Home » Security, Security Projects

Bio-Deterrence: Elimination of Anthrax as a Threat

January 11th, 2010

Bio-Deterrence:

Elimination of Anthrax as a Threat

Christa Johnson, Shana Rakowsky, Vania Reyes

Science & Society: Global Challenges

14 December, 2009

Section 1

Biological weapons are microorganisms that can be utilized to cause mass destruction. Recent commissions have predicted that one of these weapons will be used somewhere in the world in the near future. The United States has designated ten pathogens on their Select Agent List as the most dangerous, and current responses to the threat have been initiated. However, these responses address the threat posed by bioweapons as a whole. The living nature of these pathogens makes each unique, and so each poses different security challenges. Anthrax is one of the designated most dangerous pathogens due to its widespread availability, its ability to cause public fear, and the high fatality rate associated with infection.

We propose to employ a theory of bio-deterrence in order to render an anthrax attack against the United States ineffective. Bio-deterrence is a defensive strategy that can be understood as deterrence by denial. If an enemy uses anthrax as a weapon against the United States, the nation will ensure such a rapid, efficient response that the normally deadly, fear-inspiring effects will be non-apparent. The appeal of anthrax as WMD will be eliminated.

In order to create deterrence, we recommend the United States to stockpile 330 million doses of the current anthrax vaccine, Biothrax, within the Strategic National Stockpile while continuing to fund research of an improved vaccine. The timeline of anthrax symptomology is approximately 9 days from beginning symptoms to death, and our timeline of dispensal ensures all citizens will be treated or protected within 4 days.

The entirety of our proposal can be split into two parts – implementing pre-attack precautions and defining post-attack strategy. By ensuring both parts are in place, enemies will be deterred from using anthrax and an entire class of weapons will be rendered ineffective.

Section 2

Following the disastrous attacks of September 11, 2001, the population of the United States became painfully aware of the danger posed to their country by terrorists. Using mechanical means, the terrorists wreaked havoc not just on the targeted area, but on the entire nation, generating mass fear and forcing the government to take immediate action to prevent another attack. Since this attack, the government has implemented the Patriot Act, the FBI Intelligence Reform, the Intelligence Reform and Terrorism Prevention Act (P.L. 108-458), and the Homeland Security Appropriations Act, 2007 (P.L. 109-295, Title VI, Subtitle D). However, physical attacks are not the most dangerous weapon in the arsenal of terrorists. The potential for terrorist usage of biological weapons, also known as bioweapons, creates another problem of security for the United States that requires immediate attention.

The Commission on the Prevention of Weapons of Mass Destruction, Proliferation, and Terrorism in December of 2008 stated that “it is more likely than not that a weapon of mass destruction will be used in a terrorist attack somewhere in the world by the end of 2013.”[1] Bioweapons are defined as microorganisms that are employed with the intent to kill, incapacitate, or seriously impair a person, group of people, or even an entire population.[2] These pathogens can be transported to a susceptible population through food, air, water, and/or living organisms and, if properly released, can kill on a massive scale. These weapons are possible to produce without government support since the equipment it takes to develop them is found in universities, hospitals, and pharmaceutical plants, among other places. The effectiveness of a biological weapon greatly determines its ability to harm people; the more effective that it is the more damage it can cause. Currently, over twenty countries have the means (the technology and/or facilities) to plan and execute a bioweapon attack in the near future. Of these countries, nine have offensive bioweapon projects, meaning that almost half of the countries that have the technology could potentially use them against another state/nation/continent.[3] Most of the bioweapon programs in existence are remnants of programs that have existed since WWII and many of the facilities in Eastern Europe do not have the proper infrastructure to safely work with and secure the pathogens.[4]

The committee describes the susceptibility of the United States to an act of biological terror, stating,

“The United States still wields enormous power of the traditional kind, but traditional power is less effective than it used to be. In today’s world, individuals anywhere on the planet connect instantly with one another and with information…. Weapons of tremendous destructive capability can be developed or acquired by those without access to an industrial base or even an economic base of any kind, and those weapons can be used to kill thousands of people and disrupt vital financial, communications, and transportation systems, which are easy to attack and hard to defend. All these factors have made nation-states less powerful and more vulnerable relative to the terrorists, who have no national base to defend and who therefore cannot be deterred through traditional means.” [5]

Due to the obvious threat posed to the United States, government agencies have been focusing on creating and passing bills to both prevent and prepare for an attack. The threat posed by bioweapons is real, and to counter the threat NGOs have continued their research on bioweapons while the public sector has begun to take action.

Bill S.1649, The Weapons of Mass Destruction Prevention and Preparedness Act of 2009, sponsored by Senators Lieberman and Collins, is one such action. The bill addresses a vast array of problems posed to the United States by bioweapons.  When introducing the bill to Congress, Sen. Collins stated “the bill implements many of the recommendations of the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism.”[6] Bob Graham and Jim Talent of The Hill’s Congress Blog have said, “This bill is a giant step in the right direction.”[7]

The WMD Act contains five titles that attempt to regulate bioweapons on a domestic and foreign scale – I. Enhanced Biosecurity, II. Response to a Weapon of Mass Destruction Attack, III. International Measures to Prevent Biological Terrorism, IV. Government Organization, and V. Emergency Management and Citizen Engagement.[8] Sen. Collins stressed the importance of introducing such a bill, elucidating the draw of terrorists to these weapons. “In contrast to nuclear weapons, the technological hurdle is lower to develop and disseminate bioweapons, access to pathogens is more widespread, and pathogens are harder to contain. The spread of biotechnology, the difficulty of detecting such pathogens, and terrorists’ known interest in bioterrorism combine to produce an even greater menace”[9] The bill defines bioweapons using a tiered approach, designating the most dangerous pathogens as Tier 1 agents by the following criteria;

‘(i) whether the agent or toxin has significant potential to be used effectively in a biological attack;

‘(ii) whether the risk posed by the agent or toxin requires additional biosecurity measures, beyond those required under subsection (b), to prevent misuse domestically or abroad;

‘(iii) information available from any biological or bioterrorism risk assessments conducted by the Department of Homeland Security or other relevant assessments by other departments or the intelligence community; and

‘(iv) such other criteria and information that the Secretary determines appropriate and relevant.[10]

Graham and Talent said that the “tiered approach ensures that U.S. laboratories can focus on innovation and not paperwork.”[11] The United States currently has a Select Agent List of 82 virus and bacteria, and the new bill designates 10 of these as Tier One agents.[12]

The legislation provides guidelines for increasing the security of domestic biological laboratories that handle dangerous pathogens and requires the registration of labs that handle less strictly controlled, but still dangerous, pathogens. It authorizes a grant program at $50 million for each of the next four years in order to help fund the security enhancements at the highest-risk biolabs and avoid diverting research funding to security upgrades. The bill provides a method to improve the government’s ability to distribute medical countermeasures and increases the cooperation between different government agencies by requiring actions to improve communications with the public before and during a biological attack. In order to ensure communication between agencies concerning foreign laboratories, the bill advises for the Director of National Intelligence to report on countries that have facilities with the highest-risk pathogens and the security measures in place at these facilities. The bill also allots for the Secretary of State to provide assistance to enhance security at laboratories with dangerous pathogens worldwide and to use exchange programs to train foreign nationals in proper handling of these pathogens. The overall goal of the bill is to ensure that the United States is prepared for a biological attack.[13]

Although the bill attempts to attend to all of the issues posed by bioweapons, there are many criticisms. The American Society for Microbiology (ASM), an agency of over 40,000 members that are involved in basic and applied research as well as clinical laboratory testing and public health activities, commented on each section of the bill.[14] The main criticism of the ASM was the language of the bill was very vague and broad, especially pertaining to the designation of Tier 1 agents and which laboratories should be included in the databases. The ASM felt that Tier 1 agents were not properly identified, and it was “difficult to understand the scope and impact of the potential enhanced classification of certain agents as Tier I agents.” The ASM did not agree that the authority for rulemaking concerning bioweapons should be given to the Department of Homeland Security, but recommended that the authority be given “jointly [to the] Department of Health and Human Services in coordination with the Department of Agriculture.”[15]

The Global Security Newswire also posted an article commenting on the WMD Act. The American Association for the Advancement of Science is concerned with how the bill would affect scientists that are currently working in laboratories. They feel as though the bill would hinder the ability of labs to do research due to the amount of time that would be required to be spent on guarding the facilities. This puts a strain on the scientific community and pressure on the personnel of the laboratories to enforce security measures.[16] The ASM and the AAAS are just two of many committees to find flaws with the WMD Prevention and Preparedness Act of 2009.  Their criticisms highlight that this bill is not sufficient alone to eliminate the threat posed to the United States by bioweapons.

In 2002, the G8 Global Partnership against the Spread of Weapons and Materials of Mass Destruction instructed numerous countries to contribute money to eradicating the threat of bioweapons. To further carry out this mission, the Canadian government decided in mid-2009 to build a bio-security lab in Kyrgyzstan. Canada has pledged to invest $30 million into this lab, hoping to prevent terrorist access to these weapons. Previously, the Soviet Union boasted a massive bioweapons program that produced immense volumes of dangerous pathogens. Since the fall of the Soviet Union, the labs that housed these agents, as well as the scientists that worked with them, have been neglected. The poor condition of the labs adds to the danger posed to the scientists. The labs consist of “doors with broken locks….fences that have fallen down, windows with no bars and no glass, and trees that have overgrown.” “Scientists toil in conditions that are dangerous to them, as well, lacking the airtight boxes and spacesuit-like equipment used by Westerners working with such diseases”. Moreover, the scientists are paid extremely low wages, sometimes as low as $1 per day.[17]

The lack of security implemented in the actual laboratories, as well as the vulnerability of the scientists to terrorist bribes, are international security concerns. The Canadian government, following the lead of the United States which accomplished similar projects in other former Soviet Union countries, plans to strengthen these sites by turning them into secure research facilities. Because many of the dangerous pathogens are still endemic to the region it is important for research to continue. With their financial and instructional support, Canada hopes to ensure this research is conducted safely without risk of external or internal threats.[18]

While Canada’s efforts will strengthen physical lab security, namely the “guards and gates,” and may help increase the well-being of the scientists, it is not enough. Its critical flaw, one that affects many other actions against bioweapons, is that it fails to take into account determined insiders that want to obtain these weapons. Dr. Julie Fischer of the Stimson Center agrees, saying “You can put up guards and gates and you can engage scientists, but if one does decide to go rogue these actions will do little to stop them.” [19]

Recognizing the danger of solely relying on guards and gates to protect these pathogens, the National Academy of Sciences has released a report that focuses on personnel reliability. The report, Responsible Research with Biological Select Agents and Toxins, underlines the importance of the physical protocols already in place in bio-labs, but presents novel recommendations that are focused on strengthening personnel relations, making the scientists realize that they have a responsibility to prevent the misuse of bioweapons.[20]

Fundamentally, the report demands that specific actions be taken by laboratory scientists when dealing with Biological Select Agents and Toxins (BSAT) as opposed to other pathogens. The report contains nine key recommendations to augment security of BSATs.[21] On a broader scale, the recommendations call for increased training in scientific ethics as well as shared knowledge of how to conduct proper research with BSAT materials. They propose the creation of an additional oversight committee of the Select Agent Program, in order to:

Promulgate guidance on the implementation of the Select Agent Program; facilitate exchange of information across institutions and sectors; promote sharing of successful practices across institutions and sectors; Provide oversight for evaluation of the Select Agent Program; provide advice on the composition/stratification of the list of select agents and toxins; convene regular meetings of key constituency groups; and promote harmonization of regulatory policies and practices. [22]

The problems pertaining to laboratory security and how to properly identify pathogens as select agents are more specifically addressed in the third, fourth, and sixth recommendations. The eighth recommendation advises that inspectors of BSAT research facilities receive special training and boast years of experience working in similar labs in order to recognize secure labs.[23]

Although the report reiterates the necessity of maintaining the strength of current lab security, the novelty of the report’s recommendation lies in its focus on personnel reliability. The current screening process, the Security Risk Assessment, was deemed sufficient, with the minor addition of an appeals process. However, the report stresses that even though an individual may pass the SRA when they are hired his/her position or personal life may change, thus affecting his/her decisions while working in the lab. Therefore, the report heavily emphasizes the need for colleagues to monitor each other, being conscious of changes in behavior and/or mood.[24]

However, this report contains two main flaws. First, it advises the establishment of cross sector committees and collaboration, but does not provide sufficient detail of which departments should be responsible for funding, management, or leadership in the endeavors. Since BSATs are used for medical and scientific research as well bioweapons, they are important to numerous governmental organizations. Thus, collaboration and information sharing is a valid problem and while the NAS addresses the matter, it fails in identifying a plausible solution. Secondly, the NAS’s support for personnel reliability is an important novel stance but it rests on many assumptions. Similar to Canada paying Kyrgyzstani scientists higher wages and hoping they will less likely to take bribes, NAS’s report rests on the hope that scientists will be able to correctly identify lifestyle and behavioral changes.

The most current response to biological WMDs was the Obama administration’s response to biological threats issued on December 9, 2009. The National Strategy for Countering Biological Threats combines many of the recommendations of the NRC and the Commission on WMDs. It contains seven key objectives:

To promote global health security; to reinforce norms of safe and responsible conduct; to obtain timely and accurate insight on current and emerging risks; to take reasonable steps to reduce the potential for exploitation; to expand our capability to prevent, attribute, and apprehend; to communicate effectively with all stakeholders; and to transform the international dialogue on biological threats.[25]

Primarily, the Strategy underlines the Biological Weapons Convention and facilitates its implementation. The response addresses fundamental problems with the way the government formerly addressed the issue. In the past, biological threats, both domestic and abroad, were dealt with throughout the government in many different sectors. This dispersion caused a severe lack of discussion among experts. The Strategy aims to centralize the issue with the creation of the World Health Organization Collaborating Center under the CDC for the implementation of International Health Regulations.[26] Moreover, the report recognizes the unique problems of biological pathogens and therefore underlines the need for international collaboration to produce transparency in scientific research.

While this report solves many of the intricacies involved in addressing bioweapons, it still relies heavily on trusting scientists to act in an ethical manner. The report also establishes “that confidence in BWC compliance should be promoted by enhanced transparency about activities and pursuing compliance diplomacy to address concerns,” rather than by verification. Thus, the report contains many of the same weaknesses previously discussed.[27] It fails to guarantee prevention of a biological attack because of the fear of inhibiting scientific research and the inability to verify compliance.

While these government actions attempt to decrease the threat of a bio-attack, each has inherent flaws. The WMD Act hinders the freedom of scientific research. The Canadian response focuses solely on physical protection, while neglecting the living properties of biological pathogens. The NAS the Obama administration focus on personnel reliability, providing no absolute guarantees. Biological weapons prove a complicated threat to handle because the pathogens can be utilized as a diverse group of weapons. These pathogens are alive; they grow, spread, and develop on their own. This living quality makes each pathogen unique, and thus each presents unique challenges. Characteristics that are important to addressing a threat, such as level of contagiousness, fatality rate, and treatment, differ depending on the pathogen that is weaponized. Thus, in order to address the overall solution to the problem of bioweapons, each pathogen must be addressed individually.

Section 3

Anthrax is one such pathogen whose unique threats cannot be eliminated by a general solution. Stan Bedlington, a retired CIA analyst at the agency’s Counterterrorism Center, said, “… you could take a small plane and sprinkle anthrax over New York City and wipe out half the population.”[28] The described attack would require properly weaponized anthrax as well as a successful dispersion tool. Nonetheless, the risk and consequences are significant. A report titled, Clinical and Epidemiologic Principles of Anthrax, published by the World Health Organization in 1993, also described the risk posed by anthrax. The report quantified the danger by explicating a plausible attack scenario, “that if a city of 500,000 people was attacked by 50kg anthrax, approximately 125,000 infections would occur. Of the 125,000 infected people, 95,000 would die.” The predicted number of deaths from an anthrax attack, when compared to similar scenarios following the release of other bioweapons, is substantially higher.[29] The danger is heightened by the availability of the pathogen. Numerous countries’ arsenals contain stockpiles of anthrax. For example, Iraq’s stockpile possessed enough anthrax in 1995 to kill the entire world 2500 times over.[30] Due to the substantial risk posed by this pathogen, its elimination as a viable weapon would be significant in reducing the overall threat of bioweapons.

Anthrax results from the weaponization of the bacterium, bacillus anthracis. A typical anthrax spore is roughly 1 micron in diameter and weighs approximately one trillionth of a gram. Bacillus anthracis thrives in soil and has the ability to remain dormant for long periods of time, up to 40 years, before being activated. These spores are extremely resilient, and are resistant to boiling, freezing, and suspension in alcohol. Activation occurs when the bacterium comes into the right environment – one that is rich in amino acids, nucleosides and glucose. One such environment is human blood.[31]

This agent as a bioweapon exists in three forms – cutaneous, gastrointestinal, and inhalation. In cutaneous anthrax, the spores enter into a host through an open cut or scrape. This form of anthrax is the most common, accounting for about 95% of observed cases worldwide, and has a fatality rate of 20%.  Symptoms begin to appear after about 12 days. The germination of the bacteria results in local swelling of the skin, and a small papule (bump) will appear. The following day the bump will enlarge into an ulcer and begin discharging a clear fluid. Then, a painless, depressed, black scab will form, dry, and fall off within one to two weeks. The second form, gastrointestinal anthrax, is the rarest form of infection. This form affects its hosts after they eat infected undercooked meat or drink unchlorinated water. Causing death in 25-60% of the cases, the beginning symptoms are similar to the flu. After approximately one week, the symptoms intensify to nausea, vomiting blood, abdominal pain, bloody diarrhea, and extreme weakness. The third form, which is the most deadly, is inhalation anthrax. In order for an infection to occur, a host must inhale at least 2500 spores. The deadliness of the spores is increased by the fact that they are colorless, tasteless, and odorless. Symptoms begin to appear after about 7 to 10 days. This first stage may last anywhere from a few hours to a few days. The stage includes symptoms of fever, cough, headache, vomiting, chills, weakness, abdominal pain, shortness of breath and chest pain. Then, there may be a brief break in symptoms or the infection can progress into the next stage. The second, and final, stage of the disease can last anywhere from two to four days. The symptoms include fever, difficulty breathing, sweating, a bluish discoloration of the skin, shock, and, ultimately, death.[32]

Because the beginning symptoms of anthrax infection are similar to many other ailments, it can be difficult to realize that a patient is suffering from this particular agent before it is too late. However, if anthrax is suspected as a cause, a series of tests are performed to identify the strain of anthrax. Because multiple strains exist, such as the Vollum, Ames, and Sterne strains, it is important to figure out which the patient is infected with.[33] A complete test begins with the culturing of a blood sample that is taken from the patient, which takes 6 to 24 hours. Then a Gram stain, which highlights the bacterium, is performed, taking 10-15 minutes. Finally, a biochemical test is performed, in which the stain is sent out to the national reference lab for comparison. This step takes approximately 24 hours.[34] A new method of diagnosis, a direct patient blood test, is now available. This test is much quicker because it eliminates the need to send the sample to the national reference lab and does not require specialized equipment or trained personnel.[35]

Currently, patients suffering from anthrax infection are treated with a 60 day regimen of twice daily antibiotics. The most commonly used antibiotics are penicillin, doxycycline and ciprofloxacin. Even with antibiotic therapy, the prognosis of inhalation anthrax once it reaches the second stage is poor. Up to 90% of cases in the second stage result in death.[36]

Fatalities occur due to anthrax’s ability to attack the body in a calculated, precise manner. When anthrax enters the body, it is activated from its dormant state into its active state due to the environment of the blood. The active bacterium moves into the lymph nodes producing a toxin that attacks human cells. This toxin is formed by the combination of three proteins – the protective antigen, the edema factor, and the lethal factor. Separately, these proteins pose no threat to the host, but, in combination, can be deadly. When these proteins are released, the protective antigen binds to the cell surface and forms a type of channel in the cell membrane that allows the edema factor and lethal factor to enter the cell. The edema factor, when combined with the protective antigen, forms a toxin known as the edema toxin. The lethal factor, when combined with the protective antigen, forms a toxin known as the lethal toxin. It is the lethal toxin that does the most damage within the cell.[37]

In order to make anthrax from the spores, one must undergo a refining process containing five difficult steps. For a microbiologist, growing bacillus anthracis in the laboratory and causing it to form spores is an easy task. However, converting a culture containing millions of these spores into an effective weapon is not easy. The first step, which can be performed by any trained microbiologist, is germination, or causing the seed spores to develop into living germs. The next step is vegetation, in which one grows sufficient anthrax germs to provide what is needed. The third step is sporulation, in which one causes the anthrax germs to create spores. The fourth step, separation, purifies the anthrax spores by freeing spores from dead “mother germs” and other debris. The fifth, and most difficult step, is weaponization. Weaponization involves drying the spores into a superfine powder and is extremely difficult to perform correctly.[38] Each of these steps has as many as 50 sub-steps, all of which could be carried out in hundreds of different ways. For example, Bill Patrick, a scientist who used to make anthrax weaponry for the United States, patented a secret process for weaponization. His process involves freeze-drying the spores, milling the resulting anthrax ‘cake’ to yield particles of the proper diameter, and then coating them with a special mixture to dampen electrostatic charges that cause clumping. Patrick calls this making the particles ‘slippery.’[39] If one manages to carry out these five steps efficiently, the anthrax will be ready for use as a bioweapon.

Since WWII and the beginning extensive research on bioweaponry, anthrax has posed a great threat. In 1993, the religious cult Aum Shinikyo released a liquid suspension of Bacillus anthracis off of the top of an eight-story building in Tokyo. The event had the potential to cause hundreds, or even thousands, of human fatalities. However, the cult failed to generate spores that would produce inhalation anthrax from the attenuated B. anthracis strain used to vaccinate livestock. Due to the improper weaponization of the bacteria, the occurrence resulted in few symptoms and no fatalities.[40] The United States anthrax attack of 2001, in which letters containing anthrax spores were mailed to various news media offices as well as U.S. Senators, was more successful. The attack resulted in five fatalities, and panic and fear swept through the public. The FBI has since concluded that former employee, Bruce Ivins, of governmental biodefense labs in Fort Dietrick, Maryland likely carried out the attacks. However, Ivins committed suicide before any legal action could be taken.[41]

The anthrax attack of 2001 highlights the lack of detection by the medical community. For example, Case #15, a 55 year old male who most likely inhaled anthrax from a mailed letter, first entered the emergency room on October 18, 2001 complaining of progressive fatigue, myaligias, and fever. He was discharged later that day, but returned to the hospital on October 21st with significantly worse symptoms, including chills, tightness in his chest, and a high temperature. He died later that night. Case #16, a 47 year old male, was also improperly diagnosed. After his first visit to the emergency room on October 21, 2001 prompted by fatigue, nausea, vomiting, and diarrhea, he was discharged. He returned to the emergency room on October 22nd in respiratory distress, and died six hours after re-entering the hospital. If the hospitals had properly diagnosed the cases during the first stage of symptoms, these two victims would have had significantly increased chances of survival.[42]

Section 4

Anthrax is a highly deadly, fast-acting pathogen. It is available throughout the world and has proven to be appealing to both enemy states as well as rogue organizations. The technology exists to weaponize it from bacteria into an effective biological weapon of mass destruction. Because of the immense threat, we propose to employ a theory of bio-deterrence in order to render an anthrax attack against the United States ineffective. Bio-deterrence is an evolution of the traditional deterrence theory that was used during the Cold War. Instead of employing the theory in the offensive manner of mutually assured destruction, bio-deterrence can be better understood as deterrence by denial. This angle of the theory uses deterrence as a defensive measure, “ultimately aiming to decrease terrorist motivation by fortifying targets of attack.”[43] By ensuring a rapid, efficient response to an anthrax attack, which would serve to treat and protect the entire United States population from the deadly effects of weaponized anthrax, the appeal of anthrax as a biological weapon of mass destruction would be eliminated.

Deterrence theory is a strategy employed by a country to prevent domestic attack. The theory was popularized by the United States and Soviet Union governments during the Cold War. In this theory, one country prevents attack by another country by flaunting their power and making it publicly known that they have the means to and will attack the other if there is any sign that they are about to take action. In the case of the Cold War, stockpiles of nuclear weapons served as the deterrents. The United States threatened drastic retaliation on the Soviet Union if they considered using nuclear warfare.[44] David Krieger of the Nuclear Age Peace Foundation summarizes the situation as follows:

“Country A [the United States] tells country B [the Soviet Union] that if B does X, A will attack it with nuclear weapons. The theory is that country B will be deterred from doing X by fear of nuclear attack by country A. For deterrence to work, the leaders of country B must also believe that country A has nuclear weapons and will use them. Nuclear deterrence theory holds that even if country A might not have nuclear weapons, so long as the leaders of country B believed that it did they would be deterred.” [45]

Deterrence theory is a viable choice for security as long as Country B believes that Country A can carry out the retaliation they promise or that Country A is protected by a country that can.

The United States cites this theory as a reason to maintain their stockpile of nuclear weapons, claiming its arsenal is necessary to deter aggression. In the case of the Cold War, a “balance of terror” was achieved between the United States and the Soviet Union through the military doctrine of Mutually Assured Destruction.[46] The doctrine supports the idea that the population could best be protected by leaving it vulnerable so long as the other side faced comparable vulnerabilities. Both countries maintained their stockpiles of nuclear weapons with a mutual understanding that if they engaged their weapons first the other country would retaliate on a massive scale and would not hesitate to cause mutual destruction.

While this doctrine maintained an uneasy standoff in the Cold War, it could potentially fail if one side was able to destroy the other’s stockpile in the first strike. In order to prevent this, the United States has attempted to makes its nuclear weapons invulnerable to attack, placing “weapons on land in hardened silos, while those in the oceans on submarines that were difficult to locate underwater.”[47]

Our employment of the deterrence theory modifies the strategy from an offensive perspective, guaranteeing mutually assured destruction, to a defensive perspective. Deterrence of an anthrax attack can best be understood as deterrence by denial.[48] Deterrence by denial eliminates the threat of attack by negating the effectiveness of a weapon. The goal of the denial theory is not based on the threat of retaliation by retaining equivalent weapons of response; rather, the United States will be equipped to so effectively respond to an attack that anthrax as a weapon will cease to be appealing. We plan to implement pre-attack precautions and define post-attack strategy in order to ensure the United States has the ability to respond to an anthrax attack in such a way that fatalities are minimized and public fear is diminished. The key infrastructure of our pre-attack strategy is the Strategic National Stockpile.

The Strategic National Stockpile is designed to supplement and resupply state and local public health agencies in the event of a national emergency anywhere, and at anytime, within the United States or its territories. Authorized by Congress in 1998, this stockpile was originally titled the National Pharmaceutical Stockpile and operated under the Department of Health and Human Services. After a few exchanges of control of the stockpile, the signing of the BioShield legislation reaffirmed the role of the HHS as the overseer for the program. The HHS manages federal agencies, namely the Center for Disease Control and Prevention, which are responsible for maintenance and delivery of SNS assets.  The stockpile contains a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items and is located in secure, environmentally controlled areas throughout the United States. The composition of the SNS Program assets are determined by the HHS and CDC after considering many factors, such as current biological and/or chemical threats, the availability of medical materiel, and the ease of dissemination of pharmaceuticals. The most significant factor considered is the medical vulnerability of the U.S. civilian population.[49]

The majority of the inventory is made up of vaccines, ventilators, and antitoxins which are managed by specific vendors or manufacturers. The fast-response inventory, which makes up less than 5%, is known as 12-Hour Push Packs. These Push Packs contain broad-spectrum oral and intravenous antibiotics, IV fluids and fluid administration kits, airway equipment, such as ET tubes, stylettes, oropharyngeal airways, Ambu-Bags, and CO2 detectors, and bandages. The SNS maintains ownership of the inventory and is responsible for storing, monitoring, and maintaining the inventory. All medicine in the SNS is free for everyone.[50]

Although the SNS is not a first response tool, it is organized for flexible response. The inventory of the SNS would be made available following a direct request from affected state’s governor’s office to the CDC or HHS. The stockpile would be accessed post-emergency, when local public health resources would likely be or have already been overwhelmed by the magnitude of the medical emergency, such as following a natural disaster or terrorist event. The stockpile could also be accessed pre-emergency, following actionable intelligence, analysis of data derived from syndromic or epidemiologic surveillance, or a sentinel event, such as a single case of smallpox. The 12-Hour Push Packs can be delivered anywhere in the United States or its territories within 12 hours of a federal decision to deploy. The Push Packs are configured to be immediately loaded onto either trucks or commercial cargo aircraft for the most rapid transportation and, simultaneously, the SNS program will deploy its Technical Advisory Response Unit (TARU) to coordinate with state and local officials so the SNS assets can be efficiently received and distributed upon arrival at the site.[51]

State and local authorities must plan to receive, store, stage, distribute, and dispense the assets. In order to aid local distributors, the SNS project has developed practical references defining methods of dispensing that are useful for local health departments to follow. The guidelines are defined in the Cities Readiness Initiative (CRI). The CRI is a pilot program to aid cities in increasing their capacity to deliver medicines and medical supplies during a large-scale public health emergency. Funding for CRI is provided through CDC’s Public Health Emergency Preparedness (PHEP) Cooperative Agreement, and cities that receive this funding are designated based on their population, geographical location, and potential vulnerability to a bioterrorism threat. Within each designated city, points of distribution (PODs) are chosen. A POD is a location that will be converted to a medical dispensing site in an emergency. However, because the dynamic of each area is so different, the CRI has provided examples of some of the most innovative and effective ways that communities are planning to distribute their supplies.[52]

For some communities, home delivery is a viable option. One example is a method employed by Chesapeake County, Virginia known as “push distribution.” This community plans to deliver door-to-door life saving countermeasures via public school buses, with Medical Reserve Corps volunteers and City employees dispensing the medication. The community tested the feasibility in of their method in 2007, by engaging in an exercise titled “Special Delivery.” The timed test began during kit assembly, in which 1000 kits were assembled. Each kit consisted of a drawstring bag containing four bottles of a 10-day antibiotic regimen, two information sheets describing the mock anthrax bioterrorism attack being exercised, and an 8-page newspaper-size insert with teaching information about anthrax as well as instructions describing the medication being distributed and recommended treatment regimen. The kits were delivered to the door knobs of 934 residents by one bus driver and four volunteers on public school buses which followed pre-determined GIS-mapped routes. The results of the exercise were based on the assumptions that 900 City staff and volunteers from the Medical Reserve Corps will be available and show up in an event and the 196 buses that will be needed for transport will be maintained and available for use. This plan is feasible for this area due to their ability to close down roads and have access to the supplies of the community.[53]

In Palm Beach, Florida, the dynamics of the community are very different from Chesapeak County, Virginia and so require a different method. This community decided their most effective distribution would be based on a hybrid plan of involving public and closed PODs. The community decided to solidify partnerships with gated residential communities. A lease agreement was signed between the community and the private locations, which circumvents potential legal and liability challenges. In this agreement, during an emergency, the private location agrees to temporarily donate a portion of their property to the health department. This donation of real property as a service allows the residential board to register with the county and become classified as a Florida Statute 110 Volunteer. Under Florida Statute 110, all volunteers are provided state liability protections and workers compensation. Palm Beach contains a large number of retirement communities with residents 65 years of age and older, so this method of dispensing is most effective for them. [54]

For other communities, the best method is to use sites that are already well known to their citizens. In Lake County, Illinois, the PODs are the voting sites. A lot of responsibility is placed on each municipality and each has identified public works personnel and their own security to pick up and deliver the medications and supplies to each of the activated polling places. The method was originally tested in 2007 using one polling site. Lake County activated the plan from the point of the county drop site to a single polling site located several miles from the drop site, which was then opened and actively operated for 2 hours. With scenario cards in hand, 70 volunteer “mock” patients repeatedly went through the dispensing site. Projections of time data collected during the exercise demonstrated that all heads of households in Lake County could receive medication for their household well within the 48-hour time frame required by the CDC. In July, 2008 the community repeated the test run with two polling sites and a 15% efficiency increase was noted.[55]

As of 2009, the government had allotted $600 million in order to increase the amount of anthrax vaccines in the SNS. The current goal of the government is to increase the number of vaccines in the stockpile by 25 million doses.[56]

The only current licensed vaccine for anthrax infections is BioThrax® (Anthrax Vaccine Adsorbed). It is produced and manufactured by Emergent Biosolutions, a company based in Rockville, Maryland. The vaccine stimulates the body to produce protective antibodies against the protective antigen, therefore preventing PA from interacting with the other factors in anthrax that make it lethal. The vaccine is considered “inactivated” because it does not contain whole live or dead bacteria, and is made from a strain of the anthrax bacteria that cannot cause anthrax infection.[57] A number of components make up the vaccine, including aluminum, benzethonium chloride, and formaldehyde. The aluminum acts as an adjuvant, helping to increase the body’s immune response by attracting white blood cells and acting as a storage depot to slow the release of PA in one’s system. The benzethonium chloride functions as an antimicrobial preservative in the vaccine, preventing contamination in multi-dose vials. Formaldehyde acts as a stabilizer and helps to increase the shelf life of the vaccine to approximately four years.[58] The vaccine regimen is made up of five doses taken over 18 months supported by an annual booster shot. After the full vaccination series, the individual is considered protected. “One of the studies used to support the original marketing approval of BioThrax constituted a controlled field study in which the BioThrax predecessor vaccine was calculated to be 92.5% effective in preventing inhalational and cutaneous anthrax.” Currently, BioThrax is only licensed for prophylactic use among high risk persons, including military personnel, laboratory workers, or postal workers. To date, 2.1 million individuals have been vaccinated. [59]

While the protective capacity of the BioThrax vaccine is relatively high, the current vaccine does have many criticisms. One major con is that the vaccine is only fully protective for one to two years, and requires an annual booster shot to maintain its efficacy. This demanding vaccination schedule results in an increase in the number of people who do not complete the full series. If the series is not completed, that person is not fully protected. Another con to the vaccine is the incidence of side effects. In clinical studies, greater than 10% of participants reported injection-site reactions, including tenderness, pain, erythema, and limitation of arm motion. Systemic adverse reactions were also observed in approximately 5% of participants, including muscle aches, fatigue, and headaches.  In post-marketing surveillance, more severe side effects were observed, including serious allergic reactions.[60] Due to the difficulty for the public to weigh the probability of experiencing a side effect versus the probability of an anthrax attack, many people do not feel it is necessary for them to get vaccinated.

In order to address these criticisms, a second-generation vaccine is currently under development by Emergent Biosolutions as well as Pharmathene. Both companies are pursuing recombinant protective antigen vaccines, which vary slightly, but should result in a lesser dosage vaccination series that causes fewer side effects. Studies on a new vaccine have been on-going for years. A study performed by Welsh School of Pharmacy, Cardiff University concluded that after “Almost two decades and millions of dollars, we still do not have a replacement vaccine and some argue that the spectrum of protection that [the new vaccine] confers will not be as broad as the vaccine it replaces.”[61] To deal with this issue, Department of Health and Human Services awarded both Emergent and Pharmathene funds for research and development in order to stimulate the process. Whichever company is able to construct a quality vaccine first will secure an exclusive contract with the government to manufacture the new vaccine in bulk.[62]

Regardless of the motivation to produce a new vaccine, the research and development process still takes time. As stated by the WMD Commission of 2008, the threat of an attack by a biological weapon is imminent – it will likely occur within the next 5 years.[63] Because of this pressing threat, our proposal requires action. We recommend the immediate augmentation of the Strategic National Stockpile with 330 million doses of the current Biothrax vaccine, at the cost of approximately $3.3 billion.

The Stockpile must be increased to 330 million doses to be able to protect and treat the entire United States population. The U.S. Census of 2000 determined the population of the United States to be approximately 300 million people (See Appendix 1).[64] The number of doses of vaccination in the stockpile would be sufficient to provide every member of the United States with their first dose of the vaccination regimen. Although every member would not be fully protected, vaccination of adults with the licensed vaccine induced an immune response measured by indirect hemagglutination in 83% of vaccinees 2 weeks after the first dose.[65]

The additional 30 million doses are recommended to be stockpiled in order to immediately treat the affected population in the areas which were attacked. Supposing the worst, if the nation’s two largest cities, New York and Los Angeles, were to be simultaneously attacked, approximately 13 million people would be exposed to anthrax. Current research proves that the most cost-effective and successful treatment of exposed persons is combination prophylaxis, antibiotic and vaccine therapy. The shortened vaccine regimen consists of 3 doses, one at 0, 2, and 4 weeks, in combination with 14 days of ciprofloxacin.[66] The additional 30 million doses would ensure that the entire populations of New York and Los Angeles could receive this treatment in full.

Thus, our proposal also recommends that the FDA immediately license BioThrax for post-exposure prophylaxis. The Division of Bacteriology at the United States Army Medical Research Institute of Infectious Diseases in Fort Detrick, MD conducted a study following the 2001 attacks in which two groups of ten macaques were exposed to inhalation anthrax. The first group was treated with only ciprofloxacin twice daily for 14 days. The second group received this same treatment in combination with three doses of the anthrax vaccine absorbed. Out of the ciprofloxacin-only group, four monkeys survived. In the combination therapy group, all ten survived. The study concluded that “postexposure vaccination can shorten the duration of antibiotic prophylaxis required to protect against inhalational anthrax.”[67]

Ciprofloxacin, although a critical part of effective treatment, does not need to be further stockpiled as per our proposal. The SNS already contains a sufficient amount of the antibiotic, and, due to its numerous FDA approved uses, is readily available at pharmacies nationwide.

Section 5

The strength of our proposal lies in the ability to quickly and effectively distribute the vaccine via the SNS. The timeline of symptoms of inhalation anthrax occurs over an approximately 9 day period (See Appendix 2).[68] On Day 1, an affected person would present with prodromal phase symptoms, such as sore throat, fever, and muscle aches. These symptoms would increase in severity over the next four days before reaching the fulminant phase, in which patients experience difficulty breathing, shock, and meningitis. After someone enters the fulminant phase, they have a 90% chance of death even with treatment within two days.[69] Our deployment of treatment via the SNS enables all citizens to be reached within a four day period.

The timeline relies heavily on the ability of doctors and emergency personnel to properly diagnose a patient. Two preventable deaths that occurred following the 2001 attacks highlighted the need to instruct the medical community about weapons of mass destruction. To respond to this gap in knowledge, the government and the medical community have made efforts to increase the awareness of doctors and emergency personnel. The government responded by creating the National Domestic Preparedness Consortium, sponsored by the Department of Defense. The mission of the consortium is to

Enhance the preparedness of federal, state, local, and tribal emergency responders/first receivers and teams, including non-governmental organizations and the private sector, to reduce the Nation’s vulnerability to incidents involving weapons of mass destruction, terrorism, and all-hazard high-consequence events by developing, delivering, and assessing plans, training, technical assistance, and exercises[70]

The vision of the consortium is to eventually be recognized as an ally of the premier institutions of medicine. The program has conducted training programs in all 50 states, and has already trained 60,000 emergency responders and state, local, and tribal government employees. The program offers many courses to increase WMD awareness, both online and in classroom settings.[71] One example of a class offered is the WMD Awareness-Level Training Course. The objectives of this six-hour training program are to provide students with a working knowledge of the current prevention and deterrence strategies, to help them identify indicators of potential terrorist acts, and to allow them to understand recognition, avoidance, isolation, and notification techniques of chemical agents, toxic industrial chemicals and materials, biological materials, radiological and nuclear materials, and explosive devices when used as WMD.  Students will receive awareness-level instruction covering the ways to deal with these hazards. At the end of the course, students receive an ODP certificate of completion.[72]

The medical community has responded by increasing the prevalence of WMD information in their major publications. Respected journals such as the Journal of the American Medical Association and the Annals of Emergency Medicine have published articles depicting symptoms, treatments, and case studies of those affected by WMD. One such article is “Bioterrorism and weapons of mass destruction 2004: Physicians as first responders” by Robin B. McFee DO, MPH. She cites the 2001 attack to show doctors the consequences of their lack of awareness, stating “Physicians who do not know the common signs of deadly, albeit uncommon illnesses, will lose lives.” The article provides symptoms, pictures, medical management, and treatment options for multiple WMD, ensuring that doctors have a training guide which to refer.[73] The medical community has also improved their methods for diagnosing anthrax. In June, 2004, the FDA approved a test for anthrax known as the Immunetics Test. This is the first anthrax test to directly test a patient’s blood specimen, and can be used by any public or private laboratory without the need for specialized equipment or trained personnel. The test was shown to detect 100% of the anthrax patients tested in clinical trials, with less than a 1% chance of false positive results by detecting the presence of the lethal factor in the blood.[74]

Another strength of our solution is the cost-effectiveness of the recommended combination therapy over the antibiotic therapy alone. The full 60 day regimen of Ciprofloxacin costs approximately $204.[75] Three doses of the vaccine combined with the 14 day shortened antibiotic regimen equates to $126 per person.[76] Thus, combination treatment saves $78 per infected person.

Our proposal recommends that the United States incurs a great cost. Each dose of the current anthrax vaccine is $10, and to stockpile the SNS as recommended by our proposal requires the government to spend approximately $3.3 billion.[77] While this number may seem excessive, the solution is actually the most cost-effective method for eliminating anthrax as a biological threat. If the entire nation were to be pre-vaccinated, every citizen would require 5 doses to complete the initial regimen plus an annual booster shot.[78] The cost of pre-vaccination would be at least $18 billion. By stockpiling only the first dose of the vaccine and enough to treat those affected with the short-regimen, the United States has a great enough number of doses to eliminate the threat of anthrax without investing in vaccinations, that under the deterrence theory, will never be necessary.

In addition to being less cost-effective, pre-vaccination can be deemed as implausible as shown by past government attempts. In 2003, an attempt was made to vaccinate the U.S. population against small pox, another Select agent, with a newly developed vaccine. The CDC proposed to vaccinate 500,000 doctors, nurses and other health workers in a 3 month period. They then proposed to be ready to vaccinate up to 10 million others. At the end of 3 months, only about six percent of the targeted workers had been vaccinated. Health-care workers refused to get the vaccine due to fear of risks to themselves and their families. Despite major efforts by the CDC to address these concerns, they were not able to overcome the hesitancy of the participants.[79] Currently, the United States has been dealing with the H1N1 flu epidemic. Although a vaccine is available to the public, the fear of extreme and rare side effects such as Guillain-Barre, has prevented many susceptible people from receiving the vaccine.[80]

Our proposal also relies on the ability of Emergent to quickly produce a great number of vaccines. Although Emergent is attempting to scale-up its Biothrax activities, its new facility is only capable of producing 60 million vaccines per annum.[81] Ideally, every citizen would be able to strictly follow the current vaccination regimen, meaning that one month after the attack they should receive their second dose of vaccine. Emergent does not currently have the capability to provide this many doses in the one-month time frame. We recommend the government put forth whatever funds are necessary to expand these capabilities to produce another cycle of 300 million doses in one month if an attack should occur.

Another weakness of our solution is that the current vaccine has a shelf-life of only four years.[82] Thus, the entire stockpile must be replaced in four years. However, as previously stated, both Emergent and Pharmathene are currently developing second generation vaccines that will require less doses. The SNS should contain the most up-to-date vaccine available, thus BioThrax expiring in four years allows the government to cycle in the newer vaccine that ideally will also have a longer shelf life. This process of perfecting the vaccine will continue until a single dose, cost-effective, 100% efficient vaccine is produced and stockpiled.

Our proposal attempts to address all of the elements of anthrax that make it a viable biological weapon. The entirety of our proposal can be split into two parts- implementing pre-attack precautions and defining post-attack strategy. By ensuring both parts are in place, all enemies of the United States will be deterred from using anthrax in an attack. The strategy of bio-deterrence will render an entire class of weapons ineffective.

Section 6

The Department of Homeland Security was created to protect the civilian sphere of the United States. This department oversees 22 government agencies, all of which focus on benefiting the citizens and protecting their civil liberties. Due to the domestic focus of the solution, the Department of Homeland Security is the most suitable department to support the proposal and publicly announce the strategy.[83]

The current secretary of the Department of Homeland Security, Janet Napolitano, would relay the biodeterrence proposal through a national address. As the secretary of a position that was created in response to the attacks of September 11, 2001, her main responsibilities are to help the nation respond to terrorist attacks and natural disasters. Napolitano has spoken on issues such as border security, securing Americans against cyber attacks, and the preparedness of the Red Cross.[84]

Napolitano’s speeches function to relay any updates to national security or any new strategies that are currently being implemented or have already been established to the public. These addresses are nationally and globally broadcasted in order to make them available to both national and international audiences. This enables the address to reach a broader audience and guarantees the documentation and support of the solution by the U.S. government.

As a means to further national security, the solution would need to be made known to all citizens, civilian and military personnel. The most efficient way to do so is through a national address from a prominent political figure. The speech would create deterrence because it solidifies the plan as a current strategy of the United States to global leaders. The audience for such a speech will be the some of the major players in the global community. By stating the proposal publically they will have the opportunity to know what the United States is doing to protect itself (See Appendix 3).

Works Cited

“A Shot in the Dark: Swine Flu’s Vaccine Lessons.” UCLA School of Public Health | “Building Healthy Futures…” Web. 13 Oct. 2009. <http://www.ph.ucla.edu/epi/bioter/smallpoxprotein.html>.

“Analysis of the US anthrax cases.” Analyzing The Anthrax Attacks – 2009 edition. Web. 22 Sep. 2009. <http://www.anthraxinvestigation.com/index.html#refining>.

“Anthrax.” Manbir Online … for Health & Fitness. Web. 25 Sep. 2009. <http://www.manbir-online.com/diseases/anthrax-2.htm>.

“Anthrax Treatments Cost Effectiveness Shown in Stanford Study – Office of Communications & Public Affairs.” Stanford University School of Medicine. Web. 19 Nov. 2009. <http://med.stanford.edu/news_releases/2005/april/anthrax.htm>.

“Anthrax Vaccination Information Program” The Official DoD Anthrax Information Web Site. Web. 4 Nov. 2009. <http://www.anthrax.osd.mil/>.

“American Anthrax Outbreak of 2001.” UCLA Department of Epidemiology: School of Public Health. 28, Oct. 2009.

<http://www.ph.ucla.edu/epi/bioter/detect/antdetect_list.html.>

“ASA Newsletter – Anthrax Toxin.” ASA Inc – Topics In Chemical And Biological Warfare And Bio Terrorism. Web. 2 Oct. 2009. <http://www.asanltr.com/newsletter/03-3/articles/Anthrax.htm>.

“ASM Comments on the Weapons of Mass Destruction Prevention and Preparedness Act of 2009.” Microbiology — The American Society For Microbiology. Web. 5 Oct. 2009. <http://www.asm.org/index.php?option=com_content&view=article&id=91066&title=ASM+Comments+on+the+Weapons+of+Mass+Destruction+Prevention+and+Preparedness+Act+of+2009&Itemid=349>.

“Biodefense Category A, B, C Pathogens, NIAID, NIH.” National Institute of Allergy and Infectious Diseases. Web. 13 Nov. 2009. <http://www3.niaid.nih.gov/topics/BiodefenseRelated/Biodefense/research/CatA.htm>.

“Biological weapons – definition of Biological weapons in the Medical dictionary – by the Free Online , Thesaurus and Encyclopedia.” Medical Dictionary. Web. 15 Sept. 2009. <http://medical-dictionary.thefreedictionary.com/Biological+weapons>.

“The Biological Weapons Convention (BWC) At A Glance | Arms Control Association.” Arms Control Association | The authoritative source on arms control since 1971. Web. 24 Nov. 2009. <http://www.armscontrol.org/factsheets/bwc>.

“Canada to build bioweapons lab in former Soviet Union.” The Jane Burgermeister website – investigating the swine flu pandemic. Web. 10 Nov. 2009. <http://www.theflucase.com/index.php?option=com_content&view=article&id=387:canada-to-build-bioweapons-lab-in-former-soviet-union&catid=1:latest-news&Itemid=64%E2%8C%A9=en>.

“The Case Against Bruce Ivins – washingtonpost.com.” Washingtonpost.com – nation, world, technology and Washington area news and headlines. Web. 22 Oct. 2009. <http://www.washingtonpost.com/wp-dyn/content/article/2008/08/06/AR2008080602794.html>.

“CDC – Bacillus anthracis Incident, Kameido, Tokyo, 1993.” Centers for Disease Control and Prevention. Web. 21 Sep. 2009. <http://www.cdc.gov/ncidod/EID/vol10no1/03-0238.htm>.

“CDC designates new Kentucky biodefe…( LOUISVILLE Ky. — A new biodefense cen…).” News Center – latest biology news and medical news. Web.  20 Nov. 2009. <http://news.bio-medicine.org/medicine-news-2/CDC-designates-new-Kentucky-biodefense-center-6705-1/>.

“CDC | Strategic National Stockpile.” CDC Emergency Preparedness & Response Site. Web. 5 Oct. 2009. <http://www.bt.cdc.gov/stockpile/>.

“Certainty, Severity, and Their Relative Deterrent Effects: Questioning the Implications of the Role of Risk in Criminal Deterrence Policy | Science & Technology Experimentation & Research from AllBusiness.com.” Business Resources, Advice and Forms for Large and Small Businesses. Web. 15 Nov. 2009. <http://www.allbusiness.com/specialty-businesses/1026901-1.html>.

“CIDRAP HHS evaluates proposals for new anthrax vaccine.” CIDRAP Center for Infectious Disease Research and Policy. Web. 12 Nov. 2009. <http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/aug1208vaccine-jw.html>.

Cieslak, Theodore J., and Edward M. Eitzen. “Clinical and Epidemiologic Principles of Anthrax.” Centers for Disease Control and Prevention. Web. 2 Nov. 2009. <http://www.cdc.gov/ncidod/EID/vol5no4/cieslak.htm>.

“Cities Readiness Initiative Webcast-PHTN-CDC.” Web. 25 Nov. 2009. <http://www2.cdc.gov/phtn/cri/default.asp>.

“Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Congress must act to prevent WMD attack.” Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Home. Web. 8 Oct. 2009. <http://www.preventwmd.gov/congress_must_act_to_prevent_wmd_attack/>.

Committee on Laboratory Security and Personnel Reliability Assurance Systems for Laboratories.Responsible Research with Biological Select Agents and Toxins. Prepublication ed. Washington: The National Academies, 2009. Print.

“DHS: Remarks by Secretary Napolitano at the Council on Foreign Relations.” Department of Homeland Security | Preserving our Freedoms, Protecting America. Web. 23 Nov. 2009. <http://www.dhs.gov/ynews/speeches/sp_1248891649195.shtm>.

DHS | Secretary Janet Napolitano.” Department of Homeland Security | Preserving our Freedoms, Protecting America. Web. 01 Dec. 2009. <http://www.dhs.gov/xabout/structure/gc_1232568253959.shtm>.

Eisner, Peter, and Delthia Ricks. “Experts divided on odds of germ attack –

chicagotribune.com.” Chicago Tribune breaking news, sports, weather and traffic in Chicago – chicagotribune.com. 13 Sept. 2001. Web. 28 Sept. 2009. <http://www.chicagotribune.com/news/nationworld/chi-0109130352sep13,0,4909373.story>.

“Emergent BioSolutions-BioThrax.” Emergent Biosolutions. Web. 3 Oct. 2009. <http://www.emergentbiosolutions.com/html/biothrax.aspx>.

“FDA Approves First Blood Test for Anthrax; Boston Based Company Test Shown to be Accurate for Anthrax Diagnosis. – Free Online Library.” News, Magazines, Newspapers, Journals, Reference Articles and Classic Books – Free Online Library. Web. 3 Dec. 2009. <http://www.thefreelibrary.com/FDA+Approves+First+Blood+Test+for+Anthrax;+Boston+Based+Company+Test+…-a0117874737>.

Fischer, Dr. Julie. “Interview with Dr. Fischer.” Personal interview. 30 Oct. 2009.

Fritsky, Lauren. “Why I Won’t Get the H1N1 Vaccine -.” Lemondrop.com. Web. 5 Dec. 2009. <http://www.lemondrop.com/2009/11/05/why-i-wont-get-the-h1n1-vaccine/>.

Gaddis, John L. “Nuclear Files: Key Issues: Nuclear Weapons: History: Cold War: Strategy: Mutual Assured Destruction.” Nuclear Files – From nuclear proliferation to nuclear testing, from Hiroshima to North Korea, Nuclear Files offers the A to Z on nuclear issues. Web. 16 Nov. 2009. <http://www.nuclearfiles.org/menu/key-issues/nuclear-weapons/history/cold-war/strategy/strategy-mutual-assured-destruction.htm>.

Geddes, Alasdair. “Infection in the twenty-first century: predictions and postulates — Geddes 46 (6): 873 — Journal of Antimicrobial Chemotherapy.” Oxford Journals | Medicine | Journal of Antimicrobial Chemotherapy. 1999. Web. 26 Oct. 2009. <http://jac.oxfordjournals.org/cgi/content/full/46/6/873>.

Graham, Bob, and Jim Talent. “Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism :: Bioterrorism: Redefining Prevention.” Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism :: Home. Web. 18 Sept. 2009. <http://www.preventwmd.gov/6_09/>.

“HHS Cancels RFP for rPA Procurement and Modifies Their Approach in Favor of BAA for Development of rPA Vaccines: Business Wire Business News – MSN Money.” News: Business, Financial and Investing News – MSN Money. Web. 13 Dec. 2009. <http://news.moneycentral.msn.com/provider/providerarticle.aspx?feed=BW&date=20091207&id=10844410>.

“Homeland Security Presidential Directive / HSPD-10: Biodefense for the 21st Century.” Federation of American Scientists. Web. 23 Nov. 2009. <http://www.fas.org/irp/offdocs/nspd/hspd-10.html>.

“Homeland Security Training Program homepage.” Wyoming Law Enforcement Academy. Web. 8 Dec. 2009. <http://www.wleacademy.com/HLS/index.htm>.

“HowStuffWorks “Bioweapon 9: Anthrax”” Howstuffworks “Science” Web. 24 Sep. 2009. <http://science.howstuffworks.com/bioweapon2.htm>.

“HowStuffWorks “How Anthrax Works”” Howstuffworks “Science” Web. 24 Sep. 2009. <http://science.howstuffworks.com/anthrax.htm>.

“Inhalation Anthrax.”Medline Plus Web. 2 Dec. 2009. <http://www.nlm.nih.gov/medlineplus/ency/article/000641.htm.>

“Introduction of the WMD Prevention and Preparedness Act of 2009 (S.1649).” Federation of American Scientists. Web. 13 Sep. 2009. <http://www.fas.org/irp/congress/2009_cr/s1649.html>.

“Is new always better than old?: The development of… [Hum Vaccin. 2009] – PubMed result.” National Center for Biotechnology Information. Web. 27 Oct. 2009. <http://www.ncbi.nlm.nih.gov/pubmed/19786839>.

Kleiman, Mark, and Beau Kilmer. The Dynamics of Deterrence. Publication. University of California in Los Angeles, 15 June 2009. Web. 25 Oct. 2009. <http://www.spa.ucla.edu/faculty/kleiman/Dynamics%20of%20Deterrence%20PNAS%202009[1].pdf>.

Kosal, Margaret E., Terron, Ann, and Lange, Katherine. 2009. Bioterrorism Deterrence:

the Role of Public Health in Security. Atlanta, Georgia: Sam Nunn School of International Affairs Publications.(PDF document downloaded 21 Nov 2009)

Matishak, Martin. “NTI: Global Security Newswire – Group Warns Biosecurity Bill

Could Burden Scientific Research.” NTI – Global Security Newswire. 19 Nov. 2009. Web. 5 Dec. 2009. <http://www.globalsecuritynewswire.org/gsn/nw_20091119_7367.php>.

McFee, Robin B. 2004. Bioterrorism and weapons of mass destruction 2004:

Physicians as first responders. Wynnewood, PA: American Academy of Clinical Toxicology.(PDF document downloaded 3 Dec 2009)

“Mode of Communication of Cholera(John Snow, 1855).” UCLA School of Public Health | “Building Healthy Futures…” Web. 24 Oct. 2009. <http://www.ph.ucla.edu/epi/bioter/detect/antdetect_list.html>.

“NOVA Online | Bioterror | Global Guide to Bioweapons (Flash).” PBS. Web. 17 Sep. 2009. <http://www.pbs.org/wgbh/nova/bioterror/glob_flash.html>.

“Nuclear Deterrence, Missile Defenses and Global Instability, by David Krieger, April 2001.” Nuclear Age Peace Foundation. Web. 1 Nov. 2009. <http://www.wagingpeace.org/articles/2001/04/00_krieger_nuclear-deterrence.htm>.

PharmAthene. Web. 4 Oct. 2009. <http://www.pharmathene.com/index.html>.

“Preventing Biological Weapons Proliferation and Bioterrorism.” U.S. Department of State. Web. 10 Dec., 2009. <http://www.state.gov/t/us/133335.htm#>.

“Profile of Janet Napolitano, Homeland Security Director for President Obama – Janet Napolitano Biography.” Liberal & Progressive Politics & Perspectives. Web. 02 Dec. 2009. <http://usliberals.about.com/od/stategovernors/p/Napolitano.htm>.

“Rational Choice and Deterrence Theory.” University of Missouri – St. Louis Home. Web.

13 Dec. 2009. <http://www.umsl.edu/~keelr/200/ratchoc.html>.

“Report: Smallpox Program Too Slow to Evaluate.” Vaccination News. Web. 13 Dec. 2009.<http://www.vaccinationnews.com/DailyNews/2003/May/03/ReportSmallpox3.htm>.

Responsible Research with Biological Select Agents and Toxins. Washington: The National Academies, 2009. Print.

“Science News Blog — HHS News.” Science Blog | Science news straight from the source. Web. 30 Nov. 2009. <http://www.scienceblog.com/community/older/archives/A/hhs102.html>.

“Short-course postexposure antibiotic prophylaxis c… [Proc Natl Acad Sci U S A. 2006] – PubMed result.” National Center for Biotechnology Information. Web. 8 Nov. 2009. <http://www.ncbi.nlm.nih.gov/pubmed/16672361>.

“Six Years After Anthrax: Are We Better Prepared to Respond to Bioterrorism? (10-23-2007).” Home Page: Center for Biosecurity of UPMC | Bioterrorism, Biodefense, Public Policy, Public Health Preparedness. Web. 8 Nov. 2009. <http://www.upmc-biosecurity.org/website/resources/hearings/2007/20071023-sixyearsafteranthrax.html>.

Smith, Bradley T., Thomas V. Inglesby, and Tara O’Toole. Biodefense R&D:

Anticipating Future Threats, Establishing a Strategic Environment. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, & Strategy. Publication. University of Pittsburgh, 18 Sept. 2003. Web. 26 Sept. 2009. <http://www.upmc-biosecurity.org/website/resources/publications/2003_orig-articles/2003_article_pdfs/2003-09-15-biodefenserandd.pdf>.

“Strategic National Stockpile | NACCHO.” National Connection for Local Public Health | NACCHO. Web. 23 Oct. 2009. <http://www.naccho.org/topics/emergency/SNS/>.

“Strategic National Stockpile (SNS) – Radiation Event Medical Management.” Radiation Event Medical Management, U.S. Dept. of Health and Human Services – REMM. Web. 23 Oct. 2009. <http://www.remm.nlm.gov/sns.htm>.

Takahashi H, Keim P, Kaufmann AF, Keys C, Smith KL, Taniguchi K, et al. Bacillus anthracis incident, Kameido, Tokyo, 1993. Emerg Infect Dis [serial online] 2004 Jan [date cited]. Available <http://www.cdc.gov/ncidod/EID/vol10no1/03-0238.htm>

“Thousands Infected With Natural Anthrax.” UCLA School of Public Health | “Building Healthy Futures…” Web. 30 Nov. 2009. <http://www.ph.ucla.edu/epi/bioter/naturalanthrax.html>.

United States of America. National Secutiy Council. Executive Office of the President. National Strategy for Countering Biological Threats. National Security Council, 23 Nov. 2009. Web. 5 Dec. 2009. <http://www.whitehouse.gov/sites/default/files/National_Strategy_for_Countering_BioThreats.pdf>.

“The US capitol bioterrorism anthrax exposures: cli… [J Infect Dis. 2007] – PubMed result.” National Center for Biotechnology Information. Web. 3 Oct. 2009. <http://www.ncbi.nlm.nih.gov/pubmed/17191162>.

“USA 2000 Population Density.” Map. Boston University School of Theology Library Archives. Boston University, 10 Sept. 2007. Web. 14 Oct. 2009. <http://sthweb.bu.edu/archives/index.php?option=com_awiki&view=mediawiki&article=File:USA-2000-population-density.gif>.

“Use of Anthrax Vaccine in the United States.” Centers for Disease Control and Prevention. 15 Dec. 2000. Web. 25 Oct. 2009. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm>.

“Vaccines: countering anthrax: vaccines and immunog… [Clin Infect Dis. 2008] – PubMed result.” National Center for Biotechnology Information. Web. 7 Oct. 2009. <http://www.ncbi.nlm.nih.gov/pubmed/18171228>.

Vergano, Dan. “Anthrax case not closed: Panel reviews Bruce Ivins, mail probe – USATODAY.com.” News, Travel, Weather, Entertainment, Sports, Technology, U.S. & World – USATODAY.com. Web. 27 Oct. 2009. <http://www.usatoday.com/tech/science/2009-08-03-anthrax-ivins_N.htm>.

Weapons of Mass Destruction Act of 2009, S. 1649, 111 Cong., United States Senate Committee on Homeland Security and Government Affairs: Press 3 (2009). Print.

Welcome to NDPC. Web. 3 Dec. 2009. <http://www.ndpc.us/>.

Wright, Robert.”Why a real war on terrorism brings out the best in us. (8) – By Robert Wright -.” Slate Magazine. Web. 18 Sep. 2009. <http://www.slate.com/id/2070210/entry/2070799/>.

Appendix 1 – Population Density Map of the United States

Figure 1″USA 2000 Population Density.” Map. Boston University School of Theology Library Archives. Boston University, 10 Sept. 2007. Web. 14 Oct. 2009. <http://sthweb.bu.edu/archives/index.php?option=com_awiki&view=mediawiki&article=File:USA-2000-population-density.gif>.

Description: 2000 U.S. population density in persons per sq. mile (contiguous U.S. only). Averaged on a per-county basis.

Legend, light to dark (white to dark blue):

  • 0-1 (white)
  • 1-4 (yellow)
  • 5-9 (yellow-green)
  • 10-24 (green)
  • 25-49 (teal)
  • 50-99 (dark teal)
  • 100-249 (blue)
  • 250-66,995 (dark blue)

Appendix 2 – Timelines


[1] “Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Congress must act to prevent WMD attack.” Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Home. Web. 8 Oct. 2009. <http://www.preventwmd.gov/congress_must_act_to_prevent_wmd_attack/>.

[2] “Biological weapons – definition of Biological weapons in the Medical dictionary – by the Free Online , Thesaurus and Encyclopedia.” Medical Dictionary. Web. 15 Sept. 2009. <http://medical-dictionary.thefreedictionary.com/Biological+weapons>.

[3] “NOVA Online | Bioterror | Global Guide to Bioweapons (Flash).” PBS. Web. 17 Sep. 2009. <http://www.pbs.org/wgbh/nova/bioterror/glob_flash.html>.

[4] “Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Congress must act to prevent WMD attack.” Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Home. Web. 8 Oct. 2009. <http://www.preventwmd.gov/congress_must_act_to_prevent_wmd_attack/>.

[5] “Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Congress must act to prevent WMD attack.” Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Home. Web. 8 Oct. 2009. <http://www.preventwmd.gov/congress_must_act_to_prevent_wmd_attack/>.

[6] “Introduction of the WMD Prevention and Preparedness Act of 2009 (S.1649).” Federation of American Scientists. Web. 13 Sep. 2009. <http://www.fas.org/irp/congress/2009_cr/s1649.html>.

[7] Graham, Bob, and Jim Talent. “Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism :: Bioterrorism: Redefining Prevention.” Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism :: Home. Web. 18 Sept. 2009. <http://www.preventwmd.gov/6_09/>.

[8] Weapons of Mass Destruction Act of 2009, S. 1649, 111 Cong., United States Senate Committee on Homeland Security and Government Affairs: Press 3 (2009). Print.

[9]“Introduction of the WMD Prevention and Preparedness Act of 2009 (S.1649).” Federation of American Scientists. Web. 13 Sep. 2009. <http://www.fas.org/irp/congress/2009_cr/s1649.html>.

[10] Weapons of Mass Destruction Act of 2009, S. 1649, 111 Cong., United States Senate Committee on Homeland Security and Government Affairs: Press 3 (2009). Print.

[11] Graham, Bob, and Jim Talent. “Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism :: Bioterrorism: Redefining Prevention.” Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism :: Home. Web. 18 Sept. 2009. <http://www.preventwmd.gov/6_09/>.

[12] Weapons of Mass Destruction Act of 2009, S. 1649, 111 Cong., United States Senate Committee on Homeland Security and Government Affairs: Press 3 (2009). Print.

[13] Weapons of Mass Destruction Act of 2009, S. 1649, 111 Cong., United States Senate Committee on Homeland Security and Government Affairs: Press 3 (2009). Print.

[14] “ASM Comments on the Weapons of Mass Destruction Prevention and Preparedness Act of 2009.” Microbiology — The American Society For Microbiology. Web. 5 Oct. 2009. <http://www.asm.org/index.php?option=com_content&view=article&id=91066&title=ASM+Comments+on+the+Weapons+of+Mass+Destruction+Prevention+and+Preparedness+Act+of+2009&Itemid=349>.

[15] “ASM Comments on the Weapons of Mass Destruction Prevention and Preparedness Act of 2009.” Microbiology — The American Society For Microbiology. Web. 5 Oct. 2009. <http://www.asm.org/index.php?option=com_content&view=article&id=91066&title=ASM+Comments+on+the+Weapons+of+Mass+Destruction+Prevention+and+Preparedness+Act+of+2009&Itemid=349>.

[16] Matishak, Martin. “NTI: Global Security Newswire – Group Warns Biosecurity Bill

Could Burden Scientific Research.” NTI – Global Security Newswire. 19 Nov. 2009. Web. 5 Dec. 2009. <http://www.globalsecuritynewswire.org/gsn/nw_20091119_7367.php>.

[17] “Canada to build bioweapons lab in former Soviet Union.” The Jane Burgermeister website – investigating the swine flu pandemic. Web. 10 Nov. 2009.

[18] “Canada to build bioweapons lab in former Soviet Union.” The Jane Burgermeister website – investigating the swine flu pandemic. Web. 10 Nov. 2009. <http://www.theflucase.com/index.php?option=com_content&view=article&id=387:canada-to-build-bioweapons-lab-in-former-soviet-union&catid=1:latest-news&Itemid=64%E2%8C%A9=en>.

[19] Fischer, Dr. Julie. “Interview with Dr. Fischer.” Personal interview. 30 Oct. 2009.

[20] Responsible Research with Biological Select Agents and Toxins. Washington: The National Academies, 2009. Print.

[21] Responsible Research with Biological Select Agents and Toxins. Washington: The National Academies, 2009. Print.

[22] Responsible Research with Biological Select Agents and Toxins. Washington: The National Academies, 2009. Print.

[23] Responsible Research with Biological Select Agents and Toxins. Washington: The National Academies, 2009. Print.

[24] Responsible Research with Biological Select Agents and Toxins. Washington: The National Academies, 2009. Print.

[25] United States of America. National Secutiy Council. Executive Office of the President. National Strategy for Countering Biological Threats. National Security Council, 9 Dec. 2009. Web. 9Dec. 2009. <http://www.whitehouse.gov/sites/default/files/National_Strategy_for_Countering_BioThreats.pdf>.

[26] “Preventing Biological Weapons Proliferation and Bioterrorism.” U.S. Department of State. Web. 10 Dec., 2009. <http://www.state.gov/t/us/133335.htm#>.

[27] United States of America. National Secutiy Council. Executive Office of the President. National Strategy for Countering Biological Threats. National Security Council, 9 Dec. 2009. Web. 9 Dec. 2009. <http://www.whitehouse.gov/sites/default/files/National_Strategy_for_Countering_BioThreats.pdf>.

[28] Eisner, Peter, and Delthia Ricks. “Experts divided on odds of germ attack — chicagotribune.com.” Chicago Tribune breaking news, sports, weather and traffic in Chicago – chicagotribune.com. 13 Sept. 2001. Web. 28 Sept. 2009. <http://www.chicagotribune.com/news/nationworld/chi-0109130352sep13,0,4909373.story>.

[29] Cieslak, Theodore J., and Edward M. Eitzen. “Clinical and Epidemiologic Principles of Anthrax.” Centers for Disease Control and Prevention. Web. 2 Nov. 2009. <http://www.cdc.gov/ncidod/EID/vol5no4/cieslak.htm>.

[30] Geddes, Alasdair. “Infection in the twenty-first century: predictions and postulates — Geddes 46 (6): 873 — Journal of Antimicrobial Chemotherapy.” Oxford Journals | Medicine | Journal of Antimicrobial Chemotherapy. 1999. Web. 26 Oct. 2009. <http://jac.oxfordjournals.org/cgi/content/full/46/6/873>.

[31] “HowStuffWorks “How Anthrax Works”” Howstuffworks “Science” Web. 24 Sep. 2009. <http://science.howstuffworks.com/anthrax.htm>.

[32] “Anthrax.” Manbir Online … for Health & Fitness. Web. 25 Sep. 2009. <http://www.manbir-online.com/diseases/anthrax-2.htm>.

[33] “ASA Newsletter – Anthrax Toxin.” ASA Inc – Topics In Chemical And Biological Warfare And Bio Terrorism. Web. 2 Oct. 2009. <http://www.asanltr.com/newsletter/03-3/articles/Anthrax.htm>.

[34] “HowStuffWorks “How Anthrax Works”” Howstuffworks “Science” Web. 24 Sep. 2009. <http://science.howstuffworks.com/anthrax.htm>.

[35] “FDA Approves First Blood Test for Anthrax; Boston Based Company Test Shown to be Accurate for Anthrax Diagnosis. – Free Online Library.” News, Magazines, Newspapers, Journals, Reference Articles and Classic Books – Free Online Library. Web. 3 Dec. 2009.

[36] “Inhalation Anthrax.”Medline Plus Web. 2 Dec. 2009. <http://www.nlm.nih.gov/medlineplus/ency/article/000641.htm.>

[37] “HowStuffWorks “How Anthrax Works”” Howstuffworks “Science” Web. 24 Sep. 2009. <http://science.howstuffworks.com/anthrax.htm>.

[38] “Analysis of the US anthrax cases.” Analyzing The Anthrax Attacks – 2009 edition. Web. 22 Sep. 2009. <http://www.anthraxinvestigation.com/index.html#refining>.

[39] “Analysis of the US anthrax cases.” Analyzing The Anthrax Attacks – 2009 edition. Web. 22 Sep. 2009. <http://www.anthraxinvestigation.com/index.html#refining>.

[40] Takahashi H, Keim P, Kaufmann AF, Keys C, Smith KL, Taniguchi K, et al. Bacillus anthracis incident, Kameido, Tokyo, 1993. Emerg Infect Dis [serial online] 2004 Jan [date cited]. Available <http://www.cdc.gov/ncidod/EID/vol10no1/03-0238.htm>

[41] “The Case Against Bruce Ivins – washingtonpost.com.” Washingtonpost.com – nation, world, technology and Washington area news and headlines. Web. 22 Oct. 2009. <http://www.washingtonpost.com/wp-dyn/content/article/2008/08/06/AR2008080602794.html>.

[42] “American Anthrax Outbreak of 2001.” UCLA Department of Epidemiology: School of Public Health. 28, Oct.2009.

<http://www.ph.ucla.edu/epi/bioter/detect/antdetect_list.html.>

[43] Kosal, Margaret E., Terron, Ann, and Lange, Katherine. 2009. Bioterrorism Deterrence:

the Role of Public Health in Security. Atlanta, Georgia: Sam Nunn School of International Affairs Publications.(PDF document downloaded 21 Nov 2009)

[44]“Nuclear Deterrence, Missile Defenses and Global Instability, by David Krieger, April 2001.” Nuclear Age Peace Foundation. Web. 1 Nov. 2009. <http://www.wagingpeace.org/articles/2001/04/00_krieger_nuclear-deterrence.htm>.

[45] “Nuclear Deterrence, Missile Defenses and Global Instability, by David Krieger, April 2001.” Nuclear Age Peace Foundation. Web. 1 Nov. 2009. <http://www.wagingpeace.org/articles/2001/04/00_krieger_nuclear-deterrence.htm>.

[46] Wright, Robert.”Why a real war on terrorism brings out the best in us. (8) – By Robert Wright -.” Slate Magazine. Web. 18 Sep. 2009. <http://www.slate.com/id/2070210/entry/2070799/>.

[47] Kleiman, Mark, and Beau Kilmer. The Dynamics of Deterrence. Publication. University of California in Los Angeles, 15 June 2009. Web. 25 Oct. 2009. <http://www.spa.ucla.edu/faculty/kleiman/Dynamics%20of%20Deterrence%20PNAS%202009[1].pdf>.

[48]Kosal, Margaret E., Terron, Ann, and Lange, Katherine. 2009. Bioterrorism Deterrence:

the Role of Public Health in Security. Atlanta, Georgia: Sam Nunn School of International Affairs Publications.(PDF document downloaded 21 Nov 2009)

[49] “CDC | Strategic National Stockpile.” CDC Emergency Preparedness & Response Site. Web. 5 Oct. 2009. <http://www.bt.cdc.gov/stockpile/>.

[50] “CDC | Strategic National Stockpile.” CDC Emergency Preparedness & Response Site. Web. 5 Oct. 2009. <http://www.bt.cdc.gov/stockpile/>.

[51]“CDC | Strategic National Stockpile.” CDC Emergency Preparedness & Response Site. Web. 5 Oct. 2009. <http://www.bt.cdc.gov/stockpile/>.

[52] “Strategic National Stockpile | NACCHO.” National Connection for Local Public Health | NACCHO. Web. 23 Oct. 2009. <http://www.naccho.org/topics/emergency/SNS/>.

[53] “Strategic National Stockpile | NACCHO.” National Connection for Local Public Health | NACCHO. Web. 23 Oct. 2009. <http://www.naccho.org/topics/emergency/SNS/>.

[54] “Strategic National Stockpile | NACCHO.” National Connection for Local Public Health | NACCHO. Web. 23 Oct. 2009. <http://www.naccho.org/topics/emergency/SNS/>.

[55] “Strategic National Stockpile | NACCHO.” National Connection for Local Public Health | NACCHO. Web. 23 Oct. 2009. <http://www.naccho.org/topics/emergency/SNS/>.

[56] “CIDRAP HHS evaluates proposals for new anthrax vaccine.” CIDRAP Center for Infectious Disease Research and Policy. Web. 12 Nov. 2009. <http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/aug1208vaccine-jw.html>.

[57] “Anthrax Vaccine Immunization Program.” The Official DoD Anthrax Information Web Site. Web. 4 Nov. 2009. <http://www.anthrax.osd.mil/>.

[58] “Anthrax Vaccine Immunization Program.” The Official DoD Anthrax Information Web Site. Web. 4 Nov. 2009. <http://www.anthrax.osd.mil/>.

[59]“Emergent BioSolutions-BioThrax.” Emergent Biosolutions. Web. 3 Oct. 2009. <http://www.emergentbiosolutions.com/html/biothrax.aspx>.

[60] “Anthrax Vaccine Immunization Program.” The Official DoD Anthrax Information Web Site. Web. 4 Nov. 2009. <http://www.anthrax.osd.mil/>.

[61]“Is new always better than old?: The development of… [Hum Vaccin. 2009] – PubMed result.” National Center for Biotechnology Information. Web. 27 Oct. 2009. <http://www.ncbi.nlm.nih.gov/pubmed/19786839>.

[62] “Emergent BioSolutions-BioThrax.” Emergent Biosolutions. Web. 3 Oct. 2009. <http://www.emergentbiosolutions.com/html/biothrax.aspx>.

[63] “Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Congress must act to prevent WMD attack.” Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism: Home. Web. 8 Oct. 2009. <http://www.preventwmd.gov/congress_must_act_to_prevent_wmd_attack>.

[64] “USA 2000 Population Density.” Map. Boston University School of Theology Library Archives. Boston University, 10 Sept. 2007. Web. 14 Oct. 2009. <http://sthweb.bu.edu/archives/index.php?option=com_awiki&view=mediawiki&article=File:USA-2000-population-density.gif>.

[65] “Use of Anthrax Vaccine in the United States.” Centers for Disease Control and Prevention. 15 Dec. 2000. Web. 25 Oct. 2009. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm>.

[66] “Use of Anthrax Vaccine in the United States.” Centers for Disease Control and Prevention. 15 Dec. 2000. Web. 25 Oct. 2009. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm>.

[67] “Use of Anthrax Vaccine in the United States.” Centers for Disease Control and Prevention. 15 Dec. 2000. Web. 25 Oct. 2009. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm>.

[68] “Anthrax.” Manbir Online … for Health & Fitness. Web. 25 Sep. 2009. <http://www.manbir-online.com/diseases/anthrax-2.htm>.

[69] “Inhalation Anthrax.”Medline Plus Web. 2 Dec. 2009. <http://www.nlm.nih.gov/medlineplus/ency/article/000641.htm.>

[70] Welcome to NDPC. Web. 3 Dec. 2009. <http://www.ndpc.us/>

[71] “Homeland Security Training Program homepage.” Wyoming Law Enforcement Academy. Web. 8 Dec. 2009. <http://www.wleacademy.com/HLS/index.htm>.

[72] “Homeland Security Training Program homepage.” Wyoming Law Enforcement Academy. Web. 8 Dec. 2009. <http://www.wleacademy.com/HLS/index.htm>.

[73]McFee, Robin B. 2004. Bioterrorism and weapons of mass destruction 2004:

Physicians as first responders. Wynnewood, PA: American Academy of Clinical Toxicology.(PDF document downloaded 3 Dec 2009)

[74] “FDA Approves First Blood Test for Anthrax; Boston Based Company Test Shown to be Accurate for Anthrax Diagnosis. – Free Online Library.” News, Magazines, Newspapers, Journals, Reference Articles and Classic Books – Free Online Library. Web. 3 Dec. 2009. <http://www.thefreelibrary.com/FDA+Approves+First+Blood+Test+for+Anthrax;+Boston+Based+Company+Test+…-a0117874737>.

[75] “Use of Anthrax Vaccine in the United States.” Centers for Disease Control and Prevention. 15 Dec. 2000. Web. 25 Oct. 2009. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm>.

[76] “Use of Anthrax Vaccine in the United States.” Centers for Disease Control and Prevention. 15 Dec. 2000. Web. 25 Oct. 2009. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm>.\

[77] “Use of Anthrax Vaccine in the United States.” Centers for Disease Control and Prevention. 15 Dec. 2000. Web. 25 Oct. 2009. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm>.

[78] “Emergent BioSolutions-BioThrax.” Emergent Biosolutions. Web. 3 Oct. 2009. <http://www.emergentbiosolutions.com/html/biothrax.aspx>.

[79] “Report: Smallpox Program Too Slow to Evaluate.” Vaccination News. Web. 13 Dec. 2009. <http://www.vaccinationnews.com/DailyNews/2003/May/03/ReportSmallpox3.htm>.

[80] Fritsky, Lauren. “Why I Won’t Get the H1N1 Vaccine -.” Lemondrop.com. Web. 5 Dec. 2009. <http://www.lemondrop.com/2009/11/05/why-i-wont-get-the-h1n1-vaccine/>.

[81] “HHS Cancels RFP for rPA Procurement and Modifies Their Approach in Favor of BAA for Development of rPA Vaccines: Business Wire Business News – MSN Money.” News: Business, Financial and Investing News – MSN Money. Web. 13 Dec. 2009. <http://news.moneycentral.msn.com/provider/providerarticle.aspx?feed=BW&date=20091207&id=10844410>.

[82] “Emergent BioSolutions-BioThrax.” Emergent Biosolutions. Web. 3 Oct. 2009. <http://www.emergentbiosolutions.com/html/biothrax.aspx>.

[83] “Profile of Janet Napolitano, Homeland Security Director for President Obama – Janet Napolitano Biography.” Liberal & Progressive Politics & Perspectives. Web. 02 Dec. 2009. <http://usliberals.about.com/od/stategovernors/p/Napolitano.htm>.

[84] DHS | Secretary Janet Napolitano.” Department of Homeland Security | Preserving our Freedoms, Protecting America. Web. 01 Dec. 2009. <http://www.dhs.gov/xabout/structure/gc_1232568253959.shtm>.

Security, Security Projects


Leave a Reply