Weapons of Mass Destruction & Bioterrorism

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

2. Weapon of Mass Destruction “…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.” Federal Response Plan Annex Nunn “…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….” Lugar Domenici Legislation

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

4. 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

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

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

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

11. Programs • Domestic Preparedness • Interagency effort directed by Congress • AKA: Nunn-Lugar-Domenici City Training • 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

12. 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 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

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

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

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

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

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

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

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

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

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

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

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

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

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

29. Agent Reach KIA WIA RVF 1 400 35000 TBE 1 9500 35000 Typhus 5 19000 85000 Brucella 10 500 100000 Q fever >20 150 125000 Tularemia >20 30000 125000 Anthrax >>20 95000 125000 Hypothetical Dissemination50 kg agent, 2 km front, upwind of city of 500,000

30. Hazardous Biologic Material • Letters • Packages • Cultures • Person – to - Person

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

32. Issues • Rapid Detection • Public Health • Hospital Capacity • Stockpiling • Vaccine Production

34. Health Providers’ Responsibilities • Awareness • Presumptive Diagnosis • Reporting • Epidemiology • Response • Triage • Prophylaxis • Immunizations • Treatment • Risk Communications

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