-President George W. Bush June 12, 2002
Biological weapons are one of the biggest threats we face today. They are potentially as deadly as nuclear weapons and can leave an area contaminated for weeks. Despite this however, the threat of biological weapons does not seem to be a major priority of our current administration. There seems to be a significant rush to implement counter-terrorism policies that focus on more conventional means of attacks and more specifically those attacks that we have already experienced. Consequently, we see much improvement in the screening of airline passengers and the regulation of traditional explosives, but no further regulation of biological weapons, dispersion systems, or the implementation of better response procedures. Therefore, more should be done to prevent biological attacks and prepare our nation to respond in the event there is one.
According to the Terrorism Knowledge Base, since nineteen sixty eight there have been a total of thirteen incidents involving biological weapons with forty-six injuries, and six fatalities. Of these thirteen incidents, nine of them have taken place in the United States, with all of the injuries, and five out of six of the deaths all taking place in the United States as well. If these statistics are examined in a general sense and in comparison to other weapons used in terrorists attacks (bombs, fire, firearms, etc) then the trend of biological terrorism does not seem very important. However, the reality is that the more technologically advanced we become globally, the more efficient biological weapons and their dispersion systems become, and the greater the threat is for an attack. We are currently in an age where scientific discovery, and advances in biology are putting us at risk for an attack from a terrorist group, or even an individual with access to biological weapons and a grudge.
In order to repair our current system, revision of our current policies must be done, as well as creation of new policies and procedures to mitigate the threat. This paper will provide information on our current policies, how the problems with out current policies can be fixed, and a risk assessment of the Brazos Valley with specific emphasis on the Texas A&M University System.
The following are the policies that have been developed in response to the threat of biological weapons. All polices regarding biological weapons should have two parts: prevention of a biological weapon attack, and response after a biological attack. While each is important on its own, together they make a comprehensive plan to create policies around. Before any suggestions can be made, however, our current policies must be known and judged against the threat we currently face.
There are three main policies and plans concerning biological weapons that have come from the White House. They are Homeland Security Presidential Directive 10, Homeland Security Presidential Directive 21, and Project Bioshield. Together these are designed to provide us with maximum protection and response in the case of a biological threat.
Homeland Security Presidential Directive 10 (Biodefense for the 21st Century):
Homeland Security Presidential Directive 10 has four major goals as outlined by the White House: threat awareness, prevention and protection, surveillance and detection, and response and recovery. Each of these is an integral part of the overall plan.
In order for our government to prepare for a biological attack, we must know the nature of the threat. This is where the “Threat Awareness” pillar comes into play. This pillar seeks to provide our government with the ability to use technology and intelligence to provide the most realistic appraisal of our current threat. The concept of threat awareness allows us to create functional policies specially designed around our current threat. There are three totals components of the threat awareness pillar: biological warfare related intelligence, assessments, and anticipation of future threats.
Biological warfare related intelligence is the name given to the process of using the intelligence community (Central Intelligence Agency, National Security Agency, and others) to gather all information pertaining to biological weapons. This would involve overseas missions for intelligence gathering purposes, development of systems to analyze collected data, and the dissemination of that data to all important parties. Biological warfare related intelligence also incorporates Red Teaming, a term indicating the team in a preparedness exercise (similar to a war game) whose role is to simulate enemy tactics. “Red Teaming efforts are used to understand new scientific trends that may be exploited by our adversaries to develop biological weapons and to help position intelligence collectors ahead of our problem.” (www.whitehouse.gov)
Assessments are the second component of the threat awareness pillar. “The Unites States requires a continuous, formal process for conducting routine capabilities assessments to guide prioritization of our on-going investments in biodefense-related research, development, planning and preparedness.” (www.whitehose.gov) The Department of Homeland Security will be made responsible for gathering information and production of periodical assessments and making recommendations of division of resources based on the assessment.
The anticipation of future threats component asserts that the need to stay current with existing technology is of great importance. It enables the government the government to anticipate and prepare for the emergence of new threats (www.whitehouse.gov). How these assessments are to be done and what exactly is to be included in them, is not stated in the White House’s version of Homeland Security Presidential Directive ten however.
Prevention and Protection
The first component of the prevention and protection pillar is proactive prevention. As stated by the White House, “preventing biological weapons attacks is by far the most cost-effective approach to biodefense.” This will be accomplished by limiting access of biological agents and dispersal methods to countries, groups, or individuals seeking to develop, produce, and use these agents. (www.whitehouse.gov) This will be accomplished using law enforcement investigative techniques, diplomacy, and export controls. Agencies responsible for prevention are the Department of State, Department of Defense, Department of Justice, and the intelligence community, but specific duties are not given.
The second component of prevention and protection is critical infrastructure protection. The directive explains that protection of critical infrastructure, especially in the case of those that would be important after an attack (public health, food, water, energy, agriculture, transportation, etc.) should be protected. Once again, details as to how this is to be done are not given, only that it should be done.
Surveillance and Detection
The first component of the surveillance and detection pillar is attack warning. This would entail the development of an attack warning system, similar to severe weather warning systems, “which rapidly recognizes and characterizes the dispersal of biological agents.” The logic behind this component of surveillance and detection is that an efficient and effective response can be mounted to counter the threat if the biological agent used in an attack is able to be detected and characterized earlier.
The second component of surveillance and detection is attribution. The ability to attribute an attack to a particular country, group, or individual can help authorities to deter attacks with the promise of severe repercussions to the group or country that perpetrates the attack. The recently created National Bioforensic Analysis Center of the National Biodefense Analysis and Countermeasure Center is responsible for the analysis of the biological agent, and interpretation of data to determine responsibility. This concept has been tried for lesser crimes (three-strike laws) with varied degrees of success.
Response and Recovery
The components of the response and recovery attack are numerous. But this is necessary as the response after an attack is a huge intricate undertaking. This part of the Directive 10 is composed of: response planning, mass casualty care, risk communication, medical countermeasure development, and decontamination.
Response planning is the most important part of the response and recovery pillar. Without a reasonable plan of attack, nothing can be accomplished. Evidence of this idea can be seen in the days and weeks following Hurricane Katrina, when recovery efforts were mishandled by Federal Emergency Management Agency due in large part to ill-preparedness. As a part of this component, the plans are also to be tested regularly at the local, state, and federal level. Mass casualty care, decontamination, and medical countermeasure all go together in preventing loss of life after an attack. In order for all of these to occur, there needs to be funding in areas of research pertaining to countermeasures of biological agents, and also funding in the public health arena such that all medical facilities are adequately prepared to handle such an event. This includes stocking medical facilities with countermeasures and keeping them abreast of terrorism activities via a communication network.
Homeland Security Presidential Directive 21
Released October two-thousand seven, Homeland Security Presidential Directive twenty-one in a much more comprehensive version of the response and recover pillar of Homeland Security Presidential Directive ten. It delves into exactly how we go about preparing for the aftermath of a biological attack. The five major priorities / goals when considering preparedness are: preparedness for all potential catastrophic health events; vertical and horizontal coordination across levels of government, jurisdictions and disciplines; a regional approach to health preparedness; engagement of the private sector, academia, and other nongovernmental entities in preparedness and response efforts; and the important roles of individuals, families, and communities. To accomplish these priorities, Homeland Security Presidential Directive twenty-one outlines several actions that must be implemented to mount a successful response to a biological attack. These are mostly the same as those mentioned in Homeland Security Presidential Directive ten; however, the greatest difference is in the case of Homeland Security Presidential Directive twenty-one, deadlines are established as to when these should be done.
Biosurveillance calls for the establishment of a “national epidemiological surveillance system for human health.” This would entail an electronic network linking federal, state and local public health assets. This system would also have to protect patient privacy, while giving access to those medical professionals most likely to come into contact with the agents. This network would also include keeping health professionals abreast in what to look for in the way of symptoms. The deadline for this goal was one-hundred eighty days, but only required meetings to examine progress.
Countermeasure stockpiling and distribution
Countermeasure stockpiling and distribution calls for the creation of a plan to amass a supply of common countermeasures including antibiotics, anti-virals and others. The countermeasure stockpiling and distribution section of the directive mandates that a template or plan for these efforts would be created within nine months of its release date, but once again, does not explain exactly how anything is to be done, only that it should be within nine months.
Mass Casualty Care
Through a joint effort between the Secretaries of Health and Human Services, Defense, Veteran Affairs, and Homeland Security, experts at the state, federal and private levels are to provide feedback on “high-priority gaps in mass casualty care capabilities.” After this event, there is to be an analysis of the information in order to build a plan for mass casualty care after a biological attack. This plan would call for changes in out public health system specifically geared towards biodefense, and not towards improving our public health system as a whole.
Perhaps the most important component of Homeland Security presidential Directive 21, this section encourages engaging citizens in education and risk awareness in the area of biological weapons. Civic leaders, citizens and families are to be educated such that they are able to lessen some of the risk in their respective areas.
The Project Bioshield Act of 2004 was signed on June 21, 2004 by current President George W. Bush. Project Bioshield deals specifically with the development and the procurement of countermeasures from pharmaceutical companies. The signing of the Project Bioshield Act allowed for the production of seventy-five million doses of anthrax vaccines for stockpiling, production of botulinum antitoxin, and production of a safer smallpox toxin. Project Bioshield is not designed to fix all of our problems, but solve a big problem in the lack of response resources.
Problems with our current system and policies
Our current biological weapons policies consist mainly of Homeland Security Presidential Directives ten and twenty-one and the Project Bioshield Act. Together, they represent the most comprehensive plan we have, but still fall short of providing us with the protection and security from what President Bush describes as a “real threat to our country.” While our current system provides a good foundation for a biological weapons defense policy, it has several major gaps. Our current policies display one major flaw in our biodefense plan: we know what to do, but not how to accomplish it. In the summary of all three aspects of our biodefense policy, there is no detailed plan of how to repair the holes in our system. Also, despite being released in April two-thousand four, many of the objectives seen Homeland Security Presidential Directive ten, are yet incomplete; particularly in the case of the “Response and Recovery” objective. What this translates to is we are not following the plans we have set up to prevent and respond to bioterrorism. In two-thousand one, approximately one-half a billion dollars w as spent on civilian biodefense. Every year since then, the spending has gone up with spending reaching approximately seven and one-half billion dollars. (Schuler 88) We are considerably further than we were in two-thousand one, but still significantly lacking in bio-terrorism security.
There are only a few things we currently lack, but they are very important to our security. Firstly we lack a decent public health system. “The basic needs of bioterrorism preparedness remain the basic tasks of public health- identifying unusual disease events, their cause, and intervening to alleviate the situation” (Avery 284) The federal government is attempting to pump more resources into a flawed system. Without a good public health system, any biodefense plan ultimately falls apart because our public health system is of utmost importance in response efforts.
Another big flaw in our system is the lack of talented people. Having great policies and resources but lacking talented employees to put them into practice is unacceptable. Federal agencies are losing potential employees to the private sector when the demand for defense talent will to continue rise by as much as twenty-five percent through the year two-thousand ten. (Partnership for Public Service 224) Policies cannot be put into action without talented people leading them. It is estimated that nearly half of the federal employees in occupations critical to out biodefense will be eligible to retire within the next five years. (Executive Summary 224).
An additional significant error with our current system is lack of action. While our current policies are not perfect, they do provide a very good base plan. So why are we not where we need to be? The reason may be budget concerns, or biological weapons are less of a priority than they should be, but whatever the reason, creation of policies without putting them into action leaves us at risk. In Homeland Security Presidential Directive 21, it calls for public outreach and education to inform the general public as to the dangers of biological weapons, and how to reach in the case of the attack, but this has not been done. In Homeland Security Presidential Directive 10, a biosurveillance system is proposed to keep our public health facilities informed as to emerging threats and suspicious events in other parts of the country. While the directive was released in two-thousand four, this has not been accomplished.
Proposed Biological Terrorism Prevention and Response Plan
Our current policies and recent actions have provided us with a good foundation to build a solid biological weapons prevention and response plan on. However, in order to mitigate the threat more needs to be done. My plan has the potential to fill in most of the holes in our current policy / system. I propose several changes in out current system and policies. My proposed will emphasize all aspects of security (prevention and response). Our current public health seems to be the most important part of the equation, so this is where my biodefense plan will begin.
In order to mount an efficient response in the aftermath of an attack, we must have a well-organized public health system. This particular part of the plan would call for government-funded upgrades in public health facilities. As stated previously, an analysis of our current public health system shows that “upgrading public health facilities for broad based-surveillance avoids the threat of tunnel vision that is inherent in the bioterrorism-specific approach.” (Avery 285) Upgrades to our public health facilities should include larger stockpiles of antibiotics, anti-virals, and other countermeasures. According to Homeland Security Presidential Directive 21, “few if any cities are presently able to meet the objective of dispensing countermeasures to their entire population within forty-eight hours after the decision to do so.” These stockpiles should be large enough to aid in the response after most any disaster, and located in such places that they could be sent to affected areas within twenty-four hours. Proximity to a major metropolitan area should not be a concern in response efforts. This phase would also require coordination with biotechnology and pharmaceutical companies to coordinate and distribute supplies of counter-measures to several regions in each state. Other responsibilities of our current public health system include vaccination of general public. This would be improved beyond our current status.
The next step in upgrading out public health system is personnel training and education. Biological weapons can utilize some of the most deadly bacteria and viruses in the world. Medical personnel should be trained in the recognition and treatment of the most deadly agents. This would necessitate training provided by the Center for Disease Control and other similarly competent private sector facilities and professionals. While many biological agents present with peculiar symptoms, many present with flu-like symptoms and can be easily confused with other less lethal illnesses. All of this information needs to make its way to not only our medical doctors and nurses, but all those involved in public health.
The last step of my public health plan is the creation of a centralized network available to all public health facilities. This network would be created and maintained by the federal government with the aid of such agencies as the Center for Disease Control and the National Institute of Health. This network / database would track the progression of illnesses and symptoms throughout the country. It would also serve as a link between facilities. In the event of an attack in one part of the country, all facilities can be put on alert almost instantly. This could lead to significantly less deaths during the aftermath of an attack, and aid in the day to day operations of our country’s public health system.
Homeland Security Presidential Directive 10 is a general diagram for both prevention and response. While it outlines both aspects, it does not go into great detail as to how its plans are to be accomplished. The same can be said for Homeland Security Presidential Directive 21. Our major policies do not give a detailed picture of what out initial response plan is. We cannot organize a functional response if we do not possess a nation-wide incident response plan for a biological attack. So Phase II would be the creation of a thorough plan that is able to be utilized in all regions of the country. One standardized plan would alleviate any indecisiveness when deciding what to do for a specific region as well as make training much easier. With one standardized plan there is no question of what the local government is to do, everything is planned and only has to be executed.
This plan would have three major goals: defining authority after an attack, setup a timeline for when response efforts need to be completed, and provide a basis for training first responders and other charged with response. In the aftermath of an attack authority is always a concern. Because agencies often have different ideas on how response should proceed, authority needs to be defined before an attack ever happens. The two options for authority are federal and state with each having their advantages. Federal agencies have near limitless resources when compared to state agencies. They are usually able to procure and implement necessary resources much faster. State agencies have the benefit of local knowledge. Local knowledge of a particular region and its working is an invaluable asset during times of disaster. Federal agencies cannot possibly all aspects of a particular region and thus this responsibility falls to the state government. State governments also the advantage of being able to react more quickly because of their close proximity to the affected area. So the best compromise between the two would be joint authority shared between the state government (governor, mayors, city managers, etc.), and a representative of the federal government designated by the president. Because a plan will already be in place prior to an attack, the state government would have a definitive game plan within the days following an attack. After the government representative arrives, they can work as a cohesive team to plan the best course of action.
Along with defining authority, the national response plan should define timelines as to when certain actions are to be taken. Phase one of this plan would ensure that countermeasures were available in the event of a biological attack. This timeline would establish when these countermeasures are to be given,
Our current president has described biological weapons as a very serious threat. Mitigation of this threat can be achieved, but needs specialized actions from personnel trained in biology as well as investigative techniques. Phase II would call for the creation of an agency dedicated to the threat of bioterrorism. The First step of phase II is finding people with diverse experience (science, investigation, intelligence gather, etc.) to work in this agency. Bioterrorism is a much different threat than most conventional methods of terrorism. To mount a superior defense / offense, it takes a deep understanding of biology, biochemistry, virology, and several other biological sciences. Investigating offenses involving such agents cannot be done without the proper knowledge and practical experience. Most agencies currently tasked with counter-terrorism do not have the requisite personnel with science backgrounds, nor the resources to handle their other responsibilities and the threat from bioterrorism. The need for people with expertise in those areas has been established as is yet unfulfilled. We cannot properly stop a threat if those that are tasked with this responsibility do not know everything there is to know about the threat. The first step would be to obtain the right personnel for the agency. The agency would be made up of doctors, scientists, policy makers, first responders, investigators (law enforcement), security personnel, and any other necessary personnel to mount a comprehensive response.
The next step would be to define the responsibilities of the agency. I propose this agency be accountable for investigation of biological weapons threats, regulation of biological agents, working in tandem with intelligence agencies here and overseas, and working with other countries to insure the regulation of said materials there as well. These responsibilities are no small task. They will require countless hours of intelligence gathering, diplomacy, investigation, and law enforcement. The scope of this agency would be extensive, but still well within reach if done properly. This agency would have to utilize techniques used by the Central Intelligence Agency, the Federal Bureau of Investigations, and many other similar agencies in order to reach such massive goals.
Phase IV would consist of public education / outreach. The group of people most vulnerable to biological attacks is everyday citizens. If we are to protect the public, then they must be educated as to risks, current counter measures, and what to do in the case of an attack. This is where the educational outreach programs would enter. They would have to be non-invasive as in a pamphlet given out to each patient after a doctors visit, or educational videos provided to employers to be shown at employment orientations. Using this idea could save us billions of dollars in expenditures subsequent to an attack by saving much time and effort in organizing and coordinating public actions.
Phase V would consist of training those people responsible for first response. Our first line of defense is not government agencies, but the people who are closest to the attack; this will always be local law enforcement, firefighters, and local public health staff. Current local law enforcement agencies are unprepared and unknowledgeable about probably biological attacks and they of all responders would be well versed in what to expect and how to react after a biological attack. Phase V would mandate training of all probably first responders at least once a year. This training would include simulated attacks in a simulated environment. All those that would be involved in the response efforts would be trained in what to do, and then using that training to a simulated attack. This training would also help the public rest easier knowing that their first responders are prepared for the possibility of a biological attack.
Advantages vs. Disadvantages
Advantages: The greatest strength of the proposed plan is its comprehensiveness. This plan covers all aspects of biological terrorism (prevention and response) as well as addressing the current holes in our system. It provides us with the best possible response, along with directing preventative techniques prior to an attack. Agencies dedicated to specific purposes have a long history of effectiveness as can be seen in the Center for Disease Control and other similar agencies. This plan could not work if the responsibilities were placed upon another agency already tasked with other unrelated obligations. Biological weapons are too great a threat to be relegated to one of the many responsibilities of an agency with many other missions. Also in comparison to outsourcing these responsibilities to the private sector, this proposal represent a method of maintaining security, but also maintaining faith in out government. Most citizens want to know that their government is more than capable of protecting them from major security threats. This proposal has the advantage of allowing all responsibilities to stay in house such that there is no division of responsibilities between government and private. This proposal also allows for improvements in out current countermeasure stockpiles, a public more concerned with their own safety, and a standardized response plan such that
Disadvantages: The greatest thing working against an agency of this type is cost. As stated previously, biodefense funding has gone up significantly every year since two-thousand one. (Schuler 88) A plan of this magnitude would be costly. Also, creating of another agency has the possibility of making an already confusing counter-terrorism more perplexing.
Brazos Valley threat assessment
All the problems that plague the nation in reference to a biological weapons threat are compounded in the Brazos valley Area. The main industry in the region is Texas A&M University, and this is also could be considered a high value target.
A threat assessment can be viewed as having three components: the threat to a target, the target’s vulnerability to the threat, and the consequences should the target be successfully attacked. (Willis 16) In this regard the risk assessment regarding the Brazos Valley is three-parted.
Threat to the target:
According to the CDC, bioterrorism agents are typically divided into three categories: categories A, B, and C (www.cdc.gov). Category A organisms include biological agents with both a high potential for adverse public health impact and that also have a serious potential for large-scale dissemination. Category B agents are moderately easy to disseminate and have low mortality rates. Category C agents are pathogens that might be engineered for mass dissemination because they are easy to produce and have potential for high morbidity or mortality. Based on information gathered from interviews with Assistant Chief Freddy Komar of the Bryan Police Department and Doctor Garry Adams of the Texas A&M University School of Veterinary Medicine, the biggest threat to Texas A&M and the surrounding areas is the dissemination of a Category A organism, more specifically one that can be easily ported to an aerosol method of dispersal. With an effective dispersal in a highly populated and confined area or event like a football game at Kyle Field, the destructive potential is massive.
As an agricultural staple, the Brazos Valley Area
Target’s Vulnerability to Threat:
The government of the Brazos Valley operates in a continuous state of alertness according to an Interview with Mr. Bill May. Using the Texas A&M University Engineering Extension Service (TEEX), the Brazos Valley trains emergency workers from all over the world at the request of their home agency. TEEX uses a large training facility to provide simulated disasters in order to prepare the trainees for any type of disaster. TEEX is different from other agencies in that it provides the most realistic training found in the country, if not the world. However, this only takes care of the aftermath. The front line of defense is the local law enforcement branches. In speaking with the assistant chief of police, I found that while Texas A&M is a veritable hub for disaster training, the first line of defense against bio-terrorist attacks (local law enforcement) are not trained in what to do to prevent local terrorist attacks, identify probably terrorist behavior, and how to properly deal with someone suspected of being a terrorist. This responsibility falls primarily to the closest FBI field office which is located ninety miles away in Houston, Texas. Both the Bryan and College Stations Police Departments depend on an agency ninety miles away, and this is a huge error that both departments need to fix immediately.
Consequences Should the Target be Successfully Attacked:
Texas A&M University is probably the most likely target for a bio-terrorist attack in the Brazos Valley Area. It has a large concentration of people, a lot of open space, and a student body wholly unaware of their surroundings. Texas A&M is a place where many different people from many different parts of the world co-exist in one large area. It is an open campus with a police force that is too small to monitor such a large area with so many places to hide. A bio-terrorist attack would at the very worst kill several thousand people depending on the method of dispersal, organism, and weather. It would also cripple the economy of the state of Texas for years to come.
The most important idea that the interviewees could give me was that the fight against terrorism consists of two major tasks; intense training and education. These concepts are very rarely addressed in both the case of the general public, and more importantly, the local law enforcement agencies. This is what comprises the largest portion of our risk, and if improved, the Brazos Valley’s already low risk factor would plummet even more.
How to Fix the Problem:
The deficiencies are not hard to fix, but as stated by Doctor Adams, politics and money get in the way. What is needed is: A federally regulated and funded system with common procedures for all of the states, but also an individual expert in each state that is able to cater response tactics to each area. The system that is used now is different for each state, and some work much better than others. As described above, the incident commander system that Texas uses is very useful, but as with everything has faults. I feel a uniformed system is probably the best way to minimize the faults. Funding, as always, is necessary to train personnel and to hire experienced persons who are capable of handling large and dense populations. To improve the allocation of homeland security resources and thereby to reduce loss of life and property to terrorism or minimize poor investments in homeland security measures if attacks do not take place, it is essential to have good estimates of the terrorism risk to which different regions or groups are exposed (manuscript). Risk and event models based on population size and density are needed in order to properly educate the community. Specifically those communities that are at greater risks should be identified and educated with community outreach and television programs on local stations. Training of local law enforcement and emergency response agencies would greatly improve not only the response to attacks, but also prevention of attacks by helping them identify possible targets, suspect behavior, and other precursors to an attack.
Avery, George. Bioterrorism, Fear, and Public Health Reform: Matching a Policy Solution to the Wrong Window. “Public Administration Review” Vol. 64, No. 3, May/June 2004 275-288
Schuler, Ari. Billions of Biodefense: Federal Agency Biodefense Funding, FY2001—FY2005 Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Vol 2, No. 2 2004, 86-97
Partnership for Public Service. Homeland Insecurity: Building the Expertise to Defend America from Terrorism. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Vol. 1 No. 3, 2003 223-224.
Willis, Henry; Morral, Andrew; Kelly, Terrence; Medby, Jamison. “Estimating Terrorism Risk.” Rand Corporation. (2005): 1-56.
Komar, Freddie. Personal Interview. 28 June 2007.
May, Bill. Personal Interview. 26 July 2007.
Adams, Garry. Personal Interview. 2 Aug. 2007.
Bioterrorism Agents/Diseases. July 2007. Center for Disease Control. 30 November 2007. <http://www.bt.cdc.gov/agent/agentlist.asp>.
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