Is the U.S. Ready for a Nuclear Attack?

Emergency nuclear response programs across several federal agencies have been quietly updating existing preparedness plans in recent months, but one expert warned that the U.S. is still not ready for a potential radiological disaster.

With occasional news reports of hostile nuclear-armed nations and summer blockbusters — like “Oppenheimer” — re-stoking fears of nuclear fallout, dozens of federal and local government agencies have engaged in efforts to address potential shortfalls or gaps in preparedness planning for a potential nuclear emergency.

“We just came out of a pandemic, and you can see that there’s a lot of gaps when it comes to coordination [and] messaging,” Amesh Adalja, MD, of Johns Hopkins University Center for Health Security in Baltimore, told MedPage Today. “All of that is going to be very critical for response to an IND [improvised nuclear device] explosion.”

He noted that the nation’s current nuclear and radiological emergency response would be run by a complex combination of government agencies, including HHS’s Administration for Strategic Preparedness & Response (ASPR), the CDC’s National Center for Environmental Health, the Environmental Protection Agency, the Federal Emergency Management Agency, the Department of Energy’s Nuclear Emergency Support Team, the FDA, and local and state healthcare systems.

Adalja reassured that the steady drum beat of announcements from these agencies about their nuclear emergency preparedness planning should be commonplace, since the nation continually upgrades and maintains these programs.

Quiet Nuclear Preparedness Planning

The availability of medical countermeasures is a key aspect of preparedness for nuclear emergencies, according to Adalja. He noted that maintaining the national stockpile is one way that governmental offices can focus on preparing for such a crisis, and this requires upkeep.

In April, the FDA released draft guidance on developing drugs for acute radiation syndrome (ARS), which came amid numerous announcements related to new and existing treatments for radiation exposure.

Last week, RedHill Biopharma announced that it was awarded nearly $2 million in U.S. funding to develop opaganib, a novel oral therapy for gastrointestinal ARS, which will have a 5-year shelf-life for the Strategic National Stockpile.

In May, the first-in-human, NIH-funded clinical trial of an oral drug to remove radioactive contamination began, which will determine the safety and tolerability of the experimental therapy HOPO 14-1.

Both treatments would reportedly be easier to stockpile and deploy during an emergency than the two existing FDA-approved intravenous drugs for removing internal radioactive contamination.

However, the existing treatments for ARS have also been receiving new attention. ASPR announced last year that it would purchase a supply of romiplostim (Nplate), an FDA-approved treatment for blood cell injuries related to ARS in adult and pediatric patients. The agency emphasized that this purchase was “part of long-standing, ongoing efforts to be better prepared to save lives following radiological and nuclear emergencies.”

Local governments have also recently gotten into the planning game. Last year, New York City released a public service announcement that outlined three simple steps for residents to take should a nuclear detonation happen: “Get inside. Stay inside. Stay tuned.”

Sen. Edward Markey (D-Mass.) also announced efforts to increase resources for these preparedness programs and to strengthen rules around the protocols of nuclear weapons in the U.S.

In February, Markey announced in a tweet that he had introduced the Nuclear Meltdown and Fallout Prevention and Preparedness Act on the 1-year anniversary of the war in Ukraine. He also introduced proposed amendments to the National Defense Authorization Act to prohibit the use of artificial intelligence in use of nuclear weapons.

All of these updates were announced or implemented in the past 12 months, but there has been no specific announcement of a larger coordinated government effort to improve nuclear emergency preparedness.

However, Adalja noted that increasing the national stockpile of drugs for ARS is just one piece of a vast, complex preparedness puzzle.

“The medical countermeasures are important,” Adalja said. “It’s part of a portfolio of preparedness that’s necessary, [but] it’s not going to just be medical countermeasures. A lot of it is communication and coordination.”

Constant Need for Preparedness Planning

Adalja noted that it is not surprising that these government agencies and officials would be taking steps to improve overall preparedness.

“When you think about IND, the biggest thing that you have to think about is the infrastructure needed to be able to deal with that,” he said. “The biggest issue to me is going to be public health communication.”

“It’s a cascade,” he added. “A lot of the stuff that has to happen is communication, and cities have to have a coordinated way of telling the population things that are really important.”

Adalja emphasized that coordination and communication are so important because the wrong information could increase people’s exposure to radiation unnecessarily. While the medical countermeasures are important for people with direct exposure, public health messaging can also reduce the number of people who will ultimately need those measures in the first place.

“People have to know, first of all, that staying in your house will actually probably shield you from radiation for some period of time,” he explained. “Or if you’re outside, taking off your clothes and taking a shower is going to decrease the amount of radiation that resides in your body.”

“Certain individuals may or may not benefit from potassium iodide, although there will probably be a surge in demand, just like there was after the Fukushima nuclear incident,” he said. “The people that actually benefit from that, it’s probably going to be much smaller than the actual people that want it.”

Some people who are exposed to moderate levels of radiation will still need to get blood work to determine whether they might benefit from certain growth factors or antibiotics to prevent infection, he added.

Adalja pointed out that government agencies are likely simply following standard practices, noting that more work should be done to improve the overall infrastructure of communicating with the public in the event of a nuclear emergency.

“Our preparedness is going to be inadequate,” he said. “When you look at the public health infrastructure problems we had during COVID, those same issues would likely crop up in this type of a response.”