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One week after the terrorist attacks on 11 September 2001, which destroyed the World Trade Center in New York City and damaged the Pentagon in Arlington, Virginia, seven letters containing anthrax spores were sent by mail to two US Senators – Tom Daschl
One week after the terrorist attacks on 11 September 2001, which destroyed the World Trade Center in New York City and damaged the Pentagon in Arlington, Virginia, seven letters containing anthrax spores were sent by mail to two US Senators – Tom Daschle of South Dakota and Patrick Leahy of Vermont – and five media outlets (those of ABC News, CBS News, NBC News, the New York Post, and the National Enquirer). The type of anthrax used in the letters was the Ames strain of the bacterium.
Five of the letters were postmarked 18 September 2001; the other two were postmarked 9 October 2001. All of them had a Trenton, New Jersey postmark. The material in the two letters to the Senators was a highly refined dry powder (about a gram of almost pure anthrax spores), which was much more potent than the material in the other five anthrax letters.
Five people died of inhalation anthrax and 17 others were infected. The FBI, which investigated the attack, said that the investigation was "one of the largest and most complex in the history of law enforcement”.
The FBI concluded in 2008 that a US Army researcher, who worked in the US Army Medical Research Institute of Infectious Diseases in Fort Detrick, Maryland, committed the 2001 anthrax attacks but a panel of scientists cast much doubt of the FBI scientific evidence and “found it impossible to reach any definitive conclusion about the origins of the anthrax in the letters, based solely on the available scientific evidence” (1).
The person suspected by the FBI committed suicide in July 2008. The FBI is no longer investigating the case but the person/persons responsible for the attacks have in, the opinion of many, yet to be conclusively identified.
The anthrax attacks, coming while the USA was still reeling from the 9/11 attacks, stunned Americans. In response to the considerable public concern, the US government launched a major programme to develop countermeasures to a bioattack, including the development of diagnostics, vaccines and drugs against bioterrorist threats, particularly attacks using anthrax and smallpox. The government poured funds into basic research at the National Institutes of Health (NIH); set up the Biomedical Advanced Research and Development Authority (BARDA), to develop and test new concepts; and established project BioShield.
In 2004, the US Congress passed the Project BioShield Act (signed by President George W. Bush on 21 July 2004) calling for funding for purchasing vaccines that would be used in the event of a bioterrorist attack. Specifically, it proposed a $5.6 billion programme to purchase approved drugs and vaccines.
According to the scientific journal Science, about $60 billion have been spent on biodefense preparedness in the USA. Of this, some $19 billion has gone into biodefense research in America, a very large increase over previous levels. “The country now has a dozen labs, eight more than in 2001, that will operate at biosafety level 4, the highest security level for deadly pathogens such as Ebola virus” (2). In June 2011, the US Congress proposed reauthorizing BARDA and funding BioShield at $2.8 billion for 2014-2018.
How much safer is America after this large expenditure? According to an article in the science journal Nature, written by Erika Check Hayden, the money spent on countering bioterrorism “has helped to modernize the nation’s crumbling public-health system, and BioShield has invested in a stockpile of 20 million dose of smallpox vaccine and 28.75 million doses of anthrax vaccine and 1.98 million doses of four medicines to treat complications of smallpox, anthrax and botulism”.
But policy makers are less than happy with the range of drugs available to deal with potential threats. Hayden’s article quotes Kathleen Sebelius, US Secretary of Health and Human Services, who said: “The pipe line we rely on to provide those critical countermeasures – diagnostics, vaccines, antivirals, antibiotics – is full of leaks, choke points and dead ends.” In July 2009, BARDA ordered 45,000 doses of anthrax drug but the FDA did not approve the drug.
Only two vaccines approved by the US Food and Drug Administration (FDA) are available – one for anthrax and one for smallpox. But no product for the treatment of smallpox will probably become available in the foreseeable future. For other possible bioterrorism agents – including plague, tularemia, Ebola and Marburg viruses and botulinum – no FDA-approved vaccines are likely to become available in the foreseeable future.
FDA-approved antibiotics are available for plague and tularemia but no product is likely to become available in the foreseeable future for the treatment of Ebola and Marburg viruses. Experimental antitoxins could be given in an emergency to treat botulinum. For the treatment of anthrax, antibiotics and antitoxins that are not FDA approved could, in an emergency, be given (2).
Bioterrorists aim to spread disease by using a biological agent to expose people to infectious micro-organisms or the toxins they produce. The most likely biological agent used in a bioterrorist attack is a bacterium or a virus. Bacteria cause diseases such as anthrax and pneumonic plague; viruses cause diseases like Ebola and smallpox.
Bioterrorism may be much more lethal than chemical terrorism. It is also more feared by populations, perhaps because we have an atavistic fear of disease. This may date back to past epidemics. The Black Death, for example, killed a third of Europe’s population when it swept through the region between 1346 and 1350. The psychological impact of this and other disasters may be deep in our psyche. A successful bioterrorist attack can be expected to provoke a pervasive panic in the populations affected.
Terrorists are likely to consider a bioattack for a number of reasons. One is that some biological agents are relatively easy to acquire. Another reason is that they are not expensive. Once acquired, biological agents are relatively easily dispersed – as an aerosol, for example, using crude sprayers.
Terrorists could steal a biological agent from a medical research laboratory or acquire it from a sympathizer working in one. Biological agents could also be obtained from natural sources. The spores of anthrax, which survive fir decades, could, for example, be collected from the soil in locations where anthrax is endemic in cattle.
The dispersal of anthrax could be achieved by preparing a slurry of anthrax spores and deposing it in the tunnels of a subway-train system. When dry, the spores would be swept through the tunnel system by passing trains. Biological agents could also be freeze-dried and later rehydrated and dispersed as an aerosol.
In fact, anthrax is the biological agent most likely to be used by bioterrorists. The bacteria Bacillus anthracis, which causes inhalation anthrax when breathed into the lung, may well be the biological agent of choice for terrorists. The disease is not usually diagnosed in time to allow effective treatment and the mortality rate is high – typically about 95 per cent.
The first symptoms of inhalation anthrax are non-specific – including fever, malaise and fatigue, sometimes accompanied by a dry hacking cough. Once these symptoms occur, treatment cannot help. After about three days, serious respiratory distress occurs and death usually follows within thirty-six hours.
Small pox is a very contagious disease caused by the virus variola. The smallpox virus is very stable in aerosol form and its release could infect a large number of people, spreading from person to person by droplets or by direct contact. The incubation period is between seven and seventeen days.
An infected person suffers from a high fever, backache, headache, vomiting and possibly delirium. Two days later, a smallpox rash appears and turbid blisters are formed after about another five days. Death, which typically occurs during the second week of the illness, is usually caused by toxaemia (blood poisoning).
A global campaign, begun in 1967 and administered by the World Health Organization (WHO), eradicated the disease within ten years. The WHO recommended that all stocks of small pox should be destroyed or transferred to either the Institute of Virus Preparations, Moscow or to the Centres for Disease Control and Prevention, Atlanta, Georgia. All countries claimed to have complied with the WHO recommendation.
The fear is that some smallpox viruses have been illegally acquired and that some countries may not have sent all their stocks of virus to the designated laboratories. If a terrorist group acquires some viruses, smallpox may be used in the future as a bioterrorist weapon. But the risk of this happening is probably not high.
The $60 billion spent by the US government on biodefence in the past ten years has, in the opinion of many researchers and policy-makers, not been used properly. Critics question whether all the costly new high-containment laboratories that have been established are necessary, particularly since no new attacks have occurred since 2001. The concentration of effort to develop vaccines and drugs against potential bioterrorist threats using smallpox and anthrax, even if these two are the most serious, may prove to be dangerously short-sighted. It may encourage terrorists to consider the use of other pathogens in a future bioterrorist attack.
1. Reuters, Scientists question U.S. anthrax attack evidence, Reuters, Washington 15 February 2011. http://www.reuters.com/article/2011/02/15/us-usa-anthrax-idUSTRE71E5L620110215.
2. Jocelyn Kaiser, Taking Stock of the Biodefense Boom, Science, Volume 333, page 1214, 2 September 2011.
3. Erika Check Hayden, The Price of Protection, Nature, Volume 477, pp.150-152, 8 September 2011.
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