When Greg Burel tells people he's in charge of some secret government warehouses, he often gets asked if they're like the one at the end of Raiders of the Lost Ark, where the Ark of the Covenant gets packed away in a crate and hidden forever.
"Well, no, not really," says Burel, director of a program called the Strategic National Stockpile at the Centers for Disease Control and Prevention.
Thousands of lives might someday depend on this stockpile, which holds all kinds of medical supplies that the officials would need in the wake of a terrorist attack with a chemical, biological or nuclear weapon.
The location of these warehouses is secret. How many there are is secret. (Although a former government official recently said at a public meeting that there are six.) And exactly what's in them is secret.
"If everybody knows exactly what we have, then you know exactly what you can do to us that we can't fix," says Burel. "And we just don't want that to happen."
What he will reveal is how much the stockpile is worth: "We currently value the inventory at a little over $7 billion."
But some public health specialists worry about how all this would actually be deployed in an emergency.
"The warehouse is fine in terms of the management of stuff in there. What gets in the warehouse and where does it go after the warehouse, and how fast does it go to people, is where we have questions," says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University.
I recently asked to go take a look at one of the warehouses, and was surprised when the answer was yes. I was told I was the first reporter ever to visit a stockpile storage site.
Since I had to sign a confidentiality agreement, I can't describe the outside. But the inside is huge.
"If you envision, say, a Super Walmart and stick two of those side by side and take out all the drop ceiling, that's about the same kind of space that we would occupy in one of these storage locations," Burel says.
A big American flag hangs from the ceiling, and shelves packed with stuff stand so tall that looking up makes me dizzy.
"We have the capability, if something bad happens, that we can intervene in a positive way, but then we don't ever want to have to do that. So it's kind of a strange place," says Burel. "But we would be foolish not to prepare for those events that we could predict might happen."
The Strategic National Stockpile got its start back in 1999, with a budget of about $50 million. Since then, even though the details aren't public, it's clear that it has amassed an incredible array of countermeasures against possible security threats.
The inventory includes millions of doses of vaccines against bioterrorism agents like smallpox, antivirals in case of a deadly flu pandemic, medicines used to treat radiation sickness and burns, chemical agent antidotes, wound care supplies, IV fluids and antibiotics.
I notice that one section of the warehouse is caged off and locked. Shirley Mabry, the logistics chief for the stockpile, says that's for medicines like painkillers that could be addictive, "so that there's no pilferage of those items."
As we walk, I hear a loud hum. It's a giant freezer packed with products that have to be kept cold.
Just outside it, there are rows upon rows of ventilators that could keep sick or injured people breathing. Mabry explains that they're kept in a constant state of readiness. "If you look down to the side you'll see there's electrical outlets so they can be charged once a month," she says. Not only that—the ventilators get sent out for yearly maintenance.
In fact, everything here has to be inventoried once a year, and expiration dates have to be checked. Just tending to this vast stash costs a bundle — the stockpile program's budget is more than half a billion dollars a year.
And figuring out what to buy and put in the stockpile is no easy task. The government first has to decide which threats are realistic and then decide what can be done to prepare. "That's where we have a huge, complex bureaucracy trying to sort through that," says Redlener.
The process goes by the clunky acronym PHEMCE and involves agencies from the Department of Defense to the Food and Drug Administration. They're looking to acquire or develop products that can meet the threats.
"A lot of under-the-hood, background work goes into identifying what the size, the scope, the special needs are, and what medical countermeasures exist or need to be made," says George Korch, senior adviser to the assistant secretary for preparedness and response at the Department of Health and Human Services. "That then drives the rest of the process for research, development, procurement, stockpiling, et cetera."
There is often debate, he says, but at the end of the day they have to reach a consensus and move forward.
"We could start stockpiling cobra antivenom if we really wanted to, but should we?" says Rocco Casagrande, who runs a consulting firm called Gryphon Scientific.
The government recently hired Gryphon to do an analysis of how well the stockpile was positioned to respond to a range of scenarios based on intelligence information. "The studies that were done before have all been one-off. They've all been looking at a single type of attack at a time, or a single type of weapon of mass destruction," says Casagrande. "They haven't looked across all threats to make decisions about whether you should buy A versus B."
The results can't be discussed publicly, says Casagrande, but "one thing we can say is that across the variety of threats that we examined, the Strategic National Stockpile has the adequate amount of materials in it and by and large the right type of thing."
The trouble is, increasingly the new medicines chosen for the stockpile have some real limitations.
"These are often very powerful, very exciting and useful new medicines, but they are also very expensive and they expire after a couple years," says Dr. Tara O'Toole, a former homeland security official who is now at In-Q-Tel, a nonprofit that helps bring technological innovation to the U. S. intelligence community.
O'Toole chairs a recently formed committee at the National Academies of Sciences, Engineering and Medicine, which the government asked to study the stockpile program and offer advice. She says as the inventory of the stockpile goes up and up, the budget to maintain that inventory is staying flat.
"This is an unsustainable plan," she says. "And we don't think there's enough money to do what the stockpile says it must do, already."
That's because getting stuff out of the stockpile to the people who would need it is a major challenge. Imagine if there's a major anthrax attack, and there's just 48 hours to get prophylactic antibiotics to more than a million people.
"It is not going to be easy or simple to put medicines in the hand of everybody who wants it," says O'Toole.
Back at the warehouse, Mabry and Burel show me all the ways they're set up to expedite delivery. For example, one of the first things you see when you walk into the warehouse is rows of 130 shipping containers. "This is the 12-hour push package, approximately 50 tons of material," says Mabry.
This collection of stuff could help after a variety of disasters, and it's designed to be delivered to a city or town within hours. Mabry shows me how the outside of each container has a pouch. "That has the information that anyone would need if they were to receive this, so they could very easily identify what is in this," she explains.
The people who would receive this container — or anything else from the stockpile — are state and local public health workers. They're the ones who have to figure out how get pills into mouths and shots into arms.
But local public health officials have had budget cuts and are drastically underfunded, says Paul Petersen, director of emergency preparedness for Tennessee.
"Many jurisdictions across the U. S. have less staff and less resources available to them to surge up in large-scale events," says Petersen. "I mean, that's a risk."
While they do have plans for emergencies, and lists of volunteers, he says, "they're volunteers. And they're not guaranteed to show up in the time of need."
Over and over, I heard worries about this part of the stockpile system.
"We have drastically decreased the level of state public health resources in the last decade. We've lost 50,000 state and local health officials. That's a huge hit," says O'Toole, who wishes local officials would get more money for things like emergency drills. "The notion that this is all going to be top down, that the feds are in charge and the feds will deliver, is wrong."
She'd also like to see more interest from Congress in all of this — because it's a national security issue. "These will be do-or-die days for America, should they ever come upon us," O'Toole points out.
And having a stockpile in a warehouse will be just the beginning.
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