THE ESSENCE OF TERRORISM: USING INFORMATION, EDUCATION, AND COMMUNICATION AS WEPAONS OF PREVENTION AND DEFENSE

May 22, 2002

THE ESSENCE OF TERRORISM: USING INFORMATION, EDUCATION, AND COMMUNICATION AS WEAPONS OF PREVENTION AND DEFENSE
by Saul B. Wilen, M.D., CEO, International Horizons Unlimited, Ltd.

The following is an analysis.

The word terrorism evokes a number of significant questions:

* What does this mean?
* How vulnerable are we?
* Can terrorism be prevented?
* Are we prepared to respond? and
* Are we prepared to establish a comprehensive strategy and innovative private sector - governmental-American people cooperation that focuses on prevention, protection, preparedness, and response?

Terrorism is the use of force against people and/or property by an individual or group to create intense, overpowering fear. A significant goal of terrorism is coercion or intimidation of a society or government for ideological, social, religious, economic, and/or political reasons. The intent is to disrupt and destroy directly, and to produce collateral consequences resulting from terrorist acts and threats. The targets are diverse and can be attacked randomly, without overt warning, in varying combinations, and individually or at multiple geographic sites simultaneously. Due to these factors terrorism is now being sub-classified into entities depending on the threat agent or target (bioterrorism, agriterrorism, hydroterrorism, cyberterrorism).

Terrorist acts result in destruction. The effects are more extensive than just physical damage and include diverse collateral consequences. Terrorism works because of the psychological effects that can immobilize individuals and entire populations that feel vulnerable. This feeling of vulnerability is enhanced when the people feel excluded from the process and active participation. Along with the physical and psychological impacts, major re-allocations of resources occur to support the repair of physical and psychological damage, restore order and alleviate fear, attempt to recreate a sense of normality, and to initiate protective actions for the future, although instituted after the terrorist act has occurred. The general economic impact of terrorism diverts resources and undermines economic stability.

Vulnerability exists when preparedness to prevent and the ability to react to terrorist threats do not. The ability to respond includes disaster preparedness and crisis management. However, this only represents the reactive component of preparedness. Prevention is the necessary co-equal requirement to establish preparedness. The balance is defined through universal cooperation in real-time, incorporating shared, valid information, open communication, consistent education, and resources management.

Preparedness is accomplished through the cooperation of governments, agencies, and entities at all levels (local, regional, state, national, and international), the people, and the private sector. A primary goal is to establish a coordinated central information repository that is capable of producing data integration to support effective planning, prevention, and interventions. Horizontal Data Integration Technology is ideal for this purpose. Incorporation of a unified effort to integrate information from multiple sources simultaneously for analysis and appropriate action(s) is essential.

In January 2001 the third and final report of the U.S. Commission on National Security/21st Century (Hartman-Rudman Commission) was issued outlining the commission’s view for a new national security strategy. Titled the “The Road Map for National Security: Imperative for Change” the commission raised stark concerns about U.S. vulnerability. The principle conclusions were, “in the face of this threat (a direct attack against American citizens on American soil), our nation has no coherent or integrated governmental structures” and guarding U.S. territories should be made “the primary security mission of the United States.” The commission presented its view that preventing, protecting, deterring, and defeating attacks against America, or responding to them if prevention fails requires a new strategy including unprecedented governmental cooperation and communication. Prevention that produces initiatives rather than solely reactive responses is the goal.

The awakening of September 11, 2001 put America’s vulnerabilities and weaknesses into sharp perspective. America’s existing strengths have gone unrecognized and are yet to be unleashed. The vulnerabilities have spawned myriads of responses and proposals that do not address prevention, and do not incorporate the strengths America possesses. The approaches instituted to date have been primarily reactive in nature, waiting for the terrorist event to occur and then responding through disaster preparedness and crisis management. Disaster planning and reactive interventions to limit and control are absolutely necessary and should be supported. However, we do not have the resources to handle the casualties of: a modest nuclear attack to a handful of urban targets simultaneously; terrorist caused smallpox virus exposures in multiple, distant population centers resulting in the need to quarantine millions of people; or the release of toxic chemicals (as in the 1995 Sarin gas release by terrorists in Tokyo) into the subway systems and/or tunnels of several cities.

Preparedness to prevent terrorist threats is the mandatory component to avoid crises from occurring. If the focus remains primarily reaction then America is doomed to react forever. We must focus on the strengths and build upon them to create programs that simultaneously support prevention. A unique perspective emerges when we acknowledge the American capacity to combine information and education systems with computer technologies, coupled with American resolve, ingenuity, and courage to create this most powerful weapon to prevent, defend, and defeat terrorism. This perspective allows for the essential incorporation of prevention into the overall strategy for terrorism preparedness.

American society has historically been reactive, waiting for a cataclysmic event and then rallying support to create the needed response. But, this support soon wanes and America returns to complacency. Consider a number of pivotal events over the past 100 years that have impacted the course and future of America. The assassination of President William McKinley led President Theodore Roosevelt to implement the conversion of our monetary system from the gold standard. The December 7, 1941 attack on Pearl Harbor led to America’s entry into World War II and the defeat of the Axis Powers. The assassination of President John F. Kennedy led to the enactment of the sweeping social, voting, and civil rights legislation under the presidency of Lyndon Johnson. The September 11, 2001 terrorist bombings of the World Trade Center and the Pentagon exposed our vulnerability and lead President George W. Bush to declare a global war on terrorism. An opportunity has arisen in this millennium to respond to this challenge to civilization’s survival with an absolute departure from past behavioral patterns, prevention.

The United States has many individual, local, state, regional, and national entities and jurisdictions that receive information relevant to threats. However, the U.S. is highly vulnerable when it is not pro-actively prepared to react in a comprehensive and timely manner. Current information is often under-communicated, is seldom available or disseminated in real-time, and lacks tracking components. Real-time means the ability to implement intervention(s) while the threat is evolving, and support decision-making with the most current information. Timely personnel education and training must directly track current information.

Few systems presently exist that support the comprehensive availability of information from a central source about targets, terrorists, and threats (the focus by individuals and/or groups of actions or devices used to produce terror). Systems that focus on integrating information, communication, and education to evaluate target, terrorist, and threat concerns with the applications of existing resources are in their infancy.

September 11, 2001 certainly found America unprepared. Clues were ignored, pro-active communication and cooperation were lacking, and even the responses since have again been primarily reactive. The provisions of recent federal legislation concerning bioterrorism are appropriate, but prevention is not addressed.

A consensus statement dealing with the medical and public health management of anthrax as a biological weapon was published in May 1999 in the Journal of the American Medical Association (JAMA). The journal article detailed the measures to be taken by medical and public health professionals following the use of anthrax against a civilian population. The consensus working group consisted of representatives from major academic medical centers and research, government, military, public health, and emergency management institutions and agencies. Databases from January 1966 to April 1998 were searched. All relevant evidence obtained in conjunction with final consensus recommendations included diagnosis, indications for vaccination, therapy for those exposed, post-exposure prophylaxis, decontamination of the environment, and additional research needs. Despite the existence of this authoritative management plan, when confronted with a bioterrorism attack (limited) with anthrax, effective communication was thwarted and confusion reigned. This recent experience with just a few anthrax cases demonstrated that healthcare and financial resources could be stretched to exhaustion.

A 1997 report from the U.S. Army Medical Research Institute of Infectious Diseases and the Walter Reed Army Institute of Research published in JAMA presented the “Concern regarding the use of biological agents (bacteria, viruses, toxins) as tools of warfare or terrorism has led to measures to deter their use or, failing that to deal with the consequences. Unlike chemical agents, which typically lead to violent disease syndromes within minutes at the site of the exposure, diseases resulting from biological agents have incubation periods for days.” Human beings represent the most sensitive and may be the only detection system for a biological attack. An increased number of patients with the signs and symptoms of a disease agent is the primary indicator that a biological weapon has been used. Healthcare providers must be prepared to handle victims of biological, chemical, and radiation/nuclear terrorism. The use of these weapons by terrorists can have grave consequences. Clinicians should be alert in dealing with potential exposures to these agents and to making clear and accurate decisions about instituting prophylaxis. There must be readily available communication channels for reporting to public health officials and law enforcement. Clearly defined approaches for isolation and protective precautions require development and the subsequent education of healthcare professionals about pathophysiology, clinical presentation, diagnosis, and management. At the present time, the above delineated expectations of healthcare providers cannot be met due to lack of training and experience. Education of the American people is mandatory to assist in prevention and early detection, and the necessary cooperation with interventions. John D. Clough, M.D., Editor-in-Chief of the Cleveland Clinic Journal of Medicine clearly stated in a December 2001 editorial, “If anything good comes of recent events, it might be the rejuvenation of America’s public health system, which has languished in recent years.”

In evaluating comprehensive systems that support prevention, protection, and preparedness a similar series of questions should be posed that are similar to those used to define terrorism. Included are:

* What do we know about terrorism?
* What do we know about terrorists?
* What are the key targets?
* What are the threat methods?
* How do we prepare for terrorism?
* What weaknesses permit terrorists to succeed?
* What makes a target vulnerable?
* What is required to defeat threats?
* What is required to defend targets?
* What information do we need about a threat agent?
* What information is available that will allow for prevention and effective, real-time responses to a threat?
* What are the requirements for effective communication to defeat terrorism?
* What educational components are needed to prevent and protect against terrorism?

It is essential that planning and strategy development include systems that supply significant answers to all of these questions and include preparedness based on prevention of, protection against, defending from, and defeating terrorist threats.

A program to create preparedness must have flexibility, expandability, and adaptability. It must produce real-time integration of concurrent threat information, resources availability, planning, implementation and management, and assessment. The development and implementation of threat prevention, containment, and reversal in real-time requires important steps:

* the incorporation of all information that supports pro-active capabilities for threat prevention;
* information gathering, management, integration, tracking, and retrieval;
* resources (human, information, material) availability, development, allocation, reallocation, and management.
* rapid communication;
* optimal education strategically incorporated into preparedness, early warning, and response capabilities at all levels; and

This is a time for clear thought and decisive action. We must learn from history and seize this opportunity to institute prevention as a full and equal component in our planning and strategies, provide the necessary education for all Americans, establish meaningful and valid communication among all responsible agencies and entities, and motivate cooperation for the present and the future. As America targets terrorism, we need leadership to guarantee that the principles of prevention be applied to create enduring, positive results, thereby assuring security for the generations to come.

REFERENCES

Hart G, Rudman W, et al: United States Commission on National Security/21st Century, Road Map for National Security: Imperative for Change, January 2001

Hart G, Rudman W, et al: United States Commission on National Security/21st Century, Seeking a National Strategy, April 2000

Hart G, Rudman W, et al: United States Commission on National Security/21st Century, New World Coming: American Security in the 21st Century, September 1999

Le Due J, Jahrling P: Strengthening National Preparedness for Smallpox. Centers for Disease Control Research Update 7:1-5, January-February 2001

Ohbu S, et al: Sarin Poisoning on Tokyo Subway. Southern Medical Journal 90:587-593, June 1997

Inglesby T, et al: Anthrax as a Biological Weapon, Medical and Public Health Management Consensus Statement. JAMA 281:1735-1745, May 12, 1999

Franz D, et al: Clinical Recognition and Management of Patients Exposed to Biological Warfare Agents. JAMA 278:399-411, August 6, 1997

Clough J: Bioterrorism: An Unintended Boost to Public Health? Editorial, Cleveland Clinic Journal of Medicine 68:971, December 2001

Wilen S: America’s Preparedness for Terrorist Threats: A Prevention Perspective. Texas Healthcare 5:3&14, December 2001

* International Horizons Unlimited is a national resources and consulting consortium supporting problem solving through educational and prevention strategies. Included are assessment of needs, program and systems development, implementation, monitoring, and analysis of outcomes. Visit our Web Site: www.intlhorizons.com, call (210) 692-1268, or FAX (210) 692-1265.