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Lessons from Israel on preparing for a deadly bio-attack

Operation Orange Flame 4

On a warm, sunny day last January, two terrorists flew into Israel on a commercial airliner. One of them checked into a Tel Aviv hotel, and was found dead in his room about 20 hours later, apparently from the devastating effects of a biological agent that Israeli physicians were unable to identify.

Meanwhile, the second terrorist carried the same bio-agent to a nearby sports stadium and attempted to “aerosolize” the deadly agent so it could attack – and perhaps kill – thousands of spectators.

Emergency response officials in Israel tried to cope with the impending catastrophe by opening eight “response centers” across the country, each of which could process about 200 patients per hour by administering viral agents to those individuals they deemed most likely to have been exposed to the bio-attack. But health authorities quickly realized that the magnitude of the threat had out-run the nation’s determined efforts to stockpile sufficient viral agents and prepare for such a biological disaster.

Needless to say, this horrific episode would have generated banner headlines around the world, were it not for the fact that it was simply a hypothetical scenario, played out across Israel as part of that nation’s “Operation Orange Flame 4” bio-terrorism exercise.

In order to develop an overall game plan for coping with a terrorist attack involving anthrax, small pox, Q fever or other bio-agents – and then putting Israeli first responders, police, doctors, hospital workers and ordinary citizens through a realistic depiction of such a crisis -- Israel mounts a version of Operation Orange Flame every two years. The next exercise is planned for January 2012.

In an effort to draw inspiration from the pace-setting Orange Flame 4 exercise, and to discuss the steps necessary for the U.S. to better prepare its citizenry for a similar bio-attack, a group of physicians, think-tank scholars and would-be policy makers met in a conference room at the George Washington University Hospital, in Washington, DC, on June 23 to discuss such nightmare bio-terror scenarios.

The special guest and lead-off speaker was Dr. Yehuda Danon, a professor of pediatrics at Tel Aviv University and a former Surgeon General of the State of Israel, who has been intimately involved in the Orange Flame exercises for years. Danon told the group that the tiny nation of Israel had an extraordinarily sophisticated nationwide medical system, which maintains complete medical records for every citizen – including medical histories, lab tests, diagnostic imagery results and more – that can be immediately accessed by physicians at each of the country’s 23 inter-connected hospitals.

The immediate availability of medical diagnoses throughout the country can help authorities spot significant clusters of medical events digitally, even before a pattern can even be discerned by human public health officials. “The system can diagnose any unusual event,” said Dr. Danon.

Israel has drawn numerous lessens from its past exercises, as well as a few real-world attacks it sustained in recent decades. For example, during the first Gulf War, in 1990-1991, when Iraq fired missiles that might have contained deadly bio-agents at Tel Aviv and other Israeli cities, about 47 percent of the doctors and nurses summoned to their emergency response duties turned out to be “No Shows,” as Dr. Danon put it, “because they had families they had to take care of.”

To address this dire “No Show” situation, Israel has launched a unique and ambitious program to provide prophylactic vaccines to all of its first responders that could protect them against small pox and other bio-threats. True, some first responders might be reluctant to take the vaccine prior to an attack, Dr. Danon acknowledged – he called this phenomenon “vaccine-o-phobia” -- but on-balance the risk of being exposed to a deadly bio-agent will probably be seen as more worrisome than the risk of taking the vaccine itself, he predicted.

One of the few Americans to witness the Orange Flame bio-terrorism exercise in Israel last January was Dr. Eric Rose, the chairman of the department of health policy at Mount Sinai School of Medicine in Manhattan and the CEO of Siga Technologies, Inc., an entrepreneurial company based in New York City that develops viral agents that can be used after a bio-attack. He said he was impressed with the realism and comprehensiveness of the Israeli simulation, and chagrinned that the U.S. Government has not organized similar bio-terrorism exercises in the United States. One of the nation’s highest priorities, said Dr. Rose, should be the creation of a “drilling and simulation culture.”

As part of the Orange Flame 4 exercise, when authorities supposedly discovered they were in dire need of additional doses of the smallpox antiviral ST-246, they reached out to Dr. Rose’s company, Siga Technologies, and quickly negotiated the purchase of thousands of additional doses, which were to be flown immediately from New York to Israel.

Dr. Rose drew an important lesson from that hypothetical scenario. “If we don’t master the logistics [of shipping viral agents to locations where they’re desperately needed],” he said, “all the great science in the world will be useless.”

Barry Kellman, another participant in the symposium, is president of the International Security and Biopolicy Institute, of Washington, DC, and a professor of law at DePaul College of Law in Chicago. Kellman has been trying to develop the legal framework for common prosecution standards for bio-terrorism-related crimes that could be applied in each of the countries of the Middle East. The nations of Israel, Jordan, Egypt, Iraq, Iran, the UAE and others may not agree with each other on a wide variety of political issues, Kellman suggested, but they all share a common a desire to prevent any bio-attack in their region. “This is an area where we can make real progress,” he told his audience at the symposium, organized by the Homeland Security Policy Institute at The George Washington University.

On the issue of vigilance, Kellman finds the situation in the Middle East woefully inadequate. To illustrate the point, he said he used to carry a vial of powdered sugar -- which looks an awful lot like a vial of powdered anthrax – whenever he passed through an airport checkpoint, as an informal test of the security apparatus, but he was never stopped by screening personnel in any airport. These incidents, and years of observation, have led Kellman to the conclusion that all countries in the Middle East are “sitting ducks” if a terrorist chose to launch a bio-attack on their soil.

As for advanced planning, “only Israel can talk about preparedness,” said Kellman. Throughout the Middle East, he argued, “there is a gross deficiency of preparedness.”

The same could be said for much of the world, generally, and the U.S., specifically, according to several participants, during the question-and-answer period that followed the formal remarks.

Kellman said that in his view the real issue is not what the U.S. is prepared to do after a bio-attack. The real issue is what the U.S. is prepared to do before an attack. He posed the ultimate query: “How do we build a system that is so robust that we don’t need to use it?”


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