America At War:
Biological Weapons --
Emergency Planning
With Jason Pate
The Monterey Institute for International Studies
Wednesday, Oct. 24, 2001; 1 p.m. EDT

Health officials in Washington, D.C. confirmed that two postal workers are dead and an additional two are now infected with inhalation anthrax. Another postal worker in New Jersey is also suspected of suffering from inhalation anthrax.

How would you rate the government's response to the anthrax-related cases in the past month? Is the U.S. handling these sporadic cases well and are we prepared for a mass exposure to anthrax or other biological weapons?

Jason Pate, certified emergency medial technician (EMT) and now at the Monterey Institute of International Studies, was online Tuesday, Oct. 23 at Noon EDT, to discuss biological warfare, emergency response and preparedness.

Pate is a senior research associate and manager of the Weapons of Mass Destruction (WMD) Terrorism Project for the Chemical and Biological Weapons Nonproliferation Program, at the Center for Nonproliferation Studies (CNS), at the Monterey Institute of International Studies. His research focuses on understanding motivations and patterns of behavior associated with terrorism involving weapons of mass destruction. In addition to his work at the Center for Nonproliferation Studies, Pate has participated in biological terrorism tabletop response exercises, chemical terrorism functional response exercises, and the Nunn-Lugar-Domenici domestic preparedness training programs for the San Francisco Bay Area.

A transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

Sacramento, Calif.: Having six children born after 1970 I am concerned about the smallpox factor in bio-warfare. What should parents do to protect their children who have never been vaccinated for smallpox since vaccines were not manditory after 1970? Should we vaccinate our children now that we know the threat is real. I feel that we are not moving fast enough to prepare and we are chasing the next outbreak.

Jason Pate: Thank you for your question about smallpox. It is important to remember that the anthrax attacks do NOT translate into a smallpox threat. Smallpox exists officially in only two places in the world, and even though there are reports that smallpox samples have "leaked" to other countries, these reports are sketchy and impossible to corroborate. Even if terrorists had access to smallpox, which is extremely unlikely, it is much harder to work with than anthrax--harder to keep alive, harder to process into a form that can be used as a weapon, and even harder to deliver effectively. Given the low probability of the threat, vaccination is premature. Also, the rate of death from vaccination is about 1 in one million and may be higher in a population with so many immunocompromised people, such as in the US today. We need more research before we can safely undertake such a large vaccination campaign. Everyday threats, such as car accidents, are much more of a threat to the public and should continue to receive attention--remember that 10,000 people died of the flu last year.

Philadelphia, Pa.: Isn't it time for the powers that be to pull out all of the stops and cut through all of the red tape? If I hear one more expert say "we need to do such-and-such" in order to safeguard against mass casualties in case of a small pox infection, etc., I'm going to self-combust. I think we're all getting pretty frightened and need some reassurance and see some cohesive action from the CDC/government. Thanks.

Jason Pate: This is a good point. There has been a lot of contradictory information coming out of official sources, and to me this indicates at the least a lack of clear coordination at at most significant confusion in the government. However, we need to remember that this is a "new" type of threat, we don't have much experience with it, and it will take some time to iron out thw wrinkles, something the Office of Homeland Security hopes to do. My concern is that these reports and statements are doing more to alarm the public by focusing so much on very improbable absolute worst-case scenarios than to calm, which is what we need right now. The media have not been helpful, and twice I have seen anthrax referred to as a virus (it is a bacterium) on prominent, prestigious news stations. If our primary sources of information can't get this simple fact right, how can we expect accurate information in other areas?

San Francisco, Calif.: It seems to me we need to get beyond our current treatment-oriented approach and take more preventative, preemptive, and anticipatory action. The last one especially I think is important, because it is clearly being ignored by the people in charge. For example, in yesterday's Washington Post, CDC director Dr. Jeffrey Koplan is quoted as saying: "...you've got to know about cases to take action."

That is totally wrong-headed thinking. You do not have to know about cases to take action. Yes, if you know about cases, you do have to take action, but we should also be thinking ahead and anticipating the possibility of other problems, and taking preemptive action on an ongoing basis.

Checking workers at a few post offices would not have been an overwhelming burden on the system.

Do you think this common sense viewpoint is going to dawn on those like Dr. Koplan at CDC?

Jason Pate: Your point is well taken. The problem is that we have allowed our public health infrastructure to deteriorate over the last couple of decades to the point that we are uncertain as to whether it can handle bioterrorist attacks. Bolstering public health is the first line of defense against ANY disease outbreak, deliberately spread or naturally occurring, and in order to take the preemptive actions you suggest, we first have to have that capability in public health. Unfortunately, because of our neglect of the system, we do not have adequate capabilities to implement all the strategies we should.

Washington, D.C.: The flu season is just around the corner. Are folks preparing for the number of people who will demand anthrax testing?

Jason Pate: This is a very good question and speaks to the issue of a lack of rapid diagnostic capabilities outside a very few select labs. We simply will not be able to test everyone who has flu-like symptoms without some indication of exposure. Of course, to keep this in perspective, remember that 10,000 people died of the flu in the US in 2000, so the flu is a public health problem that is significantly greater than anthrax.

Sacramento, Calif.: What are the facts about incubation and types of anthrax. We have heard several different statistics on time frames and exposure and would like to get this straight.

Jason Pate: There are several strains of anthrax, and the incubation period is "estimated" at 3-10 days, but can take as long as a month or so. The problem is that we do not have the necessary data to show these statistics. The only data we have are from naturally occurring cases (very few annually), the 1979 Sverdlovsk incident, and some data from biological weapons testing in the 1950s. It's not like tracking the flu or TB--the data are limited, and we must rely on best estimates.

Washington, (U.K.!): I'm surprised you are so dismissive of smallpox. Don't you think that a communicative bioweapon is far more likely to have the desired terror/disruptive effect?

Jason Pate: It depends on the motivation of the attacker. The anthrax attacks were NOT designed to cause mass casualties, which is what you are suggesting might be attractive about a contagious agent. And seeking a certain effect and actually being able to achieve that effect are very different.

Hyattsville, Md.: Do other western hemisphere countries have major procedures in metropolitan areas to routinely monitor ventilation systems for specific contaminants and do you feel major metropolitan areas in the U.S. are putting enough contingency plans in place to prevent the actual spread of anthrax or other chemical/biological agents in building and subway ventilation systems?

Jason Pate: The short answer is no (to other countries' efforts) and probably (to US efforts). The US is far, far ahead of the rest of the world in preparing for chemical and biological terrorism. However, although there is equipment available for use in the field, the equipment is generally not accurate or ready for everyday use. Subways have been identified as targets for some time, and because of the sarin attck in Tokyo in 1995, a lot of the US effort has focused on public transportation. A lot of information about what steps are being taken is not available in the public domain, and for good reason--there is no need to highlight weaknesses or vulnerabilities to would-be terrorists. Therefore, it is very hard to get a good understanding of what is being done and how effective it is.

San Francisco, Calif.: Why hasn't using the anthrax vaccine been discussed as a possible preventative measure to protect our postal workers and/or anyone else who wants it? I have heard almost nothing from the media in regards to this. Didn't we vaccinate many our soldiers during the Gulf War? I realize there were some serious side effects reported with a some soldiers. However, if the side effects are temporary, that is certainly the lesser of two evils... Please comment.

Jason Pate: The controversy surrounding the military vaccination program has not been supported by any clinical data, so my understanding is that the side effects have been greatly exaggerated by reporting. Whenever there is a very large population receiving a vaccination, there will be side effects and adverse effects in some--the anthrax vaccine actually has lower rates of adverse effects than many vaccinations we employ. The issue here unfortunately is probably cost. Vaccinating everyone would limit the effects of anthrax, but would be VERY expensive. Why not spend that money on cancer, HIV, or heart disease research? In a perfect world, we could do everything--in our world, the government will need to make choices. Another idea is to make the vaccination available to people who want it, at their own expense. This of course helps the wealthy population protect itself at the expense of the lower socioeconomic segments.

Hello: I work for a major media organization. We have received a "highly questionable" package in our mailroom yesterday. However, our managers have not told us about it nor have they contacted any authorities. We did get an e-mail saying that they hired an "outside company" to check certain work areas for anthrax, but they made no mention of the letter. I'm worried because they aren't calling the proper authorities -- I know they don't want us to panic, but in this climate, the more info the better. People are thinking of going over their heads and calling someone themselves. Bad idea?

Jason Pate: I'm not sure what to tell you. These types of questionable incidents should be communicated to the authorities, but it's really your call whether you feel like you should contact them yourself.

Washington, D.C.: Jason,
Since all the mail that comes into the city of Washington (private and business) comes through the Brentwood Postal building, should the government be considering testing all the city's residents and possibly administering antibiotics? I realize that this is between 500 and 600 thousand people but if postal workers keep getting sick (aren't we up to six now hospitalzed?) people are going to wonder about their home mail that they've (we've) received prior to the Brentwood shutdown. Since we are told that anthrax can be in the body days or weeks before symptoms. That would mean trace amounts could be our homes and you can't say this isn't possible because the government doesn't know the extent of the anthrax spread.

Jason Pate: This is certainly something to keep in mind, especially if there are incidents outside that facility. My sense is that the anthrax spores were incidentally aerosolized at the facility, but it is still unclear how--perhaps from the compressed air and sorting machines. It is not beyond the realm of possibility that other mail could have been affected--we simply do not know, which increases our anxiety and fear levels.

Washington, D.C.: Thank you for taking questions Mr. Pate.

How effective would latex gloves and pollen/dust protective masks be in providing protection from airborne, surface contact, and infectious contaminates, like anthrax, small pox and others?

Jason Pate: Generally, speaking, such measures (gloves and medical masks) are highly effective against infectious disease. Think of the hospital environment: doctors, nurses, techs, and others working at the hospital wear no more than gloves and masks and work in an environment filled with potential exposures to many infectious diseases.

Burlington, Vt.: I have often read about the size of the U.S. stockpile of smallpox vaccine. But if smallpox were ever to be used against us, depending upon the means of dispersal and the time to detection, it may spread beyond our borders before we can contain it. How prepared are our friends and neighbors for a smallpox epidemic?

Jason Pate: Most developed countries maintain smallpox vaccine stockpiles, but I don't know the exact amounts. Your question highlights a critical point: these threats are international in nature, and we should design our policies accordingly.

Washington, D.C.: People are panicking about the anthrax cases. It seems to me that the postal workers were at a higher risk for inhalatory anthrax because of the processing mechanisms, but other people receiving and opening mail containing anthrax are more likely at risk for cutaneous anthras, which is highly treatable. Would you agree? And why were the postal workers not tested earlier?

Jason Pate: I would agree. I don't know why the letters were not more effectively traced through the postal system. At this point, it looks like an oversight, but without knowing exactly how it played out, I am reluctant to point fingers.

Arlington, Va.: The Post had a chart in the Health section (I think) yesterday that detailed other possible bio/chem agents that might be a problem. One of them was plague. Can you reassure us on the plague question as you have the smallpox question?

Jason Pate: Anthrax is the prototypical biological weapon agent: it is readily accessible, forms hardy spores that protect it from environmental stresses (like UV radiation, air, heat, cold), and can be processed into an aerosolizable form. Plague, although researched and weaponized in the Soviet biological weapons program after dozens of years and billions of dollars of research, is not: it is very fragile and cannot be easily made into an aerosol. What we are dealing with so far is still a low-technology threat compared to what would be required in a plague scenario. Also--we have yet to have a mass casualty anthrax attack: this is either due to a lack of motivation on the part of the adversary (my belief) or a lack of capability, or both.

Washington, D.C.: There's been a lot of talk of people hoarding CIPRO. Health officials are asking people not to panic and buy it just to have it. My question is how are these people getting it? Don't you need a prescription from a doctor? If so, shouldn't health officials be addressing their message to physcians who are writing prescriptions people don't need?

Jason Pate: I have also heard of people "hoarding" Cipro and other antibiotics. It does require a prescription, so the message should go out more strongly physicians. It's not like a run on bottled water at 7-11; we should be able to clamp down on the hoarding.

Seattle Wash.: For those that were vaccinated against small pox prior to 1970, is that vaccination still effective now, 30 or 40 years later?

Jason Pate: Unfortunately, probably not. But we don't have good data on how long the vaccination works--it would require an antibody test, and I don't know how easy it is to get such a test for smallpox.

Washington, D.C.: Mr. Pate,
How likely are terror attacks to fall along the lines of self-fulfilling prophecy? As early as Sept. 12 new articles and stories began speculating and reporting on bio-terror attacks, and low and behold we have an anthrax mail attack campaign on our hands.

Jason Pate: There is clearly a cause and effect relationship between actual terrorist cases (especially hoaxes) and media coverage. Anthrax has been made into a household name over the past five or six years, so it is not surprising that there have been anthrax hoaxes (at least 171 prior to 9-11, at least 157 since, over 2300 false alarms) and attacks. It does give would-be terrorists or criminals ideas, and now that there have been a few actual cases, the hoaxes have become much more powerful. By talking about where we are vulnerable, we perhaps provide far too much information.

Jason Pate: Thank you all for such excellent and stimulating questions. I wish I had time to reply to everyone. There is such a high level of fear and anxiety these days, we are all very jumpy--I flew last week, will fly again this weekend, and receive mail daily. And it is unnerving. But we have to do everything we can to reassure ourselves and move forward, or the terrorists win. Try to keep in mind the context and scale of the anthrax attacks thus far. In focusing so much on the bioterrorist threat, we should not forget that there is still a conventional threat (like truck bombs) out there.

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