Bioterrorism at the Salad Bar

Book excerpt

By: Bill Frist

Date: 2002.

Source: Bill Frist. When Every Moment Counts: What You Need to Know about Bioterrorism, from the Senate's Only Doctor. Lanham, Md.: Rowman & Littlefield, 2002.

About the Author: Senator Bill Frist is a Republican from Tennessee who became Senate Majority Leader in 2002. He serves on the Finance and Rules committees in addition to the Health, Education, Labor and Pensions (HELP) committee. Prior to entering politics, he was a cardiothoracic (heart and lung) surgeon.

INTRODUCTION

Senator Bill Frist first used his medical training to explain the threat of bioterrorism after the anthrax attacks in the final months of 2001. His book When Every Moment Counts is part of a personal campaign that included a series of public speeches to raise awareness of specific bioterrorist threats, especially anthrax and smallpox. Political cynics have observed that Frist, in attempting to identify himself with the cause of fighting bioterrorism, might also have been trying to raise his public profile. Be that as it may, the threat of bioterrorism against the nation's food supply certainly merits public attention, particularly because it is not just hypothetical but, as Frist points out in the following excerpt, a reality that the country has already confronted. The 1984 salmonella attack on restaurants near The Dalles, Oregon, had largely faded from popular memory by 2002 when Frist wrote his book, so it seemed clear that the United States needed a refresher course in the lessons learned from that attack.

Frist emphasizes that bioterrorism uses fear as a weapon, and to counter this, he makes a considerable amount of information accessible, even to nonspecialist readers, in a coherent, knowledgeable way. According to him, this could reduce the nation's vulnerability to future attacks by building popular support for maintaining the public health infrastructure, which is particularly valuable in motivating people to support enhanced public health preparedness across the board. He makes the case that increased spending on public health and scientific research is an important component in the fight against bioterrorism because it can provide some confidence that an outbreak can be controlled.

PRIMARY SOURCE

BIOTERRORISM AT THE SALAD BAR: THE THREAT TO OUR FOOD AND WATER SUPPLY

For the United States, a bioterrorist attack on our food supply is not merely hypothetical. It has already happened here.

In September 1984 an outbreak of food poisoning caused by the bacterium Salmonella typhimurium swept through the community of The Dalles, the quiet county seat of Wasco County, Oregon. A total of 751 people became ill, though none died. It was the largest outbreak of foodborne disease in the United States that year.

Public health and law enforcement officials were baffled. Their investigation found links to at least ten of the town's thirty-eight restaurants. Most of the restaurants where people had eaten before coming down with food poisoning had salad bars, but there was no common supplier. There didn't appear to be any pattern that connected all the cases—until the criminal investigation turned up the truth a year later.

Followers of Indian guru Bhogwan Shree Raineesh had built a huge international headquarters and commune in Wasco County and were locked in a zoning dispute with the local government. So commune members came up with a plan: If they could make enough voters sick on election day, they could influence the outcome in their favor.

In September, two months before the election, they had a test run of their plan. They prepared cultures of Salmonella typhimurium bacteria in their secret lab on the commune, and then commune members poured the bacteria loaded items in salad bars and, in some restaurants, into coffee creamers.

Two commune members eventually pleaded guilty and went to prison for the attack.

The Oregon attack taught us several hard lessons. It exposed our vulnerability to the deliberate contamination of food in public places. The salmonella culture used in the attack is easily obtained from raw foods bought in a grocery store, and it can be produced in large quantities with simple equipment and little expertise. Residents of The Dalles were fortunate that the cult didn't use a more lethal agent, such as botulinum toxin or even anthrax or tularemia.

The attack also underscored the need for health care providers and laboratories to cooperate and coordinate with local and state public health departments so that any future outbreaks can be detected more quickly.

And The Dalles case changed the way we look at public health emergencies. At the time, back in 1984, it never occurred to investigators that a group would deliberately contaminate food in several restaurants in an effort to advance their political or religious agenda.

Now we know that if a mysterious outbreak of infectious disease occurs that fits no known pattern and doesn't seem to have any common link, the possibility of intentional contamination must be considered, and law enforcement should be called in immediately to investigate.

SIGNIFICANCE

Twenty-one years after the first bioterrorism attack on salad bars in Oregon and four years after the 2001 anthrax attacks, it is both fortunate and remarkable that there has been no large-scale biological attack.

News stories published around the time of the anthrax attacks recalled the impact of the salad bar contamination at The Dalles, and noted that the town had not recovered economically from the bioterrorism incident. This publicity opened old wounds in the struggling Oregon community, which had recently seen local aluminum factories close and a downturn in the cherry market, both of which cost hundreds of local jobs. The psychological and economic impact of the attack was much more serious than its health impact, since everyone that was infected recovered quickly.

Because the salmonella attacks occurred in a rural area and were perpetrated by a small fanatical cult, the incident quickly faded from national attention. Nevertheless the incident may provide a glimpse of how the United States might respond to a more wide-spread and concerted bioterrorism attack. On one hand, people in The Dalles became afraid to go out in public, becoming prisoners in their own homes. On the other hand, however, they voted heavily in ensuing local elections to prevent cult members, who had already taken over the city council of neighboring Antelope, from taking over the whole county politically.

The confrontation was a classic case of bullying in which the aggressor crossed a line far enough to provoke determined resistance from ordinary citizens as well as both county and federal officials. After the mystery had been solved and the cult dispersed under pressure from law enforcement, the citizens of Antelope sent a bronze statue of an antelope to The Dalles, which now stands in front of the county courthouse. The statue displays a plaque that reads, "In order for evil to prevail, good men should do nothing."

The salmonella poisoning had actually been the culmination of growing hostilities between the local population and cult members, who had incorporated themselves into a municipality and created a large and threatening police force. Perhaps the most chilling aspect of the incident was the shock that local people felt from the disruption of the safety and comfort in which they lived, and when they realized that they faced aggression from opponents determined to impose their will by fear and force.

Frist believes America's cocoon of prosperity and security may require additional taxpayer support for the public health infrastructure. As often happens when providing for the common good, unfortunately, it is difficult to marshal financial support when everyday threats such as epidemics and safety hazards are perceived to threaten "other" people. Bioterrorism, however, can be directed at anyone, and such a threat could generate enough support for extraordinary expenditures and open-ended investment in the public health system.

The salmonella and anthrax attacks in the U.S. both had psychological effects that far outweighed the physical. This has led some to argue that the magnitude of bioterrorism has been exaggerated and that it does not justify the time and expense of medication stockpiling and government preparedness. Actually, biodefense, unlike other aspects of public health, devotes considerable resources for a potential future catastrophe instead of existing health threats. It is similar to proposed programs to stockpile medicines to combat bird flu, should that virus mutate and create a human pandemic. Small numbers of people have been victimized by both threats already; they remain, however, potential catastrophes.

When might political promotion of bioterrorism preparedness cross the line from a rational response to a real threat to a strategy intended to cow people into acceptance of a political agenda or raise a politician's profile as a bioterrorism expert? While all of these motivations may operate simultaneously, the ultimate result should be to marhsal people's desire for self-preservation to solve a problem that many would just as soon not think about. Just as the U.S. space program and military research benefited the civilian economy, allocating resources to biodefense has already buttressed public health preparedness, and might produce additional benefits in drug discovery as well. As a result, the nation should be better able to withstand a real large-scale bioterrorism attack.

FURTHER RESOURCES

Books

Frist, Bill. When Every Moment Counts: What You Need to Know about Bioterrorism from the Senate's Only Doctor. Lanham, Md.: Rowman & Littlefield, 2002.

Miller, Judith. Stephen Engelberg, and William J. Broad. Germs: Biological Weapons and America's Secret War. New York: Simon and Schuster, 2001.

Periodicals

Elmer-Dewitt, Philip. "America on Guard: America's First Bioterrorism Attack." Time, October 8, 2001.

Web sites

South Coast Today, "Oregon Town has Never Gotten over Its 1984 Bioterrorism Scare." 〈http://www.s-t.com/daily/10-01/10-20-01/a02wn011.htm〉 (accessed December 21, 2005).

When Every Moment Counts. 〈http://www.wheneverymomentcounts.com〉 (accessed December 21, 2005).