Carnegie Reporter, Vol. 1, No. 4 | Preventing “Dark Winter”— The Public Health System’s Role in Strengthening National Security, page 2 (low bandwidth)

Bioweapons are very available. Dr. Ken Alibek, former deputy head of the Soviet Union's secret bioweapons project, who defected to the U.S. in 1992, wrote in his book Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World (Random House, 1999), that the Soviets manufactured tons of "weaponized" smallpox virus and also made bioweapons out of pneumonic plague bacteria and anthrax, experimented with deadly viruses and worked on combining smallpox and Ebola virus into an unstoppable bioweapon.

Dr. D. A. Henderson, who led the World Health Organization's successful campaign to eliminate smallpox, believes that perhaps a dozen countries are researching bioweapons. Soviet experts in bioweapons, underpaid or unemployed in the past decade of economic turmoil, may have been recruited by rogue states. Besides walking away with the sophisticated knowledge in their brains, they may have tucked tiny samples of the smallpox virus into their pockets.

The threat of bioterrorism is very real, particularly in light of the failure to reach agreement on a biowarfare treaty. In 1972, the United States and the Soviet Union, both of which had secret biological warfare projects, were among the 144 nations signing the Biological Weapons Convention and agreeing to stop such activities. President Richard Nixon halted the U.S. biowarfare program; the Soviet Union secretly continued, developing tons of deadly organisms, as Dr. Alibek revealed.

The 1972 treaty had no provisions for inspections and verifications. Late last year, discussions to review the treaty broke down when the U.S. rejected an enforcement program, saying that it would be detrimental to American commercial biotechnology and to biodefense efforts. Review of the treaty was postponed until late 2002. Even if the treaty is finally accepted, it would only be the beginning according to Speedie, who says: "We need a UN initiative like the genocide convention. Bioterrorism has a truly global dimension. We don't know what networking is going on between terrorists, but we assume there is intelligence sharing." His Carnegie Corporation colleague, Patricia Moore Nicholas, says that failure of the treaty has led to non-governmental organizations and universities taking a closer look at the threat of biowarfare.

Dr. Tara O'Toole, current director of the Johns Hopkins University Center for Civilian Biodefense Strategies, agrees about the potential for catastrophe. "Bioterrorism is a strategic threat to the world and it is growing," she says. "Anthrax is only the beginning." Bioterrorism can kill more people than any other form of terrorism, she adds, and dozens of nations have the capacity to wage biowarfare. Chemical weapons also have deadly potential. In 1995, members of the Aum Shinrikyo cult released sarin gas in the Tokyo subway system, killing twelve people and making nearly 4,000 ill. The group also attempted unsuccessful attacks using anthrax and botulism. Unlike nations, such groups "have no return address, nothing that can be held at risk for an attack on the United States," Dr. O'Toole points out. While a uranium enrichment plant is big and difficult to hide, equipment such as fermenters have legitimate uses in producing pharmaceuticals and making beer, as well as producing virulent microbes, and they are easy to hide.

Weapon of Choice

Smallpox is the word that comes to every expert's lips when asked, "What scares you most?"

CDC defines three categories of agents that could be used as bioterror weapons, based on ease of dissemination or transmission, potential for high mortality, risk of public panic and social disruption, and requirements for public preparedness. In category one-the most dangerous agents-CDC includes anthrax, plague, smallpox, botulism, tularemia and the viruses causing hemorrhagic fevers such as Ebola. Just about all these illnesses start with flu-like symptoms that are difficult to diagnose, particularly when most doctors, nurses and emergency medical technicians have never seen these diseases.

"I'm very concerned about smallpox," says Dr. Mohammad Akhter, head of the American Public Health Association (APHA) and former health commissioner of Washington, D.C. "It's very contagious. We have a mobile population. The first week, we wouldn't know we had an outbreak." Because smallpox no longer occurs naturally, a single case anywhere in the world would likely indicate a bioterror attack.

Smallpox is an undetectable airborne infection spread by invisible droplets from an infected person. Ten days to two weeks after infection, the victim develops flu-like symptoms and muscle aches. After about two days of misery, a characteristic rash appears on the face and the extremities. The rash develops into pustules all at the same time (different from chicken pox). The pustules are more common on the arms, legs and face than on the trunk. The pustules form scabs, heal and drop off in about two weeks-if the person survives. The death rate is about 30 percent, and there is no treatment except supportive care. However, vaccine given within a few days of exposure prevents smallpox or lessens the disease's impact.

Almost everyone on the planet is unprotected against smallpox. Routine vaccination ceased in 1980 and pharmaceutical plants making the vaccine were dismantled. Older individuals who were vaccinated (and still bear the characteristic scars on their arms) may have some residual protection, but no one knows how long it lasts-ten or twenty years? When smallpox was still a threat to health workers in hospitals, a respected medical text, Manson's Tropical Diseases (Williams & Wilkins, 1972, 17th Edition), recommended revaccination every year.

Patients with smallpox would not die quickly. They would need care for several weeks, be hooked up to respirators in isolation rooms, require antibiotics to fend off secondary infections and nursing care from personnel in expensive disposable masks, gowns and gloves. The equipment itself would have to be destroyed, probably by burning. The patients would tie up thousands of hospital beds and healthcare providers. Merely arranging safe disposal of the dead would be a problem because thousands of bodies might still be infectious.

Plague is another disease of choice for terrorists. When it caused "The Black Death" in the Middle Ages, it was usually spread by bites from infected fleas. Only small numbers of people developed pneumonic plague, which involves infection of the lungs. Flea-borne plague killed perhaps one-third of the population of Europe in the 1340s and 1350s and spread from southern Russia to Iceland in a time when the fastest way to travel was on horseback.

When plague infects the lungs, it spreads through the air to those around the victim as a rapidly fatal pneumonia. Death rates range up to 90 percent unless the disease is recognized and immediately treated with antibiotics. Soviet scientists were known to be experimenting with pneumonic plague.

Anthrax, the recent cause of five deaths and national panic, was spread in the form of spores that were distributed as an airborne infection, with the U.S. postal service as the unwitting vehicle of dissemination. Individuals infected with anthrax may die unless the disease is quickly recognized and treated, but the infected person does not infect others.

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