Given the difficulty of prevention, most efforts center on being prepared to respond to an incident. “We need to be ready to react rapidly and simultaneously to various events in various parts of Europe,” Benoliel says.
Among the initiatives are worst-case scenario drills designed to assess how well existing crisis-management systems could handle an incident. For example, Interpol, the international police organization, organized a tabletop exercise in December 2007. Called Black Death, it was designed to train officials in responses to a bioterrorism event.
The scenario began with terrorists spreading large amounts of plague bacteria with hundreds of simple horns, similar to those used at sporting events. The exercise simulated an attack in Australia and monitored the spread of highly infectious plague to nine other countries around the world.
The event was staged in Lyon, France, where Interpol is headquartered. Participants included national law enforcement agencies from nine countries as well as international organizations, such as the World Health Organization (WHO) and Interpol itself.
The Black Death exercise led to several major findings, says the event’s moderator, Barry Kellman, who is director of the International Weapons Control Center at DePaul University and a special advisor to Interpol’s biocrimes prevention program.
The first finding was that current detection and investigation procedures are not adequate for a bioterrorist attack. “Black Death showed that there is no way to carry out an international [bioterrorism] investigation. It started in Australia, but as the problem multiplied, the absence of international capacity to find who was doing it and to stop them became clear,” says Kellman.
A second lesson was the need for governments to invest more in prevention. “We need to reduce the opportunities for the commission of this crime,” says Kellman. “We need better law enforcement, we need better legislation, and we need to strengthen equipment and training. We need more preparedness.” Western governments are taking action on these fronts, he says, but international cooperation is still insufficient, as the Commission’s paper made clear.
A third finding was the importance of improving first-responder training and enhancing information dissemination. Black Death indicated that some national and international agencies are simply not prepared to handle a global public-health crisis.
For instance, WHO has well-developed protocols for addressing a plague as a medical phenomenon. But Kellman says “they did not ‘get’ that when you have mass casualties that are intentionally inflicted, then plague is no longer the same as naturally occurring plague. There is a difference.”
Any plague would strain healthcare systems and worry the public, but a man-made pandemic might be designed to spread faster. Thus, it could more rapidly overwhelm healthcare systems, and populations would be swept by panic, especially because poorly informed media outlets would likely fan hysteria.
Black Death demonstrated the importance of setting up effective media relations programs. “A lot of time was spent going back and forth, not on treatment, but on panic factors, media factors,” says Kellman.
Britain, France, Germany, and Sweden have developed excellent emergency-response plans to deal with bioterrorist attacks, including attacks on food-supply networks, says Alexandre Custaud, coordinator of the European task force on bioterrorism at Europa-Bio, the European biotech trade association. Their planning runs the gamut from stockpiling key vaccines to having well-equipped sports stadiums that can be used for emergency accommodation. However, he and others are less confident about the ability of some Mediterranean countries or some of the new Eastern European member states to mobilize rapidly in response to an attack.
The United Kingdom is frequently mentioned as having the most advanced planning and response capabilities in Europe. “I’d agree that it is true. Stadiums and other facilities are being prepared for emergency use. The British are very advanced,” says the CEO of a consulting firm working on an emergency-planning project for the European Commission.
The British began taking contingency planning more seriously in 2000. “Within a few months in 2000, the U.K. government had to deal with foot-and-mouth disease, flooding, and a fuel dispute,” says Charlie Edwards, senior researcher at Demos, a London-based think tank.
“The outcome of the crises was the creation of the Civil Contingencies Secretariat (CCS). The CCS has transformed the way the government thinks and acts on issues of resilience and contingency work,” says Edwards.
Disaster planning has become more systematic, thanks to the CCS, which has a mandate to ensure that adequate plans are in place. The CCS has established an early-warning capacity to identify, and prevent or minimize, potential emergencies. It has also set in place a national risk assessment process, and it is working with others to identify sites that could be used in a crisis. Furthermore, it has strengthened links with international organizations such as the EU and NATO.
The United Kingdom plans to double the stockpile of the influenza anti-viral Tamiflu, doubling coverage to 50 percent of the population. Officials will not disclose availability of treatments for other infectious diseases, such as anthrax.
The United Kingdom also has staged elaborate exercises. Last year, 5,000 players, including cabinet secretaries, local government officials, and business executives participated in Winter Willow, a nationwide exercise held in January and February 2007, which simulated an avian flu epidemic. Like Black Death, Winter Willow revealed weaknesses in media relations and international coordination.
To improve its preparedness, the United Kingdom rolled out a sophisticated training program called Gold Standard in June 2007. The program—designed by AgustaWestland, an Italian defense contractor, and built around Automated Exercise System (AES) software from California-based SAIC—models decision outcomes and impacts in simulated crises. Among the scenarios used in the sessions are a food contamination crisis, epidemic foot-and-mouth disease, and disruption of essential services including energy, water, and food supplies.
Despite these efforts to get in front of the problem, it is still largely a reactionary battle, says Edwards. “The U.K.’s response remains 80 percent driven by events. We learn from our mistakes and then develop capacity, as opposed to being more proactive,” says Edwards. “My primary concern is that we are only able to fight from one event to the next.”