SMALLPOX - The Winter of Our Unpreparedness

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The Winter of Our Unpreparedness

By Roxanne Roberts Washington Post Staff Writer Tuesday, October 23, 2001; Page C01

On the off chance you don't have enough to obsess about these days, here are two words guaranteed to give a chill: Dark Winter.

That's the catchphrase that's popping up everywhere these days. Dark Winter is the name of a war game conducted in June at Andrews Air Force Base: In this two-day exercise, terrorists release smallpox virus in three American cities, and the object is to track the disease and the response to it. The cast of players included Oklahoma Gov. Frank Keating, former senator Sam Nunn, former presidential adviser David Gergen, former CIA director James Woolsey and former FBI director William Sessions.

The endgame, so to speak, was sobering: The government is woefully unprepared for bio-warfare, as Nunn testified to Congress in July and again in September, just days before the World Trade Center and Pentagon attacks. Now, although there hasn't been a confirmed case of smallpox in the United States for more than 50 years, Dark Winter is a hot topic on talk shows, in planning meetings and, yes, even at Washington dinner parties.

"We intentionally picked the absolutely worst-case scenario," said Randy Larsen, director of the Anser Institute for Homeland Security (a nonprofit research institute in Arlington) and a retired Air Force colonel who devised the game last January. "The purpose was to magnify the fault lines between federal and state responses and shortfalls in resources."

The point was to get the attention of government officials so they would take "appropriate actions" and think of public health as an important element of national security, said Larsen. "If you look at the lessons learned from the game, the word 'smallpox' does not appear. We're talking about biological warfare in general."

But suddenly, "smallpox" is the threat du jour. On Wednesday, Health and Human Services Secretary Tommy Thompson said he needed $509 million to obtain 300 million doses of vaccine for the virus. The United States stopped vaccinations in 1972 because the naturally occurring disease was virtually eradicated worldwide.

Today, the deadly virus is only known to exist in government labs in the United States and Russia. "The good news is that smallpox is hard to get and it's fragile," says Jay Farrar, a former Marine and military analyst at the Center for Strategic and International Studies. "The bad news is that there's no treatment once you catch it: 30 percent die, with survivors severely scarred and a large number blinded."

There are lingering fears, however, that the virus exists in clandestine labs in North Korea and Iraq. This made it the perfect disease for Dark Winter, a joint project of the CSIS, Anser, the Johns Hopkins Center for Civilian Biodefense Studies and the Oklahoma City National Memorial Institute for the Prevention of Terrorism. Working with Tara O'Toole, an epidemiologist at Johns Hopkins, Larsen selected smallpox because it is highly contagious, there is no treatment once the rash appears, the population is unprotected (vaccines administered decades ago afford little or no immunity) and there are few vaccines available.

"We wanted to over-stress the system," he says. "We designed a war game they could not win."

The game, which was played on June 22-23 in a conference center at Andrews Air Force Base, spans 13 days. Day 1: Dec. 9, 2002. The place: a National Security Council meeting. The cast: Nunn plays the president of the United States; Gergen, the national security adviser; Woolsey, the CIA director; and so forth – all people who had been present at real NSC meetings. Suddenly, the HHS secretary (Peggy Hamburg, a former New York City health commissioner) informs the meeting that the Centers for Disease Control and Prevention have confirmed one case of smallpox in Oklahoma and suspect there may be as many as 20 more.

What no one at the meeting knows is that three two-man terrorist teams (spookily prescient, they are identified as being from al Qaeda) released the virus via aerosol spray in shopping malls in Oklahoma City, Atlanta and Philadelphia eight days before. Unknowingly, 3,000 Americans have been infected.

The news of even a single infection comes as a shock. The smallpox virus has claimed uncounted millions throughout history, famously wiping out most of the native population in North America after the Spanish conquests. It has killed more people in the 20th century than all the wars combined – 300 million – most in poor countries. But the disease was presumed conquered; the last case reported anywhere in the world came in 1978.

"No one really knows how smallpox or any other highly contagious disease will spread among a densely populated, highly mobile, unvaccinated society," says Larsen. (In 1947, a single confirmed case of smallpox in New York led to vaccinations for 6.3 million people.)

Suddenly, the game players are faced with terrible decisions. medical experts tell them the outbreak can be contained with isolation and vaccination, but who should be isolated and which american citizens get the existing 15.3 million doses of vaccine?

"President" Nunn refuses to give the vaccine to all military personnel; instead, he decides to administer it to military, security and medical personnel at the scenes of infection. He calls for accelerated production of more vaccine and asks for surplus from other countries.

The game was structured to examine the roles of the federal and state governments in a health panic. In the game, Gov. Keating of Oklahoma asks for vaccine for everyone in his state; the president refuses.

By the sixth day of the crisis, all of the vaccine is gone. The question of isolating citizens who may be infected is addressed; there are no good answers. In the following days, riots for vaccine break out, interstate commerce has halted, the stock exchange stops trading.

The war game ends on Dec. 22; the disease has spread to 25 states and 15 other countries. In 13 days, 2,600 have died; more than 11,000 are infected. The future is grim considering the game uses the current international standard for transmission: Smallpox can pass to anyone standing within six feet of an infected person.

The participants – all seasoned government professionals – were shocked by the results, says Larsen. Nunn, now chairman of the CSIS board, testified to Congress; other briefings were held for top government officials. One senator told Larsen it was "the most troubling presentation he'd seen in 23 years." And the phrase "Dark Winter" crept into conversations, especially after Sept. 11.

Scary? Maybe this will help you sleep at night:

"We are so much better prepared today for a biological attack than we were in June," says Larsen. "Because the enemy has lost the element of surprise."

-- Anonymous, October 22, 2001


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