1. 2007 Public Health Preparedness Conference Current Issues in Public Health Preparedness Michael W. Proctor, M.D. Regional Director of Extra-mural Training University of Texas Health Sciences Center-Houston Center for Biosecurity and Public Health Preparedness Center for Biosecurity and Public Health Preparedness Columbia, Missouri September 26, 2007

2. TERRORISM The New Epidemic!

3. Terrorism  No single, universally accepted definition of terrorism  "one man's terrorist is another's freedom fighter" Definition…what is it?

4. Terrorism Definition common elements…  The systematic use of physical violence- actual or threatened  Typically against non-combatants but with an audience broader than the immediate victims in mind  Efforts to create a general climate of fear in a target population, in order to effect some kind of political and/or social change

5. Terrorism …Terrorism is the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives. -FBI Definition

6. United States Bombings May 4, 1886 May 4, 1886 Haymarket Square; Chicago, IllinoisHaymarket Square; Chicago, Illinois December 30, 1905 December 30, 1905 Governor of Idaho, Frank SteunenbergGovernor of Idaho, Frank Steunenberg October 1, 1910 October 1, 1910 Bombing of the Los Angeles TimesBombing of the Los Angeles Times September 16, 1920 September 16, 1920 Bombing of Wall StreetBombing of Wall Street 1951-56 1951-56 New York landmarks:New York landmarks: Grand Central Station Grand Central Station Radio City Music Hall Radio City Music Hall

7. United States Bombings September 15, 1963 September 15, 1963 16 th Street Baptist Church in Birmingham, Alabama16 th Street Baptist Church in Birmingham, Alabama March 6, 1970 March 6, 1970 Weather Underground Greenwich VillageWeather Underground Greenwich Village August 24, 1970 August 24, 1970 University of Wisconsin's Madison campusUniversity of Wisconsin's Madison campus January 24, 1975 January 24, 1975 New York's historic Fraunces TavernNew York's historic Fraunces Tavern

8. United States Bombings December 29, 1975 December 29, 1975 TWA Terminal at New York's LaGuardia AirportTWA Terminal at New York's LaGuardia Airport May 16, 1981 May 16, 1981 Pan Am Terminal at New York's Kennedy AirportPan Am Terminal at New York's Kennedy Airport November 7, 1983 November 7, 1983 U.S. Congress Senate chamberU.S. Congress Senate chamber February 26, 1993 February 26, 1993 World Trade CenterWorld Trade Center April 19, 1995 April 19, 1995 Murrah Federal Building, Oklahoma CityMurrah Federal Building, Oklahoma City

9. United States Bombings June 25, 1996 June 25, 1996 Khobar Towers Bombing, Dharan, Saudi ArabiaKhobar Towers Bombing, Dharan, Saudi Arabia August 7, 1998 August 7, 1998 US Embassy Bombings, Nairobi, Kenya and Dar es Salaam, TanzaniaUS Embassy Bombings, Nairobi, Kenya and Dar es Salaam, Tanzania October 12, 2000 October 12, 2000 U.S.S. Cole, Port of Aden, YemenU.S.S. Cole, Port of Aden, Yemen September 11, 2001 September 11, 2001 World Trade CenterWorld Trade Center PentagonPentagon Somerset County, PASomerset County, PA

10. THREAT HISTORY 1 5 2 4 3 1.New York 2.Saudi Arabia 3.Kenya 4.Seattle 5.Yemen International terrorist acts

11. THREAT HISTORY 1 2 3 4 5 7 State sponsors of international terrorism 6 5. North Korea 6. Sudan 7. Syria 1.Libya 2.Cuba 3.Iran 4.Iraq

12. INTERNATIONAL TERRORIST GROUPS Al-Qaeda Abu Sayyaf Group (ASG) Asbat al-Ansar Al-Gama’a al-Islamiyya HAMAS (Islamic Resistance Movement) Harakat ul-Mujahidin (Movement of Holy Warriors) Hizballah (Party of God) Jaish-e-Mohammed (JEM) (Army of Mohammed) The Palestine Islamic Jihad (PIJ) National Liberation Army (ELN)—Colombia

13. Al Qaeda ("The Base")  Reconcile the risks with the cause:  violence requires a purpose in harmony with the action to be understood as rational  Serve to recruit followers:  both true believers in the cause and opportunists (who like action and the feeling of belonging)

14. Al Qaeda Develop a sense of camaraderie  Ensures group loyalty  Solidarity  Self-protection

15. Al Qaeda  Injustice from a repressive political authority  Terrorists not getting their due (independent system organized by their ideology) Theme:

16. The Shade of Swords: Jihad & the Conflict Between Islam & Christianity M.J. Akbar Death is inevitable Death is inevitable pursue martyrdompursue martyrdom ultimate submission to Godultimate submission to God Promise to Muslims from a hadith that.. Promise to Muslims from a hadith that.. “the gates of Paradise are under the shade of the swords”“the gates of Paradise are under the shade of the swords” “Inside the Mind of an Islamic Terrorist”

17. The Shade of Swords: Inside the Mind of an Islamic Terrorist A martyr must:  Love God more than life  Be willing to sacrifice himself against power of the devil and infidel forces  Must overcome the physical fear of death “The purest joy in Islam is to kill and be killed for Allah” – Ayatollah Ruhollah Khomeini

18. Al-Qaeda: Key Political Themes  Palestinians’ plight and their fight for “liberation”  Fight against anti-Islamic campaigns  Bosnia,  Chechnya,  Afghanistan  Kashmir Central cause for Muslims:

19. Al-Qaeda: Key Political Themes  Is the leader of A.Q.  The imam for all Muslims  …thus the Islamic “nation” should rally around him Osama Bin Ladin

20. Al-Qaeda: Key Political Themes ■ Muslims should wake up to their “depressed condition,” ■ Should not stand passively ■ Should actively participate in the (armed) jihad

21. Al-Qaeda: Key Political Themes ■Arab/Muslim “agent regimes” ■The “far enemy”  must be targeted first,  beware of the continuing threat from the “near enemy” ■The United Nations  A lackey of the US  A U.S. tool for oppression  Is itself against Islam Targets:

22. Al-Qaeda: Key Political Themes ■“Commendable”:  the fight to stop America’s oppression of / injustice toward Muslims  The U.S. support for the Zionists (Israel) ■ “Abhorred”:  what Israel is practicing in Palestine  what America is doing in Iraq, Afghanistan, and all over the world UNCLASSIFIED Two forms of terrorism:

23. Al-Qaeda: Key Political Themes  America’s “crusade” against the Islamic world will fail:  Muslims adhere to their principles/faith  they are more cohesive domestically and internationally  AQ and Taliban are now a major presence on the world political and psychological map  Crusader “enemy front” is in conflict / disintegrating  Fall of Baghdad marks the return of “direct colonialism” in the Arab world

24. Al-Qaeda: Key Political Themes ■U.S. is really out to:  control region’s oil wealth  dominate Muslim territories (“veiled colonization”) ■The 9/11 ghazwah (“raids”) were legitimate and justified  Due to US mistreatment of Muslims  Continuing “occupation” of Saudi Arabia  Support to Israeli aggression ■US is mistreating, illegally holding the mujahedin at Guantanamo UNCLASSIFIED

25. Al-Qaeda: Key Political Themes  Bin Laden is still alive  A.Q. will “stay the course”  Women mujahedin are being mobilized to join the jihad  A.Q. took credit for the Aug 03 power outages in the Eastern US  highlighted America’s structural weakness  ineffectiveness of response to the situation

26. Al-Qaeda: Key Military Themes  A.Q. is familiar with the art of war  U.S. military has ignored past lessons in favor of technology  U.S. military is ignorant of its current foe  A.Q. is familiar with US posture on 4th generation/asymmetric warfare  U.S. (which still has a Cold War mentality)  Guerilla warfare is the best weapon –best way to prolong the conflict with the “Crusader enemy” UNCLASSIFIED

27. Al-Qaeda: Key Military Themes Examined US “nightmares”  threats from WMD  “naval jihad” attacks  attacks against oil supplies  attacks against US economy  “Internet jihad”  forging of interests / links between jihad groups and organized criminal groups

28. Al-Qaeda: Key Military Themes  U.S. doesn’t understand Arab / Middle East / Muslim culture …thus losing the “information war”  Iraq is now the key battlefield for the global jihad

29. Al-Qaeda: Key Military Themes  1972 Munich Olympics attack  9/11 New York and Washington attacks “great propaganda victories”  Surprise achieved in 9/11 “conquest” exceeded that of the Japanese attack against Pearl Harbor UNCLASSIFIED Use of historical comparisons/lessons:

30. Al-Qaeda: Key Military Themes US military has a history of: US military has a history of: BarbarityBarbarity War crimes against civiliansWar crimes against civilians Targets civilians deliberatelyTargets civilians deliberately as “political pressure card” as “political pressure card” for psychological warfare for psychological warfare  Iraq fell to America in the second Gulf War  Due to the “treachery of Ba’athist regime” Use of historical comparisons/lessons:

31. Al-Qaeda: Key Military Themes  Al-Qaeda has the right to use WMD  US Intelligence will continue to fail due to:  “bureaucratic obesity”  interagency competition  lack of understanding of a “determined and creative enemy”  Sniper tactics are a neglected but effective tactic against infidel forces

32. Al-Qaeda: Key Military Themes  U.S. is trying to apply center of gravity theory (COG) to A.Q. but has missed it  A.Q. knows our C.O.G (our economy)  targeting it all over the world  Al-Qaida has been recruiting “blue eyed foreign fighters”  they can move freely  disappear in target societies

33. Al-Qaeda: Key Religious Themes  Qur’anic basis for perpetual hostility  Armed jihad is obligatory (and an individual duty) for all against the infidels  The West is conducting a “New Crusade” against all of Islam  not a “war against terrorism” as it claims  Not all Ulama (Islamic scholars) truly represent Islam  “…beware of those under the control of the “agent regimes”

34. Al-Qaeda: Key Religious Themes  All who cooperate with the “Crusaders” are infidels  Ulama not under apostate government control need to actively support the jihad  The importance of jihad as a means of destroying the infidel countries:  “annihilation of the infidels is a divine decree”  The “Islamic Awakening” is frightening the enemies of Islam

35. Al-Qaida: Key Religious Themes  Islamic law permits  the killing of infidels (7 grounds)  the killing of fellow Muslims (6 grounds)  The West is using “radical Christian doctrine” and the Crusader Church to “Christianize” the Muslim world  Two-stage process:  Separate the people from Islam  Missionary organizations can then influence and control Muslims

36. Al-Qaida: Key Religious Themes  “Christianization” can only take place after the campaign to spread vice and corruption succeeds;  main methods are:  sex  corruption of women  alcohol and drugs  imposition of deviant curricula in schools  US campaigns in Afghanistan and Iraq illustrate this process  NGOs have helped to corrupt Muslim societies

37. Al-Qaeda: Key Religious Themes  The Jews intend to make Iraq part of “Greater Israel”  Shi’a “renegades” in Iran and Iraq are as much of a threat as the Christians and Jews  Western intellectuals are helping to mobilize public opinion against Muslims  justify waging a long-term crusade against Islam: “Islamic threat to Western civilization” (Friedman, Huntington, Lewis, Pipes)  Client governments are aiding the “Zionist- Crusader alliance” by supporting its Westernization/anti-Islamist campaign

38. Al-Qaeda: Key Religious Themes  US is imposing secularism on the region by force  Separation of religion and state transforms the human being from a servant of God into a base animal driven by self-interest  Democracy: one of “fruits of secularism”  takes ultimate authority away from God, places people’s will above God’s

39. Al-Qaeda: Strategy  Primary mission before 9/11:  arm, train, and finance as many mujahedin as possible  assist Islamist groups worldwide  Objectives of 9/11 attacks:  provoke massive Western response to show it is really at war with Islam  force Westerners and Muslims to take sides (since their fundamental values are incompatible)  Another consequence of 9/11:  Successfully “globalized” Islamist war against the West UNCLASSIFIED

40. Al-Qaeda: Strategy  Convince both Muslims and Westerners that they are in a “fight to the death”  make violent “clash of civilizations” (Huntington) a reality  Attacks help to show “high treason” of Arab governments against their publics  emphasize Western ineffectiveness  Increased investment in propaganda to compensate for physical losses  Current focus: “expand the battlefield and exhaust the enemy”  targeting US interests everywhere stretches resources, spreads fear

41. Al-Qaeda: “Counterpropaganda Strategy”  Determine strongest parts of enemy propaganda to identify degree of importance, then refute them  Remove enemy’s ideas from symbolic and emotional framework so they can be attacked and contradictions identified  Attack weak points and avoid confrontation when enemy propaganda is at its strongest “Scientific foundations & principles” to counter US media use and psychological warfare:

42. Al-Qaeda: “Counterpropaganda Strategy”  Respond with events  Affect public opinion  U.S. “Info Dominance” strategy must be understood, opposed  Muslim technical experts need to break U.S. computer monopolies so infidels won’t know mujahedin’s secrets

43. Al-Qaeda: Strategy 1.Current guerilla and information war against the “external enemy”, since the West can’t be defeated in a traditional confrontation 2.Defeat Arab “agent regimes” by influencing / removing their patron:  limit U.S. power and direction of their actions removes their legitimacy  undermining US support makes them more vulnerable UNCLASSIFIED Four Strategic Stages to Conflict

44. Al-Qaeda: Strategy 3.“Stage of Isolation”:  Remove the U.S. Administration from its own citizens  Remove the U.S. Administration from its allies (exploit Afghan and Iraqi campaigns) 4.Direct confrontation with the US: defeat of “Great Crusader” on its own soil will:  lead to loss by the West  shift international COG back to the Islamic world UNCLASSIFIED Four Strategic Stages to Conflict

45. Al-Qaeda: Shifts in Targets and Audiences  Initial focus on US and Israel, and Arab / Muslim “agent regimes”  Shift to non-Arab / non-Muslim allies:  France, UK, Australia, Russia, Japan  “Hard” vs “soft” targets; expand to third world regions  Fellow Muslims anywhere, if they are aiding the infidels UNCLASSIFIED Main targets (physical attacks):

46. Al-Qaeda: Shifts in Targets and Audiences  Focus on Muslims in Arabian Peninsula, Middle East, South Asia, Central and Southeast Asia, Europe (especially Balkans)  Muslim diaspora (ummah) worldwide, particularly “brethren” in Palestine and Iraq, and Muslim youth everywhere Primary audiences (virtual influence):

47. Al-Qaeda: Shifts in Targets and Audiences  Mujahedin networks (both affiliated and not with A.Q.)  U.S. public: accept Islam or prepare for more attacks…policies in Afghanistan and Iraq doomed to fail  Publics of U.S. allies and even non-aligned nations Primary audiences (virtual influence):

48. INTERNATIONAL TERRORIST GROUPS Founded in 1987 Founded in 1987 Outgrowth of the Palestinian branch of the Muslim Brotherhood Outgrowth of the Palestinian branch of the Muslim Brotherhood Both political and violent Both political and violent Strength is concentrated in the Gaza Strip Strength is concentrated in the Gaza Strip Hamas (Islamic Resistance Movement)

49. INTERNATIONAL TERRORIST GROUPS Conducted many attacks. Conducted many attacks. large-scale suicide bombingslarge-scale suicide bombings Israeli civilian and military targetsIsraeli civilian and military targets Has NOT targeted U.S. interestsHas NOT targeted U.S. interests Hamas (Islamic Resistance Movement)

50. INTERNATIONAL TERRORIST GROUPS Also known as: Also known as: The Islamic JihadThe Islamic Jihad Revolutionary Justice OrganizationRevolutionary Justice Organization Organization of the Oppressed on EarthOrganization of the Oppressed on Earth Islamic Jihad for the Liberation of PalestineIslamic Jihad for the Liberation of Palestine Formed in 1982 in response to the Israeli invasion of Lebanon Formed in 1982 in response to the Israeli invasion of Lebanon Hizballah (Party of God)

51. INTERNATIONAL TERRORIST GROUPS Lebanon-based radical Shi’a group. Lebanon-based radical Shi’a group. Ideological inspiration from the Ayatollah Khomeini. Ideological inspiration from the Ayatollah Khomeini. Formally advocates ultimate establishment of Islamic rule in Lebanon and liberating all occupied Arab lands, including Jerusalem. Formally advocates ultimate establishment of Islamic rule in Lebanon and liberating all occupied Arab lands, including Jerusalem. Hizballah (Party of God)

52.  U.S. Embassy in Beirut April, 1983  U.S. Marine barracks in Beirut in October,1983  U.S. Embassy annex in Beirut in September, 1984 INTERNATIONAL TERRORIST GROUPS Hizballah (Party of God) Activities:

53.  1985 TWA Flight 847 hijacking  1994 Bombing of the Israeli cultural center in Buenos Aires. INTERNATIONAL TERRORIST GROUPS Hizballah (Party of God) Activities:

55. DOMESTIC TERRORIST THREAT The FBI views domestic terrorism as the unlawful use, or threatened use, of violence by a group or individual that is based and operating entirely within the United States or its territories without foreign direction and which is committed against persons or property with the intent of intimidating or coercing a government or its population in furtherance of political or social objectives.

56. DOMESTIC TERRORIST THREAT  Hate groups  Patriot groups  Cult groups  Single issue groups  Lone individuals  Special interest

57. DOMESTIC TERRORIST THREAT LOCATIONS

58. 708 active U.S. hate groups, up from 457 in 2000. (2002 report). Ku Klux Klan Ku Klux Klan Neo-Nazi Neo-Nazi Skinhead Skinhead Christian Identity Christian Identity Black Separatist, and others Black Separatist, and others Hate Groups

59. Black Separatist Christian Identity Ku Klux Klan Neo- Confederate Neo- Nazi Other Racist Skinhead

60. DOMESTIC TERRORIST THREAT SPLC Intelligence Project identified 158“Patriot” groups active in 2001.  73 were militias  2 were “common-law courts,”  Remainder into a variety of categories; (publishers, ministries, and citizens’ groups). Patriot Groups

61. DOMESTIC TERRORIST THREAT Patriot groups increasingly overlap with the race or ethnicity-based hate groups. Patriot groups increasingly overlap with the race or ethnicity-based hate groups. Movement is growing more violent. Movement is growing more violent. Largely driven by “Identity” ideology. Largely driven by “Identity” ideology. Terrorist conspiracies and crimes have skyrocketed since the Oklahoma City bombing. Terrorist conspiracies and crimes have skyrocketed since the Oklahoma City bombing. Plans to bomb at least three IRS buildings, two federal buildings, several banks, a natural gas refinery, family planning clinics, and other targets have been made.Plans to bomb at least three IRS buildings, two federal buildings, several banks, a natural gas refinery, family planning clinics, and other targets have been made. Patriot Groups

62. DOMESTIC TERRORIST THREAT Militia Groups: general criteria  A militia is a domestic organization with two or more members.  The organization must possess and use firearms.  The organization must conduct or encourage paramilitary training. Militia groups are also called Patriots or Minutemen Patriot Groups

63. DOMESTIC TERRORIST THREAT  Composed of people who demonstrate great devotion to:  a person  Idea  Object  or movement  Cult members, on occasion, move in and out of fringe Christian groups or radical political, technological, and militia movements. Cult Groups

64. DOMESTIC TERRORIST THREAT  Some are tied to a strong belief in an apocalyptic “end time.”  From the time members enter a cult, they believe in achieving a special status in the spiritual family Cult Groups

65. DOMESTIC TERRORIST THREAT  1997: Heaven’s Gate religious cult.  members to committed mass-suicide  spaceship trailing behind the Hale-Bopp Comet.  1978: The People’s Temple, led by James (Jim) Jones.  Not terrorist incidents.  Demonstrates commitment Cult Groups

66. DOMESTIC TERRORIST THREAT  August, 1998 through December, 1999:  significant increase in incidents involving the mailing of letters informing clinic workers they had been exposed to anthrax.  Hoax letters:  Cost millions of dollars in emergency public-safety response  Caused fear and stress Single Issue Groups

67. DOMESTIC TERRORIST THREAT  Violent anti-abortion groups  Arson attacks  Bombings  Shootings  Millions of dollars in damages Single Issue Groups

68. DOMESTIC TERRORIST THREAT PETA (People for the Ethical Treatment of Animals) PETA (People for the Ethical Treatment of Animals) Animal Liberation Front (ALF) Animal Liberation Front (ALF) Earth Liberation Front (ELF) Earth Liberation Front (ELF) Arson to vandalism Arson to vandalism This type of crime is increasing in frequency! Single Issue Groups

69. DOMESTIC TERRORIST THREAT PETA (People for the Ethical Treatment of Animals) attacks against animal-research laboratories and manufacturing sites that use animal byproducts in their businesses.attacks against animal-research laboratories and manufacturing sites that use animal byproducts in their businesses. Single Issue Groups

70. DOMESTIC TERRORIST THREAT Animal Liberation Front (ALF) an extremist animal rights movementan extremist animal rights movement Single Issue Groups

71. DOMESTIC TERRORIST THREAT Earth Liberation Front (ELF).  1998; arson fires set at a Vail, Colorado Ski Resort  Destroyed eight separate structures  $12 million in damage Single Issue Groups

72. DOMESTIC TERRORIST THREAT Individuals remain the most likely domestic source of a credible threat of the use of WMD. Individuals remain the most likely domestic source of a credible threat of the use of WMD. May be affiliated on the fringes of any of the groups mentioned above. May be affiliated on the fringes of any of the groups mentioned above. Operate independently in order to demonstrate their positions Operate independently in order to demonstrate their positions Lone Individuals

73. DOMESTIC TERRORIST THREAT Timothy McVeigh Murrah Federal Building in Oklahoma City. Murrah Federal Building in Oklahoma City. Killed 168 men, women, and children. Killed 168 men, women, and children. Executed June 11, 2001 Executed June 11, 2001 Lone Individuals

74. DOMESTIC TERRORIST THREAT Eric Robert Rudolph Often aligned with the Christian Identity hate group Often aligned with the Christian Identity hate group 1996; Centennial Park Bombing ATL 1996; Centennial Park Bombing ATL 1997; Bombing of Woman's Health Clinic in Birmingham 1997; Bombing of Woman's Health Clinic in Birmingham 1998; Sandy Springs Professional Office Building north of Atlanta 1998; Sandy Springs Professional Office Building north of Atlanta Lone Individuals

75. THREAT HISTORY 1995 – Murrah Building, OK1995 – Murrah Building, OK 1996 – ATL Olympic Park1996 – ATL Olympic Park 1997 – ATL Family Planning Clinic1997 – ATL Family Planning Clinic 1997 – Atlanta Nightclub1997 – Atlanta Nightclub 1997 – Fort Worth, Texas1997 – Fort Worth, Texas 1998 – Las Vegas, Nevada1998 – Las Vegas, Nevada 1998 – Birmingham, AL1998 – Birmingham, AL 1998 – Brownsville, TX1998 – Brownsville, TX 1998 – Palm Desert, CA1998 – Palm Desert, CA 1999 – Sacramento, CA1999 – Sacramento, CA 2001 – New York City, NY2001 – New York City, NY 2001 – Washington, DC2001 – Washington, DC Terrorist acts in the United States

76. WEAPONS OF MASS DESTRUCTION Reasons terrorists might use WMD CheapCheap AvailableAvailable EffectiveEffective Difficult to detectDifficult to detect Maximum benefit/minimum resourcesMaximum benefit/minimum resources

77. THREAT TARGETS Airports Airports Apartment buildings Apartment buildings Bridges/tunnels Bridges/tunnels Buses and stations Buses and stations Chemical plants Chemical plants Civilian airliners Civilian airliners Critical infrastructure Critical infrastructure Cruise ships Cruise ships Cultural icons Cultural icons Dams Dams

78. THREAT TARGETS Financial institutions Financial institutions Government offices Government offices Government officials Government officials High-profile corporations High-profile corporations High-profile individuals High-profile individuals Large events/gatherings Large events/gatherings Military installations Military installations Nuclear reactors/related facilities Nuclear reactors/related facilities Rail targets Rail targets Shopping malls/high density locations Shopping malls/high density locations Water facilities Water facilities

79. THREAT TACTICS Biological Biological Bombing Bombing Chemical Chemical Cyber-based strikes Cyber-based strikes Hijacking Hijacking Hostage taking Hostage taking Kidnapping Kidnapping

80. THREAT TACTICS Nuclear Nuclear Radiological Radiological Sabotage Sabotage Shooting Shooting Vehicular bombing Vehicular bombing Suicide bombing Suicide bombing

81. Wrap Up!

82. Contact information The University of Texas Health Science Center-Houston Center for Biosecurity and Public Health Preparedness 1200 Herman Pressler Drive RASW334 Houston, Texas 77030 Office: 713-500-9421 Cell: 256-310-5212 Email: Michael.W.Proctor@uth.tmc.edu Michael.W.Proctor@uth.tmc.edu www.texasbiosecurity.org www.texasbiosecurity.orgwww.texasbiosecurity.org Michael W. Proctor, MD