Domestic terrorists likely live on Kaua’i, bioterrorism expert says

LIHU’E – It is highly likely that domestic terrorists live on Kaua’i and other places in Hawai’i, a bioterrorism expert said Thursday.

Where U.S. vulnerability to further bioterrorist attacks is concerned, the country must look inside and outside its borders, said Cmdr. Dr. Randall C. Culpepper, pointing to long lists of known international and domestic terrorist organizations.

“There are people out there who hate our government so much that they’ll go to any extreme to exact revenge on us,” said Culpepper, citing the bombings of the World Trade Center, U.S. military barracks overseas, the USS Cole, and Oklahoma City federal building as recent examples of international and domestic terrorists at work.

Speaking on bioterrorism before about 50 people at Wilcox Memorial Hospital, Culpepper, director of overseas medical research programs at the U.S. Department of Defense Global Emerging Infections Surveillance and Response System in Washington, D.C., said most domestic terrorist organizations are white supremacist in nature.

Before an audience here of first-responders like ambulance crews, emergency-room doctors and other medical professionals, Culpepper, who has spoken before similar groups around the country, said one outcome of increased awareness of potential bioterror incidents is a cooperative spirit between law enforcement, military, public and private health-care agencies, fire departments, and others, which may not have existed in the past.

He called it “incredible synergy. You need everybody” working together, knowing each other, to effectively respond, he continued.

Culpepper’s intent during his presentation, he said, was to raise the audience’s suspicion level up a bit, to the point where they’re “aware but not paranoid. We gotta be a little prepared,” he said.

Being prepared for emergencies like airplane crashes, hurricanes, tsunamis, bombings, and other manmade and natural disasters is a good way to ensure preparedness for and proper response to bioterrorism events, said Culpepper.

“Planning is the key to successful resolution of any large-scale disaster, manmade or otherwise. Once something happens, y’all in charge,” he said to local officials.

But how do you plan a response to a bioterrorist attack when “even a small-scale bioterrorism event will overwhelm a city’s medical-care resources?”

For example, when bioterrorists released sarin nerve gas in the Tokyo subway system, 4,000 of the 5,000 people who turned up at hospitals for treatment had no symptoms of exposure at all, he said.

“You have to be prepared for the onslaught of the ‘worried well,'” or those people who aren’t affected but fear they may have been exposed to a dangerous or toxic substance, he continued.

The discovery of anthrax in New York City, Washington, D.C. and Florida caused only five fatalities among 18 confirmed cases, “but the response was overwhelming,” he recalled.

The plan in place for bioterror response must take into consideration the need for places to store dead bodies, quarantine and isolation facilities, hospital beds for the sick and wounded, and other facets, including dealing with the media, he said.

While at one time the former Soviet Union was producing 4,000 tons of anthrax a year, and spores are easy to get and stay potent for a long time, the good news for Americans (targets, unfortunately, of most domestic and international terrorists) is that the leap from getting it to getting it into a form where it can be released in weapons-grade form requires highly sophisticated equipment and scientists, Culpepper said.

Still, the result of a release of anthrax over a metropolitan area with a population of 500,000 people would be the death of 200,000 of them, Culpepper said.

And there are several countries, including Iran, Iraq, Sudan, Syria, Libya and North Korea, that are all in different states of advancement towards developing chemical and bioterror weapons, he warned.

Iran got its anthrax seed stock via mail from an American company doing business only around two miles from his office in Washington, D.C., Culpepper continued.

He had to change one of his slides that accompanied his talk. Where the slide used to read “How likely is a bioterror attack?” it was changed to “How likely is another bioterror attack?” after last year’s anthrax events on the U.S. East Coast.

For the four years prior to 2001, there were 400 letters sent warning recipients that they had opened letters containing anthrax, and that they were going to die. Since Sept. 11 of last year, the Federal Bureau of Investigation has investigated 3,500 anthrax hoax letters and packages, and not just in the United States, he said.

Genetic engineering, which has made huge strides that may eventually be used for the good of mankind, has also been used by those seeking to develop new and deadly bioterror agents, he warned.

The audience let out a near-collective gasp when told that the Soviets had been successful in combining ebola and smallpox viruses in a laboratory. A successful combination would mean a virus that spreads from person to person easily (smallpox) with one famous for its lethal nature (ebola).

Fortunately, once combined the new creation only lasted a few seconds in the laboratory, he said. But with genetic engineering in its infancy, it is only a matter of time before someone will figure out how to make a similar deadly combination that can be transformed into a weapon of war, he said.

To indicate what the smallpox virus could do in the wrong hands, Culpepper said a “suicide bomber” of sorts, carrying the smallpox virus, could start a worldwide epidemic simply by mingling with outbound passengers at, say, Los Angeles International Airport.

The passengers would then unknowingly spread the disease around the world by boarding flights bound for various national and international destinations.

Back in 1980 declared eradicated by the World Health Organization, smallpox is near the top of bioterror experts’ lists of potential weapons.

Why would a virus that has been around since 6,000 years before the birth of Christ, which was wiped from the face of the earth near the end of the last century, be considered such a health threat?

Because, Culpepper explained, of the two known laboratories to house the remaining strains of smallpox, one is Atlanta’s Centers for Disease Control and Prevention (CDC), where the virus is kept under tight security.

The other is in the former Soviet Union, and it is not known how secure that cache is, he said.

Smallpox fits the profile of a near-perfect bioterror weapon. It is highly contagious, easily disseminated, and highly lethal. And, since the United States stopped immunizing people against smallpox in 1972, much of the world is “immunologically naive” about the virus, he explained.

A CDC plan is in the works to immunize 20,000 first responders against smallpox, but Pres. Bush wants to have 50,000 first responders immunized.

A problem is that in a country of 280 million people, there are only 100 million doses of smallpox vaccine now. More vaccine is being developed now, he continued.

That’s a good thing, because if one case of smallpox is discovered, it will signal an international emergency, and something will be wrong, because the virus as the world once knew it no longer exists outside a laboratory.

And, if one case is detected in the United States, there is a plan to immunize every American, Culpepper said.

A problem with diagnosing victims of bioterror is that many of the viruses cause victims to have mild, flu-like symptoms. If treated like conventional flu bugs, and not detected early on, victims will soon be dying, as the diseases quickly become lethal, he said.

Biological weapons are the ones of choice among many enemies of the United States, he said, because they are inexpensive and easy to obtain.

Where preparedness and response are concerned, the greatest resources should be used to prevent the biggest problems, or those that would result in the most casualties, he said.

And in this new battlefield, weapons that incapacitate are in many ways preferred over those that kill. Weapons that incapacitate not only take those affected out of action, but require large human resources to take care of those affected, taking in essence twice as many people out of action as agents that simply kill, he observed.

Unfortunately, the number of people and resources now working on immunizations and other stops for biological weapons takes away those people and resources from other research, like finding cures for cancer and other diseases, he said.

Culpepper’s talk was sponsored by APIC-Hawaii, the Hawai’i chapter of the Association for Professionals in Infection Control and Epidemiology, Inc. It was funded by a grant from CDC and the state Department of Health’s Epidemiology Branch.

Staff Writer Paul C. Curtis can be reached at or 245-3681 (ext. 224).


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