UNDERSTANDING BIOTERRORISM:

Tara O’Toole, MD, MPH

The United States Conference of Mayors

Mayors Emergency, Safety & Security SummitOctober 24, 2001

www. hopkins-biodefense.edu

Lethality Mirroring Nuclear Weapons

Bioweapons Program in Iraq

Gaseous Diffusion Plant

Germ fermenters at the former Bioweapons plant in Stepnogorsk, Kazakhstan, which are now being dismantled with American aid.

Advances in Biotech, Genomics: Potential for More Potent Bioweapons

• Understanding genetics of virulence, antibiotic resistance

• Development of global profiles of microorganisms

• New ways to control interaction of human cells and microorganisms

• Manipulation of entire genomes

Global Interconnectedness and Vulnerability:Enhanced Conditions for Swift Spread of Infectious Disease

• Antibiotic Resistance

• Urbanization - Crowding, Poor Sanitation, Malnutrition

• Human Intrusion

• International Travel and Commerce

• Globalization of Food Supply

The Consequences of a Biological Weapon Attack Would be an

Epidemic

The response required is fundamentally different from that demanded by natural disasters, conventional explosives, chemical terrorism or nuclear weapons

Child with Smallpox in Evolution

“Top 6” Bioweapon Agents

Smallpox

Anthrax Plague

Tularemia

Botulinum Toxin Viral Hemorrhagic Fevers

Contagious

Smallpox

• Worst case threat?

• Weaponized by Soviets - Others?

• Contagious - spreads via inhalation

• Vaccine effective even 3-4 days after

exposure

• No treatment, 30% mortality

• Current vaccine: 15m doses, more coming

Bioweapon Response - Vulnerabilities

• Public Health

• Medical Care

• Technologies

• Connectedness: Communications,

Coordination, Collaboration

Vulnerabilities – Public Health “System”

• Fragmented

• Understaffed, underfunded

• No surge capacity

• Strategic / operational capabilities

Vulnerabilities – Medical Care “System”

• No surge capacity – hospitals, pharmacies

• Autonomous organizations

• Hospitals, doctors not engaged in

Bioterrorism preparedness

Vulnerabilities – R + D + P Needs

• Rapid reliable diagnostics

• Vaccines, drugs for major agents

• Connect Response Sectors:

Information Flows

What Mayors Should Do?

1. Engage clinicians, hospital leaders2. Connect Medicine and Public Health3. 24x7 Public Health Response

- Outbreak investigation- Distribution of drugs, vaccine

4. Assess Lab Capacity5. Establish Communication Links6. Identify technical advisors

Engage Hospitals

– Review disaster plans: mass casualty,

contagious dz

– Educate Staff

– Community – wide response

– Communications – external & internal

– Review Inventories of drugs, supplies