One of the most important missions we have as a Nation is to be prepared for the threat of biological terrorism - the deliberate use of disease as a weapon. An effective biodefense will require a long-term strategy and significant new investment in the U.S. health care system. The President is taking steps now that will significantly improve the Nation's ability to protect its citizens against the threat of bioterrorism. The President's Budget for 2003 proposes $5.9 billion to defending against biological terrorism, an increase of $4.5 billion -- or 319 percent -- from the 2002 level. This new funding will focus on:

1. Infrastructure. Strengthen the State and local health systems, including by enhancing medical communications and disease surveillance capabilities, to maximize their contribution to the overall biodefense of the Nation.

2. Response. Improve specialized Federal capabilities to respond in coordination with State and local governments, and private capabilities in the event of a bioterrorist incident and build up the National Pharmaceutical Stockpile.

3. Science. Meet the medical needs of our bioterrorism response plans by developing specific new vaccines, medicines, and diagnostic tests through an aggressive research and development program.

Responsibility for detecting and managing a bioterrorist attack needs to be shared among a wide range of Federal, State, local, and private entities. The resources made available in the President's Budget for 2003 will help the Nation develop an effective "early warning" system against a possible bioterrorist attack, and mount an effective operational response to manage its medical consequences. These enhanced capabilities, once in place, will also enhance the Nation's ability to respond to outbreaks of naturally occurring diseases.

Infrastructure: Strengthening America's Public Health System
The President is committed to improving the ability of State and local public health care systems to deal with bioterrorism. State and local medical personnel are a principal line of defense against bioterrorism, and will often be the first to recognize that we are under a biological attack. Ensuring that State and local health care providers have the appropriate tools and the training is critical as our health care community works to carry out this mission.

Many of our health care systems are not adequately prepared for a large-scale attack:

• The health care system lacks the surge capabilities needed to handle quickly large numbers of victims and have insufficient isolation facilities for contagious patients.
• The information system that knits together hospital emergency rooms and public health officials is antiquated and inadequate.
• Little has been done to promote regional mutual aid compacts among health care institutions for bioterrorism attacks.
• Training for health care providers in the handling of bioterrorism victims has been infrequent.

In his 2003 Budget, the President has proposed $1.6 billion to assist State and local health care systems in improving their ability to manage both contagious and non-contagious biological attacks, to expand health care surge capabilities, to upgrade public health laboratory capabilities, and to provide training for medical personnel. The Budget also makes available funding to support the development of regional medical mutual aid compacts. In the event of an emergency, these compacts will enable State and local emergency managers to augment local medical care providers quickly and efficiently. Finally, the communications network that links the acute care providers of our communities with their public health counterparts will be modernized and improved so that vital information on the detection and treatment of disease can flow swiftly.

Response: Enhancing Specialized Federal Capabilities
A major act of biological terrorism would almost certainly overwhelm existing State, local, and privately owned health care capabilities. For this reason, the Federal government maintains a number of specialized response capabilities for a bioterrorist attack. The President's Budget invests $1.8 billion to ensure that these specialized Federal resources are adequate for the threat we face.

The President and the Congress have already taken steps to acquire a national supply of smallpox vaccine and ensure that by the end of fiscal year 2002, the National Pharmaceutical Stockpile will contain sufficient antibiotics to treat 20 million people against diseases such as anthrax, plague and tularemia. The President's Budget for 2003 provides $650 million to carry the process of enhancing the National Pharmaceutical Stockpile even further through:

• The acquisition of the next-generation anthrax vaccine, and the maintenance of and improvements to the national supply of smallpox vaccine. The budget will also provide resources to acquire sufficient amounts of vaccinia immunoglobulin (VIG) to treat those that might experience adverse reactions to inoculations.
• Continued maintenance of and improvements to the "push packs" that can be used in the case of both biological and conventional attacks. These pre-assembled packages contain life-saving antidotes, pharmaceuticals, and other medical supplies, and are deployed to the disaster site within 12 hours of a request. The first emergency use of the "push packs" came on September 11 in New York City. In fiscal year 2002, the national supply of these "push packs" was increased from 8 to 12.
• An enhanced vendor managed inventory program so that the Federal government can quickly obtain the additional antibiotics, antidotes, and medical equipment and supplies if an incident requires a larger or multi-phased response.
• Funding support for the States and localities to plan for the receipt and distribution of medicines from the National Pharmaceutical Stockpile.
• The streamlining and integration the Federal bioterrorism response efforts into a unified plan.

Recognizing the potentially global nature of bioterrorism, the Budget for 2003 devotes $10 million to create a team of epidemiological scientists who are committed to working with their counterparts in foreign countries to provide information, research, awareness, and early warning of potential health threats from abroad. Finally, the President's Budget for 2003 provides $20 million to strengthen the Epidemiological Intelligence Service (EIS) at the Centers for Disease Control in Atlanta. Established in 1951 following the start of the Korean War as an early-warning system against biological warfare, the EIS today has expanded into a surveillance and response unit for all types of epidemics.

Science: A New Medical Toolkit for Fighting Bioterrorism
Whether we succeed or fail in our response to an act of bioterrorism depends in large measure on the quality and effectiveness of our diagnostic tests, vaccines, and therapeutic drugs. Our experience responding to the anthrax letter attacks of October 2001 has revealed major inadequacies in our existing medical "toolkit" for fighting bioterrorism. Some of the diagnostics, vaccines, and therapeutics available to us today were developed during the Cold War and hence do not harness the full power of modern biomedical science.

The President's Budget for 2003 devotes $2.4 billion to jump-starting the research and development process needed to provide America with the medical tools needed to support an effective response to bioterrorism. These resources will be focused in the following areas:

• $1.75 billion will be provided to the National Institutes of Health to conduct basic and applied research needed to provide solutions to a range of specific operational problems in our bioterrorism response plans. To do this, NIH will lead a partnership with industry, academia, and government agencies dedicated to understanding the pathogenesis of potential bioterrorism agents and to translating this knowledge into required medical products.
• Over $600 million will be allocated to the Department of Defense, of which $420 million will be used to accelerate efforts to develop better detection, identification, collection, and monitoring technology. Additionally, the scientists working under Defense auspices will support the law enforcement, national security, and medical communities by improving our understanding of how potential bioterrorism pathogens may be weaponized, transported, and disseminated.
• $75 million will go to the Environmental Protection Agency to develop better methods for decontaminating buildings where bioterrorism agents have been released.

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