Andrew W Artenstein and Troy Martin

Bioterrorism, broadly defined as the deliberate and malicious deployment of microbial agents or their toxins as weapons in a non-combat setting, represents perhaps the most overt example of human behavior impacting epidemic infectious diseases (Artenstein, 2004a). While most of the microbial threat agents of potential use in bioterrorism occur naturally in various ecological niches throughout the world, they are rare and sporadic causes of human disease in developed countries and urban environments. It is human behavior within the context of the extant geopolitical milieu that transforms these naturally-occurring organisms into potential weapons of mass terror.

There is historical precedent for the use of biological agents against both military and civilian populations. It is postulated that the fifth plague visited upon Pharaoh in approximately 1450 BC, "murrained carcasses... pestilence," signified cutaneous anthrax (Plaut, 1981). In the fourteenth century, Tartar invaders probably introduced the Black Death to Caffa by catapulting plague-infected corpses into the besieged Crimean city for that explicit purpose (Wheelis, 2002). British forces in mid-eighteenth century colonial America, under the command of Lord Jeffrey Amherst, distributed blankets and clothing used by smallpox victims to Native American tribes in an attempt to affect the balance of power during the French and Indian wars (Christopher et al., 1997); it remains unclear whether these fomites resulted in contact transmission of smallpox to naive hosts or whether the Native Americans were infected by direct contact with infected colonists.

The use of biological (and chemical) agents as weapons of war has been well documented (Christopher et al., 1997). The German biological warfare program during World War I included covert infections of Allied livestock with anthrax and glanders. The Japanese army began conducting experiments on the effects of bacterial agents of biowarfare on Chinese prisoners in occupied Manchuria in 1932 at their infamous Unit 731; thousands of individuals were killed as a result of these experiments, which continued until 1945 (Harris, 1994). The United

States began its own offensive biological weapons program in 1942 and, during its 28-year official existence, weaponized and stockpiled lethal biological agents, such as anthrax, as well as incapacitating agents, such as the etiologic agent of Q fever (Christopher et al., 1997).

The US program was ended by two presidential executive orders in 1969 and 1970; stockpiled weapons were destroyed by mandate from 1971-1973 (Christopher et al., 1997). However, small quantities of pathogens were stored at Fort Detrick, Maryland, for biodefense research purposes. In 1972, under the auspices of the United Nations, the Convention on the Prohibition of the Development, Production, and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on Their Destruction (BWC) was ratified with more than a hundred signatory nations, including the US and the Soviet Union (Christopher et al, 1997).

Although a party to the BWC, the government of the Soviet Union apparently continued to weaponize biological agents at least through the mid-1990s (Alibek, 1999). There is direct evidence that the Soviets deployed weaponized ricin, a biological toxin, to carry out covert assassinations during the 1970s (Christopher et al., 1997). Additionally, the corroborated statements of multiple high-level government defectors confirm decades of persistent Soviet violation of the BWC. Perhaps the most egregious example of these violations arose from the revelation, years after the event occurred, that an epidemic of inhalational anthrax in Sverdlovsk in 1979, responsible for the deaths of at least 66 people, resulted from the accidental release of weaponized spores from a biological weapons plant (Guillemin, 1999).

Other more recent examples of bioterrorism, though not necessarily resulting in attacks causing morbidity or mortality, may serve as harbingers of future events. Saddam Hussein's regime in Iraq developed and deployed anthrax- and botulinum-laden warheads in the years leading up to the Gulf War (Zilinskas, 1997); the reasons that these weapons were never used in an actual attack probably had more to do with the implicit threat of overwhelming US retaliation and Iraqi technological deficiencies rather than the regime's reluctance to violate any moral principles. Biological agents have also been used to forward political ideologies: in 1984 a religious cult, intent on influencing voter turnout during a local election, contaminated restaurant salad bars in The Dalles, Oregon, with Salmonella, resulting in over 750 cases of gastroenteritis among patrons, employees, and their contacts (Torok et al., 1997). This event, coupled with revelations that the Japanese cult Aum Shinrikyo had attempted, multiple times, to release weaponized anthrax before their successful release of sarin nerve agent in the Tokyo subway system in 1995 (Olson, 1999), provides compelling evidence of the terrorist potential of these agents.

The catastrophic events of 11 September 2001 clearly ushered in a new era of global terrorism. The massive, simultaneous, and dramatic attacks on unarmed citizens in New York and Washington illustrate, convincingly, the mounting boldness of terrorists and their willingness to commit "unthinkable" acts. The anthrax attacks that followed 9/11 in the US killed 5 and sickened 17 additional people, and served to underscore the shifting sands of terrorism (Jernigan et al., 2001). While these bioterror attacks have never been directly linked to the events of 9/11, their temporal connection reinforces the persistent global threat posed by bioterrorism.

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