Stanford University

Bioterrorism

Options for European Ballistic Missile Defenses

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This talk will address alternative options for European ballistic missile defense, including the now cancelled Polish-Czech option and the recently announced Obama plan for a phased deployment of Standard Missile 3 interceptors in and around Europe. This talk will also address recent Iranian progress in developing medium-range ballistic missiles and possible missile defense cooperation with Russia.

Dean Wilkening is a Senior Research Scientist at the Center for International Security and Cooperation at Stanford University. He holds a Ph.D. in physics from Harvard University and worked at the RAND Corporation prior to coming to Stanford. His major research interests include nuclear strategy and policy, arms control, the proliferation of nuclear and biological weapons, bioterrorism, ballistic missile defense, and energy and security. His most recent research focuses on the broad strategic and political implications of ballistic missile defense deployments in Northeast Asia, South Asia and Europe. Prior work focused on the technical feasibility of boost-phase ballistic missile defense interceptors. His recent work on bioterrorism focuses on understanding the scientific and technical uncertainties associated with predicting the outcome of hypothetical airborne biological attacks and the human effects of inhalation anthrax, with the aim of devising more effective civil defenses. He has participated in, and briefed, several US National Academy of Science committees on biological terrorism and consults for several US national laboratories and government agencies.

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Dean Wilkening Senior Research Scientist, CISAC Speaker
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Biodefense in the 21st Century: The Political Realities

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Abstract:  In 2003, General John Gordon, Assistant to the President for Homeland Security and former Deputy Director of the CIA asked his staff to do an end-to-end evaluation of U.S. biodefense posture.  As a result, Homeland Security Staff, directed by Dr. Kenneth Bernard, Special Assistant to the President, did a government-wide review of national preparedness and response to a bioterrorist attack.   The resulting assessment led in 2004 to the combined Homeland Security Presidential Directive #10 and National Security Presidetial Directive #17:  "Biodefense for the 21st Century."  Dr. Bernard will discuss the process and outcome of this policy that remains the U.S. national strategy for preventing and responding to a bioterrorist event. Accomplishments, outcomes and remaining gaps will be detailed, along with budget and policy implications for the next administration. 

Admiral Kenneth Bernard was appointed by President Bush to be Special Assistant to the President for Biodefense on the Homeland Security Council (HSC) in November 2002. Dr. Bernard chaired the Whitehouse Biodefense Policy Coordinating committee and drafted Decision Directives for President Bush on both "Biodefense for the 21st Century" and Agricultural Bioterrorism, and he was the White House point person on Project Bioshield - a $5.6 billion congressional bill that is speeding development and procurement of new countermeasures against biological, chemical and radiological terrorist threats.

In January 2001, Dr. Bernard was assigned by the U.S. Surgeon General to the office of Senator Bill Frist to work on international health issues of priority concern to both the Congress and the Department of Health and Human Services (HHS).   After September 11, however, he was called back to HHS to create the position of Special Adviser for National Security, Intelligence and Defense for the Department of Health and Human Services. From August 1998 to January 2001, he served on President Clinton's National Security Council (NSC) staff as Special Adviser to the Assistant to the President for National Security Affairs. Prior to joining the NSC, Dr. Bernard served as the International Health Attaché and senior representative of the U.S. Secretary of Health at the U.S. Mission to the UN in Geneva, Switzerland (1994-1998). From 1984-1989, he held positions as the Associate Director for Medical and Scientific Affairs in the Office of International Health, HHS, and as International Health Policy Adviser to the Director of the U.S. Peace Corps. He retired from the USPHS as a Rear Admiral.

He received his AB degree from the University of California, Berkeley in 1971, an M.D. from the University of California, Davis in 1975, and the DTM&H degree from the University of London School of Hygiene and Tropical Medicine in 1977.  He is a member of the Council on Foreign Relations.

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Dr. Kenneth Bernard former Special Assistant to the President for Biodefense, Homeland Security Council Speaker
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CHP/PCOR Quarterly Update, Spring 2008 Issue

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This issue of CHP/PCOR's Quarterly Update covers news from the Winter 2008 quarter and includes articles about:

  • the Russian Mortality Crisis and the effect of Gorbachev’s anti-alcohol campaign on life expectancy;
  • bioterrorism supply chains – how should policymakers be planning for a bioterrorism attack?
  • a Research in Brief selection on the phenomenon and effect of Regression toward the Mean in statistical analysis on study findings;
  • the use of pedometers and use of human growth hormone in athletes, both widely-covered topics by the media, investigated by CHP/PCOR researchers.

The newsletter also contains various other news items that may be of interest to our readers.

Note to the reader:

The newsletter is fully-navigational. Any text that is surrounded by a dashed box is clickable and will allow the reader to navigate the newsletter more efficiently. The end of each article contains a special symbol (§) that, when clicked, will take the reader back to the table of contents. Please feel free to contact Amber Hsiao with any questions.

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Amber Hsiao

Preparation is key to avoiding 'worst-case outcome,' Chertoff says

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Lisa A. Trei
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At an April 11 symposium in Washington, D.C., Homeland Security Secretary Michael Chertoff said while the best-laid plans are likely to change if a pandemic or bioterrorism attack hits the United States, having no plans in place is a sure guarantee for disaster. CISAC members Lynn Eden, Martha Crenshaw, and Mariano-Florentino Cuéllar participated in "Germ Warfare, Contagious Disease and the Constitution," a daylong event co-hosted by Stanford Law School. CISAC affiliate Laura K. Donohue conceived and developed the project, which aimed to bring together senior policy-makers and legal experts to discuss how issues of constitutional law inform responses to natural pandemics or bioterrorism attacks.

Secretary Michael Chertoff of the Department of Homeland Security delivered the keynote address April 11 at the panel titled “Germ Warfare, Contagious Disease and the Constitution” in Washington, D.C.

Although the best-laid plans are likely to change if a pandemic or bioterrorism attack hits the United States, having no plans in place is a sure guarantee for disaster, Homeland Security Secretary Michael Chertoff told policy-makers, government officials, constitutional law experts and law students at a symposium April 11 in Washington, D.C.

"Preparation won't eliminate the problems and the stress, and it is often said that no battle plan has ever survived first contact with the enemy," Chertoff told the roughly 200 people attending the event, "Germ Warfare, Contagious Disease and the Constitution," hosted by Stanford Law School and the Constitution Project, a nonprofit organization.

"But I can tell you this," Chertoff continued. "If you don't have a plan, you are definitely going to have the worst-case outcome. A plan at least gives you a running start."

During the symposium, experts discussed the need to reform the complex web of federal and state laws to enable agencies to respond effectively to deadly natural or manmade epidemics—from pandemic flu to smallpox and aerosolized anthrax—while protecting individual rights.

Earlier that day, about 60 people from the current and two previous presidential administrations, public health officials, Stanford academics and law students participated in a closed-door, fictitious scenario that explored the federal government's response to an unfolding deadly epidemic as it crossed state lines. Lynn Eden, associate director for research at Stanford's Center for International Security and Cooperation (CISAC) at the Freeman Spogli Institute for International Studies, moderated the session, which was developed in cooperation with experts from the Department of Homeland Security.

"I think it's the first time detailed issues of constitutional law have been brought to bear in a natural pandemic or bioterrorism exercise," Eden said afterward. "It's very hard to plan for a catastrophe. This approach brought another facet to bear on disaster planning."

Margaret Hamburg, a former assistant secretary in the Department of Health and Human Services, opened the symposium, which was broadcast live on C-SPAN from the Dirksen Senate Office Building. Kathleen Sullivan, director of the Stanford Constitutional Law Center, moderated a panel featuring Stanford law Professors Pamela Karlan and Robert Weisberg; Christopher Chyba, director of the Program on Science and Global Security at Princeton and a former CISAC co-director; Jeff Runge, assistant secretary in the Department of Homeland Security; Michael Greenberger, director of the Center for Health and Human Security at the University of Maryland; and Martin Cetron, director of the Division of Global Migration and Quarantine at the U.S. Centers for Disease Control and Prevention.

Sullivan opened the panel by reflecting on how recent health crises have informed ongoing legal and policy debates: "West Nile virus. Anthrax mailings. Avian flu—responses to these infectious disease issues and concern about bioterrorism are running about our minds as we think about the response to 9/11 and Hurricane Katrina, and the complex web of local, state and federal authority to deal with such emergencies. What does the Constitution have to say about our ability to deal with infectious disease, whether it's naturally occurring or composed as a weapon of violence?"

In the 21st century, Cetron explained, health officials still rely on a "14th-century toolbox of isolation and quarantine" to control an outbreak. That is "part of our modern reality," he said. "The biggest area is not lack of specific authority, but the fact that jurisdictions are highly complex when it comes to international ports of entry [and] interstate movement. There are often overlapping jurisdictions and overlapping authorities. If there's a gap in some of this, the risk is that neither the state nor the feds would want to step up to that responsibility."

Greenberger said state officials are often ignorant about what they can do in an emergency. "The powers given to governors are extraordinary," he said. Three statutes exist in Maryland to authorize declarations of emergency and allow the governor to enforce isolation and quarantine of infected people, order citizens to take treatment against their will, force doctors to serve in dangerous situations and seize hospitals. "What's extraordinary is that most governors don't even know they have this power," Greenberger said. "The extent of legal illiteracy in this area is shocking."

Despite such challenges, Chertoff praised the participants for tackling the issue. "I think for the first time we've begun to think very seriously and in a disciplined fashion about how to plan for dealing with a major natural pandemic or a major biological attack," he said. "I wish I could tell you these things are unthinkable. But the one thing I've learned in the last seven years is there's pretty much nothing that's unthinkable."

Stanford in Washington

Laura K. Donohue, a CISAC affiliate and a 2007 Stanford Law School graduate who is the inaugural fellow at the Stanford Constitutional Law Center, conceived the daylong event to bring together policy-makers and constitutional experts to discuss response to natural pandemics and bioterrorism. "It was a chance to bring together the policy world, both operational and strategic, and give them the opportunity to talk to legal experts," she said. "This helped policy-makers think through the issues and think outside the box, and it did so in a non-threatening manner."

Donohue said she was prompted to create the symposium after directing a CISAC-supported terrorism-response exercise in 2003 that involved more than 25 agencies at the national, state and local levels. "In these exercises involving first responders, legal issues always got pushed off the table," Donohue said. "I was struck by this. In an emergency, the law goes out the window. Then, when I got to law school, I saw the broader legal and constitutional context for this discussion."

With support from the directors at CISAC and Stanford Law School, and funding from donor Peter Bing and the Stanford Constitutional Law Center, Donohue brought the two groups together in a high-profile setting.

"This was Stanford in Washington," she said. "It was an opportunity for Stanford to be visible at the U.S. Senate with participation from leading people on these issues. There is no doubt we got an audience we wouldn't otherwise have attracted."

This article first appeared in Stanford Report, 4/16/2008.

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Natural Security: A Darwinian Approach to a Dangerous World

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Arms races among invertebrates, intelligence gathering by the immune system and alarm calls by marmots are but a few of nature’s security strategies that have been tested and modified over billions of years. This provocative book applies lessons from nature to our own toughest security problems—from global terrorism to the rise of infectious disease to natural disasters. Written by a truly multidis­ciplinary group including paleobiologists, anthropologists, psychologists, ecologists, and national security experts, it considers how models and ideas from evolutionary biology can improve national security strategies ranging from risk assessment, security analysis, and public policy to long-term strategic goals.

Terence Taylor is the President and Director of the International Council for the Life Sciences and a former CISAC Science Fellow. He previously served with the United Nations as a Commissioner and Chief Inspector for Iraq on weapons of mass destruction and was a career officer in the British army. He also serves on the U.S. National Academy of Sciences Forum on Microbial Threats and is an adviser to the International Committee of the Red Cross. Mr. Taylor was also a member of the National Research Council Steering Committee on Genomic Databases for Bioterrorism Threat Agents and served as Chairman of the Permanent Monitoring Panel on Risk Analysis of the World Federation of Scientists.

Raphael Sagarin received his Ph.D. in marine ecology in 2001 from the University of California, Santa Barbara. Dr. Sagarin has served as a Geological Society of America congressional science advisor in the office of U.S. Representative Hilda L. Solis. Dr. Sagarin has used his insights as a biologist and policy advisor in his recent work on using biological insights to guide security planning and policy. Based on a short treatment of this topic in Foreign Policy, he organized a working group at the National Center for Ecological Analysis and Synthesis to explore a wide range of evolutionary insights into security analysis. Comprised of paleobiologists, psychologists, ecologists, anthropologists and security experts, the working group produced the forthcoming University of California Press volume: Natural Security: A Darwinian Approach to a Dangerous World, edited by Dr. Sagarin and Terence Taylor.

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Terence Taylor Director Speaker International Council for the Life Sciences
Raphael Sagarin Associate Director for Ocean and Coastal Policy, Nicholas Institute for Environmental Policy Solutions, Duke University Speaker
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Modeling the Logistics of Response to Anthrax Bioterrorism

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Background: A bioterrorism attack with an agent such as anthrax will require rapid deployment of medical and pharmaceutical supplies to exposed individuals. How should such a logistical system be organized? How much capacity should be built into each element of the bioterrorism response supply chain?

Methods: The authors developed a compartmental model to evaluate the costs and benefits of various strategies for preattack stockpiling and postattack distribution and dispensing of medical and pharmaceutical supplies, as well as the benefits of rapid attack detection.

Results: The authors show how the model can be used to address a broad range of logistical questions as well as related, nonlogistical questions (e.g., the cost-effectiveness of strategies to improve patient adherence to antibiotic regimens). They generate several key insights about appropriate strategies for local communities. First, stockpiling large local inventories of medical and pharmaceutical supplies is unlikely to be the most effective means of reducing mortality from an attack, given the availability of national and regional supplies. Instead, communities should create sufficient capacity for dispensing prophylactic antibiotics in the event of a large-scale bioterror attack. Second, improved surveillance systems can significantly reduce deaths from such an attack but only if the local community has sufficient antibiotic-dispensing capacity. Third, mortality from such an attack is significantly affected by the number of unexposed individuals seeking prophylaxis and treatment. Fourth, full adherence to treatment regimens is critical for reducing expected mortality.

Conclusions: Effective preparation for response to potential bioterror attacks can avert deaths in the event of an attack. Models such as this one can help communities more effectively prepare for response to potential bioterror attacks. Key words: bioterror; supply chain; logistics; anthrax; emergency response.

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Medical Decision Making
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GS Zaric
Dena M. Bravata
Jon-Erik Holty
Kathryn M. McDonald
Douglas K. Owens
Douglas K. Owens
Margaret L. Brandeau
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An Ounce of Prevention Is Worth a Pound of Cure: Improving Communication to Reduce Mortality During Bioterrorism Responses

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OBJECTIVE: To identify communication needs and evaluate the effectiveness of alternative communication strategies for bioterrorism responses. METHODS: We provide a framework for evaluating communication needs during a bioterrorism response. Then, using a simulation model of a hypothetical response to anthrax bioterrorism in a large metropolitan area, we evaluate the costs and benefits of alternative strategies for communication during a response. RESULTS: Expected mortality increases significantly with increases in the time for attack detection and announcement; decreases in the rate at which exposed individuals seek and receive prophylaxis; increases in the number of unexposed people seeking prophylaxis; and increases in workload imbalances at dispensing centers. Thus, the timeliness, accuracy, and precision of communications about the mechanisms of exposure and instructions for obtaining prophylaxis and treatment are critical. Investment in strategies that improve adherence to prophylaxis is likely to be highly cost effective, even if the improvement in adherence is modest, and even if such strategies reduce the prophylaxis dispensing rate. CONCLUSIONS: Communication during the response to a bioterror attack must involve the right information delivered at the appropriate time in an effective manner from trusted sources. Because the response system for bioterror communication is only fully operationalized once an attack has occurred, tabletop planning and simulation exercises, and other up-front investments in the design of an effective communication strategy, are critical for effective response planning.

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American Journal of Disaster Medicine
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Margaret L. Brandeau
Zaric, G.S.
Freiesleben, J.
Freiesleben, J.
Edwards, F.L.
Edwards, F.L.
Dena M. Bravata

CISAC awards 14 honors certificates in international security studies

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CISAC awarded honors certificates in international security studies to 14 undergraduates who completed theses on policy issues ranging from speeding up the detection of a bioterror attack to improving the World Bank's effectiveness at post-conflict resolution.

Among the 2006-2007 participants in CISAC's Interschool Honors Program in International Security Studies were award winners Brian Burton, who received a Firestone Medal for his thesis, "Counterinsurgency Principles and U.S. Military Effectiveness in Iraq," and Sherri Hansen, who received the William J. Perry Award for her thesis, "Explaining the Use of Child Soldiers." The Firestone Medal recognizes the top 10 percent of undergraduate theses at Stanford each year, and the Perry recognizes excellence in policy-relevant research in international security studies.

CISAC honors students "can make the world a more peaceful place in several ways," FSI senior fellow Stephen Stedman told students and guests at the honors ceremony. "They can graduate and find jobs of power and influence [and] they can identify real world problems and solve them."

This year's class, which included several double-majors, represented nine major fields of study: biology, history, human biology, international relations, mathematics, management science and engineering, physics, political science, Russia-Eurasian studies. Some students headed to business or policy positions, while others looked forward to advanced studies in law, medicine, biophysics, security studies, or other fields.

"I hope that this is the beginning, not the end, of your contributions to policy-relevant research," CISAC senior research scholar Paul Stockton, who co-directed the program with Stedman, told the students. He added, "In every potential career you have expressed a desire to pursue, from medicine to the financial sector and beyond, we need your perspectives and research contributions, to deal with emerging threats to global security."

Many students expressed interest in realizing that hope. Burton said his aspiration is to attain "a high-level cabinet or National Security Council position to cap a long career of public service in foreign policy."

Katherine Schlosser, a biology major who is headed to Case Western Reserve University for joint MD-master's in public health program, said she hopes to "keep conducting innovative research and to eventually rejoin the international security studies community in some capacity."

The 2007 honors recipients, their majors, thesis titles, advisers, and destinations, if known, are as follows:

Brian Burton, political science
"Counterinsurgency Principles and U.S. Military Effectiveness in Iraq"
Firestone Medal Winner
Adviser: David Holloway
Destination: Georgetown University, to pursue a master's degree in security studies

Martine Cicconi, political science
"Weighing the Costs of Aggression and Restraint: Explaining Variations in India's Response to Terrorism"
Adviser: Scott Sagan
Destination: Stanford University Law School

Will Frankenstein, mathematics
"Chinese Energy Security and International Security: A Case Study Analysis"
Adviser: Michael May
Destination: The Institute for Defense Analyses in Alexandria, Va., for a summer internship

Kunal Gullapalli, management science & engineering
"Understanding Water Rationality: A Game-Theoretic Analysis of Cooperation and Conflict Over Scarce Water"
Adviser: Peter Kitanidis
Destination: Investment Banking Division at Morgan Stanley in Los Angeles

Sherri Hansen, political science
"Explaining the Use of Child Soldiers"
William J. Perry Award Winner
Adviser: Jeremy Weinstein
Destination: Oxford University in England, to pursue master's degree in development studies

Andy Leifer, physics and political science
"International Scientific Engagement for Mitigating Emerging Nuclear Security Threats"
Adviser: Michael May
Destination: Harvard University, to pursue a PhD in biophysics

James Madsen, political science
"Filling the Gap: The Rise of Military Contractors in the Modern Military"
Adviser: Coit Blacker
Destination: World travel; then San Francisco to open a bar

Nico Martinez, political science
"Protracted Civil War and Failed Peace Negotiations in Colombia"
Adviser: Stephen Stedman
Destination: Washington, DC, to serve as a staff member for Senator Harry Reid

Seepan V. Parseghian, political science and Russian/Eurasian studies
"The Survival of Unrecognized States in the Hobbesian Jungle"
Advisor: James Fearon

Dave Ryan, international relations
"Security Guarantees in Non-Proliferation Negotiations"
Adviser: Scott Sagan
Destination: Stanford University, to serve as executive director of FACE AIDS

Katherine Schlosser, biology
"Gene Expression Profiling: A New Warning System for Bioterrorism"
Adviser: Dean Wilkening
Destination: Case Western Reserve University in Cleveland, to pursue a joint medical degree and master's in public health

Nigar Shaikh, human biology and political science
"No Longer Just the 'Spoils of War': Rape as an Instrument of Military Policy"
Adviser: Mariano-Florentino Cuellar

Christine Su, history and political science
"British Counterterrorism Legislation Since 2000: Parlimentary and Government Evaluations of Enhanced Security"
Adviser: Allen Weiner
Destination: Stanford University, to finish her undergraduate degree; Su completed the honors program as a junior.

Lauren Young, international relations
"Peacebuilding without Politics: The World Bank and Post Conflict Reconstruction"
Adviser: Stephen Stedman
Destination: Stanford University, to finish her undergraduate degree; Young completed the honors program as a junior.

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