Weapons Used in Bioterrorism

Weapons Used in Bioterrorism

The nature of terrorism is such that it uses fear as a means of intimidation. Thus, bioterrorism uses biological agents to instill that fear. Victor Sidel, MD,^[5] Distinguished Professor of Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, New York City, reviewed the nature of terrorism, and its effects. The incitement of extreme fear can lead to political and economic destabilization. The identification of symbolic or random targets further contributes to people’s fear and anxiety.

The agents of terror include small arms/light weapons, explosives, incendiaries, chemical weapons, and biological weapons. Dr. Sidel described how anthrax was stockpiled and tested during World War II. In the recent past, the US military began immunizing members of the armed forces against certain biological weapons, including anthrax. However, this required immunization became controversial because of uncertainty regarding the vaccine’s effectiveness and the attendant side effects. Some members of the military were dismissed when they refused to be immunized.

Dr. Sidel also addressed the issue of smallpox, which had been virtually eliminated from the globe by 1979 but could be a devastating biological weapon. When smallpox was declared eradicated, only 3 samples of the virus remained in the world. Current concern about smallpox is fueled largely by past reports from Soviet Union defectors that some Soviet scientists had continued to weaponize smallpox. The current concern is exacerbated by the suspicion that people with the intent to incite terror may now have samples of the organism. Consequently, the US Government has ordered an increase in the manufacture of smallpox vaccines so that they are available in the event that they are needed.

The Effects of War on Public Health

War creates large numbers of refugees and displaced persons, drains financial and human resources, poisons the environment, and supports violence and military engagement as a legitimate approach to settling disputes. In a seminar entitled “War and Public Health”, Barry Levy, MD, MPH,^[1] past President of the APHA, described some of the long-term physical and mental effects of war, listing 10 issues that need immediate attention from the public health community:

 

• Improving the public health infrastructure so that it is sufficient to combat terrorism
• Improving the public health infrastructure’s ability to address a wide range of public health issues
• Educating and informing the public so that it can deal appropriately with threats
• Supporting policy and programs aimed at providing adequate mental health services
• Ensuring protection of the environment, particularly food and water
• Preventing hate crimes and promoting civil liberties
• Protecting civilian communities
• Reducing poverty and disparity throughout the world
• Controlling and eliminating biological and nuclear weapons
• Ending armed conflict in Afghanistan

 

Many of the concerns described by Dr. Levy were previously reflected in a joint statement by the Public Health Association of New York City and the APHA, released soon after the September 11 attacks in New York City and Washington, DC.

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While strongly condemning all acts of terrorism, the statement urged public health workers throughout the United States to work to prevent responses of bias, hatred, vengeance, and violence in local communities. It also called for “…local, national and international policies to alleviate social and economic disparities, health disparities, injustices and violations of human rights that contribute to hatred, conflict and violence.”

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On Overview of Current Threats to Public Health

Bioterrorism raises issues that need to be addressed globally. Robert Gould, MD,^[7] President of Physicians for Social Responsibility and the Peace Caucus of the APHA, emphasized this expanded focus during his overview of current threats to public health and assessed US responses to these threats.

Approximately 70 different types of germs can be “weaponized” for use as agents of biological warfare. The term “weaponized” refers to packaging or treating an agent so that it becomes easier to distribute to a large area. For example, manufacturing anthrax spores as a fine powder increases the ability of the spores to become airborne and be inhaled.

According to Dr. Gould about 11 nations have the capacity to develop biological agents. But the ability to weaponize biological agents is limited.

Approximately 30% of the diseases that would be caused by the known available agents can be treated, Dr. Gould said. However, this percentage does not take into account the potential for genetic engineering and its potential contribution to exacerbating problems caused by currently treatable organisms. He described 4 current objective threats to the public’s health. These threats include:

 

• Emerging infectious diseases, such as tuberculosis and West Nile Virus and serious outbreaks of salmonella
• Recent incidents of terrorism, including bombings and the use of sarin gas in the Tokyo subways in 1995.
• Use of Fusarium oxysporum, an agent the United States is urging Colombia to use for eradication of cocoa plants
• Hoaxes, particularly those seen in the aftermath of confirmed reports of anthrax exposure in New York City and Washington, DC

 

Tuberculosis (TB) is the most significant reemerging infectious disease; it has once again become endemic in some areas of the United States. For example, The New York State Department of Corrections reported a 500% increase in the incidence of TB between 1985 and 1991.

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Many of these cases were attributed to a multi-drug resistant strain of TB.

The West Nile virus is also an emerging infectious disease. The virus was reported for the first time in the Western Hemisphere during the summer of 1999. Transmitted by mosquitoes, the effects of human infection range from an asymptomatic response to encephalitis, resulting in neurological impairment or death.^[9]

Another example of a recently emergent infectious disease cited was the Salmonella outbreaks that occurred on the US West Coast between 1996 and 1998. The alfalfa sprout-associated events resulted in an estimated 22,800 cases of gastrointestinal illness and 2 deaths.^[10]

Other incidents of terrorism include the World Tread Center bombings of 1993, the 1995 sarin gas attack in the subways of Tokyo, Japan, and the more recent bombing of the US Federal Building in Oklahoma City, Oklahoma.

The third concern described by Dr. Gould was the use of Fusarium oxysporum, a fungal agent that the United States is urging Colombia to employ to destroy cocoa plants. This is being done, according to Dr. Gould, without regard to the effect the agent could have if it gained entry into the food chain. Case reports of human deaths have documented death due to disseminated infection from the fungus, despite appropriate antimicrobial and antifungal therapy.^[11] Like anthrax, theFusarium fungus causes death via a hemmorrhagic toxin, which has been isolated from soybean seeds.^[12] A high risk of death has been associated with this agent, one that can be transported easily by food grains.

Finally, Dr. Gould noted the problems and disruptions that occur with hoaxes. Any perceived threat to the public health must be investigated. When a hoax is perpetuated, resources being used to address real events are diverted. For example, in a recent 2-week period (October 2001), US postal inspectors have investigated over 6000 incidents of false alarms or practical jokes related to concern about possible anthrax.^[13]

In Dr. Gould’s view, the likelihood of anthrax causing a large-scale national catastrophe is not great at this point. However, he expressed some concern about the possibility of a future smallpox epidemic and the damage it could do.

Smallpox was reportedly first used as a biological weapon during the French and Indian War (1754-1767). British soldiers distributed blankets used by smallpox patients to native Americans; subsequent outbreaks killed more than 50% of the members of infected tribes.

The smallpox organism is spread by droplets or aerosols produced by sneezing or coughing.^[14]There are no known animal or insect reservoirs. Patients are infectious from the onset of a chicken pox-like rash until the rash scabs over. Unlike chicken pox, the rash begins peripherally on the hands and feet, then migrates centrally.

In 1977, the World Health Organization declared smallpox eradicated from the world. Thus by 1980, most countries no longer required vaccination of their citizens. Given the length of time since vaccination, previously vaccinated individuals are also likely to be at risk, as vaccine effectiveness theoretically wanes over time. Given the high fatality rate in unvaccinated individuals, use of smallpox as a biological weapon would seriously threaten large populations.^[14]

According to Dr. Gould, several US agencies are now reconsidering their previous decision recommending that Americans not receive a smallpox vaccination. However the balance between the negative side effects of vaccination and the positive aspect of protection from the disease have not yet tipped in the direction of recommending large-scale vaccination programs.

Dr. Gould recommended several specific alternative responses that the public health community could adopt in response to these concerns. These include: increasing and improving surveillance and treatment, particularly of TB; ensuring a good and safe food supply; reducing chemical accidents; tending to global public health needs; and advocating for a strong biological weapons convention.

Medscape Family Medicine/Primary Care.  2001;3(2) ©2001 Medscape

SOURCE: http://www.medscape.com/viewarticle/407930_2