Senator Nunn testifies before the Senate Foreign Relations Committee

Former U.S. Senator Sam Nunn
Co-Chairman of the Nuclear Threat Initiative
Senate Foreign Relations Committee

Chairman Biden and members of the Committee, it is a privilege and honor for me today to come back to the United States Senate where I spent so much of my life. I thank you for dedicating the first of these hearings to the threats of bioterrorism and the spread of infectious diseases. Biological terrorism is one of our greatest national security threats, and one that cannot be addressed by Department of Defense standard operating procedures. The specter of a biological weapons attack – and the parallel peacetime threat of a naturally occurring infectious disease outbreak – are unique, and they deserve the time and focus you are devoting to them today.

Mr. Chairman and members of the Committee, as you may know, this past June at Andrews Air Force Base, I was a participant in the exercise Dark Winter – which simulated a biological weapons attack on the United States. It’s a lucky thing for the United States that this was just a test and not a real emergency. But, Mr. Chairman and members of the Committee, our lack of preparation is a real emergency.

Dark Winter Overview

Dark Winter simulated a series of National Security Council (NSC) meetings dealing with a terrorist attack involving the covert release of smallpox in three American cities. The exercise was conducted by the Center for Strategic and International Studies, the Johns Hopkins Center for Civilian Biodefense Studies, and the ANSER Institute for Homeland Defense, under the leadership of John Hamre, Tara O’Toole and Randy Larsen, respectively. Many of the participants in Dark Winter had served previous Presidents in cabinet or sub-cabinet positions. Most knew how the NSC worked, and they were all individuals with considerable expertise and perspective in the security, law enforcement and health fields.

I will not take the Committee’s time with a complete replay of the events, but will share with you the highlights.

In the opening minutes of Dark Winter, we learned from the Secretary of Health and Human Services that cases of smallpox had just been diagnosed by the Centers for Disease Control. Given the infectious nature of the disease, we were facing the start of a smallpox epidemic – an event with devastating, if not catastrophic, potential.

Like all of you, I received a smallpox vaccination when I was a child, but I had forgotten the horror of the disease. In the 20th century, more than 300 million people died from smallpox – more than those killed in all wars of the century combined. Thanks to a massive and highly collaborative international campaign, smallpox as a naturally occurring disease was eradicated. But once eradicated, the consequences of a smallpox outbreak have became more dangerous with each passing year as new generations of unvaccinated citizens are born and the potency of the previous vaccinations diminishes with time. Unfortunately, we know that smallpox was made into a weapon by the Soviet Union; we do not know if any other nations or groups have successfully pursued a similar goal and this should be a matter of keen intelligence focus.

Over a 24-hour period at Andrews Air Force Base, our NSC “war gamers” dealt with three weeks of simulated shock, stress and horror. I was given the role of President of the United States, and Jim Woolsey was the Director of the Central Intelligence Agency.

We learned that on December 9, 2002, some dozen patients reported to the Oklahoma City Hospital with a strange illness confirmed quickly by the CDC to be smallpox. While we only knew about the Oklahoma cases the first day, we later learned the scope of the initial infections and the sites of three simultaneous attacks in shopping centers in Oklahoma, Georgia and Pennsylvania. The initial infection quickly spread to five states and 3,000 victims although most infected individuals had not displayed symptoms or gone to the hospital in the first few days, so we did not know who they were or where they were.

We quickly learned that we had only two tools available to deal with a smallpox attack – vaccination and isolation, and we had only enough vaccine for one out of every 23 Americans.

I denied the Secretary of Defense’s demand that all 2.3 million of U.S. military personnel be immediately vaccinated wherever they were in the world. Instead, we administered vaccine to U.S. military, including the National Guard, and security and medical service personnel who were on the front lines locally and also those who were in areas of the world where a smallpox attack was more likely to occur. Our initial decision was to use our limited vaccine supply to protect health care workers, local police and fire officials, National Guard on the scene and local, state and federal officials in the line of fire. We also devised a strategy to try and put a firewall around the infections that were being reported, but that strategy was largely ineffective because of the rapid spread of the disease and our limited supply of vaccine.

So, on the first night of decision-making, we designed a vaccination strategy, and we ordered accelerated production of new stock. We asked the Secretary of State to try to find surplus stock from other countries. I will skip the agonizing details and get to the conclusions.

On Day Six of the crisis, we had very little vaccine left. We quickly faced the only alternative – forced isolation with large numbers of exposed citizens whose locations and identities remained guess work. We were down to the really tough questions. Do we force whole communities and cities to stay in their homes? How? With force? Do we physically prevent citizens in high-risk areas from fleeing their communities when they themselves may already be infected? Who provides food and care for those in forced isolation, particularly when we can no longer provide vaccine to essential providers?

One Day Twelve, when our war game ended and my brief tenure as President concluded, we were beginning the next stage of the epidemic – those who caught smallpox from the original 3,000 people who were infected in the initial terrorist attack. Our health experts told us that every two to three weeks the number of cases would increase ten-fold. To give you a glimpse of how the exercise ended, here are a few highlights from a simulated CNN broadcast:

“On Day Twelve of the worst public health crisis in America’s history, demonstrations for more vaccine in hard-hit communities disintegrated into riots and looting around the nation. Interstate commerce has stopped in several regions of the nation. A suspension of trading on America’s stock exchanges takes effect tomorrow. International commerce with the U.S. has virtually ceased.

The Centers for Disease Control report that efforts to stem the smallpox epidemic have depleted America’s inventory of smallpox vaccine. While the CDC may be out of vaccine, at least 45 Internet websites are offering what they claim are safe, effective vaccines from previously forgotten stocks. These claims have not – repeat not – been independently verified, and authorities urge caution. At least 25 more states and 10 foreign countries are reporting smallpox infections. At the United Nations, China has sponsored a resolution to censure the U.S., blaming America for reintroducing smallpox to the world. It is demanding that the U.S. supply the world with vaccine.”

In summary, Mr. Chairman, I determined from our war game that public health has become a national security issue, but that we are unprepared. We were out of vaccine. We were discussing martial law. Interstate commerce was eroding rapidly. The members of our simulated NSC, as well as state and local officials, were desperate. We came to realize too late that our country:

• Had not produced sufficient vaccine.
• Had not prepared top officials to cope with this new type of security crisis.
• Had not invested adequately in the planning and exercises absolutely necessary for coordinated response.
• Had not ensured that the public health infrastructure was adequate, with built in surge capacity.
• Had not educated the American people, or developed strategies to constructively engage the media in educating the public, about what was happening and what to do.
• Had not practiced what few plans there were in place.
• Had not ranked biological terrorism or infectious diseases as high national priorities.

Lessons Learned

Before I detail the lessons learned in this particular exercise, we should keep in mind that the results of biological attacks would vary according to the specific agent used. Technology and training for early recognition of the type of pathogen are essential. This exercise gave us valuable lessons about a possible smallpox attack. The circumstances would be very different in the case of an anthrax attack, for example. In the event of an attack using anthrax, vaccination and isolation would be irrelevant, but antibiotics would need to be administered on the scene immediately.

For the participants, the Dark Winter exercise instilled in all of us that there is much work to be done – and done quickly:

• Number one: Clearly, measures that will deter or prevent bioterrorism are the most cost effective means to counter threats to public health and social order. We need to prevent the proliferation of biological weapons, in part by strengthening intelligence gathering against such threats, but also by providing peaceful research options to scientists in the former Soviet Union.
• Two: We need to focus more attention, concern and resources on the specific threat of bioterrorism – understanding that it is different from other threats we face. Biological weapons must be countered with new protocols for securing dangerous pathogens, with increased vigilance and surveillance, as well as with increased supplies of medicines and vaccines and significantly increased training.
• Three: We need to recognize the central role of public health and medicine in this effort and engage these professionals fully as partners on the national security team. We must act on the understanding that public health is an important pillar in our national security framework.
• Four: We need to identify and put into practice the mechanisms by which all levels of government will interact and work together. It is critical that we understand our differing roles, responsibilities, capabilities, and authorities, and plan on how we will work together before an act of terrorism occurs.
• Five: We need to reexamine and modernize the legal framework for epidemic control measures and the appropriate balance with civil liberties.
• Six: There should be a clear plan for providing the news media with timely and accurate information to help save lives and prevent panic.
• Seven: We need to increase the core capacities of our public health system to detect, track and contain epidemics, by providing resources for effective surveillance systems, diagnostic laboratory facilities, and communication links to other elements of the response effort.
• Eight: The national pharmaceutical stockpile should be built to capacity, including extra production capability for drugs and vaccines, with heightened security at the various dispersal sites. We must not fall victim to a twin attack that releases a bioagent and simultaneously destroys our drugs and vaccines.
• Nine: We need to develop plans for a surge of patients in the nation’s hospitals to make the best use of existing resources in the event of an emergency. This willrequire careful advance planning, including how to utilize ancillary facilities such as gymnasiums or armories, since most hospitals are operating at or near capacity right now.
• Ten: We need to increase funding for biomedical research to develop new vaccines, new therapeutic drugs, and new rapid diagnostic tests for bioweapon agents.
• Eleven: We need to encourage the scientific community to confront the sinister potential of modern biological research, and help them devise systems and practices that ensure the safe, secure storage of, and access to, dangerous pathogens.
• Twelve: Officials at the highest levels of the federal, state, and local government need to participate in exercises like Dark Winter to understand the importance of advance preparation. Plans must be exercised, evaluated, and understood by decision-makers if they are to prove useful in a time of crisis.

Nuclear Threat Initiative-A New Foundation

Mr. Chairman and members of the Committee, encouraging and helping our government to deter, prevent, and defend against biological terrorism is a central part of our mission at the Nuclear Threat Initiative (NTI) – the organization founded by Ted Turner and guided by an experienced board that Ted and I co-chair. We are dedicated to reducing the global threat from biological, nuclear, and chemical weapons by increasing public awareness, encouraging dialogue, catalyzing action, and promoting new thinking about these dangers in this country and abroad.

We fully recognize that only our government can provide the leadership and resources to achieve our security and health priorities. But within that context, NTI is:

• Seeking ways to reduce the threat from biological weapons and their consequences.
• Exploring ways to increase education, awareness and communication among public health experts, medical professionals, and scientists, as well as among policy makers and elected officials – to make sure more and more people understand the nature and scope of the biological weapons threat.
• Considering ways to improve infectious disease surveillance around the globe – including rapid and effective detection, investigation, and response. This is a fundamental defense against any infectious disease threat, whether it occurs naturally or is released deliberately.
• Stimulating and supporting the scientific community in its efforts to limit inappropriate access to dangerous pathogens and to establish standards that will help prevent the development and spread of biological agents as weapons.
• And finally, NTI is searching for ways to help our government and the Russian government to facilitate the conversion of Russian bioweapons facilities and knowhow to peaceful purposes, to secure biomaterials for legitimate use or destruction, and to improve security of dangerous pathogens worldwide.

Concluding Remarks

Mr. Chairman, enemies don’t normally attack us where we are strong; they target us where we are weak. Enemies of the United States are not eager to engage us militarily; they saw what happened in Desert Storm. They will attack us where they believe we are vulnerable. Today, we are vulnerable to biological terrorism and those who perpetuate such an act are not likely to be quickly identified or leave a return address. It is critical that we prepare with all possible speed, because if an attack occurs, and succeeds, there will be others. Preparing is deterring.

Our first priority must be prevention. Whether the enemy achieves its objectives in an attack depends, to a large extent, on how the American people respond. Panic is as great a danger as disease. Some will respond like saints – doing whatever they can, exhibiting brave and selfless patriotism – to meet the needs of family and community. Others will respond with panic, perhaps even using violence to obtain vaccines or drugs, or try to protect themselves or their loved ones from exposure. The distance between these two is broad. How most of our citizens will respond will depend largely on what they hear from the President and their elected leaders, and how they see our government respond. This means we must be prepared.

If we are well prepared – with the ability to detect the disease quickly, report it swiftly, and implement the appropriate infection control measures, including the provision of necessary drugs or vaccines for all those who came in contact with it – then the President of the United States will address the American people with knowledge, with courage, and with confidence, and the people will respond in kind. Whether this or a future President will exert this essential leadership will depend in large part on how we all address this issue now.

I commend the Committee for tackling such a difficult but important matter. Our country’s protection and safety depend on your leadership. Thank you.