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The newspaper of The Johns Hopkins University January 24, 2005 | Vol. 34 No. 19
SAIS Co-Hosts Exercise Illuminating Need for Bioterror Preparedness

Acting as U.S. president, Madeleine Albright, center, questioned whether Americans would be willing to share vaccine with nonsupportive European countries.

A host of former prime ministers, ambassadors and other high-ranking government officials from both sides of the Atlantic came together in Washington, D.C., on Jan. 14 when the SAIS Center for Transatlantic Relations co-hosted a table-top exercise that simulated a smallpox attack on the nations of the transatlantic community.

The bioterrorism exercise, called Atlantic Storm, was also co-hosted by the Center for Biosecurity of the University of Pittsburgh Medical Center and the Transatlantic Bio-security Network.

During the exercise, participants played the roles of the heads of government of their respective nations in a mock summit.

The scenario presented was the simultaneous outbreak of smallpox in Istanbul, Frankfurt and Rotterdam, with attacks in the United States surfacing later in the day. It was made clear early on that the disease had been spread deliberately and that a terrorist group claimed responsibility for the action.

The world leaders debated the availability of vaccine in their countries and were surprised to learn that although some nations — including the United States, the United Kingdom, France, Germany and the Netherlands — had enough to vaccinate their entire populations, many did not. Italy and Sweden, for example, have enough vaccine for only 10 percent of their populations.

The issue of whether to use "ring" vaccination — that is, vaccinating only those who have been in contact with patients, and health-care workers — or to opt for mass vaccination of the population led to discussions of which countries would be willing or politically able to share vaccine, pitting the "haves" against the "have-nots."

Acting as the U.S. president, former Secretary of State Madeleine Albright, for example, expressed doubts as to whether the American people would be willing to give a portion of the U.S. stockpile to European countries that had been less than supportive of U.S. policies in the recent past.

"It was clear that this group of leaders all wanted to do the right thing, and they largely agreed on what that was," said Tara O'Toole, CEO of the Center for Biosecurity. "But they were worried that their people were not prepared to accept the necessary decisions, and they at times felt compelled to take actions that might have bad implications for the world."

As the day went on, the number of reported smallpox cases grew rapidly, and the number of countries whose populations were affected also increased. Cases were reported in the United States, Canada and Mexico as well as in countries throughout Europe.

Told that dock workers in Rotterdam were infected and the port had been closed, and that Polish citizens were streaming into Germany to try to obtain vaccine not available in their country, the leaders were forced to confront the economic and political consequences of the crisis. A debate ensued about the advisability of closing borders, quarantining cities and limiting the movement of people and goods.

In a discussion after the exercise had concluded, many players expressed surprise that their countries had not stockpiled enough vaccine, and several agreed that there was not sufficient awareness at the highest levels of government of the possibility and consequences of such a bioterrorist act.

It was also clear to the participants that no organization or structure, including NATO, the European Union and the United Nations, is now agile enough to respond to the challenges posed by a bioterrorist attack of this scope. The participants wanted the WHO to manage the distribution of vaccine, but former WHO Director-General Gro Harlem Brundtland said that the organization's limited resources were already stretched by the tsunami relief response. The annual WHO budget, she said, is "about as big as that of a middle-sized English hospital."

"A bioterrorist attack will immediately be an international crisis," O'Toole said, "and countries must be able to communicate and coordinate response in near-real time. Atlantic Storm has shown how critical it is for leaders to be prepared to respond to bioterrorist attacks of international dimensions requiring stark and extraordinary decisions."

In addition to Albright and Brundtland, participants in the mock summit included Sir Nigel Broomfield, former ambassador of the United Kingdom to Germany; Jerzy Buzek, former prime minister of Poland; Klaas de Vries, former minister of the interior of the Netherlands; Jan Eliasson, ambassador of Sweden to the United States; Wener Hoyer, member of the German Bundestag and former German deputy minister of foreign affairs; Bernard Kouchner, former minister of health of France; Erika Mann, member of the European Parliament; Barbara McDougall, former foreign minister of Canada; Stefano Silvestri, former Italian deputy minister for defense; and Eric Chevallier, associate professor, Institut d'Etudes Politiques de Paris and the French Ecole Nationale d'Administration.


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