Facing up to the bioterror thre

http://www.iht.com/articles/2005/01/30/opinion/edotoole.html

Facing up to the bioterror threat 
Daniel Hamilton and Tara O'Toole International Herald Tribune Monday, January 
31, 2005

New security alliances

WASHINGTON Earlier this month in a Washington wargame, 11 former ministers and 
heads of government from Europe and North America confronted a threat no one 
should ever have to face: the use of contagious disease as a weapon. 
.
Atlantic Storm was designed to provoke imagination and to prompt action by 
making the reality of deliberate epidemics more vivid and by underscoring our 
shared responsibility to prevent, but also to prepare for, such a threat.
.
Faced with tragic choices, Atlantic Storm leaders largely agreed on appropriate 
responses. Although they worried about sharing the vaccine to the simulated 
contagion with "have-not" allies, in the end they took courageous steps to 
vaccinate half the planet. This left the question: How, exactly, could we carry 
out a decision to immunize three billion people in the real world? 
.
The Atlantic Storm scenario - destructive and disruptive as it was - could have 
been much worse. Unless we forge new health security alliances to meet the 
bioterrorist threat, an attack of mass lethality is not a matter of whether it 
will happen, but when. 
.
Just as Atlantic Storm began, the scientific journal Nature announced the 
development of biological techniques that permit rapid synthesis of large 
viruses from non-living parts. This will help researchers seeking new drugs and 
vaccines. But it also puts the synthesis of large viruses such as smallpox 
within the reach of thousands of laboratories around the world. The age of 
engineered biological weapons is here, today. It is not science fiction.
.
Terrorists will not restrain from using such weapons. Can we shift the 
advantage from potential mass murderers? Absolutely. But it requires the will 
and the imagination to take actions that are more than piecemeal extensions of 
current policies.
.
The first step is to recognize that this threat requires something more 
holistic than buying more vaccine or training more doctors. It means 
integrating our public health and national security communities in ways that 
allow us to supplement our traditional security emphasis on territorial defense 
with a focus on integration and cooperation across borders. 
.
Beginning a comprehensive effort that renders nations immune to mass 
destruction by disease must include an international "rapid reaction" capacity 
to produce and deliver vaccines and drugs against the plagues that are meant to 
destabilize economies, disrupt societies and kill millions. 
.
In Atlantic Storm, leaders turned to the World Health Organization. Yet the WHO 
is woefully underfunded and understaffed. As Gro Harlem Brundtland, former 
director general of the WHO, commented during the exercise, "the WHO has about 
as many resources as a medium-sized hospital in England."
.
Stockpiling smallpox vaccine is a good intermediate step. Atlantic Storm 
leaders were stunned when they realized that many NATO and EU members - not to 
mention their poorer neighbors - do not have enough vaccine for their 
populations. But the real answer is recreating drug design and manufacture so 
we can develop whatever we need on short notice. 
.
Successful global approaches to biosecurity must begin with the trans-Atlantic 
community. Europe and North America together represent the largest repository 
of resources, skills, talents, leadership and international engagement to make 
health an integral part of national security, and yet their health systems are 
unprepared for intentional attacks of infectious disease. Moreover, in an age 
of catastrophic terrorism and engineered pathogens, the world's richest 
countries are only as secure as the world's poorest public health system. 
.
If the trans-Atlantic community regarded biological weapons and the deliberate 
large-scale epidemics they would bring as one of the most grave and urgent 
challenges to international security - and if we were to respond with the level 
of resources and intellectual firepower that the free world brought to 
defeating Communism - then we could, in our generation, eliminate bioweapons as 
agents of mass lethality.
.
Along the way we would, inevitably, also make profound discoveries about human 
response to infection and prevent or greatly limit the toll of death and 
suffering from naturally occurring infectious disease, which kills 1,500 people 
every hour and causes half the premature deaths in the developing world. 
.
We can create the capacity to eliminate large epidemics of infectious disease 
in our lifetimes. We can enhance our security as we enhance our health. But we 
must first choose to take on this task - the post-9/11 equivalent of putting a 
man on the moon. It can happen. But it will require imagination, commitment - 
and leadership.
.
(Tara O'Toole directs the Center for Biosecurity at the University of 
Pittsburgh Medical Center. Daniel Hamilton directs the Center for 
Trans-Atlantic Relations at the School of Advanced International Studies at 
Johns Hopkins University. They were the co-directors of the Atlantic Storm 
simulation exercise.) 

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