Bioterrorism

An act of biological or chemical terrorism might range from dissemination of aerosolized anthrax spores to food product contamination, and predicting when and how such an attack might occur is not possible. However, the possibility of biological or chemical terrorism should not be ignored, especially in light of events during the past 20 years. Like:

1. The sarin gas attack in the Tokyo subway
2. The discovery of military bioweapons programs in Iraq and the former Soviet Union

Preparing the nation to address this threat is a formidable challenge, but the consequences of being unprepared could be devastating.

The public health infrastructure must be prepared to prevent illness and injury that would result from biological and chemical terrorism, especially a covert terrorist attack. As with emerging infectious diseases, early detection and control of biological or chemical attacks depends on a strong and flexible public health system at the local, state, and federal levels. In addition, primary health-care providers throughout the United States must be vigilant because they will probably be the first to observe and report unusual illnesses or injuries.

This report is a summary of the recommendations made by CDC's Strategic Planning Workgroup in Preparedness and Response to Biological and Chemical Terrorism: A Strategic Plan (CDC, unpublished report, 2000), which outlines steps for strengthening public health and health-care capacity to protect the United States against these dangers. This strategic plan marks the first time that CDC has joined with law enforcement, intelligence, and defense agencies in addition to traditional CDC partners to address a national security threat.

As a reflection of the need for broad-based public health involvement in terrorism preparedness and planning, staff from CDC's centers, institute, and offices participated in developing the strategic plan, including:

• National Center for Infectious Diseases
• National Center for Environmental Health
• Public Health Practice Program Office
• Epidemiology Program Office
• National Institute for Occupational Safety and Health
• Office of Health and Safety
• National Immunization Program
• National Center for Injury Prevention and Control

The Agency for Toxic Substances and Disease Registry (ATSDR) is also participating with CDC in this effort and will provide expertise in the area of industrial chemical terrorism. In this report, the term CDC includes ATSDR when activities related to chemical terrorism are discussed. In addition, colleagues from local, state, and federal agencies; emergency medical services (aaaceus.com); professional societies; universities and medical centers; and private industry provided suggestions and constructive criticism.

Combating biological and chemical terrorism will require capitalizing on advances in technology, information systems, and medical sciences. Preparedness will also require a re-examination of core public health activities (e.g., disease surveillance) in light of these advances. Preparedness efforts by public health agencies and primary health-care providers to detect and respond to biological and chemical terrorism will have the added benefit of strengthening the U.S. capacity for identifying and controlling injuries and emerging infectious diseases.