By David Ruppe
Global Security Newswire
The U.S. Centers for Disease Control and Prevention decision Monday not to vaccinate the entire U.S. population against smallpox relied on some difficult assumptions, a senior U.S. official and other experts told Global Security Newswire.
Some of the agency’s premises are that the risk of a smallpox attack involving significant casualties is low and that the nation’s public health officials would be able to promptly identify and contain an attack and treat the victims.
The CDC said the risks from side effects in mass vaccination are not warranted, given the low probability of an attack (see GSN, Nov. 27). It recommended instead a strategy of containing an outbreak, using rapid surveillance and vaccination of suspected victims, but D. A. Henderson, director of the U.S. Department of Health and Human Service’s Office of Public Health Preparedness, acknowledged the difficulty in making such assumptions.
“In doing a cost-benefit analysis, we’re looking at a very difficult problem, because we’re looking at on one side a probability of events which we really can’t quantify: the likelihood of a disease occurring, smallpox being reintroduced,” he said. “You can’t really come up with a quantitative measurement of cost-benefit, it’s got to be a kind of best guess based on what we know.”
The CDC concluded that the risks from a mass vaccination—which would cause severe side effects in a small, but significant, percentage of the population—outweighed the probability of a smallpox attack. Most experts agree. They cite the limited availability of the virus worldwide since a World Health Organization-led effort successfully eradicated it from nature in the late 1970s.
Weighing the Probability of an Attack
There are only two known sites that still have the smallpox-causing variola virus: the CDC in Atlanta and a Russian facility in Novosibirsk. Other countries, however, also are suspected of having the virus, although there is no hard evidence (see related GSN story, today).
A smallpox attack might also be unlikely because of the difficulty in using the virus as a weapon, Henderson said.
“It really has to take a bit of attention, in terms of keeping it cool and in some sort of condition,” he said. “Trying to dry it out and make it a powder is much more complicated than with anthrax. You put it all together, there are much more barriers there than with anthrax.
“The best we can do is say—and I think there’s a general feeling—that it’s an unlikely event, and I think fairly unlikely,” he said, adding, “but it’s not zero…and were it to be released, you’re faced with some very serious problems unlike any other disease I can think of.”
Anticipating the Severity of an Attack
Another unknowable factor is the severity of any future outbreak. While a small outbreak might be easily contained, a large-scale outbreak, perhaps surfacing in numerous cities, could overwhelm the system, experts say.
Last summer in a tabletop exercise named “Dark Winter,” multiple releases of the virus in several cities overwhelmed the public health system and produced 3 million fictional victims and 1 million deaths. Dark Winter participants, which included former government officials, identified problems such as insufficient vaccine and an unprepared surveillance, response and public health infrastructure.
A successful response could “depend upon how many are in the initial outbreak. It could be one [victim], it could be 10, it could be more,” said Amy Smithson, a senior associate at the Henry L. Stimson Center.
Jonathan Tucker, a chemical and biological weapons analyst at the Monterey Institute of International Studies and author of a recently published book on smallpox, questioned whether the nation’s infrastructure would be able to handle a severe attack.
“One assumption that this plan relies on is a very good disease surveillance capability, so that you could detect an outbreak at an early stage so that it doesn’t spread very far,” he said.
“I think [the CDC] plan makes sense if we strengthen our public health system appreciably. I think if we had an outbreak of smallpox today under present circumstances, we might not be able to detect it early enough to contain it readily.”
Calls for Mass Vaccination
In the wake of the Sept. 11 attacks against the United States and subsequent mailings of anthrax, there have been some calls for a mass smallpox vaccination of the U.S. public.
The Bush administration is contracting to procure from a private company enough vaccine for every U.S. citizen, bringing the U.S. stockpile of vaccine doses to 286 million. Health and Human Services Secretary Tommy G. Thompson announced Tuesday a $428 million contract to produce 155 million doses of smallpox vaccine by the end of 2002 (see GSN, Nov. 29).
Some lawmakers have pressured the administration to mass-vaccinate. Senator Arlen Specter (R-Pa.), in a hearing this month, called the administration’s stated time frame for procuring the doses “inadequate” and indicated he favored preventive vaccination.
“My judgment would be to have my four granddaughters vaccinated. It's one in a million that they're going to have an adverse reaction,” he said.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, also at the hearing, seemed to agree.
“What you say makes very good sense, Senator. And as a matter of fact, myself personally, my own children, I would take the risk of getting them vaccinated, if we were given the choice of having it.”
Even experts who oppose vaccinating the population as a preventive measure seem to agree that having nearly 300 million doses on hand would be a good precaution. Were a massive outbreak to occur, they say, the vaccine could effectively prevent the disease if provided to large numbers of people up to three days after they have been exposed to the virus.
“This new contract gives us the insurance that we will have more than enough vaccine for any outbreak that might occur,” Thompson said in a statement Wednesday.
Improved Surveillance Needed
To make the CDC’s containment strategy work, the nation’s public health system needs strong surveillance and rapid response capabilities, according to the experts. That is going to require some improvements, Tucker said. “There are a lot of gaps in the system. For one thing, our surveillance systems are not that good.”
“Our physicians have for quite some time not had as a basic requirement of their medical training an intensive dose of infectious disease recognition and treatment,” said Smithson. “Only infectious disease specialists have had that type of training, and even those specialists often have not encountered those more exotic diseases,” she said.
The CDC’s plan announced Monday calls for such education, and a range of other infrastructure improvements, including preparing local health care providers across the country to rapidly administer large numbers of vaccinations.
CDC bioterrorism preparedness expert Lisa Rotz said Monday that the agency currently could deliver vaccine anywhere in the country in a matter of hours. The CDC also is preparing materials for mass distribution to help physicians better identify the disease.
“This material is just now getting out there,” said Henderson.
Asked when all the reforms might be implemented, Rotz said the CDC’s plan was released “so state and local health officials can start thinking through these issues from their local perspective and how they would start implementing the control measures very rapidly.”
She said, “Obviously, certain parts of the plan would take longer to implement.”
By Greg Seigle
Global Security Newswire
Iraq and Iran are believed to be developing genetically altered biological weapons that could resist vaccines or antibiotics, thereby making them much more deadly, a wide range of intelligence sources told Global Security Newswire in recent interviews.
Baghdad and Tehran might not only possess mutant strains of anthrax or smallpox, they may already have the ability to weaponize and deliver such devastatingly lethal bioagents, according to lawmakers, Pentagon officials, U.N. inspectors, scientists, analysts and a former CIA director.
“It’s a 50-50 possibility that Iraq and Iran have genetically modified biological weapons and may have some of the potential to weaponize them today to be used as weapons of mass destruction,” U.S. representative Curt Weldon (R-Pa.) said yesterday.
“I would expect it,” said microbiologist Gary Long, a government consultant who was in the last group of U.N. Special Commission inspectors to leave Iraq in 1998. “It would prudent for us to assume that they are developing these types of awful weapons.”
“It’s the perfect weapon,” said Ken Alibek, the former Soviet scientist who headed the Soviet civilian biological warfare agency, Biopreparat, a gigantic, once-secret organization whose experimentations since 1973 created dozens of new harmful and antidote-resistant organisms. “For now, we have no treatment whatsoever for genetically modified weapons.”
While officials at the White House, CIA, State Department and the newly created Office of Homeland Security refused to comment on grounds that the topic is classified, Undersecretary of State John Bolton last week publicly accused Iraq, Iran and four other countries of pursuing biological weapons (see GSN Nov. 20).
Former Soviet Support?
Biological weapons are banned by the 1972 Biological Weapons Convention although several countries are thought to have violated the treaty to develop them, including Russia, which according to Alibek and other former Soviet scientists also has worrisome stockpiles of genetically modified agents.
Most officials and analysts believe that any large-scale advanced biological weapons programs in Iraq, Iran or elsewhere—particularly those that manufacture altered organisms—would be spearheaded by Russian scientists who are disgruntled or simply lured away by hefty salaries. Such programs could also be aided by wayward scientists from many other countries, they add.
According to Alibek, a Kazakh native who defected to the United States in 1992, there are 1,000 to 2,000 former Soviet scientists who know how to make deadly biological agents. Of these, “hundreds” have the “ultimate knowledge”—the ability to not only to grow biological organisms but also to effectively dry, mill, weaponize, deliver and disperse them over wide areas. Out of these hundreds, 100 to 200 know how to create genetically modified life forms resistant to vaccines or antibiotics, he said.
Asked where these potentially dangerous scientists are now, Alibek said, “I don’t know. It would not surprise me if some were in Baghdad or somewhere else other than Russia.”
Focus on Iraq
During a blunt speech in Geneva during a treaty conference Nov. 19, Bolton singled out Iraq as the main biological weapons threat.
Although Bolton stopped short of accusing Iraq of developing genetically altered biological diseases that could be used as devastating weapons, the State Department official who wrote the speech told GSN that “it’s a concern” and that “if they have [such] a program and we know where it is, we’re going to get it.”
U.S. analysts say the United States is actively seeking and collecting evidence on Iraqi biological weapons programs—including those that splice the gene of one bacteria into that of another, creating a new and potentially unstoppable plague—so that President George W. Bush could justify toppling the regime of Saddam Hussein.
The administration is also probing Iran and other nations for such evidence but none with the vigor it is apparently investigating Iraq, which was caught with biological weapons by UNSCOM inspectors throughout the 1990s, analysts note.
One reason White House officials are so concerned about Iraq is that its government openly applauded the Sept. 11 terrorists attacks in New York and Washington, analysts add. There has been much speculation that Saddam Hussein had a hand in either the hijackings of the four commercial jetliners or the mailings of anthrax across the United States that so far have infected 18 people and killed five.
Because the creation of genetically modified weapons is so difficult—even with knowledgeable scientists, the right equipment and sizeable funding, such a task is very painstaking—analysts believe only countries with sizeable infrastructures can accomplish this. Besides Russia, Iraq is believed to have the largest and most comprehensive biological weapons facilities, according to intelligence estimates.
Iraq is a prime suspect for developing genetically altered biological weapons not only because it attempted to hide its biological weapons arsenal from UNSCOM inspectors—investigators found some stockpiles and believe there are many more—but because Saddam Hussein has shown a willingness to use such weapons. In the late 1980s Iraqi forces gassed Kurdish villagers in Iraq with chemical weapons, probably Sarin.
According to UNSCOM inspectors and former CIA Director James Woolsey, Iraq protected its biological sites with more zest than its nuclear facilities—a strong indicator that they have something to hide.
“Even while we were there, under the most intrusive inspections, Iraq continued working on their biological weapons programs,” said Tom O’Brien, an immunologist who was a senior UNSCOM scientist. “They’re very good at hiding and deceiving.”
Why Alter Biological Weapons?
Many analysts dismiss the possibility of Iraq, Iran or other nations splicing the genes of biological agents that could be used as weapons.
Smallpox, anthrax and other diseases are deadly enough without being modified, so a country with limited resources and funds would not want to endure the time, expense and uncertainty of trying alter these agents, said several analysts, including those who also think it is plausible Iraq has done so anyway.
“Why would you want to go through all that trouble? I don’t think they’d bother,” said William Patrick III, the former head of the U.S. biological weapons program until 1969, when then-President Richard Nixon announced the United States would end its offensive biological weapons program and destroy its stockpiles.
While smallpox itself is believed to kill 30 percent of the people it infects, it could be rendered ineffective if dispersed among populations that are vaccinated, many officials said.
Currently only small numbers of the U.S. military are vaccinated against smallpox, but plans are underway to include troops in the nationwide vaccination efforts being readied by health officials.
If U.S. troops are sent to fight in the Persian Gulf region, it is likely that deploying soldiers would receive vaccinations in order to prevent mass-casualty biological attacks by Iraq or, less likely, Iran, Pentagon officials said.
Analysts observe that it is for this particular reason that Baghdad and Tehran are believed to be genetically modifying biological agents—so they can overcome any defenses U.S. troops may possess.
“If you’re practicing bioterrorism, [genetically altered agents] may not be considered more dangerous because people are not vaccinated and they would die anyway,” said Long, the former UNSCOM inspector. “But if you’re going to use it against an army that’s vaccinated then yes, it may give you a little more bang for your buck.”
Number of Altered Biological Weapons Could be Infinite
The possibilities of mutant life forms that could be used as weapons are technically endless, although through decades of experiments the Soviet Union and Russia focused on just a handful, according to Alibek and other former Soviet scientists. Many genetically altered agents turn out to be less harmful than intended, but others have proven to be extremely lethal, they said.
Perhaps the most lethal genetically modified biological agent is “blackpox,” a cross between smallpox and the Ebola virus, Alibek said.
Alibek said blackpox would combine the two most dangerous aspects of Ebola and smallpox—it would have the contagiousness of the latter and produce the severe internal hemorrhaging of Ebola.
“The only purpose of this is to kill,” Alibek remarked.
Alibek said Russia has worked on several other genetically modified bugs, including the mixture of smallpox with the Venezuelan equine encephalitis, known as “Veepox.” Like blackpox this strain would most likely be able to overcome any known vaccines or antibiotics. And Veepox, according to Alibek, would only cost “a few million dollars.”
Russia has also developed modified versions of anthrax, including the so-called Obolensk anthrax, a strain said to be resistant to known vaccines and antidotes. In December 1997, Russian scientists openly published the recipes and methods for making Obolensk anthrax in the British journal Vaccine.
Analysts note that it would be naive to believe that scientists in countries such as Iraq and Iran have not copied these procedures.
Are There Responses to New Weapons?
Pentagon officials refused recent requests for interviews on this subject, but in March, a top military medical official said his office has been working feverishly to learn about genetically modified agents so that they can learn how to defeat them.
“When it comes to genetically modified agents, there’s almost nothing we can do to protect ourselves until we know what it is—and by then it’s probably going to be too late, at least for the people that have already been infected,” said Army Col. Bob Thompson, the program manager for the Defense Department’s Office of Health Affairs. “This stuff scares the hell out of us.”
D. A. Henderson, the newly-appointed director of the Department of Health and Human Services’ Office of Public Health Preparedness, has spent a few decades studying how to eradicate diseases for a variety of U.S. and U.N. agencies. He said there is a chance that the current vaccine might turn out to be effective against genetically altered life forms.
“It protects against a whole range of biological agents. It provides a very broad base of immunity.” Henderson said. “We’re not exactly sure what it is about this [vaccine] that makes it work, but it works.”
By David Ruppe
Global Security Newswire
Iran and Iraq may have gained access to and isolated a particularly virulent strain of the smallpox virus in the early 1970s, a senior Bush administration official told Global Security Newswire this week.
It remains unclear, however, whether they or other parties took the material and used it to develop biological weapons, the official and other experts said.
The two alleged sponsors of international terrorism may have acquired the virus during a major outbreak from 1970 to 1972. It began in Afghanistan and swept into Iran, Iraq, Syria and Yugoslavia, causing thousands of people to contract the disease before it was eradicated. The WHO detailed the outbreak in a 1988 report, Smallpox and its Eradication, co-authored by D. A. Henderson.
“I know very well the Institut Pasteur in Tehran, a very good institute, certainly isolated a lot of strains of the virus,” according to Henderson, now the director of the Department of Health and Human Service’s Office of Public Health Preparedness. “They did [it], I believe, also in Iraq. It wasn’t that they didn’t have access to the virus,” he said.
Henderson was in a good position to know. He directed the World Health Organization's successful global smallpox eradication campaign from 1966 to 1977. The disease was declared eradicated from nature in 1979, although the United States and Russia keep official repositories of the virus and other countries are suspected of having kept unofficial, secret samples.
The United States lists Iran and Iraq, as well as Syria, North Korea and Libya as sponsors of international terrorism. U.S. health officials, however, have said they believe a terrorist attack using smallpox in the United States is a slim possibility and that a mass vaccination of the U.S. population is not prudent at this time (see GSN, Nov. 27).
“I think there’s a general feeling that it’s an unlikely event, and I think it’s fairly unlikely,” said Henderson, also citing difficulties in deploying the virus (see related GSN story, today).
Questions About Possession Persist
Aside from Henderson’s comments, U.S. officials have said little publicly about which countries might have smallpox in addition to Russia and the United States.
In 1998, a classified U.S. intelligence assessment of the smallpox threat summarized many anecdotal reports of stocks of the smallpox virus, including circumstantial information suggesting that Russia, North Korea and Iraq may have retained clandestine stocks of the virus for military use. Details of the report eventually were leaked to the press.
“Even there the evidence was circumstantial,” said Jonathan Tucker, a Monterey Institute for Strategic Studies bioterrorism expert. “I don’t think there’s classified intelligence that is clear-cut on this. It’s just a possibility based on circumstantial evidence.”
Additional leaks and rumors have suggested China, Cuba, India, Iran, Israel, Pakistan and Yugoslavia may have a weaponized form of the virus also, according to Tucker’s recently published book, Scourge, The Once and Future Threat of Smallpox.
Seth Carus, a senior U.S. National Defense University researcher, told a congressional committee last year that “states that may want to prosecute wars against us, including places like North Korea, perhaps Iraq, perhaps Iran, may have smallpox.”
A Deterrence Factor
The prospect of an overwhelming retaliation would be a strong disincentive for a nation using, or sharing with nonstate terrorists, smallpox viruses that could be used against the United States, said Cheryl Loeb, also an analyst at the Monterey Institute of International Studies.
Should an attack occur, the United States could “trace it back, and if we did trace it back, and considering the reaction we’ve seen in Afghanistan, consider the reaction you’d see for a weapon of mass destruction. It would be incredible,” Loeb said.
The United States and the WHO, however, may not have all known types of the smallpox virus on record.
“There have been efforts underway for a number of years to sequence a number of strains, but they’re by no means comprehensive,” said Tucker.
The FBI yesterday identified fugitive and anti-abortionist Clayton Lee Waagner as the primary suspect in a wave of anthrax hoaxes sent to abortion clinics earlier this month (see GSN, Nov. 9). Meanwhile, investigators are retracing the paths of anthrax samples sent to researchers for clues to the origin of the recent anthrax attacks.
Waagner was linked to the anthrax hoaxes by matching his fingerprints to one taken from a hoax letter, an FBI official said. Waagner allegedly told fellow anti-abortion activist Neal Horsely that he had sent the letters, the Washington Post reported. Horsely, who runs a Web site called the Nuremberg Files that lists abortion providers, said that Waagner made the admission when he took Horsely hostage in his own home last Friday (Eggen/Slevin, Washington Post, Nov. 30).
Waagner, a self-proclaimed anti-abortionist, escaped in February from federal custody where he had been convicted on federal charges related to weapons violations and stolen cars.
“The Department of Justice considers Waagner’s threats and all anthrax hoaxes to be serious violations of federal law,” said U.S. Attorney General John Ashcroft (Megan Garvey, Los Angeles Times, Nov. 30).
Investigation Continues
Efforts to examine the anthrax spores in a letter mailed to Senate Majority Leader Tom Daschle (D-S.D.) showed the need for investigators to come up with an intricate plan to open the tainted letter mailed to Senator Patrick Leahy (D-Vt.), the Washington Post reported yesterday.
As scientists placed the spores from the Daschle letter on microscope slides, the spores floated off the surface, the Post reported. When the scientists tried to weigh the spores, again they became airborne due to tiny drafts and table vibrations. Finally, scientists doused the spores in liquid chemicals and coated others in paraffin wax before examining them.
Investigators examining the Leahy letter have come up with a detailed plan for opening the letter and maximizing recoverable evidence (see GSN, Nov. 29). Over the last few days, they have conducted test openings on a “body-double” envelope wrapped in tape like the Leahy letter, the Post reported.
“The U.S. Army and the FBI … know the sample is precious,” said Maj. Gen. John Parker, commander of the U.S. Army Medical Research and Material Command Center. “They want to make every study count toward the end of linking the sample to the perpetrator.”
The Leahy letter is particularly valuable because other anthrax samples have been virtually exhausted. Some of the anthrax in the Daschle letter was lost when it was opened by an aide, and the rest has been used by scientists. The letter to the New York Post got wet before it was opened, turning the contents into an unworkable mass resembling “Purina Dog Chow,” according to U.S. Army scientists. As for the letter to NBC News anchor Tom Brokaw, very few spores remained after opening the letter, according to the U.S. Army (Rick Weiss, Washington Post, Nov. 29).
Investigators examining how the culprit might have acquired a sample of the Ames strain of anthrax have found that the distribution of the strain is much more limited than previously thought, according to government documents. It may even be limited to about a dozen labs, an anthrax researcher said.
The FBI’s investigation has moved “way beyond” the short list of laboratories that received samples of the Ames strain, FBI spokesman Mike Kortan said yesterday. The short list was used as a guide for investigators to trace any possible movements of the strain, according to a government official.
Since the 1980s, the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) has sent samples of the Ames anthrax strain to U.S., Canadian and British researchers, according to the Washington Post. The list of facilities includes the University of New Mexico, Dugway Proving Ground in Utah and Porton Down in Britain, which in turn sent Ames anthrax to two other U.S. universities in Arizona and Louisiana, the Post reported.
The U.S. military sent out the Ames anthrax strain to “legitimate workers in the field” under strict controls, said USAMRIID senior research scientist Col. Arthur Friedlander. “This is not a cavalier thing that one does,” Friedlander said. “When anyone isolates strains, they are shared through the scientific community. That’s how research gets done. It follows a long tradition of collaboration with people that we are familiar with.”
The small number of laboratories known to have possessed the Ames strain should make it easier for investigators to narrow down who might be responsible, Friedlander said. “The world of anthrax researchers is quite small. There isn’t a large group of people working with fully virulent strains,” he said. “Obviously, if there were 1,000 labs it would be a different order of magnitude than if there were only a handful” (Fainaru/Warrick, Washington Post, Nov. 30).
Washington Christmas Cards to be Delivered on Time
Washington mail service is returning to normal, even though thousands of letters held in the anthrax-tainted Brentwood Road postal facility are just now getting to their destinations, a U.S. Postal Service spokeswoman said this week.
The Brentwood facility is still closed, but Washington mail is being sorted at suburban mail centers, according to the Washington Post. The letters stuck inside Brentwood when it was closed have been sent to Lima, Ohio, for sanitizing.
“Most of that mail is being wrapped in a small bag with a note that explains why it is postmarked in October but only being delivered now, said Postal Service spokeswoman Deborah Yackley. “Some of it won’t be bagged and marked, but all of it will be sanitized… Our goal with this batch of mail is safety rather than speed” (Neely Tucker, Washington Post, Nov. 30).
The plan to administer a smallpox vaccine would cost more than twice as much as the recently negotiated cost of $500 million to purchase the vaccine (see GSN, Nov. 29), U.S. Centers for Disease Control and Prevention Director Jeffrey Koplan said in a U.S. Senate hearing yesterday.
The CDC would need about $3 billion to fully prepare for a biological warfare attack, Koplan said. Other public health agencies added that they would need more money than the $1.5 billion Health and Human Services Secretary Tommy Thompson requested for bioterrorism prevention and response. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is launching several research projects that could cost up to $200 million, which the Bush administration did not include in its budget, NIAID Director Anthony Fauci said.
“The administration is trying to do this on the cheap,” said Senator Tom Harkin (D-Iowa). “The White House is not recognizing what really needs to be done, so we’re going to have to do the job.”
Several senators have proposed other bioterrorism spending plans. Harkin and Senator Arlen Specter (R-Pa.) have proposed spending $4 billion, according to the Washington Post. Senators Edward Kennedy (D-Mass.) and Bill Frist (R-Tenn.) have a similar plan that would spend $3.2 billion.
The remarks of Koplan and Fauci were “wish lists” and Thompson remained committed to his original budget request, said HHS spokesman William Pierce. When asked if his projects could be delayed, Koplan said, “We’re facing risks now” (Ceci Connolly, Washington Post, Nov. 30).
The United States made a sensible recommendation that parties to the Biological Weapons Convention develop ways to investigate and report infectious disease outbreaks and support the World Health Organization (see GSN, Nov. 29), but it should not wait for an international agreement before acting, said Henry Sokolski of the Nonproliferation Policy Education Center in the National Review this week.
The WHO has advocated for some time that countries monitor the outbreak of infectious diseases, but member states have only agreed to monitor and report on yellow fever, plague and cholera, Sokolski said, adding that most of the reporting focused on confirmed outbreaks rather than information that could help prevent epidemics. Monitoring and reporting is too important to wait for international agreements, so the United States should begin implementing measures unilaterally and with partner countries.
After the Sept. 11 attacks on New York and Washington, the United States authorized expanding the Rapid Syndrome Validation Project (R.S.V.P.) from New Mexico to other states. The system uses computers and the Internet to allow doctors to report certain symptoms quickly and easily to public health officials. The cost for establishing 10,000 reporting stations internationally would cost about $20 million, according to Alan Zelicoff of Sandia Laboratory, who developed the system. The United States should immediately begin establishing such stations in partner countries, Sokolski said (Henry Sokolski, National Review, Nov. 29).
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