The Next Phase: Bioterrorism?

Easily produced, germ weapons could wreak even greater chaos than suicide pilots in hijacked planes

As devastating as the World Trade Center and Pentagon attacks have been, a different kind of terrorist strike could be worse--much worse. Try to picture tens of thousands, or millions, of Americans dead; commerce, even the routine delivery of food, paralyzed across the nation; and neighbor set against neighbor as society's institutions crumble.

That's the scenario that could play out if terrorists were to unleash a biological weapon such as smallpox, anthrax, or other devastating agents of disease (table). And currently there's little we can do to prevent it--or contain it once such an epidemic begins. Oklahoma Governor Frank Keating grasped this chilling reality in late June when he participated in a war-game exercise. "It not only stunned me how horrific a biological attack could be," he says, "but also how woefully unprepared we are."

To be sure, some security experts have considered a biological attack to be extremely unlikely. They figure most terrorists don't have the capability to grow and deliver deadly viruses or bacteria. Besides, anyone who unleashes a plague is guaranteed to provoke unprecedented moral outrage and retaliation. And even terrorists know that biological assaults are notoriously unpredictable. Disease epidemics could sweep the planet, indiscriminately killing terrorists' families along with Christians, Muslims, Jews, and everyone else.

But most experts fear that the threat is real and growing. "Bioterrorism will be the next event," predicts Dr. Bertram S. Brown, co-founder of the Potomac Institute for Policy Studies. Intelligence agencies were stunned in 1993 when a defector from the Soviet bioweapons program revealed that the Soviet Union had made tons of smallpox virus for delivery in missiles, in violation of the 1972 Biological Weapons Convention. Another nasty shock came in 1995, when Saddam Hussein's son-in-law defected with news of Iraq's unexpectedly sophisticated bioweapons program.

GROWING CLUB. Now, there's evidence that Iraq, Iran, Libya, China, North Korea, Russia, Israel, Pakistan, and Taiwan have biological arsenals, and the group is growing. Only one or two of these nations is presumed to possess the most dangerous of the scourges, smallpox. But verifying that is difficult--which highlights another dimension of the problem. The facilities for breeding bioweapons, from small factories down to a laboratory bench, are almost impossible to pinpoint or track. Without more defectors, "the amount of hard information as to who has what is minimal," says Dr. D.A. Henderson, director of the Johns Hopkins University's Center for Civilian Biodefense Studies and leader of the successful global effort to eradicate smallpox.

Indeed, because of modern biotechnology, brewing up a pot of deadly germs is easier than ever. "The same fermenter used to make beer or a drug can grow anthrax an hour later," says a Capitol Hill national security aide. In addition, gene-splicing makes it theoretically possible to engineer supergerms deadlier than anything nature has created. Even if terrorists can't make the stuff themselves, they might buy it from Saddam Hussein or hire a few of the tens of thousands of former Soviet bioweapons scientists cast adrift when the country's facilities shut down. According to some reports, Osama bin Laden has been trying to create a bio arsenal. And Sept. 11 proved that hate and extremism have swept aside the political and moral restraints that once discouraged terrorists from mass slaughter. "Today, we talk about flying bombs," says Yonah Alexander, director of the Potomac Institute's International Center for Terrorism Studies. "Tomorrow, we will talk about scientific bombs."

War games have helped the U.S. security experts and politicians flesh out the gory details. In June, Colonel Randall J. Larsen, director of the nonprofit ANSER Institute for Homeland Security, conducted a simulation with Johns Hopkins, the Center for Strategic & International Studies, the Oklahoma City National Memorial Institute for the Prevention of Terrorism, Governor Keating, and others. In this exercise, dubbed Dark Winter, Iraqi-financed Afghan terrorists spray smallpox viruses into shopping malls in Oklahoma City, Atlanta, and Philadelphia. The act goes unnoticed until nine days to two weeks later when people start showing up in emergency rooms in Oklahoma City complaining of fever and rash.

Trying to contain and fight the outbreak, Keating shuts the state's airports, closes the borders, and orders vaccinations for all medical personnel. The actions anger federal authorities and the military, who want to save limited vaccine supplies for the armed forces. But it's too late, anyway. By then, each victim has infected at least 10 others, some of whom are already spreading contagion in other states.

As the horror spreads, everything spins out of control. Commerce comes to a halt; even food deliveries stop. Nationwide air travel and the stock market shut down. With no treatment, the only way to fight the disease is with vaccines, which quickly run out or can't be delivered, and quarantines, which can't be enforced without heavy-handed military muscle. "All of a sudden, the house of cards falls down," says Larsen. Within three weeks, 16,000 people are sick, and more than 5,000 of them will die. After two months, 3 million are stricken, and 1 million will die. And still, the epidemic continues to grow.

As the Dark Winter participants learned, preparations for biowarfare are frighteningly inadequate. The U.S. has only a fraction of the vaccine needed to respond to a smallpox attack. In 1972, a single case of smallpox in Yugoslavia touched off an outbreak that required 20 million vaccinations and mass quarantines to stamp out the disease. The U.S., in contrast, has only 15 million doses of old vaccine, made before 1982. "If we don't prepare for such an awful event, we may put our very democracy at risk," warns Joseph R. Biden Jr. (D-Del.), chairman of the Senate Committee on Foreign Relations.

Of the myriad biothreats, smallpox presents the gravest danger because it's so contagious and because the general population in the U.S. hasn't been vaccinated since 1972. Health authorities decided then that the risks of vaccination were greater than the danger posed by a disease being wiped out globally. But in a twist of history, we could be victims of the same scourge that Europeans--sometimes intentionally--unleashed in the New World centuries ago, decimating Native American populations.

There are plenty of other threats, as well. A suspected accidental release of just milligrams' worth of anthrax from a Soviet facility in Sverdlovsk in 1979 killed more than 65 people. Iraq has admitted to producing vast amounts of anthrax. And after the Japanese cult Aum Shinrikyo killed people on the Tokyo subway with a nerve gas in 1995, authorities learned that the group had been planning a more deadly attack using large quantities of the bacterium. Without prior vaccination or quick administration of antibiotics, anthrax is almost always fatal. "If terrorists went Johnny Appleseed and distributed it here and there across the country, there would be chaos," says Hopkins' Henderson.

NATIONAL STOCKPILE. The sliver of good news is that the U.S. has begun to face this potential horror. In 1999, the Clinton Administration launched a bioterrorism initiative. Among other things, the effort has beefed up laboratories' ability to quickly identify suspected biological agents and created a national stockpile of antibiotics and drugs that can be rushed to fight a nascent epidemic. Also, in September, 2000, the government signed a $343 million contract with biotech company Acambis PLC to make 40 million doses of smallpox vaccine by a new production method. "It will be packaged in nice kits, ready to go," says Thomas P. Monath, MD, Acambis vice-president for research & medical affairs.

Meanwhile, states have set up offices to handle the complex coordination among hospitals, rescue teams, law enforcement, and others needed to fight a terrorist bioweapons attack. "We have a ways to go, but we're better prepared now than we've been before," says Dr. Julie A. Casani, medical coordinator for emergency preparedness and response for the state of Maryland.

Not only will such plans lessen the toll from bioterrorist attacks, their existence "will discourage the use of the organisms in the first place," Henderson believes. After all, if the U.S. is capable of nipping epidemics in the bud, why bother even launching a bio attack? There's another benefit: Boosting public-health capabilities will improve America's ability to respond to nature's own outbreaks, such as West Nile virus or tomorrow's equivalent of AIDS. But experts warn that current preparations are just a start. Unless the U.S. and the rest of the world step up efforts to combat bioterrorism, the toll next time may be so high that even the horror of Sept. 11 will pale in comparison.

By John Carey, with Phoebe Eliopoulos in Washington and Neil Gross in New York

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