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  1. UNDERSTANDING BIOTERRORISM: The United States Conference of MayorsMayors Emergency, Safety & Security SummitOctober 24, 2001 Tara O’Toole, MD, MPH

  2. www. hopkins-biodefense.edu

  3. Lethality Mirroring Nuclear Weapons

  4. Bioweapons Program in Iraq

  5. Gaseous Diffusion Plant

  6. Germ fermenters at the former Bioweapons plant in Stepnogorsk, Kazakhstan, which are now being dismantled with American aid.

  7. Advances in Biotech, Genomics: Potential for More Potent Bioweapons • Understanding genetics of virulence, antibiotic resistance • Development of global profiles of microorganisms • New ways to control interaction of human cells and microorganisms • Manipulation of entire genomes

  8. Global Interconnectedness and Vulnerability:Enhanced Conditions for Swift Spread of Infectious Disease • Antibiotic Resistance • Urbanization - Crowding, Poor Sanitation, Malnutrition • Human Intrusion • International Travel and Commerce • Globalization of Food Supply

  9. The Consequences of a Biological Weapon Attack Would be an Epidemic The response required is fundamentally different from that demanded by natural disasters, conventional explosives, chemical terrorism or nuclear weapons

  10. Child with Smallpox in Evolution

  11. “Top 6” Bioweapon Agents Smallpox Anthrax • Plague  Tularemia  Botulinum Toxin  Viral Hemorrhagic Fevers Contagious

  12. Smallpox • Worst case threat? • Weaponized by Soviets - Others? • Contagious - spreads via inhalation • Vaccine effective even 3-4 days after exposure • No treatment, 30% mortality • Current vaccine: 15m doses, more coming

  13. Bioweapon Response - Vulnerabilities • Public Health • Medical Care • Technologies • Connectedness: Communications, Coordination, Collaboration

  14. Vulnerabilities – Public Health “System” • Fragmented • Understaffed, underfunded • No surge capacity • Strategic / operational capabilities

  15. Vulnerabilities – Medical Care “System” • No surge capacity – hospitals, pharmacies • Autonomous organizations • Hospitals, doctors not engaged in Bioterrorism preparedness

  16. Vulnerabilities – R + D + P Needs • Rapid reliable diagnostics • Vaccines, drugs for major agents • Connect Response Sectors: Information Flows

  17. What Mayors Should Do? • Engage clinicians, hospital leaders • Connect Medicine and Public Health • 24x7 Public Health Response - Outbreak investigation - Distribution of drugs, vaccine 4. Assess Lab Capacity • Establish Communication Links • Identify technical advisors

  18. Engage Hospitals • Review disaster plans: mass casualty, contagious dz • Educate Staff • Community – wide response • Communications – external & internal • Review Inventories of drugs, supplies