been extended to over 300 installations around the world. Every 24 hours, 30,000 ambulatory diagnoses from these various installations are downloaded, automatically analyzed, prioritized based on expected values from historic data, and visualized using geographic information systems. However, none of the systems currently being developed are likely to be adequate in and of themselves. The best solution will probably be a system of systems that is sensitive enough to detect specific conditions and even small outbreaks.

Detection and Diagnosis

In terms of environmental and clinical detection and diagnosis, although reasonably good assays are available for a limited range of specific agents, the immense diversity of microorganisms, including bioengineered pathogens, presents a major challenge. There can be considerable variability even within a strain, let alone a species. Pathogens are a natural part of the environment and can confuse detection efforts. For both environmental and clinical settings, we need rapid, standardized methods that allow for the detection of a broad spectrum of potential biological weapons in a quantitative fashion.

Rapid detection and diagnosis requires access to an extensive sequence database and high throughput laboratories. Biotechnological barriers in the public health infrastructure must be identified so that the proper tools can be appropriately distributed or accessed. Academia, industry, and government laboratories must all be brought in at appropriate levels and in appropriate ways to help build new capabilities.

Specimen collection needs to standardized and automated. For example, there is no standardized collection method for samples from the inside of a computer. Indeed, specimen collection is often the major obstacle to rapidly processing a large number of samples and the weak link in what seems to be an otherwise very promising detection and diagnosis technology.

The capability to use molecular sequences to rapidly detect and identify bioterrorist agents could serve as an important form of deterrence and might possibly prevent bioterrorist attacks from occurring in the first place. One vision is an international molecular forensics lab that would rely on a molecular fingerprint global database to identify the source of the bioterrorist agent. This capability could provide the biological equivalent of the threat of nuclear retaliation. Again, it must be emphasized that bioterrorism is a national security issue and bioterrorism preparedness efforts are a strategic defense.

Scientific Policy Issues

The fact that bioterrorism preparedness is a national security imperative raises many important and new scientific policy issues:

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