If the government ever discovers a bioterrorist attack, it immediately will ship 50-ton packages of medical supplies — antibiotics, IV fluid and other equipment — to local hospitals struggling to contain the deadly outbreak.
But will there be enough, and who gets limited supplies?
Specialists say good supplies against some diseases are being stockpiled. Already on hand are enough antibiotics to treat 2 million cases of anthrax, Tommy Thompson, the nation's health secretary, said Thursday. Plans call for stockpiling enough for 10 million people.
Also in federal storage are other antibiotics, such as streptomycin and gentamicin, to treat plague and other biological agents.
Those 50-ton packages would be just the first day's aid. Eight of the caches, each with enough drugs to treat 10,000 to 35,000 people immediately, are stored around the country, ready to ship in 12 hours. The next day, the government would begin shipping more tablets from other stockpiles and manufacturers' inventories, and emergency production of yet more would begin.
"That's an important component," stressed Dr. Margaret Hamburg, who helped set up the stockpile under the Clinton administration. "You don't necessarily need to have a warehouse full of all the drugs you might need for the long haul. You need to have a mechanism to ensure backfilling of supplies as they're utilized."
That may not even be necessary. Four companies make one of the antibiotics that can treat anthrax, and local pharmacies always have a lot on hand, noted Jerry Hauer, a New York City bioterrorism specialist who advises Thompson.
The bigger question is how to ensure the drugs get to the people who really need them fast enough.
First, local hospitals would have to recognize quickly cases of anthrax or smallpox or some other agent — all of which may in the early stages resemble the flu — and call federal health officials for help.
Then, in a panic situation, it must be determined who hands out the drugs and to whom.
Thompson assured senators this week that no member of the Cabinet or Congress would get their own special stockpile.
"It's going to be given to the people who need it in the city that has the greatest need," Hauer said. "You've got to turn it over to the locals. They've got to be able to distribute it in the city."
New York, for instance, has set up 300 potential distribution points. The city was supposed to practice how such distribution would work on Sept. 12, a drill canceled following the terror attacks on the city's World Trade Center and the Pentagon. But if an outbreak was big enough that all those sites needed to open — more likely, only a few dozen would be needed, Hauer stressed — the city would need 40,000 workers to hand out medications.
The antibiotics are stored in huge bottles, meaning doses for each person would have to be counted out by hand.
"One of the dumbest things I've seen was in the previous administration, this decision to buy bulk antibiotics rather than blister packs" of individual doses, Hauer said.
But quickly discovering bioterrorism remains the weakest link, as the diseases incubate for days to weeks before someone exposed gets sick.
"If you got really lucky, you might save quite a number of people," because of the stockpiled medications, said Dr. C.J. Peters, a virologist who recently retired from the Centers for Disease Control and Prevention, where he helped plan bioterrorism preparedness. "But you would have to be really lucky."
However, Thursday's discovery of an anthrax case in Florida provides some reassurance that the system to catch suspect diseases is working better. A Florida state lab worker recently trained by the CDC about anthrax symptoms tested the patient's blood and sounded the alarm, something that might never have happened before the Sept. 11 terrorist attacks heightened doctors' awareness, CDC director Jeffery Koplan said.
The CDC believes the patient caught anthrax naturally, not through terrorism, but is retracing his movements over the past few weeks to be sure.
Anthrax isn't spread person-to-person, so CDC doubts enough people ever would be infected at one time to stress the drug stockpile. Of more concern is the highly contagious smallpox.
There is no treatment for smallpox. The government has 15.4 million doses of vaccine in storage, ready to vaccinate those around the sick to keep them from catching it, and 40 million more doses on order.
Experts still don't agree how smallpox vaccine would be distributed. Some say only people who have had contact with the sick should be vaccinated, while others say entire cities where smallpox was found would need inoculations, Hauer said.
But no one will be vaccinated in advance out of fear of bioterrorism because smallpox is a live vaccine and thus is very risky to anyone with a weak immune system, he explained.