Editors: Note: Please scroll down for an earlier posting on this subject, bioterrorism legislation, and other subjects.

Terror Medicine and Biological and Chemical Exercises--the Israeli Experience

July 6, 2010

by Leonard A. Cole

Director, Program on Terror Medicine and Security,
Center for BioDefense

University of Medicine and Dentistry of New Jersey

Adjunct Professor, Division of Global Affairs, Rutgers University

Proper care for victims of a biological attack may differ markedly from that for victims of a chemical attack, depending on the type of agent released. This concern is part of the new field of “terror medicine,” which encompasses the constellation of medical issues related to terrorist attacks. (Terror Medicine: Birth of a Discipline) (Essentials of Terror Medicine)

Some U.S. healthcare workers, emergency management and other responders are familiar with the field, but many are not. The biological-chemical distinction is but one important facet of terror medicine that deserves greater understanding. (Terror Medicine Can Save Lives)

Many healthcare providers and hospitals in the United States have never engaged in an effective drill involving a biological or chemical attack agent. Properly conducted, such exercises include coordination of medical personnel with police, fire, emergency management and other responders. Rehearsals should include scores or hundreds of mock victims who undergo triage, hospitalization, diagnosis, and treatment.

In contrast to the American experience, in Israel, every hospital is required periodically to engage in realistic drills that mimic terror attacks with biological or chemical weapons.

In January of this year I participated in a two-day biological exercise called “Orange Flame.” (See the June 25 news item and the June 24 blog posting below -- scroll down.)

It involved medical facilities throughout the Tel Aviv area. Mock patients began to show up in clinics and hospital emergency rooms, prompting mobilization of community and medical resources to handle a swelling surge of patients. By the second day, when the cause of illness was understood to be smallpox, a mass vaccination campaign was undertaken to provide protection throughout the entire population.

The Orange Flame experience contrasted sharply with a chemical exercise that I had previously witnessed elsewhere in Israel. In that event, a chemical was released during an “attack” with explosives in central Jerusalem. Hundreds of mock victims were then rushed to area hospitals. The chemical was quickly identified as hydrogen fluoride, a material that is highly corrosive to the skin. In this case, unlike that of a biological event, victims were stripped and washed down immediately upon entering hospital courtyards.

Video snippets of both exercises show the distinctive approach in each case: Biological and Chemical Drills

In both instances, as is evident from the video, hospital and other personnel performed their roles with the utmost seriousness. The Israeli approach to such attacks can be helpful to Americans concerned with preparedness. Indeed, the Israeli experience with terrorism in general offers many lessons for the people of the United States and elsewhere. (Terror: How Israel Has Coped and What America Can Learn)





Michael B. Kraft

June 29, 2010

Legislation to strengthen the U.S. government’s to bolster security at home and abroad against potential bioterrorism attacks has passed an important stage in the House of Representatives.

The House Homeland Security Committee last week unanimously passed, 26-0 the legislation titled the WMD Prevention and Preparedness Act of 2010 (H.R.5498.)

The bill has been referred to five other committees, including the House Foreign Affairs Committee and the staffs are expected to meet this week. Floor action is uncertain this year because of the crowded schedule, but a staffer for co-author Bill Pacrell (D-NJ) expressed optimism. It is possible that if all the facets of the bill are worked out in advance, it could be fast tracked on the suspense calendar, which requires a two thirds vote with limited debate.

Committee chairman Bennie G. Thompson (D-MS) said in a statement after the vote that “With the passage of H.R. 5498, we will be taking a major step forward on the threat from WMD. Specifically, under this bill, we will – for the first time – direct the Federal government to focus its resources and capabilities, in a coordinated manner, to address this unconventional emerging threat.” He also noted the bipartisan backing for the bill, which was co-sponsored by Rep. Peter King (R-NY), the committee’s ranking Republican and was drafted to implement a number of recommendations of the Weapons of Mass Destruction Commission.

In approving the bill, the committee approved a number of amendments by unanimous consent.

Among other issues, the bill calls for the national intelligence director to be given new authority to coordinate with other federal offices to develop and implement strategies for countering WMD threats. The Department of Health and Human Services would also be required to develop and implement a national strategy for distributing medical countermeasures in the event of an unconventional weapons event.

Section 403 expresses the sense of Congress that preparedness for a chemical, biological, radiological, or nuclear incident must be undertaken not only domestically but also internationally.

It also requires the Secretary of State to “convene an interagency taskforce to examine the state of global preparedness for a major biological attack or event and identify best practices for preparedness based on lessons learned from domestic efforts that may be useful or applicable internationally. “The task force shall include representatives from DHS, USDA, DOD, DOJ, the State Department, the United States Agency for International Development, the DNI, other appropriate Federal Departments and agencies, “and other appropriate national biosecurity and biodefense stakeholders.”

For the section by section summary prepared by the Committee staff, see: http://hsc.house.gov/SiteDocuments/wmdsummary.pdf

In the Senate, Senators Lieberman and Collins introduced bioterrorism legislation S. 1649 last September but no floor action has been scheduled.


Bio Terrorism exercise and issues discussed at joint forum held by the Homeland Security Policy Institute and the International Security & Biopolicy Institute

June 24, 2010

By Michael B. Kraft

From the micro to the macro, details of a major bioterrorism exercise in Israel and a broad picture of the need to strengthen biosecurity world wide were presented at a joint forum in Washington this week.

The Homeland Security Institute (HSPI) of George Washington University and the International Security and Bioterrorism Institute (ISBI) jointly sponsored the event.

At Wednesday’s forum, Dr. Yehuda Danon of Tel Aviv University Medical School and former Surgeon General of the Israeli Defense Forces described the major biopreparedness exercise held in January.

He was joined by Dr. Eric Rose, a member of the U.S. National Biodefense Science Board and CEO of Siga Technologies, Inc, a U.S. firm that played a role in the exercise by stimulating the emergency delivery of a medical countermeasure it has developed. Prof. Barry Kellman of De Paul University Law School and President of ISBI, provided a broad picture of the international bioterrorism threat and the need to help other countries strengthen their counterterrorism efforts. Daniel Kaniewski, Deputy Director of HSPI was the moderator.

The Operation Orange Flame 4" biopreparedness exercise held in Israel in January and attended by observers from 30 countries, featured two scenarios. Dr. Danon said one involved a terrorist who entered Israel as a tourist, checked into an Israeli hotel, and was later found dead in his room a day later of an unidentified illness. In the other scenario, a terrorist who also entered Israek on a commercial flight, attended a soccer match at a large stadium and used an aerosol spray to potentially expose the crowd of thousands of people.

In the stimulated exercise, Dr. Danon said the medical personnel did not determine the cause of the outbreak of illnesses for 20 hours. He said that diagnosis of medical anomalies in Israel is aided because all the nation’s 23 hospitals and health centers in the country are part of a national health system and are linked by computers, as are general practitioners. Individual medical records are computerized. The computer system has software to help identify various ailments, including small pox and other diseased, he said.

Dr. Danon said that the Israeli experience showed that in dealing with the problem of rapid identification of the agent, clinical skills have to be developed and maintained on the individual first responder level. The first responders are required to study the various symptoms and to be able to describe them accurately. Major exercises are held every two years. He also said that Israeli first responders have been immunized for smallpox since the first Gulf War, when about 43% of the doctors and nurses did not show up at their posts when there was concern that some of the missiles launched by Saddam Hussein’s forces might be carrying bioagents.

Dr. Rose said he attended the exercise because he had not seen a bioterrorism exercise on the same scale, with government officials actually taking part instead of exercises in the U.S, where more commonly other people played the part of government officials.

As part of the exercise, Israeli officials contacted Siga to simulate the emergency shipment from the U.S. of 20,000 doses on emergency basis of its recently developed smallpox antiviral, ST-246® (Tecovirimat). Dr. Rose said then the company then quickly went through the drill of simulating the quick air delivery to Israel with a commercial air carrier.

In the simulation, 20,000 persons were exposed, largely in the soccer stadium scenario and 1000 were infected. Mock inoculations were given to 20,000 persons using eight predetermined medical facilities that could handle about 200 persons and hour. Dr. Danon said.

Siga is producing tens of thousands of doses of ST-246 as part of its commercial validation and is competing for a contract from The Department of Health and Human Services’s Biomedical Advanced Research and Development Authority (BARDA). The company announced this week that it had successfully completed the fourth round of clinical trials.)

Dr. Rose said that one of the goals of the U.S. National Biodefense Science Board on which he serves is to promote an understanding of the need here to conduct proper and frequent exercises and drills. He told the audience, which included a number of USG officials and former officials, that while the science of countermeasures is advancing, “if you don’t master the logistics, all the great science will be useless.

Professor Kellman, as did Dr. Danon, emphasized the need for preparedness because of small pox or another bioagents is used in one country, it could quickly spread to others because of modern transportation. He said that preparedness is an element of prevention—if potential terrorists see that a country is prepared to meet a potential bio attack, they may decide that it is not worth the effort to use such methods.

He suggested that despite the political controversies in the Middle East, especially over nuclear weapons, and tensions between the various governments, that medical and biosafety issues might be a noncontroversial issue that should be worth pursing for the benefit of all nations in the area. He said that except for Israel, there was a gross lack of preparedness in the Middle East as well as other parts of the country. Most countries are ”sitting ducks,” he said.

Professor Kellman, also said that “there are an enormous amount of legal issues that need to be sorted out in advance,” such as licensing and liability of medical countermeasures."

For an additional description of the symposium see the Global Security News.

By coincidence, earlier in the day, the House Homeland Security Committee approved for floor action, a major biosecurity bill. (See the newslink dated June 24 for more details.)


Bad Idea to Spend Biodefense Dollars on Flu Vaccine

The bi-partisan Commission on WMD Prevention has criticized President Obama’s recent plan to take $3 billion from a biosecurity fund and use it to help produce swine flu vaccine. The commission concluded in December 2008 that a terrorist attack with a weapon of mass destruction is likely to occur somewhere in the world by the end of 2013. Further, it believes that the weapon will more likely be a biological agent than a nuclear bomb. So the funding shift worries the commission, whose chair, former Democratic Senator Bob Graham and vice-chair, former Republican Senator Jim Talent, said the action “will severely diminish the nation's efforts to prepare for WMD events and will leave the nation less, not more, prepared.” Washington Post

The administration seems to believe that a swine flu pandemic is more likely, or more imminent, than a bioterrorist attack. But circumstances suggest the tilt should go to the commission. The country went through a swine flu scare thirty years ago that turned out to be nothing. In 1979, in anticipation of an epidemic, the government advised Americans to get vaccinated. Most ignored the advice, though several who did receive vaccinations suffered severe side effects. The result was a surge of public anger and lawsuits as people became sick as a result of a swine flu epidemic that never was. This time, we should seek clearer evidence of an impending threat before again pushing for a mass vaccination program.

Besides, taking funds from biopreparedness programs is itself risky. Al Qaeda is among several terrorist groups and other bad actors that make no secret of their desire to acquire and use biological weapons. The 2001 germ attacks, when anthrax was spread via the U.S. mail, are a reminder of how disruptive a biological assault can be. True, some biodefense programs are of questionable value and the money for them might be spent more effectively. But the funds should remain dedicated to their intended purpose, and not pulled out for an unrelated program. Little wonder that the WMD commissioners are worried.