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Jerome Hauer, MPH COL. EITZEN: I'm privileged to introduce the first of these two outstanding speakers and leaders in the field of bioterrorism to you. Our first speaker is Jerome Hauer, known to most of us as Jerry, who is currently Managing Director of Kroll Associates in New York City. Jerry is a long time colleague and friend of many of us. He's one of the world's leading experts on biological and chemical terrorism. He was one of six national experts chosen to privately brief President Clinton and Vice President Gore and four cabinet Secretaries on Good Friday of 1998 on the specific issue of the biological terrorism threat. He's formerly Commissioner for Emergency Management for the City of New York, the Office of Emergency Management from 1996 to 2000, and he set up what has been widely recognized in the interagency community as the best large city preparedness program for biological terrorism in this country. He has recently done extensive consulting work with the Australian officials for the Sydney Olympics, with Scotland Yard, and with the Israeli government on these issues. And his talk today is going to be the "Olympics 2000: Preparing to Respond to Bioterrorism." Please join me in warmly welcoming Mr. Jerome, Jerry, Hauer.
MR. HAUER: Ed, thanks very much. It's a pleasure to be here today. I, too, want to congratulate D.A. Henderson, Tara and Tom. You know, it's always -- as I've said to D.A., when you're done curing the world of smallpox or eradicating smallpox in the world, you've got to find a new challenge, and knowing the kind of person D.A. is, there's never going to be any grass growing under his feet. He took on a topic that is going to be something we're going to be confronted with for many years to come, and if anybody can take this on and make some sense out of it, it's certainly going to be D.A. and Tara and Tom, and they deserve a lot of credit for all of the work they've put into this symposium.
What I'd like to do during the next 20 minutes is basically tell you a little about the Olympics in Sydney or in Australia because it was not just in Sydney. Unfortunately this talk might, you know, tend to get a little boring because nothing happened. I mean, you know -- (Laughter.) -- the bottom line is, you know, it's great to come up here to do one of these talks after you've been through an event like the World Trade Center and you sit there and talk about all of the blood and guts and all the stuff that happened, all the people you carried out. The bottom line is the Australian government did a great job. They deserve a lot of credit. I do want to take you through some of the thinking that went on, some of the issues that we confronted not just in Sydney, but in some of the other states in Australia, and hopefully right after lunch not put you to sleep because nothing did happen, but talk to you about some of the things that we had to confront. First, just if you're kind of a dope like me who flunked geography back in, you know, junior high school, you know, when the first call came about three years ago that they asked me to come down to Australia, I kind of figured I'd look at a map and figure out where the hell I was going, and you know, I wanted to know. My first role was actually down in Melbourne. D.A. and I went to a meeting of the Virology Association down in Sydney to do a talk, and in trying to understand the geography of Australia, and there's a rationale for me saying this, Australia is about the size of the United States in square miles, and it doesn't look that way. There's only about 13 million people in Australia, but as you look at the Olympics themselves, a lot of what went on with the Olympics was in Sydney, but if you look at the little map of Australia on the side, you'll note that Alelaide, Melbourne, Canberra and Brisbane were also sites for the Olympics, and when you look at the size of Australia, those parts of the country from Brisbane down to Melbourne is about a three-hour flight. Driving from Melbourne to Sydney is about ten hours. So you've got to think about that when you think about resources and having resources basically spread out from Maine to Florida as you're trying to deal with planning for the Olympics. The Australian government dealt with that very rationally. They basically just told everybody outside of Sydney, "You're on your own," and -- (Laughter.) -- what can I tell you? The bottom line is the Olympics were basically -- the majority of the Olympics were held in Sydney, and I'll show you a map of the park in a moment or two, but in New South Wales, there's six states in Australia, and the Olympics were held in four of those states. New South Wales is the home, you know -- again, when I first went down to Australia, I figured Sydney was the capital of the country. What the heck do I know? It turns out Canberra is, and Canberra is down there in the southern part of New South Wales. But the majority of the Olympics were held 14 kilometers west of downtown Sydney, or the Sydney central business district. There were, however, events held in downtown Sydney in Darling Harbor, the marathon, the triathelon. The Convention Center in downtown Sydney was the host of the weight lifting, the boxing, and the Judo, and then all around New South Wales you had things like the shooting, the horse events, the equestrian events, and the baseball. Then east of Sydney on Bondai Beach you had beach volleyball. That's an Olympic event. Go figure. (Laughter.) If I can participate in it, it's not an Olympic event. I can tell you that much. (Laughter.) The actual site of the Olympics was a multi-acred facility, 14 miles east or west of the central business district, and that was Homebush. Fifteen different events occurred at Homebush. Kind of the crowning glory of Homebush was the Olympic stadium that held about 110,000 people. And I give you some of this as background, but when you think about the threats of terrorism and you think about a village like this and you think about a stadium with 110,000 people, some of the natural concerns are obvious. Let me give you a sense of what some of the threats were and some of the threat analysis that went on over the course of analyzing how to plan for the Olympics. First of all, the greatest threats were basically viewed as Homebush or the Olympic Village itself, as well as Darling Harbor where on any given day you could have four or 500,000 people wandering not just in the Olympic venues themselves, but because it's such a beautiful facility, wandering around the harbor itself. Two or three events, as well, were considered high threat kinds of targets. The first was the opening and closing ceremonies where you had significant numbers of people, and I'll show you that in a second or so. Second was the fireworks that concluded the Olympics in downtown Sydney, and then finally the torch arriving in downtown Sydney the night before the opening ceremony. Clearly, the American and Israeli teams were considered high profile targets and extra security was involved in their movement. There were three family hotels in downtown Sydney that hosted what they called the Olympic family, which were many of the officials and relatives of the athletes which were considered softer targets because the level of security at those hotels did not come close to what it was at the Olympic venues themselves. And then clearly, the number of high profile visitors to the Olympics were considered targets. As you know from the United States, Chelsea Clinton and Secretary Shalala represented the United States and the official delegation. Chelsea was down there for about two and a half weeks. Sydney itself is about three and a half million people. During the Olympics on an average day, there were about 400,000 additional people in downtown Sydney wandering around. Throughout the Olympics there were about 11,000 athletes, 50,000 volunteers, 5,000 officials, and 15,000 official media, but there were an additional 15,000 media that were not officially credentialed, and they tended to stay on the outskirts of the official venues. And then interestingly, and one of the challenges that they had, they had 13 or -- excuse me -- 12 cruise ships in the harbor that were used as hotels, and places like NBC brought people in. They stayed for four or five days on a cruise ship. That was their hotel, their convention center, and then they rotated other groups in and out of Sydney on these cruise ships. And one of the more significant incidents that we had that I'll talk about occurred on a cruise ship. Just by way of numbers, when you look at some of the targets, when the torch arrived in downtown Sydney the night before the Olympics, there were an additional 400,000 people crowding the square outside of town hall. During the opening and closing ceremonies, there were 110,000 people in the stadium, plus another 120,000 people in various hospitality booths in Homebush itself. So on an average night during the closing and opening ceremonies, you had about 230 to 250,000 people in the Olympic Village.The closing ceremony though in downtown Sydney brought 1.5 million people to the downtown area itself. And then an important thing to note is the City of Sydney had eight sites or six sites throughout Sydney that were not Olympic venues. These were big sites that you could put 60 or 70,000 people in. They had big screen TVs. They had bands, and they went 24 hours a day by and large. People could go in, watch events live on TV, and basically there was no security in any of these venues. In point of fact, one of the nights, they had to shut one of these venues down because crowds got out of control, and they had all kinds of problems with people climbing up on the TVs on lamp posts, and the venues had to be shut down as a result of the crowds. They expected about eight million people at these six live sites throughout the course of the Olympics. I mentioned earlier the goal was to protect Sydney. When you looked at the other venues, and I mentioned Adelaide, Canberra, Brisbane, and Melbourne, basically there was no federal involvement in the planning other than some intelligence sharing. Sydney had predeployed teams. They had a host of equipment that was bought and predeployed. The only thing that Melbourne and Brisbane got was a push package made up of some antibiotics that came from the United States, as well as some personal protective equipment that came out of the military stockpile in Australia, and that was not allowed to be opened unless there was an actual event. And most of it was stored two to three hours outside the city at the nearest military base. So, for instance, if you need Mark One kits, which were part of the cache, and you needed them quickly, it was about a two hour mobilization to get it up there, and for those of you that, you know, have been involved in the planning for these events, that two hours is far too much when you're dealing with organophosphates. So this was a big issue as we were working on Melbourne. Basically we had to buy everything on our own down in Melbourne. Brisbane had to do the same thing. All of the supplies had to be purchased on their own because they got little or no assistance from the national government. The New South Wales Department of Health was responsible for dealing with bioterrorism, and in the State of New South Wales. In Brisbane it was Queensland Health. In Melbourne it was Victoria Health, and New South Wales had worked on this problem basically from 1994. As the Olympics approached, they put in place a number of plans, and I'm not going to go into a lot of detail because I don't have the time right now, but you can take a look at these. They are available, and I'll tell you how you can get the plans. They looked at a number of the issues that could impact the Olympics, and it's important to note, and there's going to be a thread as I finish up in a few minutes, a lot of these had to do with things other than bioterrorism, but the planning that you used was very similar whether you were planning for a food outbreak or a bioterrorist event, and I'll talk about that as we get into surveillance because there were a lot of commonalities. Clearly, the clandestine release of a biologic agent is a major concern, and certainly Tom Clancy's book didn't dampen their concern about it. I'm sure everybody has read Clancy's book where they sprayed ebola or Marburgh in the Olympic stadium in these cooling systems. There were no cooling systems like that at the Olympic stadium, but Clancy did a good job on the book and got everyone's attention. I must say that there was no specific threat information regarding bioterrorism in Australia. It was a concern. As many of you know, the Aum Shinrikyo did their initial work in western Australia. Their labs were in western Australia. So there was a high level of concern for biological terrorism, but there were no specific threats.
They put in place a very comprehensive strategy that involved both prevention, detection, response, and communications. First of all, prevention, and you know, this strategy seemed to have worked the best since we didn't have any incidents at the Olympics, but the intelligence and law enforcement played a very key role in insuring that there was good communications in tracking individuals, making sure they knew who was coming into the country, in monitoring any threats that occurred, and there were representatives from the FBI had a significant contingent of people down there. Other agencies from the United States were well represented in the intelligence and law enforcement cluster. They did do some things for prevention that were fairly simplistic, like restricting flights over Homebush. Surprisingly though, during major events in downtown Sydney, you could find six or eight helicopters flying over the city at any one point in time, and when you think about bioterrorism and you think about these planes that are trailing banners, they're ideal vehicles for disseminating agents, but there didn't seem to be a whole lot of concern about any restriction of these types of aircraft over the downtown venues. They had very tight entry security into all of the Olympic venues, but the focus was mostly bombs and guns. Surprisingly, you could walk into the Olympic Homebush Village with a bottle of fluid or liquid, and no challenge at all. You really got the sense that all they were looking for was either a bomb or a gun and nothing else. They had no training. They were not police officers doing the searches. Police officers were nearby at the magnetometers, but by and large, they were either volunteers or people that came from other agencies that wound up manning the entry points. And finally, they felt as far as prevention they went out and very aggressively used public relations to let people know that security was going to be tight. They felt it would be a disincentive to people if they recognized how tight security would be. And they also let people know that they had good response plans in place, and they felt that that as well would be a disincentive. Let me quickly go through some of the detection and environmental monitoring. First, you know, there are no real good environmental monitors that you can put in place. Amy will be talking about that today or tomorrow, but it's a challenge that we continue to have. They used wet walled cyclone samplers, and they basically did samples inside the samplers, brought those to the lab two or three times a day to see if there were, in fact, anything in the environment that would pose a challenge. And then if, in fact, they had something that they found at a venue, they would use the hand held assays. The heart and soul though of the whole Olympic monitoring system was a very sophisticated Olympic surveillance system that was put in place by the New South Wales Department of Health, and that involved a host of information that was coming in on a daily basis. Public Health Network, that was their normal reporting system. They just enhanced for the Olympics. They used information from WHO to look at what was going on throughout the world to see if anything out of the ordinary occurred in another country, to see if it cropped up in Australia. They did environmental monitoring, and then SOCOG had their own medical system within the fence of the village, the Olympic Committee, and that tracked very closely as well. Every day they did briefings. They had a briefing every day at about two o'clock where they went through the data from the previous 24 hours to look at any patterns that might have shifted, any changes, any emerging patterns.
They also looked at what was going on inside the fence, any patient contacts that occurred at the Olympic Village to see if there were any trends going on in patient contacts either with athletes or visitors. And then they had public health investigation teams who were mobilized rapidly if they saw anything going on within the village. I'm going to have to move quickly because I've got about four minutes left. Finally, the Australian Defense Force had teams prepositioned at Homebush and Sydney in the event that they had either a chemical or a biological incident or a radiological incident. The ADF teams were very well trained. Several of the members came to the United States and Canada for a lot of their training and worked very closely with a lot of the agencies here. But they were ready to be mobilized in the event of any kind of an actual site specific incident, but they were not as involved if it was a clandestine release. In addition, the fire department had medical response teams on site at various venues that they could mobilize, and then they also had additional physician support outside of Sydney that they could fly in in the event that they needed help real quickly. And then I've already mentioned clandestine relief. New South Wales was the lead agency for managing the consequences of a clandestine release. It was theirs to own. It was something they would have to deal with because it was not a response. It was a public health emergency. They were supported by the Australian Defense Forces, and then the U.S. had significant stockpiles. Both Bob Knouss and Mike Anderson, who's here, were down there during the Olympics, served as a liaison to the Australian government, and then they worked close with Bayer Pharmaceuticals to ensure that they had additional pharmaceutical capability in the event that something happened. They had plans in place for augmenting hospital staffing in the event a major incident occurred through the New South Wales medical disaster plan, and surprisingly there was not a lot of emphasis on how they would do mass prophylaxis or mass vaccination in the event that that was needed. Finally, communications. Communications was an important part of their response, and they actually had a communications plan. The most important thing that they wanted to get across in the event of an incident was that they spoke with one voice, that there not be conflicting information which would cause the public to lose confidence, and that's something that we continue to struggle with here in the United States. Finally, let me just go through the incidents, and I'll finish up. Most of the incidents tend to be bomb related. Right before the Olympics, there was a package on the subway about two weeks before the Olympics that was detonated by the police department. It turned out to be a relatively amateur type of bomb. Many of you probably read about the nuclear reactor outside of Sydney near Homebush where they had found some people in Aukland, New Zealand, that were supposedly making plans to blow this up. It turned out to be a lot more media hype than it was substance. It really got a lot more play than there was reality. One of the more interesting incidents we had was a stuffed animal that showed up at the airport that was X-rayed, and it had two vials of liquid stuffed inside of it, and as of the time I left Sydney, they were still analyzing it, but they didn't think it was any type of biologic agent. They were trying to figure out what kind of a chemical it is. More importantly, they were trying to figure out what it was doing inside of this stuffed animal. They had a couple of major gas leaks at the airport. Most importantly, they had an outbreak. They had a couple deaths on one of the cruise ships, and it became a big deal in the media. I was reading Pro-MED every day down in Sydney, and on Pro-MED -- I mean, it was a big deal. You know, people are dying on these cruise ships. It turned out in all likelihood that it was the flu, and they had two crew members die. They originally thought it might have been Legionella. they ruled that out. In summary, while bioterrorism was a concern, conventional weapons were still viewed as the greatest threat, but the health agencies took the threat very seriously and incorporated significant planning for bioterrorism in all their plans. An important point. As they looked at surveillance, the surveillance system they put in place was not only good for bioterrorism, but it was good for monitoring food borne outbreaks, flu outbreaks, and any other kind of public health emergency that occurred. So these dual systems, when you think about surveillance for bioterrorism, you think about surveillance for any other emerging type of public health threat. And finally, close links between the intelligence and public health communities were essential, and that's something that we need to continue to work on here in the United States. And then one thing that we learned is special events like this are an excellent catalyst of enhancing and using it as a catalyst to enhance public health infrastructure and bridging the communications between the public health community and the medical community.
So with that in mind, I'm going to stop. I'll turn it over to Ed. I ran about four minutes over. I just wanted -- planning for the Olympics, Michael Hills and Dr. Michael Flynn and Dr. Jerry McNulty were the guys that really did the yeoman's work on this and deserve the credit for what went on down in Sydney.
With that I'll stop. I apologize for racing through it so quickly, but I've got a tough task master over here in Ed Eitzen. Thank you.
(Applause.)
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