28 November 2016

Bioterror: The Known Unknown

By: Shannon Mizzi,

It is increasingly clear that nation states no longer have a monopoly on biological weapons. At the same time, new technology is making the information and equipment needed to create them cheaper and more accessible. Both state and non-state actors could weaponize known bacteria or viruses such as anthrax, smallpox, botulinum, and Ebola. However, because of advances in genetic engineering, it is just as likely that future threats will come from a new, more deadly strain of a known disease. Despite a heavy counterterrorism emphasis, the United States government is in no way ready for a bioterror attack on a grand scale, and should be doing more to prepare for both conventional and emerging threats.

Conventional threats are the weaponization of known diseases or bacteria such as smallpox and anthrax. Although the U.S. and Russia are the only two countries permitted to retain smallpox samples, intelligence tells us both Iraq and North Korea have them illegally, and North Korea has a long-standing biological weapons program.[i] Experts believe that North Korea can produce smallpox, anthrax, rabbit fever, and hemorrhagic fever-based biological weapons without external help.[ii] Meanwhile, the U.S. is almost entirely focused on North Korea’s nuclear missile program even though their nuclear missiles are not yet able to reach us. A group or individual bent on perpetrating a bioterror attack on the U.S. need not set foot on American soil to create a pandemic, they need only release an undetectable sample in a crowded airport terminal. Because most of the rest of the world is even less prepared to face an attack, the U.S. is extremely vulnerable, making readiness even more important. A comprehensive strategy must prevent information from falling into the wrong hands and defend against public health threats with appropriate policies and interagency coordination.

Unconventional threats-those that are genetically engineered-are difficult to define. We’re not yet sure what form they will take, but we do know how they might be created. For example, CRISPR, perhaps the simplest tool for editing genes in any organism, is increasingly inexpensive and easy to use. Just last week, CRISPR was used on a human for the first time to combat cancer cells, but in the wrong hands, it could be exploited for nefarious purposes.[iii] A single person with the know-how could genetically engineer an insect or disease that could target livestock, destroy crop yields, and cause pandemics.

Currently, the United States has scattered anti-bioterror programs in a variety of agencies. They are not coordinated, well-funded, or ready to respond to a modern attack in a comprehensive manner. Much of the current American biodefense “strategy” is delineated in the reauthorized Project BioShield Act of 2004, but it does not provide guidance for all agencies that have biodefense programming. For example, the Department of Homeland Security maintains its own preparedness protocols for a bioterror event, and rolled out its updated BioSurveillance Program in 2012 to pinpoint the origins of an attack and send early warnings to healthcare workers. However, DHS has not yet implemented key aspects of this program, including information sharing at the local, state, and national levels.

Other agencies have beneficial programs, but don’t communicate with one another, risking duplication of efforts. Departments with bioterror programs include the Department of Health and Human Services, the CDC, Department of Defense, FEMA, USAID, and the U.S. Department of Agriculture. The problem is not a lack of programming, but a lack of readiness, funding, forward thinking, and coordination on this important issue.[iv] A comprehensive study of biodefense capabilities and preparedness was last published in 2010; not surprisingly, the report gave U.S. biodefense an “F.”[v] Assessments of individual agencies since then indicate little improvement, and dramatic budget cuts for the CDC and USDA are not helping.[vi] Federal spending on biodefense programs was $6.69 billion in FY2014. However, only 12% of that figure was reserved for programs solely focused on biodefense; the remaining 88% went to programs with multiple goals.[vii]

There are a number of steps the U.S. can take to remedy this situation. First, a comprehensive interagency strategy must place a premium on readiness. There is no point in having a stockpile of enough smallpox vaccinations to inoculate every American if there are no vaccine distribution plans in place.[viii] It is important to create systems to aggregate data on both humans and animals from hospitals on the local, regional, and national level to help doctors identify the cause of patients’ symptoms, and stop or limit the spread of a bioterror agent. Hospital workers should be trained on symptoms of potential bioterror bacteria or viruses, as there will be little time for such training during an outbreak.

Second, the government must address the major emerging challenge of “dual use” biotechnology that can be manipulated to help or to harm. The government should carefully monitor synthetic biological experimentation, such as gene editing, both domestically and internationally. It should also regulate, where appropriate, as new techniques are developed. However, it is exceptionally important to avoid over-regulation lest it stifle positive innovation in a nascent field which could bring an economic boom and eradicate diseases in the not-so-distant future. The United States must strike a balance between measured steps to enhance readiness and pushing the panic button. To increase public knowledge without inciting panic, the government should also encourage and facilitate public conversations around a new bioethics framework, in light of gene editing technology and the rise of “do-it-yourself” biology.[ix]

Finally, in addition to strengthening domestic strategy, the United States must also advocate internationally. The 1972 UN Biological Weapons Convention (BWC), which prohibits their use, has 175 parties but only 22 have ratified it.[x] Though the convention is old, it still covers any form of genetic engineering performed to intentionally do harm. As we enter a new era in biotechnology, the international community must be vigilant and impose sanctions on countries that use bioweapons. The U.S. should continue to encourage preparedness measures through the United Nations and advocate for the strengthening of the BWC to ensure violators are held accountable. A new monitoring organization, like the International Atomic Energy Agency, may be needed as the genetics-based biotechnology industry takes off.

The U.S. government no longer has a functioning bioterror strategy, just a series of unconnected programs in disparate agencies. Both interagency and intra-agency cooperation must be dramatically improved if the maximum number of lives are to be saved in the event of an attack. Terrorists of all stripes look for weak points in national defense systems, and this is one of ours. The U.S. government must broaden its conception of what a bioterror attack might look like, and go beyond – but still be ready for – conventional agents. Whether an attack comes this month, or ten years from now, we must raise public awareness without creating public alarm.

[i] David Cloud and Nicholas Kulish, “Iraq and North Korea Possess Smallpox, Intelligence Indicates.” The Wall Street Journal, November 6, 2002, http://www.wsj.com/articles/SB1036495803321406668.

[ii] Ministry of National Defense Republic of Korea. “2012 Defense White Paper,” December 11, 2012, https://www.nti.org/media/pdfs/ROK_2012_White_Paper.pdf.

[iii] David Cyranoski, “CRISPR gene-editing tested in a person for the first time.” Nature, November 15, 2016, http://www.nature.com/news/crispr-gene-editing-tested-in-a-person-for-the-first-time-1.20988?WT.mc_id=FBK_NA_1611_FHNEWSCRISPRTESTED_PORTFOLIO.

[iv] Thomas Gibbons-Neff, “Blue Ribbon Panel report: United States lacking in biodefense.” The Washington Post, October 28, 2015; Blue Ribbon Panel, “A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts.” October 2015,

[v] National Biodefense Science Board, “Where are the countermeasures?: Protecting America’s Health from CBRN Threats.” March 2010. http://www.phe.gov/Preparedness/legal/boards/nprsb/meetings/Documents/nbsb-mcmreport.pdf.

[vi] Oliver Grundmann, “The current state of bioterrorist attack surveillance and preparedness in the U.S.” Risk Management Health Policy, October 9, 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199656.

[vii] Tara Kirk Sell and Matthew Watson, “Federal Agency Biodefense Funding, FY2013-FY2014.” Biosecurity and Bioterrorism, September 11, 2013.

[viii] Center for Disease Control, ‘Smallpox: Fact vs. Fiction.” December 30, 2004, https://emergency.cdc.gov/agent/smallpox/disease/pdf/factorfiction.pdf.

[ix] Laurie Garrett. “Biology’s Brave New World: The Promise and Perils of the Synbio Revolution.” Foreign Affairs, November/December 2013, https://www.foreignaffairs.com/articles/2013-10-15/biologys-brave-new-world.

[x] Arms Control Association. “Biological Weapons Convention Signatories and States-Parties.” Updated July 2016, https://www.armscontrol.org/factsheets/bwcsig.
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