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Introduction

“These are interesting times. Concerns for the use of nuclear warfare against the United States, originally dating back to the Cold War, are now steadily increasing,” Tener Veenema, professor, Johns Hopkins University School of Nursing and Bloomberg School of Public Health, stated in her welcoming remarks at Exploring Medical and Public Health Preparedness for a Nuclear Incident: A Workshop. The workshop, held on August 22–23, 2018, in Washington, DC, was hosted by the Forum on Medical and Public Health Preparedness for Disaster and Emergencies (the Forum) of the National Academies of Sciences, Engineering, and Medicine (the National Academies). The event brought together experts from government, nongovernmental organizations, academia, and the private sector to explore current assumptions behind the status of medical and public health preparedness for a nuclear incident, examine potential changes in these assumptions in light of increasing concerns about the use of nuclear warfare, and discuss challenges and opportunities for capacity building in the current threat environment (see Box 1-1 for the workshop’s complete Statement of Task).¹

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¹ The role of the workshop planning committee was limited to planning the workshop. This Proceedings of a Workshop was prepared by the rapporteurs as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting consensus on the part of the planning committee, the forum, the National Academies, or any other group.

During her opening remarks, Veenema laid the foundation for the rest of the workshop by discussing realities surrounding the present risk of nuclear attacks, beginning with the fact that there are five officially recognized nuclear weapons states in the world: China, France, Russia, the United Kingdom, and the United States. Of these, Russia and the United States possess approximately 90 percent of the weapons, and the weapons are not distributed equally between the two. In addition, four other countries are known to possess nuclear weapons: India, Israel, North Korea, and Pakistan. Altogether, Veenema said, the world’s current collection of

15,000 nuclear weapons possesses enough power to destroy many cities and kill millions of people.

As far back as 2010, the first National Health Security Strategy (NHSS) stated that the American people face no greater or more urgent danger than a terrorist attack using a nuclear weapon (HHS, 2009), Veenema continued. More recently, in its annual announcement in January 2018, the Science and Security Board of the Bulletin of the Atomic Scientists warned that leaders are failing to act with the speed and scale required to protect citizens from the extreme dangers posed by both climate change and nuclear war (Bulletin of the Atomic Scientists, 2018). Now, in light of the current intensifying geopolitical tensions between countries in possession of nuclear weapons, the need for medical and public health systems with the capacity to accommodate a sudden, unanticipated surge of victims and a workforce capable of responding to a nuclear incident is of critical importance, Veenema stressed.

James Blumenstock, chief, health security, Association of State and Territorial Health Officials, provided some additional opening remarks. In addition to the NHSS document that Veenema mentioned (HHS, 2009), he called attention to another federal document, the 2018 National Defense Strategy (DoD, 2018), where it is stated that it is now undeniable that the United States is no longer a sanctuary but a target of potential attacks. Clearly, Blumenstock said, a nuclear threat is one of the elements in the CBRN (chemical, biological, radiological, and nuclear) spectrum that is of critical concern and importance. This, in large part, is why this particular assembly of experts was convened, he said, referring to the many representatives of the health care and public health community responsible for preparing to manage the consequences of such acts of aggression.

Blumenstock noted that while the workshop was initially planned to include a focus on radiation in addition to nuclear incident preparedness, it did not take long for the planning committee to realize that the workshop needed to more narrowly focus on the current imminent threat. Because of their scientific similarity, radiation and nuclear threats are usually lumped together, but in this case the planning committee decided to split them. Notwithstanding the similarities between the two threat scenarios, there are substantial differences in planning assumptions, response, tactics and strategies, and the consequences of the disaster. Thus, the committee chose to focus on nuclear incidents, specifically the weapons of mass destruction that Veenema mentioned.

Both Veenema and Blumenstock encouraged active engagement of the audience over the course of the workshop. To foster interactivity, in addition to keynote and other speakers, there were several panel discussions and question-and-answer periods throughout the agenda (the workshop agenda is provided in Appendix A).

ORGANIZATION OF THE PROCEEDINGS

The organization of these proceedings largely parallels the organization of the workshop itself. Chapter 2 focuses on federal planning for nuclear incidents. Chapter 3 focuses on the current state of preparedness at the state and local levels. Chapter 4 addresses updating planning assumptions for nuclear incidents. Chapter 5 discusses communication, education, and information challenges of nuclear events. Chapter 6 addresses challenges for building capacity to respond to nuclear incidents across the health care system. Chapter 7 discusses building response and recovery capability following a nuclear incident. Chapter 8 focuses on workforce readiness for nuclear incidents. Chapter 9 discusses takeaways identified by workshop session moderators. Chapter 10 recounts the closing remarks.