| Home > Events > 2nd National Symposium > Richard Falkenrath U.S. Domestic Preparedness and the Complex Threat of Bioterrorism
Richard A. Falkenrath, PhD DR. HENDERSON: Our next speaker is Dr. Richard Falkenrath, who's Assistant Professor of Public Policy at Harvard's Kennedy School of Government and Director of the Executive Session on Domestic Preparedness. He's the author of a number books, the most recently being America's Achilles Heel, Nuclear, Biological, Chemical Terrorism and Covert Attack. He's a member of the Council on Foreign Relations and a frequent consultant to the Departments of Defense, of Justice, as well as the intelligence community and private industry. He's a graduate of Occidental College and holds a doctorate degree from the Department of War Studies, King's College, London. His paper is entitled "U.S. Domestic Preparedness and the Complex Threat of Bioterrorism." Dr. Falkenrath. (Applause.) DR. FALKENRATH: Thank you very much, D.A. I'm honored to be here. I don't have very elaborate slides. I apologize, and I'm going to focus my remarks today on the organizational dimensions of civilian biodefense. I'm from a school of government, and this is my expertise. I don't have very much to add to the technical expertise that's already been brought before you today. But on the organizational side, I do think I have a few things to add. I'm going to start with my conclusions, and these are based on five years of observing the country's efforts to prepare itself not just for bioterrorism, but all forms of high consequence domestic terrorism.
So to begin with the conclusions, first, I think without a doubt U.S. biodefense is disorganized and excessively fragmented. I'm going to support these conclusions with some analysis. I just tell you right now so that you know where I'm going. Second, I think it's clear that these organizational problems are undermining the effectiveness and efficiency of our national system to prepare for and respond to a bioterrorist event at home. And, third, therefore, I think it's beholden upon the next administration to enact an appropriate set of organizational reforms. There will be very complex. I'm not going to be able to get into them entirely, but I will give you a few suggestions. Now, in my judgment, Washington, if not the nation, is now past the stage of broad consciousness raising about the threat of biological terrorism, and I would say good riddance to it. I think there have been far too many loose, sometimes shrill, and often simplified and inflammatory statements to the public and the media about this, and I think that needs to stop. What we need now is quite careful, expert level analysis of the problem of the sort we saw earlier this morning from Dr. Poste, I think. It strikes me that further efforts to raise consciousness about this threat broadly are they sound increasingly shrill and exaggerated. There is, of course, an intellectual reaction going on right now to the prevailing assessment of this threat. That's entirely natural. There's a growing body of work that supports it. I don't want to get into a debate about that issue, but I think it's fair to say the issue of bioterrorism and the need for a national system of preparedness is now firmly lodged at least in Washington in the federal Executive Branch and I think also in the Congress. And so I take this as good news. I think we've made significant progress on this issue and really probably over the last year. The first one of these symposiums spent a lot more time trying to raise consciousness about this threat. Now we're getting down to the serious and much more difficult business of building a system to respond to it if it happens. However, and I think this is bad news, there has been a great deal of real progress made very quickly and very impressively in parts, but as we've begun serious efforts to prepare ourselves for the threat of bioterrorism, I think the great difficulty of this endeavor has become apparent to us all, and it's really a difficulty of implementation. It's not at the level of sort of policy conception. We think we've got the right ideas or a conventional wisdom at least has emerged on what the right set of ideas are. But as we try to implement these things, they turn out to be very difficult, and I think it's worthwhile to be clear about why that's the case. What are the sources of difficulty building an effective system for bioterrorism preparedness, and I think there are really three.
First, on the threat, we've got no specific information about the threat. We've got lots of scenarios, but we don't know what sort of weapons will be used. We don't know how big the attack will be. We don't know the agents that will be used, how they will be delivered. We don't know when an attack will happen, where it will happen. We don't know how likely it is. Essentially, we have no specific information about the threat. We have a very abstract statement of a range of possibilities, some of which are more worrisome than others, but we have no specific problem definition. This makes planning immensely difficult. As all of you know, it's much harder to answer a poorly specified question than to answer a well specified question. Now, many of us, including myself, would like greater specificity and certainty about this threat. We'd like to know concretely which agents are more likely to be used than others or how big the attack will be or how sophisticated the attack will be, but in my view that quest for ever increasing levels of certainty and specificity about the threat has become vaguely Quixotic and something of a fool's errand. I've lost count of the number of GAO studies that call for greater specificity and treat assessment, and there's really no way to provide it. It's not there. The problem is that uncomfortably high levels of uncertainty, uncertainty, in here in the nature of the bioterrorism problem. Take, for instance, the question of probability. How likely is an attack? Well, I think -- and I will state this -- terrorism is not a statistically patterned phenomenon. We can't -- and in a sense that makes the notion of probability for terrorism sort of meaningless. Rather, terrorism is a strategic phenomenon. Every terrorist act is a result of a conscious decision by some intelligent, reactive individual or set of individuals, and that to my way of thinking at least makes it statistically non-patterned and, therefore, very difficult to talk about probability. I see no basis for saying a major attack of bioterrorism is inevitable for that reason because there is no certainty that deterrence will fail and that individuals will not continue in the future to decide against waging this sort of warfare. But that's not to say that the probability is zero either. I think all we can really say with certainty is the probability is pretty low. It has to be. It's the only way you can explain the rarity of occurrence in history of biological. This is what's known as the frequency theory of probability. You get the sense of future probabilities based on past frequency, and I think our only safe conclusion is it's pretty low in aggregate, and at any specific time and place, it is vanishingly low. But that's about all we need to say about it because the reason bioterrorism has risen on the national agenda is basically because of a national security calculation that is concerned with the severity of the consequences if it happens, and given the severity of those consequences, the judgment that I make and that is shared by many people in Washington is that the probability is sufficient to take it fairly seriously and to enact a prudent set of preparatory measures, which is what we're doing today. The second reason for complexity: the enormous technical -- the second reason for difficulty in civilian biodefense is the enormous technical complexity of the attack scenarios and appropriate response. I really have very little to add to this beyond what was heard in the first session. It's not my area of expertise. So I'm not going to get into that, but let's just say by any measure, this is an exceedingly difficult mission to deal with, attack recognition and appropriate response after the attack. Very, very difficult. To make matters worse, however, that technical difficulty overlays a very fragmented set of institutions that have to implement such a response system. In effect, I would say this new mission of civilian biodefense has been dropped in upon an organizational landscape that is uncharted and basically unfriendly to the mission. Civilian biodefense is, to use a phrase coined by my colleague at Harvard, Ash Carter, a homeless mission. Why? Well, it's new, first of all. It's never been done before, not in the United States and not in any other country, not in the way we're talking about it today. And, second, there is no single logical home for all of it. There are single homes for big parts of it, but not for all of it. So as someone from a school of government, this last set of issues, this institutional fragmentation is what I'm going to focus on, and I'm going to try to tease out why I think the bureaucracy is so fragmented. To do this, and to try to explain what the organizational challenges we face as a nation in building a more effective system of biodefense, I'm going to divide it into four levels, four layers of fragmentation and disorganization and go through a little bit on each one. First, the federal Executive Branch. Response to a bioterrorism incident, as all of you know, will be drawn from many different professional disciplines. Obviously medical professionals and public health professionals will play extremely important roles, but they are not alone. It will also be a law enforcement issue. It will also be a national security issue. It will also be an issue of emergency management. It will also be an issue of intelligence. All of these different response elements, if I were to say, need to be pulled together and coordinated in some reasonably coherent fashion, and there's only two options of who can do that at least at the federal level, and that's the White House and FEMA. And at the moment we say both are going to do it. The White House in some sense claims this responsibility in PDD-62, and FEMA also has it statutorily. In my view, neither is really doing the job very effectively, not at least in the level of program coordination. There is some policy coordination so that everyone has basically the same talking points, but at the level of program coordination and making sure the system works as a whole, I think we've got a long way to go. And let me just note I'm coming across as fairly critical here, but I also recognize this is a very new program, and these sorts of problems are not at all unusual in the early implementation of such a complex program. So this is entirely natural, and it doesn't have to do with any of the specific individuals who occupy these offices. It's just the way governments react to new problems dropped in upon them. Now, I could go through each of the individual departments in the federal government and give you my sense of where the organizational disconnects are, and there are many. We've already heard a little bit about the problems in the R&D area, but let's just focus for a moment on the medical community and the Department of HHS.
HHS was very slow to the table on this issue. The master preparedness for high consequence terrorism got going in about 1995, obviously reactive to the Ashun Richio attack. HHS has been a significant player in this area really only since late 1998, early 1999. In that time, they've made enormous progress, and I think it's to be commended, but the system that the Department of HHS brought to bear in this, I think, is unusual and probably not how we should continue to do things. Essentially the only Senate confirmed official in the Department of HHS who can spend any real time on bioterrorism is the Assistant Secretary for Planning and Evaluation, Peggy Hamburg. She's played that role. She's played it because of her personal interest in the issue and by default because no one else was, but she had no standing mandate to do that and had inherited no staff that positioned her to do that, and this, I think, is a significant organizational gap that needs to be corrected going forward. Now, CDC is clearly the right place to locate the bulk of our specific programs to prepare for management of the consequences of a bioterrorist attack. No question about that, and it's created an impressive program in very short order. However, CDC is based in Atlanta, and as such, it's geographically segregated from the national security and intelligence and emergency management institutions that are also involved in our response. Furthermore, CDC has other priorities, quite understandably, which and by many people's judgments are under funded, and this in a way seems like a new mission that seems to be getting a disproportionate level of funding by the existing way of thinking. I don't mean to be overly critical here, but let me just say I think the notion that you can create a program in CDC without clear oversight back in Washington of it and strategic direction of that program is problematic. Second, the federal Legislative Branch, the Congress. Well, the Congress, in fact, got us started in this business back in 1995 with a domestic preparedness initiative that the Executive Branch did not ask for, the Nunn-Luger-Dominici Program. The Congress has continued to take the initiative and create additional new programs in the general area of domestic preparedness for high consequence terrorism. While this initiative, I think, is commendable, at a point it starts to create its own problems because these programs established by the Congress acquire in a way a life of their own, and since most of them were basically earmarks in specific appropriations bills, there is very little ability for anybody in the federal Executive Branch to coordinate them. They simply must be implemented. They're part of a law signed by the President that said these monies will be spent for this purpose. Furthermore, Congress has too many committees doing oversight. In the broad area of terrorism and WMD preparedness, there are 11 Senate full committees and 14 House full committees that claim oversight authority in one way or another, each one of which has numerous subcommittees. I can't get into them. Congress further would like to tell the Executive Branch how it should organize itself. In the past five years I am aware of about a half dozen congressional efforts to reorganize Executive Branch in this general area that we're talking about, not just biodefense, but counterterrorism and/or weapons of mass destruction. All half dozen, all six have failed, and none enjoy the support of the Executive Branch. Finally, and I think we should be clear about this, as we look at the budget being devoted to WMD preparedness nationwide, and I think the level is now 1.3 billion, I see an increasingly wide stratum of pork in there. A growing number of politically motivated programs, programs that did not derive from Executive Branch requests for specific capabilities in a specific place, and I worry about this a lot. People don't often say these sorts of things in public, but being a professor, an academic, I think someone should say it. We have to watch out for the politicization of this budget, and it's happening very fast. So I think it's a serious problem. The Congress shares responsibility for some of the organizational problems present in the federal Executive Branch. Third, federal, state and local relations. I completely endorse the remarks of Dr. Koplan, and it is essential that the federal government work very closely with state and local government in building capacity nationwide to detect and respond to bioterrorist attack. There's also a legal basis for this. The Tenth Amendment of the Constitution gives the states and governors principal responsibility for public health and for emergency management, and that's why in our history states and local governments have developed those capabilities in their own regions. So the federal government must, for reasons of practicality, leverage off of those existing systems, but it's been difficult. It's been very difficult for the federal government to figure out how to do that efficiently and for several reasons. First, state and local government in America obviously is not organized in any clear hierarchical way, and it's exceedingly diverse. It's just a very rich set of organizations out there with a great deal of diversity and difference across them, and it's hard for the federal government to figure out an efficient template for dealing with them all.
Plus, state and local governments have different priorities, and they don't necessarily share this one. They don't necessarily share civilian biodefense because they're not responsible for national security,a nd this issue emerged on our agenda from a national security calculation. In my judgment the federal government needs to get much more serious about an effective interface with state and local government and also has to deal with the resistance in all federal bureaucracies of moving money out to build resources at other levels of government. And I think the CDC and DOJ are commended for recognizing that resources do have to move across the layers of governance in America, but I think the ratios are still too small. Finally, private sector and public sector. It's a very difficult one. As we all know, medical care and biomedical research in the United States and insurance is principally, primarily privately owned. We need to figure out a way to create incentives hopefully in a positive sense in that sector to build the surge capacity we need, we will need in a bioterrorist incident, and right now we don't have the right idea. And I don't have a simple idea to give you on how we should do this, but it's clear to me we need to rethink how we're communicating with the public biomedical and health care sector and get them better engaged in building the capacity we are going to need to respond appropriately to this problem. I've got one minute left, and I will give you very briefly -- the next slide -- a summary of -- next -- four big -- the first bullet point, please -- four big institutional ideas that I think need to be enacted here. I think we need a new Assistant Secretary of HHS for national security. This person would be Senate confirmed, would provide oversight for the existing OEP in HHS, would have a robust staff, all with security clearances to engage this problem appropriately. It would also provide oversight of the CDC program and the FDA and NIH programs that exist already.
In effect, there would be a dotted line that would supplement the hard line that goes from the Secretary to the Director of CDC to the Director of the CDC program. There would be a dotted line that goes around that. Second, the next bullet point, we need to enhance White House coordination. Next bullet point. We need to have a presidential domestic terrorism advisory board to help us with this interface with state and local government. And last, we need to consolidate congressional oversight in some reasonable way to get the number of committees engaged in this process down to a reasonable number. Thank you very much for you attention. (Applause.)
| 
