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Pox Americana

Biological weapons have never been a greater threat, and both Congress and the White House know it. Here's the briefing Dick Cheney got just after the attack.

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In early September, a few days before a group of Middle Eastern men took a final tour of an airstrip in rural Florida to inspect crop dusters, the Senate Foreign Relations Committee held a hearing on the threat of bioterrorism. The hearing was designed partly as a way for Democrats to criticize the Bush administration's "ominous, myopic" commitment to building a missile defense ("How is Star Wars going to stop germs?" was the general refrain), and partly out of a genuine concern that terrorists might someday try to kill thousands of people in the United States.

Six days later, thousands of Americans were killed by terrorists. Congress takes a lot of flak for being a reactive body, and much of it is deserved. But in this case, the Foreign Relations Committee proved to be remarkably prescient. In his opening remarks, Senator Joe Biden declared a biological-weapons attack "more likely today than it ever has been in the past."

This turned out to be perhaps the only understatement Biden has ever uttered. At that moment, a biological or chemical attack was indeed quite likely. Mohamed Atta and his fellow hijackers appear to have been planning one. Last year, Atta tried to get a federal loan to buy a crop duster, presumably to spray something deadly over a crowd. Several other suspected terrorists applied for and got licenses to carry hazardous chemicals.

It's not clear why the plot, if there was one, never came off. It may be that the hijackers were planning for a future attack, to be carried out by others. Two weeks ago, Senator Chuck Hagel said that the U.S. can "expect" to be hit with biological weapons. The administration hasn't said so publicly, but some Bush advisers seem to agree. (So, apparently, does Congress. Last year, members and their staffs were issued gas masks.) There is a growing consensus that the terrorists' germ of choice is likely to be smallpox.

Smallpox isn't supposed to exist. The world's last case was reported in 1977 in Somalia. Both the Soviet Union and the United States, however, retained samples of the virus. All of the Russian samples should be in Russia. Whether they are is another question. A couple of years ago, Senator Dick Lugar toured an old Soviet biological-weapons factory that had been partially converted to private-sector use. Vats that had recently held anthrax were being used to produce Green Mama Shampoo.

The point is, Russia is a poor, disorganized country. It's possible to imagine vials of the virus being sold, stolen, or in some way winding up in the hands of terrorists. That would be bad. You don't want to get smallpox.

The early symptoms are flulike: chills, headache, nausea, thirst, bad breath, and constipation. Soon, foul-smelling pustules erupt all over the body, clustering around the hands, feet and face. Lesions appear on the mucus membranes. Sufferers often become unrecognizable. After about two weeks of agony, roughly a third of patients die, a disproportionate number of them children. Survivors are frequently left blind, deaf, bald, and horribly scarred.

And that's a relatively rosy scenario. There is some evidence that Soviet scientists tried to alter the smallpox virus in order to make it resistant to American vaccines. (It is known for certain that the Soviets altered anthrax.) Such a strain would be even more devastating -- though not as devastating as an outbreak of hemorrhagic smallpox. Like Ebola, hemorrhagic smallpox melts its victims from within, causing massive bleeding from the nose and genitals. It is almost always fatal.

What would happen if the smallpox virus was released in the United States? Thanks to an exercise conducted this summer, we have some idea. In June, the Center for Strategic and International Studies and a couple other think tanks sponsored a kind of war game at Andrews Air Force Base outside Washington. A cast of players -- including former Senator Sam Nunn as the president, former CIA director James Woolsey as the CIA director -- spent two days formulating a response to a fictional smallpox outbreak. The exercise, called Dark Winter, has since been packaged into a multimedia briefing. A number of members of Congress have seen it. So have Dick Cheney and his staff. By all accounts, it has frightened all of them.

Dark Winter is punctuated by simulated news clips from an imaginary cable news network called NCN. Actors playing anchors chart the smallpox outbreak as it spreads from shopping malls in three states to virtually every part of the country. By the sixth day of the epidemic, hundreds have died, thousands are infected, and the government has run out of vaccine. Hospitals are overwhelmed. Riots have broken out. The markets have tanked. No one has yet claimed responsibility for spreading the virus, the anchor announces, "but NCN has learned that Iraq may have provided the technology behind the attacks to terrorist groups based in Afghanistan."

It is spooky to watch. But the spookiest parts are the scenes of chaos in the streets. You realize as you watch them how emotionally powerful disease is. Not only can smallpox decimate a huge percentage of a population -- it killed half the Aborigines in Australia in the nineteenth century, 300 million people worldwide in the twentieth -- but it terrifies the rest. Smallpox is scary. It makes people panic. It can make societies fall apart. How does a democratic government respond to an epidemic?

That's a question Tom Ridge will have to answer as he takes over the newly formed Office of Homeland Security later this month. The first thing to do, of course, is assemble enough vaccine, and within days of the World Trade Center attacks, the Bush administration ordered more from a biotech company in England. But that's only part of the solution. Unlike anthrax, or chemical poisons, smallpox is contagious. Which means that during an outbreak, people who are already infected and symptomatic would have to be quarantined.

This raises hard questions. As Sam Nunn put it when he went before the Foreign Relations Committee, "We need to reexamine and modernize the legal framework for epidemic-control measures and the appropriate balance with civil liberties." Later in his testimony, Nunn dropped the euphemisms: "Do we force whole communities and cities to stay in their homes? How? With force. How much force? Does it include lethal force?" It did in Dark Winter. The governor of Texas put soldiers on his border with Oklahoma with orders to shoot fleeing Oklahomans on sight.

Nunn went on: "Who provides food and care for those in forced isolation, particularly when we can no longer provide vaccine? Who is going to make the health-care people show up when you don't have any vaccine for them?"

These are revolting questions. But from now on they will be answered. When people say the world changed forever on September 11, this is part of what they mean.


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