[Bioterror] Take a few monments and read this

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It is in your best interest to take a few minutes, go to the Johns-Hopkins Site and read about the Dark Winter Bioterrorism Exercise

http://www.hopkins-biodefense.org/

Definitly look at the slide show if nothing else.

ExCop

-- Anonymous, October 04, 2001

Answers

ExCop,

Thanks.

For all others, here is a hot link.

-- Anonymous, October 04, 2001


Hi Ex-Cop!

-- Anonymous, October 04, 2001

The link worked, but the site wouldn't let me look at the slide show.

-- Anonymous, October 04, 2001

SHINING LIGHT ON DARK WINTER Tara O'Toole, MD, MPH Thomas Inglesby, MD Johns Hopkins Center for Civilian Biodefense Studies

On June 22 - 23, 2001 The Johns Hopkins Center for Civilian Biodefense Studies, in conjunction with The Center for Strategic and International Studies, The ANSER Institute for Homeland Security, and The Oklahoma National Memorial Institute for the Prevention of Terrorism, held an exercise at Andrews Air Force Base in Washington, DC entitled DARK WINTER. The first such exercise of its kind, DARK WINTER was constructed as a series of mock National Security Council (NSC) meetings in reaction to a fictional, covert smallpox attack in the US.

EXERCISE DESIGN

Participants

12 former senior government officials portrayed members of a National Security Council responding to an evolving epidemic crisis. Former Senator Sam Nunn played the role of the President of the United States. (Other participants are cited in Appendix A.) 5 distinguished representatives from the media acted as journalists during a mock press conference within the exercise. 50 individuals with current or former policy or operational responsibilities related to biological weapons preparedness observed the exercise. Structure

The exercise simulated a time span of about 2 weeks and was divided into three segments ( December 9th, 15th, and 22nd) as NSC meetings. Key players obtained information on which to act through a variety of channels: Briefings to the NSC meeting by exercise controllers playing the roles of deputies or special assistants. Newspaper summaries and video news clips as stories "broke" and were seen by the nation over the course of the epidemic. Memos on issues or events within the purview of an individual's position or agency. NSC members debated and acted upon a range of policy options. Decisions made in one segment structured possible alternatives in the subsequent segments. SCENARIO HIGHLIGHTS

Segment 1, December 9, 2002

Situation Iraq suspected of reconstituting its bioweapons program. Iraqi forces moving into offensive positions along the Kuwait border. 20 confirmed smallpox cases in Oklahoma. Additional, suspect cases in Georgia and Pennsylvania. Key Issues and Decisions What is best containment strategy with only 12 million doses of vaccine? Who are priority vaccine recipients (e.g. military or civilian, all or some states, critical personnel and family members)? What to tell the public? Segment 2, December 15, 2002

Situation 2000 cases in 15 states; isolated cases in Canada, Mexico and the U.K. Dwindling vaccine supply, overwhelmed healthcare system, social unrest. International borders closed to US trade and travel; some state borders closed. Intense media coverage; scrutiny and criticism of government response. Sporadic violence against minorities who appear to be of Arabic descent. Key Issues and Decisions How to meet homeland security and disease containment needs while maintaining international commitments? What alternative epidemic controls (e.g., quarantine, travel restriction) are possible? What about economic disruption and civil rights infringement? What assistance can the federal government offer states? What is the role of the National Guard? Is the nation at war? Segment 3, December 22, 2002

Situation 16,000 cases in 25 states with 1000 deaths; 10 other countries with reported cases. Grim predictions: within 3 weeks as many as 300,000 total victims - 1/3 to die. Uncertainty whether new cases are due to identified contacts, contacts not vaccinated in time, ineffective vaccine, new attacks or some combination. Depleted vaccine supplies, with no new stocks ready for 4 weeks. National economy suffering; food shortages; states restrict nonessential travel. Key Issues and Decisions What containment strategy with no vaccine? Can continuity of government be maintained? If unknown perpetrator finally discovered, what kind of response by US? CAVEATS

Lessons synthesized by Johns Hopkins Biodefense staff were based upon review and analysis of the following: Important comments and decisions made by exercise participants. Subsequent Congressional testimony from key participants. Interviews with key participants. Lessons in this document reflect the conclusions and interpretations of the Johns Hopkins Center for Civilian Biodefense Studies and do not necessarily reflect the views of the participants or the other collaborating organizations. DARK WINTER was a "not for attribution without permission from individual participants" exercise. Where comments are attributed, permission has been obtained from participants. LESSONS OF DARK WINTER

1. Leaders are unfamiliar with the character of bioterrorist attacks, available policy options and their consequences

The consequences of a bioterrorist attack would be substantially different from the terrorist events of September 11, 2001. The senior decision-makers in Dark Winter were largely unfamiliar with the sequence of events that would follow bioterrorist attacks. Key decisions and their implications were dependent on public health strategies and the possible mechanisms to care for large numbers of sick people - issues not typically briefed or studied in the national security or defense community. "We are used to thinking about health problems as naturally occurring problems outside the framework of a malicious actor... If you're going against someone who is using a tool that you're not used to having him use - disease - and using it toward - quite rationally and craftily, but using it toward an entirely unreasonable and god awful end - we are in a world we haven't ever really been in before." - Senior Dark Winter Participant

"This was very revealing to me - that there is something out there that can cause havoc in my state that I know nothing about, and for that matter, the federal family doesn't know a whole lot either." - Senior Dark Winter Participant

"My feeling here was the biggest deficiency was, how do I think about this? This is not a standard problem that I'm presented in the national security arena. I know how to think about that, I've been trained to think about that... - a certain amount of what I think went [on] around this table was, 'I don't get it. I'm not in gear in terms of how to think about this problem as a decision-maker. So then I get very tentative in terms of what to do.'" - Senior Dark Winter Participant

"...this was unique...[you know] that you're in for a long term problem, and it's going to get worse and worse and worse and worse and worse." - Senior Dark Winter Participant

2. Following a bioterrorist attack, leaders' key decisions would depend on data and expertise from medical and public health sectors

In Dark Winter, even after the smallpox attack was recognized, decision-makers were confronted with many uncertainties and wanted information that was not immediately available. (In fact, they were given more information on locations and numbers of infected persons than would likely be available in reality.) For example, it was difficult to identify the locations of the original attacks; know how many persons were exposed; find out how many were hospitalized and where; or, keep track of how many had been vaccinated. This lack of information critical for leaders' situational awareness in Dark Winter reflects the fact that few systems exist for rapid flow of this type of information in the medical and public health sectors in US. "What's the worst case? To make decisions on how much risk to take...whether to use vaccines, whether to isolate people, whether to quarantine people...I've got to know what the worst case is." - Senior Dark Winter Participant

"You can't respond and make decisions unless you have the crispest, most current, and the best information. And that's what strikes me as a civil leader...that is...clearly missing." - Senior Dark Winter Participant

3. The lack of sufficient vaccine or drugs to prevent the spread of disease severely limited management options

In Dark Winter, smallpox vaccine shortages had significant impact on the response available to contain the epidemic, as well as the ability of political leaders to offer reassurance to the American people. Emergency (crash) vaccine production strategies were untested and uncertain. Populations in affected states were frantic to get vaccine, while populations in unaffected states were worried that no vaccine would be left by the time the epidemic spread to their communities. The increasing scarcity of smallpox vaccine led to violence and flight by persons desperate to get vaccinated, and it had great impact on the decisions taken by political leaders. "We can't ration...Who do you choose and who do you not choose to get vaccinated?... People are going to go where the vaccine is. And if they know that you're going to provide the vaccine to my people, they'll stay to get vaccinated. I think they'll run if they think the vaccine is somewhere else." - Senior Dark Winter Participant

"...[I]f we had had adequate vaccine supplies,...we would have had more strategies to help deal with this thing and help control the epidemic." - Senior Dark Winter Participant

4. The US health care system lacks the surge capacity to deal with mass casualties

In Dark Winter, hospital systems across the country were flooded with demands for patient care. The demand was highest in the cities and states directly attacked, but victims were geographically dispersed, with some having traveled far from the original site of attack. The numbers of people flooding into hospitals across the country included people with common illnesses who feared they had smallpox as well as the worried well. The challenges of distinguishing the sick from the well, of rationing scarce resources, and of shortages of health care staff worried about becoming infected or about bringing infection home to their families all imposed a huge burden on the medical system. "...[W]e think an enemy of the United States could attack us with smallpox or with anthrax - whatever - and we really don't prepare for it, we have no vaccines for it - that's astonishing. That's like, for me, in [my state], where we do have tornados, to be assiduously studying hurricanes, or not studying tornados." - Senior Dark Winter Participant

"It isn't just [a matter of] buying more vaccine. It's a question of how we integrate these [public health and national security communities] in ways that allow us to deal with various facets of the problem." - Senior Dark Winter Participant

5. To end a disease outbreak after a bioterrorist attack, decision- makers will require ongoing expert advice from senior public health and medical leaders

The leaders in Dark Winter were confronted with rapidly dwindling supplies of smallpox vaccine and an expanding smallpox epidemic. Some advised imposition of geographic quarantines around affected areas, but the implications of these measures, e.g. cessation of normal flows of medicines, food and energy supplies, and other critical needs, were not clearly understood at first. In the end, it is not clear that such draconian measures would have led to more effective interruption of disease spread. "...[A] complete quarantine would isolate people so that they would not be able to be fed, and they would not have medical [care]... So we can't have a complete quarantine. We are, in effect, asking the governors to restrict travel from their states that would be non- essential. We can't slam down the entire society." - Senior Dark Winter Participant

6. Federal and state priorities may be unclear, differ or conflict, authorities may be uncertain, and constitutional issues may arise

In Dark Winter, tensions rapidly developed between state and federal authorities in multiple contexts. State leaders wanted control of decisions regarding imposition of disease containment measures - e.g. mandatory vs. voluntary isolation and vaccination; closure of state borders to all traffic and transportation; when or if to close airports. Federal officials argued that such issues were best decided on a national basis to ensure consistency and to give the president maximum control of military and public safety assets. Leaders in states most affected by smallpox wanted immediate access to smallpox vaccine for all citizens of their states, but the federal government had to balance these requests against military and other national priorities. State leaders were opposed to federalizing the National Guard on which they were relying to support logistical and public supply needs. A number of federal leaders argued that the National Guard should be federalized. "My fellow governors are not going to permit you to make our states leper colonies. We'll determine the nature and extent of the isolation of our citizens...you're going to say that people can't gather. That's not your [the federal government's] function. That's the function, if it's the function of anybody, of state and local officials." - Senior Dark Winter Participant

"Mr. President, this question got settled at Appomattox. You need to federalize the National Guard..." - Senior Dark Winter Participant

"We're going to have absolute chaos if we start having war between the federal government and the state government." - Senior Dark Winter Participant

7. The individual actions of US citizens will be critical in ending the spread of contagious disease - leaders must gain the trust and sustained cooperation of the American people

Dark Winter participants worried that it would not be possible to forcibly impose vaccination or travel restrictions on large groups of the population without their general cooperation. To gain that cooperation, the president and other leaders in the Dark Winter exercise recognized a the importance or persuading their constituents that there was fairness in the distribution of vaccine and other scarce resources, that the disease containment measures were for the general good of society, that all possible measures were being taken to prevent the further spread of the disease, and that the government remained firmly in control despite the expanding epidemic. "For one thing, the federal government has to have the cooperation from the American people. There is no federal force out there that can require three hundred million people to take steps they don't want to take." - Senior Dark Winter Participant

APPENDIX A

Key Participants

President The Hon. Sam Nunn National Security Advisor The Hon. David Gergen Director of Central Intelligence The Hon. R. James Woolsey Secretary of Defense The Hon. John White Chairman, Joint Chiefs of Staff General John Tilelli (USA, Ret.) Secretary of Health & Human Services The Hon. Margaret Hamburg Secretary of State The Hon. Frank Wisner Attorney General The Hon. George Terwilliger Director, Federal Emergency Management Agency Mr. Jerome Hauer Director, Federal Bureau of Investigation The Hon. William Sessions Governor of Oklahoma The Hon. Frank Keating Press Secretary, Gov. Frank Keating (OK) Mr. Dan Mahoney Correspondent, NBC News Mr. Jim Miklaszewski Pentagon Producer, CBS News Ms. Mary Walsh Reporter, British Broadcasting Corporation Ms. Sian Edwards Reporter, The New York Times Ms. Judith Miller Reporter, Freelance Mr. Lester Reingold

Tara O'Toole and Thomas Inglesby of the Johns Hopkins Center for Civilian Biodefense Studies, and Randy Larsen and Mark DeMier of Analytic Services Inc. (ANSER) were the principal designers, authors and controllers of the DARK WINTER exercise. John Hamre of the Center for Strategic and International Studies (CSIS) initiated and conceived of an exercise wherein senior former officials would respond to a bioweapon induced national security crisis. Sue Reingold of CSIS managed administrative and logistical arrangements for the exercise. General Dennis Reimer of the Memorial Institute for the Prevention of Terrorism (MIPT) provided funding for exercise.

-- Anonymous, October 04, 2001


ex-cop, I took the link, gave you credit for the post, and cross posted this at IC...I just heard about Dark winter this morning on a radio talk show......my blood ran cold!

thanks for the post..and thanks, sheeple for the hot link..it worked for me...ps, sheeple..I posted another dream I had this morning..I was gone all day finishing the preps!

-- Anonymous, October 04, 2001



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