Strategies to Counter Bioterrorism

Introduction

There is a shared global concern that biological warfare (BW) or bioterror can be initiated in a deliberate use of microbes and toxins aimed at killing or incapacitating people, livestock and crops. These types of weapons of mass destruction (WMD) target only living beings without destroying infrastructure compared to the traditional warfare agents. The three basic groups of BW agents that would likely be used as weapons are bacteria, viruses and toxins. In addition, ‘designer’ BW agent may be created that can specifically target particular human races, and cause confusing symptoms or resistant to antidotes/vaccines. Technologies presently under development across multiple disciplines of biological sciences will lead to a departure from the traditional model of BW to agents capable of advanced biological warfare (ABW).

There are chances that unprotected BW agents get into the hands of terrorists. Many of BW agents like viruses degrade quickly when exposed to environmental factors, while others such as anthrax spores have a long life cycle. BW agents can be dispersed indirectly; by spraying them into air, by infecting animals that can infect humans and by contaminating food and water resources. Therefore, inhalation, contact as well as consumption of contaminated product can spread BW agents. Subsequently, unlike an explosion or chemical attack, a biological attack may not be immediately recognized. It is most likely that there will be a large number of people seeking emergency medical attention or the local healthcare workers will see a pattern of an unusual illness. Government will have to plan an effective public announcement system not only to share necessary information but also to avoid panic to deal with such eventuality.

High priority BW agents:

Biological select agents and toxins (BSATS) are a severe threat to public and animal health and to plant and plant products. Centres for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) USA and other national and international organizations including the National Disaster Management Authority (NDMA) and the Biological and Toxin Weapon Convention (BWC) have identified these as the highest priority threat agents and diseases for medical countermeasure development and acquisition. According to the CDC, these agents are classified in three different categories, based on criteria like ease of dissemination and transmission, stability on storage at environmental conditions, rate of mortality, ease of production and on availability of antidotes and vaccines. Highest priority agents and diseases include anthrax, clostridium botulinum toxins, plague, smallpox, tularaemia, and viral haemorrhagic fevers.

Strategies to be adopted during biological warfare attack

The chemical, biological, radiological and nuclear (CBRN) terrorism has been widely discussed but insufficient attention has been given to formulating counter-policies. It is the need of the hour to frame strategy and policy to take preventive actions and to mitigate any bioterrorist attacks.

The evidence of an attack is the appearance of the symptoms of the disease caused by the exposure of an agent or informed by reliable sources. In case of a biological attack, health care officials may not immediately be able to provide detailed information to the people, since identification tends to take fair amount of time. However, mass media like TV, radio, community’s warning systems and internet can be used to spread awareness on signs and symptoms, contagiousness, medication, vaccination, disaster management plans and availability of the medical camps.

Following guidelines should be followed during a biological warfare attack:

1. If you know about an unusual and suspicious substance, quickly get away and inform officials regarding the same.
2. Wear a face mask to reduce the spread of germs to others if you are sick and to avoid contact with contagious germs if people around you are infected.
3. If any individual is exposed to a biological warfare agent, remove the clothes and personal items and follow official instructions to dispose contaminated items. Wash with soap and warm water.
4. Contact authorities; seek medical help, if advised stay away from others.
5. If symptoms match those described in the news and then it must be considered as risk and immediate medical attention is required.
6. If infection is contagious, it may be advised to stay away from others or even deliberately quarantined.
7. In a declared biological warfare attack/emergency leading to epidemic, it is advised to stay away from crowd where others may be infected.
8. The medical services for a biological attack need to be equipped and handled differently to respond to increased demand.

Biodefence

At the national level, there must be the guidelines to follow in a case of a bioterror attack: a) there must stringent legal defence strategy against bioterrorism; b) framing, enforcement and education programs are key strategy for defence against bioterrorism; c) there should be a biological weapon agents repository and epidemiological surveillance systems; d) there should be inter-institutional anti-bioterrorism national agency that should provide medical assistance and sample collection in case of bioterror attack; e) there must be a national laboratory for biological material analysis for the timely detection of agents of bioterrorist incidents; and f) bio-threat against animals and plants must be addressed.

International level action must be based on the BWC. At international level: a) there must be full international cooperation on this BW problem; b) stringent monitoring of potential producers and users of BW agents must be undertaken and shared with member countries; c) improvements in technology must be shared globally; d) promote stockpiling of BW fighting supplies; and e) educate and create awareness in population at large.

Bio-surveillance

The responsible agencies must prioritize development of bio-surveillance technologies to identify impending attacks. The sooner the officials identify an attack or agent, easier it will be to ensure adequate time frame for treatment and prevention. The administration must emphasize on placement of different detection approaches, including environmental detection techniques and information sharing. Implementing these would help in identifying bioterror attack and in restricting its spread. Public health laboratories must be enabled to correctly detect and analyse clinical and environmental samples.

Microbial forensics

Microbial forensics is a discipline dedicated for the analysis of samples from bio-crime, bioterror or deliberate use of microorganisms or toxin that serves as evidence. This will help law enforcement agencies to identify the source and agents of BW. Strong microbial forensics might discourage at least some terrorists.

To combat with the covert or intentional BW agent attack, following responses are required;

1. Proper collection of samples at the site, triple packaging is advised.
2. Analysis and detection system.
3. Decontamination of patient and environment.
4. Arrangements to handle large number of cadavers for post-mortem and cremation.
5. Implementation of biosafety and biosecurity guidelines in the institutes dealing with potential agents that can be used as agent of bioterror.
6. Resources should be allocated for evaluating and assessments of bioterror threats.
7. Funds must be allocated to develop technologies of future for environmental and medical detection, prophylactics and therapeutics.
8. A fully validated database of all potential BW agents and toxins should be created that will help in microbial forensics.

Conclusion

Adequate research and analyses of vulnerability to chemical, biological and nuclear threats and nuanced public health policies are the ways to combat future BW incidents. This is possible only if there is adequate budget backed by a robust crisis management strategy based on an efficient public health infrastructure. Modern technological advancements allows timely identification of multiple infectious/toxin agents by molecular analysis and should be widely available in reference laboratories. What type of biodefence research should be classified is a strategic decision and there should be some legal mechanism to restrict advanced biological research. Measures recommended here will help in framing guidelines and for managing and preventing potential bioterrorist threats.

Note: Thoughts presents here are author’s own and does not reflect as that of the organization he represents.