Reaching into an inside pocket of his suit jacket, retired Air Force Col. Randall Larsen took out a clear, test-tube-shaped vial with a red plastic cap. He held up the vial so his audience could see the white, powdery substance inside.
``The vice president asked me the other day what a biological weapon looked like. Well, this is what it looks like,'' said Larsen, who has been briefing top administration officials and members of Congress on bioterrorism almost nonstop since Sept. 11.
His vial contains a substance that is harmless, but chemically almost identical to the lethal anthrax. The material is in a ``weaponized'' form - that is, it has been reduced to a fine powder no bigger than 5 microns, small enough to be inhaled and penetrate the lungs and bloodstream.
Not once in his briefing rounds, including a White House meeting with Vice President Dick Cheney, did any security officer question him about his vial, said Larsen, a former chairman of the department of military strategy and operations at the National War College and currently director of the ANSER Institute for Homeland Security in Arlington, Va.
His message to government officials is simple - and stark: The United States is woefully unprepared to deal with a bioterrorist attack and the nation needs to move quickly to beef up emergency response systems, especially its public health infrastructure.
In June, Larsen was part of an elaborate war game with the ominous name ``Dark Winter.'' In the simulated attack, terrorists unleashed smallpox in three shopping malls in Oklahoma City, Atlanta and Philadelphia.
Twenty-two days after the outbreak, the disease had spread to 25 states and 15 countries, thousands of people were dead, hospitals were overwhelmed, there was rioting by those who could not obtain vaccines, and infections were predicted to increase tenfold every two to three weeks.
In the exercise, which has been the subject of two congressional hearings and numerous Capitol Hill briefings, national and state officials were forced to decide who to vaccinate. With the nation having a supply of only 12 million doses of smallpox vaccine, officials knew that many people who didn't receive it would die from the disease.
Last year, the Clinton administration signed a contract for 40 million doses of the vaccine to be ready in 2004. In the past week, the Bush administration moved the timetable up to some time in 2002.
``The biggest lesson here is that public health is a part of national security in the 21st century,'' Larsen said. ``This is a bigger threat in the 21st century than Russian missiles or nuclear weapons. We need to understand that.''
While many bioterrorism experts echo that opinion, others caution that the public is being unduly alarmed because the probability of a successful attack is very low. It is often difficult to obtain seed cultures to make the germs, particularly smallpox, they say. And converting the material to a usable weapon requires special equipment and knowledge.
``The attacks that took place on the 11th of September certainly demonstrated that terrorists can conduct a sophisticated logistical attack,'' said Amy Smithson, a biological-weapons specialist with the Henry L. Stimson Center, a think tank in Washington. ``But just because they've learned how to fly airplanes doesn't by any stretch of the imagination demonstrate an ability to overcome the series of significant technical hurdles required to effectively disperse a biological agent.
``It's not just the technical hurdles,'' she said. ``Time after time (terrorists) turn to the tools they know the best. It's relatively easy to make conventional bombs. It's so much more difficult to figure out how to release disease effectively.''
However, many experts have long been warning that Osama bin Laden's al-Qaeda network - the key suspect in the Sept. 11 attacks - and other terrorist groups have been trying to obtain biological weapons. White House Chief of Staff Andrew Card recently confirmed that terrorist organizations ``have probably found the means to use biological and chemical warfare.''
It's a case of ``low probability, but high impact,'' said Christopher Davis, chief scientist at the Veridian Corp., a defense consulting firm.
``This is not about panic, but about preparedness,'' said Davis, a former British intelligence officer. ``It's like saying, 'I hope my car never gets smashed up, but at least I've got insurance.' If we raise the bar, we make it more difficult for the perpetrator and we make the population feel that at least something is being done.''
According to Jonathan Tucker, a chemical and biological-weapons expert with the Monterey Institute of International Studies, one of the weaknesses in the U.S. public health-care system is a lack of training for doctors, nurses and others on the front lines in recognizing exotic infections and then reporting them effectively so that outbreaks can be detected early on.
For example, less than one-tenth of 1 percent of U.S. doctors have actually seen a smallpox case - mainly doctors who were in the Peace Corps before 1978, said Larsen. In the ``Dark Winter'' scenario, some of the first smallpox cases were misdiagnosed as severe adult chicken pox.
The last known case of smallpox in the world was in Somalia in 1978. The last U.S. case was in 1949. However, the United States and the former Soviet Union retained smallpox germs. Smallpox killed an estimated 300 million people in the 20th century.
With U.S. hospitals generally operating at 95 percent capacity, the nation is ill-equipped to deal with an epidemic on the scale of Dark Winter, Larsen noted.
``We made a decision in this nation to have private health care,'' Larsen said. ``I can make a lot of good arguments for that. One of the problems in terms of national security is that if you don't have excess capacity, you are going to have problems.''
Health and Human Services Secretary Tommy Thompson said over the weekend that eight staging areas around America are each stocked with 50 tons of medical supplies - including vaccines, antibiotics, gas masks and ventilators - that can be moved within hours to the site of any bioterrorist attack. He also said that 7,000 medical personnel are ready to respond to any crisis anywhere in the country.
Even if bioterrorism were not a threat, major improvements to the public health infrastructure would still be in order, Tucker said.
``The same systems that would give greater security against bioterrorism would give greater protection against natural outbreaks of diseases like the West Nile virus,'' Tucker said.
Smithson agreed: ``Among those who specialize in these issues one of the phrases often heard is that Mother Nature is the worst terrorist around.''
On the Net:
Dark Winter Bioterrorism Exercise -www.homelandsecurity.org/darkwinter/index.cfm
(Joan Lowy is a reporter for Scripps Howard News Service. E-mail LowyJ(at)shns.com)
