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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		First National Symposium on Medical and Public Health Responses to Bioterrorism
		Arlington, Virginia
DATE:		February 16, 1999

This haunting thriller-which Preston dedicates to public health professionals-weaves a chilling, but compelling, tale about a lone terrorist's attack on Manhattan with a genetically engineered virus.

It's true that this story of designer-made microbes on the rampage is a work of fiction. But it's also true that perhaps more than any recent news article or report, Preston's thought-provoking novel has helped shine the national spotlight on the shadowy threat of bioterrorism. And the book raises a logical question: How do we successfully contain and combat this emerging threat? To do so, I believe we must meet four important challenges. Four challenges that we cannot ignore. And four challenges that government cannot meet alone.

Our first challenge is to be aware that an act of bioterrorism could happen. The likelihood of an attack is entirely unknown-and it may never occur. But we've seen terrorism emerge as one of the thorniest problems of the post-cold war era. We've seen that terrorists are always searching for new weapons. And we've already seen sarin nerve gas released in the Tokyo subway. It may not happen immediately, but somewhere, sometime, in the future, terrorists may well threaten to use-or attempt to use-a biological weapon against the United States. But when discussing the possibility of a terrorist attack in the next few years, the President unequivocally stated that: "This is not a cause for panic. It is cause for serious, deliberate, disciplined, long-term concern." In other words, we must not be afraid-but we must be aware. That's why this National Symposium is so important-because it will help replace complacency with a new sense of urgency-And because it will help keep the national spotlight focused on the threat of bioterrorism.

Of course, once we're fully aware that a bioterrorism event could happen, then our second challenge is to do everything we can to be prepared. With the threat of bioterrorism knocking at our door, we can't afford to be caught off guard-because it's only in movies like "Outbreak" that we can save the world from a deadly virus in just 24 hours. That's why my Department is spending 158 million dollars this fiscal year to prepare for bioterorrism. And that's why the President has proposed increasing that investment by an additional 72 million dollars in his Fiscal Year 2000 budget.

This investment will fund our on-going "Anti-Bioterrorism Initiative." Devised to significantly raise our level of preparedness, this year the Initiative is expanding its activities in a number of key areas-these include surveillance; medical response; building a stockpile of pharmaceuticals; and research and development. We're working to improve and strengthen our nation's public health surveillance network- including detection and reporting, electronic communications, and laboratories. And, of course, we're also enhancing our epidemiological capacity-so we can quickly respond to a suspected biological agent.

We're enhancing our medical response capacity by spearheading an administration-wide effort to develop infrastructure at the local and national levels-by establishing medical response teams in major American cities-specifically designed to deal with the consequences of bioterrorism-and by expanding our capacity to provide immunizations, infection control and patient care on a massive scale.

We're creating-and maintaining-an unprecedented national "stockpile" of drugs and vaccines for civilian use in case of a bioterrorist attack.

Finally, we're accelerating our research and development in diagnostics and vaccines-so we can more effectively combat any threat. In addition, we'll be working to decipher and map the genetic material of microbes-so we can quickly identify biological agents, and develop new therapies. All of our efforts in surveillance, medical response, stockpile development, and research and development will help prepare us to meet-and beat-any bioterrorism threat.

Of course, if we want to be truly prepared, then our third challenge is for the public health and medical communities to take the lead in our fight against bioterrorism. With a conventional terrorist attack, it's the military and law enforcement that are the first line of defense. But with bioterrorism, it's the public health and medical communities who stand directly on the front lines. And how well we respond to a threat will depend on how well our public health and medical communities function. Think about it, if a specific bioterrorism threat is issued-perhaps someone claims to have released a deadly pathogen in a public place-then trained public health officials must first verify that an incident has actually occurred, and identify the biological agent. They may need to decontaminate the area; to determine the likelihood of secondary transmission; to identify exposed populations; and to provide preventive measures and treatments.

Of course, if a threat isn't issued-and no warning is given.the attack would be silent. Affected individuals might not develop symptoms for days or even weeks-and the victims would be visiting many doctors throughout a large area. Quarantine would not be a viable option-because only one biological agent-smallpox-is communicable. And even with smallpox, it would be impossible to know whom to quarantine-due to the long time period between infection and the development of symptoms. A strong communications network would be needed to piece together early reports and quickly determine what happened-so public health officials could promptly identify the deadly agent, the route of exposure, and the likely origin. The CDC, of course, would be an important part of this process-because of its particular expertise in infectious disease. And everyone-from the physicians who first see victims to the scientists who identify the infectious agents-must coordinate their efforts.

And that brings me to our fourth, and final, challenge: We must all work together. In the fight against bioterrorism, the Federal government-particularly HHS-has an obvious leadership role to play. Among other things, we need to support state and local planning efforts; to provide training at every level; to develop an infrastructure for delivering mass medical care; and to offer expertise to our communities.

But this is a fight we certainly can't win by ourselves. Across the board, we must forge new, working partnerships among health, public safety and intelligence agencies. We need unprecedented cooperation between the Federal government, state and local health agencies, and the medical community. And we must ensure that plans for managing the medical consequences of terrorist acts are well integrated-and coordinated-with other emergency response systems.

But there's also another aspect to working together. We know that microbes spread across boundaries of culture, language and territory. We know that an act of bioterrorism cannot be contained by any national border or barrier. And we know that when it comes to microbes, we aren't protected, in the word of Indian poet Tagore, "by narrow domestic walls." Since microbes recognize no border-in our battle against them-neither can we. The fight against bioterrorism must be a global fight. That's why I'm so pleased to see representatives from so many different countries here today. Because we share a common future, we must share a common ground. Or as Dr. Gro Bruntland, the Director-General of the World Health Organization has said, when it comes to public health and safety, "solutions, like the problems, have to be global in scope." And as we work together to defeat bioterrorism, we must also do one more thing. We must do what we are doing at this symposium-we must pool our wits and our will. It is precisely our restless intellects and soaring imaginations that are the most potent weapons and greatest resources in the collective fight against bioterrorism. Let's pit our wits and our will to the battle, and let's ensure that we meet our challenges-so that we are aware; that we are prepared; that we take the lead; and that we always work together.