Confronting Bio-Terrorism: The Anthrax Threat

With a rise in the calculated and malicious use of anthrax by bad actors, experts are issuing a “wake-up call.”

Published January 1, 2002

By Fred Moreno, Dan Van Atta, Jill Stolarik, and Jennifer Tang
Academy Contributors

Anthrax-contaminated mail has spread fear and anxiety around the world. What can we do to thwart the threat of bio-terrorism and prepare for possible future attacks that may use other, even more potentially lethal, bioagents? These were some of the questions addressed at a recent public forum, “Confronting Bio-terrorism: What is the Threat? How Can We Effectively Deal with It?” Held at Hunter College in New York, the gathering was co-sponsored by the college and The New York Academy of Sciences (the Academy).

Dr. Andrea Branch, a research virologist at the Mount Sinai School of Medicine, outlined her proposal for a comprehensive biological warfare defense program. Stressing the variety and complexity of potential bio-weaponry, she said experts need to consider the biodiversity of the microbe world.

“It’s not enough to attack one pathogen with one vaccine,” Branch said. “There are many microbes and many variants of each microbe. Each vaccine would have to take into account the variants of a particular virus.”

Better Tools Needed

Knowing the “timeline” for these various infections is also very important. “We need to identify places along the timeline where there can be effective intervention,” Branch said. “We must consider the incubation periods, the route of transmission for the disease and how we can intervene at each stage of the cycle.” Some interventions can be used at more than one point in the timeline. For example, the smallpox vaccine can be used either years before — or immediately after — exposure to the virus.

Infections can travel via contaminated water, air, food, or be vector-borne, as in the case of the West Nile Virus. To identify people who have been infected by pathogens, Branch stressed the importance of developing better diagnostic tools. “The sooner we know what we’re dealing with, the sooner we may be able to prevent the spread of the disease,” she said. Quarantine is an old, and still very effective, way to slow disease spread. Specific medical interventions —vaccines and pharmaceuticals — can be developed only after a disease agent has been identified.

A Centralized Database

Branch also proposed the development of a centralized, electronic medical database. For example, given that the recent anthrax attacks put postal workers and mailroom personnel at higher risk for this disease than the general population, an individual’s occupation would be a part of such a database, as it would aid health care workers in making an accurate diagnosis. Branch recognized, however, that such a database could raise privacy issues.

Another issue is the cost of implementing an effective bio-warfare defense program. In the past, the federal government has balked at making a commitment to purchase large quantities of improved anthrax vaccine if one became available. As a result, Branch noted, the vaccine was never improved. In addition, there are few laboratories in the United States where new therapies can be tested. Restrictions on where R&D can be conducted on experimental vaccines and medicines also pose problems and cause delay. In light of the anthrax attacks, however, she predicted the government might overcome its inertia in these areas.

One must also consider what to do after a bio-terrorist attack occurs. “We need to consider how to decontaminate buildings and spaces and how to test for decontamination,” Branch said.

Cipro and Drug-Resistant Microbes

Dr. Barry Kreiswirth, director of the Tuberculosis Center at the Public Health Research Institute, said the indiscriminate use of Ciprofloxacin, a powerful antibiotic used to treat anthrax, might encourage the development of antibiotic-resistant bacteria. “Over time, we will not only have bacteria that are resistant to Cipro, but the whole class of antibiotics that Cipro belongs to as well,” he said.

Officials and the media have sent mixed signals regarding Cipro in recent months, Kreiswirth said –– at times discouraging its use unless there is a clear threat; at other times suggesting its use as a precaution. In addition, some have recommended taking a 60-day (the incubation period for anthrax) regimen of Cipro. Expecting people who don’t have any symptoms to take a drug that may produce significant side effects, such as nausea, for 60 days may be unrealistic. People without symptoms may not stick to their schedule, Kreiswirth said, leading to the likelihood that inappropriate limited use of the drug may create antibiotic-resistant bacteria.

Other Serious Threats

Dr. Vincent Fischetti, co-head of the Laboratory of Bacterial Pathogenesis and Immunology at The Rockefeller University, said anthrax is a logical choice for a bio-terrorist attack; its spores may last as long as 100 years in the soil. While we’re fortunate that anthrax is not contagious, Fischetti noted that there are other, highly infectious bacteria that could potentially be used as weapons.

Examples include Yersinia pestis (plague) –– a contagious and often fatal bacterial disease that produces high fevers, headaches, glandular swelling and pneumonia, and clostridium botulinum (botulism), a bacterium that produces a toxin that’s the most poisonous compound known to science. Unlike anthrax spores, however, he noted that infectious bacteria have very short survival times –– a matter of hours or days –– when they are released into the environment.

In addition to bacteria, Fischetti said the potential for terrorist use of viruses –– like smallpox and hemorrhagic fevers (such as Ebola and Marburg) –– is another concern. Other types of microbes that could be used as weapons include fungi and parasites. Fortunately, however, he said many of these microbes are not likely to be used by terrorists for various reasons, including their instability and the difficulty of disseminating them.

Because smallpox vaccinations ended in 1972, Kreiswirth noted that people who were vaccinated are no longer fully immune to the virus, as the immunity has probably worn off. That’s why there’s a call for making enough new smallpox vaccine to protect every American. But he pointed out that vaccinations carry their own serious health risks, including death, particularly in the very young and the elderly.

An Old Problem

Dr. Larry Lutwick, director, Division of Infectious Diseases at the Brooklyn campus of Veterans Administration’s New York Harbor Health Care System, observed that bio-terrorism is not a new threat. Germ warfare has been around since at least the Middle Ages, when armies besieging a city would catapult corpses infected with the “black plague” over the walls. But smallpox does pose a threat today, he said, because it is highly contagious and incurable.

Lutwick recalled how the “eradication” of smallpox was considered a monumental public health victory in 1980. By international agreement, all stocks of the virus were to be destroyed except for samples to be kept frozen in the U.S. and Russia. When President Richard Nixon abolished the program and ordered the stockpiles destroyed in the 1970s, Soviet leaders agreed to do the same. But no one is sure this actually occurred, and there are unconfirmed reports that repositories of the virus now exist in Iraq and North Korea.

The September 11 attacks should serve as a wake-up call that the U.S. must improve its preparation for possible bio-terrorist attacks, Lutwick said. The medical community, in particular, needs to be informed. “Health-care providers should be alert to illness patterns and diagnostic clues that might indicate an unusual infectious disease outbreak. They should report any clusters or findings to their local or state health department,” he said.

In addition, he supported enhancing the public health infrastructure and system of hospitals, noting that the system’s ability to treat a large number of patients in the event of an infectious disease outbreak has been weakened following a decade of budget cutbacks.

Prepare for the Unexpected

Dr. Gideon Rose, a social scientist and managing editor of Foreign Affairs, offered a different perspective on how the U.S. must prepare for future bio-terrorist attacks. He observed that the terrorist attacks have not conformed to what some social scientists predicted might happen and that we should be prepared for the unexpected. For example, based on their knowledge of past terrorist hijackings, experts did not foresee the existence of suicidal terrorists who would be willing to crash planes into the WTC.

Rose proposed that we improve our ability to identify, track and detect terrorist threats. Unlike nuclear weapons, biological weapons are cheap and much easier to make. Compared to chemical weapons, biological weapons have the potential to kill more people. In addition, the potential spectrum of those involved in bio-terrorism can range from individuals and small groups to state-sponsored terrorism. “Crisis management is especially crucial,” he said. The U.S. should invest in academic programs and institutions that seek to gather knowledge on issues related to terrorism, Rose added. He also urged the rebuilding of “an intellectual capacity” in fields such as political science. “We need to understand the mentality of the people who would perpetrate attacks on the U.S.,” he said

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