Emerging Threats Assessments Conference Summary Principal Investigator: Lewis Duncan, Ph.D., Dean, Thayer School of Engineering Conference Chairman & Organizer: Joseph Rosen, M.D., Dartmouth Medical School Emerging Threats - Biological Terrorism A Technology-Based Threat Assessment Workshop July 7 - 9, 2000 Purpose Assess the Present & Future Threat from the Use of Biological Weapons and Cyber Attacks by Terrorists, and to Help Better prepare for such Catastrophic Events Scope Broad-based Threat and Action Assessment Involving a Range of Technical and Other Professionals Anticipated Results Clearer Threat Assessment Refined Key Research and Action Issues Recommendations for Governmental, Public Health, & Other Organizations Disclaimer: The opinions expressed are personal and are not attributable to any group or organization unless explicitly expressed. Conference Summary Friday morning Richard Scribner, Ph.D., acting director, ISTS, opened the meeting. He welcomed the conference and briefly reviewed the history and mission of ISTS, inviting conferees to approach him for more information. He then introduced Joseph Rosen, M.D., as the conference director. Dr. Rosen welcomed the attendees and pointed out the significance of the conference's mission to peer into the future and help the United States set research priorities regarding emerging biological threats. Dr. Rosen introduced the morning's first panel. Brian Sullivan, Ph.D. (writer, consultant, former professor at the Naval War College and the National Defense University) was the first of two speakers for the Threat Panel Discussion. Dr. Sullivan stated his belief that acts of terrorism are frequently found in history and armed conflicts. The United States had episodes of tar and feathering British tax collectors before the Revolutionary War, a cause of painful burns meant to intimidate to accomplish a political end. Brian reviewed how the Irish Republican Army sought to use terrorism to intimidate and to cause martyrs for the populace to revere. In response, the British sought to jail rather than kill terrorists. The extent of the British desire for good public relations was their policy not to chase terrorists into Ireland during hot pursuit. Brian Sullivan then discussed how coordinatation and commensurate response may be very complex. He raised the issue of what level of attribution is necessary before considering retaliating on a state sponsor, asking what type of response is justifiable? He stressed how counterterrorism could be a victim of its own success-the need for prevention without publicity causing the unaware public to discount the need to prepare for future acts. Why are we a target? Brian believes it is our power, with the resentment, which it causes. Barbara Seiders, Ph.D. (Pacific Northwest National Laboratory) then reviewed the nature of biothreats. While her talk was mostly on viable organisms, she pointed out that biological toxins are potent and easily isolated. They fall under both chemical and biological weapon conventions. Barbara told about how she used beer-making equipment, bought at a local store, to research making these agents. They are cheap and easy to produce. She found that they don't require sophisticated equipment or expertise. Many materials and equipment have a dual purpose, with use in the food or medical industries, making their control problematic. First sign of attack can takes days to detect. They can be difficult to detect in the environment in the absence of an explosive dissemination. A couple of points were brought up in the discussion following these presentations. There was a discussion of the differences in response to chemical and biological incidents by first responders. The point was also made that public health personnel may be first responders to biological attacks which have delayed onset of symptoms. There was also a discussion of how modern treaties apply to nations, but may not technically apply to unrecognized countries, such as Afghanistan. The second threat panel combined talks on biothreats with cyberthreats. Raymond Zilinskas, Ph.D. (Monterey Institute of International Studies), reviewed his white paper, Possible Terrorist Use of Modern Biotechnology Techniques. This paper reviewed a collaborative effort of the National Defense University (NDU) and Monterey Institute to assess the impact that scientific advances may have on biological terrorism for the next five years. This panel reviewed major areas of advances and concluded that there was no probable, practical threat over the next 5 years from these advances. For many of the advances, the scientific concept of pleiotropism is a major obstacle. This is the creation of unwanted side-effects when altering nature to achieve a desired effect. A single gene may influence several distinct and seemingly unrelated phenotypic expressions, making genetic manipulation quite complicated for unexpected results. Another point that many books and Dr. Zilinskas make is that the manufacture of dry powder aerosol is the main barrier to using a biological organism to kill many people. Meteorological factors are also a complicating factor, which for example, causes 80% of scientific tests attempting to study this to be scrubbed. A second issue that Ray raised in his paper regarded how terrorists might be hindered by limited ability to field test their discoveries but also asking whether we would detect failed attacks as such? Ray's presentation stimulated some discussion. Milton Leitenberg believes that it is misleading to overestimate the scientific capabilities of terrorist groups. In the many studies in which he has participated, or reviewed, there is no evidence that expertise in biological weapons has been obtained by terrorists. However, Leitenberg did concur that, if biological terrorism did happen, it would be catastrophic. He also argued that the conference keeps slipping into assumptions about what international states can do, rather than terrorists. Dr. Rosen wished to emphasize the question "Is it possible?" not, "Is it likely, or probable?' The mission of this conference is to help better prepare for such catastrophic events. Leitenberg insists that it is essential for the United States to take a strong stance to discourage terrorist acts. From a public relations perspective, overstating risks will not contribute to constructive changes. He reiterated his perspective later, serving on the public discussion panel. Dennis Klinman, M.D., Ph.D., called genetic engineering "child's play," in today's modern lab. Dennis points to incredible advances over past ten years and the good number of graduate students familiar with them. When challenged about the practicality, he replied with this example: take the animal host of Respiratory Syncytial Virus (RSV), infect the animals to select the most virulent mutants, repeat this process every three months with the selected organisms, and, quite soon, one will have a biological WMD. Michael Ascher, M.D. (Chief, Viral and Rickettsial Disease Laboratory, California Department of Health Services) stood up and made the following pints. While he was aware of historical evidence of the difficulty the U.S. had researching biological weapons, modern medicine and recent public health outbreaks illustrate the danger which we face. Mike emphasized the importance of preparing the public health infrastructure to be prepared. Mother nature can accomplish many tricks. HIV and other recent infections demonstrate new threats and evolution to avoid the body's natural defense. Looking into the future, may one day be able to vaccinate through breakfast cereal. Could foresee the release of drug resistant infections to challenge health system. Pneumococcus and TB are examples. Other recent viruses, Ebola, yellow fever, hantavirus, etc., raise concern as biological threats. Imported cases from abroad demonstrate the importance of a vigilant, prepared public health structure to detect and fight disease. Mike is a proponent of strengthening public health systems to fight natural and terrorist acts (dual purpose use). He pointed out little bit of flu can close all hospital beds in San Diego. Dr. Asher mentioned the difficulty of differentiating background from emerging infections or even terrorist acts, using E. coli as an example. Smallpox is the major threat for spreading serious illness, in his opinion. Mike stated that imported food is not inspected for pathogens, and has had associated outbreaks. An agricultural terrorist act, such as foot and mouth disease, could be economic disaster. Dr. Roger Breeze, USDA, spoke about two recent instances that his agency was asked to investigate abroad to determine if an outbreak was natural or possibly terrorist. Through genetic analysis and other research techniques, they were reasonably certain that one was natural and the other man-made. There was further discussion about the importance of determining origin so that attribution could be determined and then retaliation planned. George Cybenko, Ph.D., ISTS, lectured the audience in his breezily, entertaining fashion, using PowerPoint presentations to show internet cable systems across the world. He discussed how one might overload the system and may need to lay down new cable to meet demand. There was some discussion over comments by Bill Zinnikas (FBI), regarding the NYC World Trade Center bombing which nearly severed the ATT cable lines for the east coast. There was also some talk about the need to shut off cable access for news media to free up broadband for emergency response. Andy Ogielski, Ph.D. (ISTS) pointed out that there were current networking challenges and that the people involved in running some of the telecommunication networks were inexperienced. Reliability and capacity could be easily attacked. Friday's lunchtime presentation Richard Hutchinson, Ph.D. (BW Improved Response Leader, Soldier and Biological Chemical Command) gave a two-part presentation on threat variables and threat response, which was informative and thorough. Much of this information can be seen in the web-posted PowerPoint slides, white paper, and reprint, which he submitted. A key idea that Dick championed was a Command & Control (C&C) simulator, which allows modeling of response components to see how all of these might work together. The simulation would also provide a tool to evaluate and improve these concepts. We are physically testing and modeling components of the BW response template, but a field test to really demonstrate such a comprehensive, system seems almost impossible. This simulation is needed to test our, and any other BW response system at the strategic level. Dr. Hutchinson mentioned there is beta testing of automating the BW response template at the city level through the RAMS (Response Assets Management System). This has been funded for 5 sites at present and takes two weeks to customize for each city. A much broader system would be needed to link the cities and other assets together. Dick indicated his strong belief in the need for future research and development in this area. Friday afternoon panels The response teams from New Hampshire, New Mexico, and Maryland gave their insights for the afternoon's first panel discussion. New Hampshire is comfortable with the present Command and Control structure. They can active their command and control center within 15 minutes of being alerted to a disaster situation. The two members of the Maryland National Guard Rapid Response Team, Bill Bograkos, D.O. (Lieutenant Colonel, Flight Surgeon) and Daniel Kaszeta (Disaster Preparedness Advisor, White House Military Office) stressed the following in their white paper and presentation: 1) build appropriate infrastructure to equip response, 2) the Crisis Management Planning cell is a multidiscipline team of people who must be ready to coordinate, communicate, and form an organized team (otherwise we will see (have seen) crisis, chaos, and confusion, 3) in comparing the 3 states presenting today, appreciate not only is the geography different but the threat analysis can be different, and, 4) The model to apply is the U.S. Interagency Domestic Terrorism Concept of Operations Plan, a copy of which they shared in reprint form. They are also confident in their area planning and preparation. Paul Roth, M.D. (Dean, University of New Mexico, School of Medicine) led the team discussion for his state, reviewing some of the topics found in his white paper. They reviewed their collaboration with Los Alamos National Laboratories, Sandia National Laboratories, State Department of Health, and Lovelace Respiratory Research Institute to research new technologies, implement new population surveillance via real-time reporting of E.R. complaints which may be sentinel events, and to provide training of physicians and first responders. Paul stressed the very real danger of the current threat and pushed this concept of partnership between federal, state, and private entities to mount a meaningful response strategy. There was a good discussion with Peter LaPorte (Executive Director, D.C. Emergency Management Agency) providing animated leadership. Peter's main point was that the response teams must share common training and communication skills. In his experience, that public health people don't speak a common language with command and control personnel until they learn to understand one another. The Response Technology Panel began with Mike Myjak (The Virtual Workshop, Inc.) reviewing how military technology and costs have made it cost-effective for the development of modeling and simulation (M&S) systems to improve training. The effectiveness of these systems was demonstrated convincingly in the Gulf War. MEDical simulation NETwork (MEDNET) is a proposal to develop similar technology to apply to bioterrorism planning, training, and C&C implementation. His paper provides many of the technological details, which Mike states are already in existence, ready to apply. The system could be useful for combat, natural disaster, and other training. John Bowersox, M.D., Ph.D. (University of California, San Francisco) gave an overview of Telemedicine and how its present acceptance is limited to niches like prison or military medicine by social and market (reimbursement) forces rather than technological concerns. In the future, informatics, the widespread use of computers and the Internet, and real improvement in patient care will lead to further acceptance. John believes there will always need to be a human touch behind telemedicine and robotic surgery but he cited neurosugery as one area, this technology, is currently impacting. Remote medical care, training, testing, and supervision are all feasible uses of this technology. David Zelter, Ph.D. (Fraunhofer Center for Research), reviewed how computer visualization technology can contribute to detection through the use of sensors and monitoring. Situation awareness requires systems to monitor data and give alerts, filtering events from background, constantly data-mining to discover emerging threat patterns, and to utilize artificial intelligence (AI) stratagems to test the hypothesis, "Is an attack underway?" Decision-centered visualization is an interactive information architecture ergonomically assisting human thinking and analysis. The panel on threat protection for biological and cyber threats had Dennis Kleinman, MD of the FDA further talk about the growing power for scientists to select virulent organisms through natural selection and then modify with variable genetic code that can be changed easily to defeat vaccine development. Dr. Jian Zhao presented his white paper on "mobile code," which will be covered in our white paper section. Mobile code refers to code that is transferred to a computer chip/system, via wire or wireless transmission, as instructions or data to change the behavior of the instrument or robot. There are security concerns that terrorists could exploit to shut down our power and communication networks, by attaching this instruction code. The panel on nanotechnology, robotics and genetic engineering featured scientific presentations by three Dartmouth College professors. Ursula Gibson described nanotechnology as engineering at the molecular level using physics, chemistry, and biochemistry to make a machine which can function at a molecular level. Daniela Rus reviewed her work with robots which can assemble and operate in different modes while using identical robotic parts, like a Leggo set. Chris Lowery, MD, reviewed the remarkable progress of genetic engineering in attempts to treat human disease, emphasizing that this technology could be used for offensive or defensive weapon development. Friday night address with panel discussion, public invited Dr. George Baer, Chairman, Strategy and Policy Department, US Naval War College, welcomed the public and spoke on, "Is the American public safe from bioterrorism?" Dr. Baer states that there is no certain answer this question. Public awareness must not become public panic. Because there is a possibility of some attack, some social disaster, there is an absolute need to prepare. Dr. Baer asks what are the social costs of public safety? Consider the New Hampshire state motto, "Live free or die." Will society trade freedom for security? How does one balance the two? Does a potential terrorist have social rights? Should a terrorist be treated by standard criminal process and procedures, or, should a terrorist be subject to vigorous counterterrorist measures which may abrogate that terrorists rights? If urgent intelligence were needed, would torture be used as an effective means of reflecting the community's moral authority to protect itself from more terrorism? The key to all counterterrorism is timely and accurate intelligence. This may require intrusive information collection by more powerful governmental agencies. This may impose significant restrictions or even violations of what we think it means to "live free," that is to our civil liberties and perhaps even our constitutional rights. This could affect our rule of law, our right to privacy, even the fabric of our "open society." Dr. Baer asks us, if Bioterrorism is such a threat to national security that we will decide to sacrifice some freedom in the face of this threat? Or would we choose to sacrifice the liberty and safeguards which we guarantee the innocent until they are proven guilty? Would we allow torture and other violations of due process constitutional guarantees, which could protect an innocent terrorist, rather than sacrificing freedom for all? Dr. Baer stated that is from discussions and debates such as this one, that society established political values and maintain cohesion. The this process can be aided by wise political leadership, by good information gathering, and our democratic election process. We will have to decide how much is a society willing to live "less free" to prevent death. Dr. Baer concluded by stating that the answers to these questions depend ultimately on public awareness, on results of a "live free or die" debate, and value judgments discussed above. With this answer, politicians, police authorities, government agencies, and our military can plan intelligence gathering, preemptive action, and response planning. Dr. Ken Alibek provided a broad and comprehensive review of bioweapons. He discussed his personal experience in the Russian bioweapons program. Key to his discussion was the nature of individual agents that have been developed and can be developed in the near future. He discussed the agents and how the specific weapons are classified. He also discussed have violated its our modify from their natural state to their new state to optimize delivery as a weapon. He also discussed examples of a series of known agents and how they can be weaponized further. Dr. Alibek discussed how these agents can be delivered to their targets, and how they would be spread throughout the targeted population. Note: We welcome additional information on these talks, panel comments, and audience participation. Saturday The participants were divided into three groups to develop timelines and responses, using present technology, for the following scenario. At Dartmouth College, students begin having flu-like symptoms and report both to the college infirmary and to local hospitals. How would you decide if there was a terrorist attack, how would you handle forensics, and what would be your response timeline as students start dying from a confined space biological agent release? Each group allowed its members to use their expertise to work out a plan and timeline. Group 1 discussed the following response elements. How to deal with the worried well and avoid panic? How would the campus and the community function under such stress? They postulated that the local medical response would be overwhelmed and that antibiotics would need to be imported. They foresaw a need for good communications between different provider systems who may be operating on different forms of technology. They predicted that many students would flee the outbreak while locals would hesitate to leave. Group one felt there would be trouble making a timely diagnosis with present technology. With local first responders becoming quickly overextended, they saw a need to identify and activate relevant state agencies. They felt forensics would be difficult. Eventually there would be a need to transport patients to other state hospitals and intensive care units. Group Two agreed with Group One that it would be difficult to identify this initially as a terrorist act or to make a diagnosis early. They expressed concern about a lack of local stockpiles for vaccines, antibiotics, and other protective items. They felt that isolation measures should be instituted to prevent possible spread and discussed strategic concerns regarding this, with two interstate highways and Canada nearby. They postulated that campus connections would allow cameras to transmit live from many locations over the Internet to news media. These transmissions could hog bandwidth and force officials to ask that the media be blacked out. Group Two felt a command and control operations center would need to be set up. Most felt that local police and other officials would remain at their posts while others felt that they would probably flee, requiring military units to replace their functions. They wondered about whether a terrorist would issue a statement and how that might impact a response plan. They also wondered about copycat false claims and how the op center could evaluate other threats. Group Three decided that early diagnosis was the most important means of intervention. They charted a flow diagram with 20 or more boxes representing local, state, and federal resources which would need to be contacted and coordinated. They postulated that sentinel cases (patients with concurrent serious medical conditions) would be more quickly and thoroughly investigated resulting in an infectious diagnosis of plague within 4 to 5 days. Group 3 felt that education and awareness by medical personnel could make a real difference but didn't know if local physicians had taken any special training for biological attacks. They felt that due to the seriousness of the illness and the small Dartmouth College community, physicians would realize within 24 hours of the first sick student that an epidemic of some sort was occurring. Group 3 theorized that 5 to 10% of the population may be on antibiotics at any time and be protected from some infections. They theorized that some patients with flu symptoms would receive antibiotics early in the disease while others would be treated with antivirals which would not be protective. They identidfied 7 negative pressure rooms for protective isolation available locally. While this initially would be overwhelmed, they felt that once prophylactic antibiotics were started, containment would be less of an issue. They felt that hotels and dorms would be converted to patient wards. In the discussion which followed the small group presentations, a timeline was established for identification of the agent of 5 to ten days post attack. Suspicion of terrorist attack would be then quickly aroused by the unique infection- plague. Identifying the site of the attack would take some good epidemiology to show where the agent was released. The terrorists could be difficult to identify and be attacking other sites while the investigation proceeded. Another point made by some participants was how different biological incidents are from other disaster planning. Some felt that many parts of response planning were similar while others sided with the unique needs for vaccines, medicines, and infection control measures. There was a sense that local responders would have difficulty with coordinating the response. Some worried that a significant number might flee or refuse to perform assigned roles, requiring military units to substitute, possibly exposing more people to deadly organisms. It was noted that the community would experience chaos. At noon, Tracey McNamara, DVM, recounted the West Nile Virus epidemic, which caused New York City to ask if it had been attacked in the summer of 1999. Her very detailed presentation gave nearly a day-by-day, month-by-month account of the challenge she and her colleagues faced in NY. When the zoo first noticed dying crows and other birds, it was a struggle to make the correct diagnosis. No secure veterinary labs are available comparable to the Level 4 lab which the CDC maintains. Necessary diagnostic tools such as electron microscopy had to be begged for and waited on. Tremendous communication barriers required daily conference calls with many different speakers. A misdiagnosis was made of another mosquito borne virus. There just aren't enough resources devoted to veterinary pathology laboratories, in this country, which played a central role in detecting and diagnosing this virus, which had not previously been known to be on the east coast. Saturday afternoon was the whole group's opportunity to respond to another scenario, in 2005, with several participants grouped together to act as the FBI, FDA, FEMA, and so forth. They were instructed to think how advanced technology might be useful if employed. The local response group reported on the scenario, as time passed from the moment that Hanover's Chief of Police learned that 4 similarly ill patients had been treated in the local ER, with the staff now believing that it was smallpox clinically. The Chief immediately placed a call to the governor's office to request assistance. The CDC (Center for Disease Control) was contacted in Atlanta. The CDC directed samples to be secured and transported to Atlanta by a field representative trained to handle such dangerously infective materials. The FBI was notified to become the lead agency for possible terrorist incident. FEMA was notified, vaccine mobilization was done, and planning undertaken. CDC epidemiologists started determining where the cases have been and who they have been in contact with. The decision was made to place the hospital under protective quarantine for public health reasons. The White House issued a press statement that all necessary measures were being taken to both protect the public health and to determine if a terrorist incident had occurred. In Hanover, the Police Chief was now awaiting for National Guard to arrive. The local radio and TV stations were providing education and reassurance. Further consideration was being given to how to deploy police and fire department assets to contain the infection. While there were only 4 suspected cases of smallpox, it was decided that this could be a national emergency requiring an interstate quarantine. The Attorney Generals for both VT and NH cooperated to achieve this. By 24 hours after the Police Chief had been notified, the worried well and the news media had completely overwhelmed the 911 and commercial communication systems. There are concerns about distributing food and water. The roads and airport have been closed by state police. The CDC is coordinating additional medical supplies. They are utilizing PCR (polymerize chain reaction) and EM (electron microscopy) to study their samples. The preliminary diagnosis is pox virus. Their epidemiology officers have found that all victims ate at Thayer dining hall, 8 to 9 days earlier. The Department of Defense is mobilizing additional resources for command and control. The FBI has started to investigate the backgrounds of the sick patients and other suspicious visitors for leads. They are also helping the CDC determine where the cases have been and who their contacts have been. The vaccines arrive but there is confusion on how to organize vaccination efforts. The CDC personnel begin training local persons on how they want the vaccine administered. They have told the White House that they need to contain this now as it would take 6 months to make enough vaccine to protect the country. The Attorney General has briefed the President on the range of emergency powers he may exercise, including restricting immigration and use of quarantine for public health protection. As Hanover approaches 48 hours since the emergency started, interactive video links and telesupport from remote sites are set up and staffed. Hanover hasn't gotten any more food and the National Guard needs more resources. The CDC is working on genetically identifying the virus and containment strategies. National healthcare providers are briefed and their assistance requested. Experts at USAMRIID are requesting samples and data to assist the CDC. As we enter the third 24-hour period of the crisis, the President is notified that more smallpox cases are being diagnosed and that there is a concern that this is a terrorist attack which may be complicated by other attacks. No group has claimed responsibility. In Baltimore, there are two possible additional cases, which the CDC is investigating. The military and the Department of Defense (DOD) are further developing logistics coordination, deploying immunized medical staff, providing security, and assisting with civil affairs. In Hanover, residents are quarantined at home, containment of individuals is enforced, and there is need for more protective suits. The CDC is working on national guidelines should the epidemic spread outside of current areas. The Maryland National Guard has been put on alert. Available communication bandwidth has suffered several blackouts due to heavy demand and suspicious denial of service episodes. Communication companies are attempting to manage networks but appear somewhat hampered by young, inexperienced, engineers and directors. New Hampshire has issued a call for assistance from other states. Volunteers, led by the Maryland National Guard, are ready to operate telemedicine remote hospital wards. They include 500 physicians and 1500 nurses with other support staff, using a staffing ration of one physician and three nurses per 10 critically ill patients. Other patients can be telesupported in their homes via Internet 2 bandwidth. At one week out, 30% of the Hanover population is deceased with the number of deaths increasing each day. The population doesn't believe the immunizations to be protective. The CDC and USARMIID now believe that this is a monkey pox, biologically altered with smallpox, a deliberate act of terrorism. It does not seem to be as contagious as smallpox. They are unsure how to make the natural smallpox vaccine more effective. They estimate it could take 6 months to develop a new vaccine. They are performing susceptibility testing for the limited antiviral compounds currently approved for other indications. By day 9, the Hanover area is passing through a second cycle of disease. The ranks of the caretakers and their medical supplies are depleted. Some inhabitants, principally students, are feared to have left the area. Only families fully quarantined from the community are untouched by illness, staying indoors in their homes. The military has fully taken control of police and emergency services and is suffering some casualties, despite previous smallpox vaccination and investigational prophylaxis with anitiviral medicinals. In Maryland, the are currently 17 infected patients. The airports are closed, the national guard has been called out, the worried well are flooding hospital emergency rooms with flu symptoms and minor rashes. While the CDC has confirmed the second epidemic center, two other suspected outbreaks have been ruled improbable while investigation continue. The White House has been issuing frequent press briefings to calm people while urging citizens to be aware of any suspicious activities. They have agreed with Canada to close their Northern Boarder as a precaution while Mexico continues to monitor the situation. There is a sense of terrible national crisis. The European union is expected to ban travel and commerce. They are setting up 30 day quarantine procedures, though no one knows how long a quarantine is needed to prevent transmission. The good news is that although there have been isolated confrontations between affected citizens demanding medicine or vaccination, the populace has remained calm. The country has rallied around the executive branch's vow to find and prosecute the terrorists, promising retribution to any country caught aiding them. Congress meets in special session, passing emergency legislation for the FDA and other agencies to meet the urgent demand to find new vaccines or medicine. Sunday July 9th Dr. Joe Rosen addressed the session. He start off by referring to the Defense Science Board finding that biological attack could equaled a nuclear attack in its impact on our population. He read his position paper, which is included in the white papers. Dr. Rosen proposed that it is our national interest to embark upon a major research initiative comparable to the Manhattan project to develop a coherent strategy for biodefense based upon advanced computer simulation combined with robotic technology. Dr. Rosen used the experience of the simulation scenarios performed on Saturday as an argument that the present plan for extensive cooperation between various federal and state agencies may need to be improved by unified command structure which would probably best manage the military units trained to deal with biowarfare. Dr. Rosen foresees a great need to build a strong science and technology base for biological defense. He sees the need for extensive practice and training, which would engage non-DoD participants for that preparation. Dr. David Franz of the Southern Research Institute presented the findings of his white paper. He stated that we do not know the limits of biotechnology either offensively or defensively. At present they are no technological solutions. We need a much deeper technological research base to find future answers. We need to find the sustained leadership necessary to find and manage a Manhattan-type initiative. This initiative would have to be coordinated across agencies, civilian, and military lines. The Department of Defense can do the research and development but we need to bring industry into the project to bring the items to market. Intelligence procurement is both important of and difficult to implement. Much of the production machinery can be used for dual purposes. Intelligence with technological resources must be complemented with human access. There is a need for cooperative threat reduction just as we have done with the Russian nuclear program. There is a need for better threat analysis so that prevention, preparation, simulation, and response are properly planned out. The public health structure can be improved to help us deal with biological threats, and, has the added benefit of improving the health of our society. Forensics is another top priority. We must be able to dissect down to molecular level. This type of crime must be handled like any other to preserve evidence including microbial and DNA sampling. Laboratory architecture must continue to improve for more rapid detection, analysis, and treatment. Its methods of analysis will need to be validated. These investments in our capabilities will allow the president to respond the future threats. Medical countermeasures must be improved. This includes preclinical diagnosis (detection). This allows for earlier treatment he also allows us to know who was exposed. Dr. Franz believes that selective vaccines may be effective for military personnel. We can work harder on our antiviral drug program, leveraging the efforts of the pharmaceutical industry. New masks and suits are more useful for the military than for the civilian population. Dr. Franz points out that even the use of a mask requires early warning. Dr. Franz discussed the need for interagency collaboration, both horizontally and vertically. He commented that yesterday's scenarios illustrated how this can be difficult. Good information is key for good cooperation. Better educating the public and first responders must be a priority. The effort must be thought out carefully. The United States might look to the Israeli model for such planning. In the discussion that followed Dr. Franz's presentation, there was agreement of a need to have the will to retaliate based on our forensic findings. Our technology we needs to be accurate enough to properly attribute a terrorist incident so that conventional retaliation can be made. Randall Murch, Director of Advanced Systems and Concepts Office, Defense Threat Reduction Agency addressed the panel with the following observations. This conference, like others that preceded it, has assessed the threat from biological terrorism to be real. The United States needs to consider how social engineering may be able to prevent future terrorist incidents by its own citizens. Using modern technology, there is now the opportunity to study and model terrorist groups. From such modeling, we can be better prepared to design our responses. They threat is critical. There needs to be seamless integration of information technology. Command and control centers must be able to communicate important information to response teams. There is a need for rapid response and mobie response teams. Mr. Murch agrees that are educational resources must be better distributed. He cites a naval operation in Orlando as one resource. Early warning is imperative for effect deterrents. There must be good medical intelligence and preparation. He believes that the best defense is a good offense. Planning is entwined with education. Education then leads to better preparation. In his opinion, the public health system needs to be prepared for such a threat. Grants and funding can bring more attention to this public health need. Awareness is very important for good preparation. Mr. Murch believes that this effort requires leadership though it may not quite rise to level of a Manhattan project. In the discussion that followed Mr. Murch's discourse, Dr. Rosen discussed some of the new technology which can be quickly brought to bear upon this problem. Robotics as response technology is now feasible. It institutions like Carnegie-Mellon, robotics research is progressing rapidly. Dr. Rosen has seen demonstrated a small, autonomous helicopter which can fly up 50 feet off the ground and accurately deliver a 1 kg package. This helicopter can be programmed with GPS (global positioning system) instructions. He foresees using robotics to feel often quarantined an area. His proposed simulation system relies upon hardened networks or rapidly deployed fiber-optic cable to provide communication bandwidth. Dr. Rosen believes that science has become so specialized that we lack people who can operate across specialties to create these types of response technologies. Prof. George Cybenko spoke to the computer issues. Dr. Cybenko sees command and control as radically evolving in the next few years. To illustrate this, he pointed to the bust of Sylvanius Thayer in the conference room. The Mr. Thayer graduated from Dartmouth College and attended West Point around 1800. From there, he traveled to France to study how Napoleon led his troops. Napoleon required regular reports every week. Napoleon found this led to better management and helped avoid confrontation. This type of management came to be known as the line staff method. It's time for us to invent new management styles. We need to study the infrastructure of the Web deal to find new management techniques. The Web allows for information to be shared. Information is also dispersed on many servers. This net infrastructure allows for new sensors (software gauges and monitors) to be programmed, for the structures to be built (programmed), and for us to synthesize novel ways to organize ourselves. A question was raised regarding the reliability of such a network. Prof. Cybenko answer to the effect that nobody said it would be easy but he felt confident it could be done. With time running out for the conference, a few last comments were taken from the participants. Dedicated communication capabilities and mobile telemedicine were described as quite desirable. The important idea that an ounce of prevention is worth a pound of cure applies here as well. There can be lots of dual utility of systems to promote worthwhile projects such as improving public health. The conferees agreed that an advisory board would review and approve a final report, then adjourned. For further conference information, please view our website, Error! Bookmark not defined., and the white papers submitted. INSTITUTE FOR SECURITY TECHNOLOGY STUDIES DARTMOUTH COLLEGE 3 INSTITUTE FOR SECURITY TECHNOLOGY STUDIES DARTMOUTH COLLEGE