Microbial Soldiers and Bio-terrorism

In the 20th century, your average American feared nuclear armament more than anything else. Now, at the advent of the 21st century when all the countries have nukes, smaller even more lethal agents are beginning to come from the shadowy corners of science to wreak havoc once again– bio-terrorism. Chief among these biological weapons of mass destruction is the once eradicated virus of smallpox. However, the clock is ticking for this particular microbial soldier. Will the United Nations rule for it to be destroyed or kept in the reserves? What if unidentified parties, such as North Korea, hold vials of this killer? If we destroy the virus, how could we make new antiviral or more effective vaccines? Trick question– we couldn’t. We should keep smallpox because there is a lot we can learn from it. Creating a new vaccine or drugs from this knowledge can be used to treat the millions who would fall ill should a bio-terrorism event ever occur with smallpox.

What is Bio-terrorism?^[1]

Bio-terrorism is an attack in which bacteria, viruses, or other germs are deliberately released with the intent to cause illness or death in people, animals, or plants.  Most of these agents are found naturally in the environment, but they can be changed to make them resistant to medicines, increase their ability to cause disease, or to increase their ability to be spread into the environment.  Potential biological agents can be purposely spread through water, through the air, or in food. Most of the biological agents are extremely difficult to detect and don’t cause disease for several hours to several days, which makes them very appealing to terrorists.  Different biological agents can be spread in different ways, for example:

The septicemic plague causes the infection of blood. The limbs result in the black color.

• The smallpox virus can be spread person to person, while anthrax cannot
• Clostridium botulinum is typically spread in food to people
• Francisella tularensis, the causative agent of tularemia, is made airborne for exposure by inhalation
• Yersinia pestis, the causative agent of bubonic plague, is made airborne and can also be weaponized by using fleas

Depending on how easily bio-terrorism agents can be spread and the severity of the illness of death they cause, they can be separated into three categories:  Category A, Category B, and Category C.  The bio-terrorism agents classified as Category A are the highest risk while Category C agents are those considered emerging threats for disease.  For more information of the different Categories, look here.

If you are worried about a bio-terrorism attack, or are interested in how to prepare for a bio-terrorism attack, the CDC and American Red Cross have created an Emergency Preparedness and You website.

History

Infectious diseases have had an impact on people and in war as early as 600 BC. One of the most common strategies that has been used in the early European wars and even the American Civil War was polluting the water of the enemy’s army. Another common use of disease was to use the victims themselves. Military leaders realized that they could use victims of terrible diseases as a weapon against their enemies. These diseases can include the plague, smallpox, and anthrax because they are highly contagious and have a high mortality rate. A few examples include:

This child is showing symptoms of smallpox

• Around 1336, a Tartar army took their dead that had died of the bubonic plague and catapultedthem over city walls of their enemy. This started an epidemic in the city and resulted in a retreat.^[11]

• In 1763, British soldiers intentionally gave smallpox contaminated blankets to the Native Americans during a rebellion in hopes of wiping them out.
• In the late 1930’s and 1940’s, the Japanese filled bombs with fleas infected with plague to drop over two cities in China. The Japanese has also been known to used cholera and shigella during war.
• In 1979, an outbreak of anthrax killed 70 people in Sverdlovsk. Contaminated meat was blamed by the Soviet government, but the United States expected that this was the work from a secret lab. ^[3]

The Soviet Biological Weapons Program

The United States, the Soviet Union, and other nations decided to sign the Biological and Toxin Weapons Convention in 1972 to ban the use of biological weapons. Even though this was signed, the Soviet Union was still expanding its biological weapons program which began in the 1920’s. This program was hidden under layers of deception and secrecy for a long time. “The Soviet Biological Weapons Program: A History” contains stories told by soviet scientists, the nature of the research, and descriptions of its history and institutes.

“The Demon in the Freezer” is a true story written by Richard Preston. The author writes about biological attacks, after the 9/11 attack on the twin towers, involving anthrax and smallpox. Smallpox was eradicated in 1979, but there are two freezers that are said to still contain this deadly virus. These two freezers are located in Atlanta, Georgia and the other in Vector, Siberia.

What is the probability of an attack?^[3]

Everybody has different opinions but according to the National Intelligence council, bioterrorism is a greater threat than nuclear terrorism. Others say that a large attack is small because of the challenges that come with creating and utilizing the biological agents. No matter what the opinion is, experts acknowledge that there could be a potential attack. There are many programs and agencies that prepare for this kind of attack. Click here to read about a testimony assessing the threat of bio-terrorism.

Agencies involved in the response

The Department of Homeland Security and the Department of Health and Human Services both take active roles in biodefense and responding to outbreaks. The Department of State, particularly the Office of International Health and Biodefense, is responsible for policy on international health issues while the Department of Defense  is involved in biological weapons and threat reduction policy. We will also discuss the role of the World Health Organization, and the Army Medical Department.

The Department of Homeland Security  maintains a biodefense program that focuses on awareness, prevention, surveillance, response and recovery. Within the department, The Office of Health Affairs  is in charge of this program. The Department of Homeland Security runs several centers that research biological threats, processes information about disease events , and determine where any incidents originated from, and how to stop them. Security at these facilities is taken seriously, and periodically assessed.^[2]

The Department of Health and Human Services  helps create public health systems that can respond to disease outbreaks from any source. This department has a large role in the legal and regulatory framework for dealing with diseases, and runs the CDC .^[10]

The Centers for Disease Control and Prevention (CDC)is a big player in biodefense and disease response. This organization acts on a local level to handle outbreaks and emergency situations. They spend most of the time monitoring public health information for potential problems and preparing to address any that arise. When a public health emergency occurs, the CDC coordinates the delivery of supplies, equipment and experts to handle the situation.^[6] A lot of information about bioterrorism, diseases and prevention is available for the public here https://emergency.cdc.gov/bioterrorism/.

This chart shows some of the responses from the CDC

While there are countless other organizations that deal with disease and biodefense worldwide, two in particular are noteworthy: the World Health Organization’s Global Outbreak and Response Network (GOARN), and the U.S. Army Medical Research Institute of Infectious Diseases . GOARN works with countries and organizations around the world to detect and respond to disease outbreaks.^[7] The U.S. Army Medical Research Institute of Infectious Diseases develops vaccines, drugs and information, including diagnostic information and participate in emerging disease investigations. It is run by the Department of Defense and works with the CDC and World Health Organization.^[4]

Vaccine Response

Vaccines are the preferred bio-defense tool to try and prevent spread of disease. Most agents, such as anthrax, have a vaccine already in production due to cost and the odds of natural anthrax infecting people. Others, such as Brucella, have many types of vaccines in development for both animals and humans. Only one agent does not have a vaccine, and even in that instance there are other methods to confer immunity: smallpox.

There were actually two different ways to try and prevent smallpox:

• Edward Jenner used vaccinia, cowpox, to vaccinate against smallpox. This proved to work in an experiment with gardner’s son. The young boy was purposely exposed to smallpox as a challenge after inoculating him with pus from a cowpox sore. The boy never became ill causing this to be the technique to eradicate smallpox. When a case of smallpox was reported, everyone in the village or town was vaccinated. However, it’s not perfect. Jarhling noticed that even a successful inoculation by vaccinia would not protect as well against the more virulent strains of smallpox (Preston, Demon in the Freezer).
• Inoculation as a preventative is the usage of less lethal smallpox strains to give a minor case of smallpox.  This didn’t work well as different people have different immune responses, so people would potentially die from this inoculation, even if it was thought to be a “weak” strain.

Smallpox

Smallpox is man’s natural enemy– no other virus has succeeded in killing more people or maintaining itself in its natural host for as long as smallpox did. Even with those figures, however, it was still conquered. Edward Jenner used vaccinia to inoculate people and succeeded in providing a immune response strong enough to withstand the virus. With humans as smallpox’s natural host, it was possible to eradicate it from the natural world by 1980, thanks to agencies such as the CDC and WHO. Now the question remains; should smallpox be kept, or destroyed? If it is destroyed, it would be the first virus to ever be totally eradicated– or not. Smallpox would still exist, viable, tucked away in the back of a forgotten research lab, as what happened in Bethesda, Maryland in 2014. Or, even worse, it will exist to become a weapon of terror in the hands of nations like North Korea or terrorist groups such as ISIS. With these threats in mind, why should the U.N. destroy the stocks? More effective vaccines could be produced from smallpox itself– vaccinia just doesn’t have the efficacy a true smallpox vaccine would achieve. What about antivirals? No vaccine has a 100% effectiveness– so could a drug be devised to treat those who would fall ill? I think so. As much as smallpox is humanity’s natural enemy, we need it. The better we understand humanity’s most ancient killer, the better prepared we can be when that killer tries to strike again.

References

1. Bioterrorism Overview. Centers for Disease Control and Prevention. 2007 Feb 12 [accessed 2016 Nov 16]. https://emergency.cdc.gov/bioterrorism/overview.asp
2. Biological security [Internet]. Department of Homeland Security; 2015 July 20 [cited 2016 Nov 18]. Available from https://www.dhs.gov/topic/biological-security
3. Biological Weapons, Bioterrorism, and Vaccines. The History of Vaccines. 2016 Aug 4.  http://www.historyofvaccines.org/content/articles/biological-weapons-bioterrorism-and-vaccines
4. Bundt TS. USAMRIID: biodefense solutions to protect our nation [Internet]. U.S. Army Medical Department; 2015 Aug 10 [cited 2016 Nov 18]. Available from http://labs.russell.wisc.edu/pddc/files/Fact_Sheets/FC_PDF/Deciduous_Tree_Galls.pdf
5. Deputy assistant secretary of defense for countering weapons of mass destruction [Internet]. Department of Defense; [cited 2016 Nov 18]. http://policy.defense.gov/OUSDP-Offices/ASD-for-Homeland-Defense-Global-Security/Countering-Weapons-of-Mass-Destruction/
6. Emergency operations centers: CDC emergency operations center [Internet]. Centers for Disease Control and Prevention; 2004 Apr 25 [cited 2016 Nov 18]. Available from http://www.cdc.gov/phpr/eoc.htm
7. Global outbreak alert and response network (GOARN) [Internet]. World Health Organization; 2016 [cited 2016 Nov 18]. Available from http://www.who.int/ihr/alert_and_response/outbreak-network/en/
8. International health and biodefense [Internet]. Department of State; [cited 2016 Nov 18]. Available from http://www.state.gov/e/oes/intlhealthbiodefense/
9. Office of health affairs [Internet]. Department of Homeland Security; 2016 Oct 24 [cited 2016 Nov 18]. Available from https://www.dhs.gov/office-health-affairs
10. On the front line of biodefense [Internet]. Department of Health and Human Services; 2011 July 6 [cited 2016 Nov 18]. Available from http://www.phe.gov/about/opp/pages/bwc.aspx
11. Riedel S. Biological warfare and bioterrorism: a historical review. Proceedings (Baylor University Medical Center). 2004;17(4):400-406. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200679/