THE THREAT OF BIOLOGICAL AND CHEMICAL WARFARE

MICHAEL FRANZBLAU, M.D.

Is the United States really prepared?

The attacks by unknown perpetrators using anthrax in 2001, and ricin in 2003, constituted a reality check on the threat of biological and chemical warfare today. In the 20th century, certain countries began experimenting with chemical and biological agents, providing the first hints of their horrifying potential in warfare. In the 21st century, however, it is rogue nations and terrorist organizations that prompt the United States to take new measures to prevent attacks by these entities using chemical and biological agents. Yet, despite all the plans and preparations, is America in fact ready? Is it truly prepared to thwart the terrorist attempts, or, if unsuccessful, to respond effectively?

During World War I, both the Allies and the Germans used phosgene and mustard gas as offensive weapons. In addition, the Germans created a plan to taint blankets with glanders, a highly contagious and destructive bacterial disease, and transport them to the United States to infect our livestock. They hoped to create economic havoc, and also to infect people handling the livestock. Though the glanders plan never was implemented, the horrific phosgene and mustard gas casualties prompted an outcry against these weapons. In 1925, the League of Nations issued the Geneva Protocol outlawing the use of chemical and biological agents in warfare forever. Most of the nations of the world became signatories to the treaty, but, with no effective enforcement mechanism, compliance was based on the “honor system.”

Some nations continued clandestine research on chemical and biological weapons. During the 1920s and 1930s, the Imperial Japanese Army General Staff began to develop chemical and biological agents to use in the event of a Soviet attack, thereby hoping to neutralize the Soviet Union’s overwhelming superiority in the size of its armies. The research program was enthusiastically supported by Emperor Hirohito, and resulted in a secret but effective program to use mustard gas, as well as weaponized pathogens, including anthrax, plague, glanders, cholera, and typhoid fever, as offensive weapons of war. The Japanese biological and chemical warfare program was not discovered by the rest of the world until 1943. By that time, these weapons already had been used against Soviet and Chinese soldiers, prisoners of war, and civilians in countries invaded by the Japanese. There were hundreds of thousands of victims, including 10,000 Japanese soldiers who reportedly died from cholera and typhoid fever in 1942, unaware that their own water supply had been infected by the Japanese authorities with the pathogens responsible for those diseases.

Later, throughout the Cold War, both the United States and the Soviet Union developed substantial stockpiles of chemical and biological weapons. In 1972, at the initiation of President Nixon, the Biological Weapons Convention was crafted. All signatories to this document declared their intention to refrain from developing, producing, stockpiling, or acquiring biological agents or toxins. Over 100 nations are signatories, though there is no effective enforcement mechanism. By 1997, 164 nations had signed the Chemical Weapons Convention, which bans the development, production, stockpiling, transfer, and use of toxic chemical agents, including mustard and nerve gas.

For both chemical and biological weapons, however, there are lingering treaty compliance and enforcement issues, even among signatory nations. And there is no guarantee that global monitoring efforts will eliminate the possibility that non-signatories to these treaties, including terrorist organizations, are developing known or entirely new forms of chemical and biological weapons.

THE THREAT TODAY

Today, the threat of biological and or chemical agents as instruments of terror by rogue nations or terrorist groups brings home the need for greater vigilance in the United States.At the federal, state, county, and city levels, significant efforts are being made to mobilize and coordinate responsibilities among the various agencies working to protect our nation. Increased resources are being spent to upgrade communications networks and public health laboratories and facilities to ensure accurate and rapid identification of dangerous biological and chemical agents. The Atlanta-based Centers for Disease Control and Prevention (CDC) has created an emergency response team composed of physicians, microbiologists, epidemiologists, and other technical experts ready to fly to any part of the nation to help identify pathogens and provide assistance if there is a suspicion of an attack.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires all US health care facilities to have contingency plans in place to deal with potential catastrophes, including biological and chemical attacks. There is continuous in-service training for all public health laboratory personnel, as well as ongoing seminars for health care professionals. Lectures and posters indicating the most effective way to deal with potential biological or chemical attacks are found in emergency rooms of acute care general hospitals. Drills for readiness are mandated at regular intervals in all hospitals in most jurisdictions.

We are prepared... at least on paper.At the state, county, and city levels, drills are held to determine the efficacy of the contingency plans for biological and chemical attacks. In many locations, citizens are encouraged to participate in the emergency preparedness drills and first aid training. There also is a strategic allocation system to ensure medical equipment and appropriate antibiotics are in place all over the United States. Public and private health care facilities, including clinics and hospitals, regularly receive information from the state and federal agencies to enhance their readiness to deal with potential threats, and are asked to report suspicious events, such as the appearance of unusual illnesses, a cluster of illnesses in previously healthy people, or an outbreak of disease at the wrong time of year (flu in the middle of summer, for example).

All the plans, and all the drills, however, may have little bearing on whether the United States is, or will be, suf- ficiently prepared.We have reason to be concerned if the recent flu vaccine shortages are any measure of careful planning for unforeseen contingencies.

It is my view, that despite these preparations, we unfortunately still are vulnerable to attack by those who would seek to harm us using chemical or biological weapons. The attacks of 9/11 showed how quickly telecommunications and transportation systems were crippled in the vicinity of the New York and Virginia targets. In a mass attack scenario, will US health care personnel be able to communicate readily with the CDC, and with each other? Nobody can say for sure that medical personnel will be able to report to their assigned stations, especially if urban road networks are gridlocked by people fleeing from the city centers. What treatment plans are in place for people who remain in their homes, schools, offices, or nursing homes? Will the necessary treatments be available to those who show up in the emergency rooms, assuming they can get there in the first place? The CDC website lists no fewer than 41 known bioterrorism agents or diseases, making any successful plans relying on nationwide stockpiles of medicines and antidotes rather questionable.

These very areas of vulnerability are why biological and chemical weapons are attractive to terrorist groups and rogue nations. These weapons can be relatively cheap to manufacture, and easy to hide, transport, and disperse. Despite the highest security levels and the ongoing vigilance of government anti-terrorist and lawenforcement personnel, America remains inescapably vulnerable to biological or chemical attacks. Yes, Americans need to make sure their routine immunizations are up to date, and they need to participate in emergency drills. But local and regional citizen groups also must be prepared to protect themselves with fallback plans, and must insist on being effectively informed regarding official anti-bioterrorism response policies and planning, and participating in the development of these plans.

Michael Franzblau, M.D., (CC ’01) is clinical professor of dermatology at the University of California, San Francisco.

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