Veterans for Common Sense

December 27, 2002

When a nemesis such as Osama bin Laden speaks, one would expect his words to be of great interest. But this is apparently not the case. The latest audiotape of a voice purporting to be bin Laden’s prompted discussion principally of three issues: (1) Was it really him? (2) Why wasn’t it a videotape? (3) Where is he?

There was virtually no analysis of what the voice said. Could it be that bin Laden’s words contradict the official version of why al-Qaeda struck the World Trade Center and the Pentagon? Those attacks were monstrous crimes against innocent people.

Thus the search for an explanation is not an exercise in exoneration — there can be no exoneration.

It’s an exercise in comprehension so that such crimes can be averted in the future. It is in that spirit that bin Laden’s words should be scrutinized.

The official version of 9/11 is that Muslim radicals attacked America because they hate our way of life: freedom, democracy, secular affluence. President Bush has said this repeatedly. There were many indications at the time that this was not accurate.

Bin Laden’s own recruiting tapes, which were aired post-9/11, never showed him denouncing the American way of life. Rather, they routinely stuck to three grievances: the embargo against Iraq, the stationing of American troops on Islamic holy ground in Saudi Arabia, and the ill treatment of Palestinians by America’s ally Israel.

Despite this, the U.S. official position was that to acknowledge that bin Laden was motivated by anything other than blind hatred was to make excuses for him. That was a preposterous, even demagogic response to the efforts to understand Muslim anti-Americanism.

But it served a purpose: it averted a candid evaluation of U.S. policy in the Middle East. That response continues to this day. It can be seen in the refusal to discuss or even acknowledge what bin Laden said in his latest tape (and the one before that). As President Bush reacted, “Whoever put this tape out has put the world on notice yet again that we’re at war.”

But that is precisely what it does not do.

It is worthwhile to note that in the new tape, bin Laden, again, nowhere condemns the American people for their way of life. Rather, “the unjust government of the United States” is singled out for criticism. The governments of U.S. allies are similarly condemned.

Moreover, as bin Laden sees it, his past acts and threats of future acts are not unprovoked. They are responses to what he regards as acts of violence committed by the U.S. and Israeli governments: “[what] Bush…did by murdering our children in Iraq and what Israel, the ally of America, did in bombing houses of the elderly, women, and children in Palestine, using American planes.”

He goes on: “Why should fear, killing, destruction, displacement, orphaning, and widowing continue to be our lot, while security, stability and happiness be your lot? This is unfair. It is time that we get even. You will be killed just as you kill, and will be bombed just as you bomb… The road to safety starts with stopping aggression.”

His message is clear: if the U.S. government and Israeli governments stop their use of violence, so would his devotees. Maybe he is not to be believed. But why isn’t this message worthy of discussion?

Is U.S. policy so sacrosanct that it may not be questioned? Maybe it’s time we looked at it the way the people on the receiving end see it.

Americans do not like to hear it, but their government has behaved like an imperial power in the Middle East for more than 50 years. This has caused untold misery to innocent people, generated violent resentment, and spawned terrorism, the historical price of empire. In more ways than one, bin Laden is another in a series of Frankenstein’s monsters created by U.S. foreign-policy makers.

No, the American people did not deserve what happened on 9/11. But they neither did they deserve being put in harm’s way by their government’s policies. It’s time we returned to the foreign policy of our Founders: minding our own business.

Sheldon Richman is senior fellow at The Future of Freedom Foundation in Fairfax, Va., and editor of Ideas on Liberty magazine and author of “‘Ancient History’: U.S. Conduct in the Middle East since World War II and the Folly of Intervention.”

fff@fff.org

January 2, 2003

Tokyo, Japan — The government plans to draft a new law to pave the way for Tokyo to provide noncombatant support to the U.S. military in case of a U.S. attack on Iraq, a national newspaper said Wednesday.

The Mainichi Shimbun [newspaper] said the Japanese support is expected to focus on fuel supplies to U.S. Navy vessels and cargo shipment as in the case with Tokyo’s support to the U.S. military in the U.S.-led war against terrorism in Afghanistan.

“There is a need to demonstrate the Japan-U.S. alliance is strong,” a government official was quoted as saying.

The government intends to submit a related bill to the ordinary Diet session slated to be convened Jan 20, but there is a cautious view within the government and ruling parties about putting priority on Diet debate on the new law over that on the budget for fiscal 2003, the newspaper said.

Japan currently provides the U.S. military involved in the war against terrorism with logistic support under a law on support for antiterrorism activities, but a possible U.S. war against Iraq would not be covered under the law.

The Mainichi said the government is also considering mapping out a law to provide logistic support to U.S.-led forces to be stationed in Iraq after the war and supply assistance to refugees in neighboring countries.

Steve Robinson’s phone rings all the time these days. Usually, the callers are soldiers who want to know what they should do to prepare for chemical or biological attacks if there is a war with Iraq.

He tells them to pay close attention to their surroundings, to note any medications they’re given and to keep careful medical records.

Robinson is a veteran of the Gulf War who spent 20 years in the Army. He retired last year but is now an advocate for Gulf War vets as the executive director of the National Gulf War Resource Center in Maryland.

Robinson gives his advice from experience. He has seen and heard many stories about Gulf War illness, the unexplained health problems that struck hundreds of soldiers following their return from Desert Storm in 1991. But the symptoms of the illnesses of Gulf War veterans are so varied that some have been unable to demonstrate that the disorder is connected to their military service.

With another possible war with Iraq looming, Robinson fears that mistakes will be repeated from the first war.

“The guys who fight the next gulf war, they’re going to be just as unprepared as we were,” Robinson said.

Department of Defense officials could not be reached for comment.

Robinson said the military’s equipment for fending off chemical agents wasn’t effective in the Gulf War and will not work in another war.

“Nobody’s talking about it because it’s going to affect morale,” he said. “I know I would have a morale problem if I were in the military and my equipment didn’t work. I don’t know what to tell guys now that don’t have the proper equipment.”

Robinson’s opinion is echoed by other other veterans advocates and people have fallen ill since their services in the Gulf War.

“I’m not sure there’s any good protection against biological or chemical warfare,” said retired Maj. Gloria Nickerson, a Gulf War veteran who lives in Hoke County. “It’s pretty hard to test. You wouldn’t want to be the subject.”

Nickerson, who is 50, said she is one of the victims of Gulf War illness. She spent six weeks in Saudi Arabia in 1991. She was healthy then. But since her return she has been diagnosed with diabetes and Hepatitis C. The illnesses have kept her out of work, but she receives no compensation from the Department of Defense.

“It’s very depressing,” she said. “I don’t feel enthusiasm for pursuing the disability claims. It’s kind of hard to expect sick people to fight for themselves.”

Medical mystery

Nearly 700,000 men and women were sent to the Middle East as a part of Operation Desert Storm.

Many were afflicted with various maladies after they returned home. Doctors are still at a loss to explain the sicknesses, which range from rashes and headaches to chronic fatigue and immune system problems.

Sick soldiers, their families and veterans advocates have suspected that exposure to chemical weapons, oil field fires or depleted uranium caused the mysterious illnesses. Medications and vaccines that were supposed to protect them could also be the cause, they said.

Many are people like retired Air Force Staff Sgt. Richard Wadzinski Jr.

Wadzinski’s military records show he was vaccinated before his deployment against a host of diseases and infectious agents, including anthrax and botulism. He also took many pills the military provided as protection against nerve gas.

By the time he got home, however, Wadzinski had recurring rashes on his arms, chest and legs. Later, the headaches began, followed by chronic fatigue, and joint and muscle aches.

Some doctors told him his problems were in his head, he said.

He took early retirement in 1994 after 18 years of service. He took a job as an emergency services worker. Then, in December 1997, he learned his liver was failing. A transplant saved his life, but he says he lives in constant pain.

He has advice for the next wave of troops that could be headed to Iraq: “Have a good gas mask that’s in good working order, and know how to use it. And every time something happens, put it on. There is no such thing as a false alarm.”

The federal government has spent $213 million on 224 projects investigating the cause of the illnesses. In October, the Department of Veterans Affairs announced it will spend $20 million for research in fiscal 2004.

Compensation fight

For people like Sarah Overdorff, it’s too late. Overdorff’s son, John O’Brien, died in 1998 at the age of 31. O’Brien was in the Navy reserves and spent six months in the Middle East in 1990 and 1991. But he began having health problems almost as soon as he returned home to Mars Hill. His hands and legs would go numb, she said. He also had psychological and memory problems. He died of a bacterial infection, something Overdorff said showed that her son’s immune system was compromised.

Overdorff said she and O’Brien’s widow are still fighting for compensation. Another war with Iraq should be a cause for concern, Overdorff said.

“We all agreed that if they have to do it, OK,” she said. “But as far as we’re concerned, they’re nowhere near ready because the gear is not ready and the training isn’t ready. If they had done their homework and had followed up on it, they would be ready.”

According to the Department of Veterans Affairs, 11,783 claims for undiagnosed illnesses have been filed by Gulf War veterans since the war, but only 3,129 claims – about 26 percent – have been approved.

Soldiers are taxed with the job of proving their illnesses are connected to their service in the Middle East. Robinson advises soldiers who might go off to another war to keep detailed medical records and to pay attention to their surroundings at all times, something he said isn’t easy.

“The problem is they put the burden of the proof on the soldiers,” he said. “A soldier can’t be a journalist and an epidemiologist while he’s fighting a war and shooting bullets downrange.”

David Autry, a spokesman for Disabled Veterans of America, said the Department of Defense needs to recognize the sick veterans. He said another wave of sickness from another war could tax a military health-care system that’s already strained.

“Historically, it seems to be a recurring problem that troops are exposed to something and then don’t find out about it until years later,” he said. “We hope things are different now. We hope the Department of Defense has learned that lesson.”

Staff writer Todd Leskanic can be reached at leskanict@fayettevillenc.com or 486-3572

And should those soldiers suffer the huge number of disabilities that Gulf War I vets do, they can expect their government, in the words of U.S. Rep. Christopher Shey (R-N.C.), to have “a tin ear, a cold heart and a closed mind.”

For 11 years, more than 100,000 Gulf War vets have complained of chronic fatigue, headaches, joint pains, memory loss, cancer and birth defects. For 11 years the Department of Defense (DOD) has known the cause but systematically denied that the disabilities were anything but psychosomatic.

But, layer by layer, the lies have come undone. A recent study in a British medical journal demonstrated that British Gulf vets were three times as likely to be disabled as all other vets.

The study is hardly a bolt from the blue. The Centers for Disease Control concluded in 1995 that Gulf War vets suffered illnesses at 12 times the rate as non-Gulf War vets.

The stonewalling started when young soldiers were inoculated with an experimental anthrax vaccine that included squalene, an additive with dangerous side effects.

The Defense Department denies the vaccine included squalene, but a University of Tulane Medical School study found squalene antibodies in 36 out of 38 Gulf vets suffering from the syndrome and a high incidence of similar disorders in vaccinated vets who never served in the Gulf. The DOD won’t release information on the vaccine because it is “classified.”

The Pentagon also maintained that none of our troops had been exposed to chemical weapons, in spite of the fact that Army logs indicated the presence of chemical weapons on Jan. 20, 1991. When Sen. Donald Riegle (D-Mich.) requested those logs, he was told they didn’t exist. Eight months later the logs were finally released — with most of the pages missing.

It was not until 1998 that the DOD admitted that as many as 130,000 troops (the vets claim more) were exposed to chemical weapons after the destruction of the Iraqi arms depot at Kamisiyah.

The DOD says it never said anything about the exposure because “scientific research and medical research do not indicate that this type of exposure is harmful,” according to Pentagon spokesperson Lt. Col. Dian Lawhon.

But the Army never researched the matter and ignored a 1974 Swedish study showing that small doses of chemical weapons did produce long-term effects.

The tragedy here is that because the Pentagon lied, the vets’ complaints were dismissed.

“Because doctors were told that chemicals had not been used, many veterans were sent straight to the psychiatric department,” said Paul Sullivan of the Gulf War Veterans of Georgia.

By July 1995, 95 percent of vets seeking disability had been turned away because doctors thought they were nut cases.

When research was done, it was ignored. A 1997 University of Texas Southwestern Medical Center study demonstrated that the interaction of nerve gas pills (another experimental and dangerous drug given the troops), insecticides and nerve gas produced a rare disorder called “organophosphate-induced delayed polyneuropathy,” which is essentially Gulf War Syndrome.

With an Iraqi invasion looming, this is hardly an academic issue. As Shaun Rusling, chairman of the British National Gulf War Veterans and Families Association, said, “Our troops, who will be exposed to the same as we were 11 years ago, need to know that should they be ill or injured, they will get the best medical care and proper pensions.”

The track record on our side of the Atlantic suggests quite the opposite.

The Army this week brushed off new reports that American forces needlessly attacked retreating Iraqi troops after a cease-fire was declared in the Persian Gulf war. The accounts, contained in a New Yorker article written by Seymour Hersh, cannot be so easily dismissed.

Though questions about the battle were raised as the war ended in 1991, and subsequent Army investigations found no fault, there is good reason for the Pentagon and Congress to revisit the matter. Some officers familiar with the American assault offer detailed testimony that one of the country’s most decorated commanders, Gen. Barry McCaffrey, ordered a punishing and unwarranted attack.

The sequence of events described by Mr. Hersh is complex and filled with the confusion and ambiguities that are common in war. There are conflicting accounts about what happened and why, and General McCaffrey, now retired from the Army and serving as the Clinton administration’s top drug-control official, has vigorously defended his actions. But none of that justifies the Army’s cavalier response to the New Yorker article.

Few matters are more important to a democracy than the conduct of its military forces, and any credible accusation of reckless or unjustified killing by American servicemen must be thoroughly investigated by an independent panel of experts. The Army’s internal inquiries are not an adequate answer.

The core issue raised by the Hersh piece is whether General McCaffrey, who was commander of the 24th Infantry Division, deliberately provoked a fight with retreating Iraqi forces after the cease-fire was in place by blocking a main escape route and then seizing on the firing of several Iraqi weapons to launch a withering assault. The ferocity of the American attack is not in question. American ground and air units all but pulverized a Republican Guard tank division on March 2, 1991, in one of the most devastating and one-sided battles of the war.

A number of General McCaffrey’s fellow commanders, including Lt. Col. Patrick Lamar, who was the division’s operations officer, told Mr. Hersh that excessive firepower was used against a weakened and retreating Iraqi force that did not seriously threaten the Americans. They believe that the American assault was a clear and willful violation of the cease-fire rules of engagement that had been established by the Pentagon. General McCaffrey maintains that he acted properly to defend his troops after the Iraqi forces initiated combat. He denies that he blocked their escape route in hopes of forcing a confrontation.

Mr. Hersh examines other serious charges involving General McCaffrey’s troops, including reports that they massacred a group of Iraqi prisoners of war, but the evidence he cites here is not definitive. The Army’s investigations of all these matters, which cleared General McCaffrey and the division, should not be the last word. The military services have a poor record of holding their own members accountable for misconduct, especially top officers.

As Walter Cronkite, the former CBS News anchorman, noted in a letter to The Times earlier this week, the Pentagon’s efforts to restrict coverage of the war denied the American people an immediate and full account of the battles American forces fought in Kuwait and Iraq. More comprehensive coverage might long ago have clarified whether General McCaffrey’s order to attack was appropriate.

The Senate did not inquire deeply into the 24th Infantry Division’s actions when it approved promotions for General McCaffrey after the war or when it confirmed his appointment to the drug policy post. Secretary of Defense William Cohen should appoint an independent review panel. If he does not, the Senate or House should conduct its own investigation.

If General McCaffrey acted responsibly, he should welcome an unflinching examination of the facts.

“On the economic assistance package, we’ve made some good progress. We’ve established an agreement on the overall structure of the assistance,” John Taylor, the Treasury Department’s undersecretary for international affairs, told reporters at the end of two days of talks in the Turkish capital.

Taylor did not elaborate on the scope of the aid, but characterized it as “flexible” and “adaptable.”

Turkish news reports have said Turkey is demanding up to $28 billion in support, but the report say the amount could vary according to what type of operation takes place.

“The overall magnitude is not the thing that we focused on. We focused on trying to make it as useful for Turkey in the event of a conflict,” Taylor said.

“Our assistance package is part of preparations. But the purpose is to avoid conflict.”

Turkey’s support is crucial to any U.S. military operation against Iraq, and Turkey was a staging point for air raids during the 1991 Gulf War. But Turkey prefers a peaceful solution to the situation, fearing a new war could devastate its economy or destabilize the region.

“Agreement was reached that this support must be … adaptive, quick, flexible, effective and changing,” Economy Minister Ali Babacan said in a written statement.

Turkish newspapers have reported that Washington is looking to use Turkish bases, ports and railroads and possibly deploy tens of thousands of troops to Turkey. The U.S. and Turkish governments have not commented.

Turkey says it has lost up to $40 billion in trade with Iraq over the past decade.

“There’s going to be an economic loss during this war,” Turkish Foreign Minister Yasar Yakis said Saturday, according to the semiofficial Anatolia news agency. “We’re telling the United States: You need to support us so we can get over these difficulties.”

Turkey’s military and political leaders met Friday to discuss Washington’s “expectations from Turkey” in a war, but did not say if they would extend help to Washington.

Taylor was accompanied by Undersecretary of State Marc Grossman.

The United States is Turkey’s most important ally. Although Turkey’s leaders have long expressed opposition to a war, Turkey is likely to have little choice but to extend support to the United States if Washington resorts to war.

Washington’s support was key to helping Ankara receive some $16 billion in loans, amid a recession that saw Turkey’s economy shrink 9.4 percent last year. Taylor said Turkey was making good progress in implementing belt-tightening measures and its economy was recovering from the crisis.

Turkey especially fears that a war to depose Iraqi leader Saddam Hussein could open the way to independent Kurdish state in northern Iraq. That, Turkish leaders fear, could encourage Kurdish rebels who waged a 15-year war in southeastern Turkey.

Turkey also wants to avoid a refugee crisis as in 1991, when some 500,000 Iraqi Kurds gathered at the Turkish-Iraqi border.

December 27, 2002

It has been a perfect Christmas here in this small segment of the US eastern seaboard where the great decisions of our time are taken. It began snowing in Washington at dusk on 24 December.

Next morning, for the first time I remember, we woke up to a true White Christmas. And the quantity of snow was just right – enough to create a wonderland, but not enough to inconvenience Washingtonians seriously.

However, the idyllic spectacle has only served to make Christmas an even more unreal interlude than usual, a pleasant fantasy before the unpleasantness of the New Year. As the snowflakes fluttered down late on Christmas Eve, we sang in church about peace on earth and goodwill to all men – knowing full well that, barring miracles, a long-planned war will be starting in perhaps five weeks.

You can present the coming attack on Iraq as proof irrefutable of a superpower’s imperial arrogance, as another example of the world’s true rogue nation acting unilaterally to settle a score (having first bullied or bribed a few other countries into going along with it, to give the enterprise a respectable veneer). But I don’t see it like that.

If any people believe the words of the carols, it is God-fearing, church-going Americans. If there is an American empire, it is of a more benign variety than the majority of its earthly predecessors. During the past century, America has been on balance an immense force for good.

We may mock Woodrow Wilson’s vision as Utopian, but his goals of peace, democracy, free trade and a supranational authority (the League of Nations then, the United Nations today) to manage the rules of the international system remain virtually universal aspirations.

As Britain should know as well as anyone, being top nation is a lonely job, in which gratitude from others is not among the rewards. Someone once wrote about the “tragic lesson” that any dominant country must learn – that it cannot be loved.

President Bush, I am sure, has learnt that lesson. No, my objections to the forthcoming war are practical. The minuses outweigh the pluses; the sums just don’t add up.

That is the European way of looking at it. We are inherently pessimistic and dread the unknown. Convinced of human shortcomings, we prefer the status quo. But America does not see things that way.

In its pursuit of Iraq, it is obeying one of its oldest instincts, that things – in this case the Middle East – can be changed for the better. America is not a prisoner of the status quo.

Yes, self-interest is involved, oil and a desire to buttress Israel. Yes, the Bush crowd have used Iraq to keep people’s minds off domestic economic problems. But people in very high places in Washington really do share the Wilsonian belief that Iraq can be remade into a progressive state to serve as a model for a blighted region. And, they would privately add, the whole place is such a mess that whatever happens post-Saddam can hardly make matters worse.

But I, like most Europeans, think things can get even worse, that you shouldn’t make history simply by shaking the kaleidoscope. I fear that an invasion of Iraq will merely toss fuel onto a smouldering fire. The consequences will not be peace and goodwill, but more anti-Americanism. Have the Americans thought this through? There is scant sign.

Mr Bush proclaims that the war against Saddam is a war for peace. His administration believes that it can foster democracy in the Middle East. But these heirs of Woodrow Wilson are reluctant to put their money where their mouth is.

America spends $400bn (£250bn) a year on its defence. But what’s the budget of the outreach scheme, unveiled by Colin Powell a few weeks ago to advance education, the market economy and democracy in the region? A paltry $29m, or just 1 per cent of the cost of one of those fancy aircraft carriers queuing up in the Gulf to strike Saddam (and incidentally, that $3bn-plus price tag doesn’t include the aircraft).

With magnificently enlightened self-interest, the US offered Europe the Marshall Plan after the Second World War. The self-interest argument is at least as strong today. So why not a Powell Plan to rebuild the Middle East?

But Mr Bush is locked in. The words “regime change” are avoided these days, but no one doubts he has decided to get rid of Saddam, come what may. Whatever Iraq does, the bar is set higher. Now Baghdad faces the near-impossible task of proving a negative, that it doesn’t have weapons of mass destruction. Even if inspectors with the best Western intelligence come up with nothing, any outcome with Saddam still in place as Iraqi leader is unacceptable.

At this point, we confront that most powerful driving force in human affairs: face, or rather the importance of not losing it. Just think of those headlines if America’s legions are pulled back. “Bush’s bluff called” or “Saddam wriggles free again”.

The very thought of them must induce apoplexy in the White House. This President’s projected image of relentless purpose, his strongest political asset, would lie in ruins.

The best we can hope for is that someone in Iraq acts first against Saddam and does the dirty work for us. But pinning hopes on that eventuality does not make for a joyous Christmas, even when the Christmas is white.

The Bush administration is taking initial steps to plan for a potential military role in enforcing a massive quarantine, if smallpox or another highly contagious virus were to break out somewhere in the United States,
defense officials tell Inside the Pentagon.

Talks have begun among various federal agencies that could delineate a role for U.S. troops, should local and state law enforcement authorities become
overwhelmed, officials say.

This week a congressionally mandated commission on homeland security said the military should begin preparing for the possibility that “rapid-response”
forces will be needed in such a case.

The commander of U.S. Northern Command — the military organization assigned to defend the American homeland from attack — must have “dedicated, rapid-reaction units with a wide range of response capabilities such as an ability to support implementation of a quarantine,” states a new report from the Gilmore Commission. The panel was created four years ago to advise the president and Congress on domestic response to terrorism involving weapons of mass destruction.

The possibility of a biological attack on the United States is receiving increased attention as the nation contemplates war against Iraq, which experts fear may have “weaponized” smallpox, anthrax or other biowarfare
agents. On Dec. 13, President Bush announced a plan to vaccinate almost 500,000 military personnel against smallpox, beginning immediately, and to start inoculating up to 10 million medical workers and emergency responders shortly thereafter.

Administration officials say the nation soon will have stockpiled enough smallpox vaccine to inoculate all Americans within days after an outbreak occurs. The vaccine is believed to be effective as many as four days after exposure to the disease. Without rapid treatment, this once-eradicated virus is deadly.
“Our government has no information that a smallpox attack is imminent,” Bush said last week. “Yet it is prudent to prepare for the possibility that terrorists who kill indiscriminately would use diseases as a weapon.”

Existing public health plans call for local and state officials to institute and enforce a quarantine, if necessary, in which individuals who may have been exposed to a contagious disease — but show no ymptoms — are confined and physically separated from those who have not been exposed.

But some federal officials, public health analysts and national security experts anticipate a large-scale quarantine would almost surely incite public panic and could require the use of federal troops to restore order. Defense officials emphasize military forces would act solely in a support role to federal civil authorities in such a domestic mission.

Controlling the spread

In the case of even a limited outbreak of a highly contagious disease like smallpox, plague or yellow fever, health officials may call for a broad
geographic area to be sealed off, officials say. That is because an infected individual might come into casual contact with dozens of people days before
developing or identifying symptoms. Simply breathing within six feet of another person can spread the smallpox virus.

A common example of a large quarantine is the creation of a perimeter around a city like Cincinnati, OH, so that no one may leave or enter on foot or by vehicle, train, aircraft or boat. Such a quarantine might be lifted for individuals who remain symptom-free for a period of time, or could be eliminated en masse after an outbreak has been contained, sources said.

But depending on the extent of the outbreak, a quarantine could remain in place — potentially in multiple U.S. cities or regions simultaneously — for
weeks, months or even years.

“Is there any doubt in your mind if a single case of smallpox is discovered that the troops would be in there in a flash?” asks Stephen Dycus, a specialist in national security law on the faculty of Vermont Law School. “I don’t have any doubt, because smallpox or pneumonic plague are highly contagious,” and both have a latency period that increases the risk of a
rapid spread, he said.

“As soon as word gets out, there’s going to be panic in the population,” Dycus said in a Dec. 17 interview.

“There will have to be quarantines on a massive scale.”

Experts imagine scenarios in which large numbers of parents, seeking to protect their families, attempt to flee a city in which one or more smallpox cases have been identified. Conversely, a mother or father who is out of town during an outbreak would almost certainly want to return to a quarantine zone to care for their children.

Although local and state health officials are the first line of defense — and a governor can call up the National Guard under Title 32, if necessary, to enforce a quarantine — Pentagon and federal civil authorities are concerned state and local law enforcement capabilities may quickly become overwhelmed.
Particularly in situations where smallpox has been discovered simultaneously in multiple cities, the federal government anticipates getting involved in
the response.

Guidelines for “isolation and quarantine” published by the Centers for Disease Control and Prevention note that federal regulations authorize action by CDC “in the event that measures taken by local and state health
authorities are insufficient to prevent the spread of smallpox to other states.”

Title 42 of the U.S. Code says health regulations “may provide for the apprehension and examination of any individual reasonably believed to be infected with a communicable disease in a communicable stages,” who is moving from one state to another or in contact with a person in transit. “Such regulations may provide that if, upon examination, any such individual is found to be infected, he may be detained for such time and in such manner as may be reasonably necessary,” states the law.

Title 42 suggests the U.S. surgeon general, with approval from the secretary of health and human services, has the authority to make and enforce
regulations in this regard. However, experts say in the case of a bioterrorism attack, health policy decisions that begin on a local or state level would likely elevate quickly to the U.S. president.

The Posse Comitatus Act, which generally prevents U.S. military forces from engaging in domestic search and seizure, includes exceptions that allow the use of federal troops to restore civil order in national emergencies. Legal experts believe an outbreak of smallpox may well justify the involvement of U.S. troops.

How much force?

But if military personnel are deployed to enforce a quarantine, what level of force could they use to stop the movement of individuals seeking to leave or enter a quarantine area? Experts cite concerns about domestic missions for a military generally trained to use lethal force more readily than local law enforcement. Should troops be allowed to shoot someone trying to escape quarantine, given the risk of widening a limited smallpox outbreak into an epidemic?

“You should use the lowest degree of force necessary to achieve the end in view,” says Eugene Fidell, a former Coast Guard judge advocate general now in private practice. He says a bio-terror attack “strikes me as a 21st century equivalent of a natural disaster that could potentially involve the breakdown of civil order.”

But the U.S. military should plan for non-lethal force in such a case, using devices for crowd control, rubber bullets and warning shots, he said.

Fidell described a massive quarantine as “a siege in the public interest.”

CDC envisions the creation of a “cordon sanitaire” or “line around a quarantine area guarded to prevent spread of disease by restricting passage into and out of the area,” according to the organization’s published
guidelines. Concentric circles of quarantine might be established that allow for various levels of restriction.

If just a single case of smallpox has been discovered, “isolation and quarantine measures can be implemented on a voluntary basis,” CDC states. But
a wider outbreak may necessitate “population-wide quarantine measures which restrict activities or limit movement of individuals,” according to CDC.

Prior to a smallpox attack, CDC recommends public officials identify “relevant legal authorities, persons and organizations empowered to invoke and enforce” a quarantine, build “public trust and compliance with government directives,” and vaccinate “personnel required to implement and enforce quarantine measures.”
As the federal government kicks off its inoculation campaign, the other two imperatives have barely begun implementation, experts note.

Dycus says CDC draws upon a confusing set of statutory and regulatory authorities in planning to handle communicable disease outbreaks. He says a number of critical factors remain undecided:

* Whether CDC has the authority to mandate that persons — citizens, legal and illegal residents, and visitors — undergo physical exams or inoculations, or take pharmaceutical drugs;

* Who has the authority to declare a quarantine or determine the criteria for ordering one; and

* Who will determine the geographic scope, duration, or allowable activities in a quarantine.

The Gilmore Commission — named for its chairman, James Gilmore, the former Republican governor of Virginia — also advises the federal government to review the statutory basis for establishing quarantines.

The new U.S. national strategy for homeland security “appropriately calls for a review of legal authority for use of the military domestically,” states the panel’s fourth report, released Dec. 16. “But other legal and regulatory issues must be addressed, not the least of which are quarantine, isolation [of those symptomatic or exposed], mandatory vaccinations, and other prescriptive measures that may be called for in the event of a biological attack.”

The Gilmore Commission recommends the president direct the attorney general to conduct such a review of applicable laws and regulations immediately, and
“recommend legislative changes before the opening of the next Congress.”

Informing the public

Dycus and others say public information is among the most important elements currently missing. If the federal government recognizes the need to plan for a potential smallpox quarantine, “we should do it openly,” he says.

Others say a massive quarantine may actually be unworkable, with panicked individuals perhaps triggering the very spread of disease that the quarantine aims to contain.

Planning should focus on less Draconian measures, says retired Air Force Col. Randy Larsen, director of the ANSER Institute for Homeland Security. The kind
of small-scale quarantines the World Health rganization used to eradicate smallpox in African and Indian villages in the early 1970s will not work in
today’s “densely populated, highly mobile, unvaccinated” U.S. population, he told ITP this week.

The Gilmore Commission notes that following the 2001 anthrax mailings, which resulted in deaths in New York, Washington and Florida, “only 44 percent of those instructed to complete a 60-day course of Cipro actually did so. This does not bode well for quarantine, isolation, vaccination or other public
health measures.”

The federal government should focus its planning on a public information campaign and massive inoculations, to be implemented immediately upon discovering a large-scale smallpox attack, Larsen says.

Mass vaccinations of the entire public would be difficult but not impossible, following the model of getting 100 million Americans to the voting booths
every Election Day, Larsen says. Both quarantines and public inoculations should be highly recommended, but made voluntary, he says.

“Many health care workers will say that people must be forcibly quarantined,” Larsen wrote in a July white paper. “I disagree. Those who do not receive the
vaccine will not be a threat to those of us who choose to vaccinate our families.”

Public health experts note, though, that additional people may be at risk. The smallpox vaccine is not recommended for pregnant women, young children,
or those with skin conditions or weak immune systems. The latter includes people with the AIDS virus, many cancer patients and those who have recently received organ transplants. But these individuals would be encouraged to take the vaccine if risk of smallpox exposure were high.

“Imposition of large-scale quarantine . . . should not be considered a primary public health strategy in most imaginable circumstances,” a group of physicians wrote in a December 2001 article in the Journal of the American Medical Association. “In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended
adverse consequences than quarantine.”

A broad information campaign is an essential part of the federal government’s planning for responding to a smallpox outbreak, one defense official said this week, speaking on condition of anonymity. “But will it be effective? Probably not,” said the official, noting that more rigous alternatives must be planned in case they become necessary.