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Anatomy of a Crisis 7 Republican-dominated Congress. Details of Iraq’s biological weapons program emerged in 1995, causing a great amount of introspection as to what defensive capabilities the U.S. military should have for future com- bat operations. Two terrorism incidents in 1995—Aum Shinrikyo’s use of nerve agent in Tokyo’s subway and the Oklahoma City bombing—led the U.S. government to develop a Terrorism Annex within the Federal Response Plan, which identified federal responsibilities to respond to acts of chemical, biological, and radiological (CBR) terrorism. The DoD coun- terproliferation concept grew to include military capabilities to respond to terrorist use of WMD. The H5N1 influenza outbreak in Hong Kong in 1997 also caused some concern but did not significantly impact the United States. Between 1994 and 2000, President Clinton issued a number of executive orders addressing domestic terrorism and WMD preparedness, perhaps based on his reading of the Richard Preston’s novel The Cobra Event and Laurie Garrett’s The Coming Plague, which counseled the need for proac- tive initiatives against epidemic outbreaks.14 He released a presidential decision directive in 1996 that called for enhancing U.S. public health sur- veillance and response capabilities and increasing research on emerging infectious diseases.15 He directed the development of a National Pharma- ceutical Stockpile under the CDC that would be responsible for respond- ing to state requests for medical support against chemical and biological incidents. Congress also passed a “Defense Against WMD Act” in 1996 that directed the Federal Emergency Management Agency, Department of Health and Human Services (HHS), and DoD to develop capabilities that would assist states in responding to domestic CBR terrorism incidents. The Clinton administration also had to face the appearance of the West Nile virus in the United States in 1999, which caused some concern by its quick spread through the northeast. At the time, individuals within the U.S. government suggested the use all government capabilities to identify a deliberate biological incident as soon as possible, but there was no action to implement such an effort. In January 2000, the National Intelligence Council produced a National Intelligence Estimate (NIE) titled “The Global Infectious Disease Threat and Its Implications for the United States.” This was perhaps the first time the intelligence community had reviewed infectious disease outbreaks as a national security issue, directed through a presidential executive order. The NIE warned that the spread of new and reemerging infectious dis- eases would pose a “rising global health threat and [would] complicate US and global security over the next 20 years.” In particular, seven diseases were seen as major killers—tuberculosis, malaria, hepatitis, HIV/AIDS, acute lower respiratory infections, diarrheal diseases, and measles. The report noted the lack of a global health surveillance and response system as a significant factor. The United States, as a major hub for global travel,