Biological Terrorism: An Operational Perspective
James M Wilson V, MD FAAP
Director, UNR International Center for Medical Intelligence
Uncertainty is a driver of fear. If we allow fear to drive improbable scenarios, then we will expend limited resources on remote “possibilities” rather than actual threats. Biological terrorism is a real threat. However, compared to global climate change and associated rapidly evolving disease patterns, its overall impact is negligible. We are seeing a dramatic decline in antibiotic susceptibility among bacterial disease seen on a daily basis in medicine. It is this latter threat that will cost more American lives than all modern acts of biological crime, terrorism, and warfare combined.
The international community, including the United States, focuses on threats and risks that are “most probable.” This implies that our chances of anticipation and rapid detection of a biological weapon before it is used are low. The reality is that we need a given sample size of affected targets (i.e. people) before a pattern is noticed. We characteristically recognize patterns “after the fact.” A cluster of people will likely be infected and possibly die before recognition and response occurs.
Recent news about Zika virus and hysteric calls for the cancellation of the Olympic Games, as well as requests for nearly two billion dollars in funding to defend against epidemic transmission in the continental United States, highlights tremendous gaps in our understanding of how to produce balanced threat assessments.
When monitoring the world for unusual infectious disease activity over the last quarter century, I have found unequivocally that Mother Nature remains the single worst biological terrorist. This finding is based purely on statistics for morbidity and mortality, economic disruption, and direct threat to any nation’s security. The international community continues to exhibit grossly delayed event recognition, verification, and response. This was evident during the emergence of SARS in Hong Kong, pandemic influenza A/H1N1 in Mexico, MERS in Saudi Arabia, Ebola in West Africa, and now Zika virus in the tropical regions of the Americas.
The impact of an intentional release remains debatable. For example, after the conclusion of World War II, members of the Imperial Japanese Army biological warfare Unit 731 testified to a Soviet military court they conducted a live test deployment of plague-infected fleas in Ningpo, Zhejiang Province, Manchuria with a population of approximately 300,000. The deployment triggered an outbreak in a close knit community involving 78 cases and 74 fatalities (case fatality rate 95%) that included the death of seven families. Children and young adults aged 11-30 were most severely affected. Despite lack of access to effective medical countermeasures such as antibiotics, the Ningpo community exhibited a high degree of social cohesion and resilience in the context of effective public health response. In other words, this community remained a functional community despite not having any practical access to medical countermeasures.
We are often confronted with harrowing proclamations of national apocalypse when discussing biological terrorism. Yet these fears are not borne out in experience or fact. While we should always remain vigilant, we should not be captive to hyperbole.
Dr. James Wilson is the Director of the Nevada State Infectious Disease Forecast Station at the University of Nevada-Reno, and teaches in the School of Community Health Sciences at the UNR Medical School.