Biological Warfare and Terrorism
Biological weapons are deliberately used to produce disease to incapacitate or kill individuals or produce mass casualties. Microbes are deployed to grow in (or on) their target host. Microbial products are used to produce clinical disease. Biological warfare is the sanctioned use of biological weapons by nations in the conduct of war; while biological terrorism is the use of biological weapons by non-state government groups, including religious cults, militants, and “crazies.”
War and Disease
Microbes have always played a large role in battles and wars. Battlefields are conducive to the spread of infectious diseases due to the following: unsanitary conditions and lack of clean drinking water, poor personal hygiene and overcrowding, inadequate supply of safe food, and overwhelmed and inadequate medical facilities. Napoleon’s army was defeated by typhus fever. During the Civil War, infectious diseases killed and incapacitated more soldiers than did all weapons combined. International relief agencies, like the Red Cross and the UN, have played and continue to play a vital role in attempting to minimize the human misery caused by war.
History of Biological Weaponry
There is ample evidence that biological weapons have been used since ancient times. The history of biological weapons is presented over 3 time frames: 1) early history to World War II; 2) World War II to the 1972 Biological Weapons Convention; 3) 1972 to September 11, 2001.
Early History to World War II
In 184 B.C., Hannibal had his soldiers ﬁll pots with “serpents of every kind,” which they hurled onto enemy ships to terrorize the enemy. During the siege of Kaffa in 1346, Tatar military leaders catapulted their own soldiers, who had died from plague, into the city. In Bohemia in 1422, bodies of plague victims and excrement were hurled into the ranks of the enemy. In 1710, Russian troops battling Swedish forces threw their plague victims over the walls into the midst of the enemy. 16th century Spanish conquistadors reportedly gave smallpox-contaminated clothing to native South Americans. General Sherman wrote that Confederate troops shot farm animals in ponds so that their “stinking carcasses” would contaminate the water supplies of the Union forces during the Civil War. During WW I, Germany was accused of using biological warfare by shipping infected horses and cattle to the United States and others. After WW I, the Protocol for the Prohibition of the Use in War of Asphyxiating, Poisonous or other Gases and of Bacteriological Methods of Warfare (i.e., the Geneva Protocol of 1925), was signed by 108 nations, including Iraq. No provisions were made prohibiting the use of microbes for basic research or mandating inspection for purposes of monitoring compliance. These limitations were at the heart of Iraq’s deﬁance of inspections for their alleged production of bioweapons. The Geneva Protocol allowed the retaliatory use of chemical or biological weapons.
World War II to 1972
Japan used biological weapons in China from 1932 to the end of WW II. The Japanese Unit 731 experimented on prisoners from many countries (e.g., Manchuria, Russia, the United States, Great Britain, and Australia). They infected prisoners with Bacillus anthracis, Neisseria meningitidis, Vibrio cholerae, Shigella species, and Y. pestis. Over 3,000 prisoners died at Ping Fan alone. In eleven separate Chinese cities, the Japanese contaminated water and food supplies with a variety of pathogens, throwing cultures into homes, or spraying infective aerosols from aircraft over cities. However, using Vibrio cholerae as a bioweapon backfired on Japanese troops in an attack on Changteh in 1941, causing 1,700 deaths among Japanese troops. The Japanese government later stated that its conduct was “most regrettable from the viewpoint of humanity.” Britain reportedly was prepared to use anthrax in retaliation, if Nazi Germany used biological agents against Britain. The Soviet Union began a bioweapons program during WW II; and in 1942, the United States also started an offensive biological weapons program under the War Reserve Service, a civilian agency. This program was held at Camp Detrick (later renamed Fort Detrick) in Maryland (Figure 15.1). At its peak in 1945, about 2000 scientiﬁc and military personnel were employed there. After the Korean War, the U.S. program focused on retaliatory capability under the jurisdiction of the U.S. Army. Weapons systems using several pathogens were tested there. Major cities in the United States were unknowingly used to test aerosolization and dispersal methods using “harmless bacteria.” Also troubling to learn is that, in 1966, Bacillus globigii was released into the NYC subways to test the effectiveness of dispersal methods.
During the 1960s, international concern peaked regarding the risk, unpredictability, lack of control measures, and the failure of the 1925 Geneva Protocol for preventing biological weapons proliferation. In November, 1969, President Richard Nixon, in a surprising move, terminated the U.S. offensive biological weapons program. A1972 Biological Weapons Convention on the Prohibition of the Development, Production, and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction was held. A treaty was signed by 103 nations and went into effect in 1975. It prohibited the development of delivery systems for bioweapons, and it required destruction of stocks of biological agents, delivery systems, and related equipment. The treaty was ratiﬁed in April, 1972, and went into effect in March, 1975.
1972 to September 11, 2001
As a result of the Biological Weapons Convention of 1972, the biological arsenal at Fort Detrick was destroyed, including agents of anthrax, tularemia, and Venezuelan equine encephalitis and of botulinum toxin, staphylococcal enterotoxin B, and several anticrop biological agents. Fort Detrick shifted to defensive strategies and was placed under the U.S. Army Medical Research Institute of Infectious Diseases. The USSR ignored the 1972 biological weapons treaty it signed. Consequently, on April 2, 1979, people in Sverdlovsk, a city 4 km downwind of a Soviet military facility, went to hospitals with symptoms of anthrax. It was the largest epidemic of inhalational anthrax ever; 77 cases and 66-conﬁrmed deaths resulted (livestock also died). Western intelligence claimed the Sverdlovsk facility was a biowarfare research center and that the epidemic was due to the release of anthrax. The Soviets, however, insisted the sickened citizens ate contaminated meat. In 1992, Russian president Boris Yeltsin admitted that the Sverdlovsk facility was part of an offensive biological weapons program that accidentally released anthrax spores. Yeltsin said he would terminate biological warfare initiatives, however, some believe biological weapons are still being developed.
Iraq also ignored the 1972 biological weapons treaty it had signed. From 1986 to the end of the Gulf War in 1991, Iraqi scientists investigated the potential of a large number of biological weapons, including bacteria, fungi, and viruses, as well as botulinum toxin. In 1990, the UN imposed sanctions on Iraq because of its invasion of Kuwait and the threatened use of biological weapons. Iraq’s failure to allow inspection of its biological weapons by the UN led to air strikes by the United States and Britain in 1998. The alleged possession of weapons of mass destruction by Iraq was a major factor in Iraq being invaded by a multinational force in 2003.
Emergence of Biological Terrorism
Religious cults, terrorists, and other individuals can use biological weapons to further their own personal or political agendas. In 1981, cult followers of Bhagwan Shree Rajneesh contaminated 10 restaurant salad bars in an Oregon community with Salmonella; over 750 people fell ill with Salmonella gastroenteritis. It was intended as a “rehearsal” for a plan to sicken voters on election day in order to influence the outcome of the county elections. In 1995, the Aum Shinrikyo (“Supreme Truth”) cult released sarin gas into a Tokyo subway, killing 11 and making thousands ill. They previously had attempted at least nine biological attacks with pathogens they possessed, with the intent of causing mass murder.
The U.S. congress has responded to the threat of bioterrorism from non-state perpetrators. Recent anti-bioterrorism statutes and directives have been passed: Biological Weapons Act of 1989, Chemical and Biological Weapons Control and Warfare Elimination Act of 1991, and the Anti-Terrorism and Effective Death Penalty Act of 1996 (Table 15.1). In 1997, the CDC was charged with regulating and monitoring the movement of microbes and toxins (Table 15.2).
Assessment of the Threat of Biological Weaponry
There are four major ways in which a public health emergency, including those caused
by biological weapons, threatens a nation’s security: 1) pressure on the economy at both a micro and macro level, 2) social disruption (panic), 3) political destabilization, and 4) interfering with the national defense.
Advantages of biological weapons over chemical or nuclear ones include deadly or incapacitating effects on the target population, low cost (as little as $1.00 per square kilometer), continued microbial proliferation, the diffculty/impossibility of immediate detection, and lack of physical damage to the area. The disadvantages of biological weapons over chemical or nuclear ones include possible danger to the aggressors, the fact that effectiveness can be limited by weather conditions, etc., public backlash, and the environmental persistence of some agents (Table 15.3).
Category A Biological Threats
Biological agents and the diseases they cause are categorized into three groups based on their risk to the national security (category A includes the most dangerous agents). Category A Agents include Anthrax—Bacillus anthracis, Botulism—Clostridium botulinum toxin, plague—Yersinia pestis, smallpox virus, tularemia—Franciscella tularensis and viral hemorrhagic fevers (Table 15.4).
Anthrax (Bacillus anthracis) is the most likely biological weapon, and it is thought to be in the arsenal of at least 10 countries (Figure 15.2). Also, genetically engineered strains of anthrax may exist. B. anthracis spores easily disseminated by bombs, artillery shells, etc. Anthrax spores are resistant to heat and chemicals so they are hard to kill and can remain viable in soil for 50 years or more. Inhalation anthrax has the highest mortality rate (99%, if untreated). Antibiotics may be effective if administered within 24 - 48 hours. Iraq had produced 8,000 liters of weaponized anthrax spores. The acellular anthrax vaccine has several drawbacks (5- 6 injections are required, it needs an annual booster, its effectiveness is unproven for inhalation anthrax, etc.).
Smallpox, the ﬁrst disease to be eradicated, is now a top biological weapon candidate. The current lack of herd immunity makes a population highly susceptible. It is feared that covert stocks of the virus may be in the hands of hostile groups. Smallpox is transmitted directly from person-to-person by infected droplets of saliva; the mortality rate is 30%. The early signs are high fever, fatigue, headaches, and backache, followed in a few days by a disfiguring rash and blisters over the entire body. The United States, Germany, the United Kingdom, France, and Israel all have stockpiled enough vaccine to treat 100% of their populations. However, vaccine coverage is below 1% in many countries. The occurrence of adverse side effects, though rare, is the reason given for not vaccinating the entire populace before there is an attack.
Countermeasures to Biological Weaponry
The U.S. government’s plans for coping with potential bioterrorism are as follows: Charge the CDC with handling of and controlling access to pathogens (this includes monitoring of the facilities and procedures currently in use with these agents). Carry out surveillance and rapid detection using the number of sick people and their symptoms to assess if a biological agent has been released. Aim to strengthen the public health response at the local level by improving mass immunization or prophylactic management capabilities. Improve methods for safe disposal of the deceased and infection control. Create a stockpile of pharmaceuticals and vaccines as a national resource, with ability to reach victims within 24 hours. Expand support for research and development of rapid diagnostic methods, new vaccines and new or improved antimicrobial agents.
More recently, the United States has placed emphasis on the coordination of clinical, public health, and law enforcement activities to deal with suspected bioterrorism. Hospitals, ﬁre and police departments, and other agencies charged with protecting the public have developed strategic plans to cope with disaster (Figure 15.3).
In the Aftermath of September 11, 2001
Anthrax spores were used as a bioweapon two weeks after Sept. 11th. On Sept. 25th, an assistant at NBC developed cutaneous anthrax. Other attacks soon followed: two at NBC, one at CBS, three at the New York Post, and one at ABC. The buildings housing these offices tested positive for anthrax spores. The offices of Senators Tom Daschle and Patrick Leahy and dozens of personnel were contaminated on Oct. 14th by letters with “anthrax powder.” Two postal workers died in the Wash., DC area; mail served as the vector for anthrax spores. People hoarded ciproﬂoxacin in a buying frenzy of the antibiotic. The USPS instituted new security measures (Figure 15.4). Security in and around airports was heightened to protect the ﬂying public. Fire and police departments were overwhelmed with calls to check out “suspicious powders,” and emergency rooms filled with people fearful that they had been exposed to anthrax spores. So what do we do? As stated in an earlier chapter, we must avoid an epidemic of fear.