The threat of non-state actors acquiring weapons of mass destruction underpinned most of the discussion. “For all of human history, there has been this relationship between concentrated industrial power and the ability to kill lots and lots of people. We are at a moment in history…where the capacity to do mass violence is now something that is devolving to any group of a half dozen people,” said Kellman.
This year’s Orange Flame—a national, biannual exercise in Israel—rehearsed such a nightmare scenario. Two terrorists infected with an unknown agent arrived by plane in Tel Aviv. One went to a major hotel and was found dead 24-48 hours later. The other entered a soccer stadium with an aerosolized form of the virus. 20,000 people were exposed. As part of the drill, the Israelis identified the agent (smallpox), set up response centers to immunize the population, tested coordination of relevant response agencies, and even conducted a mock negotiation and purchase of smallpox anti-viral courses.
In his remarks on the exercise, Danon noted that Israel’s universal healthcare system—specifically its computerized record-keeping—
To build and maintain a culture of preparedness, Israel conducts a bioterror drill every two years in each of its hospitals. First responders and hospital management alike must pass an exam at the conclusion of the drill. “You need the clinical skill on the individual level,” Danon argued. “We hope they will not be the victims…but they also need to have the capability to do the initial diagnosis of what they’re seeing.”
Rose—one of the few Americans to witness Orange Flame 4—praised the openness and large scale of the Israeli exercise. “We in the US don’t do this at all on a systemic basis, and certainly not at the regional scale,” he observed, adding that the Israeli health care system is “remarkably well-coordinated.”
As the old military adage goes, amateurs do strategy; experts do logistics. To that end, Danon remarked that the Israeli drills make a point to evaluate logistical capacity. As a scientist developing countermeasures, Rose acknowledged the primacy of logistics: “If we don’t master the logistics of mounting a response, having…all the great science in the world—especially if you have no quantities of these miracle agents—will be useless.”
Kellman warned that legal obstacles represent another barrier to progress in biodefense. “Legal problems permeate this entire domain,” he said. Whether licensing questions, liability questions, incentivization questions, or a host of other issues, “they are unresolved, unaddressed.”
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