Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, spoke to a luncheon meeting at the National Press Club about the lessons learned from last fall's anthrax mailings.
"Although the risk of a bioterrorism attack (affecting the United States) is relatively small compared to other risks that you take, it is not zero," Fauci told the gathering. "And so the American public must learn to accept and deal with risks that are unfortunately going to be with us for a long period of time."
Accepting the situation should not include giving up, however. The very normal concerns over bioterror can be converted into productive, heightened public awareness, Fauci said. These concerns also should spawn ongoing support from government leaders, he said.
The anthrax mailings were ineffectual from a warfare standpoint, but the episode was a very effective bioterror scenario, he said. Public officials responded to a basic need to reassure people with quick information and did not take the time to clearly differentiate conjecture from fact. This led, for example, to the confusion over the need for anthrax vaccinations on Capitol Hill.
"The textbooks were clearly incomplete in what they told us, since prior experience in bioterrorism with anthrax was minimal," Fauci said. "There was even minimal experience in this country in the naturally occurring anthrax diseases."
This lack of information was compounded by the small number of people affected, Fauci said. Disease symptoms do not always fall within a narrow band; even now, officials cannot be certain they have seen every possible manifestation of anthrax that could appear in a future incident, he said. Even so, the effectiveness of antibiotics such as Cipro mean any outbreak could be quickly contained, he said.
The public must keep in mind that "quickly" will not always equate to saving every patient, he said. The patterns established by the anthrax mailing will be easily recognizable in the future, but spotting the signs means people have gotten ill, he said.
As for the threat posed by smallpox, it remains very real because of the success of vaccination programs worldwide the past few decades, Fauci said. People with the mindset needed to pull off the World Trade Center and Pentagon attacks could very easily infect themselves with the disease and spread it by personal contact, he said.
"This is a very difficult issue because of the potential toxicities from vaccinating people against smallpox," Fauci said. "This should be an open discussion, be that at a hearing or an open town meeting, so that information can be given to the American public (and) they can understand the reasons why recommendations are or are not being made."
Instead of a widespread vaccination program before any attack, Fauci suggested the approach of identifying possible smallpox victims and those who have come in contact with them after an attack is recognized. Quarantining these people and quickly vaccinating them would stop an outbreak and save many of those already infected, he said.