OPINION:
The successful strike against Osama bin Laden’s Pakistan hide-out has rightfully made counterterrorism headlines in recent weeks. But while attention was focused overseas, an ominous set of incidents was occurring in Dallas, Houston, Washington and elsewhere during the first week of May. Letters containing vague references to al Qaeda and the FBI and laden with an off-white powder were mailed to schools. Public reaction to those events has ranged from general unawareness to concern on the part of parents and advancement of a bizarre conspiracy theory that this is a government plot designed as a prelude to immunizing children against anthrax.
Though not cause for alarm, the letters do represent a muted warning of a latent and persistent vulnerability. The mailing of the letters implies bioterrorism. Disruptive and evocative of a real danger that claimed five lives a decade ago, the letters should serve as a warning both of the vulnerabilities inherent in our open society and of the nation’s limited capacity to respond to a widespread bioterrorism event.
At last count, there were more than three dozen envelopes and no identified health threats. But what if the next envelope contains a toxic or pathogenic substance? What has been a minor annoyance can rapidly become a crisis. Bomb threats against government buildings were once a slight distraction - until the Murrah Building in Oklahoma City came down. Consider the distribution path from Dallas to Washington and the dispersal to about 30 schools. In 2001, four of the five anthrax fatalities were caused by incidental exposure. How many people might be exposed to slowly leaking contents of these envelopes? Would a physician seeing flulike symptoms in Grapevine, Texas, know to check for anthrax? If an incident were confirmed, would the U.S. health system be able to serve the tens, if not hundreds, of thousands of people likely to seek evaluation or treatment?
This is an extensive and coordinated incident, even if perpetrated by a lone, disturbed individual. It highlights an aspect of preparedness that is underserved. Despite the best efforts of public health and emergency preparedness officials, the domestic capacity for a significant surge remains limited. Significantly expanded training and response capabilities at the federal level have been deferred to other missions and prolonged planning. State and local capabilities lag under the burden of fiscal constraints and manpower shortages. It can take a week or more to get a primary care appointment, even with the best insurance available. In 2001, a handful of anthrax letters wreaked havoc. What impact might a sackful have?
The arrival of most of the letters after the killing of bin Laden was mere coincidence. Some were mailed before that news broke - in some cases as early as 2008. This is itself disturbing in that the perpetrator has yet to be identified even after several years. It took years to identify a suspect in the 2001 attacks; there are those who do not believe the FBI’s conclusion to this day. The current incidents have fewer clues upon which to base an investigation, such as a specific strain of anthrax, as was the case a decade ago. This could be a lengthy process.
In the interim, time and circumstance afford a window of opportunity. An ancient idiom advises that “forewarned is forearmed.” Someone in Texas is placing us on notice. The question is: Are we sufficiently astute to heed that warning?
Donald Donahue is director of the Center for Health Policy and Preparedness at the Potomac Institute.
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