Remarks
Senator Bob Graham
Center for Biosecurity-UPMC Conference
The State of Biopreparedness: Lessons from Leaders, Proposals for Progress
September 23, 2010

Tom Inglesby: Let me introduce to you Senator Bob Graham who I don’t think really needs an introduction but I’ll do it anyway. He’s a former two-term governor of Florida where he had staggering popularity at the time, in today’s world of politics, an 83-percent approval rate which I found quite striking when I was looking at his bio this morning. He also served for 18 years as U.S. senator. He’s widely recognized for his leadership in national security, intelligence, environmental preservation and healthcare. And of great importance to this audience, Senator Graham served as chairman of the Commission on the Prevention of Weapons of Mass Destruction, Proliferation and Terrorism, whose mandate was to assess the nation’s progress in WMD prevention and preparedness and provide recommendations for action.

Senator Graham has recently co-founded the WMD Center with the goal of continuing the work from this commission. In addition, this year, the president has appointed Senator Graham as co-chair of the National Commission on the BP Deepwater Horizon Oil Spill and he also serves as commissioner on the Financial Crisis Inquiry Commission. He’s a very busy man. So please, help me welcome Senator Graham and he’ll speak about strengthening the change of resilience.

Bob Graham: Thank you very much, Tom. I can see that Tom is a real taskmaster. He has not left much time for any other activities today, except for those that are on the schedule. Thank you very much for this opportunity to share some thoughts with you and I hope that there’ll be –- I know Tom is going to ask me some questions which I think are drawn from inquiries that you have given to him. I will try to hold my remarks to approximately 20 minutes and use the rest to respond to those questions.

Tom indicated that I am currently serving or have recently served on three commissions: the WMD Commission, Financial Crisis Inquiry, and the Oil Spill. One of the things that has interested me are the similarities in those three areas. Let me mention three of those similarities. First, in each of those three instances, offense overran defense. In the case of the oil spill, in 1990 there was virtually no deepwater defined as over a thousand feet offshore oil drilling done in United States’ waters. We are soon to be at the position that 80 percent of all the offshore oil lifted in the United States is from a depth of greater than a thousand feet. This dramatic increase has been allowed because of an equally dramatic increase in the technology for deepwater drilling. What has not happened is an equal development in issues of safety and response to a negative incident such as we had on April the 20th. The offense to drill deeper outran the defense to avoid negative consequences. The same is true in Financial and in WMD.

A second similarity was the diminution of the threat by responsible voices. Alan Greenspan said that we no longer need to focus on the regulation of our financial industry, that we have developed the economic tools to be able to have market self-regulation of financial institutions, and therefore for a period of about 15 years we systematically dismantled many of the institutions which have been established in the 1930s to avoid a repetition of the Great Depression and the consequence of listening to those voices of diminution of threat or to create the climate that led to this enormous financial collapse. There has recently been a report by a very respected think tank here in Washington saying that the threat of terrorism and particularly the use of weapons of mass destruction is less today than it has been in the past. We strongly disagree with that statement.

A third similarity is that warning signals were systematically dismissed. In the case of the financial crisis, the number of high-risk mortgages doubled between 2004 and 2006 while the average price of homes was rapidly escalating. These were not seen as warning signals that something was amiss but rather as reassurances that we could do almost anything we wanted and would be bailed out by constantly increasing housing prices. We paid a very serious price for that.

What is the one big difference among these three, the financial crisis, the oil spill and weapons of mass destruction? The big difference is that the first two have actually happened. We’ve had a financial crisis. We’ve had an oil spill with enormous environmental damage. What we have not yet had is a weapon of mass destruction. The good news is that while warning signals were missed, voices of diminution of threat were listened to, offense was invested in – not defense – in the first two, we still have a chance to avoid what I think would be the ultimate catastrophe, which would be a weapon of mass destruction.

Our commission in large part was formed when the 9/11 Commission commented that the worst threat to the United States was when the worst weapons fell into the worst hands. Congress responded to that observation by creating our commission to examine what is the current state of our policies to attempt to avoid that worst weapons in worst hands and what recommendations would we make to make it stronger.

Our commission was established in 2008 and made three major findings. The first was that we’re losing ground. That came as a surprise to a lot of Americans because we were aware of the things that we had done such as the increased security at airports but this is not a race in which we are running and our opposition is standing on the sidelines. They are running, too. And it was our conclusion that they’re running faster than we are and so while we may be running a hundred-yard dash in 10 seconds, they’re running it in 9.5 seconds and therefore are gaining ground.

Second, that it is more likely than not that there will be a weapon of mass destruction used some place on earth by a terrorist group before the end of the year 2013. That was roughly five years from the date that our report was issued. We have now used two of those five years.
Finally, that it was more likely that the form of that weapon would be a biological rather than a nuclear.

Our commission is now out of business but we started in January of this year with a practice that we intend to continue through our now nonprofit WMD Center and that is to issue an annual report card of how well is the country doing in its efforts to avoid weapons of mass destruction falling into the hands of the worst people.

In our first report card which was, as I said, issued in January, we gave three Fs. One of those “Fs” was in response to the recommendation that we had made a year earlier to enhance the nation’s capabilities for rapid response to prevent biological attacks from inflicting mass casualties. And we found, to read the first sentence, as we gave an F that “the lack of U.S. capability to rapidly recognize, respond and recover from a biological attack is the most significant failure identified in this report card.”

I’d like to talk about what we think is going to be necessary in order to move up from an “F” grade in terms of capability, and the good news as Tom has already said is that considerable progress has in fact been made. We believe and I think we’re going to have a chart that’s going to be — that the key to that effective response is a chain; a chain composed of these links. And like any chain, the strength of the totality is a function of the strength of each link and so it is critical that we have adequate capability at each point along this chain in order to be able to give the American people the assurance that they deserve that we are prepared to respond.

We believe that having this chain is the most effective deterrent available to the use of a biological weapon against the people of America; unlike nuclear for which there is no real deterrent, the strategy for nuclear during the Cold War was one of massive destruction that we would deter the other side because they knew what we were prepared and capable of responding. That today, the response in nuclear is an identification and lockdown strategy to know where they are and that they are under secure conditions.

It is possible we think to have a deterrence strategy for biological. We talked to over 250 experts in the United States and worldwide about the attitude of terrorists in the use of these weapons. Included in that list was our own intelligence community. The consensus judgment is that if a terrorist group were to come into possession of a biological weapon, they would ask themselves the question: Where can we use this weapon to inflict the greatest degree of damage and terror? They would be looking for the softest, most vulnerable target; thus, if you are a hardened target, you are less likely to be the target selected. Also, if you are the hardened target, you have the opportunity to reduce the consequences of an attack should it be launched to below weapon of mass destruction level. We think these are the links of the chain necessary to accomplish both deterrence and minimization of effect.

A brief comment as to the current state of these links: The first is detection and diagnosis, knowing that you’re under attack. You got a community with 30 hospitals, three or four people arrive at each one of them, hypothetically, do the totality of the medical community realize that this isn’t just three or four people, it’s three or four people times 30, that there’s something that deserves rapid attention and do we have the capacity to diagnose what that something is so that we’re able to communicate effectively what is occurring.

We’re encouraged by the Generation 3 BioWatch. We think that if this functions as it is presented, it will provide an automated real-time detection of more pathogens and also provide the opportunity for this detection to work in an indoor setting. The President’s initiative on medical countermeasures’ modernization will also give us some increased capability of the diagnostic of the nature of the attack.

The second link in the chain is actionable information, to be able to communicate to the people who will be responsible for responding that we are under attack and the nature of the attack. There have not been major initiatives in 2010 on this front, but we believe that the CDC’s communication to the general public during the H1N1 crisis struck a fine balance between being candid but not alarmist. We think this issue is particularly important now because we are going to be providing information to an increasingly skeptical American public. One of the things that the oil spill has indicated is that the public, rather than being in a position of accepting information from the government as to the state of affairs, has reached a mindset of being skeptical to hostile to government information, making this challenge of providing actionable information more difficult.

The third is the medical countermeasures development and production. This may be the area in which we’ve made the greatest progress in the last year. The president’s initiative which was recently signed will give us some significant additional resources and focus on the medical countermeasures. We take a little bit of credit for this. Our commission developed a film, a short video which got considerable amount of television coverage about the fact that here, today, in 2010, we’re still producing vaccines in many areas basically as we did a half century ago using chicken eggs and as we found out in H1N1 that’s a very slow process to be able to respond to a rapidly developing epidemic. The President, when he signed this new initiative said, “No more chicken eggs.” I hope that we will soon be there. The Chick-fil-A people will be happy about that. (laughter)

Next is the capability to dispense those countermeasures. Here again, there are now 72 cities covered by the City Readiness Initiative funded by the CDC to be able to dispense appropriate countermeasures. That’s the good news. The bad news is that 55 percent of the population of the United States is not covered by this initiative, so we still have a lot of our folks who will need to have a guaranteed and effective and tested means of distribution. The executive order to use the postal service in smaller communities is a step in this direction.

We also think this is an area for citizen involvement. One thing that other countries, and particularly the United Kingdom and Israel have done is actively involve citizens in a variety of areas related to weapons of mass destruction. We have not seen that as the asset that we believe it is, and I think this is an area in which active citizen involvement could be an extremely important national resource.

The next link is treating the sick and protecting the well, the ability to be able to triage the population. The Department of Homeland Security has a tabletop exercise on the dispersal of various pathogens in New York City on a hot day in the summer, and their projection was that in less than eight hours over a half million people could be impacted and that if those half million people fail to get immediate medical response, a high percentage of them will become fatalities. So how do we have the ability to respond, to identify those who are capable of receiving assistance? To isolate those who have not yet been impacted will be another major challenge.

And finally, environmental cleanup, we learned in October of 2001 after those seven letters were sent to mainly journalists and politicians how difficult and expensive the cleanup process will be. It cost hundreds of millions of dollars to clean up the buildings that were affected, mainly here in this city, in New York, and in Lantana, Florida. We have not made the effort to understand and prepare for environmental cleanup that’s required in fact. And I hope that there are no either Marines here or musicians, at least Marines or musicians who harbor hostile intent and capability because in 2011, the United States Marine Corps will spend twice as much on its marching bands as the EPA will spend on research for cleaning up an American city after a WMD attack. Am I vulnerable? (laughter)

So I am pleased to report that there has been progress on almost each of the links in this chain and I would hope that when we get to January of 2011 and issue our next report card that we will be able to credibly give a better than “F” grade.

There are a couple other issues that I’d like to touch on. One is the title of our commission’s report was World at Risk, and that was a thoughtful and long discussed title. One of the implications of this is that this is not an issue that the United States can singularly give our people assurance that we can achieve the goal of avoiding weapons of mass destruction falling into the hands of terrorists. This has to be a global effort. One of the principal forums for that global effort occurs every five years when the countries that are signatories to the Biological Weapons Convention meet to discuss what’s happened in the last five years and what plans should be made for the future. That next meeting will occur in 2011. We think it’s critical that the United States have a robust agenda, analyzing what the world can do together to reduce our collective vulnerability to a biological weapon of mass destruction.

Second, there has been a long history of conflicts between policies that would reduce our capability to avoid proliferation of weapons of mass destruction and policies that would advance political and economic interests. In almost every one of those instances, proliferation lost. We fought in the past couple of years several times on the issue of raiding the BioShield Strategic Reserve Fund. There’s a problem. There’s a need for a couple of billion dollars to solve it. Time after time, both the executive branch through the Office of Management and Budget and the congressional branch through its appropriators have looked at that Bioshield program and said they’ve got $3 or $4 billion unspent, we’ll go take it from there. We think that is absolutely the wrong policy which would send the wrong message to the people that we’re trying to encourage to make an investment in the research, development and production of the countermeasures that will be critical in a time of emergency.

Now, fortunately, to date, none of those efforts to raid Bioshield have been successful, but I don’t think we’ve seen the last attack. We need to have someone in the national government who can stand up to the budget director and to the congressman who would advocate such a program and explain in the strongest terms what the significance of this would be to our nation’s security.

We have recommended that as an institutional matter, not as a personal occupant matter, that this responsibility be placed with the Vice President of the United States. We think that office has the kind of political gravitas to stand up to the Secretary of State or the Secretary of the Treasury or the Chairman of the Senate Appropriations Committee when we have – and we will have – more of these showdowns between proliferation, politics and economics.

I’m going to conclude by having a little test. On May 25th of 2011, approximately seven or eight months from now, we’re going to celebrate a significant 50th anniversary. What is that anniversary that we’ll be celebrating? I’m very disappointed. I’m going to have to make a report to the leadership at the Sloan Foundation that they have convened this meeting and also to the University of Pittsburgh Medical Center that they have been associated with this and no one can answer that question.

The answer is it will be the 50th anniversary of President Kennedy giving a speech which contained this commitment, “I believe that this nation should commit itself to achieving the goal before this decade is out of landing a man on the moon and returning him safely to the earth.” That commitment was made on May 25th, 1961. I believe that we should make a similar commitment today and that commitment is to remove bioterrorism from the category of a weapon of mass destruction because we can tell the American people that we have done the things that would give them the protection of a deterrence or the protection of a reduction of consequence that would eliminate bioterrorism from becoming a weapon of mass destruction.

In that same speech to a joint session of Congress, President Kennedy said, “I believe we possess all the resources and talents necessary, but the facts of the matter are that we have never made the national decisions or marshaled the national resources required for such leadership. We have never specified long-range goals on an urgent time schedule or managed our resources and our time so as to ensure their fulfillment.”

If we are to avoid weapon of mass destruction joining financial crisis and oil spill as a foreseeable threat, which has now matured into a real disaster, we must follow those standards of President Kennedy and say that we will marshal our resources and we will coordinate our national decisions so that we will remove bioterrorism from the category of weapon of mass destruction. Thank you.

Tom Inglesby: Thank you. Do you have time for a few questions?

Bob Graham: Yes, sure.

Tom Inglesby: Thank you so much for that talk, Senator Graham. It was excellent. One thing that you said recently at a congressional hearing, you talked about your concern about the possibility in the future of a nation providing a terrorist group with some form of weapon of mass destruction. Is there anything more that you can say about this in the open setting?

Bob Graham: Well, I can say that this is a period that justifies great concern and alertness. There is a nuclear arms race going on today in South Asia among China, India and Pakistan. Pakistan, for instance, entered the last decade with an estimated 20 nuclear devices; today, it’s estimated that they are having the range of 60 nuclear devices; a very unstable country with a history of proliferation and with a continuing simmering animosity to its neighbor, India.

I recently have spent a considerable amount of time in the Middle East and I’m concerned about what I saw, heard as to the buildup of biological weapons in that region. In both Central Asia and in the Middle East, there are non-state actors who are of increasing competency to be the actual users of these weapons. As long as a nation-state, which uses a weapon of mass destruction faces the prospect of catastrophic response to the use of that weapon, the temptation, in my judgment, is going to be for them to use an intermediary as the means of dispersal. As these intermediaries, including some that we know well like Hezbollah and Al Qaeda and some that we’re just learning about such as the Al Qaeda on the Arabian Peninsula become more capable of being that intermediary, I think the threat escalates.

Tom Inglesby: Many people in this room have as part of their responsibility communicating with Congress or staff about particular matters. Can you say something about how you would suggest that we communicate effectively with the Hill?

Bob Graham: I personally think the best way to communicate to the Hill is a) personal, and b) at the place where the message can be most effectively communicated – what do those principles mean for you? I would suggest identifying those members of Congress who are likely to have the most to do with this issue, which will be particularly people who are on the committees that have either authorizing regulatory or appropriation responsibility for these matters. Assign one of your people to that person so that there is a person-to-person relationship and then ask yourself, where is the best place that I can take this member of Congress in order to give him or her not only an intellectual but also an emotional experience with what is happening? That may well be a laboratory at a research center or at a university. It may be a hospital which is preparing for some of the triage activities that I discussed.

You know best what in your community would be the most effective venue to present the information. I can tell you the worst place to do it is in their office in the Capitol where if you have been through this process, you’re likely to have your meeting cut short because a vote is called or an urgent phone call arise while you happen to be there. At the very best you’re talking to a distracted and frequently harried member of Congress in a setting that is not the most conducive to transferring important and technical and in some cases emotionally impacting information.

Tom Inglesby: Well, great. Well, thank you so much Senator Graham. We’re very mindful of your time. We know you have a flight to Florida in just a bit, so we thank you again for your time and your [clapping].

Bob Graham: Thank you. I’d like first, again, to thank you for the opportunity to share these thoughts with you but I also want to thank you for what you are doing everyday to move this needle of our nation’s preparedness closer to where we as Americans require and the American people may not know of the good work that you are doing but the fact that they are not directly knowledgeable does not indicate a lack of appreciation for the contribution that you are making to their and our national security. Thank you very much.

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