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Surviving World War III

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Biological terrorism began with hurling of diseased animal and human cadavers, clothing, bedding, over city walls or into wells to contaminate water supplies, in attempts to subdue an enemy city. The spread of infections disease along with the sixteenth century age of exploration resulted in untold numbers of deaths. It's estimated that the arrival of smallpox in Mexico with the Spanish Conquistadors reduced the Aztec population by 10-15 million, effectively ending the Aztec civilization [19]. The glorious victories attributed to Spanish arms would not have been possible without the devastation wrought by Spanish diseases.

Writing in the Bulletin of the History of Medicine, Professor Duffy informs us that [20]

The colonists were well aware of the potency of smallpox as a weapon against the Indians, and on several occasions deliberate efforts were made to infect the Redmen. One of the instances occurred during the Pontiac Conspiracy in 1763. The British Commander, Sir Jeffrey Amherst, added the following postscript to a letter to Col. Henry Bouquet, "could it not be contrived to send the smallpox among those disaffected tribes of Indians? We must on this occasion use every stratege in our power to reduce them." Bouquet replied on July 13, 1763, "I will try to inoculate the . . . with some blankets that may fall in their hands, and take care not to get the disease myself." Just how successful Bouquet's experiment was is not known

During World War I, Germany successfully infected allied livestock and animal feed with the bacilli of anthrax and Glanders, to infect mules and horses of the French Calvary. Argentinean livestock intended for allied troops were also infected with anthrax. As many as 15 million fleas per city were released by the Japanese over 11 Chinese cities during World War II, to initiate epidemics of bubonic plague. Indeed, bioterrorism is an old microbial story—well before microbes were known—with today's new microbial twists.

Biological weapons are characterized by invisibility, high potency, ready accessibility, and ease of delivery. Biological agents can be carried in easily in disguisable vials, tubes, or an envelope in a jacket, vest, or back pocket unde-tectable as a person passes through metal detectors, odor detectors, or pat-downs. They are the real stealth bombers, and with their ability to sow fear and chaos, they can be the real weapons of mass destruction. Being invisible, odorless, and tasteless, no one would know that an attack was underway. Their concealment, transportation, and dissemination are exceptionally easy. Unlike nuclear weapons or missiles, delivery systems are not required for bacteria, viruses, or fungi. In addition, as aerosolization is a major means of dissemination, such low-tech methods as agricultural crop dusters, backpack sprayers, and purse-size atomizers can spread fine powders effectively. Small groups of knaves, modestly financed, and with basic biological and engineering skills, can produce effective weapons. That's scary. To ratchet up this potential, recipes for making bioweapons can be downloaded from the Internet. These simple qualifications must suggest that we are vulnerable.

The obvious question then is if bioweapons are so potent, are so easy to come by, and can easily fall into the wrong hands, why has this not been of greater concern to our political leaders? It is reasonable to believe that because such weapons have never been used on a grand scale against civilian populations, they would never be. It may also be understood that if such weapons were used, nuclear retaliation would be swift. But who could be retaliated against after 9/11, when the attackers were not a declared state, but only a group of terrorists? Nevertheless, it would be reckless and unreasonable to assume that biological weapons would not be used in the future. We must accept the reality that we will not be able to prevent every act of bioterrorism.

A case in point occurred in Oregon in 1984, but not made public until 1997. This event had all the qualifications noted earlier. It was a malicious, malignant, and premeditated attempt to control the outcome of a municipal election by sickening and killing enough voters that the Bhagwanshree Rajneesh Commune (cult) would win the upcoming election and thereby control community zoning and other municipal issues.

The Rajneesh religious commune had its headquarters in the Dalles, Oregon, county seat of Wasco County, a community of some 11,000 people, located near the Columbia River on Interstate 54. Between September 9 and October 10, 1984, 751 adults became ill with a salmonella-induced gastroenteritis. All had eaten at salad bars in some 10 restaurants. It took more than a year to accumulate evidence linking the commune with the epidemic. FBI agents found a vial of Salmonella typhimurium (a bacterial culture obtained from the American Type Culture Collection, Baltimore, MD) in the commune's clandestine laboratory. On March 19, 1986, two commune members were indicted for poisoning food in violation of a federal antitampering act, and were sentenced to substantial prison terms. They admitted that they had intended to make enough citizens sick to prevent them from voting. They also admitted sloshing cultures of salmonella on foods in salad bars, and in coffee creamers [21]. As is well known, salad bars are open to all. Who would know? Who could tell? It was so easy, so uncomplicated. That's the beauty of bioterrorism. Given the ease with which the Rajneesh slipped S. typhimurium into salads, dissemination of other agents by serious terrorists is foregone. In an open society, the team on the offense has the advantage over the unsuspecting.

The idea of infection due to invisible agents is frightening. "It touches a deep human concern about the risk of being destroyed by a powerful, evil, imperceptible force. These beliefs activate emotions that are extremely difficult to direct with that tools of reason" [22]. Obviously, in addition to the illnesses directly related to a specific microbe, there will be psychiatric casualties. Bioterrorism is an ugly undertaking.

So, where would the microbes be obtained, and what are the desirable characteristics of a biological (warfare) agent, and how would it (they) be dispersed? Microbes can be easily obtained from natural sources. Any microbiological text lists the reservoirs of pathogenic organisms. As all are found worldwide, obtaining them poses little problem. Should the rogues prefer to stay out of the woods, so to speak—well, there are always laboratories, public and private, from which cultures of organisms could be stolen or purchased. Given the nature of humans, a bribe here or there could produce the most lethal organisms.

Only two laboratories in the world, one in the United States and one in Russia (the former Soviet Union), are supposed to house the smallpox virus— and under strict security. If, however, certain countries sequestered the virus and continue to hold stocks of it clandestinely, they could be a source. This is unlikely, but in our uncertain world, one never knows. There is the real possibility that microbes (especially viruses) or their toxins could be synthesized or genetically manipulated in a laboratory, although to do so would require a high degree of expertise along with advance technology; nevertheless, we must assume that there are no bars to acquisition.

Knowing that microbes can be obtained, what would a villain want by way of an effective weapon? It should

• Involve as many people as possible

• Be aerosolizable to within 1-10 ^m

• Be able to survive drying, heat, and UV light

• Be capable of causing disabling illness, death, or both

• Be capable of person-person transmission

• Be capable of causing panic

• Be able to reach the target population

• Also, effective treatment must be unavailable or lacking.

Let us also understand that the term infectious is different from the terms contagious or communicable. Infectious refers to the number of bacteria, bacterial spores, or viral particles needed to infect an individual. The fewer the number, the more infectious the agent. Agents are contagious if they spread from person to person. Some agents that are highly infectious such as tularemia and the viral hemorrhagic fevers (VHFs) are not contagious. So, which ones do we choose? Which is a terrorist most likely to choose? Category A, set up by the Department of Homeland Security and the Centers for Disease Control, contains the elite five: anthrax, botulism, tularemia, smallpox, and plague. Category A agents are those that pose the greatest possible threat for an adverse effect on public health, may spread across a large area or need public awareness, and need a great deal of planning to protect the public's health. All five fit comfortably in this category. Each is in excellent company.

It's back to the future. The ancient scourges are still those given prime time. Each requires some detail.

As we deal with each of the elite, the "big five," ask yourself whether we are in for a global influenza pandemic that could conceivably remove 100 million of us in rapid fashion, and if so, what more could bioterrorism do? Is bioterrorism as much of a threat as an influenza pandemic, or more so? Is it a different kind of a problem, or in terms of society the same or similar?

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