2. Weapons of Mass Destruction & Bioterrorism Ronald R. Blanck, D.O. LTG, USA (Retired)

3. “…any weapon or device that is intended, or has the capability, to cause death or serious bodily injury…through the release of…poisonous chemicals…disease…or radiation….” “…any explosive, incendiary, or poison gas, bomb, grenade, rocket having propellant charge more than four ounces, missile having an explosive charge of more than one quarter ounce, mine or device similar to the above…poison gas…disease organism…radiation.”

4. WMD : Significant casualties from terrorist use of:   Chemical Device Tabun (GA) Tabun (GA) Sarin (GB) Sarin (GB) Soman (GD) Soman (GD)   Biological Device Botulism Toxin Botulism Toxin Anthrax Anthrax Plague Plague Ricin Ricin   Large Conventional Explosive Device   Nuclear Device

5. Terrorism Is… “Warfare deliberately waged against civilians with the purpose of destroying their will to support either leaders or policies that the agents of such violence find objectionable.” Lessons of Terror - Caleb Cobb - Caleb Cobb

6. FRIGHTEN 10,000 -- Tom Clancy The Sum of All Fears KILL ONE

10. Presidential Decision Directive 39 U.S. Policy on Counterterrorism June 21, 1995 PRESIDENT NATIONAL SECURITY COUNCIL Coordination of Federal Agencies FBI FEMA FEDERAL RESPONSE PLAN INCIDENT CONTINGENCY PLANS Crisis ManagementConsequence Management HOMELAND DEFENSE Governor Tom Ridge

11. Definitions Crisis Management Crisis Management –Measures to anticipate, prevent, and/or resolve a terrorist threat or incident Primary Responsibility: Federal GovernmentPrimary Responsibility: Federal Government Lead Federal Agency: FBILead Federal Agency: FBI Consequence Management Consequence Management –Measures to alleviate the damage, loss, hardship, or suffering caused by incident Primary Responsibility: State/Local GovernmentPrimary Responsibility: State/Local Government Lead Federal Agency: FEMA, coordinating Federal Consequence Management support to the stateLead Federal Agency: FEMA, coordinating Federal Consequence Management support to the state

12. Programs Domestic Preparedness Domestic Preparedness  Interagency effort directed by Congress  AKA: Nunn-Lugar-Domenici City Training Consequence Management Program Integration Consequence Management Program Integration  DoD efforts directed by SECDEF (DRID #25)  Improve DoD Support for Response to WMD attacks  Integrate National Guard and Reserve Components

13. Purpose of Nunn-Lugar- Domenici To enhance the capability of the Federal Government to prevent and respond to terrorist incidents involving weapons of mass destruction To enhance the capability of the Federal Government to prevent and respond to terrorist incidents involving weapons of mass destruction To provide enhanced support to improve the capabilities of state and local emergency response agencies to prevent and respond to such incidents at both the national and local levels To provide enhanced support to improve the capabilities of state and local emergency response agencies to prevent and respond to such incidents at both the national and local levels

14. Domestic Emergency Continuum Most Likely Least Likely Greatest Least Probability -- Aircraft Accident HAZMAT -- MAJOR FLOODING IED -- STATE & LOCAL FEDERAL HURRICANE -- IND WMD ICD -- IBD -- Civil Demo -- Severe T-Storm -- Civil Disturbance -- Impact

15. Tiered Disaster/Emergency Response Local Response Incident Commander Federal Response State Response Full response requires local, state, and federal assets State response includes National Guard Military support requires Total Force involvement

16. Information * Bottom Line - we are not ready! Scenario CommandComm.EquipmentLogisticsPlans Overall Radiological Threat (Plutonium) Nuclear Explosion Threat (Uranium) Biological Agent Threat (Anthrax) Chemical Nerve Agent Threat (GB) Chemical Nerve Agent Threat (VX) (Persistent) Summary: Terrorists place a radiation Dispersal Device which distributes plutonium over a populated area. Summary: An improvised nuclear device (1.5KT) is exploded at midday in the vicinity of a state capitol building. Summary: 100 grams of anthrax released into the air distribution system at a major airport. Summary: 10 Gallons of Sarin is released on a busy morning in trash canisters at 5 Subway stations in a major city. Summary: M23 Land mines (.8lb) placed in suitcases at major airport and exploded at midday Capacity Federal WMD Response Assessment It’s not IF, It’s WHEN and WHERE?

17. Biological Warfare The intentional use of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants

19. Biological Warfare History 14th Century: plague at Kaffa 14th Century: plague at Kaffa 18th Century: smallpox blankets 18th Century: smallpox blankets 1943: USA program established 1943: USA program established 1953: Defensive program established 1953: Defensive program established 1969: Offensive program disestablished 1969: Offensive program disestablished 1979: Sverdlovsk Anthrax incident 1979: Sverdlovsk Anthrax incident SE Asia: Yellow Rain SE Asia: Yellow Rain London, Virginia: Ricin London, Virginia: Ricin

20. BW Agreements 1925 Geneva Protocol 1925 Geneva Protocol 1969 Nixon renounces BW 1969 Nixon renounces BW 1972 Biological Weapons Convention 1972 Biological Weapons Convention 1975 Geneva Conventions Ratified 1975 Geneva Conventions Ratified

21. Biological Weapons Policy No use under any circumstance No use under any circumstance Research limited to defensive measures Research limited to defensive measures We possess NO weaponized biologicals We possess NO weaponized biologicals Previous weapons stocks destroyed Previous weapons stocks destroyed Destruction supervised: Destruction supervised: –USDA –Dept of HEW –DNR of AR, CO, MD

22. Destroyed U.S. Biological Warfare Agents Lethal Lethal –B. anthracis –Botulinum toxins –F. tularensis Anticrop Anticrop –wheat stem rust –rye stem rust –rice blast Incapacitating Incapacitating –Brucella suis –VEE virus –SEB –Q fever agent

23. The Sverdlovsk Incident April-May 1979 April-May 1979 –66 Anthrax fatalities 1988 1988 –Soviets present data: 96 cases96 cases 79 gastrointestinal79 gastrointestinal May 1992 May 1992 –Yeltsin admits “military developments”

26. Soviet BW Priorities “Agents Likely to be Used” Smallpox Smallpox Plague Plague Anthrax Anthrax Botulism Botulism VEE VEE Tularemia Tularemia Q Fever Q Fever Marburg Marburg Influenza Influenza Melioidosis Melioidosis Typhus Typhus

27. “There were more INSTITUTES working on Plague in the USSR than PERSONNEL working on Plague in the USA” -- Dr Ken Alibek

28. Advantages of BW: Are Biologicals the Ultimate Weapon? agents easy to procure agents easy to procure inexpensive to produce inexpensive to produce can disseminate at great distance can disseminate at great distance agent clouds invisible agent clouds invisible detection quite difficult detection quite difficult first sign is illness first sign is illness overwhelms medical capabilities overwhelms medical capabilities simple threat creates panic simple threat creates panic perpetrators escape before effects perpetrators escape before effects ideal terrorist weapon ideal terrorist weapon

29. Acquisition of Etiologic Agents Multiple Culture Collections Multiple Culture Collections Universities Universities Commercial Supply Houses Commercial Supply Houses Foreign Laboratories Foreign Laboratories Field Samples or Clinical Specimens Field Samples or Clinical Specimens

30. Hypothetical Dissemination 50 kg agent, 2 km front, upwind of city of 500,000 AgentReachKIAWIA RVF140035000 TBE1950035000 Typhus51900085000 Brucella10500100000 Q fever>20150125000 Tularemia>2030000125000 Anthrax>>2095000125000

31. Hazardous Biologic Material Letters Letters Packages Packages Cultures Cultures Person – to - Person Person – to - Person

32. Response Not Typical First Responders Not Typical First Responders BIO First Responders BIO First Responders - Physician’s Office - Physician’s Office - ER - ER - Clinics - Clinics All Organizations Involved All Organizations Involved

33. Issues Rapid Detection Rapid Detection Public Health Public Health Hospital Capacity Hospital Capacity Stockpiling Stockpiling Vaccine Production Vaccine Production

35. Health Providers’ Responsibilities lAwareness lPresumptive Diagnosis lReporting lEpidemiology lResponse –Triage –Prophylaxis –Immunizations –Treatment lRisk Communications

37. 19 April 1995, Oklahoma City 26 February 1993, New York 20 March 1995, Tokyo It’s not a question of if... 11 September 2001, New York It’s not even a question of when… It’s a question of when next…