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(Bacterium) untreated; 4“15% if treated; days; Fever, coughing up aerosol/person-to-person aerosolized delivery; highly sensitive to
blood, lymph node contact weather conditions; rapid incubation
pneumonic = 95% if
untreated in¬‚ammation, septic shock requires prompt response

Q fever (Coxiella 1% 10“20 days; Fever, Low (rare): spread via food Disseminated by water or aerosol; stable
burnetii) (Bacterium) pulmonary edema, heart or airborne dust particles in environment; can survive for long
in¬‚ammation periods outside host

Ricin Toxin produced 100% with 0.2 milligrams 8 hours Not contagious Easily produced from castor beans; highly
from Ricinus communis lethal; useful for assassination

Salmonella 0.5% 12“72 hours; diarrhea, Not contagious Easy to acquire; useful for food
(Bacterium) severe dehydration contamination to incapacitate

Smallpox Variola 20“40% 10“12 days; Rash, internal Moderately high: Thought to be unavailable; if obtained
major (Virus) bleeding, organ failure Person-to-person via would spread rapidly through
respiratory sputum; unvaccinated populations
contact with bodily ¬‚uids
or contaminated objects

Tularemia 2% if treated; 30“60% if 1“14 days; Fever, diarrhea, Not contagious; only Highly infectious; can be aerosolized
untreated can lead to meningitis spreads via aerosol or (slow progression; low case fatality rate)
arthropod bites

Typhus Rickettsia 10“60% 6“12 days; Fever, delirium Not contagious; spreads Thrives in regions infested by ¬‚eas, lice,
prowazekii Bacterium by infected vectors mites, and rats; readily preventable

Venezuelan Equine 1“20% 1“5 days No reported Dif¬cult to distinguish from in¬‚uenza; no
Encephalitis (Virus) human-to-human transfer; speci¬c therapy; experimental vaccines
infection by vectors not licensed for distribution




23
24 BIOVIOLENCE: PREVENTING BIOLOGICAL TERROR AND CRIME

put in writing. Undeniably, information about how to conduct bioviolence
is widely available. Yet, unlikely as it might be that this book would be a
reference for a bio-offender, I am hesitant to put such information in print.


SMALLPOX

Smallpox, Variola major, is perhaps the most feared bioviolence agent.
It is exceptionally lethal (up to 30 percent of its victims die). Smallpox is
unique to humans; there is no other animal or insect vector. Except for
specialized laboratory conditions, it can survive only brie¬‚y outside the
human body “ six to twenty-four hours depending on temperature and
humidity.
Smallpox is contagious through inhalation of droplets exhaled by vic-
tims but only after a rash appears about ten days after exposure. Victims
remain contagious but less so in the disease™s later stages as scabs form
and separate; during this period, most patients are incapacitated. Death
usually occurs during the second week. It has a high incidence of second-
generation cases. A single carrier can infect on average three but as many
as twenty people.1


Eradication?
An effective vaccine was discovered centuries ago that led to the eradi-
cation of naturally occurring smallpox. After World War II, in humanity™s
greatest victory against disease, 120,000 doctors and health care person-
nel af¬liated with the World Health Organization (WHO) initiated the ring
vaccination campaign to identify smallpox victims and vaccinate everyone
around them. If the disease would have nowhere to go, it would eventu-
ally die out for lack of a host. Identifying victims was horrifyingly easy due
to the disease™s unique red blisters; immune survivors could be identi¬ed
by the disease™s permanent scars. Key to the campaign™s success was that
WHO encouraged people in villages to report smallpox carriers “ perhaps
history™s most successful global health reporting system. The campaign
worked; the last reported case of naturally occurring smallpox occurred
in the late 1970s. During the campaign, few unvaccinated people from
smallpox-infected areas moved transnationally which helped contain out-
breaks. This type of strategy might be less effective today especially if an
outbreak occurs in global transport hubs.
Mass vaccination has serious consequences. For every million persons,
14 to 52 will experience life-threatening adverse reactions; one or two may
25
METHODS OF BIOVIOLENCE

die.2 For people who are immune-compromised (e.g., carriers of HIV/AIDS
or chemotherapy patients), the vaccine™s lethality skyrockets. Therefore,
following eradication, the WHO recommended that all nations cease vac-
cinations. In the United States, vaccinations stopped around 1972. Any-
one born since then lacks immunity; older people™s residual immunity has
certainly faded over the years. Likely less than 15 percent of Americans
are immune, but the percentages are even lower in less developed nations.
Among children and young adults, only a handful of emergency responders
and military personnel in advanced countries are vaccinated. Everyone
else is susceptible. Ironically, vaccination led to eradication, which in turn
has led to vulnerability should the disease reappear.
Today, a smallpox pandemic would run rampant through unvacci-
nated populations until health authorities could immunize enough peo-
ple to once again enclose its spread. Speed is essential; vaccination can
be administered within four days of ¬rst exposure, but it has limited effect
thereafter.3 In regions heavily impacted by HIV/AIDS, emergency vacci-
nation administrators would have to carefully select who should be vac-
cinated. Safer and more effective vaccines are being developed, but their
availability and consequences cannot now be accurately assessed. More-
over, while natural smallpox cannot easily leap over a ring of vaccinated
persons, a human attacker could readily outwit tactics for containing the
disease™s spread.


The Challenge: Getting the Virus
Smallpox is not available in nature and may not be available anywhere
else. If so, smallpox should not be a big worry. When the WHO declared
the world free of smallpox, it recommended that every seed stock of the
virus be destroyed. Only two viral stocks are known to exist, and they are
tightly secured in the Centers for Disease Control and Prevention (CDC)
in Atlanta and VEKTOR, a research laboratory outside of Novosibirsk,
Russia. An attack on these sites is unlikely as it would set off worldwide
alarms. Of greater concern is the risk that samples have been diverted. For
example, after the Russians moved their strains from the Institute for Viral
Preparations in Moscow, three samples of a speci¬c strain were discovered
missing and never seen again.4 The WHO, which does not conduct on-site
veri¬cation of either CDC or VEKTOR, was not informed of the move.
Whether to destroy the two remaining stockpiles has been contro-
versial. During the 1980s and 1990s, the WHO Executive Committee
on Orthopox unanimously decided (under U.S. pressure) to destroy the
26 BIOVIOLENCE: PREVENTING BIOLOGICAL TERROR AND CRIME

world™s last strains of smallpox; each time, scientists and medical providers
questioned the prudence of the virus™s destruction. In the late 1990s, Presi-
dent Clinton reluctantly changed course and promoted a delay in destruc-
tion. Several types of research to develop an improved vaccine and antivi-
ral medications (needed if there is ever a smallpox outbreak) require a
viable virus sample. The WHO agreed to allow two to three additional
years of research to combat the threat of smallpox™s re-emergence. Clin-
ton™s spokesman Joe Lockhart said, “The decision re¬‚ects our concern that
we cannot be entirely certain that after we destroy the declared stocks in
Atlanta and Koltsovo, we will eliminate all the smallpox virus in existence.”5
In December 2002, President Bush initiated the U.S. smallpox vacci-
nation program; over 350 million doses of vaccine have been stockpiled,
and health care response professionals are prepared to provide assistance
if there is an outbreak. The U.S. military must vaccinate some service peo-
ple, but mandatory vaccination for everyone was ruled out.
Why retain samples and vaccinate health care workers if the disease
is unavailable? Maybe reports of its eradication are premature. A great
fear is that the virus might exist outside the two designated high-security
storage labs, perhaps at the former Soviet Union™s bioweapons facilities.
Former senior VEKTOR of¬cial, Ken Alibek, has testi¬ed that the Soviet
Union produced dozens of tonnes of smallpox and other diseases dur-
ing the Cold War until 1992, as will be discussed in Chapter 3. According
to Alibek, VEKTOR scientists, starting with a strain obtained from India
in 1959, genetically altered at least ¬fty strains of smallpox. They might
have spliced smallpox with ebola thereby combining the two diseases™
symptoms in order to create a “battle strain” that would be impervious
to vaccine and incurable. Alibek said, “It is important to note that, in the
Soviet™s view, the best biological agents were those for which there was no
prevention and no cure.”6 Most frightening is that the Soviets might have
isolated a speci¬c strain that causes hemorrhagic smallpox; instead of a
mortality rate of about one in three, this virus could have a mortality rate
of virtually 100 percent. These allegations are not currently veri¬able, and
some experts question them. Unquestionably, the Soviets ¬gured out how
to grow large quantities of smallpox, and they accomplished what some
scientists believed was impossible: aerosolization.7
Former Soviet scientists might have sold virus samples or hidden them
for later sale. If the virus exists in an undisclosed site, a bio-offender might
overcome lax security or gain access via an insider™s malfeasance. Russian
scientists are known to have taught genetic engineering and molecular
27
METHODS OF BIOVIOLENCE

biology to scientists from Eastern Europe, Cuba, Libya, India, Iran, and
Iraq. A recent intelligence assessment posits that Iraq and North Korea
might have weaponized smallpox.8 Iraq at one time had camelpox,
although reports that Iraq created a smallpox-like disease have not been
substantiated. North Korea continues to vaccinate its troops against small-
pox to this day “ an ominous sign in view of its research on bioweapons
including propagation of germs for weaponization.
Even more frightening than the possibility of smallpox existing out-
side WHO-approved sites is that scientists might re-create the virus using
modern genetic engineering techniques. Scientists posit that this is beyond
current capabilities: the smallpox genome has been deciphered, but it is
among nature™s most complex viruses. Yet, many scientists agree that it is
only a matter of time “ perhaps within a decade “ before the virus might
be re-engineered “from scratch.”
What is beyond doubt is that if the virus were to fall into the wrong
hands, a global pandemic could be ignited with innumerable casualties.
No intricate steps are needed to start its spread. Ring vaccination would
be complicated by the disease™s long incubation period (over a week) that
would allow carriers to move around the world without anyone (including
themselves) knowing that they are an infectious timebomb. In some coun-
tries, widespread vaccination would be rapidly initiated upon discovery
of an outbreak “ as the disease does not exist in nature, a victim would be
proof that there has been an attack. If there is enough vaccine and it can be
rapidly distributed into target communities where trained personnel can
apply it and separate the immune-de¬cient from carriers, then the death
toll could be limited.
The United States is far better prepared to meet a smallpox attack than
it was a few years ago; likely the same can be said about other highly
developed countries where response preparation is ongoing. The WHO™s
rapid response capabilities are commendably being enhanced. However,
upwards of 75 percent of the world™s population lacks emergency access to
smallpox vaccine. A deliberately ignited epidemic in over-crowded cities
in developing nations would horrifyingly meet few public health systems
that are remotely capable of containing its spread. Outside perhaps two
dozen States, a smallpox attack could kill three in ten unvaccinated healthy
persons and many more who are weakened by HIV, malaria, tuberculosis,
or other widespread af¬‚ictions. Conservatively stated, millions of people
could die from a well-planned attack. 9 Short of thermonuclear holocaust,
it is hard to envision any worse human-in¬‚icted cataclysm.
28 BIOVIOLENCE: PREVENTING BIOLOGICAL TERROR AND CRIME


INFLUENZA AND HEMORRHAGIC FEVERS

Today, the direst biothreats are contagious viruses that are much more
available than smallpox. These viral agents can be weaponzied in moder-
ately equipped laboratories and disseminated by human carriers. There
are obstacles to using viruses, and some of these viral threats exceed cur-
rent capabilities. Yet, there are techniques for circumventing those obsta-
cles readily within tomorrow™s grasp.


In¬‚uenza
In¬‚uenza is ubiquitous and remarkably contagious after a short one to
two day incubation period.10 Its common variants have low lethality rates
but are so widespread that ¬‚u causes more deaths than any of the 1,500
human disease microbes: over one million people worldwide in an average
year.11 Scientists estimate that an in¬‚uenza pandemic could spread across
the globe in eight to twelve months infecting 40 percent of humanity.12 It
bears remembering that the worst global pandemic in modern times was
the 1918“19 Spanish Flu that killed more than forty million people. The
1957 Asian Flu and the 1968 Hong Kong Flu each accounted for millions
of casualties.

Reasons for Concern
A key to ¬‚u™s dangers is its mutability. It is among nature™s simplest and most
mutation-prone RNA viruses, with an eight-segment genome encoding
ten proteins.13 Its segments break up in the host and absorb different
genetic material in a process called reassortment. As the virus moves from
migratory birds to domesticated foul and swine and then to humans, its
genetic code “shifts” creating new strains. This natural process is random,
but it is a trivial matter to induce changes with rudimentary equipment, a
stockpile of eggs, and pedestrian understanding of its well-mapped gene
sequence. Legitimate scientists extensively study the in¬‚uenza virus and
regularly mix and match ¬‚u genes; modifying its genome requires common
knowledge and equipment.14 It is more dif¬cult to direct that process to
make ¬‚u effective for bioviolence.
The lethality of a particular strain of ¬‚u depends in part on how rapidly
the virus replicates within the host. Most human strains replicate slowly
enough so that healthy persons™ immune systems can defeat the inva-
sion albeit after a few days of fever and discomfort. People with compro-
mised immune systems or elderly persons succumb more readily because
29
METHODS OF BIOVIOLENCE

even a slowly replicating virus meets little resistance. By contrast, the 1918
virus (an H5 N1 variant) replicated thousands of times faster than common
strains; young healthy adults died disproportionately, often within a day
of contracting the disease. Midlife healthy persons™ stronger immune sys-
tems might have been their death sentence as the wildly multiplying virus
caused shock due to immune system overload.
Recently, scientists took RNA fragments of the 1918 in¬‚uenza from the
lungs of victims preserved in pathology museums or frozen permafrost15
and reconstituted the disease using commonly available reverse genet-
ics techniques.16 Researchers learned which genes were responsible for
making the virus so harmful17 and, in 2005, published the virus™s genetic
code on the internet and in Science magazine.18 Experts are concerned
that hostile perpetrators could abuse these widely understood techniques
to reproduce the 1918 in¬‚uenza.19
At this time, the Avian Flu (another H5 N1 variant) is threatening to ignite
a new pandemic. Remarkably lethal, it has killed upward of 50 percent of
those who contracted it from infected birds or very close contact with
infected persons. Fortunately, it is not now readily contagious human-
to-human via casual aerosol delivery. Could the virus, through natural

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