Global Question of Bioterrorism

You wake up early for work and kill your family goodbye. On your daily transit you see a man drop a glass vial in the subway, but you think nothing of it. Moments later you become a statistic. A statistic of Bioterrorism. The threat of Bioterrorism, long ignored and denied, has heightened over the past years and needs to be publicly addressed. Today's biggest hazards are anthrax and smallpox, yet people are left uncertain at what should be done while the government goes undercover to solve the problem as the media is left to give its own over exaggerated version of everything opinions on things.

Although terrorists could use many disease-causing agents, experts on biological warfare regard anthrax and smallpox as the two biggest hazards. Other infectious diseases that pose a threat include plague, tularemia, botulism and tuberculosis. However, experts believe these organisms and diseases are unlikely to cause widespread illness because they're difficult to manufacture and distribute. These organisms are also less hardy than anthrax is.

Anthrax is caused by Bacillus anthracis and its spores. Anthrax can infect people in three different ways. Cutaneous anthrax develops when the bacteria enter your body through superficial cuts or wounds on your skin. The vast majority of anthrax infections are cutaneous. Intestinal anthrax results from eating food contaminated with the anthrax bacteria. Inhalational anthrax occurs when you breathe the anthrax bacterial spores into your lungs. This form of anthrax is usually fatal.

The death rate for anthrax from inhaled sources is very high, approaching 100 percent. Death rates are lower for anthrax that enters your body through food or a wound. Anthrax is not transmitted from person to person, the way a cold or influenza is passed, therefore, it cannot spread in large populations. However, microbiologists consider anthrax a serious hazard because its bacteria are suitable as a weapon. Anthrax is easy to produce, and it's readily available around the world. The spores don't require special handling procedures, so terrorists could take anthrax to many points for distribution. It could be used to take out specific people or locations. Unlike many disease-causing bacteria, spores can survive severe heat and cold.

Doctors have no experience treating anthrax on the scale of a biological attack, so it's difficult to predict exactly what might happen. Treatment of anthrax with antibiotics such as Cipro may be successful if anthrax is identified as the cause of disease and people who were exposed receive treatment quickly.

Anthrax is only one of our main concerns. Another hazard is smallpox. Smallpox, an infectious disease caused by the variola virus, was eradicated from the world in 1977. Three years later, the World Health Assembly recommended an end to routine vaccination, and most countries complied. Smallpox is passed from person to person when infected people sneeze, spraying fine droplets of the virus into the air, or through direct contact such as kissing. Infected people can transmit the disease after developing a rash, but high fever and fatigue often send them to bed first. Because a virus causes smallpox, antibiotics won't treat the infection. At this time, no other drugs are known to treat smallpox. However, some initial results from laboratory studies show promise for the drug cidofovir in fighting the smallpox virus. If you're exposed to the smallpox virus, vaccination within three days of exposure may prevent the onset of the disease. Vaccination within one week of exposure to the virus may help lessen the severity of the disease.

Unlike anthrax, the smallpox virus is generally considered a "worst-case" bioterrorist threat agent because it is infectious through the air, kills about a third of its victims, and is contagious from person to person. But terrorists would have a hard time obtaining the virus because smallpox was eradicated from the human population by means of a global vaccination campaign during the 1960s and '70s, and the last reported case in the world was in 1978. Samples of the smallpox virus currently exist only in a few laboratories. Nevertheless, in addition to two secure repositories of the virus located in the United States and Russia, circumstantial evidence suggests that undeclared stocks of smallpox virus may exist in countries of concern such as Iraq and North Korea.

If terrorists were to get their hands on the virus, they would have to cultivate it and then find some means of dissemination. The simplest method would be for suicide terrorists to infect themselves with the virus and spread it in crowds, but even terrorists willing to die instantly in a blaze of glory might think twice about suffering the torments and disfigurement of smallpox. Other delivery methods would be technically challenging. Still, although the risk of a terrorist attack with smallpox is low, it is not zero, and the disastrous consequences of an uncontrolled epidemic mean that the U.S. government must err on the side of caution.

At present, the federal government is taking two steps to reduce the nation's vulnerability to smallpox: testing to determine if the roughly 7.5 million doses of smallpox vaccine currently available could be diluted safely to provide as many as 75 million doses, and accelerating production of 40 million additional doses of the vaccine so that they are available by the end of next year. Even if a large amount of smallpox vaccine were available today, however, it would not be desirable to vaccinate the general population prophylactically because of the risk of serious complications, particularly in people who are HIV-positive or have some other form of immune-system impairment.

Because of the risk, most Americans alive today were never vaccinated against smallpox or no longer have effective immunity. Until 1971, it was mandatory for U.S. children to be vaccinated before school entry, even though the last case of smallpox in the United States was in 1949. After 1971, however, the government halted routine vaccination, having assessed that the risk that smallpox could be imported into the United States from a country where it was still endemic was lower than the risk of side effects associated with smallpox vaccine, which caused occasional deaths or serious complications in people with immune-system impairments, eczema, and even in a few healthy people. Moreover, a single smallpox vaccination did not provide life-long protection; instead, the level of immunity diminished gradually over a period of about ten years unless it was "boosted" by a second vaccination, which provided much longer-lasting protection. Thus, Americans who were vaccinated only once as children, or who were never vaccinated, are susceptible to infection if the disease were ever to reappear.

Vaccination can prevent smallpox if administered up to four days after exposure but before the appearance of symptoms, but no drug treatment is available once fever and skin rash develop. Even without treatment, however, victims of smallpox would have a two-in-three chance of surviving the disease.

Although the United States is not entirely unprepared for bioterrorism, we are -- in the words of Senator Bill Frist -- "underprepared" Federal agencies such as the Centers for Disease Control have great depth of expertise on bioterrorism threats, and large amounts of antibiotics and other therapeutic drugs have been stockpiled, but a number of serious gaps remain in the nation's defenses. The main weakness is at the level of state and local health departments, which would provide the first line of defense against a bioterrorist attack by detecting an unusual outbreak of disease early on, while it is still treatable or readily containable.

To fill these gaps, it will be essential to: (1) train doctors and nurse-practitioners so that they can recognize unusual diseases such as anthrax, plague, and smallpox, which they would not normally encounter in their medical practice; (2) improve staffing and communications at city, county, and state health departments so that physicians can report suspicious cases by phone or e-mail on a 24/7 basis; (3) increase the number of clinical laboratories around the country capable of diagnosing bioterrorist threat agents; and (4) help hospitals to develop emergency-response plans for dealing with a range of attack scenarios.

Fortunately, Congress appears to have recognized the urgency of the bioterrorism threat in the wake of the recent attacks, and a substantial increase in funding to strengthen the U.S. public-health system now appears likely.

There is considerable room for improvement. The federal government needs to develop a coherent strategy for informing the public about the threat of bioterrorism without spreading panic or spawning false rumors. Thus far, various federal agencies have provided conflicting information or have made vague statements that have fostered unhelpful speculation. More generally, the government has failed to reassure the public by putting the threat of bioterrorism into perspective compared with other risks of daily life. Despite all the anxiety, the average American is probably at greater risk of death or injury from driving on the highway than from exposure to anthrax.

Americans also need to take care of themselves. Besides urging members of Congress to increase spending on disease surveillance and other public-health measures for combating bioterrorism, Americans should remain vigilant and inform the police of any suspicious activities they might observe, such as someone spraying a fine mist from a building, a vehicle, or in an enclosed space such as a subway station.

Americans also need to stop and look at the facts. The level of public anxiety about anthrax appears to be disproportionate to the current threat. To date, the various anthrax incidents around the country have produced one fatal case of inhalation anthrax, by far the most deadly form of the disease, and one or two cases of cutaneous skin anthrax, which is eminently treatable if recognized within a reasonable amount of time. All the other incidents have involved either exposure to anthrax spores in doses too low to cause infection, or hoaxes involving harmless powders.

If only we would stop overreacting and calmly look at the overall picture, we can see that the media is causing even the smallest biological warfare seem like the end of the world. The chances of getting killed in a car accident are still much greater than dying because of smallpox or anthrax. Even though the government is successfully finding solutions to our problems, it is keeping everything undercover. If only the government would reassure the people that they truly are doing everything that they can, and if everyone wouldn't take everything the media said so seriously, the bioterrorists wouldn't succeed in what they set out to do.