Conquering the Microscopic Foe

Anthrax, smallpox, plague, Ebola, tularemia--”hard words which stick in the soft Muses’ gullets,” as Lord Byron once said of other, more traditional, weapons. Thinking of diseases as armaments is difficult, but it’s something we have been forced to do lately. And it’s not just the possible threat we’ve had to confront, but also our impotence in its face. “Don’t panic” and “Be alert” are the only pieces of advice officials have offered. But we may be less helpless than we think.

First, we need to consider the threat: What exactly are we facing? Some bioweapons experts insist that there are dozens of diseases that could be used as biological weapons: anthrax, of course; the tropical hemorrhagic fevers, including the dreaded Ebola virus, which causes uncontrollable bleeding from all orifices; pneumonic plague, the same bacterium that caused the Black Death; tularemia, also known as rabbit fever, a debilitating and sometimes lethal infection that can attack numerous organs and cause hemorrhagic inflammation of the airways; botulin toxin, one of the most poisonous substances known, which causes paralysis and, often, death; Venezuelan equine encephalitis or eastern equine encephalitis, incapacitating viruses that cause brain inflammation and for which there is no treatment; brucellosis, glanders and Q fever, serious and sometimes lethal bacterial infections; smallpox, the deadly, wildly contagious virus that’s the most feared agent of all. And that’s the short list. Ken Alibek, former deputy director of Biopreparat, the Soviet bioweaponry apparatus, lists more than 50 agents that could be turned into weapons.

But there’s more--or less--to this litany than you might think. Not all bioweapons agents are created equal. Each has certain advantages, from a bioweaponeer’s standpoint, and each certain drawbacks. Each requires a kind of calculus, a cost-benefit analysis on the part of those who would like to use them. Bioterrorists would have to consider how to get the strains, how to grow them, process them, distribute them. Contagiousness is another important factor. A contagious disease does the work for you: It spreads by itself, using its victims as delivery vehicles. But contagious diseases can spread quickly and randomly, and epidemics, as we’ve seen throughout history, are no respecters of national or religious boundaries. A terrorist may himself be willing to die--but would he risk killing his mother, his sister, his daughter, his son?

Still, a vial of smallpox might be irresistible to a terrorist, a sort of Unholy Grail. The disease is untreatable (though there are new anti-viral drugs that would certainly be tried in the event of an outbreak); it’s quite durable in the external environment; it’s extremely contagious. As Sergei Popov, a former Soviet bioweaponeer who now works on biodefense at Advanced Biosystems, Inc., in Manassas, Va., puts it, people who have inhalation anthrax just die or get very sick. “But smallpox is more than just unpleasant; it’s chilling. It’s a really frightening disease.” The sight of victims completely covered with hard, blackening pustules would terrify anyone.

The drawback of smallpox, for the terrorist, is that it is so hard to obtain. There are only two legal stocks of the virus, one at the Centers for Disease Control and Prevention in Atlanta, the other at the Vector Laboratories in Siberia. Intelligence reports indicate that North Korea also has the virus, possibly attained from Soviet sources; weaponized stocks of smallpox were also held at two or three locations in the Soviet Union. Persistent rumor, but no proof, suggests that the virus is in Iraqi hands. Do the Al Qaeda terrorists have access to it? No one knows.

Anthrax is another almost ideal weapon. As we have seen, turning it into a sophisticated weapon is well within terrorist capabilities. The two drawbacks to anthrax are that it cannot be spread from person to person, and, in its natural state, it’s vulnerable to antibiotics. The technology exists to create antibiotic-resistant strains, but getting a functional weapon out of engineered strains is much more difficult, says Raymond Zilinskas, a biodefense expert from California’s Monterey Institute of International Studies. When you introduce something new into a germ, all sorts of unwanted effects crop up, including that the engineered anthrax may lose its ability to kill. It takes time, and a lot of processing, to overcome these effects.

But the problems of smallpox and anthrax seem trivial when compared with the drawbacks of other agents. Plague is a deadly, terrifying disease, and extremely contagious when spread from lung to lung, but it’s extremely difficult to turn into a weapon. Plague quickly loses its virulence when grown in large quantities, which is why the U.S. lost interest in it during its experiments in bioweaponry. Even if terrorists overcame this hurdle, they’d still have to be able to disperse plague, which would quickly die on any surface and is extremely vulnerable to ultraviolet light. Plague was the deadliest bacterial weapon in the Soviet arsenal, but terrorists are not Soviet scientists and can’t be expected to master the significant complexities of this agent.

Tularemia, or rabbit fever, is easy to grow and spray into the air, and it only takes a few germs to make people sick, but it’s not contagious, not terribly lethal and it can easily infect anyone who’s working with it. It also can be treated with antibiotics.

Moving down the list, there is botulin toxin, which comes from the naturally occurring bacterium that causes botulism. Of this agent, former U.S. army bioweaponeer William Patrick III says, “I really hope bioterrorists work with this one.” It’s a deadly disease, but almost useless as an aerosol; swiftly weakened in water (“dilution is the solution” says Patrick.) You could spray it on food in a salad bar, perhaps, but this would hardly slaughter millions.

Next come the more exotic agents of brucellosis, a cow disease, glanders and Q fever. But these are not terribly lethal, they aren’t contagious and they are all treatable. There are also incapacitating viruses such as Venezuelan equine encephalitis and eastern equine encephalitis. These are not treatable, but they also don’t spread and aren’t very dangerous.

After that, the list drops off even further: Where would a terrorist get Ebola or any other hemorrhagic fever? You need high-containment laboratories and protective suits to handle them, or you’d have a lot of dead terrorists and not much else. And the viruses are too fragile to be easily spread unless someone were washing the bodies of the dead or practically bathing in infected blood. Cholera? Not transmissible by air and easily destroyed by chlorination. Shigella? Same story, and it’s even less lethal.

Apparently recognizing the limitations of most agents, the Journal of the American Medical Assn. in 1999 published five “consensus statements” developed by its Working Group on Civilian Biodefense, a group of 23 experts from government, academic and private biodefense institutions. These five agents are anthrax, plague, smallpox, tularemia and botulin. Since there are significant reasons to discount plague, botulin, and tularemia, at least for the present, that leaves us with anthrax and smallpox.

If we want to take biological weapons out of bioterrorist hands--at least for the present--we will soon have the means to do it. Voluntary vaccinations against smallpox and anthrax will radically diminish the threat of bioweapons altogether. The significant drawbacks to other agents make them less desirable as weapons; the risks of vaccine-resistant anthrax and smallpox, which are very real when we are thinking about the former Soviet program, are vanishingly small in the hands of terrorists, and probably even for a rogue state like Iraq. The government now plans to stockpile enough smallpox vaccine for everyone in the nation; anthrax vaccine will be available to those deemed “at high risk.”

But isn’t everybody at high risk? We don’t know what delivery systems terrorists could use next; we only know that high-grade weaponized anthrax is in someone’s hands. Smallpox could be next.

We would be well-advised to plan ahead rather than wait until the next outbreak happens.