The Pandemic and America’s Response to Future Bioweapons
In the fall of 2011, Dr. Ron Fouchier developed “one of the most dangerous viruses you can make.” Fouchier, a Dutch virologist at the Erasmus Medical Center in Rotterdam, claimed that his team had “done something really, really stupid” and “mutated the hell out of H5N1.” At nearly the same time, Dr. Yoshihiro Kawaoka at the University of Wisconsin-Madison worked on grafting the H5N1 spike gene onto 2009 H1N1 swine flu, creating another transmissible, virulent strain.
Despite only 600 human cases of the H5N1 (“bird flu”) virus in the previous two decades, the exceptionally high mortality rate — greater than 50 percent — pushed the National Science Advisory Board for Biosecurity to block the publication of both teams’ research. After a heated debate in the scientific community, the World Health Organization deemed it safe to publish the findings. While Kawaoka’s paper appeared in the journal Nature, Fouchier’s original study appeared in Science. Although both teams generated viruses that were not as lethal as their wild forms, critics worried that the papers would enable rogue scientists to replicate the manipulations and weaponize a more contagious virus.
While some arms control experts like Graham Allison believe that “terrorists are more likely to be able to obtain and use a biological weapon than a nuclear weapon,” others have dismissed bioweapons due to dissemination issues, exemplified in failed biological attacks with botulinum toxin and anthrax by the terrorist group Aum Shinrikyo. Furthermore, studies from the U.S. Office of Technology Assessment indicated that bioweapons could cause tens of thousands of deaths under ideal environmental conditions but would not severely undermine critical infrastructure. In 2012, Dr. Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, argued that the benefits in vaccine advancement from Fouchier’s research outweighed the risks of nefarious use.
Today, however, Fauci is at the helm of America’s response to a global pandemic. Although the world has never experienced a mass-casualty bioweapons incident, COVID-19 has caused sustained, strategic-level harm. In the absence of a vaccine, it has killed more than 60,000 Americans and forced over 30 million Americans into unemployment. The isolation of large segments of society has crippled the economy and traditional sources of American power: domestically, cascading, second- and third-order effects plague critical national infrastructure; and internationally, power projection wanes, epitomized by the U.S. Navy’s sidelining of the USS Theodore Roosevelt.
While the SARS-CoV-2 virus that causes COVID-19 is not a bioweapon, technological advances increase the possibility of a future bioweapon wreaking similar strategic havoc. Specifically, advancements in genetic engineering and delivery mechanisms may lead to the more lethal microorganisms and toxins and, consequently, the most dangerous pandemic yet. Therefore, the United States should develop a new strategy to deter and disrupt biological threats to the nation.
Engineering the Next Pandemic
Although a bioweapon-induced pandemic seems unlikely in the short term, preparedness for future attacks begins with understanding the possible threat. According to the Centers for Disease Control, bioweapons are intentionally released microorganisms — bacteria, viruses, fungi — or toxins, coupled with a delivery system, that cause disease or death in people, animals, or plants. In contrast to other chemical, biological, radiological, or nuclear weapons, they have distinctive dangerous characteristics: miniscule quantities — even 10-8 milligrams per person — can be lethal; the symptoms can have a delayed onset; and ensuing waves of infection can manifest beyond the original attack site. The Centers for Disease Control grouped over 30 weaponizable microorganisms and toxins into three threat categories based on lethality, transmissibility, and necessity for special public heath interventions. While Categories A and B cover existing high and moderate threats, respectively, Category C focuses on emerging pathogens, like the Nipah virus and hantavirus, that could be engineered for mass dissemination. Historically, though, bioweapons were relatively unsophisticated and inexpensive when compared to chemical and nuclear production chains, which explains their protracted use.
One of the earliest examples of biological warfare occurred over 2,000 years ago, when Assyrians infected enemy wells with rye ergot fungus. In 1763, the British army presented smallpox-infested blankets to Native American during the Siege of Fort Pitt. During World War II, the Japanese army poisoned over 1,000 water wells in Chinese villages to study typhus and cholera outbreaks. In 1984, the Rajneeshee cult contaminated salad bars in Oregon restaurants with Salmonella typhimurium, causing 751 cases of enteritis. Most recently, Bacillus anthracis spores sent in the U.S. postal system induced 22 cases of anthrax and five deaths in 2001, and three U.S. Senate office buildings shut down in February 2004 after the discovery of ricin in a mailroom.
Despite this history of usage, the challenge of disseminating the biological agent has, thus far, meant that bioweapons attacks have not produced high casualties. Bioweapons can be delivered in numerous ways: direct absorption or injection into the skin, inhalation of aerosol sprays, or via consumption of food and water. The most vulnerable — and often most lethal — point of entry is the lungs, but particles must fall within a restrictive size range of 1 micrometer to 5 micrometers to penetrate them. Fortunately, most biological agents break down quickly in the environment through exposure to heat, oxidation, and pollution, coupled with the roughly 50 percent loss of the microorganism during aerosol dissemination or 90 percent loss during explosive dissemination.
The revolution in genetic engineering provides a path for overcoming delivery issues and escalating a biological attack into a pandemic. First, tools for analyzing and altering a microorganism’s DNA or RNA are available and affordable worldwide. The introduction of clustered regularly interspersed short palindromic repeats (CRISPR) — a technique that acts like scissors or a pencil to alter DNA sequences and gene functions — in 2013 made biodefense more challenging. Even as experienced researchers struggle to control clustered regularly interspersed short palindromic repeats and prevent unintended effects, malevolent actors with newfound access can attempt to manipulate existing agents to increase contagiousness; improve resistance to antibiotics, vaccines, and anti-virals; enhance survivability in the environment; and develop means of mass production. Infamously, Australian researchers in 2001 endeavored to induce infertility in mice by inserting the interleukin-4 gene into the mousepox virus. Instead, they inadvertently altered the virus to become more virulent and kill previously vaccinated mice, insinuating that the same could be done with smallpox for humans.
Moving one step further, genetic engineering raises the possibility of creating completely new biological weapons from scratch via methods similar to the test-tube synthesis of poliovirus in 2002. It is, thankfully, hard to use this process to create agents that can kill humans. However, genetic engineering can be used to create “non-lethal” weapons that, when coupled with longer-range delivery devices, could kill crops and animals, and destroy materials — fuel, plastic, rubber, stealth paints, and constructional supplies — that are critical to the economy.
Skeptics might question why a rational adversary would risk creating and employing bioweapons that are unpredictable and relatively hard to deliver to a target. First, some potential terrorists are “irrational” in the sense that death does not deter their service to a higher purpose; or, they may simply show a willingness to carry out orders from a state sponsor or a lack of concern for public opinion. Second, future state aggressors might genetically engineer a vaccine to immunize their populations prior to unleashing a bioweapon so that the attack would only be indiscriminate within targeted nations. Third, the unprecedented harm done by COVID-19 demands a transformation of 9/11-era priorities to recognize that “preparing for domestic threats like pandemics will be far greater concerns for most Americans than threats from foreign adversaries.” Bioweapons combine the worst of these national and international threats.
Ultimately, for a bioweapon attack to turn into a pandemic like the SARS-CoV-2 virus, three initial conditions must be met: first, the microorganism or toxin must not have an effective remedy available; second, it must be easily transmittable; and third, it must be fatal for some victims. Whereas a number of natural-born microbes satisfied these conditions in the past, it is possible for a genetically engineered bioweapon to have the same strategic impact in the future.
Prepare for the Worst
John Barry’s The Great Influenza: The Story of the Deadliest Pandemic in History provides insight into what the world might look like in the approaching age of biological attacks. It portrays how researchers failed to counter the 1918 flu strain while it spread to one-third of the global population. With a mortality rate of approximately 20 percent, the Spanish flu’s viral mutations proved especially fatal for military members with strong immune systems. Young people with previous exposure to milder flu strains likely suffered from immunological memory, which prompted a dysregulated immune response to the 1918 strain. At the time of the book’s publication in 2004, President George W. Bush took notice.
In a November 2005 speech at the National Institutes of Health, with Fauci notably in attendance, Bush warned, “If we wait for a pandemic to appear, it will be too late to prepare. And one day many lives could be needlessly lost because we failed to act today.” Similarly, the government should prepare now to respond to a future bioweapon attack — whether from terrorism or interstate warfare. This preparation ought to proceed along three categories of action: deterrence, disruption, and defense.
In the realm of biological warfare, the most effective way to save lives is to persuade an adversary that an attack will not succeed. Specifically, deterrence by denial makes the act of aggression unprofitable by “rendering the target harder to take, harder to keep, or both.” To this end, the United States can harden its biowarfare response by increasing interagency cooperation, wargaming the resulting plans, and compiling the materials required for their execution.
The Department of Defense — the largest agency in the U.S. government — is the logical choice to organize a “whole-of-government” approach to countering bioweapons. Last November, the Pentagon released the Joint Countering Weapons of Mass Destruction doctrine, which outlined how the military will synchronize its response with governmental stakeholders like the Director of National Intelligence, the United States Agency for International Development, the Department of Energy, and the Department of Health and Human Services. Partnerships, however, should expand beyond governmental agencies via a military joint task force with leadership from the medical community and information technology professionals. The Department of Homeland Security and Centers for Disease Control should coordinate with medical schools to incorporate more curriculum and periodic exercises on pandemic control and emergency response. Likewise, the Pentagon should develop best practices for establishing communications, sustaining services, and combatting disinformation during a pandemic.
While increased interagency cooperation will encourage more robust pandemic plans, wargaming is key to testing how such plans fare in a biowarfare crisis. Last September, the Naval War College in Newport, Rhode Island, ran a two-day wargame called Urban Outbreak 2019, in which 50 experts combatted a notional pandemic. Even though this scenario had a vaccine available from the start, the findings offer prescient insight into actions surrounding COVID-19 — particularly that experienced leaders may display “significant resistance” when encountering first-time situations or prevent troops from interfacing with infected populations. Military and agency leaders should use wargames with worst-case, extraordinary bioweapons to recognize and overcome inherent biases while simultaneously brainstorming how to lower infection rates, implement quarantines, and communicate best practices to the public.
Wargaming should also help planners identify which materials require stockpiling ahead of the next pandemic. COVID-19, for example, exposed shortages of durable protective masks, hand sanitizer, antiseptic wipes, and surface cleaners. The 300,000 businesses that make up the defense industrial base should prepare for the research, production, and delivery of personal protective equipment whenever shortages arise. They should also expect to be tapped for antibiotic, vaccine, or anti-viral production, depending on the nature of the bioweapon.
“A pandemic is a lot like a forest fire,” Bush said in his 2005 speech. “If caught early it might be extinguished with limited damage.” If deterrence fails, American policy should focus on the early detection and disruption of bioweapons. To achieve this goal, the United States can advocate for increased verification measures and high-performing information operations.
Although the Biological Weapons Convention went into force in 1975 and has 182 state parties, the treaty lacks verification procedures and merely prohibits the production, stockpiling, and transfer of biological agents for warfare purposes. Since the treaty permits defensive research, a major challenge is the dual-use nature of production chains, wherein the technology for allowable projects also supports harmful weapons. Given the complex and sensitive nature of vital biological research, the United States has chosen not to support the establishment of a verification agency for routine facility inspections. This choice stands in contrast to the American approach toward the Organization for the Prohibition of Chemical Weapons and the International Atomic Energy Agency, both of which have robust verification mechanisms. Without this accountability, however, the Soviet Union established the Biopreparat after signing the Biological Weapons Convention treaty, employing over 50,000 people to produce tons of anthrax bacilli, smallpox virus, and multidrug-resistant plague bacteria.
To assist with the early warning of bioweapon threats, the United States should improve its understanding of international biological facilities. For instance, International Gene Synthesis Consortium members use automated software and a common protocol to screen their customers, as well as synthetic gene orders with dangerous sequences from the Regulated Pathogen Database. Particular attention should be paid to biosafety level-4 and biosafety level-3 labs around the world, where human error has led to the unintentional escape of pathogens. The U.K. foot and mouth outbreak of 2007 was traced to a faulty waste disposal system at Pirbright Laboratory in Surrey. Additionally, SARS laboratory accidents occurred in China in 2004. Increasing the priority given to intelligence gathering and analysis related to bioweapons would be an important step in the right direction.
If the United States is unable to deter or disrupt a bioweapons attack, it should be prepared to execute a strong defense against it. First and foremost, the military ought to maintain the health of its servicemembers through a COVID-19-inspired operational plan for screening and quarantine. This plan would facilitate prompt and sustained emergency responses and combat operations, including key missions like strategic nuclear deterrent patrols. Domestically, the military will need to assist in civil support, law enforcement, border patrol, and the defense of critical infrastructure. Internationally, the Defense Department will serve as a logistics powerhouse.
At home, the armed forces have the manpower and experience to aid in a variety of national security sectors. In addition to the deployment of U.S. Navy hospital ships to New York City and Los Angeles during COVID-19, the National Guard has conducted drive-through testing, delivered water to vulnerable populations, and carried out state governors’ law enforcement orders for curfews and quarantines. For critical national infrastructure, the military will serve as first responders to newfound issues with electrical generation, water purification, sanitation, and information technology.
Abroad, the military could benefit from military-to-military planning and exercises with what former Supreme Allied Commander Europe Adm. (ret.) James Stavridis calls “the equivalent of a North Atlantic Treaty Organization against pandemics.” In the absence of this organization, the Air Force can coordinate logistics efforts to move overseas medical supplies to the United States and bring Americans home.
The United States should draw lessons learned from past international pandemic responses. The cholera outbreak among half a million Haitians following a 2010 earthquake demonstrated that the American military could work with international military counterparts to regenerate critical infrastructure in other countries. The Ebola outbreak in West Africa in 2014 extended that cooperation to nongovernmental organizations like the Red Cross, Doctors Without Borders, and Project Hope.
Successful military cooperation abroad will fulfill basic international needs and build trust for peaceful scientific cooperation, shifting the focus to future questions like whether the bioweapon is mutating, how environmental factors affect its spread, if infected people develop short- or long-term immunity, and which mitigation efforts are effective. Successful in-situ defense will fill interdisciplinary gaps in deterrence and disruption while a layered “3D” approach will determine how well the world fares during the most dangerous pandemic yet.
The COVID-19 pandemic foreshadows how a future bioweapons attack would unfold without proper preparation. Planning for a bioweapons attack is incredibly difficult — bioweapons can be delivered by states or terrorist groups, originate from existing agents or from scratch, and can be delivered in a number of different ways. While establishing a permanent military joint task force with appropriate funding is an achievable first step, combined efforts in deterrence, disruption, and defense are key in anticipating these variables of an attack and surviving it once unleashed.
Lt. Andrea Howard is a nuclear submarine officer aboard the USS Ohio. Following her graduation from the U.S. Naval Academy in 2015, she was a Marshall Scholar at the University of Oxford and King’s College London, where she focused on the intersection of technology, security, and diplomacy in weapons of mass destruction policy. Lt. Howard won the U.S. Naval Institute’s 2019 Emerging and Disruptive Technologies Essay Contest and is a member of the Seattle Chapter of the Truman National Security Project.
Image: North Carolina Air National Guard (Photo by Tech. Sgt. Julianne Showalter)