“AMERICANS,” wrote Thomas Jefferson, “love peace, yet spurn a tame submission to wrong.” In the wake of September 11thand October 4th, our adversaries have learned this lesson well.

Yet our decisive military victories and response to the anthrax attacks have been tempered by the knowledge that bioterrorism remains a genuine threat. Unlike traditional warfare, the battle against devastating bio-organisms cannot be won on a battlefield. It must be achieved in the laboratory, the emergency room, and the local clinic and hospital.

The anthrax mailings of last fall forced us to reevaluate our ability to respond effectively to acts of bioterrorism. We have done that, and we have acted.

The President's budget for 2003 calls for $518 million to enhance preparedness at the nation's hospitals to respond to incidents of biological or chemical terrorism. This funding represents a 284% increase over the amount provided this year.

The President's budget supports a variety of activities to prevent, identify, and respond to bioterrorism. These include: epidemic detection and response; maintaining and securing the National Pharmaceutical Stockpile; performing research to improve our methods, training, and health care service delivery; and assisting our state, local, and other federal partners in improving our capability to respond to an emergency. This funding will also provide resources to expand the capacity of hospitals and outpatient facilities to confront large scale casualty incidents; improve capabilities to control infection and treat individuals at risk for a communicable disease; training in recognition of rare diseases and treatment of toxic exposures; and such infrastructure improvements as infectious disease containment systems.

The budget includes another $100 million for bioterrorism training for health care professionals, poison control centers, and emergency medical services for children.

We also have provided $1.1 billion to states and several major cities to help them build public health infrastructures capable of responding quickly to sudden disease outbreaks. States and localities submitted plans that we approved in a matter of months—in some cases, weeks—and we have released the funds to help equip first-responders with the resources they need.

This is the first time that federal, state, and local governments have come together on a unified plan to strengthen our public health system and better prepare to respond to a terrorist attack. The importance of this fact cannot be overstated. For the first time, we're working together and are on the same page. Now that we have plans, we need to get on with building. The grant money will allow that to take place. In addition, state and local public health workers and hospitals must have access to adequate supplies of medicines, and must be trained to receive and distribute these essential supplies once they are delivered. So, we have purchased enough antibiotics to treat 20 million people exposed to anthrax, and enough smallpox vaccine for every American. With the recent donation of smallpox vaccine by Aventis Pasteur (Lyon, France), we can respond in an emergency even sooner than we had anticipated.

Public and private-sector initiatives alike are needed, since our nation's physicians and nurses stand in the first line of defense against potential incidents that could involve large-scale casualties. They must be ready to respond effectively. With careful planning, adequate funding and sound execution, they are becoming better prepared than ever to meet the challenges of a bioterrorist attack.

Yet even their tremendous work will be insufficient if we lack an adequate food inspection system and thereby leave ourselves open to bioterrorism through our food supply. We are committed to hiring 655 new field staff for food safety. Hiring and training these new inspectors is FDA's top priority, and I am pleased to report to you that FDA has nearly all of these men and women, just 5 months after these funds were provided. As these inspectors are trained, FDA will double physical examinations of food imports in FY 2002, and double them again in FY 2003. We have also asked for an additional $17 million just for food safety above the 2003 request.

While food safety has been FDA's most visible role in protecting against bioterrorism, I have also asked for an additional $5 million for blood safety efforts. FDA must expand its capacity to ensure the availability of safe blood and blood products at the time of an emergency.

The Department of Health and Human Services has worked hard to provide timely, accurate, and readily understandable information about dealing with bioterrorism to health care professionals. For example, the Centers for Disease Control and Prevention publishes breaking reports on bioterror and public health-related news in its ‘Morbidity Mortality Weekly Reports.’

The CDC also produces fact sheets, guidelines, news briefs, announcements, and video and satellite broadcasts about bioterrorism on its Web site. The site has received more than 6 million visits and 14 million requests for information since September 11th.. In addition, the Agency for Healthcare Research and Quality (AHRQ), an agency within HHS, initiated a new Web site to teach hospital-based physicians and nurses how to diagnose and treat rare infections and exposures to bioterrorist agents such as anthrax and smallpox.

The site was designed by researchers in the Center for Disaster Preparedness at the University of Alabama at Birmingham under a contract from AHRQ. It is the first of its kind to offer free continuing education credits in bioterrorism preparedness to clinicians. The site offers online courses for emergency department clinicians, including physicians, nurses, radiologists, pathologists, and infection control practitioners. You can check it out at http://www.bioterrorism.uab.edu.

In the article by Drs. Abraham, Rudick, and Weinbroum 1, you will read sound medical counsel concerning how to help patients suffering from both conventional injuries and bioterrorism—and how to do so on a large scale. I urge you to study this article carefully and consider how you, as a medical professional, can best ready yourself and your staff for critical care, anesthesia, and other medical needs of significant numbers of people affected by biological or chemical agents in combination with trauma.

Thanks to each of you for your commitment to your patients and to our country. We at the Department of Health and Human Services are proud to be your partners in this effort.

Abraham RB, Rudick V, Weinbroum AA: Guidelines for acute care of victims of bioterrorism: Conventional injuries and concomitant nerve agent intoxication. A nesthesiology 2002; 97: 989–1004