nerdgirl

Yes, we can produce DNA synthetically: oligonucleotide synthesis & gene synthesis. Iirc, current cost is ~50 cents per base pair. The virus, polio, has been chemically synthesized and it was physiologically active (the mice got sick). That took close to 2 years. Subsequently, a bacteriophage (a virus for bacteria), was synthesized in less than a month (2 weeks, iirc). Proteins can be designed and created from 'scratch': de novo synthesis of proteins (one of my favorite researchers in the area is Prof Les Dutton from U Penn; he calls them "maquettes"), RNA, and DNA. That in addition to this. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

I’m confused? How did you both come to that conclusion based on what Amazon wrote? She (& President Eisenhower) were talking about private contractors. President Eisenhower's phrase was "arms industry." Some private contractors are post-military service; some aren't. Of all the folks who have made explicit or implicit comments regarding military service as a requirement to vote in the US or as prerequisite to speak regarding national security, I’ve not observed [Amazon] engaging in that behavior. If you have, please correct me. She’s proud of her service, rightfully. And of all the folks who seem to have a ‘knee-jerk’ for giving credibility to those who have been in the military, she's not among that group. E.g., recently a retired military officer's nomination to President-elect Obama's cabinet was given credibility with the phrase "He's a Marine. 'Nuff said." Really? I'd cite his experience and record, but that's just me. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

I think a hundred million is still subjective, imprecise and probably on the high side. Okay, I provided the sources and some ranges, within those sources there are more sources. Those are just the estmates available. One can find much higher estimates and much lower on the internet. Those are also standard estimates of death. Estimating deaths from wars, famines, autocratic dictatorships, etc *is* inherantly an imprecise task. While some regimes have kept horrifically precise records (e.g., the Nazis and the Gautemalan police), not all regimes have followed that model. There are fairly robust and substantianted methods to obtain best estimates in situations in which regimes have not kept records. If that was the interpretation you made, it was not intended. Please look at what I wrote: "Given that arguably the single most brutal and repressive regime of the 20th century -- measured in estimated lives lost, length, and suppression of civil & human rights and that was a strategic threat to the United States and allies -- fell without military invasion, should the US have invaded the Soviet Union?" I'm not sure how you came up with "a single event" from that statement. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

Good question: I ‘back of the enveloped’: 9M Russian civil war 4M-10M under Lenin 20M-60M Stalin’s regime forced labor and Gulags 6M-11M famines under Stalin 6-10M post-Stalin I did not include 20M WWII deaths (10M military & 10M civilian), which one can build an argument either way. (Some estimate higher: 27M military/19M civilian.) Also didn't include 1921 famine (5M). A hundred million would have been more precise & more accurate. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

This suggests a couple questions that have been posed before and are good ones to keep bringing up (imo). They don’t have easy answers for some of us; for isolationists, there is an easy answer: metaphorically build a wall. Challenging questions are the most interesting one, again im-ever-ho. (1) Given that arguably the single most brutal and repressive regime of the 20th century -- measured in estimated lives lost, length, and suppression of civil & human rights and that was a strategic threat to the United States and allies -- fell without military invasion, should the US have invaded the Soviet Union? That’s the extreme case. Hundreds of millions killed. Brutal repression of civil liberties. (2) If one argues that foreign policy should be based on an “ends justifies the means” rationale and one argues from normatives (i.e., preventing people from people killed is the ultimate moral good that should drive foreign policy and not doing everything that the US can to achieve that goal is morally bad) … what does that say with respect to current and past US foreign policy toward other states, e.g., China/Tibet, Myanmar (nee Burma), Sudan, Rwanda, East Timor, most of Central America in the 1980s, Chile under Pinochet, Argentina's dictators ... ? What is the US responsibility toward the rest of the world? Should the US assume a Wilsonian foreign policy driven by humanitarian intervention? VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

You're most welcome, altho' I'm a lil' confused (I included links) ... but to be more explicit: -- http://www.nap.edu/catalog.php?record_id=11876 -- http://www.pbs.org/wgbh/nova/id/ -- http://www.anthro.utah.edu/PDFs/Papers/khnbj05.pdf -- http://plato.stanford.edu/entries/altruism-biological/ VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

And so I shall . . . Terror events in the past have been generally local or finely focused on a specific group. Yes & no. A great deal of thinking on terrorism is still influenced by the separatist-nationalist terrorism that predominated (but was not exclusive) from the 1940s (e.g., early Zionists) through 1980s (e.g., Western Sahara, IRA, Tupac Amura, Shining Path, GIA). As you write they were frequently focused specific territories; it was also a concurrence of the anti-colonialism of the time. Before that the predominant terrorists were globally focused, and others have argued as such offer a better model for planning that the separatists-nationalists, i.e., the anarchists of the late 1800s and early 1900s. Similarly non-specific territory-focused but very different in their goals/motivations and operations was another much earlier terrorist group. One of the most well-known of early sub-state actors that operated multi-regionally, were the Hashishiyyin (origin of the modern word “Assassin”). Concur. And recognition of that is critical to recognition of the importance of the wider world … strategic communications and why what the rest of the world thinks matters, (part 2). Once one makes that recognition, what does that suggest with respect to response and planning for response? There are lots of reasons terrorists might not execute an attack: pressure from tacit supporters (e.g., seen w/IRA and PKK) pressure from credible authorities re-integration (e.g., IRA, Tamil and Uraguay) disintergration/collapse (e.g., Red Cells, Tupac Amura) disruption of a group’s operations [e.g., MNF at start of OEF] reality or perception of target hardening/decreased (or less) vulnerability of targets success in conventional weapons and improvised explosives patience success at achieving the group’s goals. Yours is one that I’ve never heard put forth before. Doesn’t make it invalid. Just one that I’d like to hear more evidence and understand the process behind it. You may find interesting and edifying in the non-pejorative sense of the word a relatively recent RAND study: How Terrorists Groups End, which I was asked to review last summer, on the end of terrorist groups – how they end & what has been found to work best toward ending them. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

Yes.

Do pencil pushers get medals? [sarcasm] And perhaps at the heart of the issue: do you put them on your "I love me" wall? [/sarcasm] /Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

One can speculate. I would suggest looking to the response to Hurricane Katrina as a model case for comparison w/r/t federalization of response. (And hurricanes can trigger [usually do] the Stafford Act.) Regardless, the law is written the way it is written today. Additionally, across the TOPOFF-2, -3, & -4 events (the closest full scale terrorism response exercise that involves federal, State, local, and tribal governments), local governments and police resist ceding authority to States, States governments and police resist ceding authority to DHS & FBI, and most have resisted DoD coming into play. The initial response to the first Amerithrax cases in Florida wesn't federalized until use of the US postal system was discovered. Now in the event of another bioterrorism or chemical terrorism or radiological terrorism, things may change. That’s speculation. And the robustness of those speculations both w/r/t policy acuity and technical content/reality may vary. (Detonation of a nuclear device would trigger Stafford Act but through a different route.) Over the weekend, I was part of a group that was mostly clinicians and PharmD's (of which I am neither). About half were former military/DoD. One observation that struck me -- because it was surprising to me -- was how the private sector folks kept asking for federal guidelines and requirements (w/r/t acquisition, dosage, usage, storage, emergency response plans, etc of medical treatments and response to a CBW terrorism event). Basically, the private sector representatives (mostly ER docs and hospital pharmacists) were wanting federal intrusion w/r/t preparation. What States do is up to the States. Federal agencies can issue advisories and minimum requirements if one requests funding through certain programs (e.g., MMRS). VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

*Exactly* That's where weighing probability versus (potential) consequence is important. It's also where fictional and fictionalized (read: Ken Alibek post his first 3 months of debriefing) scenarios can become highly problematic. What is feasible and by whom is not as explicitly clear as some might like to suggest. While difficult, dealing with military-scenarios is comparatively less complicated (still complicated but just a little less so) than civilian scenarios. From the very basic recognition that the active duty are federal. With civilians there's a tremendously important issue of States. As I wrote, use of a biological agent does not automatically trigger the Stafford Act nor allow domestic use of Title 10 forces (i.e., the active duty military). VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

yes and there are several fictional books out there that use that scenario,some better than others in their application. Which is why bio is a concern IMO. Again, it depends on the agent. Is it the most likely scenario? No. Look to the Aum Shinrikyo and Bacillus anthracis for a likely scenario. Would it be a very effective scenario? Not likely, regardless of fictional accounts. (And by the way, the question wasn't whether biological agents should or shouldn't be of concern ... but should chemical (& radiological) be dismissed/disregarded/ignored.) The simple measure of transmissibility is the R0. If R0 is less than zero, one person infects less then one other person -- the disease does not spread. Getting an R0 of zero is a combination of the characteristics of the bug and the success of public health intervention efforts (vaccination, quarantine). If R0 equals 1, 1 person infects 1 other person. If R0 is greater than 1, than the infection can potentially be exponential. Measles pre-vaccine R0 was 14-18. Polio is 5-7. Tuberculosis is 2-5. Ebola is 1.34 - 1.8. AIDS is 0.34 - 1.5 Pneumonic plague is 0.8 - 3.0. Smallpox is 1-3. The Dark Winter folks used an R0 of 10 and were (appropriately, imo) excoriated for it. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

Depends on the agent. Scenarios of folks walking while infective w/VHFs (e.g., Ebola) are completely notional. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

The problem is that your 'cliff notes' version is problematic. And one doesn't need to go to JWICS to discuss it. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

Thanks. On what do you base that assessment of probability? (Or your assessment of ease of weaponization and dissemination of a biological agent?) I'm always curious as to process behind one's thinking. How different is ‘street chemistry’ of IED production from the street chemistry of simple improvised chemical devices? Are you familiar w/the Mubtakkar device? (Call NGIC not Ron Suskind.) VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

Don’t doubt that. As I wrote, until recently, the plague vaccine was administered. It wasn’t just available to military either. Also available to federal civilians and non-federal researchers. There is no FDA licensed plague vaccine that provides protection against the pneumonic form of the disease. For a long time, the military used the old plague vaccine under guidelines that allowed it to be used as “investigational drugs.” Older generations of a plague vaccine exist, but they never were, or no longer are, licensed in the US, Canada, or the UK. The old vaccine was used for years. In 2009, the DoD's Joint Vaccine Acquisition Program (JPEO-MO) through the CBDP plans to start buying a new plague vaccine developed jointly w/UK & Canada. These vaccines aren’t procured through the Military Health System, as most (all?) other medical treatments are. (The services refuse buy BW vaccines themselves post-anthrax vaccines ‘issues’/court-cases/etc; there’s a fight/rice-bowl battle among OSD(Health Affairs), the CBDP[under USD(AT&L)], and the services.) Medical chemical and medical radiological countermeasure research are ~1% of the total budget – don’t expect any finished products within the POM. You make it sound so easy. How would you propose dealing with domestic politics? How? Are you familiar with the TOP-OFF 3 national full-scale exercise? That exercise incorporated release of poorly-weaponized Y. pestis (plague) w/an international component. A biological terrorist event does not automatically trigger the Stafford Act much less use of Title 10 forces. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

I read this report when it came out, and I was unimpressed. Concur that there are reasons to be critical of the latest report. The Commission explicitly elected to not include chemical (& radiological), so it is not de facto included. Representatives of the Commission and the Commission staff have publically stated a reason why they made that choice. While I can speculate on the underlying reasoning for choosing to focus solely on biological and nuclear terrorism, I disagree *strongly* with the choice. Nuclear terrorism is the only WMD that is likely to pose a threat to the Republic. By disregarding the threat of chemical (& radiological terrorism), however, a potential vulnerability is created. When I think about risk, I consider both the “probability” and “consequence” components. The probability of use of a chemical agent by foreign or domestic terrorists is the highest across the WMD spectrum in my opinion. Point of clarification: having yellow-cakes uranium and a dirty bomb are not the same thing. A dirty bomb is not related to a nuclear device, even tho' they occasionally get 'mashed' together colloquially. Dirty bombs are radiological dispersive devices (RDD). Incorporate isotopes with much shorter half life than Uranium, e.g., Cobalt-60 or Strontium-90. Uranium would be a very poor choice for a dirty bomb. Concur. I know of >$110B that has been spent toward reducing that risk, which one can argue whether that has been the most effective use of taxpayers dollars. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

The exercise itself, no. Some of the questions going through my squishy gray matter and some of the impetus for the thread here, probably. My thinking was more the balance between domestic politics and most effective policy, tho. It's even more complicated than what you suggest. By *not* sharing the vaccine, the US may actually be *increasing* the risk to the US. (Sounds counterintuitive at first, eh?) Ring vaccination, which would not require mass vaccination of all US citizens, has been used successfully and is backed by all the science. The US could share the vaccine, still protect the US, and prevent spread of disease further ... including to additional US cities. But, science very rarely drives policy, tho. So it's the tension between what might be the best policy (ring vaccination & share) versus what I though was likely via domestic politics. And frankly, I'm not sure that any other state would behave differently than how I suspect the US would. Not a democratic one at least. Autocratic ones likely would not even consider the question. Within the exercise, one piece that comes out is German citizens (as that was one of the notional sites for relese) trying to get out of Germany and (again notionally) Polish citizens trying to come into Germany in order to get the vaccine. That brings up additional issues of securing/closing borders, quarantine, and pragmatics of distribution logistics. (Even more complicated than the original question I posed.) From a real world outbreak of pneumonic plague in India, the issue was dealt with by winthdrawing all antibiotics to the central health district. Therefore, people were compelled to not leave. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

Depends on the vaccine. At this point, I would not recommend vaccination against smallpox or Hepatitis, for example, for most children. Personally, I don’t like the tendency toward anti-bacterial soap/whatever and not letting kids get dirty. Otoh, over the last 5-10 years, the US has seen significant increases in incidence of measles (in the UK too) and mumps largely due to parents electing to not have children vaccinated for a wide set of beliefs … some that are dubious at best. With the original post/thread, I was less interested in giving a tutorial on smallpox, bioterrorism, or vaccines, than curiosity w/r/t folks response to the original question regarding opinions on sharing vaccines in the event of a terrorist release. Do you have an opinion on that? I'd be curious to hear.

Symptoms typically appear within 7 to 14 days depending on the strain. The first symptoms are "flu-like." The characteristic rash appears a few days later. By the time, the first patients exhibit symptoms, yes it would be too late for ~30% of them. (~60% of folks survive with varying degrees of disfigurement). It's consequence management to stop the spread of the infectious disease. One is distributing vaccine for two groups: the uninfected/unexposed and those who may be exposed/infected but are not yet exhibiting symptoms. Isolate the ill-infected, and quarantine those who may be exposed but are not yet symptomatic. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

Yes, for the reasons detailed in my response to Mike, smallpox was particularly chosen for this exercise. As I noted in my OP Stan Foster, who led the efforts to eradicate smallpox in Bangladesh and parts of Africa was also involved. When you’ve got one of the world’s experts (who’s also a *really* cool human) involved, it’s strategic to use that expertise. Additionally, with smallpox one can administer the vaccine post-exposure and it still provides protection. Earlier is better. Most other vaccines don’t work that way. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

I was unaware of that, so does one just go down to the doctors office and request one? Officially the federal government did not recommend vaccination for all US citizens and residents after the Dec 2002 National Smallpox Preparedness Program policy was implemented. As the vaccine program was phasing its way through first responders, hospital workers, and other health preparedness related individuals, yes, you would likely have been able to get a vaccination, however. Probably not through your local primary care physician but through a State public health department or large hospital. It would be more challenging for the “average citizen” to get vaccinated now. One generally needs to be part of certain groups: first-responder, ER team member, part of a smallpox response team, certain military and federal civilians, variola researcher, or clinical trial participant. Today, the US maintains that it has over 300M doses of the smallpox vaccine, enough for every US citizen. These are also not the old ‘grown on the side of a cow’ versions of the vaccine; all of those in the US stockpile were destroyed. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

It’s a good question. There are lots of reasons to choose it. For the exercise in which I participated, it was largely driven by modeling on the Atlantic Storm exercise. The latter itself was not directly modeled on but was influenced by the Dark Winter exercise. It was designed and executed by the same folks. Why smallpox? Lots of reasons. It’s a near-universally feared infectious disease. It has a history of being used for asymmetric warfare (by British against Native Americans [e.g., see letters between COL Bouquet & Lord Amherst]). Smallpox was weaponized as part of the former US and former Soviet weapons program. Some of us still wonder what happened to the stocks of weaponized smallpox that the Soviets had on ICBMs. These are terrorism scenarios as well. The most terrifying agent does not necessarily equal the most effective agent. Smallpox is a very effective agent to use for raising awareness and garnering media and policy maker attention. There are other reasons to argue for pneumonic plague. You’re right about the mortality rates of untreated pneumonic plague being greater (basically 99% die). Both pneumonic & bubonic are largely treatable. Y. pestis has less of a history w/r/t known & suspected offensive weapons programs. It is also still a disease found around the world. Heck, there are a dozen or so cases, usually bubonic, in the US every year in the southwest ‘four corners’ region. Lots of prairie dogs carry Y. pestis. Y. pestis was part of both the former US & Soviet weapons programs, however. Scenarios between smallpox & pneumonic plague are both fairly grim … or add in a hemorrhagic fever or a genetically manipulation measles strain. Measles is *much* *much* more transmissible than vaccinia variola major, Y. pestis, or any of the VHFs. Also one of the experts affiliated with the group that designed & led both the Dark Winter and Atlantic Storm is DA Henderson, i.e., the physician who led the eradication of smallpox. One could make a similar argument/ask a similar question w/r/t distribution of therapeutics post-pneumonic plague terrorist event … altho’ it’s more complicated because of multiple different antibiotics that can be used to treat. There is a vaccine for plague, which was used by the US military during the Vietnam war til recently, but it is not FDA approved. VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying

100% (I'm also willing to bet [Amazon] scored similarly.

Yesterday I was at Emory University (in Atlanta) for a table-top exercise on bioterrorism response. I got to play DHS Secretary. Stan Foster, who led WHO smallpox eradication efforts in Bangladesh, played head of CDC. The exercise was modeled on the Atlantic Storm exercise of a few years back. If terrorist use of smallpox occurred in Europe (e.g., Netherlands, Sweden, and Germany in the exercise); Turkey; and the US (NYC & LA), what would you recommend the response be? Particularly w/r/t sharing vaccines? The US currently has the largest stockpile of smallpox vaccine (>300M doses), which is about half the world’s stockpile. The US also has among the most vulnerable population in the developed world: we stopped mandatory smallpox vaccination in early 1973. States like Russia continued into the 1990s and most of Europe continued into the late 1970s or early 1980s. Many developing nations continued vaccinations into the 1990s, but our public health system is much better. Otoh, ring vaccination (basically, giving the vaccine only to people in close contact or secondary contact with an isolated infected individual) was used in the real world and shown to be effective without the potential problems/contraindications of mass vaccination. The smallpox vaccine is also effective up to 3 or 4 days *after* exposure … a couple days longer if a weak strain. The science and the real-world success of ring vaccination is sound. But science rarely drives policy. If states like Turkey (~70M population) with less than 1M doses of the smallpox vaccine stockpiled, should the US share some portion of our vaccine stockpile if requested? I asserted that once a single smallpox case was discovered in the US, it would be exceedingly unlikely that any US vaccine doses would be shared with other countries. Not because it’s counter to science and not because of other strategic considerations (of which there are quite a few) but because of domestic politics. Most of the folks in the room didn’t like that for various reasons. This isn’t just policy wonk/academic. On Tuesday, the (latest) WMD Commission released their findings in which they assert that a biological terrorism attack (not necessarily smallpox) is “more than likely” within the next 5 years. Would you get vaccinated today if it was available? The efficacy of the vaccine for those who were born before 1973 is low today. (NB: In December 2002, President Bush ordered smallpox vaccines be made available for all American citizens. Less than 50k were vaccinated.) VR/Marg Act as if everything you do matters, while laughing at yourself for thinking anything you do matters. Tibetan Buddhist saying