BY PETER KATONA
The federal government has recently allocated hundreds of millions of dollars to prepare for a possible incident of biological warfare. This funding is a complex though well-intended effort. But one might reasonably ask if this endeavor is ultimately destined for failure for logistic, financial, legal or political reasons.
Though the use of biological weapons seems like a modern attack methodology, their use dates back to ancient times. For example, the Tartars hurled the bodies of plague victims over the fortified walls of Kaffa in the 14th century to infect those within; the British, as an "act of good faith," gave the Indians blankets previously used by smallpox sufferers during the French and Indian War in the 18th century, which nearly wiped out their population.
Today, some easily dismiss the threat of biological weapons because they are technologically difficult to apply. Weather conditions, for example, may play a prominent role, with temperature, wind, sunlight, rain and desiccation all critical factors that might render an attack ineffective. Moreover, newer laws have made the agents harder to acquire.
Some also feel that the magnitude of the threat is overstated and sensationalized, citing this as just another example of fear-mongering and governmental opportunism. The fatalist's view is that a bioterrorist attack is impossible to plan and diverts resources from "real" health problems like childhood immunization, cancer or AIDS.
Consider the possibilities: First, a bioterrorist event never happens. Then we have nothing other than fear to concern ourselves with. Second, an event occurs, but it is of such great magnitude that it overwhelms all available resources. Even a large influenza outbreak can quickly fill emergency rooms and hospital beds. According to military estimates, 100 kilograms of aerosolized anthrax, for example, released from a plane on a clear day can potentially spread over a 300-kilometer area and cause 1 million to 3 million deaths! This, of course, would be a worst-case scenario.
Finally, a relatively small-scale event happens, and appropriate preparations can have a positive effect on the outcome. Is this more likely to occur than the two other scenarios? No one knows for sure. But even in this case, there are issues that might arise: Could excellent preparations in Dallas help an event in Los Angeles? Are preparations complete? Local governmental bureaucracy can often slow things down. Would all the agencies involved be able to work together in a coordinated way? Would mass hysteria and panic overwhelm all available resources anyway? Would the "walking well" utilize so many medical resources that the "actually ill" would have a hard time getting their needed medical attention?
Acts of biologic, chemical or nuclear terrorism are not problems that can be completely solved or eradicated. Nor can an open and democratic society such as ours hope to insulate itself from any and every contingency. Yet, the threat of biologic terrorism needs to be kept in perspective.
We should be prepared to the best of our abilities, with the understanding that it would be impossible to cover all contingencies. We can hope for the best, yet try to be prepared for the worst. There is often a thin line between prudence and panic. With the proper blend of rationality, practicality and resources, let's hope we do the right thing.
Peter Katona is assistant clinical professor of infectious diseases in the School of Medicine and a consultant to the Los Angeles County Department of Health Services on bioterrorism preparations.
