STANFORD, Calif.- For the past seven years, the United States has been negotiating a verification protocol to the Biological Weapons Convention of 1972, hoping to put teeth into the convention's ban on biological weapons production. The Bush administration recently rejected the latest draft of the protocol, viewing it as irredeemably flawed. This is a good time to ask what a new American strategy should be for security against biological threats. It is difficult to predict the likelihood or scale of biological attack. The right policy will provide benefits whether or not an attack occurs.

The first step is conceptual: we must stop thinking about biological security in the way we think about nuclear security. Few aspects of the United States strategy for nuclear security carry over cleanly to the biological case. Security against nuclear attack has relied upon nonproliferation and deterrence, with comparatively little role, so far, for defense. Security against biological-weapons threats should lean primarily on defense.

Nonproliferation, for example, is far more difficult in the biological case. Biological agents are microscopic organisms that can be grown with equipment readily available all over the world -- although the resulting weapons have proved difficult for terrorists to master. Many of the organisms can be acquired during naturally occurring outbreaks. Controls remain valuable, but they will never play the central role that they do in nuclear security. And as biotechnology explodes in the coming decades, nonproliferation will face ever greater challenges.

Deterrence may likewise be of limited use in preventing attacks with biological weapons. While the use of battlefield biological weapons may be deterred by threats, biological terrorism could remain largely immune. The incubation times of most diseases -- for example, seven to 17 days for smallpox -- may lead terrorists to hope they can cover their tracks through covert releases of biological agents. Deterrence relies on the threat of punishment. An attacker who cannot be identified cannot be threatened.

When the Aum Shinrikyo cultists sprayed an anthrax organism in Tokyo -- they did so unsuccessfully several times before their deadly 1995 nerve-gas attack -- they made no announcements and the attacks went unnoticed. When followers of the Bhagwan Shree Rajneesh infected 750 Oregonians in 1984 with salmonella, it took over a year for the attack to be distinguished from a natural outbreak.

Rather than nonproliferation and deterrence, biological security must emphasize civil defense. Civil defense in the biological realm means improving the public health system. Most important, it requires improving disease surveillance. Unusual disease outbreaks must be recognized quickly, so that a rapid response is possible. Health care workers in clinics, hospitals and private practice must know how to identify such outbreaks and be ready and able to pass their information rapidly to city, state and national authorities.

This kind of preparedness would also help to prevent unintentional outbreaks of disease. Because infected passengers can travel the world in less time than it takes for a disease to incubate, it is crucial, for the national interest as well as for humanitarian reasons, to improve disease surveillance overseas. The United States welcomes 50 million visitors every year and imports $40 billion worth of food. Disease cannot be stopped at the border. The United States must act internationally as well as nationally.

Because biological security would offer protection against both natural and nefarious transmission of disease, a sound policy would directly benefit society even if no attack ever happened. Effective biological security requires that we fit the cure to the disease.

The Twenty-fifth Amendment to the Constitution evolved as a response to the need to relieve a sick and disabled president fromthe responsibilities of office, in the best interests of both the sick president and the nation. The congressional hearings that preceded and accompanied its enactment made clear that some members of Congress understood the need for objective medical information to be available to the vice president andCabinet before they couldmake the political determination of disability.Nevertheless, not a single physician was called to testify or advise in the Senate or the House despite the fact that they represent the only societal repository of expertise on physical and mental impairment. Nor was any mechanism defined whereby a dispassionate medical appraisal of the cognitive competence of the president could be obtained if it were in question. Instead, there was an implicit reliance on the physician to the president, whose conflict of interest is so strong that he or she has been used in the past more to conceal than to reveal the true state of the president’s health. The Twenty-fifth Amendment remains a vital mechanism for ensuring the stability of the presidency. But its disability provisions (sections 3 and 4) have not been implemented as the framers intended. Sooner or later, the nation will be confronted with a president who has Alzheimer’s disease, brain trauma, or illness such that his cognitive faculties are not up to the demands of office. A powerful antidote to the White House cover-ups of the past would be a medical advisory committee on the health of the president, created by congressional action. The committee would review the president’s health annually and report to the nation on its significant findings; it also would be convened urgently to assess his health status whenever it was in serious question. It would then advise the vice president and Cabinet of the degree of presidential impairment to provide a scientific medical foundation for the political decision as to the presence or absence of disability. The independence, breadth of expertise, lack of conflict of interest, availability, and credibility of the committee would assure the public of an objective appraisal and would preclude inaction by the executive branch in the face of disability. The arguments against such an advisory committee—that physicians would decide rather than advise; that they might disagree; that they might harass the president or violate confidentiality; and that the committee is unnecessary,would function poorly,
could not assemble quickly, and would infringe on the separation of powers doctrine —have been carefully analyzed and been found wanting. Because the advantages of establishing a medical advisory committee are compelling, it should be the subject of congressional action before, rather than after, the next medical cover-up in the White
House and the accompanying public crisis of confidence.

Disabling illness has been widely observed among national leaders. This is hardly unexpected because many of them govern at an age when there is a high incidence of debilitating disease. Age became an important issue during the presidential campaign of 1996 because Senator Dole was the oldest candidate ever nominated for a first term. Polls demonstrated a substantial level of concern in the electorate, particularly among older Americans.

The heightened risk of disability or death from heart disease, stroke, and cancer at age 70 and over was one important consideration. It raised doubts as to whether a 73-year-old president would be able to fulfill his implicit contract to serve 208 weeks in office. A second related element was the profound change in cognitive capacities known to be associated with those diseases, even when the symptoms and physical impairment are stable or have improved. Finally, quite separate from the cognitive impairment of illness, age itself carries with it on average a decline in mental acuity, efficient information processing, memory, problem solving, and other requisites of effective decision making. Many older voters reacted to Dole as they did because of their awareness that their own memory, concentration, and energy levels had diminished over the years, sometimes drastically.

In spite of the national concern about job discrimination of any kind, including that based on age, it seems clear that mandatory retirement for chief executive officers at the age of 65 will continue to be an important tenet of our great corporations. Similarly, the most demanding job in the world--the U.S. presidency--need not be imposed on senior citizens. Congress should craft a resolution expressing its conviction that 65 should be the upper age limit for candidates running for a first term as president of the United States.