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 . . . We're Unprepared
 
 By David Ignatius
 
  Suppose the single-engine Cessna that flew through restricted airspace toward the White House on May 11 had been piloted by a terrorist, rather than a retired farmer. And suppose the plane had been carrying a deadly payload of anthrax spores or some other biological weapon. That was one of the terrifying possibilities that triggered the rushed evacuation of the Capitol, the White House and other buildings that day.
 
 Now suppose we are conducting a postmortem investigation of how well the nation was prepared for such a biological attack. Think of the exercise as a "May 11 Commission," a mini-version of the exhaustive report that was prepared after the Sept. 11, 2001, attacks. The likely conclusion of our imaginary panel can be summed up in one sentence: America is shockingly unprepared for bioterrorism.
 
 There's no way to know how many people would be affected by such an attack. One simulation done by a major defense contractor estimated that an airborne bioterrorist assault on Washington would bring tens of thousands of potential casualties within the first 10 minutes and hundreds of thousands within the first five hours.
 
 Certainly, as with Sept. 11, the warning signs are flashing red. The recent report by the commission on weapons of mass destruction noted that al Qaeda conducted "extensive, well-organized" research and planning for a biological attack, starting in 1999. Past studies have described anthrax laboratories in Afghanistan, but the commission report mentions an especially deadly toxin it describes only as "Agent X." The report notes that the terrorist group " 'probably' acquired at least a small quantity of this virulent strain and had plans to assemble devices to disperse the agent." How much more warning do we need?
 
 For help in my imaginary postmortem, I turned to a leading expert in the field, Tara O'Toole, who is director of the Center for Biosecurity sponsored by the University of Pittsburgh Medical Center. She says a key problem in the event of an attack would be the lack of preparedness at hospitals. They need better systems for triage after a biological attack, better protection for health care workers and, most important, the ability to immunize large numbers of people quickly. What's more, there's no rapid clinical diagnostic test available today for anthrax, according to O'Toole, even though one could be produced with current technology.
 
 The most surprising vulnerability to biological attack is the lack of electronic connectivity among hospitals. O'Toole estimates that only 10 percent of the country's hospitals have electronic record systems that allow rapid sharing of medical information. Without them, epidemiologists would have trouble seeing patterns of exposure to an attack -- or even being certain that it had occurred. For the first 24 hours, physicians might simply be guessing. "Medical surveillance is the single most important component of a biodetection architecture," noted a 2003 study by a scientific panel known as JASON. But this is now a weak link.
 
 The Washington area is believed to have an extensive network of sensors that, in theory, should warn of a biological attack. But it's not clear that these sensors would actually pick up the presence of anthrax or other toxins. And since it often takes 24 hours to collect and analyze the specimens, the sensors might not pick up a stealth attack any more quickly than would doctors, diagnosing the symptoms of individual patients.
 
 O'Toole fears that much of the roughly $27 billion the federal government has spent on civilian biodefense since 2001 has produced only modest results. The main achievement, she says, has been development of a stockpile of smallpox vaccine. Billions of dollars have been doled out to state governments for public health preparedness, but this money has often gone to supplant other health care spending.
 
 Nearly four years after Sept. 11 and the anthrax mail attacks, the United States still lacks a coherent overall strategy for dealing with bioterrorism. The Department of Homeland Security is supposed to be developing a threat assessment, which in turn would drive planning by the Department of Health and Human Services. But O'Toole says this strategic plan hasn't yet been completed. Without it, there can be little progress on the drug countermeasures that, in theory, would be funded through the Bioshield program that became law last year.
 
 The Cessna that approached the capital on May 11 was flown by a couple of off-track amateur pilots. But it's useful to imagine a real attack -- and to realize how ill-prepared the country is. Nearly four years after what should have been the wake-up call, says O'Toole, "We're not much better off than we were. There's no strategy for setting national priorities, and no one in charge of creating a robust biodefense."
 
 We can see this one coming at us, as clear as that little single-engine plane. It's intolerable that the nation isn't better prepared.
 
 davidignatius at washpost.com
 
 
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