The Centers for Disease Control and Prevention (CDC) define ‘bioterrorism’ as, “the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants.” (1) The CDC breaks down these agents into three categories: Category A agents are considered the highest risk, Category C agents are those that are considered emerging threats for disease and Category B agents fall in the middle.
Remember the Anthrax situation back in 2001? I’ll use that as my first example to help set the stage. The agent was intentionally spread via the United States Postal Service and, as a result, 22 individuals became infected. Anthrax is considered to be a Category A agent – this means that it
- poses the greatest possible threat for a bad effect on public health
- may spread across a large area or need public awareness
- needs a great deal of planning to protect the public’s health (2)
Anthrax can be contracted in three ways:
- Cutaneous (through the skin)
- Inhalation (through the lungs)
- Gastrointestinal (through the digestive tract)
If cutaneous anthrax is discovered early enough it can be cured with antibiotics. Even if cutaneous anthrax is not detected quickly, approximately eighty percent of infected individuals will not die. However, gastrointestinal anthrax is significantly more dangerous — somewhere between 1/4th and 1/2th of those infected will die. Finally, inhalation anthrax is the most lethal. In the 2001 situation around 50% of those patients who contracted inhalation anthrax died. The Federal Bureau of Investigation said that the 2001 anthrax situation was, “one of the largest and most complex [investigations] in the history of law enforcement. (3)
Anthrax can be prevented by receiving a vaccine. In the United States only one human anthrax vaccine is licensed by the Food and Drug Administration: BioThrax. What’s the problem? It’s not available for the general public. (Department of Defense Anthrax Vaccine Immunization Program)
Now, allow me to make anthrax look like child’s play by introducing you to the Ebola virus (EBOV). The CDC classifies Ebola as a Category A Bioterrorism Agent. The National Institutes of Health consider it to be a Category A Priority Pathogen as well. Handling Ebola requires a “Biosafety Level 4-equiavlent containment.” If one were to average the case-fatality rates of all Ebola virus disease outbreaks recorded they would find that 68% of infected patients do not survive. At this time there are no vaccines approved by the FDA for preventing this disease. In other words, Ebola is incredibly dangerous and its lethality is disconcerting, to say the least.
The article Ebola: A Significant Threat as an Infectious Disease, and as a Potential Bioterrorism Agent by Cagatay Ustun and Ozge Ozgurler (4) discusses a number of fascinating points regarding Ebola and its potential role in bioterrorism. First, the authors make a point that is critical to note: “Generally, there is a low risk of a bioterrorism attack, however, if an event did occur there would be severe consequences.”
This is an incredibly accurate statement. Bioterrorism is not necessarily an imminent threat hanging over our heads. Rogue nations develop bioterrorism programs because they are cheaper than more complex avenues of attack (such as nuclear weapons). The downside is that they are difficult to maintain and utilize in a weapons-based format. It’s not at all easy for your “average Joe” to go and pick up Ebola and transform it into a weapon. However, if this were to occur, we would suffer ungodly consequences. Allow me to elaborate…
Aerosol transmission (remember “inhalation anthrax,” for example) is the most deadly because of its potential to be spread far, wide, and fast. An experiment was done in 1995 where the Ebola virus was given to rhesus monkeys (via inhalation) and they were successfully infected. (5) Quite simply, this means that it is possible to spread the Ebola virus aerogenically. It really wakes us up to the threat of Ebola as both an infectious disease and a bioterrorism device.
At this point, you are surely asking, “How prepared are we?” Let me tell you: Not nearly enough. According to the WMD Center, the United States received 15 F’s, 15 D’s, 7 C’s, 8 B’s, and zero A’s. When it comes to “large-scale, drug resistant” and “global crisis, contagious” the United States receives virtually all F’s. The Center stated, “In the past decade the United States government has spent more than $65 billion on bio-defense, and yet it has done so without an end-to-end, strategic assessment of the nation’s bio-response capabilities.” In a more grim, eye-opening statement (within the report) the Center wrote that, “advances in biotechnology have now enabled a small team of individuals with college-level training to create biological weapons.”
Dr. Arthur Kellerman (RAND Corporation) said, “Most major hospitals in this country are operating at 80, 90, 95 percent capacity on any given day, and I would think they would be sorely challenged to deal with hundreds, much less thousands or tens of thousands of casualties. And a circus tent in a parking lot is not going to make up the difference.”
The WMD Center is a “not-for-profit research and education organization founded in March 2010 by the chair, vice chair, and executive director of the Congressional Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism.” You can find their full Bio-Response Report Card PDF here.
Tomorrow (June 6th 2012), the Homeland Security Subcommittee on Emergency Preparedness, Response, and Communications will be holding a hearing entitled, “The National Preparedness Report: Assessing the State of Preparedness.” It will be interesting to see exactly what is selected for discussion and what plans will be made as a result. If you are concerned about our nation’s bioterrorism preparedness then it is time to:
1. CDC | Bioterrorism Overview. (n.d.). CDC Emergency Preparedness & Response Site. Retrieved June 5, 2012, from http://www.bt.cdc.gov/bioterrorism/overview.asp
2. CDC Anthrax | What You Need To Know. (n.d.). CDC Emergency Preparedness & Response Site. Retrieved June 5, 2012, from http://www.bt.cdc.gov/agent/anthrax/needtoknow.asp
3. FBI — Amerithrax Investigation. (n.d.). FBI — Homepage. Retrieved June 5, 2012, from http://www.fbi.gov/about-us/history/famous-cases/anthrax-amerithrax/amerithrax-investigation
5. Johnson E, Jaax N, White J et al. Lethal experimental infections of rhesus monkeysby aerosolized Ebola virus. Int J Exp Pathol, 76, 227-236, 1995.
6. Bio-Response Report Card Released | The WMD Center. (n.d.). The WMD Center | A Bipartisan Research Center. Retrieved June 5, 2012, from http://www.wmdcenter.org/?p=196