U.S. STILL UNPREPARED FOR BIOTERRORIST ATTACK.

Byline: Keith Richman 

Late last year, stories of anthrax covered the front pages of our newspapers and prompted fears of dying from a disease-laced letter. In recent weeks, those stories have moved to the inside pages and those fears have, for the most part, subsided.

Yet federal, state and local leaders cannot forget the continuing threat of bioterrorism.

A bioterrorist attack with a deadly pathogen could cause hundreds of thousands of deaths. Diseases such as smallpox are highly contagious and would run rampant in our nonimmunized population. Experts believe 30 percent of the people who contract smallpox would die.

Various scenarios of bioterrorist attacks run by government agencies have revealed critical deficiencies in our response. Planning proved to be inadequate and the hoped-for coordinated response between local, state and federal officials showed instead jurisdictional confusion.

In some scenarios, the lack of timely and accurate public communications produced chaos and even public anarchy.

During the Cold War, our nation's defense against a nuclear attack was based upon the concept of mutual assured destruction. Had the United States been attacked, we maintained an overwhelming nuclear force that would have annihilated our foe; eliminating any benefit from a first strike.

This strategy worked well in the Cold War, but it provides no protection against a bioterrorist attack.

A covert bioterrorist attack using a small amount of contagion such as smallpox would very likely go undetected until the first victim showed symptoms or signs of the disease. By the time the correct diagnosis would be made, many others would already be exposed and the epidemic would be well on its way toward mass casualties.

Although it is very difficult to prevent a bioterrorism attack, a strong public health system with good planning, preparedness and adequate funding would be critical to minimizing casualties.

A coordinated response between local, state and federal officials must be established up front and appropriate public health law must be in place.

With emergency rooms beginning to fill and contagious people unknowingly walking the streets, each hour of indecision and conflict could cost thousands of lives.

Our community health care providers - doctors, nurses and pharmacists - must be well-trained in recognizing the symptoms and signs of diseases that may be used as weapons.

Disease surveillance, the ability to identify and track diseases, is a primary responsibility of our public health system and cannot be compromised. Identifying instances of bioterrorism early rather than later is an important first defense and will potentially save thousands of lives.

Electronic communications between doctors, hospitals, emergency rooms and public health officials must be our early warning system for a bioterrorist attack.

Besides the early warning system of good public health surveillance, preparedness is key. Our health care system must be ready to respond.

Stockpiling of antibiotics, vaccines and other medical supplies in easily accessible geographic locales should be undertaken now. Distribution systems for antibiotics and vaccines must be developed in order to expedite treatment of individuals exposed to a bioterrorist attack.

The controversial public health measures needed to respond to a public health emergency - such as isolation and quarantine of individuals, commandeering and use of facilities, and mass treatment of vulnerable populations - are issues that must be addressed and resolved.

Such measures designed to protect the public must be scientifically based and must protect individual civil liberties to the maximum extent possible.

President George W. Bush has made a major commitment to bioterrorism defense. His new budget calls for $5.9 billion in bioterrorism defense expenditures, a more than 300 percent increase in current spending.

In announcing this budget priority, the president said, ``It's money that we've got to spend. We must do everything in our power to protect our fellow Americans.''

That same resolve must be demonstrated in California. Our public health infrastructure has been sorely neglected for many years. Budget writers must resist the temptation to divert California's share of the $1.6 billion earmarked for state and local public health programs to fill the state's budget hole. That money is needed to reinforce our first line of public health defense.

Much like preparing for the Cold War nuclear strike that never came, we must dedicate the time, energy and resources needed to protect ourselves against this terrorist tactic. Hundreds of thousands of California lives might depend upon it.