter,’” Clinical Infectious Diseases, (April 2001), vol. 

34, pp. 972-983.

90 Center for Biosecurity, “Dark Winter,” www.upmcbiosecurity.org/website/events/2001_ darkwinter/index.html. 

91 O’Toole, “Shining Light,” pp. 972-983.

92 Center for Biosecurity, “Dark Winter”

93 O’Toole, “Shining Light,” pp. 972-983.

94 Center for Biosecurity, “Dark Winter”

95 O’Toole, “Shining Light,” pp. 972-983.

96 Ibid., pp. 972-983.

97 Ibid., pp. 972-983.

98 In the George W. Bush administration, the directives used to 

communicate presidential decisions regarding national security matters are 

designated National Security Presidential Directives (NSPDs). In the 

Barack Obama administration, these directives are designated Presidential 

Policy Directives (PPD) and directives that are used to initiate policy 

review procedures are called Presidential Study Directives (PSDs). Both 

Presidents Bush and Obama issued policy directives related to terrorism 

and consequence management activities which are listed here and 

referenced throughout this section of the paper: HSPD-4 National Strategy 

to Combat WMD Dec. 11, 2002 HSPD-5 Management of Domestic 

Incidents Feb. 28, 2003
67

 

HSPD-8 National Preparedness

Dec. 17, 2003

HSPD-10 Biodefense in the 21st Century

April 28, 2004

HSPD-18 Medical Countermeasures against WMD

Feb. 7, 2007

HSPD-21 Public Health and Medical Preparedness

Oct. 18, 2007

PSD-1 Organizing for Homeland Security and Counterterrorism

Feb. 23, 2009

99 Department of Homeland Security, “Fact Sheet: President Bush 

Signs Biodefense for the 21st Century,” 

http://www.dhs.gov/xnews/releases/press_release_0399.shtm. 

100 U.S. Department of State, “Nonproliferation of WMD Expertise,” 

http://www.state.gov/t/isn/c12265.htm.

101 U.S. Department of State, “Office of Cooperative Threat 

Reduction (ISN/CTR),” http://www.state.gov/t/isn/58381.htm.

102 U.S. Department of State and U.S. Agency for International 

Development, “FY 2006 Performance Summary, Strategic Goal 4: 

Weapons of Mass Destruction,” 

http://www.state.gov/s/d/rm/rls/perfrpt/2005hlts/html/57972.htm.

103 International Science and Technology Center, http://www.istc.ru/.

104 Science and Technology Center in Ukraine, http://www.stcu.int/.

105 Michael Roston, “Redirection of WMD Scientists in Iraq and 

Libya: A Status Report,” RANSAC Policy Update, (April 2004), pp. 1-9. 

106 National Security Strategy of the United States of America,

(Washington D.C., March 2006), p. 22.

107 Central Intelligence Agency, The Worldwide Biological Warfare 

Weapons Threat, (Washington, D.C., Government Printing Office, 2001), 

FOUO.

108 National Strategy to Combat Weapons of Mass Destruction,

(Washington D.C., December 2002), p. 4.

109 Frederick R. Sidell, et al., eds, Medical Aspects of Chemical and 

Biological Warfare, (Washington, D.C.: Office of The Surgeon General at 

TMM Publications, 1997), p. 419.
68

 110 National Strategy to Combat Weapons of Mass Destruction, p. 2

111 Department of Defense, National Military Strategy for Combating 

Weapons of Mass Destruction, (Washington, D.C.: Chairman of the Joint 

Chiefs of Staff, Feb. 13, 2006), pp. 6-7.

112 Ibid., p. 48.

113 Jessica Eva Stern, “Larry Wayne Harris (1998),” in Jonathan B. 

Tucker, ed., Toxic Terror: Assessing Terrorist Use of Chemical and 

Biological Weapons, (Cambridge Mass., MIT Press, 2001), pp. 227-246.

114 Select Agent Regulation, 42 CFR 73, www.cdc.gov/od/sap.

115 Center for Disease Control, “Select Agent Program,” 

www.cdc.gov/od/sap.

116 Homeland Security Council, National Strategy for Homeland 

Security, (Washington D.C., October 2007), p. 6.

117 National Security Strategy, p. 19.

118 Source unknown, personal knowledge from experience.

119 U.S. Department of Homeland Security, “Fact Sheet: Homeland 

Security Operations Center (HSOC),” (2004), www.dhs.gov/dhspublic. 120 Ibid.

121 Argonne National Laboratory was the first national laboratory and is 

one of the U.S. Department of Energy’s research centers. In 1946, the 

laboratory was given the mission to develop nuclear reactors for peaceful 

purposes. Argonne’s current mission is “to apply a unique mix of worldclass science, engineering and user facilities to deliver innovative research 

and technologies. We create new knowledge that addresses the most 

important scientific and societal needs of our nation,” (www.anl.gov). The 

laboratory hosts three major research divisions, including Energy Sciences 

and Engineering; Computing, Environment, and Life Sciences; and Photon 

Sciences. Argonne is also home to the Advanced Photon Source electron 

accelerator and storage system, or APS. The APS is a National User 

Facility open to anyone with a need for the nation’s most brilliant x-ray 

photon beams. “These x-rays allow scientists to pursue new knowledge 

about the structure and function of materials in the center of the Earth and 

in outer space and all points in between. The knowledge gained from this 

research can impact the evolution of combustion engines and 

microcircuits, aid in the development of new pharmaceuticals, and pioneer 

nanotechnologies whose scale is measured in billionths of a meter. These 
69

 

studies promise to have far-reaching impact on our technology, economy, 

health and our fundamental knowledge of the materials that make up our 

world,” http://www.aps.anl.gov/About/APS_Overview/.

122 http://www.anl.gov/National_Security/docs/factsheet_JTAC.pdf.

123 http://www.anl.gov/National_Security/docs/factsheet_Netbreaker.pdf.

124 Homeland Security Presidential Directive-21, Public Health and 

Medical Preparedness, (Oct. 18, 2007).

125 Centers for Disease Control, Agency for Toxic Substances and 

Disease Registry, and Department of Health and Human Services, A 

National Public Health Strategy for Terrorism Preparedness and 

Response 2003-2008, (March 2004), p. 9.

126 U.S. Department of Homeland Security, “Fact Sheet: A Better 

Prepared America: A Year in Review,” (2004), 

www.whitehouse.gov/news/releases/2004/05/print/20040525-4.html. 127

http://www.dis.anl.gov/publications/fact_sheets/BWIC_FactSheet.pdf.

128 Richard R. Cirillo, director of the Center for Energy, Environment,

and Economic Systems Analysis in the Department of Information 

Sciences, presentation to Air Force Fellows, (August 2009). 

129 National Security Strategy, p. 22.

130 HSPD-21.

131

http://www.cdc.gov/biosense/files/BioSenseOverviewWeb_20090421.pdf.

132 Homeland Security Presidential Directive-5, Management of 

Domestic Incidents, (Feb. 28, 2003).

133 Department of Homeland Security, “National Response 

Framework,” (January 2008), http://www.fema.gov/pdf/emergency/nrf/nrfcore.pdf. 134 National Response Framework, p. 27.

135 Ibid., p. 27.

136 Ibid., p. 2.

137

http://www.dis.anl.gov/publications/fact_sheets/SyncMatrix_General_FactSh

eet_2007May.pdf.

138 http://www.dis.anl.gov/pubs/59259.pdf.
70

 139

http://www.dis.anl.gov/publications/fact_sheets/TEVA_FactSheet.pdf.

140

http://www.dis.anl.gov/publications/fact_sheets/Fort_Future_FactSheet.pdf.

141 National Response Framework, p. 29.

142 Ibid., p. 31.

143 Jeremy Harrell, “Hospitals Receive Bioterrorism Grants,” The 

Daily Reporter, (Milwaukee, Wis., Dolan Media Newswires, May 6, 

2004).

144 Ibid. 

145 National Response Framework, p. 30.

146 Jim Garamone, “Bush Signs $5.6 Billion BioShield Legislation,” 

American Forces Information Service, (July 23, 2004), 

www.defenselink.mil/news/. 147 Frank Gottron, “Project BioShield,” Congressional Research 

Service Report for Congress, (July 23, 2003).

148 National Security Strategy, p. 22 and National Strategy for 

Homeland Security, p. 6 

149 National Strategy for Homeland Security, p. 48.

150 Homeland Security Presidential Directive-8, National 

Preparedness, (Dec. 17, 2003).

151 National Strategy for Homeland Security, p. 6.

152 National Response Framework, p. 31.

153 http://www.dis.anl.gov/pubs/60363.pdf and 

http://www.dis.anl.gov/pubs/63275.pdf.

154 National Response Framework, p. 31.

155 Ibid., p. 31.

156 Ibid., p. 32.

157 Ibid., p. 32. 

158 HSPD-8. 

159 National Response Framework, p. 35.

160 HSPD-21.

161 Department of Defense, National Defense Strategy, (Washington, 

D.C., June 2008), p. 7.

162 Center for Disease Control and Prevention, “Strategic National 

Stockpile,” (Aug. 11, 2003), www.bt.cdc.gov/stockpile/index.asp.
71

 163 National Response Framework, pp. 36-37.

164 Ibid., p. 45.

165 National Strategy for Combating Terrorism, (Washington D.C., 

September 2006), p. 16.

166 Ibid., p. 17.

167 Department of Homeland Security, “National Biodefense Analysis 

and Countermeasure Center,” 

http://www.dhs.gov/files/labs/gc_1166211221830.shtm.

168 LTC George Korch, deputy director NBACC, “Leading Edge of 

Biodefense” slide 9, http://www.cbwtransparency.org/archive/nbacc.pdf.

169 National Biodefense Analysis and Countermeasure Center.

170 Department of Defense, National Defense Strategy, (Washington, 

D.C.: June 2008), p. 7.

171 American College of Physicians, “ACP/ASIM Guide to 

Bioterrorism Identification,”

www.acponline.org/clinical_information/resouces/bioterrorism/bio_pocket

guide.pdf. 172 Tracee A. Treadwell, Denise Koo, Kathleen Kuker and Ali S. 

Khan, “Epidemiologic Clues to Bioterrorism,” Public Health Reports, 

(March-April 2003), vol. 118, pp. 92-98.

173 Zygmunt F. Dembek, Julie A. Pavlin, Mark G. Kortepeter, 

“Epidemiology of Biowarfare and Bioterrorism,” Medical Aspects of 

Biological Warfare, pp. 39-68. 174 “California Hospital Bioterrorism Response Planning Guide,”

(2002), www.emsa.ca.gov/disaster/files/ca_hosp_guide.pdf. 175 Joshua Lederberg, ed., Biological Weapons: Limiting the Threat

(Cambridge Mass.: The MIT Press, 1999), p. 329.