Next month, in a closed-door meeting in Atlanta, FBI and other intelligence agents will meet with physician experts on germ and chemical warfare and radiation to figure out what therapies should be bought next.
On the table are experimental treatments for hemorrhagic fevers and smallpox, the proper supply of antitoxin for botulism, and a new cyanide antidote that may replace one some experts call antiquated.
And while the stockpile has lots of antibiotics that prevent anthrax infection, it doesn't include some drugs that may be key to treating an already sick person.
``Everything is up for grabs,'' said Steven Bice, who runs the National Pharmaceutical Stockpile. ``We'll review our entire formulary.''
Most Americans had never heard of the federal stockpile until the fall anthrax attacks. The Centers for Disease Control and Prevention started it in 1999, spending $150 million over the next three years quietly purchasing antidotes -- fortunately, starting with antibiotics that can fend off anthrax. Those drugs were a good buy: Many also can treat plague and tularemia, other potential bioterror agents.
When anthrax struck, the government swiftly spent more than half a billion dollars pumping up the stockpile, adding 100 million more doses of anthrax-fighting Cipro and enough smallpox vaccine for every American. The latest buy: millions of potassium iodide tablets, used to prevent thyroid cancer after release of radioactive iodine.
Now the big question is what to buy next.
CDC won't release an entire list of the stockpile's contents, citing security. Likewise, next month's meeting between intelligence officials and CDC-picked physicians on which pathogens top the threat list is closed to the public.
But some options will generate serious debate.
