Who’s Afraid of the Big, Bad Bioterrorist?

The recent dustup about The H5N1 Bird Flu Plague That Will Kill Us All (not) has brought the topic of “bioterrorism” into the media spotlight again. This is an issue I’ve been following for several years, and during that time I’ve come to a conclusion that’s pretty much the opposite of everything we’ve been told: biodefense is largely a waste of money.

Let’s start with the current definition of the problem. The US government has prepared a list of “select agents” that are considered potential biological weapons. Researchers who work on these agents have to get special clearances, and an entire multi-billion-dollar industry of defense contractors has sprung up to help the nation prepare for a terrorist attack using one of these weapons. I have two problems with this list.

First, several of the listed “agents” shouldn’t be treated as biological threats at all; they are chemical weapons. Botulinum toxin and ricin, for example, both appear on the list, but an attack with either of these toxins would bear no resemblance to a biological outbreak. Their toxicity is generally acute, so the first responders to such attacks would be police and firefighters, whereas the first responders to a true biological attack would be physicians and nurses. Toxins don’t reproduce or spread, so the response would be about containing and decontaminating the scene, not tracking contacts and cases. The list conflates two completely different types of threats. But perhaps that’s just a technical gripe.

The second problem is much more serious. Eliminating the toxins, we’re left with a list of infectious bacteria and viruses. With a single exception, these organisms are probably near-useless as weapons, and history proves it.

There have been at least three well-documented military-style deployments of infectious agents from the list, plus one deployment of an agent that’s not on the list. I’m focusing entirely on the modern era, by the way. There are historical reports of armies catapulting plague-ridden corpses over city walls and conquistadors trying to inoculate blankets with Variola (smallpox), but it’s not clear those “attacks” were effective. Those diseases tended to spread like, well, plagues, so there’s no telling whether the targets really caught the diseases from the bodies and blankets, or simply picked them up through casual contact with their enemies.

Of the four modern biowarfare incidents, two have been fatal. The first was the 1979 Sverdlovsk anthrax incident, which killed an estimated 100 people. In that case, a Soviet-built biological weapons lab accidentally released a large plume of weaponized Bacillus anthracis (anthrax) over a major city. Soviet authorities tried to blame the resulting fatalities on “bad meat,” but in the 1990s Western investigators were finally able to piece together the real story. The second fatal incident also involved anthrax from a government-run lab: the 2001 “Amerithrax” attacks. That time, a rogue employee (or perhaps employees) of the government’s main bioweapons lab sent weaponized, powdered anthrax through the US postal service. Five people died.

That gives us a grand total of around 105 deaths, entirely from agents that were grown and weaponized in officially-sanctioned and funded bioweapons research labs. Remember that.

Terrorist groups have also deployed biological weapons twice, and these cases are very instructive. The first was the 1984 Rajneeshee bioterror attack, in which members of a cult in Oregon inoculated restaurant salad bars with Salmonella bacteria (an agent that’s not on the “select” list). 751 people got sick, but nobody died. Public health authorities handled it as a conventional foodborne Salmonella outbreak, identified the sources and contained them. Nobody even would have known it was a deliberate attack if a member of the cult hadn’t come forward afterward with a confession. Lesson: our existing public health infrastructure was entirely adequate to respond to a major bioterrorist attack.

The second genuine bioterrorist attack took place in 1993. Members of the Aum Shinrikyo cult successfully isolated and grew a large stock of anthrax bacteria, then sprayed it as an aerosol from the roof of a building in downtown Tokyo. The cult was well-financed, and had many highly educated members, so this release over the world’s largest city really represented a worst-case scenario.

Nobody got sick or died. From the cult’s perspective, it was a complete and utter failure. Again, the only reason we even found out about it was a post-hoc confession. Aum members later demonstrated their lab skills by producing Sarin nerve gas, with far deadlier results. Lesson: one of the top “select agents” is extremely hard to grow and deploy even for relatively skilled non-state groups. It’s a really crappy bioterrorist weapon.

Taken together, these events point to an uncomfortable but inevitable conclusion: our biodefense industry is a far greater threat to us than any actual bioterrorists.

For comparison, Timothy McVeigh pulled a Ryder rental truck full of ammonium nitrate and fuel oil (both very easily obtained) in front of a Federal building, and killed 168 people. The 9/11 hijackers killed almost 3,000 people and blew up the headquarters of the United States military, using box cutters and basic flight training. In 2000, a couple of guys in an inflatable boat full of explosives totaled an American battleship. I could go on, but hopefully you get the point: conventional weapons are orders of magnitude more effective for terrorism than biological ones.

Astute readers may have noticed that I mentioned a single exception on the select agent list. I’m talking about smallpox, and the reason it’s an exception is interesting: it’s a good weapon only because we successfully eradicated it.

Had the World Health Organization focused on controlling smallpox instead of eradicating it, there would have been continued pressure to develop improved vaccines, and likely continued vaccination. That’s the pattern now with poliovirus, which has been incorporated into one of the standard combination vaccines that kids receive.

But because the WHO focused on eradicating smallpox instead, they stuck with the primitive vaccine originally developed in the 18th century by Edward Jenner. Once the world was certified smallpox-free, vaccination stopped. Now, nearly everyone born in the past forty years or so is susceptible to this highly contagious, highly lethal virus.

Smallpox would still be a very poor choice for bioterrorism, but for a different reason than the rest of the select agents. A terrorist group that actually got ahold of it could probably culture it and deploy it without much trouble – in many ways it would be easier to work with than anthrax. However, there is no question who would be hit hardest by a new global pandemic of smallpox: the poor countries. The US already stockpiles hundreds of millions of doses of smallpox vaccine and antivirals. Once an outbreak was identified, it would be straightforward to track and stop, at least in the developed world. The people who would suffer and die would be precisely the ones most terrorist groups are trying to represent. Military types call that “blowback,” and it’s a very bad thing.

So what should we do? First, stop panicking. Terrorist groups have repeatedly said they want biological weapons, but that’s either propaganda or fantasy. The groups that have actually pursued such weapons have found that they’re a complete waste of resources. However, the fear of bioweapons has caused governments around the world – particularly in the US – to spend billions of dollars on technologies they will never need. Spending the same money on our ailing public health system would have been a much better investment.

We should keep stockpiling vaccines and antivirals against smallpox, against the tiny but nonzero probability that some terrorist might actually have the contradictory combination of resourcefulness and stupidity necessary to get ahold of this virus, then deploy it. We should probably continue researching improved smallpox vaccines, too, if only because the work could yield useful insights about other, more relevant viruses. But most importantly, we should drastically reduce the size of our current “biodefense” efforts, which have unambiguously proven themselves to be more harmful than beneficial. Hiring and training more people to work with select agents is the problem, not the solution.