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Are Our Defences Against Bioterrorism Adequate?
Prof. C Kameswara Rao
Bioterrorism: Bioterrorism employs biological weapons to inflict damage on human populations, livestock and the environment.   It is largely a matter of microbiology, principally involving the use of micro-organisms and/or their toxins.  

Determined bioterrorists with support from like-minded people with basic capabilities in handling micro-organisms can easily get into the production of biological arsenal by accessing into an enormous range of infectious agents and toxins.     When the terrorist groups are technically and/or financially supported by regimes of rogue states, the potential to cause damage immensely increases.   In every part of the world, civilian populations are highly susceptible to bioterrorism, to some degree or the other.

Perception of risk:  The state of perception of risk is an important aspect.   Developed countries are more conscious of anthrax, botulism, pneumonic plague, tularaemia and smallpox.   A lot of information has been pouring into websites on these diseases, their potential risks and the precautions to be taken, in the unfortunate event.    However, there is not much concern about the diarrhoeal diseases caused by several viruses and bacteria, which can be used as bioweapons.   The website of Medscape and even the official US website of the Centres for Disease Control and Prevention, do not contain any information on diarrhoeal diseases, which can cause immense damage in the developing countries, more particularly among the poorer sections of the population.   Poverty, ignorance, high population density and low levels of hygiene in the developing countries, coupled with incompetence and apathy on the part of public and medical authorities, make such diseases as cholera, pneumonic plague, tularaemia, smallpox, haemorrhagic viral infections and other contagious diseases, effective weapons in the arsenal of a bioterrorist targeting the developing countries.    

Extensive economic damage can be inflicted through the introduction of animal and plant diseases or pests into the livestock and crops.  

Introduced exotic plant species can become gregarious weeds and disturb the balance of the
composition of natural vegetation.   A recent such example is Parthenium hysterophorus that has been dominant for three decades in India.   Another example is Chromolaena odorata, which colonises gregariously, the moment a patch of forest becomes open, in the Western Ghats.   However, the impact of weeds is slow and can be contained, particularly when detected early.    It is also possible to discover an economic use for such species to convert the situation to advantage.

Dual potential of biotechnology: Biotechnology is a potential means to combat the danger of bioterrorism, through the production of diagnostics, drugs and vaccines against bioweapons and/or their source organisms.   Nevertheless, it can also be a source of bioweapons.   Weaponised agents produced through biotechnological means, not yet realised, are a long-term possibility.   New pathogenic organisms can be created using genetic tools that are programmed to trigger replication or toxin production in response to an environmental chemical, such as an antibiotic in drinking water.   The research that is now trying to understand what makes an organism pathogenic is aimed at designing more efficient drugs.   Such knowledge can also be used to create pathogenicity in hitherto non-pathogenic organisms or to increase the existing pathogenic potential of an organism, posing enhanced threats, from bioterrorism.     Nevertheless, research into these aspects should be adequately funded, in spite of the risks involved, for the outweighing advantages.

Race between the pathogen and the pathologist:  An unfortunate situation is that biological defences through vaccines and drugs, will in the course of time, be defeated by an inherent biological factor.   The efficacy of a drug against an organism is short lived, as pathogens acquire resistance, sooner or later, against the once effective drug.   Recurrence of malaria and tuberculosis, thought to have been contained, is the case in point.   There are very serious fears of recurrence of smallpox, believed to have been eliminated over two decades ago.   No amount of technical advancement will provide defence against the compelling evolutionary component of acquired resistance.   It is an eternal race between the pathogen and the pathologist, the former being a little ahead of the latter, most of the time.

Measures to control production of bioweapons:  In an Editorial in Nature Biotechnology (19:993, November 2001), three approaches were suggested to control the production of bioweapons: 

1. Deterrence:  The Biological and Toxin Weapon Convention (BTWC) is in obscurity.   Resurrecting the BTWC and persuading more nations to sign in will facilitate inspection by UN Inspectors, of sites and facilities suspected to be involved in the production of biological weapons.   It was the UN Inspectors who stumbled upon the tell tale signs of production of biological weapons in Iraq.   UN can ensure compliance of member countries with their obligations to the BTWC, under the Verification Regime.   Such inspections facilitate stopping errant countries before they go too far.   The counties that refuse to sign into the BTWC should be subjected to extreme and frequent scrutiny, under the other powers of the UN.   

2. Restricting accessibility: 
Currently, it is not difficult to obtain, or to redistribute, strains of pathogenic bacteria and viruses from the repositories, under pretences of research and drug development.   Accessibility to, and security of, biological material that can be employed in bioterrorism should be tightened.   Recipients of such material should be prohibited from redistributing it to unauthorised third parties.   Though easier said than done, this is a very important preventive measure and will also help in fixing responsibilities.

3.  Regulation of technology transfer: Transfer of dual-purpose technologies (those that can be used in developing protective measures against the disease and also as bioweapons) should be under strict watch.   Transfer of such technology to suspect groups and/or regimes, as well as a subsequent deployment to unauthorised parties, should be prohibited.   Iran is believed to have obtained recombinant technology from Cuba.   Companies in the US, Europe and the erstwhile USSR are supposed to have provided materials used by Iraq for her biowarfare programme.  

Preparedness to face bioterrorism:  In no part of the world, the public health and medical authorities are adequately geared up to detect and respond to biological hazards, natural or inflicted by bioterrorists.   Almost all the developing countries are virtually totally unprepared against bioterrorism.   There is a lack of scientific awareness, preparedness and funding.   Stocks of antibiotics and vaccines against known pathogens that are essentially needed are inadequate to meet with even the periodical natural high incidence, let alone in the event of a bioterrorist attack.    The situation is worse in the developing countries.   The havoc caused by the plague epidemic that caught everyone napping, in Surat in India a few years ago, is a recent example.  

The degree of damage an organism or a toxin can inflict varies widely and this also depends upon the socio-economic status of the country or sections of her vulnerable population.    Although anthrax is much in the news currently, it is a poor biological weapon and can cause only a localised damage, as it is primarily not a prevalent human disease and it is not contagious.   Diseases that spread through food and water (or by human contact) cause a far greater damage among the poorer sections of the population of any country.

Some aspects of preparedness against bioterrorism are similar to those needed to face natural disasters like cyclones, floods and earthquakes, as epidemics often follow such disasters.   We should act in advance and not after the disaster strikes, as we usually do.   Some urgent measures in this regard are:
1.  Public awareness: It is reasonable to expect that the bioterrorist would choose a particular disease for use in a particular country, and may even target a particular segment of the population of that country.   For example, a human pathogen can be transmitted through susceptible or carrier bovine hosts to affect beef eaters.    People can be affected by the New Variant of Creutzfeldt-Jacob’s Disease (nvCJD), a prion disease, on consumption of food contaminated with the mad cow disease (Bovine Spongiform Encephalopathy).     Public health and medical authorities should identify the probable diseases and the means of their spread, and make the public aware of these possibilities.   Public should also be made aware of the precautionary measures to be taken and the methods of management of the diseases, when they appear.   Facts about different diseases of bioterrorist import should be publicised, the way Centres for Disease Control and Prevention in US do.   All this is not a small task in countries with large illiterate populations but an infrastructure to achieve this must be built up, without loss of time.

2.   Research and Development: We need adequate number of well equipped labs with facilities for microbiologists to develop quick and certain means to identify the pathogen and the disease, for biochemists to develop diagnostic kits, for pharmacologists to develop drugs and for immunologists to produce vaccines.     In every country there is some activity of this nature but it is not adequate.

3.  Stockpiling vaccines and drugs: We need very large stocks of vaccines and drugs for different diseases in times of disaster.   Authorities should identify the vaccines and drugs that would be required to meet the eventuality and advice the manufacturing units to produce the required quantities.   Care should be taken that the drug manufacturers do not exploit the situation by hiking the prices, as seems to have happened with anti-anthrax drugs recently.

4.   Contingency plan of action: Authorities should draw contingency plans of action, separately for each vulnerable area, to meet with the situation when it develops, and identify the hospitals, health care units, doctors and para-medical personnel and prepare them to face the situation.

Problems of logistics:  There are practical difficulties.   Stockpiling antibiotics and other drugs, against all the potential weapons of bioterrorism, in quantities adequate to protect the susceptible human populations and livestock, is an unimaginably immense and nearly impossible task, not to speak of the expenditure involved, even in the developed countries.   ‘How much and of what?’ is a question that cannot be answered with confidence.

Biodefence research and preparedness:  In our efforts of building defences against bioterrorism we can never anticipate all possibilities.   It would be naïve to think that any amount of investment in biodefence research will protect us in the long term against bioterrorism, which is almost always a random act of calculated savagery, often from a hidden insidious enemy, as is the case with any form of terrorism.  

Preparedness, more so advertised preparedness, minimises the risks, particularly because a bioterrorist attack is futile in the face of defence.   It is extremely unlikely that anthrax would be used in US again.

Biodefence research must continue both to provide improved drugs and protective measures to deal with normal illness, as well as to prepare us to face a bioterrorist attack.   One may argue that we should expect the unexpected, but that is not always possible, and certainly not all the time, and not forever.   We should not forget that the degree of success of a terrorist attack lies in the element of surprise, in terms of the place, manner and the time of the attack.    Almost certainly, there will be no bioterrorist attack where and when we are prepared.

Potential role of indigenous systems of medicine:  In countries like India and China, the indigenous systems of medicine have a number of plant based drugs effective against several infectious diseases that can be a means of bioterrorism.   For many there are clinical data in support of their efficacy.   A lot of damage can be contained if the probable diseases are identified and the precautionary and remedial measures from the indigenous systems of medicine are publicised.   For example, the yellow sheets in the pomegranate fruit (other than the outer leathery covering and the seeds) contain a principle that is effective against a broad range of gastrointestinal pathogens, including the cholera bacterium.   Dried and powdered, this material is traditionally administered in buttermilk or even water, to control diarrhoeal infections.   Oral rehydration solution that saves the lives of millions of children suffering from diarrhoea can also prevent dehydration in adults.   Countries that cannot afford modern approaches, in terms of the expertise, infrastructure, time and money involved, better find solution to the problem, from within the local tradition.  

The models of research and defence measures of the advanced countries cannot be directly imported into the developing countries, as the strains of pathogens, their severity, the susceptibility of the populations to a particular disease, and the affordability of the costs involved, are all different.    In the efforts of each country to develop her own defences, indigenous systems of medicine come in here very handy.

The advantages of indigenous systems are accessibility, economic viability and reasonable effectiveness, in terms of both prevention and management of infectious diseases, with a local import.

Should biodefence preparedness be public knowledge?

A question that is raised often is, ‘whether it is wise to make the biodefence strategy and state of preparedness public knowledge?’   It is felt that the bioterrorist also gets to know of the detailed plans and defences built up and would act bypassing them.   There are at least three considerations in favour of transparency.   Firstly, biodefence is aimed at facing a bioterrorist attack, but preventing this is the better choice.   Well-advertised preparedness against the best arsenal of a bioterrorist would be a deterrent.  We are fighting bioterrorism and not the bioterrorist. Secondly, if the public come to know of what the governments and other agencies have been doing for their safety, their confidence in our public institutions, which is a very important psychological factor, would grow.   Thirdly, awareness of the governmental efforts may inspire private organisations and individuals to add their own bit to the national effort.   Upon these considerations, it is not wise to keep biodefence strategy under the warp, on the grounds that military strategy, which is an entirely different issue, is a closely guarded secret.