oversight

Combating Terrorism: Observations on Biological Terrorism and Public Health Initiatives

Published by the Government Accountability Office on 1999-03-16.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                          United States General Accounting Office

GAO                       Testimony
                          Before the Committee on Veterans’ Affairs and the
                          Subcommittee on Labor, Health and Human Services,
                          Education and Related Agencies, Committee on
                          Appropriations, U.S. Senate

For Release on Delivery

Expected at

9:30 a.m., EST
                          COMBATING TERRORISM
Tuesday,

March 16, 1999




                          Observations on Biological
                          Terrorism and Public
                          Health Initiatives
                          Statement of Henry L. Hinton, Jr., Assistant Comptroller
                          General, National Security and International Affairs
                          Division




GAO/T-NSIAD-99-112
        Mr. Chairman and Members of the Committee and Subcommittee:



        I am pleased to be here to discuss our ongoing work and preliminary

        observations on the biological terrorist threat and some aspects of the

        Department of Health and Human Services’ (HHS) bioterrorism initiative.

        As you know, our ongoing work was requested by you in your capacity as

        the Chairman and Senator Rockefeller as Ranking Minority Member of the

        Senate Veterans’ Affairs Committee; Congressman Shays as the Chairman

        of the House Government Reform Committee, Subcommittee on National

        Security, Veterans Affairs, and International Relations; and Congressman

        Skelton as Ranking Minority Member of the House Armed Services

        Committee. Over the past 3 years, we have studied and reported on a

        number of issues concerning federal agencies’ programs and activities to

        combat terrorism. A list of related GAO reports and testimonies is in

        appendix I.



        It is frightening to think that a lone terrorist or terrorist group might be able

        to improvise a biological weapon or use other means to spread anthrax,

        smallpox, or other biological agents to cause mass casualties and

        overwhelm the health care system in the United States. There is no

        question that it would be unconscionable not to prepare to respond to, if

        not be able to prevent, such an incident. But some very important

        questions should be asked and answered as an integral part of any federal

        decision to invest in medical countermeasures or preparedness initiatives.

        This is one of those few areas in which national security and public health

        issues clearly intersect. It is also an area in which many disciplines of

        expertise must come together to perform the challenging tasks of assessing

        an emerging threat and focusing our investments on the most appropriate

        countermeasures and preparedness efforts.



        My testimony will address four issues. First, I will briefly discuss

        intelligence agencies’ judgments about the threat of terrorism.                      Second, I

        will highlight the importance and benefits of threat and risk assessments to

        provide a sound basis for targeting the nation’s investments in combating

        terrorism—a widely recognized sound business practice we have discussed
                                                 1
        in our reports and testimonies.              Third, I will share some preliminary




        1
            See Combating Terrorism: Spending on Governmentwide Programs Requires Better Management and

        Coordination (GAO/NSIAD-98-39, Dec. 1, 1997);   Combating Terrorism: Threat and Risk Assessments

        Can Help Prioritize and Target Program Investments   (GAO/NSIAD-98-74, Apr. 9, 1998); and   Combating

        Terrorism: Observations on Federal Spending to Combat Terrorism    (GAO/T-NSIAD/GGD-99-107,

        Mar. 11, 1999).




Leter   Page 1                                                                        GAO/T-NSIAD-99-112
                  observations from our ongoing work on the science behind the biological

                  and chemical terrorist threat, with some focus on biological agents.

                  Finally, I will provide some of our overall observations on public health

                  initiatives that deal with a new national pharmaceutical stockpile and the

                  basis for selecting items to research, produce, procure, and stockpile for

                  civilian defense against terrorism.




Summary           The U.S. intelligence community continuously assesses both the

                  foreign-origin and the domestic terrorist threat to the United States and

                  notes that, overall, conventional explosives and firearms continue to be the

                  weapons of choice for terrorists. Terrorists are less likely to use biological

                  and chemical weapons than conventional explosives, at least partly

                  because they are difficult to weaponize and the results are unpredictable.

                  However, some groups and individuals of concern are showing interest in

                  biological and chemical agents. The possibility that terrorists may use

                  biological and chemical materials may increase over the next decade,

                  according to intelligence agencies. While biological and chemical

                  terrorism is still an emerging threat, many agencies have initiated programs

                  and activities—with Congress’ support and funding—to combat and

                  prepare for this threat.



                  We have previously reported on the value of a new, post-Cold War approach

                  of using sound threat and risk assessments performed by a

                  multidisciplinary team of experts for focusing programs and investments to

                  combat terrorism. Without such assessments using sound inputs and a

                  multidisciplinary team of experts, there is little or no assurance that

                  programs and spending are focused in the right areas in the right amounts.



                  We are looking into the scientific and practical feasibility of a terrorist or

                  terrorist group improvising a biological weapon or device outside a

                  state-run laboratory and program, successfully and effectively
                                                                                                     2
                  disseminating biological agents, and causing mass casualties.                          Much of the

                  information we have obtained is sensitive, classified, and in the early stages

                  of evaluation. Overall, our work to date suggests that, for the most part,

                  there are serious challenges at various stages of the process for a terrorist

                  group or individual to successfully cause mass casualties with an




                  2
                      We recognize that some agents are communicable and could be spread without a weapon or device.




          Leter   Page 2                                                                         GAO/T-NSIAD-99-112
improvised biological or chemical weapon or device. More specifically, our

preliminary observations are that



•   a terrorist group or individual generally would need a relatively high

    degree of sophistication to successfully and effectively process,

    improvise a device or weapon, and disseminate biological agents to

    cause mass casualties;

•   a weapon could be made with less sophistication, but it would not likely

    cause mass casualties;

•   some biological agents are very difficult to obtain and others are

    difficult to produce; and

•   effective dissemination of biological agents can be disrupted by

    environmental (e.g., pollution) and meteorological (e.g., sun, rain, mist,

    and wind) conditions.



For its part of domestic preparedness initiatives for combating terrorism,

HHS received about $160 million in fiscal year 1999. These funds are

intended for a variety of related preparedness efforts, including research

and development and a new national stockpile for pharmaceuticals,

millions of doses of vaccines for smallpox and anthrax, antidotes for

chemical agents, and other items. For fiscal year 2000, HHS has requested

$230 million for public health initiatives for dealing with bioterrorism. Our

preliminary observations follow:



•   HHS has not yet performed a documented, formal, methodologically

    sound threat and risk assessment with a multidisciplinary team of

    experts to derive, prioritize, or rank—in accordance with the most likely

    threats the nation will face—the specific items it plans to have

    researched, developed, produced, and stockpiled.

•   Several of the items HHS plans to procure seem to be geared toward the

    worst-possible consequences from a public health perspective and do

    not match intelligence agencies’ judgments on the more likely biological

    and chemical agents a terrorist group or individual might use.

•   It is unclear from the HHS fiscal year 1999 operating plan whether and

    to what extent the Department has fully considered the long-term costs,

    benefits, and return on investment of creating and sustaining the

    production and inventory infrastructure for such an initiative.




Page 3                                                       GAO/T-NSIAD-99-112
The Foreign and        The bombings of the World Trade Center in 1993 and the federal building in



Domestic Terrorism
                       Oklahoma City, Oklahoma, in 1995, along with the use of a nerve agent in

                       the Tokyo subway in 1995, have elevated concerns about terrorism in the

Threat in the United   United States—particularly terrorists’ use of chemical and biological


States                 weapons. The U.S. intelligence community, which includes the Central

                       Intelligence Agency, the Defense Intelligence Agency, the National Security

                       Agency, the Federal Bureau of Investigation, and others, has continuously

                       assessed the foreign-origin and domestic terrorist threats to the United

                       States.      According to intelligence agencies, conventional explosives and

                       firearms continue to be the weapons of choice for terrorists. Terrorists are

                       less likely to use chemical and biological weapons, at least partly because

                       they are more difficult to weaponize and the results are unpredictable.

                       However, some groups and individuals of concern are showing interest in

                       chemical and biological weapons. According to the FBI, there were

                       4 confirmed incidents of terrorism in the United States in 1992, compared

                       with 12 in 1993, zero in 1994, 1 in 1995, 3 in 1996, and 2 in 1997.                        These

                       incidents involved the use of conventional weapons.




Threat and Risk        We have pointed out that sound threat and risk assessments can be used to



Assessments Can Help
                       define and prioritize requirements and properly focus programs and

                       investments in combating terrorism. Soundly established requirements

Define Requirements    could help ensure that specific programs and initiatives and related


and Prioritize and     expenditures are justified and targeted, given the threat and risk of

                       validated terrorist attack scenarios as assessed by a multidisciplinary team

Focus Program          of experts.

Investments
                       Several public and private sector organizations use formal, qualitative

                       threat and risk assessments to manage risk and identify and prioritize their

                       requirements and expenditures. For example, the Defense Threat

                       Reduction Agency, the Department of Energy, and the Federal Aviation

                       Administration use such assessments in their programs. In addition, the
                                                                                                              3
                       President’s Commission on Critical Infrastructure Protection

                       recommended in its final report that threat and risk assessments be

                       performed on the nation’s critical infrastructures, such as

                       telecommunications, electric power, and banking and finance systems.                                  In

                       fact, the Federal Emergency Management Agency strongly endorses the




                       3
                           The Commission, a government-private sector body established in 1996, was to develop a national

                       strategy to protect the nation’s critical infrastructures from physical and computer-based threats.




                       Page 4                                                                            GAO/T-NSIAD-99-112
concept of risk assessment, as it is the key to predisaster hazard

mitigation—the foundation of emergency management. Moreover, the

Department of Energy has stated that domestic preparedness program

equipment purchases should be delayed until a risk assessment is

completed to ensure that appropriate equipment is obtained.



Threat and risk assessments are grounded in a new, post-Cold War

approach to thinking about and dealing with security issues called risk

management. Risk management is the deliberate process of understanding

“risk”—the likelihood that a threat will harm an asset with some severity of

consequences—and deciding on and implementing actions to reduce it.

Risk management principles acknowledge that (1) while risk generally

cannot be eliminated it can be reduced by enhancing protection from

validated and credible threats and (2) although many threats are possible,

some are more likely to occur than others. Threat and risk assessment is a

deliberate, analytical approach that results in a prioritized list of risks (i.e.,

threat-asset-vulnerability combinations) that can be used to select

countermeasures to create a certain level of protection or preparedness.

Generally, because threats are dynamic and countermeasures may become

outdated, it is sound practice to periodically reassess threat and risk.



The critical first step in a sound threat and risk assessment process is the

threat analysis. The analysis should identify and evaluate each threat in

terms of capability and intent to attack an asset, the likelihood of a

successful attack, and its consequences. To perform a realistic threat

assessment, a multidisciplinary team of experts would require valid foreign

and domestic threat data from the intelligence community and law

enforcement. The intelligence community’s threat reporting on

foreign-origin terrorism is often general and, without clarification, could be

difficult to use. However, a multidisciplinary team of experts can use the

best available intelligence information on foreign-origin and domestic

threats to develop threat scenarios. The intelligence community could then

compare the threat scenarios to its threat reporting and validate or adjust

the scenarios with respect to their realism and likelihood of occurrence as

appropriate.




Page 5                                                          GAO/T-NSIAD-99-112
Our Ongoing Work     On the basis of information we obtained and analyzed to date, a terrorist
                                                   4
Examining the
                     group or individual               would generally need a relatively high degree of

                     sophistication to successfully and effectively process, improvise a device

Biological and       or weapon, and disseminate biological agents to cause mass casualties.


Chemical Terrorist   John Lauder, Special Assistant to the Director of Central Intelligence for

                     Nonproliferation, recently testified that “the preparation and effective use

Threat               of biological weapons by both potentially hostile states and by non-state

                     actors, including terrorists, is harder than some popular literature seems to
                                    5
                     suggest.”          Because we are in an open forum and our work is sensitive and

                     preliminary in nature, my discussion will remain limited.



                     Our ongoing synthesis of information and technical data from recognized

                     experts suggests that some exotic biological agents—such as smallpox—

                     are difficult to obtain, and others—such as plague—are difficult to

                     produce. Processing biological agents for effective dissemination to cause

                     mass casualties requires specific, detailed knowledge and specialized

                     equipment. Moreover, improvising a device or weapon that can effectively

                     disseminate biological agents to cause mass casualties may require certain

                     items that are not readily available. In addition, successful and effective

                     dissemination of biological agents in the right form requires the proper

                     environmental and meteorological conditions and appropriate energy

                     sources.



                     That is not to say that casualties would not occur if less sophisticated

                     means were used. For example, if an agent were dispersed in a less

                     effective form using less effective equipment , some casualties might occur.

                     However, under these circumstances, the potential incident would be less

                     likely to cause mass casualties. What we have learned is that capability is a

                     critical factor. Terrorists have to handle risk, overcome production

                     difficulties, and effectively disseminate a biological agent to cause mass

                     casualties.



                     We continue to gather and evaluate data on these matters and plan to

                     report to our requesters this summer.




                     4
                         For the purposes of our work, we define terrorist(s) as a non-state actor not provided with a

                     state-developed weapon.



                     5
                         Unclassified statement by Special Assistant to the Director of Central Intelligence for Nonproliferation

                     on the Worldwide Biological Warfare Threat to the House Permanent Select Committee on Intelligence,

                     March 3, 1999.




                     Page 6                                                                               GAO/T-NSIAD-99-112
Preliminary              On June 8, 1998, the President forwarded to Congress a fiscal year 1999



Observations on HHS’
                         budget amendment that included a proposal to (1) build—for the first

                         time—a civilian stockpile of antidotes and vaccines to respond to a

Public Health            large-scale biological or chemical attack, (2) improve the public health


Initiatives Related to   surveillance system to detect biological or chemical agents rapidly and

                         analyze resulting disease outbreaks, (3) provide specialized equipment and

Bioterrorism             training to states and localities for responding to a biological or chemical

                         incident, and (4) expand the National Institutes of Health’s research into

                         vaccines and therapies. The Omnibus Consolidated and Emergency

                         Supplemental Appropriations Act (P.L. 105-277) included $51 million for the

                         Centers for Disease Control and Prevention to begin developing a

                         pharmaceutical and vaccine stockpile for civilian populations. The act also

                         required that HHS submit an operating plan to the House and Senate

                         Committees on Appropriations before obligating the funds. The fiscal year

                         2000 request for HHS’ bioterrorism initiative is $230 million, including

                         $52 million for the Centers for Disease Control and Prevention to continue

                         procurement of a national stockpile.



                         Our preliminary work suggests that an ad hoc interagency health care

                         group led by HHS has not yet performed a formal, documented threat and

                         risk assessment to establish its list of biological and chemical terrorist

                         threat agents against which it should stockpile. In fact, several of the items

                         HHS plans to procure do not match intelligence agencies’ judgments, as

                         explained to us, on the most likely chemical and biological agents a

                         terrorist group or individual might use. According to HHS officials, the

                         group identified its list through a process of evolutionary consensus among

                         federal and nonfederal health experts. Because HHS did not document its

                         process or methodology, we have difficulty evaluating its soundness and

                         comprehensiveness.



                         According to HHS officials, the interagency participants identified the list

                         based on



                         •   agent characteristics such as transmissibility and stability,

                         •   likely impact on population (i.e., can it cause mass casualties),

                         •   availability of treatment, and

                         •   whether the agent could be weaponized.



                         The group chose four biological agents for HHS’ stockpiling initiatives—

                         inhalation anthrax, pneumonic plague, smallpox, and tularemia




                         Page 7                                                       GAO/T-NSIAD-99-112
(a bacteria)—because of their ability to affect large numbers of people

(create mass casualties) and tax the medical system.



On the basis of our discussions with HHS officials, it is unclear to us

whether and to what extent intelligence agencies’ official written threat

analyses were used in their process. According to the Joint Security

Commission’s 1994 report on Redefining Security, without documented

threat information, countermeasures are often based on worst-case

scenarios. Valid, current, and documented threat information is crucial to

ensuring that countermeasures or programs are not based solely on

worst-case scenarios and are therefore out of balance with the threat.

While HHS officials told us that they obtained information from various

experts, including intelligence analysts, the ad hoc interagency group

making the decisions comprised representatives only from the health and

medical community. As a result, we have not seen any evidence that the

group’s process has incorporated the many disciplines of knowledge and

expertise or divergent thinking that is warranted to establish sound

requirements for such a complex and challenging threat and to focus on

appropriate medical preparedness countermeasures.



As required in the appropriations act I mentioned earlier, HHS prepared an

operating plan for its fiscal year 1999 bioterrorism initiative. The plan

discusses numerous activities on which the fiscal year 1999 appropriations

will be spent within four areas:



•   deterrence of biological terrorism,

•   surveillance for unusual outbreaks of illness,

•   medical and public health responses, and

•   research and development.



We have reviewed the unclassified version of the operating plan.    On the

basis of our review of the plan, it is unclear whether and to what extent

HHS has fully considered the long-term costs, benefits, and return on

investment of establishing the production and inventory infrastructure for

such an initiative. The reason I raise the issue of return on investment is

that, until a valid threat and risk assessment is performed, we question

whether stockpiling for the items on the current HHS list is the best

approach for investing in medical preparedness. In addition, the HHS plan

does not clearly address issues surrounding (1) the long-term costs of

maintaining an inventory of items with a shelf life or (2) the safety and

efficacy of expedited regulatory review of new drugs and vaccines.




Page 8                                                      GAO/T-NSIAD-99-112
Conclusions           We see many challenges ahead for HHS as it continues to decide how to

                      target its investments for this emerging threat. Many frightening possible

                      scenarios can be generated. But the daunting task before the nation is to

                      assess—to the best of its ability—the emerging threat with the best

                      available knowledge and expertise across the many disciplines involved.

                      The United States cannot fund all the possibilities that have dire

                      consequences.   By focusing investments on worst-case possibilities, the

                      government may be missing the more likely threats the country will face.

                      With the right threat and risk assessment process, participants, inputs, and

                      methodology, the nation can have greater confidence that it is investing in

                      the right items in the right amounts. Even within the lower end of the

                      threat spectrum—where the biological and chemical terrorist threat

                      currently lies—the threats can still be ranked and prioritized in terms of

                      their likelihood and severity of consequences. A sound threat and risk

                      assessment could provide a cohesive roadmap to justify and target

                      spending for medical and other countermeasures to deal with a biological

                      and/or chemical terrorist threat.




                      Mr. Chairman, Members of the Committee and Subcommittee, that

                      concludes my prepared remarks. I would be happy to answer any

                      questions you may have.




              Leter   Page 9                                                     GAO/T-NSIAD-99-112
Appendix I




Related GAO Products                                                                        AppeInxdi




             Combating Terrorism: Observations on Federal Spending to Combat

             Terrorism (GAO/T-NSIAD/GGD-99-107, Mar. 11, 1999).



             Combating Terrorism: FBI's Use of Federal Funds for

             Counterterrorism-Related Activities (FYs 1995-98 ) (GAO/GGD-99-7,

             Nov. 20, 1998).



             Combating Terrorism: Opportunities to Improve Domestic Preparedness

             Program Focus and Efficiency (GAO/NSIAD-99-3, Nov. 12, 1998).



             Combating Terrorism: Observations on the Nunn-Lugar-Domenici Domestic

             Preparedness Program (GAO/T-NSIAD-99-16, Oct. 2, 1998).



             Combating Terrorism: Observations on Crosscutting Issues

             (GAO/T-NSIAD-98-164, Apr. 23, 1998).



             Combating Terrorism: Threat and Risk Assessments Can Help Prioritize

             and Target Program Investments (GAO/NSIAD-98-74, Apr. 9, 1998).



             Combating Terrorism: Spending on Governmentwide Programs Requires

             Better Management and Coordination (GAO/NSIAD-98-39, Dec. 1, 1997).



             Combating Terrorism: Efforts to Protect U.S. Forces in Turkey and the

             Middle East (GAO/T-NSIAD-98-44, Oct. 28, 1997).



             Combating Terrorism: Federal Agencies' Efforts to Implement National

             Policy and Strategy (GAO/NSIAD-97-254, Sept. 26, 1997).



             Combating Terrorism: Status of DOD Efforts to Protect Its Forces

             Overseas (GAO/NSIAD-97-207, July 21, 1997).



             Chemical Weapons Stockpile: Changes Needed in the Management

             Structure of Emergency Preparedness Program    (GAO/NSIAD-97-91,

             June 11, 1997).



             State Department: Efforts to Reduce Visa Fraud (GAO/T-NSIAD-97-167,

             May 20, 1997).



             Aviation Security: FAA's Procurement of Explosives Detection Devices

             (GAO/RCED-97-111R, May 1, 1997).




             Page 10                                                   GAO/T-NSIAD-99-112
Appendix I
Related GAO Products




Aviation Security: Commercially Available Advanced Explosives Detection

Devices (GAO/RCED-97-119R, Apr. 24, 1997).



Terrorism and Drug Trafficking: Responsibilities for Developing Explosives

and Narcotics Detection Technologies (GAO/NSIAD-97-95, Apr. 15, 1997).



Federal Law Enforcement: Investigative Authority and Personnel at

13 Agencies (GAO/GGD-96-154, Sept. 30, 1996).



Aviation Security: Urgent Issues Need to Be Addressed

(GAO/T-RCED/NSIAD-96-151, Sept. 11, 1996).



Terrorism and Drug Trafficking: Technologies for Detecting Explosives and

Narcotics (GAO/NSIAD/RCED-96-252, Sept. 4, 1996).



Aviation Security: Immediate Action Needed to Improve Security

(GAO/T-RCED/NSIAD-96-237, Aug. 1, 1996).



Passports and Visas: Status of Efforts to Reduce Fraud (GAO/NSIAD-96-99,

May 9, 1996).



Terrorism and Drug Trafficking: Threats and Roles of Explosives and

Narcotics Detection Technology (GAO/NSIAD/RCED-96-76BR, Mar. 27,

1996).



Nuclear Nonproliferation: Status of U.S. Efforts to Improve Nuclear

Material Controls in Newly Independent States (GAO/NSIAD/RCED-96-89,

Mar. 8, 1996).



Aviation Security: Additional Actions Needed to Meet Domestic and

International Challenges (GAO/RCED-94-38, Jan. 27, 1994).



Nuclear Security: Improving Correction of Security Deficiencies at DOE's

Weapons Facilities (GAO/RCED-93-10, Nov. 16, 1992).



Nuclear Security: Weak Internal Controls Hamper Oversight of DOE's

Security Program (GAO/RCED-92-146, June 29, 1992).



Electricity Supply: Efforts Underway to Improve Federal Electrical

Disruption Preparedness (GAO/RCED-92-125, Apr. 20, 1992).




Page 11                                                  GAO/T-NSIAD-99-112
                   Appendix I
                   Related GAO Products




                   Economic Sanctions: Effectiveness as Tools of Foreign Policy

                   (GAO/NSIAD-92-106, Feb. 19, 1992).



                   State Department: Management Weaknesses in the Security Construction

                   Program      (GAO/NSIAD-92-2, Nov. 29, 1991).



                   Chemical Weapons: Physical Security for the U.S. Chemical Stockpile

                   (GAO/NSIAD-91-200, May 15, 1991).



                   State Department: Status of the Diplomatic Security Construction Program

                   (GAO/NSIAD-91-143BR, Feb. 20, 1991).




(701167)   L
           ertet   Page 12                                                 GAO/T-NSIAD-99-112
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