Bioterrorism in the United States of America

Bioterrorism in the United States of America
Since the events of September 11, 2001, the United States has made great strides in emergency response preparedness for terrorist attacks, however, one area that is still lacking is preparedness for a widespread biological terrorist attack. The threat of a bioterrorist attack in the United States is a very real and potentially convenient method of attack for numerous terrorist organizations. An attack of this type could go unnoticed in many public areas. Major transportation hubs throughout the United States are major targets for such an attack. An act of bioterrorism is a major threat to the United States that could occur unnoticed and must be dealt with immediately by providing a nationwide vaccination against all agents, better education programs for the general public, and most importantly, the prevention of such an act from happening.
In October, 2001, the first confirmed case of inhalation anthrax was confirmed in Florida, which brought the word bioterrorism to mainstream America (Jernigan, 2001, p. 934). Throughout the fall of that year many people’s fears were stoked by this anthrax scare following shortly after the events of September 11, 2001. This anthrax scare highlighted that while the hospital system throughout the United States may not be completely prepared for a widespread bioterrorism attack, these hospitals could handle a small number of cases and brought bioterrorism preparation to the forefront of the Global War on Terrorism. Of the first ten cases of inhalation anthrax in the United States in 2001, four of the ten infected died within ten days of the onset of symptoms (Jernigan, 2001, p. 942). This statistic is very frightening as it shows the potentially devastating effect that a large scale bioterrorism attack could cause. Researchers agree that anthrax and smallpox are the most threatening biological agents that could be used in a bioterrorist attack in the United States (Phillips, 2003, p. 7).
While smallpox is less deadly than anthrax, it is nonetheless just as frightening. By 1970 most of the developed world had been vaccinated against smallpox, while much of the developing world had either been vaccinated or developed a natural immunity to smallpox (Richards, 2010). However immunity from the vaccine wears off, assumingly after thirty years. The number of individuals who have received routine smallpox vaccinations throughout the world is very small because it was considered an eradicated disease and the need to continually vaccinate for smallpox was deemed unnecessary (Richards, 2010). So the majority of the world’s population now is not immune to smallpox and is susceptible to a smallpox infection.
Also, the science behind exactly how smallpox is spread is not exactly settled, which hinders bioterrorism response and prevention efforts. One such example is of a German electrician who, in 1970, returned from Pakistan with a fever, suspected to be typhoid fever. Three days later this electrician developed a rash, which was confirmed to be smallpox. Up to this point, while the individual was in the hospital, he was kept in general isolation. Once smallpox was confirmed, he was transferred to a specialized smallpox hospital. Even though there were isolation procedures and protocols in place and the hospital staff had received vaccinations for smallpox, nineteen additional cases of smallpox developed within the hospital. It is reported that the electrician was only on the first floor of the hospital, however, individuals on all three floors of the hospital developed smallpox. Following the smallpox outbreak, investigators conducted a smoke test in the hospital. Eleven of the nineteen additional cases of smallpox were found to be in rooms outside of the smoke test air flow (Richards, 2010). The most fearful aspect of this example is the fleeting exposure to smallpox by an unprotected population compared to the prolonged exposure to smallpox by a protected population. While this example is quite dated, it shows that the spread of smallpox can easily happen within an unprotected population.
While smallpox can be deadly, the widespread outbreak of smallpox would cause mass panic. This mass panic would cause financial collapse and cause the breakdown of basic social order. This aspect is particularly frightening when it comes to the potential of smallpox being utilized in a bioterrorist attack within the United States.
While the eventuality of a large scale bioterrorist attack within the United States may be a reality, containment of such an event can be prepared for. Since September 11, 2001 great strides have been made, but there are still critical short falls in emergency response capabilities when it comes to bioterrorism.
A report by the Association of State and Territorial Health Official (ASTHO) indicates that one of the biggest pitfalls facing public health agencies when it comes to dealing with potential bioterrorism attacks is maintaining a qualified workforce (Weiner & Trangenstein, 2006, p. 215). Public health agencies have been actively addressing this issue by strategically recruiting and retaining the best and the brightest in the medical field. In the last decade information technology has played a large role in this, thus individuals entering or continuing a career in this field must be savvy when it comes to information technology. This is a key component to biological terrorism response throughout the United States. For instance, the National Electronic Disease Surveillance System (NEDSS) facilitates the transferring of public health information to local and state public health departments (NEDSS/NBS, n.d.). This will is critical when it comes to monitoring the spread of infectious disease throughout the United States and will be critical to a quick and efficient response to a biological terrorist attack.
The Laboratory Response Network (LRN) is another critical piece of the puzzle when it comes to emergency preparedness to a biological terrorist attack. The LRN is charged with maintaining an integrated network of state and local public health, federal, military, and international laboratories that can respond to bioterrorism as well as chemical attacks and other public health outbreaks (The Laboratory Response Network: Partners in Preparedness, n.d.). On the national and international level this allows for a coherent and effective response to bioterrorism.
However education of public health caregivers is important as well, and this education is at times lacking. An example of how lacking the education of nurses, in particular is, is a study conducted of one hundred and eighty-seven nurses. The most troubling aspect of this survey was that none of the respondents answered, how smallpox was transmitted, or how chemical compounds needed for biological decontamination were transported correctly (Tindale, 2008, pg. 6). The researchers of this study concluded that the overall level of knowledge that the average nurse possesses is poor, mainly relying on the internet and media for information instead of scholarly, scientific, or medical research (Tindale, 2008, pg. 6). While this is just a small sampling of nurses throughout the world, it is still unnerving.
When it comes to preparing the United States for a bioterrorist attack, one must balance the risk and the response. While it could be argued that the risk of a bioterror attack is significantly lower than other types of terrorist attacks, there are a number of terrorist actors throughout the world who would like nothing more than to conduct a biological terrorist attack within the United States. Furthermore, a biological terrorist attack often takes a back seat to other biological threats such as naturally occurring diseases (Sidel, 2007, p. 320). However, over the last decade funding for the preparedness of a biological terrorist attack has increased and there have been many preparedness benefits. Some examples of these benefits are the strengthened training and coordination between different agencies, improved training for first responders resulting in the potential of more lives being saved in the event of a biological attack, and reassurances to the general public that services are prepared for such an event (Sidel, 2007, p. 320).
While the advances that the United States has made in preparation for a bioterrorist attack have greatly improved, they are still lacking. For instance a bioterror attack will not be announced and there may not be a loud explosion alerting individuals that an attack is taking place. There will be no ground zero for first responders to cordon off and treat casualties. In fact it may prove difficult to even identify the perpetrators of such an event. The signs and symptoms indicating a possible biological attack could be delayed, thus further complicating response efforts.
In our modern fast paced society we rely on mass transit systems, congregate in large metropolitan areas, and attend large public gatherings. These all are attractive targets for terrorist organizations to attack. If a terrorist organization were to release smallpox into a busy subway system within the United States the results could be disastrous, it could be several days before individuals showed any signs and symptoms of the disease and by that time the number of other people who may have come into contact with these individuals would be countless. It is very easy to see how an outbreak could occur and cause a mass panic throughout our country.
Preventing a biological attack before it occurs is obviously the most ideal way to deal with bioterrorism. In the previous decade we have been able to do this by increasing the services our intelligence community provides throughout the world. The coordination between the intelligence community and law enforcement has not been easy, but it is continually getting stronger. This will only continue to enhance our ability to prevent a biological attack from occurring. Also we must continue to improve the security at scientific research facilities throughout the United States to prevent any types of biological agents falling into terrorist hands. The United States must continue to educate first responders on the proper protocols and procedures to follow when dealing with a biological attack. Finally the education provided to the general public must be increased. This education for the general public needs to remain general in nature, but must include the basics of what to look for and how to respond in the event of a biological terrorist attack. As stated prior a biological terror attack will cause death and agony, but ultimately the potential for the breakdown of social order is the most frightening aspect of a biological terrorist attack.
In conclusion, the United States is much more prepared to respond to a biological terrorist attack now compared to a decade ago. However the complexity in planning for every conceivable biological attack is not possible, therefore the United States still remains vulnerable. Prevention of biological terrorist attacks is the best option, as even though the United States is better prepared for a bioterror attack, as a whole the nation is still lacking. A lack of funding, qualified public health personnel, and the lack of training are just a few of the constraints that limit the response capabilities within the United States. However even with these constraints, with the continued cooperation between federal, state, and local agencies and the continued development of response capabilities at all levels, the United States will be able to effectively and efficiently respond to a bioterror attack. References
Jernigan, J. (2001). Bioterrorism-Related Inhalation Anthrax: The First 10 Cases Reported in the United States. Emerging Infectious Diseases, 7(6), 933-944. doi:10.3201/eid0706.010604

The Laboratory Response Network: Partners in Preparedness. (n.d.). Retrieved June 18, 2016, from https://emergency.cdc.gov/lrn/

NEDSS/NBS. (n.d.). Retrieved June 18, 2016, from https://wwwn.cdc.gov/nndss/nedss.html

Phillips, M. J. (2004). Bioterrorism: A Survey of Western United States Hospital Response Readiness (Order No. 3115479). Available from ProQuest Central. (305142869). Retrieved from http://search.proquest.com/docview/305142869?accountid=8289

Richards, E. (2010, August 6). The United States Smallpox Bioterrorism Preparedness Plan: Rational Response or Potekmin Planning. William Mitchell Law Review, 36(5).

Sidel, V. (2007, October 22). Bioterrorism in the United States: A Balanced Assessment of Risk and Response. Medicine, Conflict, and Survival, 19(4), 318-325. doi:10.1080/13623690308409705

Tindale, R. (2008). Bioterrorism. Emergency Nurse, 16(2), 6.

Weiner, E. and Trangenstein, P. (2006). Preparing Our Public Health Nursing Leaders With Informatics Skills to Combat Bioterrorism in the United States. Studies In Health Technology and Informatics, 122215-219