20 Years After the 2001 Anthrax Attacks, American Health Security Is in Serious Danger

By Danyale C. Kellogg, Schar School of Policy and Government, George Mason University

One week after the devastating attacks of September 11, 2001, the United States was once again met with tragedy. Beginning on September 18 that year, letters containing anthrax spores were mailed to multiple news outlets’ offices as well as the offices of U.S. Senators Tom Daschle and Patrick Leahy. Ultimately, the attacks killed five Americans and infected 17 more; contaminated at least 17 U.S. Postal Service offices, the Hart Senate Office Building, the Ford House Office Building and several news offices; and cost upwards of $1 billion in damages, including the cost of decontaminating the impacted office buildings and mail facilities, removing 31 million envelopes of interest during the investigation, and quarantining 1.8 million packages, according to the Department of Justice’s investigative summary. The ensuing investigation, spearheaded by the FBI and later termed “Amerithrax,” is to date one of the largest and most intricate in the history of U.S. law enforcement. This represented a clear threat to American public health and national security and helped identify key gaps in preparedness that could not go unaddressed.

Twenty years later, the United States is grappling with its greatest public health crisis in a century, but it has proven itself wildly unprepared for this pandemic, future pandemics, and the threat of bioterrorism. This hasn’t been for lack of attention in the immediate aftermath of the anthrax attacks. In fact, in the decade after Anthrax, the U.S. invested over $60 billion in biodefense programs designed to enhance prevention and mitigation of biological incidences. However, based on the U.S. handling of the COVID-19 pandemic, we are not ready for a public health crisis of any sort. By increasing innovations in platform technologies and more holistically addressing challenges in health security, biodefense, and pandemic preparedness the U.S. can become much better prepared for future challenges in this area.

The United States has a complicated history when it comes to assessing biological threats. The U.S. clearly underestimated the Soviet biological weapons (BW) program, miscalculating its size, breadth, and sophistication for decades. The IC also had serious gaps in its pre-1991 assessments of the Iraqi BW program, which included never identifying several production facilities, including Al Hakum. Of course, U.S. assessments of Iraqi WMDs grew worse over the next decade. It is difficult to forget the image of then Secretary of State Colin Powell holding up a model vial of anthrax during a speech before the UN Security Council in 2003. Though this was heavily influenced by faulty information from the German Federal Intelligence Service, it galvanized American and allied support for the Iraq War, demonstrating how important it is to accurately assess these kinds of threats.

Our problems are not confined to man-made threats either. Despite consistently being rated as the most prepared country for a global health crisis, including being ranked first in the most recent Global Health Security Index, the United States ranks fifth globally right now in COVID-19 deaths per 100,000 population at 200.77. This is behind just Brazil (277.59), Argentina (252.08), Mexico (208.62), and the United Kingdom (200.96), according to Johns Hopkins. This pandemic also has demonstrably threatened U.S. force readiness, as evidenced by the ordeal of the USS Roosevelt in early 2020. Furthermore, while the origin and initial outbreak of COVID-19 is unlikely to ever be completely understood, the recently released summary of the IC’s assessment of its origin indicates disagreement on several key factors within the community. This does not bode well for future biologic threats or for improving the public’s confidence in this area. These facts are particularly concerning as COVID-19 has not been as deadly compared to some historical pandemics, and the next pandemic is almost certainly coming sooner than many would like to think.

Important to consider, too, is the incredibly complex nature of the modern world. The biotechnology revolution has spurred new dual use research concerns as technologies like CRISPR-Cas9 (a genetic engineering technique that allows for cheap, precise in vivo editing) continue to proliferate. Rapid air travel and vast international commerce have made the phrase “an outbreak anywhere is an outbreak everywhere” ring true. Furthermore, the digital revolution has changed healthcare and outbreak response irreversibly, bringing with it a new slew of threats as was demonstrated by cyber attacks targeting countless companies and facilities within the COVID-19 vaccine infrastructure globally.

This all demands a whole-of-government effort with strong support from industry and academia to be ready for the next health crisis. We have obtained such a triangle to counter similar threats before, as Dr. Kendall Hoyt explains in her book, Longshot: Vaccines for National Defense, when the U.S. was able to rapidly develop and rollout ten new or improved vaccines for diseases of military significance over the course of World War II. This is incredible productivity that strong public-private collaboration afforded, and which must be replicated and generalized to combat the spectrum of threats the U.S. faces today.

Innovations in platform technologies that can ensure we are more broadly prepared to respond to future pandemics are vital to this effort. It is important that we can respond promptly and effectively to mitigate future pandemics caused by a wide variety of diseases, from certain types of influenza to other threats like nipah virus or the next Disease X. This includes platforms for diagnostics, vaccines, digital public health, and disease surveillance. The utility and desirability of such technologies are clear. For example, DARPA’s ongoing P3, or Pandemic Prevention Platform, seeks to do this with medical countermeasures, and the speed of the COVID-19 vaccine’s development and rollout is largely attributable to prior research on similar diseases and mRNA vaccines for them. This broad approach, combined with support from across the government and its partners in industry and academia, will be critical to addressing gaps in American public health preparedness and biodefense.

The twenty years since the Amerithrax attacks have seen a rise in major epidemics (including SARS, MERS, and Ebola), two pandemics (the 2009 H1N1 pandemic and the ongoing COVID-19 pandemic), increased opportunities for new infectious diseases to emerge and spread rapidly thanks to factors like ongoing urbanization and the interconnected nature of the modern world, and technological advancements that have the potential to facilitate man-made disease outbreaks. Despite prior prevention efforts, these all represent changing patterns and looming threats to national safety and security. Threats to American health security are diverse, constant, and at the heart of the intersection of public health and national security. It is critical that they are addressed as such now before it is too late once more.

Topics: Chem Bio Protection, CBRN