Nevertheless, fear of a panic-inducing anthrax event generated momentum for amassing millions of doses of vaccine as a backstop to the antibiotics that would be the first line of defense.
Bush underscored the threat as he rallied support for the Iraq war. In an October 2002 speech in Cincinnati, the president told a crowd that Saddam Hussein's regime had supplies of anthrax and other biological weapons "capable of killing millions." Such weapons could be easily deployed, Bush added: "All that might be required are a small container and one terrorist or Iraqi intelligence operative to deliver it."
The U.S. already had a military stockpile of anthrax vaccine, filled with Emergent's product. Now, support grew for creating a civilian cache, to allow mass inoculations immediately after an attack.
The idea was that a new vaccine -- faster-working, with fewer doses and fewer side effects -- would protect people who couldn't tolerate antibiotics and would work against anthrax that withstood antibiotic treatment. A vaccine might also help protect people reentering a building that had been contaminated.
In February 2002, the Institute of Medicine released its report, calling the old vaccine "reasonably safe" but "far from optimal" and concluding: "A new vaccine, developed according to more modern principles of vaccinology, is urgently needed."
Officials meeting privately in late 2003 -- including Russell, Simonson, representatives of the vice president's office, the Centers for Disease Control and Prevention, the Department of Homeland Security and Fauci's staff -- decided to push for the purchase of 75 million doses of a new, genetically engineered vaccine.
Dr. Kenneth W. Bernard, then a biodefense advisor to Bush, estimated that such a stockpile -- providing three doses for 25 million Americans -- would be enough to respond to simultaneous attacks on New York, Los Angeles and Washington.
Henderson and Russell said the requirement for 75 million doses was based as well on a desire to keep a manufacturer operating continuously, so it could quickly ramp up production in a crisis.
The problem now, both said in recent interviews, is that the nation has not gotten a newer, better vaccine.
Project BioShield contract
In July 2004, President Bush signed legislation called Project BioShield, providing $5.6 billion for "next generation" vaccines and drugs to counter threats of biological terrorism.
