25 years after the anthrax attacks, we are still unprepared for biological warfare

In the early, chaotic days after the Sept. 11, 2001 terror attacks, five letters were dropped into a mailbox in Princeton, New Jersey, across from the Princeton University campus. Containing a coarse brown powder later identified as anthrax spores, the envelopes were addressed to media organizations, including NBC News and the New York Post.

By early October 2001, the phones inside New York City’s emergency operations center were ringing off the hook with demands for Cipro , the antibiotic used to prevent anthrax infection after exposure. Powerful politicians and government officials were calling. I remember the menace in one personal assistant’s voice: “The senator wants his Cipro. Now.”

They believed, with perfect conviction, that they were entitled to receive it first — and that I was the one keeping it from them. It got ugly fast.

I have often thought about those calls over the last 25 years, and here is what they taught me. Fear is a solvent. Firm convictions about masks and social distancing and vaccine safety dissolve when people believe that they, or their children, could die. Upon first contact with a deadly pathogen, Americans will not be divided over whether they want protection. They will be unanimous. But right now, there is nobody to provide it.

COVID-19 should have pulled us together, but it did just the opposite. Instead of learning the lessons and building back stronger, we spent the last six years pointing fingers at the institutions of government, as the institutions themselves have come apart. That is the perfect storm we have built. When the nation desperately needs help, it will be from a government that has lost the ability to provide it.

With her latest book, Annie Jacobsen shines a spotlight on this alarming vulnerability. “ Biological War ” takes a threat we all agreed to ignore and lays it out in riveting detail: the Soviet stockpiles of engineered pathogens, built to kill hundreds of millions in a matter of days; the proliferation of bioweapons labs around the world, creating yet more novel pathogens through high risk “gain of function” research.

The book is not alarmism; it is dispassionate reporting based on dozens of interviews with high-level political, governmental, medical and military experts. Its conclusions should stop us cold. The weapons to end civilization exist, they are more available than they have ever been, and the geopolitical environment has never been more conducive to their use.

The good news is that we don’t need a miracle to stop a pandemic; we just need epidemiologists to do their vital work — finding the sick and tracing their contacts to break the chain of transmission. Nothing more exotic than trained people, funded and in place before the first case appears.

The COVID crisis revealed major gaps in our ability to do this. Over the past 18 months we have shut down the U.S. Agency for International Development and proposed cutting the Centers for Disease Control and Prevention’s budget. We walked out of the World Health Organization in January, surrendering our seat at the table where the world’s disease surveillance data is shared.

Here is the part that keeps me awake. No level of government could support the population at the speed and scale a major biological attack would demand. Not just to treat the sick, but to feed the people who cannot leave their homes, and to rapidly dispense preventive medications — oral antibiotics for anthrax or plague — through local points of dispensing.

We possess extraordinary scientific, medical, pharmaceutical research and logistics capabilities, but capabilities are not preparedness. Preparedness is capability organized for action, at speed, under pressure. That requires national coordination. The Federal Emergency Management Agency, the agency charged with this, has been cut, second-guessed and floated for relocation.

That is the agency Cameron Hamilton now inherits. His recent confirmation ends a long period of temporary leadership. Now he must be given the resources to build and the authority to act. This means a funded FEMA and a clear mission. It means public health and emergency management planning together before the event instead of in the middle of one. And it means the new administrator putting his agency in the room where biological threats are being tracked — not waiting to be invited after the outbreak has a name.

Call it civil defense. Call it whatever you want. We need a national effort — a sustained, funded, unglamorous program to rebuild stockpiles, strengthen disease surveillance and refresh and validate mass-prophylaxis plans.

Twenty-five years ago next week, a handful of envelopes sent people scrambling for protection. The next biological emergency will move faster, reach farther and demand infinitely more from the institutions charged with protecting us.

The threat is real. The system is blinking red. We need to be ready when the phones start ringing.

Kelly McKinney served as associate commissioner at the Department of Health during New York City’s response to the 2001 anthrax attacks and later as deputy commissioner of the New York City Office of Emergency Management.