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September 21, 2001

Dear Mr. President,

We are writing to offer our strong support as you rally the nation in the aftermath of the senseless massacre at the World Trade Center and the Pentagon. We share your commitment to provide relief to those affected by last Tuesday's attacks and to do all that we can to protect the nation from future acts of terrorism.

As your Administration takes additional steps to respond to the events of last week, we hope you will bear in mind the special challenges posed by biological weapons. A terrorist attack using a deadly infectious agent could kill or sicken millions of Americans.

Your efforts to enhance the nation's intelligence capabilities will do much to prevent such an attack, and we commend you for your leadership in this area. We also commend you and Secretary Thompson for your prompt, timely relief efforts -- arranging for medical supplies and personnel, establishing hotlines to ensure that individuals continued to receive medical and social services, alerting the public about potential environmental hazards, and releasing grants for social and community services.

Furthermore, we know of your strong commitment to taking additional measures to prepare for future acts of terrorism. In this regard, we call to your attention a series of specific recommendations that will help America prepare to respond effectively to a possible biological attack.

In our Senate Health Committee, we have held an extensive series of hearings and consultations with experts in counter-terrorism, infectious disease and national security. As a result of these efforts, we introduced the Frist-Kennedy "Public Health Threats and Emergencies Act," which was enacted by Congress last November. In light of Tuesday's attacks, we believe that it is time to fund this legislation and continue to build upon our knowledge of the best way to proceed.

• We should commit sufficient resources to developing medical counter-measures against a bioterrorist attack, including the increased use of specific vaccines and stockpiling of antibiotics. Though vaccines have already been developed for anthrax, plague, and smallpox, they are not widely available for use within the general public; and in some cases, there may not even be adequate supplies to treat disease outbreaks. Further, in some cases, vaccines have not even been developed to deal with the most destructive agents. Adequate treatment for most bioweapons includes the use of antibiotics, and we should ensure that we have an appropriate stockpile of those vital treatments.
• We should improve planning to counter bioterrorist attacks. Recent simulations and exercises reveal that coordination on bioterrorism is often inadequate among federal agencies and between federal and local officials.
• We should enhance the capacity of the nation's public health agencies at the local, state and federal levels to detect, monitor and contain disease outbreaks that may be due to a deliberate attack using a biological weapon. Rapid detection of an attack can prevent a local disease outbreak from becoming a national epidemic.
• We should ensure that hospitals are properly equipped and health professionals are adequately trained to respond to bioterrorism. Few facilities have the capacity to treat large numbers of victims after a bioterrorist attack, and few health professionals are properly trained to diagnose the victims of bioterrorism rapidly and accurately.
• We should coordinate our response to effectively evaluate and alleviate environmental hazards. The aftereffects of any attack include a clear environmental threat. In New York City and at the Pentagon, relief workers have been exposed to airborne debris, smoke, human remains, and other environmental hazards.
• We should fully integrate our physical health response with our behavioral and mental health response. Initial reports of last week's attacks focused primarily on the physical devastation. Only now, one week later, are we beginning to realize the emotional toll of those attacks.
• We should strengthen and improve international surveillance capacities and cooperation agreements, including the Cooperative Threat Reduction program.

We commend you for the resolute measures you have taken to safeguard the nation's security in the wake of last week's vicious attacks, and we look forward to working closely with you to make sure that the country's preparedness for all forms of terrorism is as strong as possible.

With respect and appreciation,

Sincerely,