Much has been accomplished, but as the millennium changes, much remains to be done. Next steps for national security include:

Improved Communication for Incident Response

Response to a terrorist incident involves government at all levels-federal, state and local. Although the federal government has developed a response structure, and the Nunn-Lugar-Domenici bill has provided training for the 120 largest U.S. cities, it is not clear whether the federal, state and local governments can effectively coordinate response and recovery actions. Even at the local level, communication is problematic. Marietta Deputy Fire Chief Phil Chovan notes that there are 13 counties and 57 local government jurisdictions in the Atlanta area with independent fire and police departments, each with its own radio frequency. He emphasizes the need for a strong communication infrastructure that enables communication among local authorities, with state and regional authorities, and with the federal government so that information from first responders at the scene can be transmitted in real time to federal and state analysts who can determine the nature of the incident and the follow-up resources needed as quickly as possible. (1)

Effective command and control requires a clear chain of communication, which should be supported by a secure, reliable communications network. Deputy Chief Chovan also notes the need for high-level security clearance for local administrators. (2) Command and control of an incident should make the best possible use of local administrators with unique knowledge of the incident locale, of state administrators who are responsible for mobilizing the national guard and requesting federal emergency funding, and the federal agent or agents in charge. Communication with the media also requires careful advance preparation. The media are critical conduits for providing life-saving information and instructions to the public. Plans for briefing the media during an emergency should be developed and shared with media representatives in all major U.S. cities.

Additional state and local training

Nunn-Lugar-Domenici provided for domestic preparedness training for the 120 largest U.S. cities, based on census population counts. The selection of 120 cities based solely on size was criticized by the General Accounting Office, which noted that many cities receiving training were clustered within a mile of each other, that state and regional emergency jurisdictions were ignored, and that smaller cities which might be at greater risk because of high-profile public events, high-profile industries, etc., did not receive training. (3) In addition, some first responder groups with an important secondary role to play were beyond the scope of the initial training. These first responder groups include funeral directors, mental health professionals, veterinarians, and agriculture agents, who may be the first to discover a biochemical attack on a critical food crop.

Initial first responder training has concentrated on providing a functional overview of terrorism response activities and on increasing awareness of weapons of mass destruction terrorism issues. A "training the trainer" approach was used to encourage ongoing training. The Department of Defense was tasked with responsibility for training the 120 initial cities. The training was well received by first responder groups, who emerged with a better understanding of WMD response issues. It is important, however, that WMD response training be institutionalized and standardized among first responder professional communities. This training needs a strong certification and testing component to insure consistent levels of expertise among first responders across the U.S. Tara O'Toole of the Johns Hopkins Center for Civilian Biodefense Studies, has suggested that professional societies such as the American College of Emergency Physicians may be the best providers of ongoing training in terrorism response. (4)

Distance learning technologies such as videoconferencing and satellite television channels can be used to expand training opportunities and for ongoing planning and consultation among emergency professionals across the country.

Increased analysis and training to identify weaponized diseases

The first twenty-four hours of a terrorism incident are the most critical for saving lives and property. A bombing or a chemical attack has immediate, recognizable consequences. A biological attack with a weaponized disease can be silent and secret, with no immediate evidence of an attack. Many weaponized diseases have an incubation period ranging from twenty-four hours to several weeks. In our highly mobile U.S. society, a contagious disease may spread around the world by the time symptoms first appear. Many deadly diseases begin with flu-like symptoms that will most likely be treated with antibiotics and bed rest. By the time a weaponized disease is accurately diagnosed, a lethal epidemic may erupt that burns through the entire country.

A weaponized disease outbreak is complicated by many factors. One critical factor is initial diagnosis. Attention is being paid to the development of diagnostic instruments and tests to physically identify weaponized diseases. This R&D includes sophisticated instruments that analyze patient exhalations. These diagnostic instruments will be expensive and probably limited to a small range of diseases. They will most likely be deployed only in the largest hospitals.

A very useful information resource for diagnosis and treatment is the expertise of physicians in developing countries and the former Soviet Union. Weaponized diseases such as smallpox, tularemia, cholera, Ebola, plague, etc. are either rare or nonexistent in the United States, but outbreaks are more common in developing countries. The last naturally occurring smallpox cases occurred in the 1970s. A generation of physicians who have treated smallpox is vanishing. These physicians, who are located mainly in developing countries, should be videotaped as they describe presenting symptoms, disease course and treatment for smallpox. Physicians in developing countries who work regularly with diseases that have been weaponized are a valuable resource for training U.S. physicians in bioterrorism response. In addition, detailed video case histories of patients with diseases that have been weaponized can be invaluable teaching and diagnosis tools.

Another critical issue is the ability to profile a disease outbreak to distinguish a natural outbreak from a bioterrorist attack. Determining malicious intent can be critical for containing the attack and preventing additional attacks. Other life-saving analyses include the rapid identification of those first infected ("index cases"), dispersal patterns and secondary infection paths, the course of the disease and herd immunity response so that quarantines and other restrictions on movement and personal freedom can be expeditiously lifted.

Epidemiological profiles and models of disease outbreaks, both real and hypothetical, should be developed and widely disseminated among health care professionals and medical emergency responders. Profiling and modeling should be a cooperative effort of federal, state and local public health authorities. Sociologists and psychologists should contribute to these profiles since diseases spread through human behaviors.

Preparing the public for WMD terrorism

Training and awareness have focused on first responders and federal agencies with responsibility for terrorism response and recovery. One of the most important stakeholder groups, however, has been largely neglected: the American public. The U.S. public may be both victim and unwitting first responder in the event of an incident. A panicked public can hinder effective response and result in increased loss of life and property, even in the breakdown of law and society. In any given city, does the public know which television channels carry emergency broadcast information? Do they know evacuation routes, emergency shelter locations or even the mass transportation routes to hospitals?

Profiles of a disease outbreak should include psychosocial profiles of community response to a disease, particularly for diseases that are highly lethal and that may require enforced quarantine. Diseases are spread through human behaviors such as physical contact and travel. Stress and mental depression weaken immune system response and impact disease recovery and survival. Tara O'Toole notes that "in any scenario involving biological weapons, the number of people who are ill and need hospital care would likely be exceeded by individuals seeking care because they are fearful of being sick." (5) Given that antibiotics and vaccines may be in short supply, it is very important that health care workers can distinguish between the truly sick and the fearful. It is also critical that the psychological needs of actual victims and those indirectly impacted-the fearful, and also those who have lost friends and family to the attack-are addressed.

Mental health professionals, sociologists, educators, politicians and the media all play a critical role in preparing the public for a WMD attack. Responders need to gain the public trust that (a) they are being truthful about the disease and its consequences and (b) that the outbreak is being handled as fairly and efficiently as possible for the greatest public good. If these conditions are met, it is very likely that the resilient U.S. public will be an ally and a partner in the response and recovery process. Otherwise, panic and social breakdown may occur, resulting in an even greater death count.

Critical facility issues

Domestic preparedness has focused on human resources and portable equipment to protect first responders and to decontaminate victims and the incident scene. However, one of the most critical resource issues is not people or equipment, but facilities, particularly hospitals and mortuaries. A biological, chemical or bombing attack can quickly overwhelm hospital capabilities, even in the largest U.S. cities. Tara O'Toole notes that hospitals are already overburdened and that public health agencies are rarely prepared to handle the logistics of identifying and allocating vacant hospital beds. (6) Contagious diseases are best contained by isolating infected people, yet most hospitals have inadequate isolation facilities. For highly lethal incidents, adequate mortuary facilities will be critical to check disease spread and to prevent serious environmental contamination.

Given that bioterrorism is still largely hypothetical, it is difficult to justify building new hospitals for a just-in-case scenario. A more flexible and cost-effective plan might be to designate public buildings such as civic centers and subway stations as overflow facilities and to develop modular "isolation rooms" that could be quickly assembled in designated overflow facilities. These facilities could be designated and identified as dual-purpose facilities just as municipal buildings and schools were identified as bomb shelters during the Cold War.

Information Warfare, Biotechnology and Ethics

Many 21st century weapons capable of inflicting deep societal harm are dual-purpose technologies. Genetic engineering cures disease, prolongs lifespans and creates biological weapons capable of destroying the species. Information warfare technologies protect our troops in battle and can insure a swift victory with minimal loss of life on either side, but those same technologies can blow back into U.S. society as malicious software that disrupts telecommunications, the electrical power grid and other critical infrastructure systems.

A very unsettling form of information technology involves the use of digital technologies to create elaborate deceptions. Current technologies, which allow undetectable editing of digital images and the creation of virtual reality and augmented reality that is part real, part simulation, can now be used with great effect for disinformation. For example, a simulation of an enemy leader can be broadcast to convince the enemy country that its leader has surrendered. Massive virtual casualties depicted in a digital video can persuade panicked citizens that whole cities have been destroyed.

The United States, like other countries, has a long practice of migrating warfare technologies to civilian uses. The Internet itself began as a defense network. In addition, information technologies such as the Global Positioning System (GPS) are often developed as dual-purpose technologies-locating fish in the ocean for fisherman or enemy troop movements in a battle. The use of virtual or augmented reality techniques to distort reality and subvert truthful communication, if acceptable for use in war, will be adopted in U.S. society, perhaps to sell a product or attract followers to a cause. Adoption of digital disinformation by the government legitimizes its use.

Digital editing techniques can be imperceptible to the naked eye. At its core, a society is a congregation of people who share a common view of reality. What will be the consequences to society when you cannot trust what you perceive with your own eyes and ears, when those in positions of power can deceive others without detection? Information warfare produces no immediate human casualties, but can society tolerate a warfare technology that destroys its integrity?

U.S. culture values entrepreneurship and innovation. "I can, therefore I do" has been an accepted---indeed a praised-rationale for scientific discovery and invention. However, technologies that can result in massive good can also result in massive evil. It is critical at the start of the 21st century that the societal ramifications of a technological breakthrough are as thoroughly explored as the technical requirements. Human and societal factors analysis should be an institutionalized component of the R&D process. Perhaps technological innovations should require a "societal impact statement" as part of the patent or other review process. Societal impact analyses could be required as a component of federal grants and contracts awards. Above all, ethics, particularly in computer use, should be a component of the educational process at all levels, from preschool through graduate school.