In recent days, the public has become increasingly concerned with the threat of “bioterrorism.” Bioterrorism, encompasses no one discipline or field of study, but rather represents a general phrase that encompasses an emerging threat to civilization. It brings together experts from a variety of scientific and public disciplines, including engineers, microbiologists (and their associated disciplines such as biochemistry and genetics), physicians, epidemiologists, law enforcement and other government agencies, and even non-scientific academics such as sociologists and historians. Bioterrorism, however, has been so sensationalized by the media, that now its perceived threat is far greater than its actual threat. Bioterror agents—anthrax, for example, which was the choice weapon of the 2001 attacks against Congress—are more accurately named a “weapon of mass hysteria.” It is very difficult, complicated, and expensive to manufacture an effective bioweapon. Yet the use of such a weapon, an effective one, could cause lethal harm and irrevocable damage. Although we have made notable preventative and precautionary measures against bioterrorism, they have not all been implemented.
BIOTERRORISM – THE HISTORICAL PERSPECTIVE
Bioterrorism is not something new, but familiar—and something in which our capabilities are considerable. Historically, bioterrorism reverts back to antiquity, to Greece, Rome, and later the Medieval Ages and Renaissance, where besiegers hurled rotting corpses into fortresses to spread disease among their defenders. Centuries later, during World War II, it is suspected that Japan dropped millions of fleas infected with bubonic plague into Chinese cities. Both the Japanese and the Nazis experimented with live subjects in an effort to understand how to make their bioterror agents more deadly. Other nations, including the United States, Japan, Germany, Iraq, China, North Korea, and especially the former Soviet Union have developed or sought to develop bioweapons and biological warfare programs.
There is no specific quantity or quality of organisms that can be used in bioterrorism. Although, bacterial and viral pathogens are the agents of choice, higher parasites, such as the eggs from parasitic roundworms, which were used to infect a number of university students in Montreal in 1970, are also heavily recruited. Therefore, when considering bioterrorism, it is important to include many types of organisms and their products, so that one makes a comprehensive investigation.
In October 2001, envelopes powdered with anthrax were mailed to various members of Congress and other prominent public figures, like Tom Brokaw. The press, however, spread unreasonable fear and panic before they had any real information on the nature and danger of the organism itself. The postal workers who handled the contaminated letters sent to the Capitol, Senators, Congressman, and their staffs, and Tom Brokaw of NBC and his staff did in fact warrant concern and attention, but of the probable thousands that were exposed to the anthrax spores, only 50 tested positive for exposure. Furthermore, only 11 patients were diagnosed with the most fatal type of anthrax (inhalation, or respiratory, anthrax), and of these 11 patients, six were saved by an aggressive antibiotic treatment.
Anthrax, in fact, is an ineffective bioweapon. First, it is not contagious. Second, its manufacture and preparation is complex and readily susceptible to failure. The bacterium has to be grown in a suitable culture to cause spore formation, and the spores themselves must be ground into very small particles, a process which many times permanently damages the spores. Terrorists, therefore, who desire to use anthrax, would require access to a sophisticated laboratory. Third, unlike viruses, anthrax can be treated successfully with antibiotics, especially during the early stages of the disease. Terrorists could theoretically develop an anthrax bacterium that is resistant to antibiotics, but in many cases, such resistance leads to defective organisms, which cannot produce spores. Once the bacterium is established in the body, however, it secretes potent toxins, which are not vulnerable to any antibiotic, and therefore require the use of a vaccine. At present, only the military has access to such vaccinations, which during a national emergency could be distributed to the public. So anthrax is an ineffective bioweapon, because it is not contagious, is difficult to manufacture, and can be combated with antibiotics and vaccines.
BIOTERRORISM TODAY: STATE OF THE ART AND PREPAREDNESS
A Congressional initiative in 1999 began upgrading our public health and public safety capabilities to counteract a potential bioterror attack. Congress designated the Center for Disease Control and Prevention (CDC) as the primary agency to coordinate all activities related to bioterrorism. The CDC considered and analyzed a wide array of topics, including planning, surveillance, diagnostics, therapy, law enforcement, stockpiling of drugs and vaccines, and a hierarchy of pathogens based on their lethality. It was not until the anthrax attack of 2001, however, that the governmental and scientific communities were really galvanized into action.
CDC’s first step was to create a comprehensive analysis of potential bioweapons. It carefully scrutinized population demographics and national, food, water, and air supplies. CDC immediately publicized two guidelines that had been developed in 1999 by pathologists and other scientists, which remain the best approach. These guidelines developed processes to evaluate and analyze potential bioterrorist agents and then organize them into a hierarchy of three classes, based on the following factors: degree of threat, mortality, contagiousness, public perception, preparation.
Furthermore, in 2003 the National Institute of Health (NIH) proposed a bio-defense research plan that integrates basic and applied research; it will cost more than $1.7 billion, if implemented. The NIH advises the construction of high containment laboratories at various research centers, an increase in research on bioterror agents, the expansion of training programs, the testing of new drugs and vaccines, the establishment of repositories for such drugs and vaccines, the development of clinical trials for all drugs and vaccines, and an incentive for industry in the overall effort. Following their suggestion, Congress recently passed a new program called Bioshield; it is a 10-year, $5.6 billion bill that guarantees the federal government will purchase any effective biodefense and accelerate its approval time. This bill is designed to provide financial assurance for pharmaceutical and biomedical companies nervous about investing in limited markets like biodefense. As a direct result of this bill, such private firms have joined with government facilities in biodefense research and have increased cooperation between themselves and related foreign firms. This cooperation has led to the creation of vaccines for the Ebola virus and the Marburg virus by scientists from the Public Health Agency in Canada and the U.S. Army Medical Research Institute in Maryland. Another government laboratory, Lawrence Livermore Labs in California, is designing and testing a "Pathogen Detection System.” This portable laboratory, the size of a small refrigerator, can rapidly test for over 90 separate pathogens from anthrax to the Plague. Congress is continuing to author bills to improve our national security against bioterrorism.
Our most serious problem concerning bioterrorism is the implementation of our federal mandated preparations, especially in the states themselves. Despite massive defense spending, efforts are lagging in the states. Although all 50 states have plans approved by CDC, 26 states have failed to spend their allotted bioterror funds, 39 states have not made information about specific diseases available to the general public, and 48 states do not have enough trained staff to receive and distribute supplies and medicine from a national repository. Only four states, according to the independent Trust for America’s Health, are adequately prepared for a bioterrorist attack. Such low rates of preparedness are attributed to state budget cuts and to state bureaucracies, where there are disagreements between health agencies in the capitol and those throughout the rest of the state. If we are to be able to mitigate the horrors of bioterrorism, every state must be adequately prepared; their current state of preparedness is completely unacceptable.
The perceived threat of bioterrorism is far greater than the actual threat because of the difficulty of manufacturing an effectice biological weapon. Yet, in the event that terrorists do create an effective bioweapon, especially with the advent of state-sponsored terrorism in countries like Iran, North Korea, and Saudi Arabia, it would wreak unmitigated havoc. Therefore the federal government must adopt and has adopted a series of preventative measures and templates to combat and contain a successful bioterrorist attack. These measures must be implemented; failure is unacceptable. We must always be prepared, so that we may always be free.