Combating Terrorism: Observations on Biological Terrorism and Public
Health Initiatives (Testimony, 03/16/99, GAO/T-NSIAD-99-112).
Pursuant to a congressional request, GAO discussed its ongoing work and
preliminary observations on the biological terrorist threat and some
aspects of the Department of Health and Human Services' (HHS)
bioterrorism initiative, focusing on: (1) intelligence agencies'
judgments about the threat of terrorism; (2) the importance and benefits
of threat and risk assessments to provide a sound basis for targeting
the nation's investments in combating terrorism; (3) preliminary
observations from GAO's ongoing work on the science behind the
biological and chemical terrorist threat, with some focus on biological
agents; and (4) overall observations on public health initiatives that
deal with a new national pharmaceutical stockpile and the basis for
selecting items to research, produce, procure, and stockpile for
civilian defense against terrorism.
GAO noted that: (1) the U.S. intelligence community continuously
assesses both the foreign-origin and the domestic terrorist threat to
the United States and notes that, overall, conventional explosives and
firearms continue to be the weapons of choice for terrorists; (2)
terrorists are less likely to use biological and chemical weapons than
conventional explosives, at least partly because they are difficult to
weaponize and the results are unpredictable; (3) however, some groups
and individuals of concern are showing interest in biological and
chemical agents; (4) the possibility that terrorists may use biological
and chemical materials may increase over the next decade, according to
intelligence agencies; (5) while biological and chemical terrorism is
still an emerging threat, many agencies have initiated programs and
activities--with Congress' support and funding--to combat and prepare
for this threat; (6) GAO has previously reported on the value of a new,
post-Cold War approach of using sound threat and risk assessments
performed by a multidisciplinary team of experts for focusing programs
and investments to combat terrorism; (7) without such assessments using
sound inputs and a multidisciplinary team of experts, there is little or
no assurance that programs and spending are focused in the right areas
in the right amounts; (8) GAO is looking into the scientific and
practical feasibility of a terrorist or terrorist group improvising a
biological weapon or device outside a state-run laboratory and program,
successfully and effectively disseminating biological agents, and
causing mass casualties; (9) much of the information obtained is
sensitive, classified, and in the early stages of evaluation; (10)
overall, there are serious challenges at various stages of the process
for a terrorist group or individual to successfully cause mass
casualties with an improvised biological or chemical weapon or device;
(11) for its part of domestic preparedness initiatives for combating
terrorism, HHS received about $160 million in fiscal year (FY) 1999;
(12) these funds are intended for a variety of related preparedness
efforts, including research and development and a new national stockpile
for pharmaceuticals, millions of doses of vaccines for smallpox and
anthrax, antidotes for chemical agents, and other items; and (13) for FY
2000, HHS has requested $230 million for public health initiatives for
dealing with bioterrorism.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: T-NSIAD-99-112
TITLE: Combating Terrorism: Observations on Biological Terrorism
and Public Health Initiatives
DATE: 03/16/99
SUBJECT: Interagency relations
Terrorism
Strategic planning
Emergency preparedness
Explosives
Domestic intelligence
Biological warfare
Chemical warfare
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NS99112T GAO
United States General Accounting Office
Testimony Before the Committee on Veterans' Affairs and the
Subcommittee on Labor, Health and Human Services, Education and
Related Agencies, Committee on Appropriations, U.S. Senate
For Release on Delivery Expected at 9:30 a.m., EST Tuesday, March
16, 1999
COMBATING TERRORISM Observations on Biological Terrorism and
Public Health Initiatives
Statement of Henry L. Hinton, Jr., Assistant Comptroller General,
National Security and International Affairs Division
GAO/T-NSIAD-99-112
Page 1 GAO/T-NSIAD-99-112
Mr. Chairman and Members of the Committee and Subcommittee: I am
pleased to be here to discuss our ongoing work and preliminary
observations on the biological terrorist threat and some aspects
of the Department of Health and Human Services' (HHS) bioterrorism
initiative. As you know, our ongoing work was requested by you in
your capacity as
the Chairman and Senator Rockefeller as Ranking Minority Member of
the Senate Veterans' Affairs Committee; Congressman Shays as the
Chairman of the House Government Reform Committee, Subcommittee on
National Security, Veterans Affairs, and International Relations;
and Congressman
Skelton as Ranking Minority Member of the House Armed Services
Committee. Over the past 3 years, we have studied and reported on
a number of issues concerning federal agencies' programs and
activities to combat terrorism. A list of related GAO reports and
testimonies is in appendix I.
It is frightening to think that a lone terrorist or terrorist
group might be able to improvise a biological weapon or use other
means to spread anthrax, smallpox, or other biological agents to
cause mass casualties and overwhelm the health care system in the
United States. There is no question that it would be
unconscionable not to prepare to respond to, if not be able to
prevent, such an incident. But some very important questions
should be asked and answered as an integral part of any federal
decision to invest in medical countermeasures or preparedness
initiatives.
This is one of those few areas in which national security and
public health issues clearly intersect. It is also an area in
which many disciplines of expertise must come together to perform
the challenging tasks of assessing an emerging threat and focusing
our investments on the most appropriate countermeasures and
preparedness efforts.
My testimony will address four issues. First, I will briefly
discuss intelligence agencies' judgments about the threat of
terrorism. Second, I will highlight the importance and benefits of
threat and risk assessments to provide a sound basis for targeting
the nation's investments in combating
terrorisma widely recognized sound business practice we have
discussed in our reports and testimonies. 1 Third, I will share
some preliminary 1 See Combating Terrorism: Spending on
Governmentwide Programs Requires Better Management and
Coordination (GAO/NSIAD-98-39, Dec. 1, 1997); Combating Terrorism:
Threat and Risk Assessments Can Help Prioritize and Target Program
Investments (GAO/NSIAD-98-74, Apr. 9, 1998); and Combating
Terrorism: Observations on Federal Spending to Combat Terrorism
(GAO/T-NSIAD/GGD-99-107, Mar. 11, 1999).
Lett er
Page 2 GAO/T-NSIAD-99-112
observations from our ongoing work on the science behind the
biological and chemical terrorist threat, with some focus on
biological agents. Finally, I will provide some of our overall
observations on public health initiatives that deal with a new
national pharmaceutical stockpile and the
basis for selecting items to research, produce, procure, and
stockpile for civilian defense against terrorism.
Summary The U.S. intelligence community continuously assesses both
the foreign-origin and the domestic terrorist threat to the United
States and
notes that, overall, conventional explosives and firearms continue
to be the weapons of choice for terrorists. Terrorists are less
likely to use biological and chemical weapons than conventional
explosives, at least partly because they are difficult to
weaponize and the results are unpredictable. However, some groups
and individuals of concern are showing interest in biological and
chemical agents. The possibility that terrorists may use
biological and chemical materials may increase over the next
decade, according to intelligence agencies. While biological and
chemical terrorism is still an emerging threat, many agencies have
initiated programs and activitieswith Congress' support and
fundingto combat and prepare for this threat. We have previously
reported on the value of a new, post-Cold War approach of using
sound threat and risk assessments performed by a multidisciplinary
team of experts for focusing programs and investments to
combat terrorism. Without such assessments using sound inputs and
a multidisciplinary team of experts, there is little or no
assurance that programs and spending are focused in the right
areas in the right amounts. We are looking into the scientific and
practical feasibility of a terrorist or terrorist group
improvising a biological weapon or device outside a state-run
laboratory and program, successfully and effectively disseminating
biological agents, and causing mass casualties. 2 Much of the
information we have obtained is sensitive, classified, and in the
early stages
of evaluation. Overall, our work to date suggests that, for the
most part, there are serious challenges at various stages of the
process for a terrorist group or individual to successfully cause
mass casualties with an
2 We recognize that some agents are communicable and could be
spread without a weapon or device. Lett er
Page 3 GAO/T-NSIAD-99-112
improvised biological or chemical weapon or device. More
specifically, our preliminary observations are that a terrorist
group or individual generally would need a relatively high
degree of sophistication to successfully and effectively process,
improvise a device or weapon, and disseminate biological agents to
cause mass casualties; a weapon could be made with less
sophistication, but it would not likely
cause mass casualties; some biological agents are very difficult
to obtain and others are difficult to produce; and effective
dissemination of biological agents can be disrupted by
environmental (e.g., pollution) and meteorological (e.g., sun,
rain, mist, and wind) conditions. For its part of domestic
preparedness initiatives for combating terrorism,
HHS received about $160 million in fiscal year 1999. These funds
are intended for a variety of related preparedness efforts,
including research and development and a new national stockpile
for pharmaceuticals, millions of doses of vaccines for smallpox
and anthrax, antidotes for chemical agents, and other items. For
fiscal year 2000, HHS has requested
$230 million for public health initiatives for dealing with
bioterrorism. Our preliminary observations follow: HHS has not
yet performed a documented, formal, methodologically
sound threat and risk assessment with a multidisciplinary team of
experts to derive, prioritize, or rankin accordance with the most
likely threats the nation will facethe specific items it plans to
have researched, developed, produced, and stockpiled. Several of
the items HHS plans to procure seem to be geared toward the
worst-possible consequences from a public health perspective and
do not match intelligence agencies' judgments on the more likely
biological and chemical agents a terrorist group or individual
might use. It is unclear from the HHS fiscal year 1999 operating
plan whether and
to what extent the Department has fully considered the long-term
costs, benefits, and return on investment of creating and
sustaining the production and inventory infrastructure for such an
initiative.
Page 4 GAO/T-NSIAD-99-112
The Foreign and Domestic Terrorism Threat in the United States
The bombings of the World Trade Center in 1993 and the federal
building in Oklahoma City, Oklahoma, in 1995, along with the use
of a nerve agent in the Tokyo subway in 1995, have elevated
concerns about terrorism in the United Statesparticularly
terrorists' use of chemical and biological weapons. The U.S.
intelligence community, which includes the Central Intelligence
Agency, the Defense Intelligence Agency, the National Security
Agency, the Federal Bureau of Investigation, and others, has
continuously assessed the foreign-origin and domestic terrorist
threats to the United States. According to intelligence agencies,
conventional explosives and firearms continue to be the weapons of
choice for terrorists. Terrorists are less likely to use chemical
and biological weapons, at least partly because they are more
difficult to weaponize and the results are unpredictable. However,
some groups and individuals of concern are showing interest in
chemical and biological weapons. According to the FBI, there were
4 confirmed incidents of terrorism in the United States in 1992,
compared with 12 in 1993, zero in 1994, 1 in 1995, 3 in 1996, and
2 in 1997. These incidents involved the use of conventional
weapons.
Threat and Risk Assessments Can Help Define Requirements
and Prioritize and Focus Program Investments
We have pointed out that sound threat and risk assessments can be
used to define and prioritize requirements and properly focus
programs and investments in combating terrorism. Soundly
established requirements could help ensure that specific programs
and initiatives and related expenditures are justified and
targeted, given the threat and risk of validated terrorist attack
scenarios as assessed by a multidisciplinary team of experts.
Several public and private sector organizations use formal,
qualitative threat and risk assessments to manage risk and
identify and prioritize their requirements and expenditures. For
example, the Defense Threat Reduction Agency, the Department of
Energy, and the Federal Aviation Administration use such
assessments in their programs. In addition, the President's
Commission on Critical Infrastructure Protection 3 recommended in
its final report that threat and risk assessments be
performed on the nation's critical infrastructures, such as
telecommunications, electric power, and banking and finance
systems. In fact, the Federal Emergency Management Agency strongly
endorses the
3 The Commission, a government-private sector body established in
1996, was to develop a national strategy to protect the nation's
critical infrastructures from physical and computer-based threats.
Page 5 GAO/T-NSIAD-99-112
concept of risk assessment, as it is the key to predisaster hazard
mitigationthe foundation of emergency management. Moreover, the
Department of Energy has stated that domestic preparedness program
equipment purchases should be delayed until a risk assessment is
completed to ensure that appropriate equipment is obtained.
Threat and risk assessments are grounded in a new, post-Cold War
approach to thinking about and dealing with security issues called
risk management. Risk management is the deliberate process of
understanding riskthe likelihood that a threat will harm an asset
with some severity of consequencesand deciding on and implementing
actions to reduce it. Risk management principles acknowledge that
(1) while risk generally cannot be eliminated it can be reduced by
enhancing protection from
validated and credible threats and (2) although many threats are
possible, some are more likely to occur than others. Threat and
risk assessment is a deliberate, analytical approach that results
in a prioritized list of risks (i.e., threat-asset-vulnerability
combinations) that can be used to select countermeasures to create
a certain level of protection or preparedness.
Generally, because threats are dynamic and countermeasures may
become outdated, it is sound practice to periodically reassess
threat and risk.
The critical first step in a sound threat and risk assessment
process is the threat analysis. The analysis should identify and
evaluate each threat in terms of capability and intent to attack
an asset, the likelihood of a
successful attack, and its consequences. To perform a realistic
threat assessment, a multidisciplinary team of experts would
require valid foreign and domestic threat data from the
intelligence community and law enforcement. The intelligence
community's threat reporting on foreign-origin terrorism is often
general and, without clarification, could be difficult to use.
However, a multidisciplinary team of experts can use the best
available intelligence information on foreign-origin and domestic
threats to develop threat scenarios. The intelligence community
could then
compare the threat scenarios to its threat reporting and validate
or adjust the scenarios with respect to their realism and
likelihood of occurrence as appropriate.
Page 6 GAO/T-NSIAD-99-112
Our Ongoing Work Examining the Biological and Chemical Terrorist
Threat
On the basis of information we obtained and analyzed to date, a
terrorist group or individual 4 would generally need a relatively
high degree of sophistication to successfully and effectively
process, improvise a device or weapon, and disseminate biological
agents to cause mass casualties. John Lauder, Special Assistant to
the Director of Central Intelligence for Nonproliferation,
recently testified that the preparation and effective use of
biological weapons by both potentially hostile states and by non-
state actors, including terrorists, is harder than some popular
literature seems to suggest. 5 Because we are in an open forum and
our work is sensitive and
preliminary in nature, my discussion will remain limited. Our
ongoing synthesis of information and technical data from
recognized experts suggests that some exotic biological agentssuch
as smallpox are difficult to obtain, and otherssuch as plagueare
difficult to produce. Processing biological agents for effective
dissemination to cause mass casualties requires specific, detailed
knowledge and specialized
equipment. Moreover, improvising a device or weapon that can
effectively disseminate biological agents to cause mass casualties
may require certain items that are not readily available. In
addition, successful and effective dissemination of biological
agents in the right form requires the proper environmental and
meteorological conditions and appropriate energy
sources. That is not to say that casualties would not occur if
less sophisticated means were used. For example, if an agent were
dispersed in a less effective form using less effective equipment
, some casualties might occur. However, under these circumstances,
the potential incident would be less likely to cause mass
casualties. What we have learned is that capability is a critical
factor. Terrorists have to handle risk, overcome production
difficulties, and effectively disseminate a biological agent to
cause mass casualties.
We continue to gather and evaluate data on these matters and plan
to report to our requesters this summer.
4 For the purposes of our work, we define terrorist(s) as a non-
state actor not provided with a state-developed weapon.
5 Unclassified statement by Special Assistant to the Director of
Central Intelligence for Nonproliferation on the Worldwide
Biological Warfare Threat to the House Permanent Select Committee
on Intelligence, March 3, 1999.
Page 7 GAO/T-NSIAD-99-112
Preliminary Observations on HHS' Public Health
Initiatives Related to Bioterrorism
On June 8, 1998, the President forwarded to Congress a fiscal year
1999 budget amendment that included a proposal to (1) buildfor the
first timea civilian stockpile of antidotes and vaccines to
respond to a large-scale biological or chemical attack, (2)
improve the public health surveillance system to detect biological
or chemical agents rapidly and
analyze resulting disease outbreaks, (3) provide specialized
equipment and training to states and localities for responding to
a biological or chemical incident, and (4) expand the National
Institutes of Health's research into vaccines and therapies. The
Omnibus Consolidated and Emergency Supplemental Appropriations Act
(P.L. 105-277) included $51 million for the Centers for Disease
Control and Prevention to begin developing a pharmaceutical and
vaccine stockpile for civilian populations. The act also
required that HHS submit an operating plan to the House and Senate
Committees on Appropriations before obligating the funds. The
fiscal year 2000 request for HHS' bioterrorism initiative is $230
million, including $52 million for the Centers for Disease Control
and Prevention to continue procurement of a national stockpile.
Our preliminary work suggests that an ad hoc interagency health
care group led by HHS has not yet performed a formal, documented
threat and risk assessment to establish its list of biological and
chemical terrorist threat agents against which it should
stockpile. In fact, several of the items HHS plans to procure do
not match intelligence agencies' judgments, as explained to us, on
the most likely chemical and biological agents a
terrorist group or individual might use. According to HHS
officials, the group identified its list through a process of
evolutionary consensus among federal and nonfederal health
experts. Because HHS did not document its process or methodology,
we have difficulty evaluating its soundness and comprehensiveness.
According to HHS officials, the interagency participants
identified the list based on agent characteristics such as
transmissibility and stability, likely impact on population
(i.e., can it cause mass casualties), availability of treatment,
and whether the agent could be weaponized.
The group chose four biological agents for HHS' stockpiling
initiatives inhalation anthrax, pneumonic plague, smallpox, and
tularemia
Page 8 GAO/T-NSIAD-99-112
(a bacteria)because of their ability to affect large numbers of
people (create mass casualties) and tax the medical system. On the
basis of our discussions with HHS officials, it is unclear to us
whether and to what extent intelligence agencies' official written
threat analyses were used in their process. According to the Joint
Security
Commission's 1994 report on Redefining Security, without
documented threat information, countermeasures are often based on
worst-case scenarios. Valid, current, and documented threat
information is crucial to ensuring that countermeasures or
programs are not based solely on
worst-case scenarios and are therefore out of balance with the
threat. While HHS officials told us that they obtained information
from various experts, including intelligence analysts, the ad hoc
interagency group making the decisions comprised representatives
only from the health and
medical community. As a result, we have not seen any evidence that
the group's process has incorporated the many disciplines of
knowledge and expertise or divergent thinking that is warranted to
establish sound requirements for such a complex and challenging
threat and to focus on appropriate medical preparedness
countermeasures.
As required in the appropriations act I mentioned earlier, HHS
prepared an operating plan for its fiscal year 1999 bioterrorism
initiative. The plan discusses numerous activities on which the
fiscal year 1999 appropriations will be spent within four areas:
deterrence of biological terrorism, surveillance for unusual
outbreaks of illness, medical and public health responses, and
research and development.
We have reviewed the unclassified version of the operating plan.
On the basis of our review of the plan, it is unclear whether and
to what extent HHS has fully considered the long-term costs,
benefits, and return on
investment of establishing the production and inventory
infrastructure for such an initiative. The reason I raise the
issue of return on investment is that, until a valid threat and
risk assessment is performed, we question whether stockpiling for
the items on the current HHS list is the best approach for
investing in medical preparedness. In addition, the HHS plan
does not clearly address issues surrounding (1) the long-term
costs of maintaining an inventory of items with a shelf life or
(2) the safety and efficacy of expedited regulatory review of new
drugs and vaccines.
Page 9 GAO/T-NSIAD-99-112
Conclusions We see many challenges ahead for HHS as it continues
to decide how to target its investments for this emerging threat.
Many frightening possible
scenarios can be generated. But the daunting task before the
nation is to assessto the best of its abilitythe emerging threat
with the best available knowledge and expertise across the many
disciplines involved.
The United States cannot fund all the possibilities that have dire
consequences. By focusing investments on worst-case possibilities,
the government may be missing the more likely threats the country
will face. With the right threat and risk assessment process,
participants, inputs, and
methodology, the nation can have greater confidence that it is
investing in the right items in the right amounts. Even within the
lower end of the threat spectrumwhere the biological and chemical
terrorist threat currently liesthe threats can still be ranked and
prioritized in terms of their likelihood and severity of
consequences. A sound threat and risk assessment could provide a
cohesive roadmap to justify and target
spending for medical and other countermeasures to deal with a
biological and/or chemical terrorist threat.
Mr. Chairman, Members of the Committee and Subcommittee, that
concludes my prepared remarks. I would be happy to answer any
questions you may have.
Lett er
Page 10 GAO/T-NSIAD-99-112
Appendix I
Related GAO Products Appendi x I
Combating Terrorism: Observations on Federal Spending to Combat
Terrorism (GAO/T-NSIAD/GGD-99-107, Mar. 11, 1999). Combating
Terrorism: FBI's Use of Federal Funds for Counterterrorism-Related
Activities (FYs 1995-98 ) (GAO/GGD-99-7, Nov. 20, 1998). Combating
Terrorism: Opportunities to Improve Domestic Preparedness Program
Focus and Efficiency (GAO/NSIAD-99-3, Nov. 12, 1998).
Combating Terrorism: Observations on the Nunn-Lugar-Domenici
Domestic Preparedness Program (GAO/T-NSIAD-99-16, Oct. 2, 1998).
Combating Terrorism: Observations on Crosscutting Issues (GAO/T-
NSIAD-98-164, Apr. 23, 1998). Combating Terrorism: Threat and Risk
Assessments Can Help Prioritize and Target Program Investments
(GAO/NSIAD-98-74, Apr. 9, 1998). Combating Terrorism: Spending on
Governmentwide Programs Requires Better Management and
Coordination (GAO/NSIAD-98-39, Dec. 1, 1997). Combating Terrorism:
Efforts to Protect U.S. Forces in Turkey and the Middle East
(GAO/T-NSIAD-98-44, Oct. 28, 1997). Combating Terrorism: Federal
Agencies' Efforts to Implement National Policy and Strategy
(GAO/NSIAD-97-254, Sept. 26, 1997). Combating Terrorism: Status of
DOD Efforts to Protect Its Forces Overseas (GAO/NSIAD-97-207, July
21, 1997). Chemical Weapons Stockpile: Changes Needed in the
Management Structure of Emergency Preparedness Program (GAO/NSIAD-
97-91, June 11, 1997). State Department: Efforts to Reduce Visa
Fraud (GAO/T-NSIAD-97-167, May 20, 1997).
Aviation Security: FAA's Procurement of Explosives Detection
Devices (GAO/RCED-97-111R, May 1, 1997).
Appendix I Related GAO Products
Page 11 GAO/T-NSIAD-99-112
Aviation Security: Commercially Available Advanced Explosives
Detection Devices (GAO/RCED-97-119R, Apr. 24, 1997). Terrorism and
Drug Trafficking: Responsibilities for Developing Explosives and
Narcotics Detection Technologies (GAO/NSIAD-97-95, Apr. 15, 1997).
Federal Law Enforcement: Investigative Authority and Personnel at
13 Agencies (GAO/GGD-96-154, Sept. 30, 1996). Aviation Security:
Urgent Issues Need to Be Addressed (GAO/T-RCED/NSIAD-96-151, Sept.
11, 1996). Terrorism and Drug Trafficking: Technologies for
Detecting Explosives and Narcotics (GAO/NSIAD/RCED-96-252, Sept.
4, 1996). Aviation Security: Immediate Action Needed to Improve
Security (GAO/T-RCED/NSIAD-96-237, Aug. 1, 1996). Passports and
Visas: Status of Efforts to Reduce Fraud (GAO/NSIAD-96-99, May 9,
1996).
Terrorism and Drug Trafficking: Threats and Roles of Explosives
and Narcotics Detection Technology (GAO/NSIAD/RCED-96-76BR, Mar.
27, 1996). Nuclear Nonproliferation: Status of U.S. Efforts to
Improve Nuclear Material Controls in Newly Independent States
(GAO/NSIAD/RCED-96-89, Mar. 8, 1996). Aviation Security:
Additional Actions Needed to Meet Domestic and International
Challenges (GAO/RCED-94-38, Jan. 27, 1994).
Nuclear Security: Improving Correction of Security Deficiencies at
DOE's Weapons Facilities (GAO/RCED-93-10, Nov. 16, 1992). Nuclear
Security: Weak Internal Controls Hamper Oversight of DOE's
Security Program (GAO/RCED-92-146, June 29, 1992). Electricity
Supply: Efforts Underway to Improve Federal Electrical Disruption
Preparedness (GAO/RCED-92-125, Apr. 20, 1992).
Appendix I Related GAO Products
Page 12 GAO/T-NSIAD-99-112
Economic Sanctions: Effectiveness as Tools of Foreign Policy
(GAO/NSIAD-92-106, Feb. 19, 1992). State Department: Management
Weaknesses in the Security Construction Program (GAO/NSIAD-92-2,
Nov. 29, 1991). Chemical Weapons: Physical Security for the U.S.
Chemical Stockpile (GAO/NSIAD-91-200, May 15, 1991). State
Department: Status of the Diplomatic Security Construction Program
(GAO/NSIAD-91-143BR, Feb. 20, 1991).
(701167) Let t er
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