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.