Bioterrorism

Bioterrorism is terrorism by intentional release or dissemination of biological agents; these may be in a naturally occurring or in a human-modified form. The CDC specifically describes the aforementioned as the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. These agents are typically found in nature, but it is possible that they could be changed to increase their ability to cause disease, make them resistant to current medicines, or to increase their ability to be spread into the environment. Biological agents can be spread through the air, through water, or in food. Terrorists may use biological agents because they can be extremely difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, like the smallpox virus, can be spread from person to person while others like anthrax, can not. The CDC has grouped bioterrorism agents into three groups, A, B , and C. Group A pathogens include anthrax and smallpox, an example of B are food supply and water threats, and C threats are pathogens that can be engineered.

The threat of bioterrorism, long ignored and denied, has heightened over the past few years. Recent events in Iraq, Japan, and Russia cast an ominous shadow. Two candidate agents are of special concern: smallpox and anthrax. The magnitude of the problems and the gravity of the scenarios associated with release of these organisms have been vividly portrayed by two epidemics of smallpox in Europe during the 1970s and by an accidental release of aerosolized anthrax from a Russian bioweapons facility in 1979. Efforts in the United States to deal with possible incidents involving bioweapons in the civilian sector have only recently begun and have made only limited progress. A comprehensive review of the problems posed by biological terrorism and warfare has been published. Four observations deserve special note. First, biological terrorism is more likely than ever before and far more threatening than either explosives or chemicals. Second, official actions directed at the threat to the civilian population have been only marginally funded and minimally supported. Third, preventing or countering bioterrorism will be extremely difficult. Recipes for making biological weapons are now available on the Internet, and even groups with modest finances and basic training in biology and engineering could develop, should they wish, an effective weapon at little cost. Fourth, detection or interdiction of those intending to use biological weapons is next to impossible. Thus, the first evidence of such weapons will almost certainly be cases in hospital emergency rooms. Specialists in infectious diseases thus constitute the front line of defense. The rapidity with which they and emergency room personnel reach a proper diagnosis and the speed with which they apply preventive and therapeutic measures could spell the difference between thousands and perhaps tens of thousands of casualties.

For a view of the various costs associated with bioterrorism, one needs to look no further than Los Angeles County hospitals. An urgent survey sent by the county’s Emergency Medical Services Agency to the 81 county hospitals with emergency rooms found that the hospitals could treat only a minute fraction of the county’s 10 million residents during the critical, initial 24-hour period before federal help would be expected to arrive. The 76 hospitals that responded to the survey only have enough antidote on hand to treat 230 severely poisoned victims of a chemical attack, and the capacity to decontaminate just 845 victims per hour, according to an analysis prepared by the county. The hospitals are better prepared to treat victims of a bioterrorist attack, with enough pharmaceutical supplies on hand to give initial doses to 46,000 victims, but then have only 1,252 beds where victims of diseases like anthrax or the plague could be isolated from other patients. The results prompted the Healthcare Association of Southern California, the industry’s regional trade group, to form a task force, at the request of Virginia Hastings, director of the emergency medical services agency. The task force also will try to get a better handle on the costs, but if a preliminary estimate by the American Hospital Association is any measure, getting the hospitals in a post-Sept. 11 state of readiness could cost upwards of $300 million.The national trade group, in a report sent to Congress this month, estimated that it would cost hospitals $11.3 billion nationwide to get them adequately prepared to handle a chemical, biological or nuclear attack. The funding would pay for, among other items, testing labs, protective gear for medical personnel, additional medical supplies and more training. Under a commonly used rule of thumb, that would mean California’s cost would be about $1 billion and L.A. County’s perhaps a third of that, according to industry officials.

President Bush’s fiscal year 2003 budget proposes $4,500 million in new funding to defend the nation against biological terrorism. The new funding will focus on strengthening state and local health systems, building up a national pharmaceutical stockpile, improving the coordination of federal, state and local agencies in the event of a bioterrorist incident, and developing new vaccines, medicines and diagnostic tests through research and development programs. One of the most important missions we have as a Nation is to be prepared for the threat of biological terrorism – the deliberate use of disease as a weapon. An effective biodefense will require a long-term strategy and significant new investment in the U.S. health care system. The President is taking steps now that will significantly improve the Nation’s ability to protect its citizens against the threat of bioterrorism. The President’s Budget for 2003 proposes $5.9 billion to defending against biological terrorism, an increase of $4.5 billion – or 319 percent – from the 2002 level. This new funding will focus on infrastructure, response, and science. By investing money in these areas, the president hopes to combat the threat or in the event of an occurrence be prepared to handle it.

Links

• Bioterrorism (Health Affairs topics page)
• Bioterrorism/Biological Warfare (Hardin MD: University of Iowa)