Important planning for responding to a future anthrax attack has quietly been under way since the last attacks seven years ago. A key part of this effort has been figuring out how best to deliver prophylactic antibiotics quickly to the people living in the city that is attacked.

This is at least as difficult and complicated as it might seem. First, an attack must be detected, either by one of the BioWatch air monitors that have been placed in many cities or by finding symptoms of anthrax poisoning in a victim. Either way, this can take at least 12 to 30 hours. Next, an adequate supply of antibiotics must be sent from the Strategic National Stockpile (held at 12 sites around the country) to the affected city, ideally within 12 hours.

Finally, the city must get the drugs out to its population. This third step is potentially the most time-consuming of all. But it can be speeded up - and made twice as effective in preventing deaths - by strategically involving the United States Postal Service and by greatly increasing the amount of medicine initially sent out to the affected city.

The Centers for Disease Control and Prevention has directed 72 major American cities to devise plans to distribute anthrax antibiotics to all their residents within 48 hours of receiving them. So far, few of these cities are able to meet that goal. The traditional approach to dispensing medical supplies to a large population is to place the medicines in schools and other public places and instruct people to pick them up. The main shortcoming of this "PODs" approach (for "points of dispensing") is labor: there are not enough public health workers to distribute the antibiotics quickly, and cities would have to rely largely on volunteers to perform unfamiliar (albeit simple) tasks in unfamiliar settings.

A better way is to let residents stay home and have mail carriers, escorted by police officers, go door to door delivering antibiotics. This can be done within eight hours, trials in Seattle, Boston and Philadelphia have shown. While the mail carriers (who have already taken antibiotics) distribute pills, public health workers can make bulk deliveries to special populations like universities, nursing homes, detention centers, homeless shelters and large hotels.

After the mail carriers have finished their routes, the next police shift can be assigned to PODs, opened up to serve anyone who may have fallen through the cracks and to supply additional antibiotics so that each citizen can ultimately be given enough for the full 60-day course of treatment.

Besides being faster, the postal approach can reach those people who, surveys suggest, might refuse to go to a dispensing point. It would also require fewer workers, and it would be much better executed - mail carriers cover their routes six days a week through rain, sleet and snow. And the elderly, the handicapped and those without cars could obtain their pills more easily.

So the mail carrier strategy is a great start. But it won't work unless the federal government provides the city with a sufficient supply of antibiotics within 12 hours of the request. The Strategic National Stockpile has the capacity now to immediately send enough medicine to last 1.8 million people for 10 days. (The rest of its supply of antibiotics is in bulk form, not prepackaged, so it cannot be delivered until 24 to 36 hours after the request.) But for many cities, the 10-day supply for 1.8 million people is not enough. The stockpile should at least triple its inventory of antibiotics that are prepackaged so they can be delivered within 12 hours.

Mathematical models suggest that such a well-executed and well-supplied approach to delivering antibiotics would result in half the number of deaths as would occur using the traditional PODs approach.

Finally, it is important that planners take into account the possibility of a campaign of attacks on several cities. After all, producing 10 pounds of anthrax spores may not be much more difficult than making one pound. To address this threat, the Strategic National Stockpile should ultimately be ready to mobilize, according to my calculations, roughly half of its inventory of anthrax antibiotics. Then, soon after sending antibiotics to the city under attack it could also distribute five-day supplies to people in all the other cities (again via mail carriers).

Most people would never need to take the medicine, but they would have it on hand in the event of an attack. This would greatly reduce the level of fear nationwide, and it might also serve as a strong deterrent to people who would consider waging such a series of attacks. It is our responsibility to stay one step ahead of them.

FSI senior fellow Stephen Stedman reviews John Bolton's book, Surrender Is not an Option, in the July/August issue of the Boston Review. "The memoir reads like an international relations primer done in the style of a modern morality tale," he writes. "Imagine Kenneth Waltz's classic Man, the State, and War as written by Ayn Rand."

One of the more remarkable underreported stories of 2008 was a speech in which the State department’s legal adviser John Bellinger admitted that there “are also realities about the International Criminal Court that the United States must accept.” He also stated that the Bush administration would work with the Court to maximize its chances of success in Darfur. Bellinger did not say that the United States might actually join the Court, but acknowledged that it enjoyed widespread international support and legitimacy, and that the United States could fruitfully cooperate with it on areas of mutual benefit.

Neither mea culpa nor volte-face, the speech nonetheless indicates the distance the administration has traveled in seven years. While Bellinger’s oratory went largely unnoticed by foreign policy wonks and the attentive public alike, it did not escape the scrutiny of John Bolton, who dismissed it as Clinton-era “pabulum” and reflective of “the yearning the Rice State Department has for acceptance” by academics and foreign intellectuals. He added ominously, “the fight resumes after Jan. 20.”

Bolton has been a powerful influence on Republican foreign policy for the last twenty years. Before his appointment as ambassador to the United Nations in 2005—which was achieved without Senate confirmation—Bolton dominated arms-control policy in the first Bush term. He killed the Anti-Ballistic Missile (ABM) Treaty, negotiations with North Korea, and the Biological Weapons Convention verification protocol. During the Clinton years, he campaigned tirelessly from his Heritage Foundation perch for missile defense and against global governance, which he seems to equate with global government. In 1998, when then-Secretary-General of the United Nations Kofi Annan released a report critical of both the United Nations secretariat and member states for the failure to prevent genocide in Srebrenica, Bolton chastized Annan for having the temerity to criticize governments for what they did or did not do in the former Yugoslavia. He added menacingly: “I think if he continues down this road, ultimately it means war, at least with the Republican Party.”

Bolton came of age politically during Barry Goldwater’s presidential campaign. The future policy heavyweight was a high schooler in Baltimore at the time. He honed his conservatism at Yale College and Yale Law School, ducked Vietnam through a National Guard posting (“looking back, I am not terribly proud of this calculation”), and got his first taste of Washington as an intern to Spiro Agnew. During the Bush Sr. presidency, Bolton was Assistant Secretary for International Organization Affairs in James Baker’s State Department, and was one of the first people who Baker called when he needed a posse of chad-disputing lawyers in Florida in November 2000. Bolton’s name keeps showing up in various articles about the fight inside the Republican Party for the soul of John McCain’s foreign policy.

All of this makes it imperative to read his memoirs, which clarify the stakes in the forthcoming election. Although it is hard to imagine Bolton in a McCain administration—his memoirs offend so many within his party, across the aisle, and overseas, that Bolton could not win Senate confirmation for capitol dog-catcher—Bolton will be plotting, pressing, and pushing to force McCain’s foreign policy back to the unilateralism of George Bush’s first term, when the war on terror meant never having to say you’re sorry. And there are important national security posts that do not require Senate approval.

The memoir reads like an international relations primer done in the style of a modern morality tale—imagine Kenneth Waltz's classic Man, the State, and War as written by Ayn Rand.

To Bolton, the United Nations is a “target rich environment,” and I had a front row seat to watch his gunslinging. In 2005 I served as Special Adviser to UN Secretary-General Kofi Annan. I was responsible for developing member-state support for his efforts to overhaul the United Nations. In that capacity, I was in Brussels in March 2005 when President Bush nominated Bolton as Ambassador to the United Nations. One high-ranking EU official recoiled in horror, and, to share his agita, repeated two of Bolton’s more famous lines: that “UN headquarters could lose ten floors and no one would know the difference,” and that “there was no United Nations.” How in the world, the official asked, could such a man be Ambassador to the United Nations?

Amidst nodding heads and shared pained looks, I offered that if I could pick the ten floors, I would agree with Bolton. Moreover, I said, any sentient being who spends time in Turtle Bay—the Manhattan site of the United Nations—will at some point in frustration say to themselves that there is no United Nations. Bolton’s sin was to say it publicly. Finally, I suggested that John Bolton was irrelevant: “If the President of the United States and the Secretary of State want a strong, effective United Nations, then Bolton will have to deliver. If they don’t, you could have John Kerry as the U.S. ambassador, and nothing will happen.”

Oh well; win some, lose some. Which is what Condoleeza Rice is rumored to have told a friend who asked how John Bolton could have possibly been nominated for the position under her watch.

Or more accurately, I was half right, half wrong. Reading this book, one can almost feel sorry for how unsuited Bolton was for his new job. For four years he had been the point man for breaking American commitments abroad, insulting allies and enemies alike, ditching the ABM Treaty, and unsigning the Rome Statute, which established the International Criminal Court (“my happiest moment at State”). In the heady days of the first Bush administration, when it believed the United States was so powerful it could get anything that it wanted without friends, partners, or institutions, Bolton was the “say no” guy, a job he performed with great brio. How could he know that in 2005 his big boss, the President, and his nominal boss, the Secretary of State, would actually decide that international cooperation was necessary, and that maybe we should start worrying about America’s free fall in world opinion? A pit bull in the first term, Bolton would be a yap dog in the second, grating on the Secretary of State, the President, and most American allies.

Almost sorry, for whatever else you say about John Bolton, he is not of the “we can disagree without being disagreeable” school of American politics. This is one of the nastiest, pettiest memoirs in the annals of American diplomatic history. Among the many targets of insults and catty remarks are former and present U.K. ambassadors to the United Nations Emyr Jones Parry, Adam Thomson (“I could never look at or listen to Thomson without immediately thinking of Harry [Potter] and all his little friends”), and John Sawers; recent U.K. foreign ministers; just about every UN civil servant mentioned; indeed, just about every U.S. civil servant mentioned, along with countless journalists and politicians.

The memoir reads like an international relations primer done in the style of a modern morality tale—imagine Kenneth Waltz’s classic Man, the State, and War as written by Ayn Rand. Bolton, usually singlehandedly, takes on what he calls the High Minded, the Normers (those who create international norms of behavior or try to “[whip] the United States into line with leftist views of the way the world should look”), the EAPeasers (career State Department officials who advocate negotiations with North Korea), the Risen Bureaucracy, the Crusaders of Compromise, the Arms Control True Believers, and the EUroids.

The book has the formulaic allegories typical of the genre—the young, innocent female (Kristen Silverberg, Assistant Secretary for International Organization Affairs) driven to tears after being berated by the cold-hearted career bureaucrat (Nicholas Burns); the noble knight (Bolton himself) fighting against the political higher ups who care only about “positioning themselves” (Rice) or their legacy (Colin Powell). And of course Bolton’s plaintive cries that the 2005-06 changes in administration policy occurred against the will of the President. One sees the peasants now: ‘If only the King knew what was happening, this would never go on.’

Now add a heaping dose of xenophobia. Foreigners, appeasing foreigners, foreigners claiming to know us better than we know ourselves: all loom large in Bolton’s memoirs. He insults the former Swedish foreign minister and President of the General Assembly Jan Eliasson as not only having “an ethereal Hammarskjöldian vision problem, but also a Gunnar Myrdal problem, yet another foreigner who ‘understood’ us better than we did ourselves.” (This is the Myrdal who shared the 1974 Nobel Prize in Economics with Friedrich Hayek, and whose classic book on race, An American Dilemma: The Negro Problem and Modern Democracy, was cited in Brown v. Board of Education.) At one point in his belittlement of a Bush political appointee, a special assistant to Condoleeza Rice, no less, Bolton adds that she was “a naturalized citizen originally from Pakistan,” in case we wondered why she could not possibly understand America’s real foreign policy interests. In Bolton’s worldview Zbigniew Brzezinski is probably a naturalized American citizen originally from Poland; Henry Kissinger, a naturalized American citizen originally from Germany.

In the Bolton universe, you want Iran and North Korea to be referred to the Security Council, so that when it fails to unite behind a resolute strategy, the United States is then free to take the tough action it needs to take. And in the case of North Korea, Bolton is clear about what that would be: “unilateralist, interventionist, and preemptive.” Is it any wonder that when it came to Iran and North Korea, our allies and adversaries were loathe to refer them anywhere near Bolton?

Richard Hofstadter’s 1964 article “The Paranoid Style in American Politics” was prompted by the supporters of the Goldwater campaign. Bolton strides right off the pages of Hofstadter’s essay:

He is always manning the barricades of civilization . . . he does not see social conflict as something to be mediated and compromised, in the manner of the working politician. Since what is at stake is always a conflict between absolute good and absolute evil, what is necessary is not compromise but the will to fight things out to a finish. Since the enemy is thought of as being totally evil and totally unappeasable, he must be totally eliminated—if not from the world, at least from the theatre of operations to which the paranoid directs his attention. This demand for total triumph leads to the formulation of hopelessly unrealistic goals, and since these goals are not even remotely attainable, failure constantly heightens the paranoid’s sense of frustration. Even partial success leaves him with the same feeling of powerlessness with which he began, and this in turn only strengthens his awareness of the vast and terrifying quality of the enemy he opposes.

According to Bolton, we do not need diplomats who negotiate, seek common ground, and strive for cooperative solutions. We need litigators who will go to the wall defending American interests, who will understand that when others say no, they mean no, and that therefore compromise is illusion. But in a world where the United States needs international cooperation for its own peace and prosperity, what comes next? Bolton’s answers are laughable—we stick with our “closest friends in the United Nations”—Israel, Palau and the Marshall Islands. Or we forge a new alliance with Japan, South Korea, Australia, Canada, and New Zealand to overcome the parasitic and paralytic EU. The road to global primacy runs through . . . Wellington?

There are, of course, some glaring contradictions in the memoirs. Bolton is known as a sovereignty hawk and he spells out the content of that doctrine as “greater independence and fewer unnecessary restraints.” The job of civil servants, politically appointed or career, is “to implement the president’s policies.” So it comes as a double shock when we find Bolton handing a draft Security Council resolution to the Israeli ambassador, in case the ambassador wants to ask his Prime Minister to appeal directly to Bush or Rice to change President Bush’s policy on Lebanon.

Another example concerns Bolton’s recurring beratement of UN officials for forgetting that they work for the member states. He then describes how one Under-Secretary-General, American appointee Christopher Burnham, surreptitiously showed him budget documents that put the United States at an advantage in budget negotiations. It is hard to see how you can have it both ways. Either UN officials serve all member states equally or the organization is up for grabs to the most powerful state.

But it is the big betrayal that is at the heart of the book. Facing a quagmire in Iraq, a faltering coalition in Afghanistan, a nuclear armed North Korea, the possibility of a nuclear Iran, and a war against terror that was creating more, not fewer, terrorists, Condoleeza Rice convinced President Bush that maybe they should stop digging a bigger hole for American foreign policy. And that meant actually trying diplomacy in North Korea, Iran, and the Middle East.

The losers were John Bolton and his acolytes; the winners were the professionals like Nicholas Burns and Christopher Hill. Faced with defeat and repudiation of the failed policies he advocated, Bolton’s response is familiar and tiresome: the professionals had secretly hijacked the president’s policy; the Secretary of State cares more about appeasing foreigners than protecting American interests.

The moment of reckoning for Bolton and for the President that nominated him is not described in the book, but it took place two months after Bolton left the administration. When the United States and North Korea reached a deal in February 2007 that holds the promise of denuclearizing the country, Bolton tried to scuttle it. Asked by reporters whether he was loyal to the President, Bolton answered, “I’m loyal to the original policy.”

What did Bolton achieve at the United Nations? Very little, which was fine by him and fine by the cast of nonaligned Ambassadors who oppose a more effective international organization. I asked one of them in December 2006 if he was happy that Bolton was leaving. He said, “No, we’ve learned how to deal with Mr. Bolton.” When I sought clarification, he said, “Look, Bolton comes in and asks for the sun, the moon, and the stars, and we say ‘no.’ He then says, ‘I told you so’ and leaves. Everybody is happy.”

Which returns us to the question of why anyone would want to wade through these 500 self-serving pages. The best answer: to remind yourself of the stakes of this upcoming election and why the United States needs more old-fashioned diplomacy and less paranoia and arrogance. A McCain presidency might not eschew diplomacy, but in the political free-for-all that is the Republican party, Bolton and his minions are always there, ready to denigrate any agreement or compromise, to sabotage and subvert real diplomacy.

Asked by reporters whether he was loyal to the President, Bolton answered, "I'm loyal to the original policy."

To understand the stakes, consider the little known and even less appreciated record of American negotiations with North Korea since 1994. Between what was called the “Agreed Framework” that brought North Korea back into the Nonproliferation Treaty (NPT) in 1994 and the end of 2000, the United States and North Korea reached twenty agreements on a wide array of issues. Certain of these agreements foundered in implementation, but an objective assessment shows that some of the noncompliance stemmed from constraints placed by American domestic politics.

The Bolton strategy killed the Agreed Framework, hoping through threats, sanctions, and use of force to end the North Korean regime. Unfortunately for Bolton—fortunately for the rest of us—our ally South Korea and our necessary partner China did not want to deal with the consequences: either a war or a collapsed, deadly state on their borders. In the end, they did not have to because North Korea left the NPT, developed a nuclear bomb, and tested it, bankrupting the Bolton policy and producing the sharp change of strategy that has born fruit in recent North Korean steps to end its nuclear program.

Writing about the successes of American negotiators in bringing North Korea and the United States back together in February 2007, former State Department negotiator Robert Carlin and Stanford Professor Emeritus John Lewis have described why Bolton and his crowd loathe diplomacy is loathed by Bolton and his crowd, and why it is so necessary:

Diplomats strive to put down words all of them can swallow and hopefully their superiors in [the] capital can stomach. Written agreements are difficult to reach. The pain often comes not so much in dealing with the other side but in dealing with your own. Unless you are dictating terms to a defeated enemy, you are going to have to compromise on something, probably several somethings, that will make many people unhappy. That was done for the February 13th agreement, and there is no shame to it.

John Bolton did much damage to American interests in the first Bush administration, but he was implementing the president’s policy. President Bush deserves the blame for putting Bolton in a position to continue hardming American interests even when the overall direction of policy changed.

Given that many countries treated the United States as radioactive in 2005; given that trust and confidence in the United States were at all time lows; given that our record was one of a violator of international law and human rights; President Bush, had he truly wanted to start to move the United States out of the hole he had been so assiduously digging, would have had to send to the United Nations an ambassador with extraordinary listening skills, who could work across various international chasms, rebuild respect for American diplomacy, and, yes, advocate agreements that would make a lot of people unhappy. Someone, in fact, a lot like our present Ambassador, Zalmay Khalilzad, a naturalized citizen originally from Afghanistan. Instead he sent . . . Yosemite Sam.

So back to January 20. A new American president will take office with grinding wars in Iraq and Afghanistan, a nuclear-armed North Korea, an Iran headed that way, and crises in Sudan, Israel and Palestine, Lebanon, and Pakistan. Our foreign policy is anathema; our reputation in tatters. Throw in big issues like global warming, non-proliferation, catastrophic terrorism, and a potential pandemic of a deadly new influenza. It is hard to see how any of these crises or issues can be solved without sustained international cooperation and strong international institutions. Take global warming: protecting Americans from its ravages will depend on exercising sovereignty to strike deals with other countries whose domestic behavior threatens us and whose security our domestic behavior threatens. A narrow view of sovereignty as the ability to do as we damned well please will be—quite literally—the death of us all.

Surrender Is not an Option: Defending America at the United Nations and Abroad
by John Bolton. Threshold Editions, $27.00 (hardcover)

 

Herbert L. Abrams, CISAC member-in-residence and Stanford professor of radiology, emeritus, looks at the issue of a presidential candidate's age and its effect on decision-making.

At an April 11 symposium in Washington, D.C., Homeland Security Secretary Michael Chertoff said while the best-laid plans are likely to change if a pandemic or bioterrorism attack hits the United States, having no plans in place is a sure guarantee for disaster. CISAC members Lynn Eden, Martha Crenshaw, and Mariano-Florentino Cuéllar participated in "Germ Warfare, Contagious Disease and the Constitution," a daylong event co-hosted by Stanford Law School. CISAC affiliate Laura K. Donohue conceived and developed the project, which aimed to bring together senior policy-makers and legal experts to discuss how issues of constitutional law inform responses to natural pandemics or bioterrorism attacks.

Secretary Michael Chertoff of the Department of Homeland Security delivered the keynote address April 11 at the panel titled “Germ Warfare, Contagious Disease and the Constitution” in Washington, D.C.