WASHINGTON — Suddenly, the threat of bioterrorism on American soil doesn't seem so far-fetched anymore.
A series of anthrax hoaxes nearly shut down Canada's immigration department this week. At the same time, a blue-ribbon U.S. commission reported that an attack using nuclear, chemical or biological agents was likely in the United States in the next 25 years. In Cambridge, Mass., a biopharmaceutical company races toward developing a new smallpox vaccine — in case a terrorist releases the deadly virus.
And inside the elegant wood-paneled Lecture Hall of the National Academy of Sciences in Washington, a group of distinguished scientists and doctors clinically discussed Friday the possible outcomes of a smallpox attack. The toll, they grimly calculated, could be millions of dead.
The threat has grown along with the exponential rise in hoaxes, hundreds of them now — including one in western Massachusetts last month — as well as the knowledge that several groups or nations have been plotting to use biological, chemical or nuclear warfare. Perhaps the most chilling known example was the revelation a few years ago of the Soviet Union's stockpiling of anthrax during the Cold War, a cache still believed in existence.
"Unfortunately, a chemical or a biological terrorist attack is something we are convinced we are more likely to see in the next 10 to 20 years than not," said former U.S. Senator Warren B. Rudman of New Hampshire, co-chair of the Commission on National Security, which called for a Cabinet-level agency to coordinate the defense against an act of terror.
The response to the elevated threat has changed greatly in the last two years, broadening out from the domain of the military and law enforcement to include teams of emergency-room doctors and nurses, laboratory specialists and infectious disease experts.
And yet, say bioterrorism experts, areas of the country remain extraordinarily unprotected if a terrorist strikes.
"The main focus of our concern is the local health establishment," said Joshua Lederberg, professor emeritus at the Rockefeller University in New York and chair of Friday's Forum on Emerging Infections at the Institute of Medicine. "The question we are facing is what levels of insanity do we have to prepare for?"
In an outbreak of smallpox, the first infectious disease afflicting humans ever eradicated, the preparation is immense. Populations are no longer vaccinated, making them frighteningly exposed to a virus that killed 300 million people in the last century.
"To use smallpox is to attack the world," said Lederberg. "It may start in New York, go to Italy and move up to Baghdad — all in 48 hours."
The United States stockpiles only about 15.4 million doses of the smallpox vaccine, enough for 7 percent of the population, a fact that spurred the government five months ago to award a $343 million contract to Acambis Inc. of Cambridge, Mass., and Cambridge, England, to produce 40 million doses of the vaccine.
"We are having to make a completely new vaccine," Thomas P. Monath, Acambis's vice president of research and medical affairs, said Friday. "Therein lies the rub: You don't make this overnight." Monath said the company hopes to win licensing of the new vaccine by 2004 and produce the doses by 2005.
On another front in the preparations against an attack, Massachusetts health officials recently upgraded communications systems that connect emergency-room doctors, laboratory experts, the FBI, fire departments and local law enforcement in the event of a terrorist attack. During the last year, the state received $1.2 million in federal funds to improve lab facilities, information systems and surveillance for an attack.
"We had a hoax situation a couple of weeks ago in western Massachusetts that happened in the evening, on a weekend, and we immediately got a team from the state lab there," said Ralph Timperi, director of the Massachusetts State Laboratory Institute and a member of the U.S. Centers for Disease Control and Prevention steering committee on bioterrorism.
"The hoax involved an envelope containing powder. There was a note claiming it contained anthrax, but it turned out to be baking soda," Timperi said, declining to give further details of the incident, which is still under investigation. "What was important was that we had a team on the road immediately. The FBI met us at the site. This is the kind of thing that is beginning to happen routinely."
Not all states, though, can mobilize so quickly.
Donald A. Henderson, director of the Center for Civilian Biodefense Studies at Johns Hopkins University, said researchers last year checked each state to learn whether they had a health department hotline to coordinate the response to an attack.
"In 10 to 15 states, people said, 'A hotline? What's that?' They had nothing. Another 10 or so said they had them but there were problems," Henderson said. "One state had a 24/7 hotline, but we had to leave a message and didn't get a response for three days."
Henderson and other public health experts said while many states have made marked improvements in the last year, much more needs to be done.
"We have not in the medical and health profession come to grips with the reality that this could happen, and if it did, that we need to move quickly," Henderson said.
In the meantime, all the work on getting ready for bioterrorism has had some other positive benefits.
Timperi, the Massachusetts state lab director, said the preparation helped in the reaction to the outbreak of the West Nile virus last year.
"We're developing early warning systems for disease outbreaks," he said. "We used some of systems we needed to build for bioterrorism for a high-containment lab. We had a safe environment in the lab to investigate the West Nile virus all because we had been gearing up for bioterrorism."