Gauging the Risk from Bioterrorism

January 6, 2014

It usually isn’t news to report when something didn’t happen, but in this case, it is worth noting: 2013 ended and there still hasn’t been a terrorist attack on America using weapons of mass destruction (WMD).  Why is this newsworthy?

In December 2008, the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism (also known as the WMD Commission) released a report titled “World at Risk.”  This effort followed a recommendation from the 9/11 Commission Report that more needed to be done to prevent proliferation of WMDs to sub-state groups.  While the WMD Commission hastened to assure Congress that the intent of the report was not to “frighten nor to reassure the American public about the current state of terrorism and weapons of mass destruction,” it declared that “terrorists are determined to attack us again – with weapons of mass destruction if they can.”  In particular, the WMD Commission stated that it was “more likely than not” that a terrorist WMD incident would occur by the end of 2013, and that a biological incident would be more likely than a nuclear one.

So, we’ve reached the end of 2013 without any terrorist WMD incidents, not merely within the United States, but across the globe (not considering the FBI’s expanded definition of WMD that includes any amount of any chemical, biological, or radiological (CBR) material or explosives).  There have been no biological incidents other than numerous anthrax hoaxes involving harmless white powders and a few abortive attempts at using ricin.  Although, it would be great news if the lack of incidents was the direct result of sound government policies, one would be challenged to accept such an assessment.  It may be that the U.S. government’s aggressive campaign against al Qaeda diminished all sub-state groups’ plans to acquire WMD, or it may be that they were never really that interested or capable of using CBR hazards.

The U.S. government has attempted to address natural disease outbreaks and bioterrorism threats within a single policy construct.  Rather than increasing efficiencies toward responding to both threats, this approach has instead allowed the public health community to subordinate bioterrorism threats to more probable natural disease outbreaks.  While understandable, this means that the U.S. government does not have a viable bioterrorism program.

The Era of Life Sciences

Some people refer to World War I as “the chemists’ war,” and World War II became the “first war of physics” as a result of the formal development of nuclear weapons.  Along that line of thought, some suggest we are now in war of life sciences, where health affairs and national security have overlapped to create new and still-evolving security challenges.  The idea of threats evolving from the misuse of life sciences by individuals is a new concept.  However, the threat of biological weapons use during military operations is not new.

Both the United States and former Soviet Union had offensive biological warfare programs during the Cold War, as well as other nation states.  Prior to 1991, the emphasis was on strategic deterrence, arms control efforts, and medical countermeasures for military forces.  And yet, U.S. forces were unprepared for biological warfare when they entered into combat with Iraq in 1991.  They lacked adequate biological detection equipment and did not have enough anthrax and botulinum toxin vaccines for the total force.

Aum Shinrikyo’s use of sarin nerve agent in the Tokyo subway in 1995 focused attention on the potential use of chemical and biological warfare agents by sub-state groups.  That cult had failed to develop any biological warfare agent, but it increased discussions on how the federal government should respond to domestic chemical, biological, radiological, and nuclear incidents.  Of course, there was the U.S. public health system and the Centers for Diseases Control and Prevention to monitor and respond to disease outbreaks.  The Amerithrax letters in 2001 created fears that the public health system was insufficiently prepared for bioterrorism incidents, in particular if the goal was to rapidly respond to minimize casualties.

When U.S. forces returned to the Middle East in 2003 to face the Iraqi military, they were better prepared than in 1991, but not to an extraordinary degree.  They had vaccines for smallpox and anthrax, but no other biological warfare threats.  A “detect to treat” capability existed in theater utilizing specialized bio-detection teams and in-theater laboratories.  There were notable policy challenges, such as offering vaccines to host nations, instituting quarantine procedures, and moving previously contaminated equipment and human casualties, which remain contentious issues even today.  The absence of WMD may, however, have induced a sense of complacency about the contemporary nation state threat.

A number of presidential executive orders and laws were drafted to address the potential threat of bioterrorism, including the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and the Biodefense for the 21st Century strategy in 2004.  Concerns relating to pandemic disease outbreaks in 2005 led to wording in the 2006 National Security Strategy and Public Health and Medical Preparedness presidential directive in 2007 that directly equated pandemic public health threats to biological weapons.  It generalized biological weapons effects as contagions that would “spread disease across large populations and around the globe.”

The Obama administration continued this policy direction with the development of a National Strategy for Countering Biological Threats, released in December 2009, following the outbreak of H1N1 influenza of that same year.  This strategy called for a single, coordinated federal response to prevent and respond to biological threats, whether natural, accidental, or deliberate in origin.  In particular, it noted the need to protect the United States “against misuse of the life sciences to support biological weapons proliferation and terrorism.”

The National Strategy for Biosurveillance, released in July 2012, further clouded the concept of countering biological threats, rather than clarifying it.  The national strategy defined bio-surveillance as “the process of gathering, integrating, interpreting, and communicating essential information related to all-hazards threats or disease activity affecting human, animal, or plant health to achieve early detection and warning…”  To summarize, the focus on protecting the general public from bioterrorism and biological disease outbreaks has been broadened to monitoring the “biosphere”—i.e., all forms of living organisms—for all potential health threats, not just biological.

The causes of policy failure are, at root, political

The focus of the federal government has been on coordinating a medical response to biological incidents, given that in the event of certain contagious diseases, the impact may be global and fast moving.  As a result of policy that addresses both natural disease outbreaks and bioterrorism, there are numerous government agencies involved.  Others have talked about the need to work public health with national security to address shared health security concerns.  However, any focus on bioterrorism is lost in the greater concern about natural disease outbreaks.  The challenge is one of resources and priorities between public health threats and deliberate biological threats.

The public health community has a prioritized list of global infectious diseases.  Diarrhea, malaria, dengue fever, and seasonal influenza top the list, followed by strains of hepatitis, HIV/AIDS, typhoid, and meningitis.  Anthrax and smallpox are not listed in the top 30 infectious diseases because there are not regular outbreaks of those diseases and vaccines exist for both.  Among the 60-70 infectious diseases that are tracked by the public health community, about ten constitute military biological warfare (BW) or bioterrorism threats.  If the public health community is leading the medical response to bioterrorism, we need to understand that it isn’t focused on deliberately released BW threats.

A 2011 CRS report on federal efforts to address the threat of bioterrorism makes this point.  Although there is clear presidential and congressional attention on bioterrorism, the report notes criticism on the lack of metrics and unclear goals across the interagency, leading to ineffective efforts.  The risk assessment process does not adequately address the intent and capabilities of deliberate actors.  National bio-surveillance is challenged by expensive environmental sensors.  The investment of billions of dollars into medical countermeasures for BW threats has been slow to produce results, and has been criticized by those who would rather see funds invested against public health threats.  The CRS report fails to address the public health community issues overshadowing bioterrorism concerns, but one should be able to read this between the lines.

It may be correct that a response to a biological incident should not be determined by the threat source (Mother Nature versus a deliberate actor), but certainly it makes a difference to those federal agencies responsible to prevent those threat sources from acting and to protect specific populations (military service members versus the general population).  Defending fit military troops against BW agents on the battlefield (bio-defense) is very different from protecting young and old civilians from biological hazards dispersed by extremists (bio-security), which is distinct from protecting the general public from natural disease outbreaks (bio-safety).  Currently, there is no clarity in national policy to reflect these distinct roles.

It is clear that the federal government has been tasked to defend the public against the threat of bioterrorism.  Numerous government agencies are involved, and given the breadth and depth of this subject, it is difficult (but not impossible) to address all aspects and programs associated with the subject.  Public health threats are more probable and affect more people than bioterrorism threats do.  But, attempts to get a “two for one” by tasking the public health system to address bioterrorism in a holistic “all-hazards” approach will fail, resulting in a loss of focus on bioterrorism.

The future challenges of infectious diseases and new biotechnology will continue to require a hard focus on how we conduct bio-defense, bio-safety, and bio-security.  As DoD and the interagency comes together to develop policies and strategies for countering biological threats, we need to ensure we are asking the right questions and not shortcutting the system in favor of quick fixes that may fail to produce viable results.  Above all, we need to abandon rhetorical statements about how “the threat is real” and how a terrorist WMD incident will happen “within the next five years.”  These statements aren’t resulting in increased resources or attention.  It’s not 2001 anymore.  It’s time for relevant analysis against tomorrow’s challenges.

 

Al Mauroni is the Director of the U.S. Air Force Counterproliferation Center. The opinions, conclusions, and recommendations expressed or implied within are those of the author and do not necessarily reflect the views of the Air University, U.S. Air Force, or Department of Defense.

 

Photo credit: Vinicius Munhoz