18 pg paper

ANALYSIS OF THE BIOTERRORISM ACT OF 2002

Criminal Justice Policy and Administration

CCJ 415

submitted by ___________________

Professors Richard B. Groskin and David Abeling-Judge

December , 20XX

Abstract

After the September 11 attacks and the 2001 anthrax attacks, a surge in bioterrorism research, planning, and preparation occurred to improve on the weaknesses displayed in the United States’ response to these attacks. One major piece of legislation that occurred was the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. This act addressed the lack of legislation, procedures, and policies for the federal government to follow during a bioterrorism attack. Even though the Bioterrorism Act did an excellent job of covering a variety of issues, there are still areas not covered in the act such as improving the failure in communication during the anthrax attack. A proposal is recommended to fix these problems which include the current leadership structure of the governmental organizations involved during a bioterrorism attack and communication abilities between the federal, state, and local governments. Finally, a strategic plan is included which details the best way to implement this proposal.

Table of Contents

Introduction/Statement of the Problem……………………………………………………………4

Policy Analysis……………………………………………………………………………………5

Program and Management Review………………………………………………………………12

Proposal…………………………………………………………………………………………..19

Action Decision Document………………………………………………………………………23

Strategic Plan…………………………………………………………………………………….26

References………………………………………………………………………………………..35

Introduction

According to the Center for Disease Control, “a bioterrorism attack is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants.”[footnoteRef:1] Even though bioterrorist attacks are not as prevalent as other forms of terrorist attacks, they are still extremely dangerous and can cause a large number of serious injuries and fatalities. Terrorist may use biological agents because “they can be extremely difficult to detect and do not cause illness for several hours to several days,”[footnoteRef:2] which can then spread and develop larger amounts of cases, impacting more groups of individuals. An important part of combating bioterrorism is to understand how exactly prevalent the issue is. Worldwide, there has been 384 biological and chemical attacks since 1970. Within the 384, 48 of these attacks were in the United States. There was a known total of 9 fatalities and 841 injured people from the 48 attacks. After the Bioterrorism Act of 2002 was implemented, there were 13 bioterrorism attacks in the United States between 2003 and 2015.[footnoteRef:3] [1: Centers for Disease Control and Prevention 2006] [2: Centers for Disease Control and Prevention 2006] [3: Global Terrorism Database 2017]

Background Information on Defining Bioterrorism Agents

Within the concept of bioterrorism, it is important to understand how exactly the CDC defines the specific agents like anthrax into three separate categories in order to understand the severity and threat each agent poses. Category A includes high priority agents due to the ease of transmission from person to person, the possibility of higher death rates, and the special action needed from public health preparedness. Category B includes agents that are the second highest priority due to the moderately easy way to spread it, the moderate illness rates and low date rates, and the specific enhancements required of the CDC’s laboratory capacity and enhanced disease monitoring. Category C includes the third highest priority agents which includes emerging pathogens that could be engineered for mass spread due to the availability of them, the ease of production, and the possibility for high morbidity and mortality rates and major health impact.[footnoteRef:4] [4: Centers for Disease Control and Prevention 2006]

Problem Addressed in the Paper

The most current legislation focused on improving programs to prevent bioterrorism in the United States is the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, also known as the Bioterrorism Act of 2002. Based on the Bioterrorism Act of 2002, how can the United States improve current policies and programs when preventing, researching, and responding to bioterrorism?

Reasons for the Bioterrorism Act of 2002

After the 9/11 attacks and the anthrax attacks of 2001, the United States discovered that they did not have the proper legislation, procedures, and policies needed to address bioterrorism attacks. The first reason for the creation of the Bioterrorism Act was based on the absence of legislation or federal statutes that focused specifically on federal bioterrorism preparedness and response activities. This resulted in a lack of focused funding for programs whose goals focused on the prevention of bioterrorism.[footnoteRef:5] The second reason was based on the flaw that the government agencies with the most public health expertise were not in charge when attempting to prepare for a bioterrorism attack. The third reason was based on the disorganization and the lack of knowledge from the federal organizations on how to properly respond to the anthrax attacks. For example, a report by the U.S. Accountability Office analyzed the CDC’s response during the anthrax attacks. The report details how the CDC cannot lead in response to a bioterrorism attack but can instead provide a key role in supporting state and local responders, the CDC had major difficulties when communicating with governmental agencies and the general public during the attacks, and the CDC did not have the necessary medical expertise to understand the anthrax attacks.[footnoteRef:6] The fourth reason was based on the lack of registration of dangerous chemical and biological agents to the federal government. During the anthrax attacks, the CDC only regulated the transfer of dangerous biological agents but did not require individuals and laboratories to register the biological agents they had.[footnoteRef:7] [5: Kemper 2005] [6: Kemper 2005] [7: Kemper 2005]

Background Information on the Bioterrorism Act of 2002

The Bioterrorism Act of 2002, is a large, complex piece of legislation which includes five titles focused on improving the ability of the United States to prevent, prepare for, and respond to bioterrorism and other public health emergencies. The policy is written in five different titles which includes the major problem that each part of the legislation is intending on addressing. Title I is focused on improving national preparedness for bioterrorism and other public health emergencies. Title II is focused on enhancing controls on dangerous biological agents and toxins. Title III is focused on protecting the safety and security of the food and drug supply for the United States. Title IV is focused on protecting the security and safety of drinking water. Title V includes additional provisions not found in other sections of the legislation. For this paper, the focus will include Title I and Title II since these sections of the Act focus on government agencies and the overall improvement of the bioterrorism policies. Titles III, IV, and V are all equally important but mainly focus on the improvement of the food, drug, and water supplies instead of establishing and improving specific government functions.

Intended Impact and Goals of Title I

Within Title I, there are several areas that the policy intends to impact which includes improving the national preparedness and response planning, coordinating, and reporting systems, maintaining and improving the strategic national stockpile, improving the current countermeasure research and development for bioterrorism attacks, improving the state, local, and hospital preparedness for and response to bioterrorism and other public health emergencies, and analyzing current emergency authority services when addressing a bioterrorism attack.[footnoteRef:8] The goals of Title I include improving the ability of Centers for Disease and Control and Prevention to address bioterrorism attacks, analyzing current communication abilities between public health agencies, improving the education of health care personnel, researching more about antimicrobial resistance and how this affects the way health care professionals treat strains. More goals include creating grants based on shortages of certain health care professionals, maintaining the strategic national stockpile which consists of antibiotics, vaccines, chemical antidotes, antitoxins, and other pharmaceuticals and medical supplies used to address bioterrorist acts, evaluating new technologies regarding bioterrorism attacks and other public health emergencies, and making potassium iodide tablets available to state and local governments through the national stockpile to individuals living near a nuclear power plant. Also, the Act focused on giving grants to help improve state, local, and hospital preparedness and response to bioterrorism attacks, improving the communicable disease quarantine provisions, analyzing the current state public emergency announcement plan, expanding research on worker health and safety and improving the emergency preparedness of Department of Veterans Affairs. [8: Public Health Security and Bioterrorism Preparedness and Response Act of 2002]

Intended Impact and Goals of Title II

Within Title II, there are several areas that the policy intends to impact which include improving controls of biological agents and toxins for the Department of Health and Human Services, improving controls of biological agents and toxins for the Department of Agriculture, improving interagency coordination regarding overlap agents and toxins, and establishing and improving current criminal penalties regarding certain biological agents and toxins.[footnoteRef:9] The goals of Title II include creating a regulation of certain biological agents and toxins and addressing how the Department of Health and Human Services can implement these regulations and creating a regulation of certain biological agents and toxins and addressing how the Department of Agriculture can implement these regulations. [9: Public Health Security and Bioterrorism Preparedness and Response Act of 2002]

Effectiveness of the Bioterrorism Act of 2002

The policy outcomes that were intended were to improve national preparedness for bioterrorism and other public health emergencies, enhance controls on dangerous biological agents and toxins, protect the safety and security of the food and drug supply for the United States, and protect the security and safety of drinking water.

Effectiveness of Title I

Overall, title I vastly improved and clarified the roles for federal, state, and local governments when responding to a bioterrorism attack. Title I gives the majority of the responsibility to local governments when dealing with a bioterrorism attack since they are the mostly likely to detect and respond to the release of a biological agent. State governments are the next responders and rely heavily on police departments and other first responders to help minimize the impact of the terrorist attack. The federal government is mainly in charge of planning for a bioterrorism attack through preparing the National Preparedness Plan and will help when the national security is compromised due to bioterrorism attacks on public health.[footnoteRef:10] Based on these relationships between the federal, state, and local governments, some confusion has occurred over understanding exactly what each level of government is responsible for and which level of government is ultimately responsible for leading the response of a bioterrorism attack. This confusion is an important problem that needs to be addressed since a delayed response time to a bioterrorism attack due to misunderstandings and unclear leadership could result in more injuries and fatalities to individuals. The obvious choice for leadership would be the federal government such as the Department of Homeland Security due to its resources and knowledge of bioterrorism but there are still issues that need to be addressed due to fragmentation and unclear relationships with the federal organizations that would be responsible for helping during a bioterrorism attack. This fragmentation was best highlighted during the anthrax attacks of 2001. Unfortunately, the Bioterrorism Act of 2002 was inadequate in addressing these issues. [10: Kemper 2005]

There are three major examples of fragmentation not addressed within the Bioterrorism Act of 2002. The first example is that there is no clear role outlined when the Assistant Secretary for Public Health and Emergency Preparedness (who is formally in charge when a bioterrorism attack occurs) interacts with the FBI (who is leading federal agency in charge during any terrorist attack). The second example is the Bioterrorism Act of 2002 does not clearly define the FBI and CDC’s relationship during a bioterrorist attack, which caused problems with the federal response during the 2001 anthrax attacks. Not defining this relationship allows “the FBI to spearhead the response to a bioterrorism attack and effectively “freeze-out” the CDC much in the same way as it did in 2001.”[footnoteRef:11] The third example focuses on the unified work group for all federal agencies that was established under the Bioterrorism Act that focuses on improving the United States’ response to bioterrorism. Unfortunately, the Bioterrorism Act does not require any reporting provisions for the group which results in “little incentive to generate hard and fast solutions to fragmentation problems.”[footnoteRef:12] [11: Kemper 2005] [12: Kemper 2005]

Another important part of Title I was the requirement for the CDC to improve their facilities. Congress provided the power and funding to the CDC to improve the general organization and to improve the security for their labs. The Act provides funding for “facilities and communication networks” but the act does not address, “the need for expanding the biodefense workforce at the CDC.”[footnoteRef:13] Without the expansion of the workforce, the CDC will be unable to complete the needed research in biological agents that is needed. [13: Kemper 2005]

Effectiveness of Title II

Within Title II, the Bioterrorism Act of 2002 establishes a complete regulation process for the possession and use of specific biological agents. With this regulation in place, the CDC can finally specify who has control of biological agents, where those agents are located, and why that entity or individual possesses that type of agent.[footnoteRef:14] In addition, health officials may be better able to determine whether a breach of laboratory security may endanger the surrounding community because information on the types of pathogens stored in particular labs will be readily available to the government. Before the Bioterrorism Act of 2002, the CDC had no record of which laboratories were conducting tests with biological agents, and a security breach would have probably gone undetected. [14: Kemper 2005]

One of the most important expansions of regulations under Title II focuses on a reporting requirement by the CDC. Within the Bioterrorism Act of 2002, an individual in possession of a select biological agent is required to notify federal, state, and local law enforcement agencies immediately if an agent is lost or stolen.[footnoteRef:15] This is an important update to the select agent regulations because it allows for an immediate response by law enforcement and allows public health authorities to known exactly what type of pathogen might be used in a bioterrorism attack. Knowing which agent might be used in the attack could lead to less fatalities and injuries since the public health authorities could start requesting help from the CDC to understand exactly what the specific agent is and what the best treatment and prevention methods would be to use. [15: Kemper 2005]

Other policies created to address bioterrorism

In general, the most recent legislation that is related to bioterrorism is usually a broad piece of legislation that is mainly focused on improving the health care system. For example, the main objective of the Pandemic and All-Hazards Preparedness Act of 2006 “is to improve the Nation’s public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural.”[footnoteRef:16] Essentially, the act is mainly focused on improving the ability of the public health sector to respond to emergencies that occurs. Within the act, a small portion is focused on improving the public health sector’s ability to respond to emergency situations caused by bioterrorist attacks. [16: Public Health Emergency 2014]

Organizations Involved in the Bioterrorism Act of 2002

There are many different organizations that try to address the bioterrorism problem. One of the strengths to the Bioterrorism Act of 2002 was tasking certain organizations like the CDC to have a larger leadership role in preventing bioterrorism. This has resulted in more organizations researching and developing technologies to combat bioterrorism. However, the more organizations involved without a strong, central leader to direct efforts, the less cohesion and directed initiates there are to focus on research in specific topic areas like the detection of ricin.

Introduction to the Program Review

Before the 9/11 attacks and the 2001 Anthrax attacks, there were many federal organizations that were responsible for different aspects of terrorism prevention and response. Once these attacks occurred, there were major flaws found within the existing system, including major flaws in accountability and understanding of how bioterrorism operates. After the Bioterrorism Act of 2002, five main federal organizations were tasked with improving bioterrorism research and defining what each organization is responsible for in case of another bioterrorism attack. These five federal organizations include the Department of Defense, Department of Justice, Department of Health and Human Services, Department of Veterans Affairs, and Department of Homeland Security. Even though Homeland Security was created after the Bioterrorism Act was passed, there were key sections that later transferred authority to Homeland Security. In the next sections, there will be an analysis of what each department is now responsible for and some of the major projects created to combat bioterrorism.

The Department of Defense Responsibilities

The Department of Defense plays a crucial role in supporting other federal departments with resources during a terrorist attack, especially bioterrorism attacks. The DOD is able to provide technical and personnel support to the DHS and state authorities during a declared biological or other terrorist attack. This support includes the U.S. Army's Medical Research Institute for Infectious Diseases (USAMRIID) Aeromedical Isolation Team and the U.S. Marine Corps Chemical and Biological Incident Response Force (CBIRF).[footnoteRef:17] [17: Carafano 2003]

The Department of Justice Responsibilities

Within the Department of Justice, the FBI has a critical role when addressing terrorist attacks. Even though the Assistant Secretary for Public Health and Emergency Preparedness is formally in charge when a bioterrorism attack occurs, the FBI is still the leading agency for federal crisis management at a terrorist scene for all types of terrorist attacks. This distinction was outlined in the Federal Response Plan. The Federal Response Plan was a significant project that was expanded due to requirements in the Bioterrorism Act of 2002.

The Department of Health and Human Services Responsibilities

The Department of Health and Human Services is influential of bioterrorism research and response since it houses key programs such as the CDC and FDA. HHS is the federal agency that handles public health responses to terrorist attacks and other emergencies. The Bioterrorism Act of 2002 expanded HHS’ powers and created the position Assistant Secretary for Public Health and Emergency Preparedness, which increased the responsibilities of the department when responding to a bioterrorism attack. One major development in the Bioterrorism Act was to allow HHS to provide assistance to state or local governments when dealing with a health emergency that is “of such a nature as to warrant Federal assistance.”[footnoteRef:18] [18: Carafano 2003]

Powers Given to the Newly Created Secretary Position

The Bioterrorism Act of 2002 gave the Secretary of HHS “broad statutory powers to respond to a public health crisis and is authorized to develop and take such actions as necessary to implement a plan to control infectious diseases.”[footnoteRef:19] The act also always the Secretary to create federal quarantines to prevent the spread of cholera, diphtheria, tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, and SARS. Also, when the United States is at war, the Secretary can “detain persons who are infected with a biological agent, are contagious, and pose a threat of infecting any member of the armed forces.”[footnoteRef:20] [19: Carafano 2003] [20: Carafano 2003]

Key Communication Efforts of the CDC

Within HHS, the CDC is one of the most powerful federal organizations available to help prevent, research, and respond to bioterrorism attacks. Within the department, a key role that the CDC focuses on during a bioterrorism attack is communicating between the numerous departments. The project created by the CDC to improve the communication between organizations was the Health Alert Network. The network transfers health alerts, disease data, treatment guidelines, and secure disease surveillance between the CDC and state and local officials located at the bioterrorism attack sites.[footnoteRef:21] The CDC used the network during the 2001 anthrax attacks to help coordinate and provide information to local officials when dealing with these attacks. Unfortunately, the system proved to be “only marginally effective as many local jurisdictions received incomplete data.”[footnoteRef:22] The Bioterrorism Act of 2002 tasked the CDC with improving their capabilities, including the ability to better communicate with state and local governments during a bioterrorism attack. The CDC is still working on the improvements but there has not been as much research on improving the Health Alert Network. Improving the communication efforts will help get information to state and local governments faster, resulting in less loss of life. [21: Carafano 2003] [22: Carafano 2003]

National Disaster Medical System

Another major project that was expanded due to the Bioterrorism Act of 2002 was the National Disaster Medical System. NDMS was a project created in 1984 by the HHS, VA, and DOD to “help care for causalities that occurred in a domestic disaster or an overseas conventional war.”[footnoteRef:23] However, the system transformed into focusing mainly on helping with domestic disasters but not with terrorist attacks. After the terrorist attacks of 2001, the NDMS mission was expanded to include medical response to terrorist attacks, as well as pre-staging for national security special events like political conventions. After the creation of the Bioterrorism Act of 2002, Congress statutorily created the National Medical System and transferred the control of the system from HHS to DHS.[footnoteRef:24] The NDMS components include deployable medical response teams, a patient evacuation system, and definitive hospital care. [23: Franco et al. 2007] [24: Public Health Security and Bioterrorism Preparedness and Response Act of 2002]

Department of Veterans Affairs

The VA was another department that was impacted by the Bioterrorism Act of 2002. The act required that the VA “participates in the National Disaster Medical System, works in collaboration with the States and other public or private entities to provide health services and health-related social services, and responds to the needs of victims of a public health emergency.”[footnoteRef:25] The VA also assigned preparedness and response functions to the nationwide system of hospitals and clinics operated by the VA. Due to the Bioterrorism Act of 2002, the VA created the Department of Veterans Affairs Emergency Preparedness Act of 2002 in order to help address the new requirements for the VA bioterrorism research and prevention. [25: VA Office of Inspector General 2006]

Department of Homeland Security Responsibilities

The Department of Homeland Security was created in response to the 9/11 attacks in order to oversee and coordinate the comprehensive national strategy to safeguard the country against terrorism.[footnoteRef:26] Homeland Security plays a key role in bioterrorism research and response. After the department was created, the responsibility of certain programs was transferred to Homeland Security. DHS has general oversight of the Strategic National Stockpile, while the CDC manages the daily operations. DHS oversees the Metropolitan Response System and the National Disaster Medical System including the national Disaster Medical Assistance Teams, Veterinary Medical Assistance Teams, and the Disaster Mortuary Support Teams. DHS took over the managing functions of the HHS’s Office of Emergency Preparedness. This office “manages and coordinates federal health, medical, and health-related social services for major emergencies and disasters.”[footnoteRef:27] Responsibility was transferred to DHS for the Department of Agriculture’s Plum Island Animal Disease Center, (research conducted on animal pathogens), and the Animal and Plant Health Inspection Service, (border inspections). Another department that DHS gained oversight was the Federal Emergency Management Agency. This agency was formerly independent but control was shifted to DHS since the agency handles bioterrorism threats and coordinates the federal response to terrorism attacks or other major disasters. In general, “FEMA manages national mitigation and disaster assistance programs, including coordinating the types and levels of support provided by all federal departments and agencies in the response to and recovery from a terrorist strike”[footnoteRef:28] [26: The Department of Homeland Security] [27: Carafano 2003] [28: Carafano 2003]

The best way to illustrate the flaws in the federal response to bioterrorism attacks is to analyze a case study to see how the Bioterrorism Act of 2002 improved on the weaknesses of the federal response and what currently still needs to be addressed. An analysis of the 2001 anthrax attacks will provide important insight to how the act fixed some of the issues that occurred during the attack and what issues have still not been addressed. The flaws discussed in this section are discussed in a report prepared by the Center for Strategic and International Studies and the Defense Threat Reduction Agency titled Lessons from the Anthrax Attacks: Implications for U.S. Bioterrorism Preparedness.

One major issue during the 2001 anthrax attacks was that a state of emergency was not declared in any of the states that had cases of anthrax like in Florida. As stated in the report, “The strain on resources that communities faced during the anthrax attacks evolved partially out of the fact that no local state of emergency was ever invoked and no national of emergency was ever declared.”[footnoteRef:29] If the state does not declare a state of emergency and formally request federal governmentally help, there is no way to get the resources and personnel needed to address a bioterrorism attack. This resulted in the Bioterrorism Act of 2002 giving authority to the Department of Health and Human Services to aid local and state governments if the department believes the specific emergency warrants federal involvement. This helps fix the issue of the state of emergency not being declared in the anthrax attacks since the federal government can now help provide resources, information, and personnel during a crisis without needing the state to ask for federal involvement. [29: Heyman, Achterberg, & Laszio 2002]

Another issue discussed was the confusion and lack of organization in the command structure by the federal government. The report discusses how the U.S. Capital Police operated the Senate crisis without an incident command structure until they hired an outside consultant to operate as the incident commander to coordinate all the federal agencies involved in the attack.[footnoteRef:30] Due to the time without this commander, “initial confusion prior to retaining the consultant about who was in charge and the roles, missions, and capabilities of each agency tended to slow the response.”[footnoteRef:31] Without a clear understanding of which agencies and individuals are in charge during a bioterrorism attack, the more confusion there is and more resources are wasted. [30: Heyman, Achterberg, & Laszio 2002] [31: Heyman, Achterberg, & Laszio 2002]

A different report by the United States General Accounting Office discussed more issues that occurred during the anthrax attack. The titled of the report was the Public Health Response to Anthrax Incidents of 2001 and was specifically created for Honorable Bill Frist, the majority leader of the U.S. Senate. During the anthrax attack, the CDC mainly used the HAN to provide information to state and local governments. During the attack, all state health departments used the HAN but only 13 states had connected all of their local health jurisdictions to the HAN.[footnoteRef:32] Overall, the CDC received mixed reviews of the HAN. Based on the information provided by the HAN, “some states were satisfied with the information they received via HAN, but others claimed they did not get much information from HAN and what they did get was incomplete.”[footnoteRef:33] More improvement to the HAN need to be made in order to improve on the current communication network used during bioterrorism attacks. [32: United States General Accounting Office 2003] [33: United States General Accounting Office 2003]

In the report, there were a few sections that discussed the response of the FBI during the anthrax attacks. One example focuses on the lack of information the public health officials at an epicenter received from the FBI during the anthrax attacks. The public health officials stated that “if they had received more detailed information earlier about the nature of the anthrax spores in the envelopes, it might have affected how their agencies were responding.”[footnoteRef:34] During a bioterrorism attack, the more information received, the better chance of responding quickly enough to prevent more loss of life. Most of the governmental reports do not discuss the failure of the FBI to communicate with the CDC and other federal organizations. There is one quote from the report that highlights the need for better communication between the FBI and CDC. The quote discusses how the “CDC has held joint training with the FBI to discuss what they learned from their experience that could facilitate working together in the future.”[footnoteRef:35] Even though this quote is vague, it does demonstrate that the FBI needs to work on their communication abilities. [34: United States General Accounting Office 2003] [35: United States General Accounting Office 2003]

Introduction to the Policy and Program Proposal

The Bioterrorism Act of 2002 was the first necessary step to improving the United States’ response in the event of a bioterrorism attack. The act assigned responsibility to federal organizations, provided needed funding to improve current bioterrorism research and response capabilities, and provided basic legislation to address the major issues discovered during the Anthrax attacks of 2001. However, as shown in the policy and program analysis, there are several areas that need to be addressed in order to improve the overall Bioterrorism Act and the capabilities of responding to a bioterrorism attack. The overall areas that need to be addressed are the current leadership structure of the governmental organizations in response to a bioterrorism attack and communication abilities between the federal, state, and local governments.

Leadership Structure Issues

As stated in the policy and program analyses, there is an issue of which individual and government agency is in charge during a bioterrorism attack. The FBI is the leading agency during a bioterrorism attack but the Assistant Secretary for Public Health and Emergency Preparedness is the lead individual in charge during a bioterrorism attack. As seen during the Anthrax Attacks of 2001, the FBI did not use the valuable information of other agencies like the CDC to their benefit. The FBI attempted to lead the response alone, which caused more issues and confusion between the different governmental organizations. Unfortunately, the Bioterrorism Act of 2002 did not address this major issue but instead created a conflict between the FBI and the lead individual in charge during a bioterrorism attack. This paper proposes a reauthorization of Title I for the Bioterrorism Act of 2002 in order to restructure the current authority and responsibilities of the different governmental agencies.

Reauthorization of Title I

The department of Homeland Security should be the leading agency in charge during a bioterrorism attack. Even though the most logical organization would be the Department of Health and Human Services, they do not have the knowledge capable of leading and organizing the response to a bioterrorism attack. HHS is better suited to providing support, resources, and knowledge to another leading agency since they do not have enough experience to properly address a terrorist attack. The mission of Homeland Security is to maintain the national strategy to prevent terrorist attacks. Since DHS has knowledge of bioterrorism attacks and some of the resources needed to combat bioterrorism, they are the best suited to lead the response of a bioterrorism attack. Also, DHS manages the functions of the Office of Emergency Preparedness. This office is focused on coordinating the federal medical and other health related responses during a major emergency or disaster. Under the oversite of DHS, this department would play a crucial role during a bioterrorism attack. HHS, FBI, DOD, and VA will have supporting roles in the event of a bioterrorism attack since each agency brings a unique set of skills and resources that can best help the US.

HHS and DHS

With DHS becoming the lead agency in charge during a bioterrorism attack, some responsibilities of DHS should be transferred back to HHS. One of the major programs that needs to be transferred is the National Strategic Stockpile. The CDC still manages the daily operations but DHS has general oversight over the program. Having multiple agencies in charge of major medical emergency response programs causes delays in response to state and local governmental requests for assistance from the federal government when dealing with bioterrorism attacks. This could result in more fatalities since time is critical in stopping and responding to a bioterrorism attack. In addition to the National Strategic Stockpile, Congress should also give responsibility of the Metropolitan Medical Response System and National Disaster Medical System to HHS. This would effectively switch the roles of HHS and DHS since HHS would have a complimentary role to DHS during a bioterrorism attack. HHS would be responsible for supplying the needed resources and personnel to DHS while DHS would be responsible for organizing and implementing the response of the federal government during a bioterrorism attack.

Public Health Expert on the National Security Council

Even though there are several departments on the council that are partially responsible for bioterrorism response, there needs to be an expert that is focused exclusively on public health, including bioterrorism. This is a major issue since there is not one expert to discuss with the president and other members of the council about how to properly address situations concerning public health but this information is instead tasked to other council members to be addressed during the meetings. If there was an expert that understood the complex health care system of the United States on the council, they could save countless lives in cases of public health emergencies. The expert would not just focus on bioterrorism attacks but also any other health emergencies such as nuclear weapon concerns or infectious diseases control. Having a constant presence on the council will allow for more information to be addressed to powerful decision makers in the government and to help fix the current problems that occur in the public health sector.

Improving the Health Alert Network

Another extensive topic that needs to be addressed is the communication between the federal government and state and local governments during a bioterrorism attack. Local and state governments will be the first to be alerted to a bioterrorism attack in their area. There must be an efficient way to distribute information about how to address the specific agent used in the attack and the best way to prevent the spread of the contagion. The best way to address this communication error is by improving the current Health Alert Network the CDC currently uses. It would be cheaper and easier to improve a current program rather than creating a new network that has not been tested like the HAN was during the 2001 Anthrax Attacks.

During the Anthrax Attacks of 2001, this network was used to coordinate information between local officials and the CDC during these attacks. As stated earlier in the paper, the system was proven to only be marginally effective since the local governments only received incomplete data on anthrax and the best way to treat the cases. If the local first responders and law enforcement officials do not understand the best way to help individuals suffering from different agents, they are unable to effectively perform their job, leading to more injuries. Also, this network would allow local and state governments to request the needed resources and personnel from the different federal agencies and programs like the National Strategic Stockpile. With a bioterrorism attack, the less time it takes to understand exactly what the pathogen is and to begin treatment, the less fatalities may occur.

Action Decision Document

The next page includes the memorandum used to discuss the proposal to improve current bioterrorism policies and programs. In total, the memorandum will be addressed to Speaker of the House, Assistant Secretary for Public Health and Emergency Preparedness, the Domestic Policy Advisor, Secretary of Homeland Security, Secretary of Defense, United States Attorney General, Secretary of Health and Human Services, Secretary of Veterans Affairs, and the Director of the Centers for Disease Control and Prevention. However, each memorandum will be individually addressed to each department head, so a sample is provided on the next page to the Speaker of the House as an example of the memorandum sent to each department.

Memorandum

TO: Paul Ryan, Speaker of the House

FROM: Sarah Kirk

DATE: December 8, 2017

RE: Request to modify the current Bioterrorism Act of 2002

______________________________________________________________________________

Introduction

According to the Center for Disease Control, “a bioterrorism attack is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants.” Even though bioterrorist attacks are not as prevalent as other forms of terrorist attacks, they are still extremely dangerous and can cause serious injuries and fatalities. The last major piece of legislation that affected the prevention of and response to bioterrorism attacks in the United States was the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. The act was an important step in improving the United States’ planning and response to bioterrorism attacks. However, there are serious issues concerning the federal government structure and communication with state and local governments that needs to be addressed. These issues can be fixed by reauthorizing Title I of the Bioterrorism Act of 2002 to change the responsibilities of the Department of Homeland Security and the Department of Health and Human Services. The communication errors can be fixed by creating a Public Health Expert position on the National Security Council and improving on the current Health Alert Network operated by the Center for Disease Control.

In reauthorizing Title I, DHS needs to become the lead federal agency in charge during a bioterrorism attack. The mission of Homeland Security is to maintain the national strategy to prevent terrorist attacks. Since DHS has knowledge of bioterrorism attacks and some of the resources needed to combat bioterrorism, they are the best suited to lead the response of a bioterrorism attack. Also, DHS manages the functions of the Office of Emergency Preparedness. This office is focused on coordinating the federal medical and other health related responses during a major emergency or disaster. Under the oversite of DHS, this department would play a crucial role during a bioterrorism attack.

Reauthorization of Title I - HHS

HHS is better suited to providing support, resources, and knowledge to DHS as the leading agency and some responsibilities of DHS should be transferred back to HHS. One of the major programs that should be transferred is the National Strategic Stockpile. The CDC still manages the daily operations but DHS has general oversight over the program. Having multiple agencies in charge of major medical emergency response programs causes delays in response to state and local governmental requests for assistance from the federal government when dealing with bioterrorism attacks. This could result in more fatalities since time is critical in stopping and responding to a bioterrorism attack. In addition to the National Strategic Stockpile, Congress should also give responsibility of the Metropolitan Medical Response System and National Disaster Medical System to HHS. This would effectively switch the roles of HHS and DHS since HHS would have a complimentary role to DHS during a bioterrorism attack. HHS would be responsible for supplying the needed resources and personnel to DHS while DHS would be responsible for organizing and implementing the response of the federal government during a bioterrorism attack.

Public Health Expert on the National Security Council

Even though there are many federal agencies involved in bioterrorism research and planning, there is no representative on the National Security Council for any public health department. There needs to be an expert that is focused exclusively on public health, including bioterrorism. This is a major issue since there is not one expert to discuss with the president and other members of the council about how to properly address situations concerning public health. If there was an expert that understood the complex health care system of the United States on the council, they could save countless lives in case of a public health emergency. The expert would not just focus on bioterrorism attacks but also any other health emergencies such as nuclear weapon concerns or infectious diseases control. Having a constant presence on the council will help fix the current problems that occur in our public health sector.

Improving the Health Alert Network

Improving the current Health Alert Network operated by the CDC is the cheapest and easiest way to improve the communication network between federal, state, and local governments during a bioterrorism attack. Local and state governments will be the first to be alerted to a bioterrorism attack in their area. There must be an efficient way to distribute information about how to address the specific agent used in the attack and the best way to prevent the spread of the pathogen. During the Anthrax Attacks of 2001, this network was used to coordinate information between local officials and the CDC during these attacks. Unfortunately, the system was proven to only be marginally effective since the local governments only received incomplete data on anthrax and the best way to treat the cases. Improving this network would allow local and state governments to request the needed information, resources, and personnel from the different federal agencies and programs like the National Strategic Stockpile. With a bioterrorism attack, the less time it takes to understand exactly what the pathogen is and to begin treatment, the less fatalities may occur.

I ask that you consider the previous proposal to improve the current policies and programs focused on preparing, researching, and responding to bioterrorism attacks.

Approved

_____________ _____________________________________

Date Signature Denied

Introduction to the Strategic Plan

As established in previous sections of this paper, there are major issues with the Bioterrorism Act of 2002 that need to be addressed. The three major recommendations in the proposal included the creation of the public health expert position on the National Security Council, re-authorization of Title I, and improvements of the Health Alert Network. This section of the paper will provide a specific plan on how to implement these recommendations. Implementing these strategies will improve the United States’ research and response to bioterrorism attacks.

Policy/Program Outcomes

Analyze the response of different federal government organizations that are directly involved with the US’ federal government’s response during a bioterrorism attack. Based on these findings, determine new roles for each agency to improve weaknesses in communication and response. For example, authorizing Homeland Security as the leading federal agency during a bioterrorism attack instead of the FBI. Improve the ability of the current communication networks between the federal government and state and local officials, such as first responders, law enforcement, and hospital personnel, during a bioterrorism attack. Create a new position focused on public health awareness and improving the current bioterrorism policies and programs by establishing a Public Health Expert position on the National Security Council.

Program Design/Administrative “Blueprints”

Inputs

The inputs needed to implement the strategic plan include financial resources, personnel, and time needed to implement all components of the strategic plan. The financial resources would contribute to the HAN, the creation of the mock training exercises, and pay for the creation of the Public Health Expert position and the HAN Strategic Network Operator. Key personnel needed to implement the strategic plan include all members of the working group such as the Assistant Secretary for Public Health and Emergency Preparedness, the Domestic Policy Advisor, Secretary of Homeland Security, Secretary of Defense, United States Attorney General, Secretary of Health and Human Services, Secretary of Veterans Affairs, and the Director of the Centers for Disease Control and Prevention

Processes

The processes needed to implement the strategic plan include creating a new position on the National Security Council and establishing a working group to address changes in bioterrorism policies and programs. These components are crucial in implementing the strategic plan, since the Public Health Expert will establish the working group. The working group, including the Public Health Expert, will have the ability to reauthorize legislation, leading to improvements in the HAN and overall communication between different federal agencies concerning bioterrorism research. The specific processes of how to implement each step of the strategic plan are included below in the implementation strategy section of the paper.

Outputs

The outputs of the strategic plan include researched improvements in communication with the HAN between the federal government, state, and local officials during a bioterrorism attack, effective yearly mock training exercises, which lead to better communication and response during a bioterrorism attack. Also, two other outputs would include a new position on the National Security Council titled the Public Health Expert and a new position with the HAN titled the Strategic Network Operator.

Outcomes and Impacts of the Strategic Plan

Overall, this strategic plan is focused on improving current legislation and programs dedicated to preventing and responding to bioterrorism attacks in the United States. One major outcome of the plan is to improve general communication between the federal, state, and local governments during a bioterrorism attack. Specifically, improving the communication between the five main federal agencies responsible for the research of, response to, and prevention of a bioterrorism event. One major impact that may occur will be more accurate and faster responses to a bioterrorism attack, resulting in less casualties and injuries. Another major outcome from the strategic plan involves the mock yearly training exercises. The outcome from these exercises includes improvements in the response to bioterrorism attacks by all agencies involved in the program. The more unique scenarios these agencies are exposed to during the training exercises, the more experience the agencies will have. The impact of this experience is for the federal agencies to be better prepared to respond to a bioterrorism attack, since they have dealt with a variety of different scenarios.

Implementation Strategy

Establishing a Working Group

Once the public health expert is established, they can be the leading agent to help address the problems in other areas of bioterrorism. Next, the expert should establish a working group to address the current bioterrorism policy and to implement the changes that are proposed. Within this working group, the Assistant Secretary for Public Health and Emergency Preparedness will chair the group and include the newly appointed Public Health Expert, the Domestic Policy Advisor, Secretary of Homeland Security, Secretary of Defense, United States Attorney General, Secretary of Health and Human Services, Secretary of Veterans Affairs, and the Director of the Centers for Disease Control and Prevention. One major responsibility of this working group is to transfer authority to homeland security to be the leading agency in charge during a bioterrorism attack. Even though the FBI would not be in charge, they would still have a key supporting role in providing resources and field expertise that is vital during a bioterrorism attack. Also, authority for the National Strategic Stockpile, Metropolitan Response System and the National Disaster Medical System should be transferred back in control of the CDC.

Improving the Communication Network

Once this re-authorization occurs, the working group can then focus on improving the current communication network used during a bioterrorism attack. One major issue within this communication is the number of different alert networks available and the problem that occurs with multiple networks competing to give information. For example, the CDC offers multiple communication networks such as the Online Technical Resource and Assistance Center and Epidemic Information Exchange, which can cause confusion if multiple alerts are being received from the different forms of communication networks available. Multiple alerts may have conflicting or redundant information that can delay decision making during a bioterrorism attack.

Primary Communication Network

The working group should require that the Health Alert Network be the main communication network between federal, state, and local hospitals, first responders, law enforcement, and any other official involved during a bioterrorism attack. The HAN is the established network in the Public Health Emergency Preparedness and Response Plan but it is not the only required network for the program. The working group can establish requirements for HAN to be the main source of communication and to have another program like On-TRAC as the secondary source of communication.

Creating HAN Strategic Network Operator

Next, the group should establish a new position called the Strategic Network Operator. The purpose of this position is to allow one individual to help address the confusion of multiple messages. If all messages are cleared with one main individual first before being sent through the HAN, it will decrease the number of repeated and conflicting messages. Also, having one individual in charge will ensure that messages are actually sent during an emergency. One major issue from the anthrax attacks of 2001 was the lack of information sent to local authorities. Without the needed information to address the anthrax attacks, more individuals became ill since they did not understand how to properly handle the letters containing the anthrax.

Having a position dedicated to ensuring the correct information is disseminated to local authority will help improve the overall network, since some of the major issues with using the network is the content of the messages being sent and the lack of information being sent. More research needs to be conducted once this position is established to determine other flaws within the network. Hopefully decreasing the lack of conflicting messages and increasing the amount of information provided will fix the problems within the HAN. Also, more research needs to be conducted to determine a way to evaluate all the different communication networks. Having an evaluation tool will provide more necessary feedback in order to improve the HAN and any other networks used during a bioterrorism attack.

Budget

The major components included in the budget are the salary for the Public Health Expert, salary for the Strategic Network Operator, and the budget for the yearly training exercises. The Government Management and Program Analysis position in Homeland Security averages 102,475 per year. This position focuses on “serving as analysts and advisors to management on the evaluation of the effectiveness of governmental programs and operations or the productivity and efficiency of the management of Federal agencies or both.”[footnoteRef:37] The Public Health Expert position would have the same responsibilities as this current position, so both positions should have the same salary. The Miscellaneous Administration and Program position in Homeland Security averages 91,847 per year.[footnoteRef:38] This position focuses on mainly on managing systems or processes, which most relates to the Strategic Network Operator. [37: Department of Homeland Security 2016] [38: Department of Homeland Security 2016]

Based on a mock terrorism training exercise conducted by the Regional Domestic Security Task Force in Florida, the cost for the training exercise is expensive based on the different components to the study. In the Florida study, the task force coordinated exercises between local, state, federal, and private agencies, including 12 Emergency Operations Centers and 13 hospitals. In total, the task force spent approximately, “200,000 on planning staff, documentation, and staging the exercise.”[footnoteRef:39] However, since this is a federal program that will require more personnel and resources, resulting in a budget of closer to 750,000 or more for the planning and execution of the exercise. There was not a lot of information available for terrorism training exercises for the federal government, especially the budget used for these program, but there was some information for state programs. This is why the details for the state training exercise was used as a general idea of how much the exercises may cost. [39: Whitehead 2006]

Funding

Since the anthrax attacks of 2001, there are a large variety of grants and funding resources available to different federal agencies for improving the research and response functions of the different departments. For example, some funding can come from the Public Health Emergency Preparedness cooperative agreement to help with improving the HAN. Other grants can be requested from the National Institutes for Health to fund the mock emergency training exercises. Also, since multiple agencies will be represented in the working group, some funding can come from these different federal agencies to help with the cost of meeting and discussing improvements to current bioterrorism research.

Timetable

In total, it will take approximately 5 to 8 years to fully implement the proposal program. One difficulty in establishing a timetable is not knowing an exact amount of time required between each component of the proposal. For example, it may take longer to achieve approval of the public health expert position than anticipated. However, there is a general timetable included that estimates the amount of time it may take to establish each part of the proposal.

Within the first six months to one year of the proposal being accepted, the new Public Health Expert position should be created and a qualified individual for the position should be hired. Since this position helps create the work group to fix the problems in bioterrorism, it is necessary to have this position created and filled as quickly as possible. Next, the working group must be established and begin the reauthorization of Title I. The working group should take approximately three months to six months to be fully established. Within two and a half years to three years, the reauthorization of Title I should be approved by Congress. The creation of HAN position, improving the HAN network, and planning the yearly mock exercise can occur at the same time as the reauthorization process. This process may take one year to two years to fully implement the HAN system upgrades and the creation of the new HAN position. The yearly mock exercise may take one year to two years to plan before the implementation process can occur. The implementation process can only occur once every other part of the proposal is completed since it is the main evaluation component of the proposal.

Monitoring & Evaluation

For the research evaluation component, a yearly mock bioterrorism emergency event should be conducted to test the newly created Public Health Expert position, the newly improved HAN, and the newly established authority of the different federal agencies. The mock events can include different scenarios of possible bioterrorism attacks within different areas of the country. For example, have a design one year in the rural part of a southern state then the next year have a mock design on the west coast in a busy metropolitan area. The exercise should last a total of 72 hours. Within the first 72 hours of a bioterrorism event occurring is the most crucial time to establish control of the event and provide necessary information to decrease the harm caused by the attack.

Within the mock design, a key aspect is to allow the different federal agencies to perform the normal tasks and procedures required of them during a bioterrorism attack. This would allow for a test of the new authority since Homeland Security would be required to lead the activity while the CDC tested the new resources that were re-authorized to them. This would allow for the different federal departments to interact together and build positive working relationships that are important to have during a national emergency. The mock design would also test the new public health expert since the new position would be key in helping lead the response to a bioterrorism attack. Also, the improved HAN system can be tested to see how well the system is able to relay important information from the different federal agencies to the local first responders. Through federal grants, an outside research company should be hired to assess and analysis the exercise to determine how well the federal organizations worked together and the improvements each federal agency can address to improve their overall response time and actions. The research company can assess a variety of measures which includes response times for the federal agencies to react during a bioterrorism event, how well the different agencies work together, general reactions to unexpected events that occur during the exercise, simulated rates of fatalities and injuries, and other measures to be determined.

References