In October 2001, anthrax-laden letters were sent through the mail to Florida, Washington and New York. Almost overnight domestic bioterrorism went from an unlikely prospect to a deadly reality. Twenty-two people were infected and five died. Thousands lined up to receive antibiotics, mail delivery ground to a halt in much of the East and some of the most prominent U.S. government institutions were shut down for weeks.
Unfortunately, the threat of bioterrorism is increasing worldwide. At least 11 and as many as 17 nations-including Iraq and other members of what President Bush calls the "axis of evil"-already have offensive biological weapons programs. Experts believe these countries' arsenals are stocked with agents that can be as devastating as nuclear weapons. Osama bin Laden and his Al Qaeda network also have attempted to acquire, develop and turn into weapons biological agents.
The U.S. must be prepared for the eventuality of another bioterror attack. And hospitals must play a key role in this endeavor. Before Sept. 11, 2001, only one in five hospitals had a response plan specifically tailored for biochemical attacks. Additionally, fewer than half of hospitals had adequate decontamination units, and fewer than one-third had an antidote for chemical agents such as nerve gas. Clearly we had to and must still do better.
In one recent survey of rural and urban emergency departments in the mid-Atlantic states, none of the rural hospital respondents reported being prepared at all for bioterrorism, and most of the urban respondents felt only partially prepared. None of the rural sites and only half of the urban sites had decontamination stations that could accommodate 10 to 15 patients at a time.
Although 87% of the hospitals could handle 10 to 50 noncontaminated casualties at once, only 10% could manage 50 to 100 patients. There was a universal need for training in handling casualties of weapons of mass destruction, but lack of time, available courses, computer access and funding emerged as barriers to this type of training. Although 10% conducted chemical disaster drills, only 3% conducted biological disaster drills. Only 4% of the respondents were prepared, or even knew about, the potential for secondary terrorist attacks on healthcare workers. However, recent events have shown that the potential for secondary attacks on emergency medical services units and hospitals is real.
The U.S. government is taking aggressive action to reduce our vulnerability to biological weapons. Legislation that I co-sponsored and President Bush signed will help strengthen our public health system at the local, state and national levels; train first responders; invest billions in research and development; build stockpiles of vaccines and treatments; and increase protections for our food and water supplies.
Also approved this year was $135 million specifically targeted to improve hospitals' readiness. And Bush's 2003 budget proposes to invest an additional $591 million in hospital readiness through hospital infrastructure improvements, training exercises and comprehensive regional planning. These steps not only will help better prepare our communities for future bioterrorist attacks but will reduce the likelihood of an attack in the first place.
Since Sept. 11, hospitals have been working hard to upgrade existing readiness plans to meet the new terrorist threats. As of February, two-thirds of hospitals had already developed strategies to include bioterrorism response in existing disaster plans. The remaining one-third had plans to do so within months. Hospitals have increased coordination with other community front-line response organizations, such as emergency medical units, fire, police and public health officials. Additionally, hospitals have expanded training and education for nurses, physicians and other caregivers, so they can better recognize and report symptoms of the most common biological and chemical agents. Hospitals also have developed procedures for reporting unusual trends of symptoms or diagnoses to public health authorities. Clearly our nation's nurses, doctors and healthcare workers are devoted to meeting their community's needs.
Biological weapons are the ideal instruments of terror. These deadly microorganisms can be made quickly, inexpensively and with little expertise. Many cannot be seen, smelled, heard or tasted. All that is required to transport them is a small vial that can fit easily in someone's pocket.
And it takes hours, days, even weeks for the signs of an attack to appear, allowing a perpetrator to escape undetected. These unique qualities of biological weapons make them more desirable to a terrorist or a serial mass murderer such as Saddam Hussein than any other weapon.
We must continue improving our ability to prepare for and respond to bioterrorist attacks. We must devote more time and resources to developing appropriate response capabilities, including increasing our ability to detect specific outbreaks through better surveillance, communicate to others about a pending emergency, training our healthcare workforce-including mental health workers-and creating appropriate disaster response with all of the necessary components.
During this time of increasing threats at home and abroad, we owe the American people the greatest possible preparedness.
Bill Frist, M.D., is a Republican U.S. senator from Tennessee and a heart transplant surgeon.