Smallpox – Still a Viable Bioterrorist Threat

The 9/11 terrorist attacks against the United States and, shortly thereafter, the mailing of anthrax spores to several news agencies and the offices of two U.S. Senators became evidence of the need to improve U.S. homeland security in general and the nation’s biosecurity capabilities in particular. Congress and then-President George W. Bush responded to the national outcry by passing the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 – also known as the Bioterrorism Act, which was signed into law on 12 June 2002. That Act, and other legislation since then, has significantly upgraded the federal government’s capability to prevent, prepare for, and respond to future national health emergencies and unforeseen bioterrorism incidents.

The bioterrorist threat itself continues to spawn new federal programs, additional legislation, and even increased funding – approximately $60 billion since 9/11 – to combat what previously had been considered a relatively unlikely danger. However, despite these efforts, new intelligence reports and the concerns voiced by congressional commissions about the growing threat of bioterrorism attacks have brought significant attention to the level of security and preparedness needed – but still lacking.

On 12 February 2003, Central Intelligence Agency Director George Tenet said, in testimony before the Senate Armed Services Committee, that “We continue to receive information indicating that al-Qaida still seeks chemical, biological, radiological, and nuclear weapons.” More recently, documents recovered from al-Qaida facilities in Afghanistan indicated that al-Qaida still “has a sophisticated biological weapons capability.” Terrorists also continue to acquire bioagents – e.g., various types of bacteria, viruses, fungi, and toxins – all of which are valued by terrorists not only for their psychological impact on the public, but also for their potential to kill thousands of people quickly and easily, their ease of distribution, the difficulties involved in detecting them, and the maturation period of the infectious agents themselves. For numerous reasons, therefore, an authentic bioterrorism threat poses unique challenges for those responsible for preparedness, protection, and – perhaps of the greatest importance – an effective and timely response against such an attack.

Failing Grades From the WMD Commission

Despite the strong efforts already made to upgrade the nation’s counterterrorism capabilities, numerous authorities – including congressional commissions, governmental and non-governmental organizations, and private industry – have identified the need to further improve the nation’s biodefense strategies. The U.S. Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism – formed by Congress in 2004 to evaluate the U.S. government’s readiness for a terror attack – warned the House Committee on Homeland Security in 2010, in fact, that “The threat of bioweapons being used by terrorists or rogue states has continued to worsen.”

The Commission, co-chaired by former U.S. Senators Daniel Robert Graham and James Matthes Talent, also issued a “Report Card” (on 26 January 2010) on the efforts made thus far to address several of its earlier (2008) recommendations. In that report, the Obama administration’s failure to “enhance the nation’s capabilities for rapid response to prevent biological attacks from inflicting mass casualties” received a failing grade (“F” – meaning that no action had been taken on this recommendation). For its inadequate oversight of high-containment laboratories, the administration received an almost failing “D+.”

“We no longer have the luxury of a slow learning curve,” the Commission also warned, as yet another indication that the Obama administration is not addressing urgent threats, including bioterrorism. “Especially troubling,” the Commission said, “is the lack of priority given to the development of medical countermeasures – the vaccines and medicines that would be required to mitigate the consequences of an attack.”

Despite the failing grades and missteps – of Republican as well as Democratic administrations – the U.S. biodefense efforts of the past decade have, if nothing else, led to a greater understanding of both the lack of preparedness and the actual biothreat itself. That understanding has not only spurred the development and placement of new detection technologies, but also expanded the provisions in place for effective countermeasures. Nonetheless, the enactment of additional legislation, some of it still pending, to implement other Commission recommendations is needed to further enhance the nation’s current biosecurity capabilities.

Smallpox Disasters – Still a Threat?

Largely because of a worldwide smallpox vaccination campaign carried out by the World Health Organization (WHO), naturally occurring smallpox has been successfully eliminated. According to the U.S. Centers for Disease Control & Prevention (CDC), the last reported smallpox case occurred in Somalia in 1977, and the virus has not infected anyone within the United States since 1949. Nonetheless, and primarily because of recent security concerns in embattled nations such as Libya and Syria, the use of biological weapons against civilian populations has once more become a real and present danger to the national security of the United States (and, of course, other nations throughout the world).

Currently, samples of the smallpox virus – an airborne virus that is extraordinarily contagious and extremely lethal – are now stored in only two laboratories, one in the United States and one in Russia, which are both closely guarded. Nonetheless, there are also some understandable concerns that a few other nations and/or organizations – including terrorist groups – might also have acquired samples of the virus at one time or another in the recent past. Moreover, even though naturally occurring smallpox seems to have been effectively eradicated, it might still be inexpensively replicated, both technologically and synthetically, and used as a terrorist weapon of choice.

Making smallpox an even more attractive bioweapon is that the maturation period of the virus ranges from 7 to 17 days. A human carrier of the virus thus could travel to numerous countries around the world without exhibiting any warning signs, while possibly spreading what could lead to an international pandemic. Even if the overall likelihood of a bioterror attack remains relatively low, the historical record shows that any use of the smallpox virus as a bioweapon would become a major international concern.

According to the CDC, the most common type of smallpox, variola major, had an approximately 30 percent death rate – and millions of other victims suffered major disfigurements. In the 20th century alone, smallpox killed an estimated 300 million people – more than the total number killed in all of the wars fought in all countries throughout the entire world during that century. Also, because there is no specific treatment for smallpox – beyond treating the visible signs and symptoms of the infection – the foremost concern is to stop the spread of the virus before it reaches epidemic proportions. In nations that do not possess the types or quantities of immunization to the virus that would be needed, stopping the spread of disease can be an even greater challenge.

Developing a National Plan

Securing and preparing the United States (and/or any other nation) to cope with the threat posed by bioterrorism requires that several additional actions are needed. The same WMD report that issued less than complimentary grades also recommended five steps the U.S. government itself should take to combat the threat of bioterrorism:

• Conduct a comprehensive review of the current domestic programs already in place to secure dangerous pathogens;
• Develop a national strategy for advancing the ability to conduct forensic analyses of bioterror attacks;
• Tighten government oversight of the private-sector as well as government laboratories that deal with dangerous pathogens;
• Promote a culture of security awareness among scientists; and
• Enhance the nation’s current rapid-response plans to prevent biological attacks from inflicting mass casualties.

To connect experts and build interoperability, the government should also continue to pursue a national biosurveillance strategy, including but not limited to: (a) sharing laboratory information; (b) investigating and researching the use of such unstructured data as information from the internet and social networks; (c) incorporating biosurveillance information where it is important and reasonable to integrate; and (d) developing and promoting a global disease detection network.

On 31 July 2012, the Obama White House released a National Strategy for Biosurveillance, which stressed that a “well integrated, national biosurveillance enterprise is a national security imperative.” The essential goal of that national initiative is to save lives by guaranteeing that key personnel have the correct information to make judicious decisions during a public health emergency. In addition, the National Strategy also calls for an interdisciplinary approach to biosurveillance in order to combine and integrate the information and knowledge available from areas beyond public health – e.g., law enforcement, the intelligence community, and the private sector.

In August 2007, the U.S. Congress established the National Biosurveillance Integration Center (NBIC) within the Department of Homeland Security to enhance the nation’s capability to integrate all U.S. biosurveillance efforts. NBIC’s biological common operating picture is a manually updated Google Map application that tracks biological events worldwide. The biosurveillance common operating network supports DHS’s Google Map system and also monitors, tracks, and disseminates relevant information through a system called Global Argus – a global early detection and tracking system for biological events – which depends heavily on public information sources such as newspapers and the internet.

The mission of the NBIC further includes the ability to enhance the capabilities of the federal government to: (a) rapidly identify, characterize, localize, and track a biological event of national concern; (b) integrate and analyze data relating to human health, animal, plant, food, water, and environmental domains; (c) disseminate alerts and other relevant biothreat information; and (d) oversee the development and operation of the National Biosurveillance Integration System (NBIS) interagency community.

To briefly summarize, the threat of bioterrorism is real and smallpox is the most viable bioagent that might be used as a WMD. It is conceivable, in fact, that terrorists might reproduce and deploy various infected bioweapons because the educational materials needed are widely accessible throughout various public documents and internet resources. Moreover, although the likelihood of a bioterrorist attack seems to be very small, so too was the possibility that passenger aircraft would be used to fly into buildings and/or that makeshift bombs would be smuggled inside shoes or underwear.

As with any other type of terrorist threat, the U.S. government must find a safe and reasonable equilibrium between being prepared for a possible attack and effectively managing the financial and logistical costs associated with the preparations involved. Building partnerships, especially with other countries, is a critical step in building a higher level of biosecurity.

For additional information on: The June 2002 Bioterrorism Act, visit https://www.govinfo.gov/content/pkg/PLAW-107publ188/pdf/PLAW-107publ188.pdf

The February 2003 Hearings Before the U.S. Senate Armed Services Committee, visit http://www.gpo.gov/fdsys/pkg/CHRG-108shrg91721/html/CHRG-108shrg91721.htm

The January 2010 “Prevention of WMD Proliferation and Terrorism Report Card,” visit https://interagencyboard.org/system/files/resources/Prevention%20of%20WMD%20Proliferation%20and%20Terrorism%20Report%20Card.pdf

The July 2012, National Strategy for Biosurveillance, visit https://obamawhitehouse.archives.gov/sites/default/files/National_Strategy_for_Biosurveillance_July_2012.pdf

CDC’s Smallpox Fact Sheet, visit https://www.cdc.gov/smallpox/

The NBIC, visit http://www.dhs.gov/national-biosurveillance-integration-center