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mutation, stumble upon a genetic combination that is equally lethal but
far more contagious? How dif¬cult would it be for a malevolent biosci-
entist to manipulate the natural virus to augment its contagiousness?20
Some experts predict that a readily contagious Avian Flu pandemic could
generate more than 180 million casualties worldwide.21 What might that
number be if human malevolence operates to transmit the virus through-
out diverse population centers? What if suicide carriers deliberately outwit
health care responders trying to contain the disease, thwarting efforts to
curtail the disease™s spread by harassing medical supplies and disrupting
quarantines?22

Limits of Protection
On April 1, 2005, President Bush authorized the use of quarantines and
other isolation measures against international travelers suspected of carry-
ing in¬‚uenza.23 Yet, because in¬‚uenza naturally occurs, medical personnel
would have a dif¬cult time identifying a bioviolence ¬‚u attack early on.24
An attack might initially be mistaken for a natural outbreak. Moreover, it
is unlikely that isolation measures would be successful given in¬‚uenza™s
high level of contagiousness. These measures might be marginally effec-
tive in the United States, but it is unrealistic to believe that comparable
measures could have a discernible impact in developing nations.
30 BIOVIOLENCE: PREVENTING BIOLOGICAL TERROR AND CRIME

Vaccines are the best line of defense for seasonal in¬‚uenza out-
breaks but would have doubtful ef¬cacy in controlling an intentional ¬‚u
pandemic.25 In¬‚uenza vaccines are produced each year after the WHO
identi¬es the likely disease strain. For vaccines to work, people must be
vaccinated before exposure to the virus; once a person has contracted the
disease, it is dangerous to administer a vaccine made from viral strains
because it might re-assort with the actual virus. After an outbreak of an
unexpected strain, it would take approximately six months to develop
and distribute in¬‚uenza vaccines and additional months to deliver them,
just about the same time it would take for the virus to spread around the
world.26 In view of in¬‚uenza™s very short incubation period, masses could
already be exposed before health of¬cials could administer the vaccine.
Vaccines would therefore play only a limited role within the ¬rst twelve to
eighteen months of the pandemic.
Moreover, there are barriers to vaccine preparation. Producers com-
plain that they could not manufacture suf¬cient doses of vaccine in
such haste without special liability protection.27 (Liability protections for
vaccine producers are discussed in Chapter 6.) Vaccines are produced
now by companies in nine developed nations: Australia, Canada, France,
Germany, Italy, Japan, the Netherlands, the United Kingdom, and the
United States.28 Likely, during a ¬‚u pandemic, these nations will national-
ize vaccine production facilities and reserve supplies for domestic popula-
tions. If so, perhaps fewer than 500 million people (7 percent of the world™s
population) would be vaccinated.29
Antiviral medications and inhibitor drugs could be an effective coun-
termeasure to an in¬‚uenza attack, but these medications are in short
supply. Moreover, because of ¬‚u™s short incubation period, administering
these drugs quickly enough would be a grave challenge, and they can-
not repair damage already done to the host.30 Yet, it is noteworthy that in
April 2007, the World Health Organization brought experts together to dis-
cuss the creation, maintenance, and funding of a global stockpile of H5 N1
vaccine and medications. These experts agreed that the stockpile was fea-
sible and consistent with International Health Regulations that are the
overarching framework to ensure global health security.31
Even if a super-lethal in¬‚uenza outbreak could be contained and the
number of casualties limited, the devastating economic impact through-
out the world could have dire international security implications. The
WHO estimates as much as $200 billion in losses worldwide with a mod-
est avian in¬‚uenza pandemic.32 Also worth remembering here is that
social interaction stopped during the 1918 epidemic; people were afraid
to embrace, shake hands, or even stand next to one another. Group
31
METHODS OF BIOVIOLENCE

stereotypes were exaggerated, and doctors, nurses, and healthcare work-
ers were accused of deliberately infecting patients. A modern in¬‚uenza
attack could have similar disruptive consequences.


Hemorrhagic Fever Viruses
The hemorrhagic fever viruses including ebola, marburg, lassa virus, rift
valley fever, yellow fever, omsk hemorrhagic fever, and kyasanur forest
disease are widely considered to be bioviolence agents. Indeed, both the
former Soviet Union and the United States weaponized these viruses; the
Soviets allegedly stockpiled large quantities of the ebola and marburg
viruses until 1992. These viruses can be exceptionally lethal “ marburg
has a death rate of 25“70 percent; ebola has a much higher case fatality
of 50“90 percent. No cure and no vaccine are available for these viruses.
Treatment is limited to supportive therapy requiring continual attentive
care. A widespread outbreak would put enormous strain on public health
personnel who would have to monitor everyone in a major city that exhibits
symptoms as well as take radical measures to protect themselves and the
public from contagion.
These viruses have substantial disadvantages for use as weapons. An
offender would have to avoid the substantial risk of unintentional self-
infection. Also, carriers are contagious only after the two to twenty-one
day period of incubation when symptoms of fever, chills, headache, and
body ache are horribly manifest. Yet, these viruses are regularly cited as
topics of potential research that could alter key attributes so as to make
them more favorable terror weapons.33 With advancing knowledge about
how to manipulate viruses, the traits that make these agents dif¬cult to
weaponize might be a diminishing barrier.


Acquiring the Agent: Initiating the Attack
The ¬rst challenge is acquiring the agent. One option would be to obtain
the virus from a naturally occurring outbreak. Indeed, in 1992, the Japanese
cult Aum Shinrikyo (now known as Aleph) sent a “medical mission” to
Zaire to purportedly help care for the victims of an ebola outbreak; it really
sought to collect and cultivate ebola samples to bring back to Japan.34 Its
efforts, however, did not give rise to a successful attack.
A more covert way to acquire these viruses would be from animal car-
riers. The offender would have to travel to the rainforests of Africa or to
areas in the Western Paci¬c where the virus is indigenous.35 He would
have to canvass numerous bats (the disease™s natural reservoir)36 and col-
lect several ¬eld samples in order to isolate the virus. Even if he ¬nds an
32 BIOVIOLENCE: PREVENTING BIOLOGICAL TERROR AND CRIME

infected animal, it would be dif¬cult to carry it undiscovered through cus-
toms. He could, of course, self-infect by coming into direct contact with
the animal™s feces, urine, or saliva or by handling an infected carcass. But
if he self-infects prematurely, he will be dead or obviously ill before arriv-
ing at population centers. An attack of this type would, therefore, require
substantial logistical planning.
Alternatively, a bio-offender might try to acquire agent strains from
a laboratory. It is unlikely, however, that an offender would purchase or
steal agents from a guarded laboratory lest he raise alarms and expose the
criminal plot to authorities. Experiments with viral strains are performed in
Biosafety Level (BSL) 4 labs (the highest level requiring the utmost protec-
tion and security), although specimens can be stored in BSL-2 facilities.37
A less-guarded laboratory or clinic, especially near locations where these
viruses are endemic, might pose considerably fewer obstacles.

Disseminating the Virus
Although these viruses are contagious, transmission among humans is not
as easy as transmitting the ¬‚u. Natural aerosol transmission is not con-
sidered effective for these viruses,38 although it has been documented.39
Certainly, direct contact with infected body ¬‚uids or contaminated bed
sheets and clothing would suf¬ce, but this is not an ef¬cient dissemination
method for a mass attack. To ensure transmission, offenders would have to
aggressively yet undetectably expose people to a patient™s blood, saliva, or
feces by coughing up sputum, contaminating door knobs or hand rails with
mucus or blood, bumping into people to expose their skin to sweat, or even
pricking them with a contaminated needle. There is a window of at most
a few days before being severely debilitated during which time offenders
would have to come into close contact with as many people as possible to
transmit the disease. Soon, the rash, jaundice, and massive hemorrhaging
would likely lead to their detection and isolation; health authorities would
be put on alert and could institute preemptive precautionary measures to
curb the outbreak. Anyone exhibiting symptoms would be advised to seek
medical attention.
With a modi¬ed virus or many attackers (or both), the best dissemi-
nation system is via the enclosed cabin of a crowded passenger jet where
constantly recirculating air and the close proximity of passengers could
expose many people on board. At the destination, the attackers could walk
around the airport, sneeze and cough in crowds, and board another ¬‚ight
to a new destination. At the same time, unknowing victims would board
other ¬‚ights to yet other destinations. Even this method of infecting many
33
METHODS OF BIOVIOLENCE

people is haphazard. Because death is so quick and so horrifying, vic-
tims would be incapacitated then dead before having much opportunity
to infect others. Yet, if a well-designed attack could infect a critical mass
of people, the contagion could spread as the victims would unknowingly
become attackers and continue to spread the virus on their own to an
unlimited number of people.
Aerosol release of a weaponized virus would require isolation, cultiva-
tion, and stabilization of large quantities of the virus. This would require
a thorough knowledge of the virus and sophisticated laboratory as well as
safety equipment for avoiding accidental infection. Moreover, the theory
that humans can contract the ebola or marburg viruses via aerosol deliv-
ery has been based upon reported laboratory experiments on monkeys;
even if perpetrators have the knowledge and capacity to obtain aerosolized
viruses, it is uncertain if an aerosol attack would be effective against
humans.
Another dissemination method for contagious viruses would be to
use living vectors “ typically insects “ to transmit infectious agents. Con-
ceivably, large quantities of mosquitoes could be infected with a disease
that they carry in nature. However, the insect species must be compati-
ble with the chosen pathogen; many mosquitoes have limited geographic
and climatic range; and they are notoriously unreliable. The Soviet Union
researched this dissemination method, and the U.S. Army Chemical Corps
in 1956 released uninfected mosquitoes in the southeast United States to
test the feasibility of insects as dissemination vectors. Although there is
scant evidence that terrorists have mastered techniques for insect dis-
semination, experts have noted that even developed nations such as the
United States are ill-prepared to address this type of attack:

Tools for responding to bioterrorism involving insect agents are lacking.
Effective traps or other detection methods, federal and state action plans,
eradication plans tested in the region of the insects™ origins, pesticides reg-
istered for use against insect agents, educational plans for the agricultural
community and general public, and legal understanding and enforcement
to institute control measures are needed.40



ANTHRAX

Anthrax is atop everyone™s list of bioviolence agents. U.S., Soviet, and Iraqi
bioweaponeers valued anthrax as one of the best agents for offensive
military purposes. It is remarkably lethal. Inhaled anthrax spores rapidly
34 BIOVIOLENCE: PREVENTING BIOLOGICAL TERROR AND CRIME

multiply and release powerful toxins; the fatality rate for untreated inhala-
tional anthrax approaches 100 percent. Prompt treatment with powerful
antibiotics can save lives, but the larger the quantity of inhaled anthrax,
the more quickly those antibiotics must be administered.41 If administered
too late, victims face agonizing death regardless of modern medicine™s best
efforts. Fortunately, anthrax is not contagious person-to-person. Igniting
a global anthrax epidemic is impossible, but multiple separate attacks
throughout the world present a hugely potent threat.
The WHO estimates that ¬fty kilograms of anthrax disseminated over
an urban population of ¬ve million would result in 250,000 casualties.
The United States Congressional Of¬ce of Technology Assessment esti-
mates that at least 130,000 deaths could result from the aerosolized
dissemination of one hundred kilograms of anthrax spores upwind
from the Washington, DC, area. According to a CDC economic model,
an anthrax attack would cost $26.2 billion for every 100,000 persons
exposed.42
In late 2001, only weeks after the World Trade Center bombings, highly
re¬ned anthrax powder was laced on envelopes mailed to senators and
media ¬gures. Twenty-two cases (eleven cutaneous “ through skin “ and
eleven inhalational) were identi¬ed; ¬ve people died. The genetic ¬nger-
print of the anthrax proved it was a version of the Ames strain that was used
in U.S. and other bioweapons programs, although experts contend that
the anthrax was not of weapons-quality. The spores were highly re¬ned,
enabling them to ¬‚oat for optimal dispersion and easy inhalation.43 When
asked of the potential origin of the Ames strain of anthrax mailed to the
Senate of¬ce buildings, Dr. Alibek answered, “ . . . to get this type of product
[anthrax], there is no necessity to have any sophisticated equipment. . . . It
could be done if this person knows how to do this by using very simple
techniques, very simple equipment, and this product could be obtained
in any amount.”44 Elaborating on who could obtain this particular type of
anthrax, Dr. Alibek added:

I am talking about the lowest level of expertise. It could be a lab technician.
It could be a technician working at one of the companies or even somebody
who worked before, many years before, in this ¬eld. . . . Recently, there was
a publication in the New York Times that one individual from Utah was
selling some manuals on how to make anthrax. . . . In this case, if somebody
bought this manual and has some knowledge, has some time and training,
this person would be able to develop this product.45
35
METHODS OF BIOVIOLENCE

There is an anthrax vaccine. Although its effectiveness and side effects
are disputed in connection with its use during the ¬rst Gulf War, it is now
available to military personnel, ¬rst responders, and other of¬cials. This
vaccine could enable a bio-offender to handle anthrax with less risk of
self-infection. A State contemplating use of bioweapons could inoculate
its troops so as to diminish risks of blowback (changes in wind direction
that blow the aerosol in unanticipated directions).


Getting and Cultivating Seed Stock
Anthrax is widely endemic to grazing animals such as sheep, cattle, and
goats; cutaneous infection is an occupational hazard for people who work
with such animals or their hides. Eating undercooked meat from infected
animals can lead to gastrointestinal anthrax. These types of natural anthrax
infections occur, not surprisingly, most in countries with low health safety
standards but are rare in developed nations. Neither cutaneous nor gas-
trointestinal anthrax pose a risk of a biocatastrophe that is comparable to
inhalational anthrax.
Unlike smallpox, which requires scant if any weaponization, prepara-
tion of anthrax for a mass catastrophe is challenging. Anthrax is a spore; in
its natural condition, it falls to the ground where it is unlikely to be inhaled.
An attacker would have to suspend spores in the air at nose-height, heavy
enough to not be blown away and small enough to penetrate into the lungs.
Although growing it is easy, it is dif¬cult to separate and aerosolize large
amounts with requisite size, weight, and viscosity for a widespread attack.
Moreover, there are myriad strains, most of which are not particularly
useful from a weapons perspective. The attacker would have to choose a
particular strain that satis¬es technical requirements for weaponization.
Starting with a natural seed stock, even one of a usable strain, would
entail re¬ning, which requires know-how and equipment that could be

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