1. Ethical Considerations for Germ Warfare and Bioterrorism

2. What is bioterrorism?
Dispersal of microbes or their toxins to produce illness, death and terror Biological warfare is the use of agents of disease for hostile purposes

3. Biological weapons
Biological weapons are characterized by low cost and ease of access; difficulty of detection, even after use until disease has advanced; unreliable but open-ended scale of predictable casualties, and clandestine stockpiles and delivery systems

4. The threat of bioterrorism exists  "The cold reality is that it is almost impossible to enforce the existing biological weapons treaty. There is no biological weapons facility which if shut down today could not be rebuilt tomorrow,"

5. Advantages of Biological Weapons
Ease of manufacture
Starting material readily obtainable
Expanding microbial genome database
Relative low cost, compared to chemical and nuclear weapons

6. Agents Lethal or incapacitating
Anti-personnel, anti-animal, anti-plant
Replicating pathogen, toxin
Contagious or non-contagious

7. Ideal Agent Highly contagious Highly toxic Produces severe disease
Environmentally stable
Effective vaccine or treatment not available
Difficult to identify or detect
Capable of large scale production
Efficient mass distribution

8. Human Pathogens
Bacillus anthracis
Brucella suis
Coxiella burnetii
Francisella tularensis
Yersinia pestis
Smallpox
Viral encephalitides
Viral hemorrhagic fevers
Toxins
Botulinum
Ricin
Staphylococcal enterotoxin B
Anti-crop agents
Rice blast
Rye stem rust
Wheat stem rust
Anti-animal
Foot and mouth disease

9. Biological Agents Ranking System
Public Health impact criteria based on:
Morbidity and mortality
Delivery potential
Public perception (fear, civil disruption)
Public health preparedness needs
The Centers for Disease Control and Prevention (CDC) has developed a ranking system for potential biological agents based on the following criteria:
•The level of morbidity and mortality associated with a disease
•Delivery potential of the disease (which involves the ability to be aerosolized)
•Public perception (certain diseases generate greater fear and civil disruption)
•And public health preparedness needs, such as needs for vaccine or mass chemoprophylaxis (preventive treatment).

10. Level A Bioterrorism Agents
Anthrax (Bacillus anthracis)
Smallpox (Variola major)
Plague (Yersinia pestis)
Botulism toxin (Clostridium botulinum)
Tularemia (Francisella tularensis)
Viral hemorrhagic fevers (VHF)
Level A agents cause the diseases of most concern.
They include anthrax, caused by Bacillus anthracis, smallpox caused by Variola virus, plague for which Yersina pestis is the infectious organism, botulinum toxin from Clostridium botulinum and tularemia, resulting from infection by Francisella tularensis. Viral hemorrhagic fevers are caused by 4 distinct groups of RNA viruses.

11. Other Potential Bioterrorism Agents
Brucellosis (Brucella species)
Glanders (Burkholderia mallei)
Q fever (Coxiella burnetii)
Cholera (Vibrio cholera)
Salmonella sp. and Shigella sp.
Venezuelan Equine Encephalitis (VEE)
Staphylococcal Enterotoxin B
Ricin (from castor beans)
T-2 Mycotoxins
As virtually any pathogenic biological organism can be used to intentionally cause disease, this is not a complete list but does include some of the other agents of concern.
(Note that this is not a complete listing)

12. Increase Virulence Through Genetic Manipulation
Modify antigenic properties
Increase environmental stability
Prevent detection or identification
Enhance drug resistance
Addition of virulence gene (toxin)

13. Estimate of effectiveness
US Congressional Office of Technology Assessment estimated 130, million deaths following aerosolized release anthrax spores upwind of Washington, DC. , matching or exceeding hydrogen bomb.

14. History of biological weapons
1346 Tartar siege of Kaffa (Feodossa) catapult plague victims over walls
1767 The French and Indian War the English gave Smallpox contaminated blankets to Indians
1917 (WWI) German agents inoculated horses and cattle with Glanders disease.
1940 Japan dropped Bubonic plague infected fleas and grain (to attract the local rats) in China

15. History of biological weapons (continued)
1975 Biological Weapons Convention prohibiting the production/stockpiling biological weapons
1978 Bulgarian exile, Georgi Markov, stabbed with a steel ball packed with ricin
1979 Sverdlovsk Incident accidental explosion at biological warfare facility killing an estimated people from anthrax.

16. History of biological weapons (continued)
Evidence of offensive biological weapons in Iraq, warheads with botulinum toxin, anthrax spores, and aflatoxin.
1993 Aum Shinrikyo, Japanese terrorist group, released anthrax spores and botulin toxin.
2001 anthrax spores through the USA mail.

17. Domestic Biological Terrorism
1984 Rajneeshee cult members contaminate salad bar with Salmonella typhimurium in Oregon
1992 Ricin attack planned by Minnesota militia
2001 Anthrax releases in FL, DC, NY, NJ
The U.S. has experienced bioterrorism events prior to the anthrax release that occurred in the Fall of Members of the Rajneeshee (Rahj-NEE-shee) cult in Oregon had experimented with various bioweaponery prior to their 1984 act of bioterrorism. The cult sought to influence the outcome of upcoming municipal elections by deliberately contaminating salad bars of local restaurants with Salmonella typhimurium. Despite causing illness in over 700 persons, they still lost the election.
Minnesota has not been immune to bioterrorism. In 1992, members of the Minnesota Patriots Council, a militia group, planned to kill local authorities with ricin, a potent toxin obtained from castor beans.
And the most recent and terrifying act of bioterrorism occurred in Fall 2001, when Bacillus anthracis spores were placed in at least 7 envelopes passing through U.S. mail facilities in Florida, Washington, D.C., New York and New Jersey. Twenty-two confirmed or suspected cases of anthrax resulted, 5 of whom died.

18. Rajneeshee Cult, Salmonella - Oregon, 1984
This is a picture of the Bhagwan Shri Rajneesh (“BAA-gwahn SHREE Rahj-NEESH”), leader of a religious cult near the town of The Dalles, Oregon.
In 1984, members of the Rajneeshee (“Rahj-NEE-shee”) cult intentionally contaminated restaurant salad bars in Oregon with Salmonella typhimurium. Over 750 persons were infected, and 40 hospitalized. Fortunately there were no fatalities. The act was a dry-run of a plan to influence the outcome of a local election. The cult members planned to infect enough of the population so that they would be unable to vote thus enabling the cult members to vote themselves into office. Despite their creative attempts at democracy, they still lost the election.
Since naturally occurring outbreaks of Salmonella typhimurium occur frequently, it was difficult to prove this incident occurred intentionally. The cause of this outbreak wasn’t known until one of the cult members confessed to the plot over a year after the outbreak occurred.

19. MN Patriots Council, Douglas County, 1991
The Minnesota Patriots Council was formed in the early 1970s by a retired Air Force colonel who held strong anti-government beliefs. In 1991, members of the Patriots Council extracted toxin from castor beans in order to make ricin (“RYE-sin”), a potent toxin. Patriots Council members discussed killing certain law enforcement and IRS officials by putting ricin on their targets’ shoes, doorknobs or vehicles. The ricin with mixed with a solvent so it could be absorbed dermally. Fortunately their plan was foiled when members of the group alerted law enforcement. Laboratory analysis indicated the amount of ricin in the mixture was enough to kill 129 people.
The Council members, 4 in all, were the first Americans arrested under the 1989 Biological Weapons Anti-Terrorism Act. All 4 were convicted and sentenced to prison terms ranging from 33 months to 4 years.
Reference:
Smithson AE, Levy LA. Ataxia: the chemical and biological terrorism threat and the US Response. The Henry L. Stimson Center

20. Sarin Gas Attack, Tokyo Subway, 1995
The doomsday religious cult Aum Shinrikyo launched at least 10 bio- and chemical-weapons attacks in Japan before actually causing illness. In 1995, cult members placed plastic bags containing the deadly nerve gas sarin on trains in the Tokyo subway. The bags were punctured by a cult member with an umbrella tip causing the gas to be released, spreading throughout the car. The cult members then quickly exited the train.
At the end of the day, 15 subway systems had been affected, 12 persons died, 3,800 were injured, and scores of worried well overwhelmed the medical system.

21. Operation Desert Storm
During the Gulf War in 1991, the United Nations confirmed that Iraq had weaponized anthrax, botulism and ricin. An anthrax vaccination program was initiated for troops engaged in Operation Desert Storm. (After the war, Iraq admitted testing weaponized anthrax in missiles.)

22. This slide shows the American Media Building, Florida, the workplace of the first diagnosed inhalational anthrax case in the bioterrorism-related anthrax cases of 2001.

23. Ken Alibek - U.S.S.R. Program
In 1992, the former deputy chief of research and production for the U.S.S.R.’s program, Dr. Ken Alibek, defected to the United States.
In his 1999 book, “Biohazard,” Dr. Alibek discusses secrets of the world’s largest bioweapons program, such as the program’s capability to use weaponized smallpox virus in ICBM (Inter-Continental Ballistic Missiles) and other types of bombs.
The USSR’s bioweapons program operated at a high intensity to develop and produce bioweapons through the early 1990s. At one time the program had 47 bioweapons labs and testing facilities employing approximately 50,000 scientists.

24. Continuum Responsible state Rogue state Larger terrorist organization
Smaller terrorist organization
Individual assassination/murder

25. Egypt (signed not ratified) India Iran Iraq Lebanon Libya Malaysia
Signatories of 1975 Biological Weapons Convention prohibiting the production/stockpiling biological weapons (Selected countries listed)
Afghanistan
Cyprus
Egypt (signed not ratified)
India
Iran
Iraq
Lebanon
Libya
Malaysia
North Korea
Pakistan
Russian Federation
Syria (signed not ratified)
USA
USSR

26. Biological Terrorism
Use of biological agents to intentionally produce disease or intoxication in susceptible populations - humans, animals, or plants - to meet terrorist aims
Biological terrorism can be defined as the use of biological agents to intentionally produce disease or intoxication in human, animal, or plant populations in order to meet terrorist aims.
The great fear of bioterrorism stems in part from the prospect of the recurrence of diseases we have believed to be conquered or at least controlled.

27. Advantages of Biologics As Weapons
May be easier, faster to produce and more cost-effective than other weapons
Potential for dissemination over large geographic area
High morbidity and mortality
Creates panic
Person-to-person transmission possible (smallpox, plague, and viral hemorrhagic fever)
Difficult to diagnose and/or treat
Biologic weaponry is an attractive weapon for a variety of reasons. Compared to traditional weapons, bioweapons may be faster and easier to produce and are potentially more cost effective, particularly when compared to nuclear weapons.
Bioweapons, when distributed by air, have the potential for wide geographic dispersement. While some diseases such as smallpox can spread from person-to-person, most of the likely agents cause diseases that are difficult to diagnose and/or treat and result in high morbidity and mortality.
And perhaps most important, the diseases of bioterrorism are likely to create panic among civilian populations which can result in medical systems being quickly overwhelmed.

28. Ideal Characteristics for Potential Biological Terrorism Agent
Inexpensive and easy to produce
Can be aerosolized (1-10 µm)
Survives sunlight, drying, heat
Cause lethal or disabling disease
Person-to-person transmission
No effective treatment or prophylaxis
The ideal bioweapon is inexpensive, easy to acquire and produce, and capable of being aerosolized. Disseminating the bioterrorism agent by air provides the potential to infect the greatest number of people. The purpose of weaponizing an organism is to facilitate dissemination by reducing its size (1-10 microns is optimal), enhance its potential for infectivity, and perhaps make it resistant to certain antibiotics. As a potential bioweapon becomes smaller and lighter, its ability to be airborne and lodged into the lungs increases. The spores in the Fall 2001 anthrax attacks had been treated to reduce clumping and their electrical charge was neutralized to optimize their potential to float. The naturally-occurring anthrax spore is small in size at approximately 1 micron.
In addition, the organism should be as stable in the environment as possible -- it should survive heat, sunlight and drying. Since the aim is to cause disabling or lethal disease, the ideal agent from a bioterrorist’s point of view would also be transmittable person-to-person, like smallpox, and have no treatment or prophylaxis.

29. Vaccine History
1796 Jenner’s demonstration of cowpox protecting smallpox
1881 Pasteur’s Anthrax vaccine
1897 killed plague vaccine
1957 IND for Q fever
1965 IND for VEE
1970 USA anthrax vaccine
1977 eradication of smallpox

30. Where is the ethical question?
Vaccines - Good
Germ warfare - Bad
Bioterrorism - Bad

31. Science Ethical Considerations
Government funded research - trust to use information responsibly
Effective vaccine, give first strike capability?
The right, responsibility, need to publish VS. placing sensitive information into public domain.
Purposeful or accidentally increasing a pathogen’s virulence - publish finding?

32. Science Ethical Considerations (Continued)
Will scientists have to overcome reluctance to discuss the implications of their work in the context of biological weapons?
USA scientists under investigation sending anthrax through the mail. What are the pressures?
Should means be instituted to keep technology from being used in a subversive manner?

33. Risk of dying
Smoking 10 cigarettes a day One in 200 Road accident One in 8,000 Playing soccer One in 25,000 Homicide One in 100,000 Terrorism attack since 2001 One in 100,000 Hit by lightning One in 10,000,000 Terrorism attack in 1990’s One in 50,000,000 Anthrax in 2001 One in 50,000, 000 Smallpox in 2001 Less than one in 50,000,000
The last case of smallpox in the US occurred in The last naturally acquired case of smallpox in the world was reported in Ethiopia in 1977.

34. Biological Terrorism? Epidemiologic Clues
Tight cluster of cases
High infection rate
Unusual or localized geography
Unusual clinical presentation
Unusual time of year
Dead animals
From the epidemiologic perspective, indicators of a potential bioterrorism event include a tight cluster of cases, high attack rate amongst the exposed, geographic correlates of exposure, an “exotic” disease for the area, for example a plague case in Minnesota who had no natural exposures, unusual clinical presentation, symptoms present at an unusual time of year - for example, a lot of patients presenting with flu-like symptoms in the middle of summer, and evidence of unusual disease or deaths in animals.