Bioterrorism is no longer a hypothetical event. A bioterrorist attack has occurred and could occur again at any time, under any circumstances, and at a magnitude far greater than we have thus far witnessed. U.S. bioterrorism preparedness efforts have so far focused on a number of potential agents, in particular anthrax, smallpox, plague, botulinum toxin, tularemia, and viral hemorrhagic fevers. Details of each of these threats were reviewed on the first day of the workshop. Anthrax is a proven risk and of most immediate concern, although smallpox, because it is capable of person-to-person transmission, engendered an equivalent sense of urgency. However, there is a plethora of potential, credible bioterrorist agents. One workshop participant noted that the Soviet Union is known to have weaponized some 30 different biological agents, including drug-and vaccine-resistant strains.

It is impossible for us as a nation to provide a specific defense against each of these many agents within a reasonable time frame: the diversity of readily available potential bioterrorist agents is great; the technology and knowledge that make it possible to bioengineer drug- and vaccine-resistant antimicrobial strains are becoming increasingly accessible; there are many crucial gaps in our countermeasures and public health response capabilities; and it was noted that one can develop a new bioweapon within only two to three years compared to the eight to ten years that it typically takes to bring a new vaccine or antimicrobial product into the market.

It is possible, however, to bolster our nation’s general biodefense to a level at which we can at least minimize, if not prevent, the potentially catastrophic consequences of a large-scale bioterrorist attack. Workshop participants asked the question, how do we convince policymakers and those who allocate funds that new and substantial resources are needed at all levels, from local surge capacities for clinical care to research facilities expansion? The public health, scientific, and private industrial communities involved with bioterrorism defense must present their needs in an appropriate framework and present a vision to which the country can respond.

The most powerful strategy may be to cast bioterrorism defense as a national security issue first and foremost. Indeed, it was suggested that the only way to acquire the resources needed to develop the capacity that bioterrorism defense requires is to equate these tools with other weapons defense tools. It must be made clear that the nation’s capability to respond to a bioterrorist attack is, in essence, a weapons defense system. Although most people do not know the details of how much money or research and development are required to sustain our country’s armed forces, nonetheless they are able to express the essential role of such capabilities in our national security. Several workshop participants suggested that bioterrorism defense requires the same attention and understanding.

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