Bioterror: All the Rules Change

Officials could have to deal, for example, with a public rush for vaccines - a phenomenon seen on a small scale during the anthrax scare, when many people hoarded the antibiotic Cipro, prompting fear of a shortage.

"What we're not talking about is how we'd deal with the raids on all the local health departments and hospitals," Mr. Richards says.

This is precisely what unfolded during a bioterrorism war game held last summer at Andrews Air Force Base. Called "Dark Winter," the exercise simulated the release of smallpox in Oklahoma City and included several government officials as participants (including Oklahoma Gov. Frank Keating). On Day 1 of the drill, state officials were confronted with 20 hypothetical cases of smallpox and began administering the vaccine on a prioritized basis. Six days later, 2,000 cases were reported in 15 states, and hospitals were overwhelmed. The scenario by Day 12: The disease was raging out of control, the nation's supply of vaccine had been depleted, and violence had broken out among people desperate to get it.

Participants concluded that maintaining public trust would be central to controlling any outbreak. Measures such as quarantining or rationing vaccines could be carried out only if people saw officials as behaving responsibly and were willing to cooperate.

Indeed, many experts say what matters most is not the powers state officials have, but how they exercise those powers. If they alienate the public by dramatically violating civil liberties, a backlash could result.

"There has to be, in all circumstances, a respect for the dignity of the individual," says Stephen Marks, a professor at the Harvard School of Public Health. If officials deemed a mass inoculation was needed, they shouldn't do it by "pounding on people's doors in the middle of the night."

Another bioterrorism exercise, sponsored by the Justice Department in 2000, showed how ineffective quarantines can be in the absence of public support.

Called TOPOFF, for the "top officials" tested during the drill, it simulated a release of plague in the Denver performing arts center. On the second day, with nearly 800 imaginary cases reported, Colorado officials asked Denver residents to stay home, and closed the state's borders. But authorities soon realized they didn't have the manpower to forcibly keep that many people under quarantine - or to provide them with food and medicine. By Day 3, the scenario showed panicked citizens trying to flee the state. On Day 4, riots erupted.

As a result of the exercise, the Colorado legislature fine-tuned its public-health laws. Officials hadn't been sure if they needed a court order to close state borders, and didn't know the extent to which they could enlist law enforcement. Colorado's subsequent changes have, in turn, been a major influence on the model law other states are now considering.

But a more pertinent lesson was that the law wasn't really the issue. Limited resources were.

That challenge could at the same time serve as a protection for civil liberties.

"The ability of state health departments to engage in wholesale interference with civil rights is ... limited by the fact that they've got no troops and they've got no resources and they've got no beds," says Richards. "When you talk about quarantining people in their houses, you have to be prepared to bring them food, you have to be prepared to bring them medical care, and you have to be prepared to shoot them when they come out - or at least make them think you will."

Page: 1 | 2 | 3 | 4 | 5