1. UNDERSTANDING BIOTERRORISM: Tara O’Toole, MD, MPH The United States Conference of Mayors Mayors Emergency, Safety & Security Summit October 24, 2001

2. www. hopkins-biodefense.edu

3. Lethality Mirroring Nuclear Weapons

4. Bioweapons Program in Iraq

5. Gaseous Diffusion Plant

7. Germ fermenters at the former Bioweapons plant in Stepnogorsk, Kazakhstan, which are now being dismantled with American aid.

8. Advances in Biotech, Genomics: Potential for More Potent Bioweapons Understanding genetics of virulence, antibiotic resistance Development of global profiles of microorganisms New ways to control interaction of human cells and microorganisms Manipulation of entire genomes

9. Global Interconnectedness and Vulnerability: Enhanced Conditions for Swift Spread of Infectious Disease Antibiotic Resistance Urbanization - Crowding, Poor Sanitation, Malnutrition Human Intrusion International Travel and Commerce Globalization of Food Supply

10. The Consequences of a Biological Weapon Attack Would be an Epidemic The response required is fundamentally different from that demanded by natural disasters, conventional explosives, chemical terrorism or nuclear weapons

11. Child with Smallpox in Evolution

12. “Top 6” Bioweapon Agents  Smallpox  Anthrax  Plague  Tularemia  Botulinum Toxin  Viral Hemorrhagic Fevers  Contagious

13. Smallpox Worst case threat? Weaponized by Soviets - Others? Contagious - spreads via inhalation Vaccine effective even 3-4 days after exposure No treatment, 30% mortality Current vaccine: 15m doses, more coming

14. Bioweapon Response - Vulnerabilities Public Health Medical Care Technologies Connectedness: Communications, Coordination, Collaboration

15. Vulnerabilities – Public Health “System” Fragmented Understaffed, underfunded No surge capacity Strategic / operational capabilities

16. Vulnerabilities – Medical Care “System” No surge capacity – hospitals, pharmacies Autonomous organizations Hospitals, doctors not engaged in Bioterrorism preparedness

17. Vulnerabilities – R + D + P Needs Rapid reliable diagnostics Vaccines, drugs for major agents Connect Response Sectors: Information Flows

18. What Mayors Should Do? 1.Engage clinicians, hospital leaders 2.Connect Medicine and Public Health 3.24x7 Public Health Response - Outbreak investigation - Distribution of drugs, vaccine 4. Assess Lab Capacity 5.Establish Communication Links 6.Identify technical advisors

19. Engage Hospitals –Review disaster plans: mass casualty, contagious dz –Educate Staff –Community – wide response –Communications – external & internal –Review Inventories of drugs, supplies