Germs For Generals: Biological threat assessment in a changing world order
Abstract
In a post-Cold War, post-11 September world, the field of biosecurity has increased, both in importance and scope, as a concern for military and civilian authorities. This article explores some of those nascent threats, and their implications for military forces.
Introduction
In the immediate aftermath of the attacks of 11 September 2001, the threats posed by the new world order that emerged shifted Defence and First Response agencies out of their post–Cold War comfort zone. Familiar threats, detection technology and delivery organisations became obsolete. Among the notable capability gaps to emerge in late 2001 was the need for better systems to deal with deliberate biological agent release. The white powder/anthrax attacks in the United States caused a wave of copycat incidents around the world. While almost all of these were the result of malicious hoaxes or civilian panic, response agencies were quickly inundated. The ensuing six years has seen a convergence of military and civilian emergency response tasking, with ever-closer collaboration between response agencies. The field of biosecurity has become very broad because everyone is potentially vulnerable, whether the biological threat is accidental, natural or deliberate. In this respect, there are no neutral parties; only threats and targets. Everyone is a combatant.
Changing Biological Threat Profile
The list of biological threat agents kept in view during the Cold War was remarkably short.
Table 1: Soviet biological threat agents, 1926-921
| Biological agents | Weaponised | Research only |
| • Bacterial | • Anthrax | • Brucellosis |
| • Glanders | • Typhus | |
| • Plague | • Melioidosis | |
| • Q fever | • Psittacosis | |
| • Tularaemia | ||
| • Viral | • Smallpox | • Ebola |
| • Marburg | • Bolivian hemorrhagic fever | |
| • Venezuelan equine | • Argentinian hemorrhagic fever | |
| encephalitis (VEE) | • Lassa fever | |
| • Japanese encephalitis | ||
| • Russian spring-summer encephalitis | ||
| • Machupo virus | ||
| • Yellow fever |
An edited version of this list informed public health experts during the break-up of the former Soviet Union in the 1990s. Concern was expressed by former biological weapons scientists that these agents, and the relevant handling skills, could easily fall into the hands of the highest bidder.2 The Soviet bio-weapon list therefore became a starting point for detection, protection and containment countermeasures. The worldwide elimination of smallpox paradoxically made the smallpox virus a more suitable biological weapon in the eyes of some experts.3
Smallpox
Smallpox is a contagious viral infection that was finally eradicated in the 1970s. Since the official announcement of its worldwide elimination in 1980, there has been growing concern about its potential for use as a weapon of bioterrorism. The principal reason for this concern is a combination of a high mortality rate (around 30 per cent), a lack of effective antiviral agents and an unvaccinated world population. Two high-security laboratories have been granted permission to keep stocks of the virus for research and vaccine development. These are at the Centers for Disease Control in Atlanta, Georgia, in the United States, and a Russian governmental laboratory in Koltsovo, Novosibirsk. Both are subject to inspection by the World Health Organisation. There has been persistent speculation that other nations such as North Korea have their own stock of smallpox virus. Nevertheless, current assessments indicate that this virus would be technically more difficult than anthrax to weaponise and effectively deploy, even if access to the virus could be established.4
The reluctance of a small number of laboratories with residual smallpox virus to destroy their stocks helped raise the potential weapon profile of this virus despite significant technical problems in transforming it into an effective tactical weapon. Further concern was voiced following belated recognition, almost fifteen years later, of the true nature of an accidental release of anthrax in Sverdlovsk, USSR, where over seventy people died following the accidental release of anthrax spores from a military compound.5 The accident removed the covers from the Russian biological weapons program, confirming claims made by Alibek and other former Soviet experts.6 Other potential biological weapons such as plague, glanders and tularaemia also featured in the Soviet program.
The anthrax attacks in the United States in late 2001 caused a significant shift in biological threat assessment.7 Five years later, no perpetrator has been successfully indicted. Ominously, gene profiling suggests that the strain used in the 2001 attacks was similar to strains held in US culture collections.8 Unfortunately, bacterial gene profiling was too slow in 2001 to inform forensic investigators before the trail went cold. However, it is clear that the anthrax used in these attacks was not the highly refined, weaponised type expected from a sophisticated, state-sponsored terrorist organisation. The possibility of biological attack by a disaffected US citizen, or a homegrown group with some scientific knowledge and a disruptive agenda, has not been completely ruled out.9
Another deliberate release event, only recognised afterwards, was the contamination of ready-to-eat foods with salmonella by a US religious group.10 In 1984, a spiritual sect led by Sri Bagwan Rajneesh attempted to alter the course of a local election by deliberately contaminating ready-to-eat foods in ten salad bars in Oregon. At least 750 people were infected with Salmonella typhimurium, but it took more than a year to confirm that this was the result of a deliberate release. In this particular case the objective was a high attack rate without significant mortality.
Salmonella
Salmonella is a common bacterial cause of food poisoning and in previously healthy adults usually causes a gastro-intestinal upset that subsides eventually without the need for antibiotic treatment.
These events show how diverse the biological threat can be. The ambiguity of biological threat agents lies in our inability to recognise a deliberate release until cases of human disease appear. Even then, no suspicion of a deliberate release may arise until there have been sufficient cases to show unusual clinical features or pattern of disease. The earliest warning may come from an astute physician or an emergency department, and is quite likely to be confirmed when samples reach a public health laboratory. Unless prior intelligence is available, surveillance is largely passive. That means the very occasional biological weapon event has to be detected against a background of the entire swathe of infectious diseases. If the surveillance system is overly sensitive, false positive reports can create a level of complacency in response agencies and the wider community.11
Public health physicians advise that biological weapon exposure should be considered if the disease has an unusual range of clinical features (e.g. anthrax infection of the lungs), if there is a large number of cases, or if it is an animal infection and there have been no animal cases. However, this presumes a sophisticated level of health intelligence. In reality, the consequences of deliberate biological exposure are likely to change with the specific features of each event.
Implications for Military Response
The changing perception of prevailing biological threats has forced a shift in the technical laboratory skills mix needed. Staff are needed who can work competently and confidently in personal protective equipment and safety cabinets, with unusual biological agents, in a field setting and with staff from other response agencies. This is not a job for entry-grade technicians. It needs a higher level of scientific and communication skills. The cost of developing and sustaining this level of service in any agency is prohibitive if only developed for occasional chemical, biological, radiological and explosive (CBRE) events and exercises. Thus, the growing interest in developing this type of service into a flexible, dual-purpose threat response suited to a wider range of biological threats. Unknown threats, such as powder in an unopened package, are particularly challenging because they require a mixture of chemical and biological analytical skills. Only a few response agencies have operationally tested procedures for unknown chemical and biological threats. More often, the skills and equipment to analyse these reside in different agencies.
Inhalational Anthrax
Anthrax is one of the most studied biological weapon agents because of its suitability for airborne delivery, causing mass casualties with a high fatality rate. When the bacteria that cause anthrax (known as Bacillus anthracis) enter the lungs, they enter nearby tissues where the spores germinate. The bacilli then secrete the toxin that causes most of the effects of inhalational anthrax, including massive inflammation of the nearby lymph nodes and haemorrhage into the lungs. These effects can be recognised in a rapid onset of haemorrhagic pneumonia with widening of the mediastinal shadow on chest X-rays.
In recent years, the perceived threat of bioterrorism has been the drive behind response capacity development. While the Defence Force is naturally relied upon for leadership and skilled manpower for counterterrorism, its assets and doctrine exist principally to counter external threats. Other agencies have developed and strengthened their counterterrorism capability. The opportunity now exists for the Australian Army to refocus its biological threat response capability on current and likely theatres of operation. In a specifically military context, the response posture depends on at least three different types of unit: Environmental Health, Pathology Laboratory and CBR Response units. These elements are likely to come under different chains of command, have different expectations for deployment, and do not necessarily exercise together. The health intelligence product provided by each of these types of unit has no immediate counterpart in civilian public health. These deployable logistic elements could combine in a comprehensive Health Risk Assessment Group (HRAG). An Army HRAG under a single command and control structure will give force commanders a more agile and flexible protective posture. The key elements of capability development will be a revised skills mix for lab, environmental and medical technicians. Individual and parent unit networking will contribute a strategic asset within the meaning of the HNA concept.
Table 2: Health threat assessment skills mix
| Biological threat | Unit | Capability |
| Environmental hazard | Environmental Health | water, food, air, vector borne |
| Infectious disease | Pathology Laboratory | diagnostic microbiology |
| Biological weapons | CBR Response | detection & containment |
Warstoppers
Chemical and toxic agents have received relatively more attention than biological agents as potential warstoppers. The rapid effect of chemicals and biological toxins was considered tactically useful in a Cold War setting. Though it was a civilian terrorism incident, the sarin attack on a Tokyo subway demonstrated how quickly a nerve agent could produce its effect on an unprepared population.12 Biological agents, on the other hand, take longer to manifest their effects, with the exception of a short list of biological toxins such as such as ricin, staphylococcal enterotoxin and botulinum toxin. The military potential of the classical biological weapons agent lies more in the perceived threat of delayed but possibly fatal consequences. That threat can be enough to degrade operational readiness through the need to use CBR protective equipment, and could deny use of materiel or delay access to newly occupied territory. These may seem of little concern compared to the threat from munitions and small-arms fire. In a conventional warfare setting, the risk of collateral damage to friendly forces and non-combatants is much higher with a biological weapon. These considerations have probably stayed the hand of military commanders with biological weapon capability in past conflicts. The risk from these relatively uncontrollable weapons is tragically illustrated by the circumstances of the Sverdlovsk anthrax event.
There is an evident paradox in the suitability of specific biological agents for tactical military use. The high profile agents that can theoretically survive dispersal and persist in the environment (e.g. anthrax spores, bacteria that cause glanders, melioidosis, tularaemia and Q fever) do not pose an immediate knock-down threat. While they have the potential to do serious harm and even kill following inhalation or exposure across broken skin, the attack rate would be low. They are probably more important as instruments of territorial denial and psychological attack in prolonged conventional warfare; an inconvenience to field commanders whose troops have been slowed down by the use of CBR protective equipment.
Far more suitable are readily available infective agents that combine a high attack rate with a short-lived period of disability or prostration. In the short, hot war scenarios of recent times, a high attack/disability rate may be more important than a high casefatality rate. Degradation of a unit’s fighting ability through exposure to a new strain of influenza or viral gastroenteritis might have significant tactical consequences. A simultaneous double infection hit delivered to a front-line combat unit may degrade its defensive resolve.
So what are these agents? In recent times, attention has focused on pandemic and avian influenza (H5N1). These are different entities and pose similar but subtly different threats to the general population. Australia has not yet had an outbreak of either, but the encroaching threat from nearby parts of South East Asia is considered sufficient for health planners to run a series of exercises in order to help plan for the predicted surge in demand for health services.13 Contingency planning is therefore at an advanced level for the civilian population, but has more specific relevance to a military context. These new biological threats, or emerging infectious diseases, illustrate how quickly new respiratory infections can appear and spread. Particularly noteworthy is their capacity to spread through the healthy adult population with which a peacetime army has regular contact. If any further reminders are needed about the ever-present threat of transmissible respiratory infection, the spread of pertussis (whooping cough) through parts of the adult population in Australia, including military personnel, should be noted. The level of respiratory compromise may seem relatively trivial to a civilian physician, but it can still mean the difference between combat fitness and temporary medical restrictions. An outbreak of pertussis or other acute respiratory infection in the lines therefore needs much more aggressive containment measures than would be applied in the civilian community. A common feature of many transmissible respiratory and gastrointestinal infections is the importance of young family members as preliminary incubators for subsequent adult infection. Children of primary and pre-primary age are particularly susceptible, and represent an indirect threat to service personnel in family quarters.
The other consideration for the suitability of biological threat agents is its wider psychological context. Intense media interest has introduced the civil population to the vocabulary of bioterror, but has not succeeded in educating people in how remote or specific the actual risks are. The more easily spelled historical diseases like anthrax, plague and smallpox have been demonised in the lay press. The media have had a mixed reputation as the major source of public information on biological threats. Leaving aside a lamentable record for scientific accuracy and subsequent correction of error, the mass media have inadvertently contributed to an increase in public panic levels during specific events like the white powder incidents of 2001, when a wave of panic, hoax and copycat incidents swept around the world in the wake of events in the United States.14 More immediate biological threats, such as endemic influenza and other potential biological threat agents with less familiar names like glanders and tularaemia, hardly rate a mention. Obviously, they have little or no terror potential. There are plenty of opportunities for sensationalism when public concern is at an unusually high level.
Protective Posture Through Technical System Enhancements
The technical response to biological threat agents comes from microbiology. This discipline has accumulated a range of procedures for amplifying signals that cannot be detected by the unaided human senses. By definition, microbes cannot be seen by the naked eye; a microscope is needed. In the case of viruses, this has to be an electron microscope—a very large piece of kit. While microscopy is fast, it remains easily detected and is not sufficiently specific to give a name to the threat agent in question. Biological amplification (culture) is therefore used to build up numbers so that growth can be easily seen on Petri dish agar plates. This material can then be used for agent identification and antibiotic sensitivity tests. Culture introduces a delay of around one to three days, making it unsuitable as an immediate command-decision aid. Moreover, viruses and some fastidious bacteria cannot be cultured easily. Some viruses cannot be cultured at all. Microbiologists have therefore developed specific methods to detect the molecular components of microbes. The most recent series of technical developments relies on direct amplification of microbial genes with a method called polymerase chain reaction (PCR). PCR-based tests can be performed in a few hours and are very specific. A range of methods have been developed around PCR-based systems to detect most of the biological threat agents. Portable PCR laboratory equipment has been trialed for field use. Deployable molecular microbiology is close to operational readiness as an effective solution to the problem of looking for a very small range of threat agents in samples that can contain a very wide range of non-pathogenic micro-organisms.
The issues that these new technical capabilities raise will be familiar to many senior logistic officers: who owns the service, what will its footprint look like, what will its command and control structure look like, and who will take care of training, maintenance and replacement? While recognising that these questions will be cause for debate for some years to come, now is a good time to make a few assertions based on what we can see already:
- biological threat detection technology is entering a period of rapid change, necessitating a more flexible materiel acquisition process;
- the main concentration of molecular microbiology skills is in civilian health care, from where Army will need to draw its technical and scientific officers;
- similar technical and scientific skills are required in Army pathology labs, environmental health and CBRE response units, raising the possibility of enhanced interoperability and skills retention with the Hardened and Networked Army concept;
- point-of-care diagnostic systems developed for civilian health care lend themselves to forward deployable laboratory units with minimal adaptation;
- culture-based systems will be rendered obsolete by deployable molecular biology tests, and should be considered as reference centre functions for sending base hospital operations;
- a review of pathology technician trade qualifications and rank structure would be timely, bearing in mind the double difficulty of recruiting into the civilian diagnostic laboratory and then into Army; and
- the role of the Combat Support Pathologist in future operations needs to be reconfigured in view of an increased operational tempo.
This is a list of more generic issues to be resolved before Army can reach the desired outcome of a comprehensive biological threat-assessment toolbox and the personnel to use it to best effect. We can anticipate a need to resolve the best way to achieve critical mass of operational expertise via expansion of vital trades, GRes recruitment and selective mobilisation. Reliance on GRes personnel and even civilian contract agencies may complicate the command and control structure, forcing the development of a less unified jurisdictional network, at odds with the HNA concept. The small number of currently available skilled personnel indicates that while executive command will logically be at Service or Joint Operations level, operational units will need a clear jurisdictional footprint. In order to begin the journey towards the desired outcome, the active participation of a range of Army stakeholders will be needed. Their input is essential to ensure concentration on the main effort and avoidance of mission creep. Without a clear view of a shared objective, there is a danger that biological threat assessment could include nearly everything but achieve next to nothing. In the author’s view, the logical next step is to pursue the development of a critical logistic resource in conjunction with the most frequently deployed Army Health units, whether for regional humanitarian aid or for combat missions.
Conclusion
The possible range of biological threats facing a deployed force is large and well beyond the capacity of a small, field-deployable laboratory unit or environmental health company. Emerging detection technologies offer the prospect of improved surveillance, early warning and faster threat clearance. Until systems have been developed to embed these technologies in an upgraded operational concept of health threat assessment, a rational approach can be adopted in which a tiered approach is taken to identify, contain and neutralise new threats. This tiered incident response will match more closely the approach taken by civilian first response agencies, and thus tap into a wider pool of professional emergency and disaster response skills. Development of military health threat assessment capability makes sense given the increasing likelihood that ADF elements will be deployed as a part of our national response to major humanitarian crises in our region.
Acknowledgements
The author thanks MAJ Williams, OIC, LAB PLT, I HSB and MAJ Scalzo, A/CO, 1HSB for their support and helpful comments during the preparation of this paper.
Endnotes
1 ‘Chemical and Biological Weapons: Possession and Programs Past and Present’, Chemical and Biological Weapons Resource Page, Centre for Nonproliferation Studies, Monterey Institute of International Studies, <http://cns.miis.edu/research/cbw/possess.htm>.
2 K. Alibek, Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World—Told from Inside by the Man Who Ran It, Random House, New York, 1999.
3 D.A. Henderson, ‘Bioterrorism as a public health threat’, Emerging Infectious Diseases 4, 1998, <http://www.cdc.gov/ncidod/EID/vol4no3/hendrsn.htm>.
4 World Health Organisation, Smallpox, bioterrorism and the World Health Organization, 29 June 2006, <http://www.who.int/global_health_histories/seminars/paper02.pdf>.
5 R.A. Wampler, & T.S. Blanton (eds), DIA briefing document #9, cited in the National Security Archive Electronic Briefing Book No. 61, 2001, <www.gwu.edu/~nsarchiv/NSAEBB/NSAEBB61>.
6 Alibek, Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World.
7 J. Malecki, et al, ‘Update: Investigation of bioterrorism-related anthrax’, Mortality and Morbidity Weekly Report; Vol. 50, No. 45, 16 November 2001, pp. 1008-10.
8 A.R. Hoffmaster, C.C. Fitzgerald, E. Ribot, L.W. Mayer, T. Popovic, ‘Molecular subtyping of Bacillus anthracis and the 2001 bioterrorism-associated anthrax outbreak, United States’, Emerging Infectious Diseases [serial online] Oct 8 2002, available from: <http://www.cdc.gov/ncidod/EID/vol8no10/02-0394.htm>
9 Autopsies performed on forty-two of the victims of the Sverdlovsk event present the most comprehensive analysis of pathological consequences of a single inhalational anthrax incident. It was noted that chest pain experienced by some of the victims was so intense that heart attack was considered as an initial diagnosis. Subsequent bacterial genetic analysis of material from thirteen of the forty-two autopsied victims indicated that they had been exposed to multiple types of Bacillus anthracis simultaneously. The opportunity to analyse a single point source of inhalational anthrax and introduce plume modeling has led to a revision of the previously held view that anthrax has a lower threshold for infectivity. According to Wilkening’s predictions based on Sverdlovsk data, even very small doses of inhaled anthrax spores could cause fatal disease, but with a longer incubation period; Dean Wilkening, ‘Sverdlovsk revisited: Modeling human inhalation anthrax’, Proceedings of the National Academy of Sciences, 16 May 2006, Vol. 103, No. 20, pp. 7859-95. When inhalational anthrax incidents occurred in the United States in late 2001, there were two distinct releases of anthrax spores; one in an office building in Boca Raton, Florida, one via a mail distribution centre in Brentwood, and a connected event in the Hart senate building in Washington, DC. There were five deaths from a total of twenty-two confirmed anthrax cases. Besides this human toll and the disruption to government and business services, the contaminated offices spaces took over three years to complete a thorough decontamination process. Genetic analysis of Bacillus anthracis from the victims and environmental investigations took months to complete, and ultimately showed a likely connection with a strain of Bacillus anthracis held in US culture collections. There is an interesting contrast between the Sverdlosk and US inhalational anthrax incidents in that the accidental release from a biological weapon stockpile was more devastating than the deliberate release of a possible biodefense program component. Careful reading of technical reports on both events provides helpful clues on where the most important threats lie.
10 T. Torok, et al, ‘A Large Community Outbreak of Salmonellosis Caused by Intentional Contamination of Restaurant Salad Bars’, JAMA, Vol. 278, No. 5, 6 August 1997, pp. 389-94.
11 D. L. Buckeridge, D. K. Owens, P. Switzer, J. Frank and M. A. Musen ‘Evaluating detection of an inhalational anthrax outbreak’, Emerging Infectious Diseases [serial online], December 2006, available from <http://www.cdc.gov/ncidod/EID/vol12no12/06-0331.htm>.
12 T. Okumura, et al, ‘Report on 640 victims of the Tokyo subway sarin attack.’ Annals of Emergency Medicine, Vol. 28, Issue 2, August 1996, pp. 129-35.
13 R. L. Itzwerth, C. Raina MacIntyre, Smita Shah, A. J. Plant, ‘Pandemic influenza and critical infrastructure dependencies: possible impact on hospitals’, The Medical Journal of Australia, Vol. 185, No. 10, S70-S72
14 Kenneth C. Hyams, Frances M. Murphy and Simon Wessely, ‘Responding to Chemical, Biological, or Nuclear Terrorism: The Indirect and Long-Term Health Effects May Present the Greatest Challenge’, Journal of Health Politics, Policy and Law, Vol. 27, No. 2, 2002, pp. 273-92.
