Bioterrorism: Threats and Deterrents [1 ed.] 9781607505013, 9781607505006

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BIOTERRORISM: THREATS AND DETERRENTS

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NATO Science for Peace and Security Series This Series presents the results of scientific meetings supported under the NATO Programme: Science for Peace and Security (SPS). The NATO SPS Programme supports meetings in the following Key Priority areas: (1) Defence Against Terrorism; (2) Countering other Threats to Security and (3) NATO, Partner and Mediterranean Dialogue Country Priorities. The types of meeting supported are generally “Advanced Study Institutes” and “Advanced Research Workshops”. The NATO SPS Series collects together the results of these meetings. The meetings are co-organized by scientists from NATO countries and scientists from NATO’s “Partner” or “Mediterranean Dialogue” countries. The observations and recommendations made at the meetings, as well as the contents of the volumes in the Series, reflect those of participants and contributors only; they should not necessarily be regarded as reflecting NATO views or policy. Advanced Study Institutes (ASI) are high-level tutorial courses to convey the latest developments in a subject to an advanced-level audience. Advanced Research Workshops (ARW) are expert meetings where an intense but informal exchange of views at the frontiers of a subject aims at identifying directions for future action. Following a transformation of the programme in 2006 the Series has been re-named and reorganised. Recent volumes on topics not related to security, which result from meetings supported under the programme earlier, may be found in the NATO Science Series. The Series is published by IOS Press, Amsterdam, and Springer Science and Business Media, Dordrecht, in conjunction with the NATO Public Diplomacy Division.

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Sub-Series A. Chemistry and Biology B. Physics and Biophysics C. Environmental Security D. Information and Communication Security E. Human and Societal Dynamics http://www.nato.int/science http://www.springer.com http://www.iospress.nl

Sub-Series E: Human and Societal Dynamics – Vol. 64 ISSN 1874-6276 (print) ISSN 1879-8268 (online)

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Springer Science and Business Media Springer Science and Business Media Springer Science and Business Media IOS Press IOS Press

Bioterrorism: Threats and Deterrents

Edited by

Selçuk Çankaya Centre of Excellence – Defence Against Terrorism, Ankara, Turkey and

Mustafa Kibaro÷lu

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Centre of Excellence – Defence Against Terrorism, Ankara, Turkey

Published in cooperation with NATO Public Diplomacy Division Bioterrorism: Threats and Deterrents, IOS Press, Incorporated, 2010. ProQuest Ebook Central,

Proceedings of the NATO Advanced Research Workshop on Bioterrorism Ankara, Turkey 13 – 14 November 2008

© 2010 The authors and IOS Press. All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without prior written permission from the publisher. ISBN 978-1-60750-500-6 (print) ISBN 978-1-60750-501-3 (online) Library of Congress Control Number: 2010922756

Publisher IOS Press BV Nieuwe Hemweg 6B 1013 BG Amsterdam Netherlands fax: +31 20 687 0019 e-mail: [email protected]

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LEGAL NOTICE The publisher is not responsible for the use which might be made of the following information. PRINTED IN THE NETHERLANDS

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Preface This book Bioterrorism: Threats and Deterrents collates the lectures presented at the workshop on Bioterrorism that took place in Ankara, Turkey, on 13 and 14 November 2008. The workshop was organized by the Ankara-based Centre of Excellence– Defence Against Terrorism (COE–DAT). COE–DAT was inaugurated in 2005 with the purpose of supporting NATO on defence issues related to terrorism. Turkey is the framework nation, and currently six other nations also contribute with staff and funds, namely Bulgaria, Germany, the Netherlands, Romania, the United Kingdom and the United States. Each year, COE–DAT organizes numerous workshops and courses, bringing academic rigour and institutional expertise in terrorism to interested parties in NATO, Partnership for Peace (PfP), and Mediterranean Dialogue Countries, ICI Countries, and others. This book comprises 7 papers and 4 summaries that arose from the presentations at the workshop. The presenters are both academics and practitioners, selected for their expertise in matters related to bioterrorism. The papers and summaries herein cover the definition and classification of bioterrorism taking into account the various dimensions, theoretical, historical and practical aspects, and the defence against it. The first paper by Dr. Amy Zalman looks at the discourses around bioterrorism and their responsibility in creating the framework through which people contemplate, understand and respond to bioterrorism. Zalman examines two different discourses and the resulting recommendations for response. Second, a technical elaboration on biodiversity is given in the notes from the presentation by Prof. Dr. Nicolae Manolescu wherein he outlines how knowledge of biodiversity is a first and necessary step for understanding biological threats not just in terms of bioterrorism but also in terms of unintentional accidents. It was not possible to print a full paper on Dr. Manolescu’s talk, but his presentation was valuable and the information should be included in this title. Dr. Gerald Epstein discusses the necessity for collaboration between responding bodies in the case of a biological attack on civilians. Epstein introduces a network called the Global Forum on Biorisks as a potential and already operational means for medical personnel, law enforcement, researchers, etc. to strategically collaborate across disciplines both interactively and as a means of sharing useful information. David Casale takes a look at the EU and its approach to countering bioterrorism and biological threats. He explains the process through which the EU has increased its efforts to prepare for biological threats both terrorist and accidental in nature. Included in Casale’s paper is a discussion of the recent EU Green Paper written as a result of all the increased concern and discussion around biological threats. A summary of Leo Owsiaki’s presentation outlines the role of the International Science and Technology Center and specifically looks at its role in countering bioterrorism. Owsiacki covers the structure and purpose of the ISTC as well as the current and newly proposed research projects it supports.

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Levent Kenar and Mehmet Baysallar co-presented and wrote a paper about the growing need to address bioterrorism. They look at historical uses of biological agents and the growing concern for public safety. They give technical information about biological agents as well as possible countermeasures and preparedness for attacks. Ajey Lele’s paper looks at threat assessment. It discusses tools and techniques for analyzing biological threats and appropriate responses. Lele looks at tools such as trend analysis, SWOT analysis and technology that can be useful in these endeavours. Dr. Caroline Plante and Dr. Alain Dehove presented and wrote about the role of the World Animal Health Organization. They discuss the need to control animal health and disease with reference to biological safety because of the possible transference of some diseases across the species barrier (from animals to humans). They also examine the workings and potential benefits of standards set out by the World Animal Health Organization. Dr. Rashid Chotani and David Heyman each present specific examinations of historical incidents of biological crises. Chotani examines the SARS and H5N1 Influenza outbreaks. He outlines the happenings, the responses to them and then discusses what can and should be done to prepare for any possible future outbreaks, epidemic or pandemic. Heyman looks at the anthrax attacks that occurred in the US in 2001. He makes direct assessments about the medical and law enforcement structures involved in the first response. Then Heyman further suggests direct ways in which any such future acts of bioterrorism can be more successfully countered in terms of assisting victims of an attack. The final paper, by Major Yasin Aslan, looks at the international and legal case against biological threats through a discussion on the Biological Weapons Convention. Aslan examines and explains the articles from the text of the Convention as well as the highly important review process that allows the document to stay current and relevant in an ever-advancing technological society. The collection of papers and summaries is intended to cover many different perspectives on bioterrorism and biological threats and intentionally comes from authors with varying technical and practical backgrounds. The sharing and dissemination of research, experience and perspectives on biological risk and bioterrorism allows for further consideration and improvement in countering risk, and creating and improving the authorities and systems responsible for responding to such risks. Although the workshop spanned two days and involved a handful of people, hopefully the content of this volume can be useful and informative for a much greater time and to a greater audience.

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Selçuk ÇANKAYA, Maj. ARW Director

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Contents Preface Selçuk Çankaya

v

The Social and Psychological Effects of Bioterrorism Amy Zalman

1

Bioterrorism and Biodiversity Nicolae Manolescu

13

Interdisciplinary Cooperation to Counter Biological Risk Gerald L. Epstein

19

EU Approach to Bioterrorism: EC Green Paper on Bio-Preparedness Davide Casale

25

Role of the International Science and Technology Center in Countering the Threat of Bioterrorism Leo Owsiacki

39

Types of Biological Agents and Medical Countermeasures Against Bioterrorist Attacks Levent Kenar and Mehmet Baysallar

45

An Approach for a Biological Threat Analysis Ajey Lele Preparedness for Biological Threats: Position of the World Animal Health Organisation (OIE) Caroline Planté and Alain Dehove

59

67

SARS and H5N1: What Have We Learned and How to Plan for a Pandemic Rashid Chotani

71

Lessons from the Fall 2001 Anthrax Attacks in America David Heyman

79

Biological Weapons Convention: Problems and Prospects M. Yasin Aslan

83

Subject Index

97

Author Index

99

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Bioterrorism: Threats and Deterrents S. Çankaya and M. Kibaroğlu (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved doi:10.3233/978-1-60750-501-3-1

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The Social and Psychological Effects of Bioterrorism Amy ZALMAN, Ph.D. Science Applications International Corporation, United States

Abstract. In the absence of substantial empirical data on bioterrorism, two competing discourses have emerged about the potential strategies to address psychological distress. One discourse stresses the innately terrifying qualities of biological agents and argues that the government and public health communities should do more to prepare and protect the public from psychological trauma. A second discourse identifies government and defense/security community as partly responsible for constructing a sense of danger and fear among the general population. This article summarizes these competing schools and recommends emergency preparedness and risk communication strategies that draw on both. Keywords. bioterrorism, psychological effects of terrorism, risk communication, cross-cultural communication

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Introduction Although historians have identified the use of biological agents as weapons throughout human history, the concept of biological terrorism did not emerge until the mid-1990s, when the United States’ military began to contemplate how ‘rogue state’ and non-state actors might make use of such weapons. The belief that Iraq might deploy biochemical agents in the 1991 Gulf War, coupled with Japanese cult Aum Shinrikyo’s lethal chemical gas attack in a Tokyo subway in 1995, seemed to be persuasive evidence of a new threat. Contemplating the future, military theorists concluded that, “nuclear, biological, and chemical (NBC) armaments now form a new ‘trinity’ of weapons of mass destruction that threaten to make twenty-first century warfare potentially more costly than anything seen before.” 1 At the same time, the intelligence community envisioned future scenarios in which “the dramatic increase in drug-resistant microbes, combined with the lag in development of new antibiotics, the rise of megacities with severe health care deficiencies, environmental degradation, and the growing ease and frequency of cross-border movements of people and produce” made the possibility of bioterrorism both greater and more dangerous.2 The al-Qaida attacks on September 11, 2001 pitched terrorism to the forefront of American concerns, coloring the response to the anthrax-laced letters that led to five fatalities a month later. Both the government and the media contributed to the 1 Barry R. Schneider and Lawrence E. Grinter, On Twenty-first Century Warfare, Battlefield of the Future: 21st Century Warfare Issues (September 1995). Available online at http://airpower.maxwell.af.mil/airchronicles/battle/chp11.html) 2 National Intelligence Council, National Intelligence Estimate: The Global Infectious Disease Threat and Its Implications for the United States (January 2000) 1.

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convergence of the two events in the popular imagination. Bioterrorism joined global terrorism as an urgent interest in the security community. A few months later, in his 2003 State of the Union address, President Bush proposed Project BioShield, which would provide at least $6 billion dollars to developing countermeasures. The September 11 attacks made the psychological and social consequences of terrorism newly visible to the United States policy community. The attacks produced a widespread sense of trauma and vulnerability, not only among New Yorkers and those with a personal connection to the victims, but also among those who experienced the attacks through the media.3 The anthrax attacks appeared to affect an even wider swath of the globe; fear of suspected attacks and outbreaks of mass sociogenic illness occurred on several continents. The severe acute respiratory syndrome (SARS) epidemic that began in 2002 produced evidence of powerful collective emotional responses, including mass flight and rioting in China.4 The U.S. government’s dedication of unprecedented resources to bio-defence, in the context of a more broadly defined concern with terrorism and emergency preparedness, has encouraged the growth of academic literature on psychological effects. Most recently compiled studies on the topic take for granted that there is a moderate to severe risk of an attack and that psychological and social effects stem primarily from the inherently traumatizing nature of bioterrorism. However, a number of analyses question these assumptions to examine how national security, public health and media establishments can help to create a sense of psychological vulnerability in the general public. These analyses highlight how authorities may contribute to creating precisely the sense of fear that they hope to prevent or address. Both viewpoints offer valuable starting points for planning strategies to address the potential psychological and social effects of bioterrorism.

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1. Assessments of Psychological Threat in Contemporary Literature In the absence of substantial empirical evidence, providing definitive statements about the psychosocial effects of bioterrorism has proven to be a challenging task. The paucity of evidence has led researchers to cast a wide net in search of events to compare to a projected bioterrorism attack, including: chemical attacks; state uses of biological and chemical agents as weapons; conventional terrorist attacks; nuclear accidents; industrial accidents; and outbreaks of infectious diseases. Although it would seem foolhardy to discount the general lessons to be gained about emergency preparedness and disaster relief, it is not clear that these distinct forms of disaster produce the same psychological effects. Bioterrorism is often described as having a singular ability to inspire powerful psychological responses. Many researchers attribute the terrorizing capacity to the qualities of biological agents themselves. They are “invisible, odorless, imperceptible to humans, and their effects are delayed and often protracted….”5 and might produce “both gnawing doubt over whether one has been exposed and a sense of powerlessness against 3 Afton L. Hasset and Leonard H. Sigal, Unforeseen Consequences of Terrorism. Arch Intern Med, Vol 162: pages 1809-1813, September 9, 2002. 4 Molly J. Hall, Ann E. Norwood, Robert J. Ursano and Carol S. Fullerton, The Psychological Impacts of Terrorism. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science Vol 1:2: pages 139-143, 2003. 5 Molly J. Hall, et al., p. 293.

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an unseen hazard.”6 Moreover, “uncertainty about exposure to a biological agent whether one was directly exposed is likely to increase fear and anxiety among the general public.” 7 The specter of a lethal, invisible alien (pathogen) capable of violating our individual and community boundaries appears to raise a constellation of archetypal human fears that transcend particular cultures. Virtually nothing is known about how these specific qualities might promote specific psychological responses, nor how these responses might differ among various populations with distinct values and histories. Emotional responses to bioterrorism are frequently considered to be comparable to the responses to a natural outbreak of disease, although there is no consensus. There is research to support the premise that malicious events are more frightening than naturally occurring ones, 8 as well as research concluding that ambiguity about the source of disease amplifies fear. Despite the imprecision of much of the current research, it has had the beneficial effect of broadening the discussion of bioterrorism’s psychosocial effects and creating a basis for planning risk communication, mental health responses, and community awareness. Indeed, individual and collective psychological responses to bioterrorism are increasingly perceived to be so acute that they constitute a distinct risk category, and some researchers, moreover, believe that the psychological dimensions of a bioterrorism should receive greater focus.9,10 1.1. Specific Psychological and Social Effects

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1.1.1. Individual Responses from Generalized Distress to Post-traumatic Stress Disorder While there is ample evidence that the perception of a bioterrorism risk causes anxiety and distress, there is limited evidence about how exposed individuals would respond to an attack. The authors of a 2004 compendium of research on the emotional and behavioral impact of bioterrorism found no relevant studies on exposed individuals in actual events, and only a few related to other relevant populations.11 The evidence collected following the Tokyo sarin gas attacks suggests that psychological trauma would be a substantial consequence of an attack. In that attack, three Tokyo subway lines were simultaneously permeated by the lethal gas, which had been placed on trains in liquid form in disguised packaging such as drink bottles. Gas was released when the packages leaked. Morning rush hour travelers felt the effects of the attacks immediately, and stumbled and collapsed as they exited the trains. St. Luke’s International Hospital received 641 victims on the day of the attack. Of those, 111 victims were considered to have injuries serious enough to justify admission (106 were classified as having moderate injuries; 5 were severe).12 6 Gary A. Ackerman and Kevin S. Moran, Bioterrorism and Threat Assessment, The Weapons of Mass Destruction Commission (November 2004) 7. Available at the Commission’s website at http://www.wmdcommission.org/. 7 Bradley D. Stein, et al., Emotional and Behavioral Consequences of Bioterrorism: Planning a Public Health Response. The Milbank Quarterly 82: 3 (2004) 419. 8 Ibid. 9 Seth W. Carus. Working Paper: Bioterrorism and Biocrimes: the Illicit Use of Biological Agents Since 1900, Aug. 1998/ February 2001 revision. Center for Counterproliferation Research, NDU, Washington DC. 10 Ackerman and Moran, Nov 2004. 11 Bradley, pp. 423-455. 12 Ohbu et al. characterized moderately injured victims if they were immobile or had difficulty breathing were comiting, had severe headaches; severe or critical injury was indicated by patients in cardiac or respiratory arrest. A third classification of mildly injured victims included those who suffering from eye problems, rhinorrhea (runny noses) and mild headaches.

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According to one account, 33.3% (37) were characterized on admission as suffering agitation. 13 Other psychological symptoms reported by patients in the moderately injured group following their release included “anxiety, fear, nightmares, insomnia, and irritability; of these, five had nightmares and insomnia so severe that they required visits to psychiatrists”.14 Answers provided by 475 victims one month after the attack indicated the prolonged nature of psychological distress (the 475 respondents represent 77.9% of 610 who were given a questionnaire). Nearly 60% continued to experience psychological distress in some form. The greatest number reported a fear of the subway (52 or 32%) and sleep disturbance (37 or 29%). Other reported symptoms included insomnia, flashbacks, depression, irritation and nightmares that included the presence of monsters, or large rocks dropping on victims. These symptoms and others indicative of PTSD persisted in some patients for six months or longer, and required psychiatric treatment.15 The imperceptible nature of biological agents and delayed onset of symptoms of exposure may themselves cause anxiety. This can make it difficult for people in an affected area to differentiate between anxiety about exposure and exposure. These ‘worried well,’ as they are often termed, may be viewed as panicking unnecessarily. However, they may not know whether they have suffered exposure. Moreover, they may be suffering physical symptoms.16 Authorities should consider the possibility that large numbers of those in the vicinity of a potential attack will seek treatment, and that many will suffer symptoms of psychological distress. Over 5,000 people presented for medical treatment following the Tokyo subway attack. Of the thousands of people who sought medical treatment following Iraqi Scud missile attacks on Israel during the 1991 Gulf War, nearly all of them suffered from psychological effects. Forty-three percent of the 773 people hospitalized over the four-week period of the attacks were admitted for psychological stress.17 People may also respond to hoax attacks with heightened anxiety.18,19 Alexander and Klein (2003) compiled a sketch of other potential individual responses to an attack, culled from literature on natural and intentionally provoked events. These included emotional responses such as: • • • • •

Emotional numbness Horror and disgust at unfamiliar forms of injury Anger at authorities for failing to protect them Paranoia and xenophobia Loss of trust and increased feelings of vulnerability

13 Tetsu Okumura, et al., Report on 640 Victims of the Tokyo Subway Sarin Attack, Annals of Emergency Medicine, 28: 2 (1995) 131. 14 Sadayoshi Ohbu, et al., Sarin Poisoning on Tokyo Subway, Southern Medical Journal 90:6 (June 1997) 590. 15 Ibid. 16 Ackerman and Moran, Nov 2004. 17 Glenn R. Sullivan and Bruce Bongar, “Psychological Consequences of Actual or Threatened CBRNE Terrorism.” In Bruce Michael Bongar, et. al., Psychology of Terrorism (Oxford University Press) 2007. 18 B.W. Mason and R.A. Lyons, Acute Psychological Effects of Suspected Bioterrorism, Journal of Epidemiology and Community Health 57, pages 353-354, 2003. 19 Eric Eckholm, The SARS Epidemic: Beijing: Illness’s Psychological Impact in China Exceeds its Actual Numbers. New York Times. April 24, 2003.

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• •

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Hopelessness and helplessness Survivor guilt20

Long-term anxiety may also result from a bioterrorist attack. Post-traumatic stress disorder (PTSD) is an anxiety disorder triggered by a traumatizing event such as a natural disaster, military combat or exposure to terrorism or other mass violence. PTSD symptoms are distinguished from non-clinical anxiety by their intensity and duration of over a month. In some cases, PTSD lasts for years following a traumatic event.21 There is substantial agreement that the psychological effects of bioterrorism could last for years beyond the event, based on the evidence of depression, increased alcohol and tobacco use and PTSD, supplied by Oklahoma City survivors and New York City residents following September 11.22,23 However, there is little understanding of who may be at risk for long-term or especially severe responses to bioterrorism;24,25 in the cited cases of conventional terrorism, most people recover from anxiety and other symptoms fairly quickly, within a month. Similarly, there is little understanding of which forms of intervention may prove most effective. Delhanty suggests that, since most victims of terrorism appear to recover rapidly, close monitoring for several weeks following an event may be preferable to immediate intervention.26

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1.2. Collective Responses: Mass Anxiety and Mass Sociogenic Illness The assumption that suspected or actual bioterrorism will provoke collective anxiety is nearly ubiquitous in both specialized and popular treatments of bioterrorism. The proposed consequences of such anxiety could include mass panic, mass sociogenic illness and widespread behaviors that put pressure on emergency medical systems, public transit, or food and clean water supplies. Recent disasters appear to bear out the assumption that collective, ‘contagious’ behavioral responses will ensue following an attack. Experts disagree, however, about the meaning and significance of some of these behaviors and about the use of interpreting all behaviors as panicked or irrational. Some make the case that the expectation of panic in the face of disaster is not justified, considering the lack of panic in a wide range of events including gas attacks on various cities during World War II, the sarin gas attacks in 1995, the 1995 Oklahoma City bombing, and the September 11, 2001 attack, among others.27 The actions of thousands of Beijing residents fearing exposure to SARS in April 2003 were widely perceived and communicated as reflecting panic. The New York 20 David Alan Alexander and Susan Klein, Biochemical Terrorism: Too Awful to Contemplate, Too Serious to Ignore, British Journal of Psychiatry 183, pages 491-497, 2003. 21 National Institute of Mental Health, Post-traumatic Stress Disorder. http://www.nimh.nih.gov/health/publications/anxiety-disorders/post-traumatic-stress-disorder.shtml. 22 Alexander and Klein, 2003. 23 Susan Jakes, “Beijing’s SARS Attack,” Time, April 8, 2003. http://www.time.com/time/world/article/0,8599,441615,00.html 24 Douglas L. Delhanty, “Are We Prepared to Handle the Mental Health Consequences of Terrorism?” American Journal of Psychiatry 164, pages 189-191, February 2007. http://ajp.psychiatryonline.org/cgi/content/full/ajp;164/2/189. 25 Larry E. Beutler, Gil Reyes, Zeno Franco and Jennifer Housley, “The Need for Proficient Mental Health Professionals in the Study of Terrorism.” In Bruce Michael Bongar, et. al., Psychology of Terrorism (Oxford University Press) 2007. 26 Delhantry, pp. 189-191. 27 Glenn R. Sullivan and Bruce Bongar, “Psychological Consequences of Actual or Threatened CBRNE Terrorism.” In Bruce Michael Bongar, et. al., Psychology of Terrorism (Oxford University Press) 2007.

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Times reported that residents “raced” to local shops for food, and that thousands of people “crowded railway stations and rushed onto buses … ignoring official appeals”.28 In fact, the decision to flee in the face of consistently untrustworthy information from the government29 can be interpreted as intuitively reasonable. Glass and Schoch-Spana make the case that when 40% of the population surrounding Three Mile Island evacuated themselves following the 1979 nuclear accident, they were making “a reasonable decision to remove themselves from a situation of unknown and potentially significant risk” in the absence of good information.30 The difference between the two events is the SARS virus contagious effects. Clearly, it is crucial that people be made aware of the distinct characteristics of biological agents so that they can make appropriate decisions about how to respond. Mass sociogenic illness (also called psychogenic illness) is the “rapid spread of illness signs and systems affecting members of cohesive groups … whereby physical complaints that are exhibited unconsciously have no corresponding organic aetiology”.31 Symptoms characteristically include shortness of breath, hyperventilation, headaches, nausea and other signs of stress. 32,33,34 Multiple cases appeared in 2001 following the September 11 attack and the anthrax-laced letter mailings, some with large numbers of victims. Over a thousand Manila schoolchildren with flu-like symptoms were brought in for medical attention in October in 2001, following the rapid spread of a rumor by text message. 35 Distinguishing mass sociological illness from exposure to biological or chemical agents is particularly challenging because the symptoms of fear and anxiety, such as shortness of breath, are similar to the symptoms of exposure.36

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2. Assessments of the Construction of Threat and Fear in Bioterrorism Literature Much but not all of the academic literature on bioterrorism presumes that society’s fear of bioterrorism is the natural outcome of the inherently terrifying nature of biological agents and the uncertain threat of an attack. Some analyzes suggest the existence of what may be termed a ‘bioterrorism discourse,’ in which the sum of the actions, rhetoric, resources and research dedicated to bioterrorism mobilize pre-existing fears.

28 Eric Eckholm, The SARS Epidemic: Beijing: Illness’s Psychological Impact in China Exceeds its Actual Numbers. New York Times. April 24, 2003. 29 Susan Jakes, “Beijing’s SARS Attack,” Time, April 8, 2003. http://www.time.com/time/world/article/0,8599,441615,00.html. 30 Thomas A. Glass and Monica Schoch-Spana, Bioterrorism and the People: How to Vaccinate against Panic, Confronting Biological Weapons 34, January 15, 2002. 31 Robert E. Bartholomew and Simon Wessely, Protean Nature of Mass Sociogenic Illness: From Possessed Nuns to Chemical and Biological Terrorism Fears.” British Journal of Psychology 180, pages 300306, 2002. 32 Sullivan and Bongar. 33 David Alan Alexander and Susan Klein, Biochemical Terrorism: Too Awful to Contemplate, Too Serious to Ignore, British Journal of Psychiatry 183, pages 491-497, 2003. 34 Simon Wessely, Kenneth Craig Hyams and Robert Bartholomew, Psychological Implications of Chemical and Biological Weapons, British Medical Journal 323, pages 878-879, 2001. 35 Ibid. 36 Robert E. Bartholomew and Simon Wessely, Protean Nature of Mass Sociogenic Illness: From Possessed Nuns to Chemical and Biological Terrorism Fears.” British Journal of Psychology 180, pages 300306, 2002.

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In this view, society’s fear of terrorism is not natural, but politically and socially constructed.37 When the ‘natural’ qualities of bioterrorism fears are dismantled, it becomes clearer that public fears can be “produced and deployed” by the actions, symbolic gestures and statements of public officials, the media and others.38 A number of authors point to the use of hazardous materials suits as a symbolic gesture that communicates grave threat. In their examination of psychological impact on thirteen people exposed to suspected anthrax, Mason and Lyons found that 45% reported a clinically relevant level of anxiety a week after the event. This was a substantially higher percentage than among an unexposed control group, despite the fact that the exposed were informed that the substance was inert within 24 hours of their exposure. 39 The authors conjectured that the response to the incident, which included “removal of the packages by fire service personnel wearing full protective suits and complete chemical decontamination of exposed persons,” might have played a part in creating powerful anxiety.40 These and other symbolic gestures that encourage elevated fear may have unintended health consequences. A study of 2,700 Americans’ health levels since before 2001 revealed that after the attacks, and for several years afterwards, those who feared terrorism the most had a three to five times greater likelihood of being diagnosed with cardiovascular risk. Researchers speculated that constantly elevating terrorist threat alert levels contributed to sustained fear.41 Symbolic and other direct communication about terrorism is only one of the ways bioterrorism discourse mobilizes fear. Each society’s approach to bioterrorism engages much broader cultural narratives about security and threat, and political as well as mental health. Durodié argues that mainstream bioterrorism discourse exaggerates the true vulnerability of developed Western countries. This is achieved partly by ignoring factors that mitigate the threat, such as the fact that biological agents are not easy to develop and deploy, that they have rarely been used, that there is little evidence as to the psychological effects of an attack and that developed countries’ resources for dealing with bioterrorism may deter an attack. In addition, Durodié contends that Americans’ magnified feeling of susceptibility to attack both predates September 11 and is “culturally determining, giving shape to and driving much of the bioterrorism agenda.42 The sources of such feelings are various and range from fears related to social change, globalization and ‘American standing’ in

37 The idea of a ‘bioterrorism discourse’ owes much to Joseba Zulaika and William A. Douglass, who coined the concept of a “terrorism discourse” in Terror and Taboo: The Follies, Fables and Faces of Terrorism (New York: Routledge, 1996). Without disputing the existence of political violence, they argued that the category “terrorism” is a way of representing and narrating political violence to serve particular political interests, less than it is a direct reflection of a pre-existent phenomenon. For analyses along these lines about bioterrorism, see Making Threats: Biofears and Environmental Anxieties, Eds. Betsy Hartman, et al., Rowman & Littlefield (2005) and Melinda Cooper, “Pre-empting Emergence: The Biological Turn in the War on Terror,” Theory, Culture and Society 23:4 (2006) 113-134. 38 Betsy Hartmann, Introduction, Making Threats, 3. 39 These conclusions were made on the basis of administering a questionnaire linked to symptoms on the Hospital Anxiety and Depression (HAD) Scale. Control data was borrowed from another study of the same population in the same time frame. 40 B.W. Mason and R.A. Lyons, Acute Psychological Effects of Suspected Bioterrorism, Journal of EpidemiollgyEpidemiology and Community Health 57, pages 353-354, 2003. 41 John Tierney, Living in Fear and Paying a High Cost in Heart Risk. New York Times. January 5, 2008. 42 Durodie, p. 265.

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the world to the growing role of a therapeutic sensibility that encourages a focus on human vulnerability.43 These conclusions point in two directions. For the United States and societies with some similar characteristics, they indicate that greater public clarity about the source of fear and a sense of vulnerability can actually serve to inoculate against some harmful effects of fearing and undergoing a terrorist attack. For other societies, similar analyses of their own cultural contours are indicated, as are the limits of drawing wholesale on research conclusions about the consequences of terrorism that draw solely on the American experience.

3. Strategies for Planning for the Psychological and Social Effects of Bioterrorism The following planning considerations, culled from the extant literature on bioterrorism and its effects, are divided into four areas: framing, communication, practitioner best practices and community participation. Good communication is the key recommendation in each area. Decision makers and practitioners will be well served by continuing to seek an understanding of the symbolic aspects of bioterrorism – how bioterrorism harnesses social fears, and how an attack might unleash novel ones. Authorities should also recognize that actions as well as words help shape perceptions of an attack, before, during and afterwards. 3.1. Framing Strategies

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In the social sciences, a frame refers to the conceptual structure from within which people interpret an event. How people respond to a biological attack is likely to reflect preconceived frames of reference. High-level decision makers and communications strategists can benefit from an understanding of how bioterrorism aligns with and intersects dominant social and political narratives. Framing considerations for the policy community include •

• • •

Raise awareness among authorities of current frames that dominate interpretations of bioterrorism. These include: national security, medical, globalization, and social issues. There may be others, and each will have distinct national and cultural contours in different communities. Understand these, more broadly, within the dominant national or cultural historical narratives Recognize that the entire range of actions taken in regard to bioterrorism contributes to its social framing. These include: legislation, resource allocation, public statements, and emergency preparedness plans Create emergency preparedness and disaster plans that reflect and reinforce intended frameworks Remain prepared to modify framing and communication strategies as knowledge and circumstances evolve.

43 Bill Durodie. Facing the Possibility of Bioterrorism. Current Opinion in Biotechnology 15, pages 264268, 2004.Randal Beaton et al.,The Sarin Gas Attacks on the Tokyo Subway – 10 Years Later, Traumatology 11, pages 104-105, 2005.

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3.2. Communication Strategies Framing sets the stage for how people interpret bioterrorism and how they will interpret government and other authorities’ communications while preparing for or responding to an attack. It is also the first element shaping communication between authorities and the public about bioterrorism. There are also specific communication tactics that can be taken before and during an event to encourage constructive responses within a victimized community and beyond it. They may be more likely to panic or feel helpless if they do not understand it or feel they have no control over their own safety. If, however, they view bioterrorism as one among other known biological risks, they are more likely to take constructive steps where possible. In their recommendations, Ackerman and Moran point out that “worst case scenarios and highly dramatic – but relatively improbable – potential bio-attack outcomes” dominate the public imagination, and that “extreme portrayals” may compound the psychosocial effect of an attack. They recommend placing the event in the context of similar risks.44 Above all, it is critical that authorities recognize the importance of communicating early, honestly and consistently with the public to maintain trust, reduce the invidious role of conspiracy theories or rumor, establish order and ensure that victims’ and others’ needs are met. As the chief investigator of the 1994 plague outbreak in Surat, India observed in the aftermath, “Chaos reigned supreme, rumor was the ruler. Lack of accurate information was the bane of the whole thing …. Transparency, be transparent and provide the information. Come out and do not hide …. This should be the public posture all the time.”45 •

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• • • • •

Recognize the critical nature of communication between authorities, between authorities and the general public and between different communities in the public at large Prepare a communications and media strategy in advance, recognizing that it may need communication Be prepared to provide accurate and trustworthy information. Correct mistakes early Recognize the regional or global potential of an attack, and prepare for communication for different audiences (Ackerman and Moran) Incorporate technological assistance into a communications plan. Biosurveillance technologies that help identify the cause of an attack can serve as the prelude for communication (Beaton et al.) Communication should continue after an attack. Stein et al. note that even several months following the anthrax letters, many Americans were unclear about whether it was contagious.

44 Gary A. Ackerman and Kevin S. Moran, Bioterrorism and Threat Assessment, The Weapons of Mass Destruction Commission, November 2004. http://www.wmdcommission.org/ 45 V. Ramangaswami, Psychosocial Effects of the 1994 Plague Outbreak in Surat, India, Military Medicine 166, Suppl. 2 (2001) 29.

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3.3. Practitioner Responses In the United States, the need for greater mental health preparedness is a recent phenomenon, and there is little consensus as to the specific responses that are appropriate to identify and alleviate psychological distress. Practitioners agree that a visibly sound reaction to the event in the medical community is a crucial step and that more research and involvement by the mental health community will: •

• •

•

Recognize that psychological distress and its physical symptoms are meaningful and legitimate responses to an attack and that they are deserving of the authorities’ attention. Label the system in a way that respects everyone rather than dismissing the concerns of those suffering from anxiety. Hall (2005; see footnote 1) notes that “worried well” is a dismissive term and that other terms may be more appropriate Engage the mental health community into the emergency planning process, as well as others who may participate in psychological interventions, such as community religious leaders, family heads and others Create opportunities to attend to the psychological needs of communities that may have special vulnerabilities, including rescue workers and medical personnel providing care, children and those with pre-existing psychiatric conditions Hall recommends creating a clinical registry to keep track of those concerned about potential exposure, and observes that it will serve as both psychological and public health needs.46

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3.4. Engage the Community Most bioterrorism scenarios predict negative social responses. Glass and Schoch-Spana argue that historically, adaptability and cooperation are the norm. 47 As a result of negative expectations, the public is rarely perceived as a participant in responding to emergencies. They have proposed broad guidelines to ensure that the public is made a partner bioterrorism planning. Their recommendations include • • •

Recognize that panic is unusual and can be prevented Recruit the public as a partner in emergency preparedness. The public, through civic and other groups, can be entrusted to disseminate information, monitor for disease outbreak and distribute medicine “Think beyond the hospital for mass-casualty care.” Hospitals will not be able to absorb mass numbers of exposed or infected victims. Community members can help to identify, assist and care for victims in homes and other locations.

46 Molly J. Hall, et al., The Psychological Burden of Bioterrorism, The Trauma of Terrorism: Sharing Knowledge and Shared Care, An International Handbook, Eds. Yael Danieli et al., Haworth Maltreatment and Trauma Press (2005) 293. 47 Thomas A. Glass and Monica Schoch-Spana, Bioterrorism and the People: How to Vaccinate against Panic, Confronting Biological Weapons 34, January 15, 2002.

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3.5. Regional and Cross-Cultural Considerations Analyzes of the effects of bioterrorism and, more broadly, terrorism in general, tend to speak in universal generalities. American, Japanese, Chinese, British, Israeli and other experiences are examined for their instructive use across cultures and nations. At a fundamental level, this appears to be appropriate. Narratives about the victims of political violence and natural disaster reveal basic human needs such as fear, anxiety, trauma, concern for family and community, the desire for safety and trustworthy communication. Risk-perception research over the last generation reveals that “humans appear to fear similar things, for similar reasons” which include our awareness of a risk, the uncertainty of an event’s occurrence and whether it is catastrophic.48 Behind these generalities, however, lie specific cultural and political factors that shape expectations and responses to disaster. Israelis’ intense psychological responses to the 1991 Scud missile attacks, such that several people suffocated in gas masks when there was no chemical gas attack, were shaped by expectations unlikely to be replicated elsewhere. They included the expectation that Saddam Hussein wished to tow Israel into combat and a cultural predisposition to fear chemical gas in particular, based on the Jewish experience in the Holocaust. 49 The substantial record of Americans’ distress and sense of vulnerability following the 2001 attacks relates to the specific political and cultural belief that the United States was impossible to harm, preceding the attacks. It is unclear that collective trauma would take the same shape elsewhere. In both of these instances, government authorities and the public shared expectations with their citizens. This suggests that authorities should be especially conscious of the political and cultural assumptions underwriting their emergency preparedness and risk communications planning. •

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•

•

•

•

Recognize that political, historical and cultural factors shape expectations and approaches to disaster and violence. When consulting extant research on psychological and social effects of bioterrorism, be aware of cultural assumptions in the research. Where was the research performed? Which populations does it concern? What expectations shaped responses to attacks or disaster? Examine conventional modes of communication while creating risk communication plans. Considerations include: determining the modes and sources of communication that people tend to trust; levels of existing trust in government communication; how community networks function; the existing role of rumor and conspiracy theory in society. Take into consideration specific community formations when creating emergency preparedness plans. Recommendations in American research that civic groups, religious organizations or other local groups be involved in preparing and responding to an attack may be modified in other settings as appropriate. In some areas, families or other kin structures, informal networks, unions or other professional organizations may serve as responders and conduits for trustworthy communication. Coordinate across regions and countries for potential cross-border events or outbreaks.

48 George M. Gray and David R. Ropeik, Dealing with the Dangers of Fear: the Role of Risk Communication. Politics and Public Health, pages 106-116, November/December 2002. 49 Sullivan and Bongar.

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Bioterrorism: Threats and Deterrents S. Çankaya and M. Kibaroğlu (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved doi:10.3233/978-1-60750-501-3-13

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Bioterrorism and Biodiversity Prof. Dr. Nicolae MANOLESCU Regional High Studies Center for Bioterrorism Prevention, Romania

Abstract. Terrorists have an incredible arsenal at their hand, for which they have to make minimal efforts and expenses, since it is provided by nature, thanks to biodiversity. Bioterrorism is difficult to combat. In comparison with the general types of terrorist actions against civil society, bioterrorism represents a huge advantage for terrorists. We should give the first priority to the absolute knowledge of biodiversity which offers us the key to the successful actions of combat and prevention of bioterrorism. This paper attempts to unravel the mystery of biodiversity and its applications in bioterrorism. Keywords. Bioterrorism, biodiversity

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Introduction This paper is meant to highlight and at the same time to demonstrate that, in comparison with the general types of terrorist actions against civil society, bioterrorism represents a huge advantage for terrorists. This advantage resides in the fact that terrorists have an incredible arsenal at their hand, for which they have to make minimal efforts and expenses, since it is provided by nature, thanks to biodiversity. In order to use this arsenal for biocriminal purposes, they need biomedical knowledge on the one hand, and laboratories where this incredible means of mass destruction offered by the surrounding nature should be isolated and multiplied, on the other hand. For this reason, bioterrorism is difficult to combat and therefore the whole range of defensive means at the disposal of civil society is not always sufficient. If we were to classify these defensive means in accordance with their importance, we should give first place importance to gaining absolute knowledge of biodiversity which offers us the key to the successful actions of combat and prevention of bioterrorist aggressions on civil society. What follows is an attempt to unravel the mystery of biodiversity offered by the surrounding nature, within the limits of our knowledge. Biodiversity hosts a large number of agents with high potential for biocriminal activities, namely bacterial corpuscles including spores which include bacterial toxins, viruses, fungic toxins and NGO. These agents can act directly or through vectors. Members of civil society are possible targets for biocriminal (bioterrorist) activities with high destructive potential where the biological agents used have several methods of penetration: respiratory, digestive, transcutaneous and apparent mucosa. The locus where agents with bioterrorist potential live can differ greatly in accordance with the general natural characteristics of the agents. They can be found in air, soil, water, plants, and animals. Agents living within water, plants and/or animals can be found in the food that people eat on a daily basis.

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The general consequence of the penetration of destructive agents in the possible ways mentioned above can be rendered concrete though an attack on the civil population, an attack on some military targets, or an attack on some individuals. These can be carried out through:

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A. Bacterial Corpuscles and Spores 1. B. Antracis 2. Francisella tularensis 3. Yersinia pestis 4. Brucella sp. 5. Rickettsia prowazekii 6. Coxiella burnetti 7. Chlamydia psittaci 8. Burkholderia pseudomallei 9. Mycobacterium tuberculosis 10. Salmonella sp. 11. Shigella sp. 12. Vibro cholere 13. Escherichia coli 14. Yersinia enterocolitica 15. Septospira sp. Campylobacter jejunei B. Toxins Bacteria: botulinic staphylococci enterotoxin epsilontoxin perfringens: Ricin (Riconus comunis) Fungic: fusaritoxin aflatoxin ochratoxin C. Viruses Class A: Variolic virus, virus for hemorrhagic fever Class B: Alflavirus, Viral encephalitis on the relation Class C: Hendra virus, nipah virus Proposal classification A: SARS, Avian Influenza In what follows, we will detail, wherever necessary, a biodiversity intraspecies of virus in order to identify all subclasses as well as their modalities of penetrating the human organism in order to carry out bioterrorist attacks: Hemorrhagic Fever Viruses: Filovirus, V. Marburg, V. Ebola ĺ direct transition; Flavivirus: Hemorrhagic fever OMSK, B. Kyasanur Forest ĺ transmission by lice; Flavivirus: Denga, Yellow fever ĺ transmission by mosquitoes.

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Hemorrhagic Fever Viruses II: ARENAVIRUSES (Direct transmission) V. Guanarita V. Junin V. Cariomeningitis V. Whitewater Arroyo V. Lassa V. Sabia V. Machupo Hemorrhagic Fever Viruses III: ARBOVIRUSES (Bunya Viruses) Phleboviruses: Rift-Valley fever (transmission by: milk, mosquitoes – Ruminants) Hantaviruses: Pulmonary syndrome (direct contamination from mouse (food)) Nairoviruses: Hemorrhagic fever (Crimea, Congo) (transmission by louses – Wild birds) A special place is held for food however, through which biocriminals carry out various actions by contaminating food and water. By analyzing the possibility of contamination through drinking water, we will identify the following agents with bioterrorist potential:

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I. Bacteria 1. Salmonella typhy 2. Salmonella parathyphy A.B. 3. Shigella spp. 4. Vibro cholerae 5. Yersinia enterocolitica 6. Campylobacter jejuni 7. Escherichia coli enterotoxigena 8. Leptospira sp. II. Viruses 1. Arenaviruses/hemorrhagic fevers 2. Hantaviruses 3. Polyomielitis virus 4. Norwalk virus Finally, water contamination with pathogen agents with high biocriminal potential will inexorably lead to the following diseases in human society: 1. 2. 3. 4. 5. 6. 7.

Typhoid and/or fever Bacillary dysentery Cholera Acute bacterial gastroenteropathy Hemorrhagic fever Poliomyelitis Leptospirosis

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Besides water contamination we will also take into consideration contamination of solid food, be it vegetal (graminaceae and corn flour) or animal. The separate analysis of the latter demonstrates that the above mentioned flours can be the hosts of the following toxins: 1. Fusariotoxins (mycotoxin produced by Fusarium spp.) 2. Ochratoxin (mycotoxin produced by Penicillium spp.) 3. Aflatoxin (mycotoxin produced by Aspergillus spp.) In humans, these mycotoxins can produce: fusariotoxicosis and/or cancer with destruction of the immune system of the organism. For the food of animal origin that can be contaminated we highlight primarily the following: ƒ ƒ ƒ ƒ ƒ

Milk Unprocessed dairy produce Mollusks Fresh meat Eggs

The analysis of every product of animal origin shows the existence of big differences between products from the point of view of contaminating agents. Milk and unprocessed dairy milk can be infected with: ƒ ƒ ƒ ƒ

Mycrobacterium tuberculosis – tuberculosis Brucella spp. – brucellosis Staphylococcus spp. – food poisoning Escherichia coli enterotoxic – colibacillosis

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Fresh meat can be contaminated by: ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ

Salmonella spp. Escherichia coli enteropatogena Staphylococcus aureus Clostridium perfingens Clostridium Botulinicum Leptospira Yersinia enterocolitica Compylobacter jejuni

For fowl the most feared agent is the Bird Flu Virus. This contaminating agent can cause: ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ

Salmonellosis Enterotoxic colibacellosis Staphylococcia (food poisoning) Botulism Leptospirosis Bird flu Clostridium toxicosis (food poisoning) Pseudo membranous enterocolitis etc.

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Eggs can be contaminated with: the Bird Flu virus, Salmonella pullorum, which will lead to Bird Flu or Salmonellosis. With respect to shellfish and mollusks we mention: ƒ ƒ ƒ ƒ ƒ ƒ

Clostridium botulinicum Clostridium perfringens Vibrio cholerae Vibrio parahaemolyticum Shigella spp. Flagellates which can lead to the PSP toxic mortal syndrome (paralytic shellfish poisoning) through secretion of “saxitoxin”.

These contaminating agents can cause the following diseases: ƒ ƒ ƒ ƒ ƒ

Botulism Cholera Bacillary dysentery Toxic syndrome specific to saxitoxin Clostridium toxicosis (food poisoning)

Finally, we believe it is absolutely essential to ask two major questions and to try to answer them pertinently.

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1. How shall one tell the difference between a bioterrorist attack carried out by food contamination and the disease whose cause is natural? This is difficult, but not impossible to do. In order to make a unanimously acceptable differentiation, the following are to be implemented: a) Attested BSL diagnosis laboratories that should be very well equipped with electronic devices, diagnose kits to be used by highly qualified personnel; b) First class informational system that should be functional nationwide and worldwide in order to draw up daily epidemiologic maps. 2. What is there to be done? a) The control of the quality of food of animal and vegetal origin should be carried out much more responsibly given the fact that the latter can be a vector of a bioterrorist attack. b) Food safety should be intensely monitored in order to guarantee the safety of the population. c) Some legal framework should be urgently created with respect to the safety of the areas where pathogen agents are processed and stored, so that they cannot be stolen by biocriminals; some record should be kept and agents should be marked for recognition. d) Careful monitoring of the biomedical research field should be carried out, which can lead to new species of biological agents with potential for bioterrorist activities, or to new genetic characteristics (mutations).

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e) Organization of the workplace should be such that no biologic material with bioterrorist potential should be removed with a view to using it for bioterrorist activities. f) Permanent interstate exchange of scientific information between NATO partners and those outside NATO should occur, including exchange of specialists. g) Supporting of graduate and post-graduate education should occur as well as the implementation of master programs in countries that already have experience in this domain. h) Good collaboration should occur between Romania-EFSA and NATO in the domain of prevention and combating bioterrorism.

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Interdisciplinary Cooperation to Counter Biological Risk Gerald L. EPSTEIN, Ph.D. Centre for Strategic and International Studies

Abstract. This paper is a summary of a presentation. It discusses the nature of procedures and interests in countering biological risks by personnel in various societal sectors. It particularly looks at the overlap and similarities between and amongst certain sectors in light of possible cooperative endeavors. It also introduces The Global Forum on Biorisks as a strategic way for various sectors to collaborate across disciplines both interactively and as a means of sharing useful information. Keywords. bioterrorism, biorisk, biological risk, biological threat, counterterrorism, Global Forum

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Public Health-Law Enforcement Cooperation in a Broader Context There are three main actions that are necessary when thinking about collaboration in dealing with biological risk situations. First, one must look at biological risks in general, not just bioterrorism or other deliberate misuses of biological agents. Second, one must look at interdisciplinary collaboration in general; interdisciplinary necessarily means that the collaboration extends across many professional communities and should extend to prevention as well as response. Third, effective consideration of such kind of collaboration would require an innovative mechanism to facilitate cross-discipline and cross-national engagement and cooperation such as The Global Forum on Biorisks. Biological Risk and Threat The sources of biological risk are numerous, but it is important to realize that some risks are deliberate, as in bioterrorism, and other risks can be resultant of, for example, accidents, mishandling etc. in biological research. Regarding deliberate biological threats, the ability of biological weapons to cause death, disease, and disruption on large scales has been known for decades. Despite the sparse historical precedent for biological attack, technological and political trends offer real cause for concern. But there is room for considerable diversity in how this threat is perceived. Differing perceptions motivate differing priorities and result in different policy choices. Consequently, existing response communities are not really set up for this problem and may see it quite differently. Consider the example of the anthrax incidents in the US. There were “only” 5 deaths, however, the attack was targeted at US political and media leaders, resulting in extraordinarily high profile coverage by media. There were a number of direct and indirect consequences: Business of the US Congress was heavily disrupted; there was

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widespread anxiety over mail safety; Post offices around the country had been shut down. These mailings were more responsible for the current US emphasis on bioterrorism than 9/11 was. Now consider the challenges of the deliberate misuse of a biological agent. State programs demonstrated the lethal potential of biological weapons long ago and terrorist interest in biological weapons has been long questioned. Although historically there has been little precedent or inferred desire for BW, current terrorists may be more interested in BW. We can see the correlations in that 9/11 demonstrated terrorist interest in mass destruction while the 2001 anthrax attacks raised great concern in the US. Al Qaeda is known to have explored BW but it is still impossible to truly know of a bioterror threat; there is little empirical basis for assessment and terrorist desire for and capabilities in BW is highly uncertain. Yet, technical and political trends give cause for concern. Advances in biotechnology bring both remarkable advances and challenges. • • •

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•

It is ever more powerful o Increased ability to understand and manipulate o Increased rate of development It is ever more available o Widespread geographical diffusion o Low barriers to entry It is ever more familiar o Increased market penetration in new applications o Growing infrastructure and human resources It is ever more decentralized and dispersed o State actors important but far from dominant

Internationally, with respect to biological threats, all nations’ fates are intertwined. Groups based in one nation can acquire resources in another for use in a third. Disease can spread at the speed of travel. Consequences of a biological attack can extend well beyond the locus of release. States failing to take biosecurity measures may be held accountable for attacks attributed to their inaction. Therefore, many policy measures must be coordinated internationally to be effective in this kind of environment. In terms of governance in this international arena, traditional governance measures are not well suited to problems that are inherently international, rapidly evolving, scientifically and technologically intensive, and networked and decentralized, with highly diverse sets of actors. Currently, biological weapons and bioterrorism are not major priorities among many key constituencies; however, policy must safeguard opportunities as well as mitigate risks. There are a number of facets of deliberate use of biology for harm and they each have a potential responder in a relevant community: • • • • • •

Disaster – Emergency Management Community Act of War – National Security Community Scientific Investigation – Scientific Community Business Disruption – Biotech, Pharmaceutical and Other Community Disease Outbreak – Public Health and Medical Community Act of Terrorism – Law Enforcement Community

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Implications for these communities include that the deliberate use of biology for harm is a problem that overlaps many familiar problems, but equates to none; responsibility falls on many communities, none of which see this as its primary mission; each must see whether traditional tools and approaches need to be modified. If modifications occur with the intention of collaborative response, each community will be concerned that new responsibilities should not impair existing ones; each would have a different use for resources not spent on this problem; each will have to work with – and quite possibly interfere with – other communities with which it may have little common experience. Specific implications for Law Enforcement and Public Health communities include the following. Both communities need to interview those likely to have been exposed to a bioterrorist attack wherein identifying the time and place of release allows more efficient distribution of medical countermeasures; and, locating the crime scene is important for identifying and apprehending the perpetrator(s). Therefore, collaboration in the investigation would allow critical information to be uncovered and shared more effectively and serves both agencies’ missions. Controls on particularly dangerous organisms (“select agents”) have been tightened in the United States and many other countries. Scientists working with these agents must now typically be screened by security agencies. But, on what grounds? Are there criteria that have security value in predicting possible abuse? Are those criteria scientifically justifiable and acceptable to the scientific community? Bad criteria won’t work and will damage science. Therefore, in order to effectively collaborate across these specialized communities we may consider a Global Forum on Biorisks.

Global Forum on Biorisks

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Key Requirements Firstly, it must accommodate widely diverse threat perceptions. In the case of bringing together multiple communities one must consider that: • Disparate threat perceptions are driven by – Lack of empirical evidence – Very few distinctive indicators of malicious effort – Great uncertainty in modeling capabilities – Plethora of competing priorities – Consensus on the threat unlikely • Differing perceptions and differing priorities motivate differing policy choices – Consensus on response priorities unlikely Secondly, it must take a comprehensive approach. There are no “chokepoints”, given the dual-use nature of biotechnology, but a constellation of measures, each of which may have modest effect, can aggregate to a more effective system. A successful approach must identify policy tools that might be applied at any stage of a potential attack.

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In order to reduce deliberate threats, communities can use the 4 D’s: • • • •

Dissuade malicious actors from pursuing biological weapons Deny materials, equipment, and expertise Detect covert weapons programs Defend against biological attack with effective consequence management and attribution

Thirdly, it must take an international approach. Groups posing threats can be global networks. Infrastructures on which they draw are global networks. Direct and indirect consequences of an attack can be global. Many policies require international implementation to be effective. Fourthly, it must also take a multisectoral approach. Many professional communities are on the front lines in combating biological threats: • • • • • • •

Arms control/diplomatic Defense Scientific Law enforcement Public health Medical Industry

These communities or sectors have different cultures, assumptions, priorities, and even languages. Partnerships and cross-fertilization are needed, as is a framework broad enough that can help identify and build new connections.

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Call for New Thinking In the A/60/825 report by the UN Secretary-General regarding recommendations for a global counter-terrorism strategy it is written: [The threat of bioterrorism] acutely requires new thinking on the part of the international community... what we need now is a forum that will bring together the various stakeholders — Governments, industry, science, public health, security, the public writ large — into a common programme...” (paragraphs 52 & 57).

This new thinking can be based on lessons learned from past biorisk management situations. We know that biological risk management challenges existing governance approaches and institutional models. Given the wide diversity of relevant actors and views, identifying a single prioritized set of policy proposals is unlikely and perhaps inappropriate. More importantly, inter-community and international linkage mechanisms are weak and uncoordinated; there is no real way to identify or take advantage of potential synergies. Therefore, some type of coordinating mechanism or “connective tissue” is needed. In order to build that linkage, each community must understand its role in biorisk management, and also how biorisk management affects its

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own mission. As well, each community needs to know about other communities, and how their actions impact on each other. The Global Forum on Biorisks is implemented via an interactive web portal. We are developing a highly interactive web-based forum that will allow members to work with colleagues in their own professional community; engage members of other communities; interact with counterparts elsewhere; generate ideas and provoke thinking; identify and evaluate what’s needed and why isn’t it happening. It includes a social network capability, an information database, collaborative text editing, tools to share information with individuals or groups of individuals within the website, and outside of the website, blogs and ‘Virtual workshops’. The database contains a library of policies, guidelines, regulations, and other commentary on biodefense, as well as website-generated documents. It is continuously updated by users with both external content and website-generated content where all content is tagged with keywords. A workshop series will reach out “beyond the usual suspects”, engage in substantive discussion of community roles and interactions, and introduce participants to the interactive web portal. As well a World Congress of Biological Risk Management will meet every 18 months or so to provide a “forcing function” to motivate progress, provide opportunity for self-assessment and cross-assessment, and build ties to support ongoing virtual interaction.

How to Orchestrate Progress

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No single decision maker or process has the authority, legitimacy, and competence to set a “Global Agenda”. Incentives are needed for decentralized actions to result in socially useful outcomes. The economic market forces provide a model: • • •

No single decision maker Prices provide information, identifying needs Profits provide incentive, motivating progress.

The Global Forum on Biorisks attempts to emulate this model and create a comprehensive, interdisciplinary and international approach to dealing with biorisks and biorisk management.

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Bioterrorism: Threats and Deterrents S. Çankaya and M. Kibaroğlu (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved doi:10.3233/978-1-60750-501-3-25

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EU Approach to Bioterrorism: EC Green Paper on Bio-Preparedness Davide CASALE Polytechnic of Turin, Turin, Italy

Abstract. Bio-terrorism has emerged in recent years as one of the key challenges for European security. The possibility that terrorists may resort to nonconventional weapons such as the usage of biological agents is particularly worrying for the disruptive capacity that such means may have on public health and the environment. To respond to such a threat, the European Union has stepped up its efforts to reduce risks and enhance preparedness in Member States through a comprehensive approach taking into consideration all possible sources of threat deriving from naturally occurring incidents as well as deliberate terrorist attacks. Beyond a series of communications on the topic, the European Commission launched in 2007 a consultation process releasing a Green Paper on Biopreparedness aimed at stimulating the debate with all stakeholders involved. Keywords. European Union (EU), European Commission (EC), Bio-terrorism, EC Green Paper on Bio-preparedness, generic preparedness

Introduction

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EU approach to Bioterrorism The fight against the scourge of terrorism is a key priority in the security agenda of the European Union (EU). The 2001 attacks in New York and Washington first and then in Madrid (March 2004) and London (July 2005) made it clear that terrorism is a threat to all States and that Europe is also a target. Bioterrorist incidents involving anthrax following the attacks in the US of 11th September 2001 brought to the world's attention the threat of deliberate attacks through the use of biological and chemical agents. In the broader context of the global fight against terrorism, the risk that terrorists may resort to non-conventional means such as biological materials has emerged as a key challenge, especially in consideration of the unprecedented capacity to infect thousands of people, contaminate soil, buildings and transport, destroy agriculture, infect animals and contaminate food. The seriousness of the threat was expressed by the Vice-President of the European Commission (EC) Franco Frattini, Commissioner responsible for Justice, Freedom and Security, on the occasion of the release by the EC of its Green Paper on Bio-Preparedness in July 2007: “The recent unsuccessful attacks in London demonstrate that terrorist threat continues to be real. Although in the past terrorists used explosives or improvised explosive devices, they may in the future resort to nonconventional means such as biological weapons or materials. Hence, we should avoid complacency, in particular as the impact of such an attack may have much greater consequences in terms of a death toll or economic impact. Therefore, risks from

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D. Casale / EU Approach to Bioterrorism: EC Green Paper on Bio-Preparedness

dangerous biological materials and pathogens have to be reduced and preparedness fostered in Europe through a comprehensive approach aiming at achieving a better preparedness in this area.”1 In January 2003, the discovery of ricin in a building in London demonstrated that the threat of an attack in Europe through biological agents is real and urged law enforcement as well as public health authorities to engage with determination in the endeavour of preventing and protecting from possible bioterrorist attacks. The nature of the bioterrorist threat for Europe is peculiar. In fact, an attack carried out through deadly pathogens (as well as a naturally occurring disease outbreak) could likely affect several Member States simultaneously or spread across borders and have considerable economic and social impact2. In addition, a balance is necessary between the benefits of developments in biotechnology with security concerns, because terrorists might resort to dual-use expertise and biotechnology to pursue their criminal intents using biological materials. In order to protect its citizens from such risks and improve preparedness to respond to a possible attack, the EU has developed a biological all-hazards approach (generic preparedness). Accordingly, the EU approach to risks of bio-terrorism takes into consideration all potential risks, not only an intentional (terrorist) attack, but also accidentally or naturally occurring disease, with the aim of being prepared for all emergency situations.3 The European Commission defines bio-terrorism as the threat of deliberate attacks with the use of biological agents. To tackle this threat the EU has undertaken various initiatives in recent years, reviewing existing systems of protection. The major objectives to better protect public health are the following: 1) Improved cooperation between Member States in the evaluation of risks, 2) Early warning and intervention, 3) Prevention of major accidents involving dangerous substances. Moreover, the EC emphasizes the necessity for Member States to coordinate their responses to deal with the aftermath of a biological accident, to restrain its effects on both public health and the environment.4 The first concrete actions to protect the Community from the menace of bioterrorism were undertaken in the Health Council meeting of 15 November 2001. On this occasion the Council of the European Union and the Commission agreed a programme of cooperation to enhance public health preparedness and response capacity of the Member States to biological and chemical attacks. The main result was the establishment of the Health Security Committee (HSC) in November 2001. The mandate of the HSC is to ensure coordination and exchange of information among Member States of the Union in the case of the release of biological or other agents which may threaten public health. The HSC consists of representatives of the EU Members States, representatives of the EC Directorate General for Health and Consumer Protection (DG SANCO) and other relevant Commission services and agencies (e.g.: the European Centre for Disease Control; the European Medicines Evaluation Agency). The Committee is linked to the Commission, the national 1

http://europa.eu/rapid/pressReleasesAction.do?reference=IP/07/1065, last accessed 22/11/2008. See European Commission Green Paper on Bio-preparedness, Brussels 11 July 2007, http://eurlex.europa.eu/LexUriServ/site/en/com/2007/com2007_0399en01.pdf, last accessed 22/11/2008. 3 Green Paper on bio-preparedness, European Commission, Directorate General for Health and Consumers (DG SANCO), http://ec.europa.eu/food/resources/bioprep/biopreparedness_en.htm, last accessed 22/11/2008. 4 Bioterrorism, European Commission, Directorate General for Health and Consumer Protection, http://ec.europa.eu/health-eu/my_environment/bio_terrorism/index_en.htm, last accessed 22/11/2008. 2

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authorities and all EU health alert systems by a rapid alert system which operates 24 hours a day 7 days a week. In the domain of public health preparedness and response to chemical, biological and radio nuclear (CBRN) attacks, the HSC is responsible for coordinating health preparedness systems and emergency response plans, raising the alert in the event of a health-related incident of EU concern and providing advice on crisis management strategies. Further, The EC has worked to strengthen international cooperation, in particular in the ambit of the “Ottawa Initiative” with “G7+” States (USA, Canada, UK, France, Germany, Italy, Japan and Mexico).5 With the same view, the European Union regards closer cooperation with the WHO as a key component to enhance coordination, preparedness and response capacity to biological, chemical and radio-nuclear terrorism at the international level. 6 Additionally, on 20 December 2002 the Council and the Commission also adopted a joint program to improve cooperation between Member States in the evaluation of CBRN risks, alerts and intervention, the storage of means of intervention and in the field of research. To be thoroughly understood, the EU fight against bio-terrorism must be set in the overall European framework against terrorism. In December 2005 the Justice and Home Affairs Council approved a new EU Counter-Terrorism Strategy.7 The strategy covers four strands of work: Protect, Prevent, Pursue, and Respond. Across these four categories, the strategy seeks to link actions from different policy areas and emphasize close interaction of measures at the Member State, the European and the international level. The first objective is to prevent people from turning to terrorism by tackling the root causes which can lead to radicalization and recruitment. The second objective of the EU Strategy is to protect citizens and infrastructures and to reduce Europe’s vulnerability to attacks through improved security of borders, transport and critical infrastructures. The third objective includes pursuing and investigating terrorists across EU internal borders and globally, to impede planning, travel and communications, to disrupt support networks, to cut off funding and access to attack materials and to bring terrorists to justice. The fourth objective is to prepare Member States, in a spirit of solidarity, for managing and minimizing the consequences of a terrorist attack, by improving capabilities to deal with the aftermath, the coordination of the response, and the needs of victims.

1. EC Communications on Bioterrorism In its effort to enhance intra-community cooperation on prevention and response to the bioterrorist threat, the European Commission has released in recent years a series of communications on the topic. Although such measures are not legal binding acts, they

5 On 7 November 2001 the Health Ministers from the G7 group of countries, of Mexico and the European Commissioner responsible for Health and Consumer Protection met in Ottawa (“Ottawa initiative”) to launch a global debate on public health response to the threat of international biological, chemical and radio-nuclear terrorism;. 6 Bio Terrorism and Health Security, available at http://ec.europa.eu/health/ph_threats/Bioterrorisme/ bioterrorisme_en.htm, last accessed 22/11/2008. 7 Council of the European Union, EU Counter-terrorism Strategy, 2697th Council Meeting, Brussels 1-2 December 2005, doc. 14390/05 (Presse 296), available at http://register.consilium.europa.eu/pdf/en/05/st14/ st14469-re04.en05.pdf, last accessed 22/11/2008.

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serve to clarify the key policy tendencies of the Union and put forward guidelines for Member States’ action. The first of these initiatives is Communication 320 of 2 June 2003.8 The specific aim of this document is to address the problems related to the health aspects of the EU action against bioterrorism. The communication provides an overview of progress made by EU institutions and Member States. It takes stock of the existing measures for the prevention and the response to biological accidents and identifies the prospects for future action in the health sector. The Communication first focuses on the centrality of preparedness and response to protect public health. In the view of the EC, preparedness means mitigating the effects of deliberate releases of biological and chemical agents. This requires early detection of the agents implicated and case recognition of those affected. Accordingly, the Commission requests that national health authorities emplace a series of measures, including:

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• • • •

Establish effective surveillance; Familiarise clinicians with the syndromes to look out for; Disseminate case management guidelines; Put in place effective arrangements for prompt notifications to the authorities in charge of collecting and evaluating epidemiological information.

As to the response aspect, the Commission emphasizes that in the event of an attack, national authorities must be able to take immediate actions for physical protection (remedial and treatment actions) and provide a prompt evaluation of consequences and risks to identify further adequate action for a multi-sector response to the emergency situation. Another fundamental feature highlighted in the 2003 Communication is coordination in the EU. It is underlined that since the EU is a border-free area, rapid notification and exchange of information in the event of biological threats are crucial components of an effective response. In this view, particularly important has been the creation of a Community program of cooperation on preparedness and response to biological and chemical agent attacks (BICHAT program). The main objective of this program is to set up an alert and information exchange mechanism. Such mechanism consists of the Health Security Committee (responsible for exchanging information on health-related threats) and a rapid alert system. The latter (“RAS-BICHAT”) has been operational since June 2002 for notifications of incidents involving the deliberate release of biological and chemical agents. The BICHAT program is aimed at creating the capability for rapid detection and identification of deliberate releases of biological and chemical agents to improve Member States' surveillance systems for monitoring the occurrence of infectious diseases. In addition, the BICHAT should serve as a platform for consultation to develop guidelines for a coordinated EU response to attacks from the health point of view, coordinating the national emergency plans in a common EU response to crisis situations. The 2003 Communication also focuses on the availability and stockpiling of medicines. In this respect, the Commission highlights the need to establish a 8 Communication from the Commission of 2 June 2003 to the Council and the European Parliament on cooperation in the European Union on preparedness and response to Biological and Chemical agent attacks (Health security) [COM(2003) 320 final].

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Community stockpile of smallpox vaccines, antibiotics and antivirals. With such a view, a joint Commission - pharmaceutical industry task force was created in December 2001 to address issues of availability, production capability, storage and distribution capacity for medicines in the event of a bioterrorist attack. The Commission recognizes that almost all EU countries have stockpiled antibiotics, vaccines and antivirals at the national level in order to be able to cope with bioterrorist attacks. Conversely, no medicines have yet been stockpiled at the Community level. The EC – pharmaceutical industry task force proposes the creation of EU solidarity stocks to be promptly available to any Member State affected by a sudden accidental outbreak or deliberate release of biological materials (suggestion reiterated by the Commission in the Green Paper on Bio-Preparedness in 2007). Finally, the Communication 2003/320 emphasizes the necessity of building a multi-sector response. In fact, the EC draws attention to the need for mobilization of resources in many sectors other than health in the event of a biological accident in order to cope with the consequences of an attack or an incident. In particular, the Commission puts emphasis on the fields of food safety, animal safety, plant safety and water safety. Although there already exists a vast legislation at the Community level in these fields, such regulations must be adjusted or reformulated to take into account the necessity to prevent and to respond to the threat of contamination through biological or chemical agents. A second Communication (2004/701) regarding bioterrorism was released by the European Commission in 2004.9 The communication under consideration deals with preparedness and consequence management in the fight against terrorism, focusing on action needed in the domains of civil protection and health protection. The purpose is to introduce mechanisms and training facilities with a view to protecting and giving maximum assistance to civilians in the event of an attack (in particular a bioterrorist attack). With regard to cooperation in the field of civil protection a common Community mechanism (Community Civil Protection Mechanism) was established in October 2001.10 This mechanism consists of a number of measures and instruments put in place by the Commission to improve preparedness and mutual assistance among Member States in the event of a disaster. The most remarkable among these instruments is the Monitoring and Information Centre (MIC). The MIC is a special unit that receives requests for assistance from the countries hit by a disaster and forwards them to all Member States. It can also provide technical aid by sending teams of experts in several types of disasters such as fires, earthquakes, oil slicks, industrial disasters or terrorist attacks. Within the civil protection framework, the EC also intends to advance the preparedness of the Member States to manage the consequences of an emergency situation. To this aim, the Commission has organized training and simulation exercises (e.g.: courses on the psychological aftercare of victims and on operations in a contaminated environment, simulation exercises modelled to reflect terrorist scenarios). 9 Communication from the Commission to the Council and the European Parliament of 20 October 2004 entitled “Preparedness and consequence management in the fight against terrorism” COM (2004) 701. This communication is one of a series of four designed to step up the fight against terrorism in the EU. The first lays down the general measures to prevent, prepare for and respond to terrorist acts, the other three deal more specifically with the prevention and financing of terrorism, management of consequences and protection of critical infrastructures. 10 The Community Civil Protection currently includes thirty countries: EU- 27, Iceland, Liechtenstein and Norway.

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With the same view, the EC has also prepared databases and scenarios to test the efficiency of national plans to respond to disasters. The 2004 Communication also stresses the necessity to strengthen health protection policy for the eventuality that incidents or terrorist attacks involving explosives, chemical or biological agents may occur. In this context, the Health Security Committee remains the main platform to ensure health security coordination in the EU. As in the field of civil protection, the final aim pursued is to strengthen coordination in Member States and to achieve compatibility and interoperability of national measures. Ultimately, Communication 701/2004 emphasizes the role of the Community rapid alert systems (RAS) set up by the Commission for a rapid and effective response by the EU to emergency situations. These systems are based on an information exchange network for receiving and triggering an alert as well as forwarding information. Beyond the already mentioned Monitoring and Information Centre (MIC) and the BICHAT (for biological and chemical threats), further rapid alert systems include inter alia the ECURIE system (for radiological emergency), RAPEX and RASFF (for consumer health), EWRS (for communicable diseases), EUROPHYT (phytosanitary network), SHIFT (health controls on imports of veterinary concern) and ADNS (on animal health). Finally, the Commission issued a new communication in November 2005 (Communication 2005/605) aiming to enhance European coordination in the event of public health emergencies.11 This document is intended to present a general strategy valid for health threats of various nature, whether they are anticipated (such as pandemic influenza) or unforeseen (like an epidemic similar to SARS). The objective of the EC here is to provide the Member States with general guidelines to shape standard plans for public health emergencies with the European dimension in mind. The communication delineates the essential measures needed in a variety of respects to formulate efficient national emergency plans to face crisis situations. Firstly, the EC underlines the importance of effective information management. In this regard it is essential that different sources of information (public health authorities, law enforcers, the media, etc.) be enabled to fruitfully collaborate in a health emergency in order to successfully identify the risks and monitor the ongoing crisis. Therefore, the infrastructure for the distribution of information must be as solid as possible in order to be able to provide timely and also correct information in the emergency situation. The EU institutions and the Member States should also put in place all necessary measures to ensure gathering and exchange of information between the countries involved in the disaster. Further, the communication draws attention to the necessity of preparing scientific bodies able to provide the national authorities with prompt scientific advice for crisis management and response. Hence, the Commission recommends that the Member States set up bodies such as expert groups or committees for rapid consultation to provide the scientific and technical basis for assessing and examining risks. At the Community level, such scientific advice structures have already been created in various sectors. Among these EU specialized agencies the most significant ones include: the European Centre for Disease Control (ECDC), the European Medicines Evaluation 11 Commission Communication (2005) 605 of 28 November 2005 on strengthening coordination on generic preparedness planning for public health emergencies at EU level. On the same day the Commission issued also a communication on pandemic influenza preparedness and response planning in the European Community, COM (2005) 607.

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Agency (EMEA), the Joint Research Centre (JRC), the European Food Safety Authority (EFSA), the European Environment Agency (EEA), the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the European Agency for Occupational Safety and Health (OSHA). Communication 2005/605 also recommends that national emergency plans for public health threats clearly identify command and control structures in charge of supervising and coordinating the concrete operations to restrict the spread of contamination or disease among the population and in the environment. The Commission reiterates that the effectiveness of command and control structures lies on the efficient gathering and analysis of information, communication coordination and knowledge of available resources to respond to the crisis. Therefore, Member States are required to provide command and control centers with systems for efficient information management, capable to liaise with relevant authorities of other Member States as well as with Community agencies and international organizations. Finally, the Communication under consideration underscores that efficient emergency response plans should take into account not only the preparedness of the health sector, but also preparedness in other sectors and inter-sectorally. In this view, it is highlighted that the task of stakeholders from sectors other than public health is twofold. Firstly they are required to assist the public health authorities in medical interventions to limit the spread of contamination. Moreover, they shall carry out all relevant activities pertaining to their respective competences (e.g.: logistics support, transport, civil protection operations, maintenance of public order, etc.) in order to handle the crisis situation in a coordinated fashion. However, these preparedness plans cannot be limited within the borders of the Member Sates of the Union. Hence, the preparedness of third countries is equally crucial for protecting the European Union against health risks that may arise in those countries and a coordinated approach with countries outside the EU is to be taken into consideration in setting up national emergency plans.

2. Commission Green Paper on Bio-Preparedness The Green Paper on Bio-preparedness of 11th July 2007 is the most important document of the European Commission to launch a comprehensive discussion on possible legislative measures at the EU level on bioterrorism. Although the Green Paper is aimed at setting the ground for new concrete Community measures in the near future, it is to highlight that it does not consist of binding legal provisions for the EU institutions and for the Member Sates of the Union. In fact, Community legal instruments are listed in Article 249 of the EC Treaty. They are regulations, directives, decisions, recommendations and opinions. 12 In addition to such instruments, the 12 Regulations are binding in their entirety and directly applicable in all Member States. Directives bind the Member States as to the results to be achieved; they have to be transposed into the national legal framework and thus leave margin for manoeuvre as to the form and means of implementation. Decisions are fully binding but only on those to whom they are addressed. Recommendations and opinions are non-binding, but merely declaratory instruments. Moreover, under the second and third pillars (Common Foreign and Security Policy –CFSP, and Justice and Home Affairs -JHA), specific legal instruments are used such as strategies, joint action and common positions in the area of the CFSP, and decisions, framework decisions, joint positions and conventions in the area of JHA, http://europa.eu/scadplus/glossary/community_legal_instruments_en.htm, last accessed 22/11/2008; see also: Steiner J., Woods L. and Twigg-Flesner C., EU Law, ninth edition, Oxford University Press, 2006, pp. 56-58.

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practice has led to the development of a whole series of sui generis documents: interinstitutional agreements, resolutions, conclusions, communications, green papers and white papers. Green papers are documents formulated by the European Commission to stimulate discussion on given topics at European level. They invite the relevant parties to participate in a consultation process and debate on the basis of the proposals made by the Commission, collecting ideas from individuals and categories involved in the sector under consideration. 13 Green papers may then give rise to legislative developments that are outlined in White Papers. The latter contains proposals for Community action and may finally be developed into EU law.14 The aim of the Green Paper on bio-preparedness adopted in 2007 is to stimulate a debate and launch a process of consultation at European level on how to reduce biological risks, and to enhance preparedness and response capabilities to biological threats. This consultation process is mainly aimed at the national authorities responsible for risk prevention and response, public health and customs, law enforcement authorities, bio-industry and epidemiological and health professionals. It is envisaged that consultations may eventually lead to concrete (legislative) actions in the field of bio-preparedness. The importance for the Community of the consultation process launched by the Commission through the Green Paper was highlighted in the words of Health Commissioner, Markos Kyprianou, on the occasion of the release of the Green Paper: “Protecting the health and wellbeing of EU citizens is a top priority for the European Commission. For that reason, we invite stakeholders to provide us with input on how existing instruments can be enhanced to deal with biological threats that may arise to public safety.”15

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2.1. Objectives As mentioned above, the Green Paper is intended to stimulate a debate and launch a process of consultation at the European level on how to reduce biological risks, and to enhance preparedness and response (“bio-preparedness”) within the ambit of the Community's and Union's competence in accordance with the principle of subsidiarity.16 The Commission emphasizes the importance that all relevant stakeholders in Member States and at EU level be consulted to improve the ability of the EU to prevent, respond to and recover from a biological incident or deliberate criminal activity. National authorities responsible for risk prevention and response, public health (including human, animal and plant health) authorities, customs, civil protection, law enforcement authorities, the military, bio-industry and academic institutions are all part of the solution and must cooperate to achieve the coherence of actions in the various policy sectors involved. The feedback from these stakeholders is essential for the Commission to evaluate the mechanisms and frameworks which are already in place 13

http://europa.eu/scadplus/glossary/green_paper_en.htm, last accessed 22/11/2008. http://europa.eu/scadplus/glossary/white_paper_en.htm, last accessed 22/11/2008. 15 http://europa.eu/rapid/pressReleasesAction.do?reference=IP/07/1065, last accessed 22/11/2008. 16 The principle of subsidiarity (article 5 of the Treaty on the European Community and article 1 of the Treaty on the European Union) regulates the legislative competence of the European Community stating that it can produce legislation only when the objectives of the proposed legislative action cannot be sufficiently achieved by Member States and, given the effects and the dimensions of the proposed action, can conversely be better achieved at the Community level. See, among many, Steiner J., Woods L. and Twigg-Flesner C., EU Law, ninth edition, Oxford University Press, 2006, op. cit., pp. 49-50 and 137-138. 14

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and how they are implemented, to identify possible shortcomings and subsequently recommend specific remedial actions. The Green Paper highlights that biological risks may have two origins. On the one hand, naturally occurring diseases, laboratory accidents or other inadvertent releases of disease agents may pose a threat to our societies and harm our health, the environment as well as our economies. On the other hand, the scientific development in biotechnology has the potential to pose serious security threats because it could make some dual-use expertise and technology available to criminal groups and terrorists, potentially enabling them to carry out biological attacks. If it is true that a large legal framework has already been created in many relevant sectors (such as the food industry, safety at the workplace, etc.) to ensure an adequate level of safety, it is equally to underline that there are domains where imperfect implementation of safety measures and the existence of security gaps may continue to pose a risk. Therefore, the Commission has intended to step up its efforts through the launch of a comprehensive consultation process to remedy such security gaps and enhance preparedness and response to biological threats.

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2.2. Approach and Definitions The approach to biological risks suggested by the Commission is an “all-hazards approach”. The aim is to minimize potential hazards deriving from biological materials, setting up a European strategy for a generic preparedness to cope with all crisis situations, emerging from accidental or deliberate release of harmful biological agents. The Commission highlights that there are two reasons that have led it to opt for the approach of a generic preparedness. Firstly, from a more theoretical point of view, a biological all-hazards approach has been chosen because appropriate security practices cannot be separate from a strong safety culture. Moreover, a more practical reason for this approach is that in case of an incident involving release of biological agents it may be very complicated to discern from the beginning whether a disease stems from a naturally occurring incident or inadvertent release, or it is due to a deliberate (terrorist) act. The definition of preparedness given by the Commission is purposefully very broad, entailing a vast range of activities relating to the protection of public health. In fact, the EC explains that the meaning of preparedness in the Green Paper comprises various aspects of an overall response to biological threats such as prevention, protection, first response capacity, prosecution of criminals/terrorists, surveillance, research capacity, response and recovery. As well, the Commission specifies that preparedness also covers the measures needed to reduce risks of deliberate contamination of the food supply chain, although it is other than food safety.17 In spite of the broadness of the meaning of generic preparedness, the aim of bio-preparedness is not to duplicate the existing legal framework on food safety and other related fields, but to complement it to prevent deliberate criminal acts and accidents and to respond in the event of a crisis due to release of biological agents and toxicants. The Commission highlights that the fight against the biological threat requires cross-cutting commitments, from disarmament and non-proliferation cooperation to 17 The security of the food supply is to be distinguished from food safety, which regards standards on the good manufacturing practices and quality control of agricultural products in the processing chain. Food supply security is also distinct from food security, that is the access to sufficient, safe and nutritious food.

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international assistance and cooperation. Therefore, while fostering intra-community action the EU strategy also aims at enhancing cross-border, regional and multilateral cooperation which is an essential component to enhancing preparedness strategies and a collective response in the event of naturally occurring outbreaks as well as bioterrorist attacks. Thus the EU is committed to continue working with and further strengthen cooperation on bio-preparedness within various international fora such as UN agencies, the Australia Group, G8, NATO, etc. 2.3. Key Principles of Bio-Preparedness

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The Green Paper recognizes that a large number of specific instruments and measures have already been put in place at either the Community and/or the Member State level to enhance bio-safety and civil protection. Consequently, the priority is not to adopt new legislation or protection measures. Rather, it is crucial to adapt existing tools to enable them to efficiently respond to deliberate attacks involving the usage of biological agents.18 Therefore, the Commission underlines that tools such as peer evaluations, awareness raising campaigns and supportive financial program should be developed before (or rather) than introducing new legislation. The aim is to avoid overlapping with the extensive legal framework already in place nationally and in the EU. Further, measures to be taken should be proportionate, affordable, sustainable and reliable in terms of the threat they seek to minimize and to respond to. Also, the EC draws attention to the fact that in taking measures to counter biological risks EU institutions and Member States should not underestimate the impacts on imports of agricultural products from developing countries and in particular from least developed countries. In order to set up a comprehensive response to biological threats, the Commission highlights the need for a close collaboration with the private sector. Accordingly, sharing information and best practices with and between private actors such as the pharmaceutical industry, food industries and SMEs involved in the food supply chain should be promoted. The private sector and research institutes should be involved in

18 The Green Paper recalls the importance of numerous existing European instruments such as wide exercises, training and exchange of experts dealing with the preparedness and response to terrorist scenarios organised under the Community Mechanism for Civil Protection assistance (Council Decision 2001/792/EC, Euratom). Other remarkable EU measures are: the Civil Protection Financial Instrument, established in 2007 (Council Decision 2007/162/EC, Euratom); the Council Regulation (EEC) No 315/93 introducing the basic principles of EU legislation to minimise the risks of the introduction of chemical contaminants in foodstuffs; Regulation (EC) No 178/2002 which makes it an obligation for food business operators to be able to identify any person from whom they receive food/raw materials; measures contributing to containing, controlling and eradicating animal diseases (such as identification of animals with ear-tags or electronic identification, registration of livestock holdings and animal movements within and between Member States; TRACES, the Trade Control and Expert System). Particularly important has been the establishment of 11 sectoral Rapid Alert Systems (RAS), operational 24 hours/7 days a week, such as the Rapid Alert System for Food and Feed (RASFF), the RAS-BICHAT alert system for bio- and chemo-terrorism, the Monitoring and Information Centre (MIC) of the Community mechanism for civil protection, and ARGUS, the secure general rapid alert system. ARGUS, set up with the Commission Decision 2006/25/EC, is a central crisis coordination system which links all specialised RAS hosted by the EC, bringing together representatives of all relevant EC services during an emergency in order to coordinate efforts so as to evaluate the appropriate response measures. Hence, ARGUS provides a basis for effective information sharing, consultation and coordination during an emergency, available at http://eur-lex.europa.eu/ LexUriServ/LexUriServ.do?uri=OJ:L:2006:019:0020:0022:EN:PDF, last accessed 22/11/2008.

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this process through an intensive Public-Private Security Dialogue.19 In the view of the EC, the European biotechnology industry and the bioresearch community have to become part of the European solution to the problems posed by biological risks. Consequently, this dialogue has been established in the field of research through the European Security Research and Innovation Forum (ESRIF) to address security research and innovation issues. Ultimately, the aim to be achieved is to promote the progress in biotechnology and at the same time enhance safety and security. One of the most innovative tools suggested in the Green Paper is the establishment of a European Bio-Network (EBN) to monitor and coordinate the implementation of the proposals which should emerge at the end of the consultations started with the release of the EC Green Paper. The task of the envisaged EBN should be to collect expertise on bio-preparedness and to work as an advisory body bringing together stakeholders from different sectors. It should also put forward ideas and recommendations (or codes of conduct) for researchers to foster the diffusion of common European standards on safety, security and best practices. This effort should be coupled with national awareness campaigns in Member States to encourage the adoption of secure bio-standards in all members of the Community. The Green Paper also highlights the necessity of developing a European analytical capacity for reducing biological risks. In particular, the possibility that the Commission could fund new expertise at EU level to develop a European capacity for analysis is envisaged. This should primarily aim at enhancing the capabilities of carrying out more productive risk analysis and risk classifications. In the longer term the goal would be to develop the capabilities for a multi-sector response to the bioterrorist threat bringing together expertise from different fields involved (scientific research, law enforcement, military, health, environmental authorities, etc.). Equally, the security of facilities housing collections of pathogens should be enhanced. The Commission recommends that Member States carry out an assessment of practices regarding bio-standards used in research, by industry and public biolaboratories working with dangerous pathogens. This exercise should lead to the identification of a set of obligatory common minimum-security standards and procedures for bio-laboratories and the pharmaceutical industry.20 The Commission also stresses the importance of addressing other security issues related to biological research, to promote scientific research while assuring safety and security. Recognizing that there already exist regulations in Member States for the exchange and access of biological materials, the EC seeks to render the dissemination and use of dangerous pathogens secure also within the Community, without obstructing scientific bio-research. Therefore, the Green Paper recommends the adoption of biosecurity and bio-safety guidelines to enable public health authorities and law enforcers 19 The Public-Private Security Dialogue was introduced by the Commission with its Communication on prevention, preparedness and response to terrorist attacks (COM (2004) 698). This Communication also envisaged the launch of the framework for Public Private Dialogue concerning issues related to security research and innovation. 20 The Commission enumerates some possible common minimum security standards, including inter alia: Common European guidelines for the physical protection and access control of collections of dangerous pathogens and cultures; an agreed EU list of “identified bio-agents” with a specific focus on potential terrorist misuse; European rules for national certification and registering of facilities with regard to compliance with bio-standards; procedures for security checks on scientists and technicians working with hazardous bio-agents; a European system of certification of reliable and trusted facilities and researchers, based on common minimum standards and certification methods; requirements of compliance with European bio-security standards for international researchers and experts from third countries.

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to monitor bio-research and the dissemination of pathogens for scientific use to verify their compliance with security standards. With the same view, the Commission suggests that a common European professional code of conduct for researchers be developed, especially to raise awareness on possible misuse of bio-research for criminal intents as well as to draw the attention of researchers to ethics of research and compliance with security standards. Another policy described as essential in the Green Paper on bio-preparedness is improving the European surveillance capacity. Bearing in mind that the Member States have established a single common market where capitals, goods and persons enjoy cross-border free circulation, the Commission is committed to ensure this freedom of movement as well as security and health protection at the same time. For this purpose it is recommended that Member States adopt a series of measures aimed at improving public health surveillance, early warning and detection capabilities through effective and coordinated monitoring of outbreaks of human and animal disease.21 The last issue addressed in the Green Paper is the necessity of improving response and recovery capabilities. To ensure better intra-community coordination of various actors involved in handling the crisis situation following an outbreak of biological materials (primarily national public health services, civil protection, law enforcement authorities and the military), the Commission proposes that Member States increase training activities and workshops to help develop coordination of national responses and to test efficiency and appropriateness of national emergency plans in the event of biological incidents. This cooperation would allow Member States to develop capabilities to identify and detect bioterrorist attacks, develop national and international countermeasures to contain the spread of pathogens and improve multi-sector interoperability between authorities involved in the response to emergency situations.

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2.4. Assessment: Responses from Stakeholders The analysis carried out in the Green Paper had already led the Commission to identify the major issues of concern in the fight against the bioterrorist threat. 22 In the assessment of the EC, the main concerns are the following: 1. 2. 3. 4. 5. 6. 7.

Awareness about the existing legislative framework; Practical implementation of safety standards; Existence and application of minimal security standards; A potential to misuse research and researchers; Deficits in European analytical capacity for reducing biological risks; Lacking detection capabilities; Requirement of improved multi-agency and multi-sectoral cooperation in both prevention and response.

The initiative launched by the European Commission has been generally appreciated as it gives new impetus to the discussion within and between EU Member 21

Such measures should ensure and facilitate inter alia: prompt notification and exchange of information in case of security threats and terrorist attacks; immediate action at EU or national level to be taken at source in order to stem the possible spread of infectious diseases and environmental contamination; mutual assistance for the diagnosis and management of bio-incidents; laboratory and epidemiological investigations; flexible and effective public health and civil protection responses. 22 http://ec.europa.eu/food/resources/bioprep/biopreparedness_en.htm, last accessed 22/11/2008.

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States on policies and measures to reduce biological risks. Also, the necessity of emplacing and developing adequate mechanisms both at the national and at the international levels is welcomed. The recommendation to prevent the risk that biological research is misused and exploited for criminal (terrorist) plans is one of the most appreciated features in the Green Paper. If the necessity of cross-border cooperation as described by the Commission is indeed a necessity, it is also outlined that new regulations and national measures might be unnecessary or might overlap with existing national mechanisms. Whereas a comprehensive European approach and framework seems to be beneficial for the purpose of risk reduction (especially through the exchange of good practices among Member States), additional regulations might be superfluous and unproductive.23 Recognizing the effort to work more closely with other actors of the international community, it has also been pointed out that a more holistic approach would be necessary, integrating public health and national security communities. In this view the development of stronger international partnerships and consultative mechanisms (e.g.: EU-US and EU-NATO) would give added value to the European response to the bioterrorist threat as well as to the international cooperation in the field.24 A certain degree of disappointment has been expressed with regard to the underestimation in the Green Paper of the role of law enforcement detection of bioterror preparations. It is highlighted that issues such as information gathering, training of law enforcers or strengthening international legal cooperation on prevention are neglected.25 In conclusion, it emerges that to further develop a European response to biological risks is crucial. The overall aim is to address the threats of bioterrorism with a coordinated approach bringing together national efforts with the European dimension. Therefore, the initiatives of the European Commission are of uttermost importance as they facilitate a transnational response to a cross-border threat in a spirit of intracommunity cooperation and solidarity.

23 Joint response by Research Councils UK and the Wellcome Trust, http://www.wellcome.ac.uk/stellent/ groups/corporatesite/@policy_communications/documents/web_document/WTX041321.pdf, last accessed 22/11/2008. 24 Center for Biosecurity of the University of Pittsburgh Medical Center (UPMC) and the Center for Transatlantic Relations of the Johns Hopkins University, http://www.upmc-biosecurity.org/website/ resources/commentary/2007-10-01-ec_greenpaper_biopreparedness_response.html, last accessed 22/11/2008. 25 European Task Force on Bioterrorism, Contributions of the European Task Force on Bioterrorism to the Green Paper on Bio-Preparedness, http://www.europabio.org/positions/Healthcare/CommentsGreenPaperBio-Preparedness.pdf, last accessed 22/11/2008.

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Bioterrorism: Threats and Deterrents S. Çankaya and M. Kibaroğlu (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved doi:10.3233/978-1-60750-501-3-39

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Role of the International Science and Technology Center in Countering the Threat of Bioterroism Leo OWSIACKI International Science and Technology Center

Abstract. This paper is a summary of a presentation. It discusses the purpose and structure of the International Science and Technology Center and some of its objectives and projects specifically designed to counter the threat of bioterrorism. Included are descriptions of some current as well as proposed activities as well as budget information. Keywords. bioterrorism, counter-terrorism, biosafety, biosecurity

Russian Weapons Development: Historical Background

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Russia inherited the legacy of the Soviet scientific system. It was extremely large and primarily characterized by state-managed enterprises. By 1980’s, over 97% of support for science came from state budget and the spending focus was on a military-industrial complex. Nearly three-quarters of the Soviet R&D complex was related to defense. The Soviet collapse in 1991 meant science was no longer a budget priority. The change of ideology and a difficult fiscal situation meant science was perceived as a budget luxury. The lack of funding and the demilitarization meant that scientists in the defense sector were especially affected.

The International Science and Technology Center The ISTC began operations in 1994. The Initial mission was to be a “stop-gap” measure to gainfully employ former Weapons of Mass Destruction (WMD) scientists to encourage them to remain home. It was also to be a forum for the international community to engage Russia and other CIS countries on nonproliferation and science issues. The focus was more on redirection than exploitation of results. The ISTC now has 39 member countries (27 from EU), representing the CIS, Europe, Asia, and North America. Its Parties and Partners select and fund scientific projects in Russia/CIS. The ISTC also manages projects and directs supporting programs for project participants and institutes. In this way the ISTC has engaged more than 75,000 scientists on 2,574 scientific projects worth $785 million in funding. As a result of the Kananaskis meeting of the G8 in 2002, Canada committed to spend $1 billion and joined the ISTC in 2004. They were instrumental in the creation of the Global Security & Strategic Planning Department to coordinate some of their activities through ISTC.

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L. Owsiacki / Role of the International Science and Technology Center

As of 2008, the strategic plan has two components with each their own set of tasks. 1.

2.

Sustainable Redirection a) Task: Implement an Institute Sustainability Program and Expand Commercialization Activities b) Task: Refocus Regular Projects to Build Sustainable Bridges c) Task: Expand Partners Program G8 Nonproliferation Priority Areas a) Task: Raise Profile within G8 Framework b) Task: Regionalize Activities

In 2005 the ISTC established the Department of Global Security and Strategic Planning. The new GS department redirects former weapons scientists and utilizes their scientific expertise to address global security issues with respect to CBRN in terms of: safety & security of facilities and materials (47% of 150 projects), transportation and containment technologies, destruction and conversion technologies, materials and process controls, detection and enforcement technologies. The ISTC currently has 151 Global Security projects.

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ISTC Bio/Life Sciences Projects Under the Bio/Life Sciences banner, there are three categories for projects: animal and livestock, plant and crop, and food. Some examples of matters that fall within the animal and livestock projects category include things such as infectious diseases (E. coli, anthrax, avian flu etc.), epidemiology, biodiversity, and probiotics. Plant and crop projects may include matters about pesticides/insecticides, soil fertilizers and plant diseases. Food projects may include matters such as testing (for food safety and bacteria like salmonella), developing flavors, and robotic systems. Bio/Life Sciences activities at the ISTC cover food and agriculture (bio)technology, drug and vaccine development, molecular and epidemiological surveillance of pathogens and infections as well as Biosafety and Biosecurity and others.

Biosecurity and Biosafety The budget under Biosafety and Biosecurity is divided between regular and partner funding. Completed regular project budgets totalled $30,000 USD and partner projects totalled $3,263,000 USD. Project budgets still underway account for $212,000 USD for regular projects and $10,532,000 USD for partner funding. Another $2,570,000 USD was added to this budget in June 2008. One of the developments under biosecurity and biosafety focusses on threat reduction through safety and security of facilities and materials. With this kind of focus projects covered have included such matters as the renovation of vivariums and buildings, the designing of security systems and storage facilities, the installation of perimeter fencing, vulnerability assessments, as well as developing storage facilities for pathogens.

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Significant Remaining Proliferation Threat Along with the development and improvement of research in protective measures, there have also been developments that constitute continued threats. In 2001 an Australian scientist engineered a new “good” gene, but in doing so accidentally created a totally new lethal virus. In 2002 scientists built live polioviruses from mail order/internet. In 2003, in 3 weeks, scientists created a new infectious bacteriophage. In 2004 an international team created a new & highly dangerous virus. Why should the World be Concerned? Open access to the web allows for easy global access to materials, knowledge & equipment which can be used intentionally or unintentionally to create new & lethal pathogens. However, the concern should be about unskilled people and poor lab standards than on the pathogens themselves. New designer viruses are produced almost daily everywhere. Almost all new gene technology/biotechnology can be dual use meaning depending on the user, the technology may used to promote development or hinder it. As well, biomatters are of particular concern because diseases mutate and can spread across borders. This factor makes biosecurity a world concern and does not limit it to within any particular state.

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What does Russia Need/Want? Russia has three particular interests. It wants to upgrade central Federal facilities and improve GLP/GMP in order to work towards international standards with respect to Russia’s own needs in public health & safety. Russia also wants to commercialize components of their biological facilities and make them competitive on the world stage with respect to the development of drugs and vaccines and other state-of-the-art technology developments in the biological/life sciences area. As well Russia wants to assist their scientists in engaging with and interacting with colleagues globally in order to engage more actively on the global stage with respect to biological technologies. How is the ISTC Responding? The ISTC has implemented new innovative approaches for assisting Funding Parties interested in addressing these concerns. It is also proactively developing projects and programs to enhance and promote greater engagement by both funding Parties and Partners. The ISTC is actively pursuing co-funding possibilities as well as implementing a high level client service orientation among staff.

2009-2011 Biosafety/Biosecurity Program Proposals There has been recent active bi-lateral interest by the UK, Germany, and France in engaging with biological proliferation threats as part of their Global Partnership commitments. As well, there has been recent expanded interest by the EU to engage with the ISTC and its Partners in projects addressing preventative measures. Other features of the recent proposals include the assistance for Russian & NIS facilities and personnel to meet and maintain international biosafety/biosecurity standards, as well as capacity building to integrate institutes & scientists with expertise in biological research & production into the ethical European scientific community.

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NEW 2009-2011 Biosafety/Biosecurity Program Proposals Some particular examples of new Biosafety and Biosecurity Program Proposals are as follows: CADS - Supporting Biological Threat Reduction in the CIS •

For activities predominantly funded by Europe but with active Canadian & USA contributions as well as Partners ƒ Create an international network of trained, ethical safe scientists ƒ Support for R&D science projects in disease surveillance, focused on pathogens of concern to the EU ƒ Laboratory biosecurity/biosafety construction/renovation projects ƒ Risk assessments, support for travel/workshops and development of regional biosafety associations

Vladimir (All-Russia Research Institute of Animal Health) - Establish a Co-funded Avian Influenza Surveillance Program • •

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•

USA DTRA currently making renovations and upgrades to this facility Separately, DTRA implementing a ‘Threat Agent Detection and Response’ (disease surveillance) program in several countries of the former Soviet Union, involving state-of-the-art diagnostics and biosecurity and biosafety opportunity for the EU to work with partners from Russia (Ministry of Agriculture) and other countries (i.e. USA & Canada) to develop this ISTC project and leverage their other work to create a model Avian Influenza Surveillance Program based at Vladimir, and involving several sentinel stations throughout Russia

Counter-Terrorism Targeted Initiatives (LETI) The GS Department is currently working with Canada, the USA and EU, together with the DOE, RCMP and Russian MVD on a Law Enforcement TI. This TI focuses on forensics technologies & applications. The first two projects have been funded and started. Subsequent TI’s will also be developed on this model to address other areas related to counter-terrorism.

NEW 2009-2011 Counter Bioterrorism Targeted Initiative The following initiatives were submitted for approval to the Dec.11/08 Governing Board Meeting: • •

Focus on projects developing new techniques & technologies for rapid detection of a defined list of highly dangerous microorganisms Development of reliable field diagnostic kits & supporting activities to enhance high throughput clinical diagnostics

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• •

43

Focus on developing projects to protect the food supply chain via new & better diagnostics to detect dangerous bio-agents & measures to protect against intentional and unintentional contamination New focus areas as determined by a Steering Committee formed by funding Parties

NEW 2009 ISTC Planned SB Program (Preventative Measures) • • • • • • • • •

Tajik Disease Surveillance Workshop planned together with UK MOD to identify priority areas of future project development Continue development of a self-sustainable biosecurity and biosafety training center (Train the trainer) for Central Asia in Almaty, Kazahkstan Continue support for development of a Central Asia & Caucasus Biosafety Association Continue development of a train the trainer biosafety cabinet certification program in Russia Development & modernization of laboratory guidelines & standards in Russia & the Kyrgyz Republic Support activities of the International Advisory Group on Biosafety & Biosecurity Continue development of biosafety/biosecurity training tools such as translated WHO documents, instructional DVD’s, Support travel to global training events (ABSA, EBSA etc.) Kyrgyz BSL-3 Laboratory workshops

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Types of Projects through ISTC Regular Projects through the ISTC apply finances from funding parties for CIS participants only. Foreign involvement may include an amount of Scientific Collaboration (Academic, Governmental, or Industrial). Partner Projects through the ISTC apply finances from Partners (Industrial or Governmental) and Foreign involvement comes via Partners (Academic, Governmental, or Industrial).

Benefits for ISTC Participants There are numerous benefits for ISTC participants. • Assistance in Project Management • Procurement support • Custom- and Tax-free: Imported Equipment and Materials • Tax-free: Salaries (directly paid into individual accounts) • Travel Support • Training Courses • IPR and Commercialization Support • Workshops and Conferences (Local and International)

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Benefits for Foreign Collaborators While the list of benefits is different for foreign collaborators, they may well gain from the exchange of ideas and expertise with high-level scientists and engineers, have early access to scientific results, develop potential partnership in any future commercialization of results and participate in experiments at unique installations and facilities. It is important to note that funding through the ISTC is for RF and CIS scientists only.

Benefits for Partners • • • • • • • • • •

Technology “Matchmaking service”: ISTC i.d’s potential partners Access to ISTC database and networks Reliability - Benefits from ISTC’s diplomatic status Professional, in-country project management Complete control of funds IPR is an integral part of the Project Agreement Moderate R&D costs Tax-free: salaries (directly paid as grants into individual accounts) Custom- and tax-free: imported equipment and materials ISTC facilitates on-site visits to institutes and closed cities

Some of our Bio-Partners include 3M, Akzo Nobel, Astrellas, BASF, Bayer, Dow Chemical, DSM, Fraunhofer Gesellschaft, Max-Planck Society, Mitsubishi, Novozymes, P&G, Symphogen, US DoS BII, US DHHS and US DTRA.

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Conclusions The ISTC is a vehicle for scientific collaboration. It has proven itself a useful mechanism for implementing projects. It is rich with technical resources including its 180 Moscow-based staff. As a unique source of valuable skills training, information and “matchmaking” it has helped create synergies between 37 nations and 360+ partners. The ISTC is still one of the best & most reliable implementation vehicles for S&T and nonproliferation activities in Russia/NIS having become faster and less bureaucratic as well as innovating our approaches to client service and program delivery.

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Bioterrorism: Threats and Deterrents S. Çankaya and M. Kibaroğlu (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved doi:10.3233/978-1-60750-501-3-45

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Types of Biological Agents and Medical Countermeasures Against Bioterrorist Attacks a

Levent KENARa and Mehmet BAYSALLARb Gulhane Military Medical Academy, Department of Medical, Ankara, Turkey b Gulhane Military Medical Academy, Department of Microbiology, Ankara, Turkey

Abstract. Existence of unexplained mass casualties and unnatural disease outbreaks are main indicators of chemical and biological attack. The threat from these agents should not only be considered a military issue, but also an act of terrorism. Therefore, it should be noted that civilians may also be exposed to these agents. There is an increasing concern around the possibility of terrorist use of biological agents including bacteria, viruses and toxins in recent times. Finally, the catastrophic September 2001 attacks intensified the interest of biological terrorism and the necessity of a multilateral cooperation regarding a chem-bio defense policy. Since the use of biological agents is not always initially evident contrary to chemical agents, outbreak of diseases may provide a first indication related to an attack. Collaboration between the organizations and institutions against biological terrorism has to be taken into careful and extensive consideration. Keywords. Bioterrorism, medical response, preparation

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Introduction Biological warfare is the intentional use of microorganisms, and toxins, generally of microbial, plant or animal origin to produce disease and death in humans, livestock and crops. The three ways a terrorist can release biological agents are through air, water or food. These agents are typically very difficult to detect and because the illnesses they cause are usually delayed, it makes bioterrorism a hard crime to investigate. The deliberate use of biological agents including bacteria, viruses, rickettsia and toxins has emerged as a significant threat in the last decade after the anthrax cases occurred following the terrorist attack in 11 September 2001. The use of biological agents in future wars and terrorist attacks remains a realistic concern. Bioterrorism dates back to 1340, when diseased horse corpses were catapulted over castle walls in France. Human bodies infected with plague were also used as ammunition in central Europe during the 14th and 15th centuries. In 1763, a British army general ordered that blankets used on smallpox patients be sent to American Indian tribes. British Revolutionary War troops would also infect themselves with traces of smallpox, rendering themselves immune with the hopes of passing the disease onto the enemy. During World War I, Germans infected livestock headed for the Allies with anthrax. Even though the attack proved to be unsuccessful, it led to the creation of the

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Geneva Protocol in 1925. This prohibited the use of biological and chemical agents during wartime, while allowing research and development of these agents to continue. The British and German armies may have contributed in biological warfare, but the Japanese went full steam ahead in the years that preceded Word War II. Hundreds of thousands of Chinese civilians were killed by biological means at the hands of the Japanese army. One of these attacks included dropping paper bags containing plagueinfected fleas from low-flying airplanes. In 1984, the first instance of bioterrorism occurred in the United States. Cult members in rural Oregon sprinkled salmonella on salad bars all around Wasco County, hoping to affect the outcome of a judicial vote. In the end, 750 cases of food poisoning were reported and 45 victims had to be hospitalized. The attacks of 11 September 2001, alerted the world to the realities of new terrorist threats. From a public mailbox in New Jersey, letters that contained anthrax spores were mailed to two U.S. senators and several news media outlets. The attack killed 5 people and infected 18 more. Aside from this tragic loss of life, the attacks furthered the nation's fear and paranoia, and the total cleanup costs exceeded one billion US dollars.

1. Historical use of Biological Weapons • • • •

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• • •

• • • •

Tatars attempted to infect the enemy by catapulting bodies infected with bubonic plaque over the walls of the city of Kaffa-Kırım (1346). As an “act of good will”, the British soldiers gave blankets used by smallpox victims to the Native Americans (1754). On 17 June 1925, the Protocol for the Prohibition of the Use of Bacteriological Methods in War, commonly called the Geneva Protocol, was signed. At least ten thousand prisoners died and 11 Chinese cities were attacked with biological agents manufactured in a biological warfare research facility in Pingfan, Japan (1932-1945). US started to conduct a biological warfare program in 1943 in Camp Detrick, Maryland and made research on anthrax, brucellosis, Venezuelan equine encephalitis, Q-fever, botulism and tularemia until 1969. Thousands of people were reported to be killed due to attacks of Tricothecene mycotoxins known as Yellow Rain in the war in Southeast Asia (1974-1981). As a follow-up to the 1925 Geneva Protocol, the 1972 Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological and Toxin weapons, commonly known as Biological Weapons Convention was convened. A Bulgarian exile named Georgi Markov was attacked in London with an umbrella weapon filled with Ricin (1978). A mysterious explosion at the Soviet Institute of Microbiology and Virology in Sverdlovsk caused at least 66 persons to die (most with inhalation anthrax) (3 April 1979). The Milwaukee Journal Sentinel received a package that appeared to be part of an anthrax hoax (5 November 2008). A bucket containing a white powder labeled anthrax was found in the basement of an El Cerrito business (7 November 2008).

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2. Bioterrorism Agents The North Atlantic Treaty Organization (NATO) lists 39 agents that potentially could be used as biological weapons, including viruses, bacteria and toxins. Many of these aren't as likely to be used because of the nature of the agent. In most cases, it would take far too much of any single agent to cause mass amounts of illness or infection. For example, nearly eight metric tons of the deadly toxin, Ricin is required to achieve 50 percent lethality over a 62 square mile (100 km) area [source: CDC]. These kinds of statistics make it easier to narrow the list of potential lethal agents that a terrorist might use. To help categorize and prioritize the study of these agents, the Center for Disease Control (CDC) separates them into three main groups: • • •

Category A - easily spread with a high potential for mass casualties, panic and disruption Category B - more difficult to spread with moderate illness rates and low death rates Category C - emerging pathogens that could potentially be easily spread and deadly

Category A agents are the only ones that are suspected as viable bioterrorist threats. This category includes: • • •

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• • •

Anthrax - spores that can infect humans through touch, ingestion or inhalation Botulism - muscle-paralyzing disease caused by a toxic bacterium that's typically ingested through infected food Smallpox - highly contagious, sometimes fatal disease that's only prevented by vaccination Plague - contagious disease caused by bacterium found in rodents and their fleas Tularemia - highly infectious, but not contagious, this rodent disease is also known as “rabbit fever” Viral Hemorrhagic Fevers - a group of diseases caused by viruses such as Ebola and Marbug

Category B agents include salmonella, ricin, cholerae, typhus. As for Category A agents, viruses like Ebola are expensive to produce and technically challenging to sustain, in addition to the difficulty of successfully delivering them in large doses. This makes them less likely to be used in a terror attack, but the fact that they can be spread from human to human keeps them in Category A. Bacteria are much easier to produce than viruses, so they remain the most likely agents for bioterrorism. The World Health Organization (WHO) performed a study in 1970 and found that anthrax and tularemia headed the list of most deadly bacterium with the largest airborne spread. The death rate for untreated anthrax is more than 80 percent; because it can be contracted in three different ways, it's at the top of the list as a potential biological threat. Smallpox is the one virus exception and ranks alongside anthrax as the most deadly potential threat. Smallpox can also be spread through the air and is able to be

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manufactured in large doses. Even though smallpox has been eradicated through vaccination, it's believed that no more than 20 percent of the world's population is still immune. Smallpox is also highly contagious, with a single case able to spread to 20 or more people in short time.

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3. Some Types of Organisms Having Potential Use in Biological Warfare • • • • • • • • • • • • • • • • • • • • • •

Bacteria Bacillus anthracis Brucella abortus, B. melitensis, B. suis Chlamidia psittaci Clostridium botulinum, C. tetani Francisella tularensis Pseudomonas mallei Salmonella typhi Shigella dysenteria Vibrio cholerae Yersinia pestis Rickettsiae Coxiella burnetii Rickettsia prowasecki, R. rickettsii, R. quintana Viruses Congo-Crimean haemorrhagic fever virus Venezuelan equine encephalitis virus Lassa fever virus, Ebola virus Dengue fever virus Variola virus Yellow fever virus Toxins: − Botulinum toxins − Clostridium perfringens toxins − Ricin, Saxitoxin − Staphylococcus aureus toxins − Trichothecene mycotoxins − Aflatoxins

Genetically Modified Microorganisms or genetic elements that contain nucleic acid sequences associated with pathogenicity and are derived from organisms. 3.1. Terrorist Use of Biowarfare Agents It takes a lot of money and technology to pull off a mass-scale bioterrorist attack, so it remains more of a threat than a reality. In order to launch an effective attack, the organization needs to be extremely well-funded and have access to a great deal of scientific expertise. This means that only large terror groups that may even have state funding could execute an effective mass attack.

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4. Indicators for a Biological Agent Attack • • • • • • • • •

Unusual occurrence of dead or dying animals Unusual and unexplained casualties or deaths in human beings Unusual illness for region Definite pattern inconsistent with natural disease Unusual liquid, spray or vapor in the environment Spraying and suspicious devices or packages found in the incident site Diseases emerging due to the atypic microroganisms A sudden increase in the incidence of the epidemics not normally encountered Increased number of casulties with the resistance to known therapeutic methods.

There are numerous potential scenarios for attack, but in simplest terms, the covert and overt approach for attacks will be considered in terms of bioterrorism. Although both scenarios are horrific, the second, has the potential of being enormously difficult to handle because of the many uncertainties and the possibility of panic. The psychological impact of a real attack or a successful hoax could be enormous. In an attack involving firearms or explosives or even chemical agents, the physical impact on the target can be evaluated in seconds or minutes. The result may be terrible and many lives may be lost, but the victims can be identified and the magnitude of the problem can be evaluated and an efficient response mounted. By contrast, with biological agent aerosol release, we have none of that. The weapon may be silent, invisible, and odorless. If it can be seen, we have no quick field methods for deciding what it is and if it is harmful. Triage will be extremely difficult, maybe impossible, before onset of illness. In a chemical attack, victims will be ill in a few minutes; victims of biological attack may not know for a week that they have been exposed.

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5. Medical Countermeasures Against Bioterrorism Attacks Although no accurate preventive measure is stated in practice at all, some biological defense systems titled below against any possible biological incident should be established and organized: (1) Active immunization for some agents, (2) Passive immunoprophylaxis and chemoprophylaxis (since biological agents are not only easy and cheap to be produced, but also difficult and expensive with respect to prevention and treatment, more appropriate method for reconnaissance and treatment including isolation procedures, antibiotic therapy, antiviral therapy, antitoxin therapy and vaccination has to be determined, and research has to be performed in coordination with the mentioned requirements), (3) Improvement of rapid and advanced diagnostic systems and facilities like battlefield detection systems (biosensors and fully automated biodetectors for real time sample collection, detection and identification in the field have been developed, also a miniature flow cytometer (known as miniFlo) using an immunoassay system and a portable PCR identifying the DNA inside the cell are also available for the detection and identification of biological warfare agents),

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(4) Physical protection (masks and personal protective equipment), (5) Development of decontamination procedures, (7) Development of the intelligence system and information network (follow-up of the countries likely conducting a biological warfare program and evaluations of health statistics and epidemiological data in a certain area, warning and alerting to lead the State and public to be prepared for such an attack), (8) Quarantine and isolation measures (a detailed quarantine policy and controlling mechanism is a great concern for the government in peace time; isolation methods like protective equipment and collective protection systems including shelters should also be developed and established), (9) Effective health organization and training (organizations and institutions related to the Biological Defense System should be determined and integrated to the system with the establishment of coordination amongst them; diagnostic facilities and laboratory services including on-site sampling and sample transportation should be developed by some certified health care providers). For an attack on citizens, our useful countermeasures are probably limited to identification and diagnostics, chemotherapy, and possibly decontamination for some. Furthermore, free civilian society is much less disciplined and their movements relatively uncontrolled. Kauffman et al. calculated the potential cost of bioterrorism. They estimated it to be nearly $5 million per 100,000 persons exposed effectively to brucellosis species and $26 billion per 100,000 exposed to inhalation anthrax. They concluded, “Rapid implementation of a post-attack prophylaxis program is the single most important means of reducing these losses.” Identification of the agent may be difficult and is of critical importance. Without identifying the agent, rational post-exposure prophylaxis will be impossible. If a weapon or container is found, samples may be taken directly and delivered to a reference laboratory for analysis. If the attack was covert, obtaining one of the aerosol dispersal cans would be of highest priority. Failing that, swab samples from the ground or from objects within a few yards of the release point should be taken. Such samples should be placed in sealed glass or Teflon containers and kept dry and as cold as possible. Handling a dry or powdered biological agent can be very dangerous because material may adhere to skin and clothing and could be easily inhaled. Human beings exposed, even to replicating agents, will not have measurable amounts of the agent in their blood or serum for several days at the earliest, nor will they have a measurable immune response. However, after inhalation exposure of replicating agents or toxins, nasal mucosal swab samples may contain sufficient agent to allow identification by PCR or ELISA. In this sense, human beings, or domestic animals, may be the only “collectors” at the site of the aerosol attack. Once the agent has been identified, decisions can be made regarding triage and post-exposure prophylaxis. Is specific therapy available? How much time do we have to treat primary exposures? Is there a chance of secondary spread? If the causative agent of inhalation anthrax, pneumonic plague, or possibly tularemia, with its 35% case-fatality rate, is identified from field or nasal swab samples, a rapid response becomes the first priority. With these agents, post-exposure prophylaxis within the first 24 to 48 hours can mean the difference between life and death. If the agent were Venezuelan equine encephalitis, much less could be done for individual victims, but mosquito control and equine immunization might be critical. The appropriate response

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may range from door-to-door treatment teams to simply providing the public with good information through the media. If the decision is made to treat the population within the cloud footprint, it may be done door-to-door, at central collection points-schools, churches, or civic centers, or using both approaches. If the agent used is highly contagious, the use of central collection points may be counterproductive. In the aftermath of a terrorist attack, many victims may self-admit to hospitals. City hospitals may have overwhelming admissions and emergency room visits the day of the attack. If the agent used was not life-threatening, crowd control procedures may suffice in dealing with large numbers of hospital visits. If the agent causes severe illness or death, hospitals must be prepared to increase capacities by adding beds and reducing routine patient load.

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6. Preparation for a Biological Attack It is the physician and the medical facility, not necessarily the paramedics, police, and fire service that will react to a biological terrorist attack. The prepared physician, hospital, and medical center should have the potential to make the big difference in the outcome after an attack. Therefore, preparation at this level is critical. Fortunately, much of what should be done in anticipation of a biological terrorist attack is also applicable to any public health disaster or infectious disease outbreak. At the top of the list of priorities are education and training. Much of what is needed in a hospital or medical center facing a spike in the patient load after an attack is simple application of the standard principles of medicine with which the professional and support staff are already familiar. Education and training must include the general characteristics of biological agents versus chemical agents; clinical presentation, diagnosis, prophylaxis, and therapy of the most important diseases, as well as sample handling, decontamination, and barrier patient care. Training, planning, and drills must prepare the physicians and staff for mass casualty patient treatment, respiratory support for unusual numbers of patients, and distribution of medications or support of the local government in vaccination programs. The engineering staff must be taught to establish improvised containment in patient rooms or suites. To apply the knowledge we already have or to use the facilities already in place in a mass casualty resulting from a biological terrorist attack is the least difficult, least expensive, and probably the most important thing we can do to prepare. During the Cold War, diagnostic research and diagnostic capabilities for the threat agents were relegated to second place in the all-important vaccine research and development program. While this was appropriate in the context of protecting a military force, the importance of diagnostic capabilities greatly increases as we face the threat of biological attack against civilians. We may never be able to immunize the population because of cost and logistic and technical constraints; therefore, we must be able to identify the agents and triage the exposed as quickly as possible. The standard hospital clinical lab, although typically prepared for only BSL-2 containment, can provide a significant amount of support by using staining, culture, and sensitivity capabilities. This is primarily true for the bacterial agents; in contrast, exotic viral disease agent identification may require reference lab support at the state or national level. An appropriate operating procedure might be to split samples as soon as possible and attempt identification locally while submitting samples to a definitive reference lab by the most expedient means. Early information obtained locally, although not perfect,

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in combination with epidemiologic and law enforcement information, may make an enormous difference in patient outcome, since the national authorities’ in-depth level of forensic analysis is sometimes time-consuming. Someone in the hospital should be aware of federal requirements for packaging and shipping causative agents, and the appropriate shipping containers should be stocked. If weapons agent containers or munitions are found, the law enforcement authorities would want to conduct forensic analysis to include fingerprint analysis. Therefore, all materials should be handled with gloves or forceps and, of course, with all appropriate safety precautions. Although stockpiling of medical countermeasures may be coordinated at the national or city level, hospital or medical centers in high-risk cities may consider several options. By increasing the pharmacy stocks of some of the antibiotics that are effective against anthrax, pneumonic plague, and tularemia and continuing to dispense the drugs first-in, first-out, a hospital will be better prepared. Hospitals may also consider establishing agreements with pharmaceutical distributors for “just-in-time” delivery of antibiotics. Today, neither antiviral drugs nor vaccines for the two agentssmallpox and anthrax-for which they might be needed after an attack, are available in sufficient quantities to allow hospital-level stockpiling. Most experts believe that ventilators are also likely to be in short supply after an attack on a city with certain of the most important classic agents. Hospitals should consider obtaining additional ventilators or making arrangements with suppliers or sister institutions for rapid additional acquisition or loan when needed. Although most surveillance programs may be initiated at the national level, hospitals and medical centers should consider establishing their own. This is more easily done today than in the past because of automation. For example, large numbers of flu-like illnesses seen at emergency rooms, severe gastrointestinal syndromes, or evidence of an increased caseload of communicable disease or simply non-trauma admissions or even deaths should be cause for taking a second look with an epidemiologic eye. The pharmacy service might consider monitoring selected antibiotics or antidiarrheal medications and flagging dispensing levels greater than the norm. In the case of a covert attack, surveillance may provide the very first indication of an attack. For either a covert or overt attack, a sound surveillance system may help circumscribe the geographic extent of the attack and provide essential information regarding where post-exposure prophylaxis and therapy should be initiated. For biological attack, two categories of modification to the hospital building may be required. The first, related to decontamination and segregation of patients, is probably less important for biological attack than for chemical attack. As described above, patients exposed to a true respirable aerosol may have little or no contamination externally. For most agents that are not highly infectious, simple surface decontamination of the face may be sufficient. Hospitals may develop portable shower systems and establish “hot” and “cold” lines and patient traffic patterns within the buildings. The second modification that should be considered is some sort of preparation for dealing with highly contagious or dangerous infectious patients. Fortunately, this might not be necessary for many of the agents that might be selected by the bioterrorist. High-efficiency particulate air filters (HEPA) are not expensive but do increase resistance in HVAC systems and often require more powerful blower systems and modifications to duct work. This potential need should be considered during new construction. Modification of existing HVAC systems to allow HEPA filters to be placed temporarily in a time of need might also be considered. Improvised filtration systems that use heavy plastic sheeting, portable blowers, and commercially

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available HEPA filters might be an option in some facilities. Finally, commercially available “electret-type” air filters and positive-pressure ventilation might be considered for certain zones within the hospital. Contaminated remains of victims exposed to biological agents would typically be of less risk to health care providers than would bodies of individuals exposed to chemical agents. By the time an individual became ill and died of most biological agents, it would be unlikely that significant surface contamination would remain. Simple decontamination of the body surface with bleach (sodium hypochlorite, 10%) should be adequate for all toxin and bacterial agent casualties. Animals or people dying of anthrax would have very high concentrations of vegetative bacilli in their blood and organs, which could constitute a risk of cutaneous, but not likely inhalation, exposure. Cadavers contaminated with some viral disease agents (eg, hemorrhagic fever viruses or smallpox) may pose serious risk; BSL-4 containment may be required for autopsy. It is important that the local and state authorities not be overlooked because they will be the primary source of support in the early hours after an attack before national assistance can arrive. Inside the hospital, standard procedures for notification and command structure must be carefully considered and established. Who will coordinate the center’s response? Who will serve as spokesman for the hospital? A thoughtful, coordinated, rational announcement to the community, demonstrating collaboration among health care providers, law enforcement, and city authorities, will not only facilitate the response but will serve to provide psychological support and reduce panic. Evidence of disorganization in the hospital or the staff’s lack of knowledge of the appropriate medical response will only increase the level of concern and panic in the community. An organized, rational response will calm the public and actually reduce the impact of the attack. From this point of view, I would like to give brief information about Medical CBRN (NBC) Department and its role in NBC defense and in biowarfare in our country and the Turkish Armed Forces (TAF). This department is the only scientific and academic official unit in our country with the vision, as summarized: • • •

To contribute to the medical NBC defense of mainly TAF, To possess a medical NBC research and training activities with an international perspective, To establish an internationally accepted and accredited Reference Laboratory which is capable to detect and analyze chemical, biological, nuclear and radiological toxic agents in various samples.

The Medical NBC department founded under the Commandment of Gulhane Military Medical Academy conveys an important role within the NBC organization of Turkish Armed Forces. The department has two parts: The Scientific Department where the academic training and R&D activities are performed; the Medical NBC Team, which is composed of concerned physicians, nurses and paramedics. The main responsibilities of the department are medical and academic education, scientific consultancy and support, and establishment of a medical NBC concept. The Main activities performed in the Medical NBC Department are: • •

Training and Education Research and development

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• •

Academic and some other administrative activities Medical NBC Firs-Aid Team activities.

For training activities; Doctoral and Master Degree training is important in terms of giving education to academic people in various aspects of Medical NBC Defense. Here, academic people are trained in toxicology, microbiology, laboratory issues, emergency medicine, preventive medicine in details for the association of Medical NBC courses for the military health staff and the members of the Medical NBC Team. The department is also ready to give medical training to civilian health staff upon request and the permission from Command. R&D activities are continuous along with the doctoral training for the thesis studies and other studies related with the projects. These studies are focused on detection of the agents rapidly and protection and therapeutic approaches of possibly victims of such agents and medical management of such incidents. The main studies performed in the department, which has already been published in nationally and internationally highly accepted journals are as in the following:

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1.

Kenar L., Karayılano÷lu T., Kose S., “Laboratory Conditions and Safety in a Chemical Warfare Agent Analysis and Research Laboratory”, Military Medicine, 167(8): 628-633, 2002. 2. Karayılano÷lu T., Gunhan Ö., Kenar L., Kurt B., “The Protective and Therapeutic Effects of Zinc Chloride and Desferrioxamine on Skin Exposed to Nitrogen Mustard”, Military Medicine, 168(8): 614-617, 2003. 3. Karayılano÷lu T., Kenar L., Gulec M., “Evaluations over the Medical Emergency Responding to Chemical Terrorist Attack”, Military Medicine, 168(8): 591-594, 2003. 4. Gunhan Ö., Kurt B., Karayılano÷lu T., Kenar L., Celasun B., “Morphological and Immunohistochemical Changes on Rat Skin Exposed to Nitrogen Mustard”, Military Medicine, 169(1): 7-10, 2004. 5. Kenar L., Karayılano÷lu T., “A Turkish Medical Rescue Team against NBC Weapons”, Military Medicine, 169(2): 94-96, 2004. 6. Kenar L., Karayılano÷lu T., “Prehospital Management and Medical Intervention Following A Chemical Attack”, Emerg Med J., 21(1): 84-88, 2004. 7. Karayılano÷lu T., Kenar L., “A proposal for regional chemical and biological defense among the Balkan countries”, Military Medicine, 169 (8): 580-2, 2004. 8. Kenar L, Karayılano÷lu T., Gulec M., “How would military hospitals cope with a nuclear, biological, or chemical Disaster?”, Military Medicine, 169(10): 75760, 2004. 9. Kenar L., Karayılano÷lu T., Yuksel A., Gunhan Ö., Kose S., Kurt B., “Evaluation of Protective Ointments used against Dermal Effects of Nitrogen Mustard, a Vesicant Warfare Agent”, Military Medicine, 170(1): 1-6, 2005. 10. Cosar A., Kenar L., “An anesthesiological approach to nerve agent victims”, Military Medicine, 171(1): 7-11, 2006. 11. Kenar L., Boyuna÷a H., Serdar MA., Karayılano÷lu T., Erbil MK., “Effect of Nitrogen Mustard, a Vesicant Agent, on the Lymphocyte Energy Metabolism”, Clinical Chemistry and Laboratory Medicine, 44(10): 1153-1157 (2006). 12. Kenar L., Karayılano÷lu T., Eryilmaz M., Ortatatli M., Yaren H., “Chemical release at the airport and lessons learned from the medical perspective”, J Hazard Mater, 144 (1-2): 396-399 (2007).

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.

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13. Kenar L., Ortatatli M., Karayılano÷lu T., Yaren H., “Comparison of Real-Time PCR and Conventional PCR Methods for the Rapid Identification of Bacillus Anthracis”, Military Medicine, 172 (7): 773-776, 2007. 14. Kenar L., Ortatatli M., Yaren H., Karayılano÷lu T., Aydogan H., “Comparative Sporicidal Effects of Disinfectants after Release of a Biological Agent”, Military Medicine, 172(6):616-621, 2007. 15. Kenar L., Karayılano÷lu T., “Medical Preparedness Against Chemical and Biological Incidents for NATO Summit-Istanbul and Lessons Learned”, Prehospital and Disaster Medicine, 21(4), 268-271, 2006. 16. Kenar L.: “Chemical Warfares”, Journal of Anesthesia, 11(1): 75-77, 2003. 17. Kenar L.: “General Aspects of Chemical Warfares”, Preventive Medicine Bulletin, 2(3): 48-54, 2003. 18. Dizer U., Kenar L., Ortatatlı M., Karayılano÷lu T., “How to weaponize anthrax?”, Eastern Journal of Medicine, 9(1): 13-16, 2004. 19. Kenar L., “Medical Aspect of Weapons of Mass Destruction”, Preventive Medicine Bulletin, 3(10): 243-259, 2004. 20. Ortatatli M., Kenar L., Yaren H., Karayılano÷lu T., “Security in Biological Research Laboratory”, Turkish Clinicals Journal of Medical Sciences, 26: 396403, 2006. 21. Yaren H., Kenar L., Karayılano÷lu T., “An Important Chemical Warfare Group: Nerve Agents”, Preventive Medicine Bulletin, 6(6): 491-500, 2007. 22. Karayılano÷lu T., Berenshtein E., Kenar L., Kitrossky N., Kisa Ü., Chevion M., “Comparison of Determination of Nitrogen Mustard in Biological Fluids by using High Performance Liquıd Chromatography (HPLC) and Gas Chromatography-Mass Spectrometry (GC-MS)”, Journal of Turkish Biochemistry, 26(2): 70-76, 2001. 23. Muúabak U., Sengul A., ønal A., Kenar L.: “Intravenous Immunoglobulin (IVIG) treatment”, Journal of Turkish Clinics ømmunology-Romatology, 3(2): 107-116, 2003. 24. Kenar L., Karayılano÷lu T., Sezigen S., “Medical Approach to Chemical and Biological Disasters”, National Disaster Journal, 1(1): 39-44, 2006. 25. Baysallar M., Kenar L., “Bioterrorism and Decontamination Management”, Turkish Bulletin of Hygiene and Experimental Biology, 63 (1,2,3): 115-128, 2006. 26. Karayılano÷lu T, Kenar L., Ortatatlı M., Öztuna A., “The Approach of NBC Laboratory to Anthrax Suspected Package”, Turkish Bulletin of Hygiene and Experimental Biology, 63 (1,2,3): 165-169, 2006. As an organizational role, the Medical NBC Department has also a scientific coordination function on medical NBC issues in the national and international arena. The department is an important member of TAF NBC Defense Board and represents the Command of Health in the Army. It also has made contributions on NATO NBC study and working groups for a long period of time. Other than these activities, the members of the Department have attended many national and international congresses, symposia and seminars. As known, defense against such NBC incidents should be multi-organizational and needs a higher level of coordination and collaboration. With this background, the department had organized three national NBC symposia between 2003-2007 (the last two symposia included international participation). The last symposium which was

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about medical defense against bioterrorism in 2007 was so important that many organizations and institutions gathered and discussed the bioterror issues in Turkey. The activities of the Medical NBC First-aid Team is important in terms of giving a rapid medical response in case of an NBC incident. The staff assigned to this team includes physicians who are experts in various disciplines related with the medical effects of such agents like emergency medicine, infectious diseases, nuclear medicine, etc. The team has a very well-documented deployment and response plan with the use of proper equipment required in such incidents. The team has performed in some tasks and in some exercises which are especially scenario-based in hospital response plans. The members of the team also performed medical responses in suspected cases like envelopes in military organizations as well as performed site-decontamination and laboratory analyses of the samples. The functional units within the team are: • • • • •

Medical Care and First-aid unit Sampling and Detection unit Triage unit Decontamination unit NBC Support unit

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7. Conclusion The threat that biological agents will be used by hostile forces continues to be a military and now a civilian concern. Scenarios of the future may be complicated by the possible use of multiple agents, or the delivery of chemical and replicating agents and/or their toxins that have been carefully matched, based on their stability and ability to generate specific symptoms. Health effects could be potentiated. Therefore, from a medical perspective, detection requires the availability of rapid diagnostic methods and procedures to assess illnesses that will be the result of multiple agents. In the case of any bioterror disaster, the health facilities would be overwhelmed with the casualties. Therefore, significantly more health facilities are definitely required. However, management of these casualties should be different from other types of casualties suffering from the natural disaster considering that they would need specific and sophisticated hospitals due to the need for specific medical intervention (decontamination, antidotes and other prophylaxis administration, etc.). Unless these casualties are decontaminated and triaged for the treatment priorities in the specific departments of hospitals, biological contamination may be spread to the environment and can affect the population. Our proposals are the following: • • • • •

We need to perform exchange of information and our mutual experiences, All these measures should be based on some written protocols, The response should be supported with some training activities like courses, symposium and field exercises, We have to build up a functionally Laboratory Response Network and Quality Control Studies, We need to develop national technologies for detection and protection.

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Projects should be offered and studies on these issues should be disseminated in our R&D organizations. For early warning and rapid detection, mobile field laboratory should be provided Other equipment or devices like PPE, antidotes and antibiotics, and other medical assets should be stockpiled and planned for delivery in any incident.

The use of multiple chemical and biological agents is a very likely scenario of the future, thereby challenging the medical community to be much more proactive in its development of appropriate countermeasures. The missions of the military forces and civilian agencies are changing, and deployment will require a capability to address potential biological incidents on the domestic and international fronts. Medical personnel must, therefore, be continually prepared to deal with such contingencies as they become an even more important asset to this national defense and health care structures. Taking into consideration that the threat will never disappear, medical services must maintain their ability to manage large scale chemical and biological attacks which require continual training and awareness.

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References [1] Bacon D.R. Biological Warfare: An Historical Perspective. Seminars in Anesthesia, Perioperative Medicine and Pain; Vol 22, No 4 (December), 2003: pp 224-229. [2] Clements B.; Evans R.G. The Doctor's Role in Bioterrorism. The Lancet; Dec 2004; 364. [3] DaSilva E.J. Biological warfare, Bioterrorism, Biodefence and the Biological and Toxin Weapons Convention. Electronic Journal of Biotechnology; Vol 2 No 3, 1999; 109-139. [4] Kaufmann A.F., Meltzer M.I., Schmid G.P. The Economic Impact of a Bioterrorist Attack: Are Prevention and Postattack Intervention Programs Justifiable? Emerging Infectious Diseases Vol 3, No 2, 1997; 83-94. [5] Petro J.B., Plasse T.R., McNulty J.A. Biotechnology: Impact on Biological Warfare and Biodefense. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science Vol 1, No 3, 2003; 161-168. [6] Zinkovich L., Malvey D., Hamby E., Fottler M. Bioterror Events: Preemptive Strategies for Healthcare Executives. Hospital Topics; V 83, No 3, 2005; 9-15.

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Bioterrorism: Threats and Deterrents S. Çankaya and M. Kibaroğlu (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press. All rights reserved doi:10.3233/978-1-60750-501-3-59

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An Approach for a Biological Threat Analysis Ajey LELE Institute for Defence Studies and Analyses (IDSA), New Delhi, India

Abstract. Existence of unexplained mass casualties and unnatural disease outbreaks are main indicators of chemical and biological attack. The threat from these agents should not only be considered a military issue, but also an act of terrorism. Therefore, it should be noted that civilians may also be exposed to these agents. There is an increasing concern around the possibility of terrorist use of biological agents including bacteria, viruses and toxins in recent times. Finally, the catastrophic September 2001 attacks intensified the interest of biological terrorism and the necessity of a multilateral cooperation regarding a chem-bio defense policy. Since the use of biological agents is not always initially evident contrary to chemical agents, outbreak of diseases may provide a first indication of an attack. Collaboration between the organizations and institutions against biological terrorism has to be taken into careful and extensive consideration. Keywords. Bioterrorism, medical response, preparation

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Introduction To date the world has not witnessed any major bio-terror attack killing many people. Two major incidents in the recent past could be termed attempts by the non-state actors to use ‘germs’ to create terror and panic. It is a little known fact that the religious cult in Japan called Aum Shinrikyo, which carried out Sarin gas attack in a Tokyo subway during March 1995, was also involved in acts related to biological terrorism. Between 1990 and 1993, Aum Shinrikyo had tried to release botullin toxin (Bubonic Plague) from a car near the Japanese parliament building, and then later tried to spray anthrax spores from the roof of their office building in Tokyo. However, their efforts were not successful. The second incident is the most recent one, when immediately after the 9/11 incident, anthrax spores were spread via postal envelopes in parts of the United States causing five deaths. This attack succeeded in creating panic and disruption. The attack had also caused substantial economic damage. However, absence of any bio-terror attack to date does not guarantee that such an attack could not take place in the future. Particularly, since from the beginning of the 21st century, terrorist activities have become more lethal. The attacks on the World Trade Center on September 11, 2001 clearly indicate that terrorist organizations may go to any extent to cause damage to life and property and create panic. The Bali bombing, the London shoe-bomber case, the Glasgow attack, a plan to destroy many air craft in midair, mass casualty terrorism, use of air power (to a limited extent by LTTE) etc. clearly indicate that terrorist organizations are ‘investing’ in new/innovative tools and tactics.

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Over the years terrorist organizations have used tools and tactics like guerrilla warfare, urban warfare, kidnapping, hijacking, booby traps, IED’s, grenades, automatic weapons, rocket launchers etc; attacking aerial and maritime routes, Fedayeen attacks, and acts of suicide terrorism, all with some success. It would be difficult to establish a global pattern about the change in usage of tactics by terrorist organizations. This is because acts of terror depend on a variety of things from logistical support to covert sate support to leanings of terrorist organizations. At the same time, globally it has been observed that terrorist organizations usually show a copycat syndrome. In regard to WMD terrorism in general and biological terrorism in particular, it could be said that no significant indications are available so as to conclude that the terrorist organizations would use this methodology in the immediate future. However, there are many indications that terrorist groups are looking towards acquiring the wherewithal to carry out WMD terrorism. There have been various reports available on the Internet about Osama Bin Laden and Al-Qaida attempting to acquire nuclear weapons. Time magazine ran a story on November 12, 2001 saying that Osama’s quest for nuclear weapons had started as early as the mid-1990s. Also during the US invasion of Afghanistan post 9/11, sketches and calculations to make a helium-powered balloon bomb filled with anthrax were found in the Kabul office of an NGO headed by Bashiruddin Mehmood, one of the two Pakistani nuclear scientists detained in Islamabad for questioning on alleged links to Osama bin Laden. Such balloon bombs are capable of showering anthrax over areas as vast as big cities1. At the backdrop of this it is understood that biological terrorism is an important threat which cannot be neglected but, at the same time, is a threat about which nothing can be known with any degree of certainty. This paper attempts to use a few tools of social science research to contextualize this threat in present and future terms. Terrorist use of biological weapons cannot be assessed based on traditional threat assessment because the basic universal criteria “the past is the basis for their prediction of the future” could not be applied. On the other hand, traditional methods of threat assessments in regard to bio-terrorism have been overly simplistic. They have tended to focus on only a single factor such as the agent that might be used or the motivations of the state or terrorist who might use them. In addition, threat assessments have emphasized vulnerabilities rather than risks, which are a combination of vulnerability and likelihood.2 The amorphous nature of this threat demands a comprehensive threat and risk assessment in order to establish a benchmark for evaluating counter terrorism and emergency response spending decisions across the full range of government programs. To undertake this, it becomes essential to understand the motivations and behavior patterns of the perpetrators of biological weapon (BW) attacks. For this purpose it is essential to carry out a detailed analysis of the range of terrorist behavioural patterns, preferred types of weapons and delivery methods. However, over reliance on worstcase scenarios should be avoided. It is also essential, to quantify the exact nature of the danger of bio-terrorism based on technical complexities of biological weapons. However, quantification of a threat is a very big challenge and easier said than done.

1

http://harble.blogspot.com/2001_11_25_archive.html Testimony of Michael Moodie, President Chemical and Biological Arms Control, Institute to the Subcommittee on International Security, Proliferation and Federal Services Committee on Governmental Affairs, November 7, 2001. http://bioterrorism.slu.edu/bt/official/congress/moodie110701.pdf 2

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It is often said that ‘Threat assessment is an advanced art. Like any art it can be improved but not replaced with science.’ 3 Today, however, the world has gone from a “Biological terrorist event being improbable to a stage where a biological attack by a terrorist group appears to be their best option.” Hence, there is a need to provide a more scientific basis for effective threat assessment. Various quantitative and qualitative methods could be used fully or partially for carrying out a reality check about bio-terrorism. The methods may include: Literature Survey, Trend Analysis/Extrapolation, Critical/key Technologies Assessment, Relevance Trees, Delphi Technique, Scenario Writing and SWOT Analysis. It is also essential to carry out a qualitative analysis of the threat, to identify such factors, to assess the potential for use of biological weapons by non-state actors. It is necessary to identify broad categories of factors, which in combination may constitute the basis for a future threat assessment scale for biological terrorism. In an overall threat analysis each factor will have different weight depending on the importance of that factor in the overall threat spectrum. Parametric Model for Threat Assessment4 The following parameters could be used for threat assessment.

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Access to Biological Agents • Access to bio laboratories of the US and other developed countries where bio agents are stored in various forms • Access to BW programs of rogue states • Knowledge and access to a few remote areas in the world where the diseases could exist in some form • Access to dumping grounds of bio weapons (post 1972 BTWC) Access to BW Related Technologies • Preservation technologies like stabilization; freeze drying etc. • Weapon development • Brewing of Germs, Microncapsulation • Delivery systems Access to Skilled Personnel Willing to Work for Non-state Actors • Biotechnology skills (pathologists) • Weapon design skills (engineers, aerosol physicists) • Weapon dissemination skills (meteorologists) Organizational Factors • Covert organization • Ideological acceptance and desire towards the usage of BW agents • Infrastructure facilities 3 Omar Malik, ‘Aviation Security Before and After Lockerbie’, in Paul Wilkinson and Brian Jenkins (eds.) Aviation Terrorism and Security (London and Portland, OR: Frank Class, 1999), p. 122. 4 The parametric model is based on Thomas J. Badey, ‘Nuclear Terrorism: Actor-based Threat Assessment’, Intelligence and National Security, Vol.16, No.2 (Summer 2001), Frank Cass and Company Ltd., London, p. 43.

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•

Survivability factor (sustaining power) of the organization in case the world body holds the organization accountable and reacts accordingly

Environmental Factors • Geographic factors

Trend Analysis

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Following paragraphs explain a few of the important qualitative and quantitative methods which could help to analyze the threat from bioterrorism in a logical way. This technique is based on projection of past trends into future, for a period of time and was also called Trend Extrapolation. It is based on the assumption that future will in some way be an extension of past trends.5 It is not always true that trends will offer exact answers but it is important to analyze them because ‘history has a habit of repeating itself.’ A broad analysis of the last couple of years of ‘WMD Terrorism Chronology: Incidents Involving Sub-National Actors and CBRN Materials’ indicates that there is a marked increase in number of incidences related to bio-terrorism post-1997 (almost by 50-60 per cent). More than 50 per cent of incidences occurred in the US alone. In Asia, the reported incidences are much, lesser hovering around 20 per cent. Out of these incidences almost 60 to 70 per cent fall under the category of hoaxes/pranks/threats. 6 This also indicates that there could be regional biases with regard to the usage of these tools of terror. Inputs mentioned above allow us to infer that the threat of bio-terrorism is showing signs of turning real in the last few years. A number of hoax incidences are indicative of the fact that terrorist groups are looking at this threat as a weapon to create panic (mass disruption) more than as a weapon for mass destruction. This could be the reason that a few call bio-weapons ‘weapons of mass disruption’.

Critical/Key Technologies Technological forecasting or technological impact assessment could be one important method which would give major leads about the likely nature of this threat. Technological forecasting is an attempt to forecast technological breakthroughs and developments that are most likely to occur in the future and importantly when they may occur. Technological forecast evaluation looks at how the latest technologies are likely to impact society or the environment.7 Biological threat analysis is a technical job and requires expertise in various fields like microbiology, pharmacology, forensic sciences etc. An assessment of biological threat requires an understanding of the nature of the pathogens and toxins that can

5

www.ubmail.ubalt.edu/~harsham/ stat-data/opre330Forecast.htm “WMD Terrorism Chronology: Incidents Involving Sub-National Actors and CBRN Materials”, The Nonproliferation Review (post 95 issues), Monterey Institute of International Studies. Analysis on similar lines is also available at Matin Zuberi, “WMD in hands of Non-State Actors”, Journal of the United Service Institution of India, Vol.CCXXI, No.549, July–Sep 2002. 7 http://www.risoe.dk/rispubl/SYS/TES 6

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cause infectious diseases as well as the modes of delivery of such pathogens to the target, e.g., the dissemination technique. There is disagreement among experts concerning the extent of the technical impediments that may constrain use of biological agents. Some are of the opinion that terrorists may face very few technical hurdles, while some say that it is an extremely difficult task. However, the modern day terrorist is ready to go to any extent to achieve the task. They can purchase technology and technologists if the need arises. Various branches of sciences associated with biotechnology, like medicine, microbiology or pharmacology are being taught for many years in various universities. Hence trained manpower is available; there is only the question of motivating them to work for nonstate actors. The ‘London ricin case’8 proves that terrorist organizations have started looking beyond conventional agents and are in a position to manufacture an agent. Dissemination is the process by which infectious diseases or toxins are dispersed to cause disease or intoxication. Biological weapons can be deployed in three ways: by contaminating food or water supplies; by releasing infected vectors such as mosquitoes or fleas; and by creating an aerosol cloud to be inhaled by the victims.9 Terrorists may depend on simple dissemination techniques and more importantly can adopt asymmetric tactics to deliver the agent to their target. In the 21st century, technology should not be considered an impediment preventing a terrorist from launching an attack using biological weapons. Advances in genetic engineering technologies over the past decade have made biological warfare more viable. The current database, which is being developed for commercial genetic engineering in the field of agriculture, animal husbandry and medicine, is potentially convertible to the development of a wide-range of novel pathogens that can attack plant, animal, and human population. In the 20th century, modern science reached its apex with the splitting of the atom but unfortunately it led to the development of the atomic bomb. 10 Some military observers are of the opinion that another great scientific discovery like the DNA double helix will soon be used in a comparable manner, posing a similar threat. These advancements in biotechnology pose a danger in that terrorists may be able to possess ‘Designer Gene Weapons’ in the coming years.

SWOT Analysis A few methods, which are normally used in management studies, could find some relevance by helping to explain the motivation level of the terrorist towards the usage of biological weapons. Cost-benefit analysis could be one of these methods. Another method similarly applicable may be SWOT (strengths, weaknesses, opportunities and threats) analysis. While the analogy between inter-nation or state/non-state competitions with interfirm competition may not be totally valid, there is no doubt that most foresight activities strongly emphasize national dimensions and international comparisons. Hence, one finds that a strong generic characteristic of nearly all-national foresight

8

www.nytimes.com/2003/01/08 Testimony of Dr. Kenneth Alibek, cns.miis.edu/research/cbw/threat.htm 10 www.foet.org/global/BC/Now%20for%20GM%20weapons.pdf 9

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methodologies is the more or less implicit use of Strengths, Weaknesses, Opportunities and Threats (or so-called SWOT) approach or underlying guiding principle.11 SWOT Analysis could be a very effective way of identifying terrorist organizations Strengths and Weaknesses, and of examining the Opportunities and Threats it faces. The following analysis is attempted in order to help understand what advantages and disadvantages the terrorist groups have with regard to making investments in biological weapons: first, to procure them and subsequently to use them. Strengths: • Technology is available and accessible. Weapon is low cost. • A group with modest pharmaceutical expertise can develop BW for terrorist use (crude weapon). • It is possible get the weapon with the help of state support. • Not bound by BTWC. • The weapon has got intrinsic shock value and is most feared weapon. Mere threat of these weapons could cause substantial psychological, political, and even economic damage to a state. • Can inflect large number of casualties over a wide area. • Can selectively target humans/animals/plants. • Difficult to trace origin of attack.

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Weaknesses: • Difficult to acquire high tech technologies like micro capsulation, freeze drying etc. Also difficult to form a cohesive group of specialists consisting of pathologists, aerosol physicists, meteorologists. Hence manufacture and delivery of state of art weapon is not possible. • Mass killing is not possible. • Only possible to create a crude weapon. • Impact difficult to access before an actual attack. • Popular support may go against the organization. Opportunities: • Duel use technologies give a distinct advantage. • Terrorists may seek biological weapons because traditional methods may no longer be psychologically effective. • May evolve as a basis for bargaining power with government of India. • May be able to attract attention of the entire world towards the problem. • Amongst the other terrorist organizations this organization will have an upper hand in bargaining and will have a major say during negotiations. Threats: Survivability factor (sustaining power), the threat to the existence of the organization in case India, supported by the world body, holds them accountable and reacts accordingly. •

11

May loose popular support because the front end of the organization will find it extremely difficult to deal with Indian government subsequently.

www.work-at-home-index.net/artmass and few other related sites.

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World opinion will go against them. If the act is carried out without the consent of the state sponsor, then the organization will find it difficult to survive without state support.

Such types of analysis could help the administration to develop a strategy that uses strengths and opportunities to reduce the weaknesses and threats. In spite of such analysis being subjective it still helps to focus on key issues. Most importantly such analysis will help in putting the threat of bio-terrorism into correct perspective.

Conclusion

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The trends indicate that terrorism would remain a curse for 21st century at least for coming few decades. Global terror attacks, particularly post 9/11, have shown that we are living in the age of terrorism where traditional moral standards no longer hold good. The terrorists’ goals are to disrupt and destabilize society by sowing fear among the populace. Biological terrorism could be one of the effective ways to do it. It is essential to address this threat more comprehensively at the global level. As a first step towards countering this threat, it is important to analyze the exact likely nature of the threat. The amorphous nature of this threat demands special type of analysis. It is important for every state fearing a biological threat to undertake a systematic analysis to contextualize this threat. Such analysis would help to devise active and passive methods to tackle this threat.

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Preparedness for Biological Threats: Position of the World Animal Health Organisation (OIE) Dr Caroline PLANTÉ1 and Dr Alain DEHOVE2 a OIE Sub-Regional Representation, Brussels b OIE Headquarters, Paris

Abstract. The ability to control animal diseases, whether occurring naturally or deliberately, will depend on the early detection and rapid response capacity of Veterinary Services regarding outbreaks. OIE is the reference intergovernmental organisation for animal health, which develops standards that are democratically adopted by its 173 Members. These standards include minimum requirements for quality and efficiency of national Veterinary Services such as human and financial resources, technical authority and capacity, as well as transparency of the national sanitary situation. Their implementation by all countries makes an essential contribution to preventing and responding to bioterrorism attacks, keeping in mind that 80% of pathogenic agents having a potential bioterrorist use are zoonotic (diseases transmissible to animals and humans). Keywords. OIE Standards, OIE PVS Tool, WAHIS (World Animal Health Information System), zoonoses, OIE Reference Laboratories

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Introduction The protection of public health and rural economies is closely linked to the control of animal health. A serious health event in the animal kingdom may have worldwide consequences for economy and consumption given the importance of animal production for the food supply. It may also pose a threat to public health since many animal diseases are zoonotic. Indeed, the economic impact of the fall in production and disruption of trade caused by these diseases, the social repercussions and the consequences for food safety and security fully justify effective action in the animal sector. In terms of public health, the most effective way to control zoonoses is to eliminate the pathogens at their animal source. Currently, approximately 60% of human pathogens are zoonotic and 80% of pathogenic agents having a potential bioterrorist use are zoonotic. To face animal diseases occurring either naturally or through the deliberate introduction of pathogens, the capacity of national Veterinary Services is critical. The OIE international standards provide a strong basis for Veterinary Services to develop strategies for early detection and rapid response to control animal disease outbreak(s). A number of programs have been developed by the OIE to improve the quality of VS and strengthen laboratories’ capacities. 1 2

OIE Sub-Regional Representative in Brussels, OIE Sub-Regional Representation in Brussels. OIE Co-ordinator of the World Animal Health and Welfare Fund, OIE Headquarters, Paris.

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C. Planté and A. Dehove / Preparedness for Biological Threats – Position of the OIE

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1. Strengthening Framework Mechanisms The national Veterinary Services, as defined in the OIE Terrestrial Animal Health Code (the Terrestrial Code), comprise animal health organizations working in both the public and private sector, and they are fundamental for the prevention, detection and control of animal diseases, including those transmissible to humans. In all countries the Veterinary Services play an essential role in safeguarding animal health and, consequently, public health. The OIE develops and publishes standards recognized by the World Trade Organization (WTO) within the framework of the WTO Agreement on the Application of Sanitary and Phytosanitary Measures (SPS Agreement) as the international reference on animal health and zoonoses. Annex A point 3b of the SPS Agreement defines international standards, guidelines and recommendations for animal health and zoonoses as being the standards, guidelines and recommendations developed under the auspices of the Office International des Epizooties (OIE). These standards have been developed and adopted by the OIE’s 173 Members. By implementing these standards, countries significantly increase their ability to protect humans and animals from biological threats. These standards can be accessed on the OIE website and are available in English, French and Spanish: http://www.oie.int/eng/normes/mcode/en_sommaire.htm. For Veterinary Services, standards relating to their quality and evaluation are laid out in Chapters 3.1. and 3.2. of the Terrestrial Code. Veterinary Services that comply with these international standards present the best guarantee for being able to respond effectively to a biological threat, whether accidental or deliberate. One of the objectives in evaluating the Veterinary Services is precisely to identify their deficiencies so that they can be remedied. It is therefore recommended that all countries carry out an independent evaluation of their Veterinary Services using the OIE PVS Tool (“OIE Tool for the Evaluation of Performance of Veterinary Services”) which has been recognised by the OIE International Committee as a reference tool to evaluate Veterinary Services’ compliance with the standards contained in the Terrestrial Code and which has been developed specifically for this purpose. This may consist of a self-evaluation or an evaluation carried out by an independent third party (OIE). This tool gives countries an opportunity to identify, using a consistent, internationally recognised method, the main deficiencies of their Veterinary Services in terms of governance, organization, functioning and resources. It is regularly reviewed and updated and is available in English, French and Spanish on the OIE website: http://www.oie.int/eng/oie/organisation/en_vet_eval_tool.htm?e1d2.

2. Strengthening Health Surveillance, Early Detection and Rapid Response To prevent the introduction and spread of pathogens it is essential for the whole of a country to be covered by effective epidemiological surveillance networks. These networks involve many different key players and their expertise and coordination are crucial. The OIE emphasizes the vital importance of strengthening Veterinary Services in the field of surveillance. In particular, this means strengthening the network of veterinarians in rural areas and the active and formal training and participation of producers and other professionals in animal production sectors, who can then act as

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first-line sentinels to detect any occurrence of serious diseases and provide the veterinary authorities with early warning, a precondition for a fast and effective response. To maintain a high level of vigilance, the Veterinary Authorities must develop continuing education programs adapted to each type of player and implement them on a permanent basis. In parallel, the development of diagnostic capabilities and other resources, coupled with the promulgation of new laws giving the Veterinary Services and other services involved the tools they need, will lay the foundation for more effective prevention of bioterrorism.

3. Crisis Preparedness In most cases, crises tend to involve several sectors and administrative departments. If they are to be able to work together effectively and synergistically, it is vital for the links between them to be strengthened and for their respective responsibilities to be clearly established. In terms of animal health, surveillance of wildlife must not be neglected given its potential role as a reservoir for pathogens. Pathogens do not all present the same level of danger. To help determine which should be included in surveillance programs and contingency plans, the OIE List provides a useful guide, giving the relevant criteria to be used in order to determine which diseases should be listed. In particular, capacity for international spread and zoonotic potential are taken into account.

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4. Information Sharing and International Cooperation In terms of animal diseases, including zoonoses, the OIE has a mandate to collect, analyze and disseminate global official animal health information. Rapid detection of pathogens and transmission of information is essential in order to avoid the pathogens spreading to other countries. The quality of this information depends particularly on the quality of the epidemiological surveillance networks for animal diseases and the quality of laboratory diagnoses. The OIE supports and encourages actions aimed at strengthening the functioning of both passive and active epidemiological surveillance networks and laboratory capabilities, especially in developing countries, where the deficiencies that often exist in this respect and the resulting difficulty in responding effectively constitute a danger for the whole world. In this context, international solidarity is vital. The expertise of OIE Reference Laboratories can, for example, be deployed in other countries, including in developing countries, through the “laboratory twinning project” developed by the OIE.

5. Strengthening of Contingency Plans and Setting Up of Simulation Exercises To be able to deal, on the one hand, with bioterrorist attacks in which pathogens could be released simultaneously in different places and, on the other hand, with simultaneous epidemics of different diseases which could overwhelm the response

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capabilities, there is a need to adapt existing contingency plans, and if necessary the legal framework, to make provision for the large-scale, coordinated involvement of personnel from both public and private sectors. Simulation exercises must then be carried out to test whether these plans will be effective in responding to various scenarios. Trans-boundary exercises are particularly important in order to harmonize actions and optimize the exchange of information and experts between countries. The OIE has also published a scientific and technical review on biological disasters of animal origin which contains a wealth of information on current knowledge, recommendations and experiments conducted in controlling deliberate outbreaks of animal diseases, emphasizing the role and preparedness of veterinary and public health services.

6. Biosafety and Biosecurity of Veterinary Research and Diagnostic Laboratories In terms of biological standards, the OIE Quality Standard and Guidelines for Veterinary Laboratories as well as the OIE Manual of Diagnostic Tests and Vaccines for Terrestrial Animals (the Manual) present internationally recognized principles relating in particular to biosecurity and biosafety requirements in laboratories (Chapter 1.1.6.). These requirements are designed to protect humans, and especially laboratory staff, from microbiological hazards, and to protect animal health by preventing the release of pathogens into the environment. The recommended practices for the collection, packaging and shipment of samples, biosafety and biosecurity in veterinary laboratories, disinfection and inactivation are dealt with in other chapters and are also designed to prevent the spread of pathogens, whether accidental or deliberate. The conditions for authorizing establishments to handle pathogens are defined according to the level of risk posed by each pathogen.

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References [1] OIE International standards: Terrestrial Animal Health Code (http://www.oie.int/eng/normes/en_mcode.htm?e1d10) and Manual of diagnostic tests and vaccines for Terrestrial Animals (http://www.oie.int/eng/normes/en_mmanual.htm?e1d10) [2] OIE PVS Tool (OIE Tool for the Evaluation of Performance of Veterinary Services) http://www.oie.int/eng/oie/organisation/en_vet_eval_tool.htm. [3] Biological disasters of animal origin, OIE Scientific and Technical Review, Volume 25, April 2006. http://www.oie.int/boutique/index.php?page=ficprod&id_produit=96&fichrech=1&lang=en [4] OIE Quality Standard and Guidelines for Veterinary Laboratories 2nd Ed., 2008, pp.82

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SARS and H5NI: What Have We Learned and How to Plan for a Pandemic Dr. Rashid CHOTANI Chemical and Biological Medical Systems, Joint Program Management Office, US Department of Defense

Abstract. This paper is a summary of a presentation. It discusses the history and development of the SARS and H5N1 viruses as well the measures taken to deal with virus outbreaks. Based on analysis of past events, the paper suggests improved countermeasures to be taken should another outbreak occur, either due to SARS, the H5N1 virus or another. Keywords. bioterrorism, counter-terrorism, pandemic, SARS, Influenza

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SARS: Chronology Image you are watching progressive news reports as they occurred at particular times in recent history. The reporting would have developed like this. On 16 November 2002, the first known case of atypical pneumonia occurs in Foshan City, Guangdong Province, China, but is not identified until much later. On 10 February 2003, the WHO Beijing office receives an email message describing a “strange contagious. The disease” has “already left more than 100 people dead” in Guangdong Province in the space of one week. The message further describes “a ‘panic’ attitude, currently, where people are emptying pharmaceutical stocks of any medicine they think may protect them.” On 11 February 2003, the WHO receives reports from the Chinese Ministry of Health of an outbreak of acute respiratory syndrome with 300 cases and 5 deaths in Guangdong Province. On 12 February 2003, health officials from Guangdong Province report a total of 305 cases and 5 deaths of acute respiratory syndrome. The cases and deaths occurred from 16 November to 9 February 2003. Laboratory analyses are negative for influenza viruses. On 14 February 2003, the Chinese Ministry of Health informs the WHO that the outbreak in Guangdong Province is clinically consistent with atypical pneumonia. The outbreak is said to be coming under control. On 17 February 2003, a 33-year-old Hong Kong man, who had travelled with his family to Fujian Province, China in January, dies of unknown causes in Hong Kong. His 8-yearold daughter died previously, of unknown causes, while in mainland China. His 9-yearold son is hospitalized. On 19 February 2003, an outbreak of “bird flu” in Hong Kong is reported to the WHO following the detection of the H5N1 virus in the 9-year-old boy. The WHO activates its global influenza laboratory network and calls for heightened global surveillance. On 20 February 2003, the Department of Health in Hong Kong confirms that the boy’s father was likewise infected with the H5N1 virus. On 21 February 2003, a 64-year-old medical doctor from Zhongshan University in Guangzhou (Guangdong Province) arrives in Hong Kong to attend a wedding. He checks into the ninth floor of the Metropole Hotel (room 911). Although he developed

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respiratory symptoms five days earlier, he feels well enough to sightsee and shop with his 53-year-old brother-in-law, who resides in Hong Kong. On 22 February 2003, the Guangdong doctor seeks urgent care at the Kwong Wah Hospital in Hong Kong and is admitted to the intensive care unit with respiratory failure (he had previously treated patients with atypical pneumonia in Guangdong). He warns medical staff that he fears he has contracted a “very virulent disease”. Health authorities in Hong Kong learn that his symptoms developed on 15 February, at which point he would have still been on the Chinese mainland. On 24 February 2003, the Global Public Health Intelligence Network (GPHIN) picks up a report stating that over 50 hospital staff are infected with a “mysterious pneumonia” in the city of Guangzhou. In Hong Kong, a 26-year-old local man develops a respiratory tract infection, but does not seek medical attention. From 15 to 23 February, he had visited an acquaintance staying on the ninth floor of the Metropole Hotel. On 25 February, the brother-in-law of the Guangdong doctor is admitted to Kwong Wah Hospital and discharged. On 26 February, a 48-year-old ChineseAmerican businessman is admitted to the French Hospital in Hanoi with a 3-day history of fever and respiratory symptoms. His recent travel history includes a January trip to Shanghai, and a private trip from 8 to 10 February to Guangdong Province, and Macao. He travelled to Hong Kong on 17 February, departed for Hanoi on 23 February, and fell ill there. Shortly before his departure from Hong Kong, he had stayed on the ninth floor of the Metropole Hotel in a room across the hall from the Guangdong doctor. The businessman is attended by a WHO official, Dr Carlo Urbani, based in Viet Nam. On 28 February 2003, Dr Urbani, alarmed by the unusual disease and concerned it might be a case of avian influenza, notifies the WHO office in Manila. The WHO headquarters moves into a heightened state of alert. On 13 March the WHO sends an emergency alert to its partners in the Global Outbreak Alert and Response Network (GOARN). The Chinese-American businessman dies in isolation at the Princess Margaret Hospital in Hong Kong. No cases among hospital staff are reported. The Ministry of Health in Singapore reports 3 cases of atypical pneumonia in young women who had recently returned to Singapore after traveling to Hong Kong. All had stayed on the ninth floor of the Metropole Hotel in late February. The 44-year-old son of Toronto's first case dies in Scarborough Grace Hospital. On 14 March 2003, in Hong Kong, 39 staff at 3 hospitals undergo treatment for flu-like symptoms. Twenty-four exhibit signs of pneumonia and are described as in “serious condition.” Four cases of atypical pneumonia in Toronto result in 2 deaths. All occur within a single family. The first members of a WHO GOARN multidisciplinary outbreak control team arrive in Hanoi. On 15 March, at 2:00 a.m., Singapore health authorities notify WHO staff, by urgent telecommunication, that a 32-year-old physician, who had treated the country’s first two cases, had boarded a flight from New York City to Singapore, after having attended a medical conference, was returning to Singapore via Frankfurt. Shortly before boarding the flight, he reported symptoms to an alert medical colleague in Singapore, who notified health officials. The WHO identifies the airline and flight, and the physician, his 30-year-old pregnant wife and 62-year-old mother-in-law are removed from the flight in Frankfurt and placed in isolation. They become Germany’s first cases.

Bioterrorism: Threats and Deterrents, IOS Press, Incorporated, 2010. ProQuest Ebook Central,

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As well on 15 March, the WHO issues a rare travel advisory as evidence mounts that the disease is spreading by air travel along international routes. The WHO names the mysterious illness after its symptoms: severe acute respiratory syndrome (SARS) and declares it “a worldwide health threat.” Health Canada reports 8 cases of atypical pneumonia, including the 2 deaths. The Singapore Ministry of Health reports 16 cases of atypical pneumonia. On 16 March 2003, over 150 suspect and probable cases of SARS are reported from around the world. On 17 March, China provides a first brief report to the WHO about the Guangdong outbreak. On 18 March, cases are now being reported in Canada, Germany, Taiwan (China), Thailand, and the United Kingdom as well as in Hong Kong, Viet Nam, and Singapore. The cumulative total of cases reported to the WHO is 219 cases and 4 deaths. An overwhelming majority of cases occur in health care workers, their family members, and others having close face-to-face contact with patients. On 25 March, 9 air passengers linked to a 15 March flight from Hong Kong to Beijing develop SARS after returning to Hong Kong. The flight is eventually linked to cases in 22 passengers and 2 flight attendants. Dr. Carlo Urbani, 46, of Italy, the first doctor to realize that the world was dealing with the unfamiliar disease died of illness in Bangkok, Thailand, on Saturday, March 29, 2003. Urbani became infected while working in Vietnam, where he diagnosed an American businessman hospitalized in Hanoi, who later died. On 1 April 2003, Dr. Lutz Freitag, of the Pulmonary Hospital in Hemer, Germany shows the first Corona virus. On 8 April, Professor Malik Peiris, the chief virologist at the University of Hong Kong, stands in front of a projection of a virus infected cell at Queen Mary Hospital in Hong Kong.

Copyright © 2010. IOS Press, Incorporated. All rights reserved.

Coronavirus The coronavirus is a single-strand RNA, nonsegmented and enveloped. There are 2 serogroups (229E and OC43) in humans. It may account for ~1/3 of common colds. Reinfections are common. The envelope is composed of: S - spike protein, M - matrix protein, HE – hemagglutinin. S protein M protein

HE protein

N protein

RNA genome

The name “coronavirus” refers to the protein molecules surrounding the virus, making it look like a crown (n.“corona” lat = crown). It causes mild to moderate Bioterrorism: Threats and Deterrents, IOS Press, Incorporated, 2010. ProQuest Ebook Central,

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respiratory illnesses such as the common cold. It is able to survive 6 days in suspension and in dry air for up to 3 hours. It can be killed by exposure to ultra-violet light, so the cellsy will not survive under sunlight. However, they mutate easily, and each mutation triggers an epidemic of respiratory disease. A new mutation, which arose in Guangdong is suspected of causing SARS. The SARS outbreak had many consequences. It caused “mask hysteria”, where everyone was walking around wearing paper face masks. In a total of 29 countries, reported cases totalled 8,098 with 5,327 of those occurring in Mainland China and 1,755 more in Hong Kong. Seven hundred and seventy-four deaths were reported due to SARS where 349 of those occurred in Mainland China and another 299 occurred in Hong Kong. On a more positive note, 7,322 of the reported cases were instances wherein people recovered. Healthcare facilities played an important role in the epidemiology of SARSl. Patients infected with SARS-CoV disease are likely to present to healthcare facilities. If unrecognized as SARS, these patients may transmit SARSCoV to healthcare workers and other patients. In the 2003 outbreak, health care workers accounted for a significant percentage of cases in every major SARS outbreak reported.

Copyright © 2010. IOS Press, Incorporated. All rights reserved.

Lessons Learned Respiratory diseases can spread rapidly. They can have a very non-specific clinical presentation making it difficult to distinguish them. Healthcare facilities play a central role in the spread of respiratory diseases. Therefore, critical components for management should include surveillance, contact tracing (which is resource intensive but critical to disease containment), communication, stringent infection control practices including quarantine. There must be clear messages about the need for quarantine in order to increase public acceptance about the idea. Quarantine can be voluntary in most cases. Mental health support is a critical need for those in quarantine. It is worthy of note that the implementation of large-scale quarantine is complex and resource-intensive. A practice worth further explanation is Social Distancing. There are a few ways that are already familiar to populations that may allow more effective implementation of Social Distancing. Implement “Snow Day” restrictions. Close schools, daycare centers, etc. Cancel large public gatherings (concerts, theaters). Minimize other exposures (markets, churches, public transit). In conjunction, ask nonessential workers to stay home. If necessary, consider additional measures such as the distribution of surgical masks, temperature screening in public venues and the scaling back of transportation services. SARS: The Economic Impact The Asian Development Bank (ADB) predicted a $28 billion in lost economic output in the four most vulnerable economies: China, Hong Kong, South Korea and Taiwan. In the case of Hong Kong, the ADB predicted the SARS could knock 4% points off economic growth that year - taking it down more or less to zero. Published estimates based on the cost of cancelled travel and decreased investment in Asia ranged from US$ 30,000 to 140,000 million.

Bioterrorism: Threats and Deterrents, IOS Press, Incorporated, 2010. ProQuest Ebook Central,

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Similarities between SARS and the 1917-18 Flu Pandemic When considering lessons learned, it is always useful to consider more than one case. The SARS outbreak of 2003 can be considered in comparison to the 1917-18 Influenza pandemic. They have some distinct similarities. They were both highly transmissible and virulent. They moved from animals to humans and share the same seasonal pattern. The source of transmission, in both cases, was airborne droplets. As well, in both cases, there was no effective antiviral or vaccine. Generally Seasonal Influenza causes, globally, 250,000 to 500,000 deaths per year. In the US (per year) approximately 35,000 deaths occur along with greater than 200,000 hospitalizations. Economically speaking, there is a $37.5 billion cost (influenza & pneumonia) with a greater than $10 billion cost in lost productivity. Pandemic Influenza is an ever present threat. Transmission and Survival The 3 modes of transmission include droplet transmission, airborne transmission, and contact transmission. Most human influenza infections are spread by virus-laden respiratory droplets that are expelled during coughing and sneezing. They are carried in respiratory secretions as small-particle aerosols (particle sized