Thinking about the unthinkable

Planning is underway for the first global BioSecurity conference, sponsored by Harvard Medical School, HMI, Harvard School of Public Health, and Key3Media Group, Inc. BioSecurity 2002, to be held November 18–21 in Las Vegas, is an international scientific and educational conference designed to provide a forum for representatives from government, research, medicine, and public health to prepare for and learn how to respond to bioterrorism threats. In this article, conference co-chairman Bob Howard explains some of the past uses of biological weapons and current responses to the possibility of bioterrorism. Howard is a senior vice president at Key3Media Inc., and the former director of strategic communication at the Centers for Disease Control and Prevention's National Center for Infectious Diseases.

Bob Howard, co-chair of Biosecurity 2002

On 24 June 1763, Captain Ecuyer, acting on the orders of Sir Jeffery Amherst, commander of British military forces in North America, issued two blankets and a handkerchief from the Fort Pitt smallpox hospital to Native Americans who lived nearby.

An entry in his journal indicated that he hoped the distribution of these items would "have the desired effect." The desired effect in this case was not the warmth and comfort of these indigenous groups, but rather the aim of his commanding officer to use smallpox as a biological weapon against the local tribes who had virtually no natural immunity or previous exposure to the virus. The plan worked: over the next few months, some 100,000 people in the Ohio River valley-Shawnee, Delaware, Mingo, and others-died from the disease.

The captain's use of a biologic agent as a weapon was neither novel nor specific to North America. During the 14th century siege of Kaffa, a seaport on the Black Sea on Russia's Crimean peninsula, the attacking Tartar force experienced an outbreak of plague. Being good soldiers and masters of turning misfortune into fortune and benefit, the Tartars took to launching the disease-ridden bodies of their comrades over the walls of the fortress in an effort to infect the troops within. An outbreak of plague followed as the Tartars retreated. Intentional contamination of water sources during the Napoleonic wars was as common an event as the use of pungi sticks (sharpened bamboo poles covered with feces) during the Vietnam War in the 1960s.

Unfortunately, humans have been adept at weaponizing both naturally occurring and artificially created biologic toxins for years. These efforts can be as sophisticated as those very recently undertaken by Iraq to weaponize anthrax and botulism, or as simple and exquisitely effective as the darts and arrows dipped in curare and other plant- and animal-derived toxins that have been used for centuries in the jungles of South America to poison and disable enemies.

The threat today
Both distant and recent history are littered with case studies of persons and groups who, having possessed the will, have found a way to inflict terror and destruction. How widespread are the knowledge and expertise among individuals and organizations to carry out effective acts of bioterrorism? Consider the case of a small commune of followers of an Indian guru in Oregon in 1984, who displayed an extraordinary amount of creativity in their efforts to impact the local city council elections. The commune members visited local restaurants over a number of evenings prior to election night and secretly poisoned the salad bars with a salmonella agent, making 751 people sick with vomiting and diarrhea.

Instances like these prove that the pathogens need not be exotic and remote in origin to be effective or have impact. Both public health officials and battlefield commanders who specialize in the use of biological toxins openly admit that they worry as much about a commonplace agent used with skill and determination as they do about more exotic and esoteric chemical creations. In some past wars, as many soldiers have died from influenza, bacterial diseases, malaria, shigella, cholera, and other foodborne, waterborne, and vector-borne diseases as from actual battle.

Since the 1972 ratification of the Convention on the Prohibition, Development, Production, and Stockpiling of Biological and Toxic Weapons and on Their Destruction, more than 100 nations have agreed that these weapons would not be a part of their arsenals. Yet there is significant evidence that a number of the treaty's signatories continue to stockpile the weapons and are even working to improve their effectiveness and deployment. In 1992, Russian President Boris Yeltsin publicly admitted that an accidental anthrax release in 1979 had sickened and killed people and livestock in the area around a military biological production facility near Sverdlovsk. Additionally, there is no question that Iraq's Saddam Hussein ordered the use of chemical and biological agents on his own citizens of Kurdish descent following the Gulf War.

A public health response
For four decades, the world worried and debated the concerns and dangers posed by nuclear weapons, and the United States and other superpowers focused much of their energy on making sure they were protected and capable of responding to an attack from an enemy using these weapons. Submarine launching platforms, airborne early warning and delivery, along with land-based missile systems provided a "triad" of protection that was never breached.

But when it comes to biological terrorism, the front line of defense for every nation is quite simply its nation's public health system. A theme that consistently has run through all of the programs in countries and communities that have dealt with these threats has been the absolute need for a solid public health infrastructure. Increasingly, partners in the international public health community have come to realize they must marshal all possible resources and assets at their disposal and share information and their concerns with others.

The development of epidemiological and laboratory systems that can share information has been an important tool in these efforts. Effective collaborations have emerged between inter-governmental agencies and international organizations. Even former Cold War enemies have come together on a number of projects. One such effort has been a partnership between hospitals in New Mexico and Russia in which health professionals are sharing information on hepatitis C. Many policymakers and politicians now are coming to realize what doctors long have understood: disease is apolitical, knows no borders, respects no boundaries, and honors no treaties.

The upcoming conference BioSecurity 2002 will provide an international forum for all groups and individuals dealing with the threat of bioterrorism to come together in one place at one time to share their experiences and learn from one another. Attendees will leave the conference with an understanding of the current state of preparedness and the tools to develop practical solutions to challenges facing the global community.