Tara O'Toole, MD, deputy director of the Center for Civilian Biodefense Studies at the Johns Hopkins Bloomberg School of Public Health, discussed the threat that bioterrorism poses for major cities during a national videoconference moderated by Baltimore Mayor Martin O'Malley. The videoconference, sponsored by the U.S. Conference of Mayors, was held October 1, in Washington, D.C., and is the first in a groundbreaking series of discussions geared toward helping mayors across the country stay up to date on the latest efforts, information, and ideas on urban emergency preparedness in the wake of recent terrorist attacks. The event centered the threat of bioterrorism on major U.S. cities. Dr. O'Toole focused on the current threat cities face, what cities can do to prepare for and deal with a biological event, and how cities can best coordinate with the federal government on their response to bioterrorism. "There really are a great number of things that can be done beforehand to mitigate the consequences of a bioterror attack," says Dr. O'Toole. According to Dr. O'Toole, cities need to review and update their emergency plans and communications. Doctors and emergency workers must be trained to recognize and report strange illnesses to authorities. Most doctors have never seen a case of smallpox, anthrax, and many other diseases that could be used as potential weapons, but an outbreak of an unknown illness could be the first sign of a bioterrorism attack. "I can't emphasize enough how important it is that clinicians be alert to the threat of bioterrorism," adds Dr. O'Toole. A communications network is also needed to quickly report information to public health officials so that a properly coordinated response can be taken in the event of an outbreak. Rapid warning and testing systems will also be needed as well as adequate supplies of vaccines and antibiotics. "Because of our population bases, American cities are the frontlines of any possible terrorist attacks, biological and otherwise. As mayors, we must be ready to respond or prevent these events," Mayor O'Malley told the participants. "The goal is to mobilize our resources and share information—not only intracity but intercity as well." Mayor O'Malley added that his top priority, since the events on September 11, has been to prepare Baltimore's effective and efficient response in the face of a crisis. His administration says it has taken steps to increase security, including daily security briefings with city departments, securing and protecting the city's vulnerabilities, working closely with hospital CEOs on areas of preparedness, data collection, and training personnel—specifically those who work in water and wastewater facilities. The mayor also issued an executive order requiring all city employees to display picture identification in any and all city buildings. The U. S. Conference of Mayors is the official nonpartisan organization of cities with populations of 30,000 or more. There are about 1,200 such cities in the country today. The Johns Hopkins Center for Civilian Biodefense Studies was established to increase national and international awareness of the medical and public health threats posed by biological weapons, thereby augmenting the potential legal, political, and moral prohibitions against their use. The offices of 225 mayors from across the country participated in the videoconference event. ### For more information on civilian biodefense and public health preparedness, visit the Johns Hopkins Bloomberg School of Public Health online at www.jhsph.edu. Visit the U.S. Conference of Mayors online at www.usmayors.org to view the archived videoconference. | 
