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Preparing for the unthinkable
Boston considers a bioterrorist attack -- and takes precautions

By Brian Fitzgerald

If terrorists unleashed a strain of smallpox on the United States, would this country be prepared? Unfortunately, Americans are no longer vaccinated against the virus. "Most people in the United States do not have immunity to smallpox," says Anita Barry, director of the Boston Public Health Commission's Department of Communicable Disease Control.

	Anita Barry Photo by Albert L'Etoile

Barry's department is spearheading Boston's Bioterrorism Surveillance Project, which is readying the response from hospitals and public safety agencies should such a scenario happen in the city. Barry (SPH'88) will address the issue during a talk on campus on October 14.

In January, a blue-ribbon U.S. commission reported that an attack using chemical or biological agents was likely in the United States in the next 25 years. That finding was proven to be all the more cogent after the terrorist attacks in New York City and Washington, D.C., on September 11.

Responding to the need to coordinate a defense against bioterrorism -- whether it be an outbreak of smallpox, anthrax, or pneumonic plague -- the U.S. Centers for Disease Control and Prevention (CDC) have been strengthening communications systems that connect emergency room doctors, laboratory specialists, the FBI, fire departments, and the police.

"We've received funding from the CDC to develop a surveillance network that will allow us to identify problems more quickly," says Barry. "We will be able to make health-care providers aware of unusual syndromes and coordinate services in the event of a bioterrorist attack." The Bioterrorism Surveillance Project has already undergone several "tabletop" exercises that have involved representatives from Boston area community health departments, hospitals, and schools, as well as officials from the Federal Emergency Management Agency and the Massachusetts Emergency Management Agency.

"Public health officials clearly have an important role if something like this happens," says Barry, who received an SPH alumni award for distinguished service in 1993. "It's the role of public health agencies to keep track of hospital volume and to coordinate services as the emergency is unfolding. Health-care providers will look to us for guidelines and as a major source of public information. We have to figure out where to triage people before they're taken to hospitals. And hospitals will look to us for supply needs."

At present, hospitals are not equipped with enough smallpox vaccine. The United States has 15.4 million doses, enough for only 7 percent of the population. "Routine vaccinations against smallpox stopped in 1972, and it was declared eradicated in 1977," says Barry. "And in the remaining vaccination stores, potency is a question." Last year, the U.S. government awarded a $343 million contract to Acambis, Inc., of Cambridge, Mass., and Cambridge, England, to produce 40 million doses of the vaccine -- the first time in three decades that a new vaccine will be produced. However, deliveries aren't scheduled to begin until 2004.

The use of biological weapons is nothing new. In 1346, the Tartars catapulted plague-infected cadavers over their enemies' city walls. A few years ago it was revealed that during the Cold War the Soviet Union stockpiled anthrax. These stockpiles remain in Russia. North Korea is also developing biological weapons. "We know that Saddam Hussein had weaponized anthrax even before the Gulf War," Barry points out. It is unclear what has happened to these weapons in Iraq, but if fired on a large city, one warhead containing enough anthrax toxin could kill hundreds of thousands.

Researchers at the Army Medical Research Institute of Infectious Diseases at Fort Detrick, in Frederick, Md., are developing a new anthrax vaccine. Because anthrax kills its victims over several days, concluded the Commission on National Security last year, it is crucial for local health establishments to be able to make diagnoses and administer vaccines quickly.

"A chemical or a biological terrorist attack is something we are convinced we are more likely to see in the next 10 to 20 years than not," said former New Hampshire Senator Warren Rudman, the commission's cochairman.

Barry says that the responsibility of public health officials "is to be as prepared as we can. Fortunately, there has been some push federally to help us take those necessary steps."

For information on Barry's talk, call 617-638-4640.

21 September 2001
Boston University
Office of University Relations