Issues in Chemical and Biological Terrorism

This manuscript describes the overview presented at the 23rd Annual Meeting of the American College of Toxicology in 2002. Although it is recognized that weapons of mass destruction that can be used against our military and civilian populations include chemical, biological, radiological, and nuclear (CBRN) agents, this overview is limited primarily to chemical and biological (CB) agents. The issues of CB terrorism are discussed in terms of When, What, How, and Who. The US Army has been providing chemical and biological solutions since 1917, and has since 1996 applied these solutions to homeland defense and domestic preparedness. The use of chemical and biological agents as terrorist weapons both in the United States and elsewhere in the world is reviewed. The CB threat spectrum is presented, as is the further categorization of biological threat agents by the Centers for Disease Control and Prevention (CDC). In addition, the CB agents considered to be a potential threat to our water supply are also presented. These are agents that are water soluble, stable, and resistant to water treatment and/or disinfection. The overview concludes with the chronological accomplishments of ECBC since 1917.

[New challenges in the biological weapons convention]

Microbes and their toxins are biological weapons that can cause disease in humans, animals or plants, and which can be used with hostile intent in warfare and terrorism. Biological agents can be used as weapons of mass destruction and therefore, immense human and social and major economical damage can be caused. Rapid development of life sciences and technologies during the recent decades has posed new challenges to the Biological Weapons Convention. The Convention states that the States Parties to the BWC strive to ensure that the Convention remains relevant and effective, despite changes in science, technology or politics.

Biological warfare agents

Biological warfare agents are a group of pathogens and toxins of biological origin that can be potentially misused for military or criminal purposes. The present review attempts to summarize necessary knowledge about biological warfare agents. The historical aspects, examples of applications of these agents such as anthrax letters, biological weapons impact, a summary of biological warfare agents and epidemiology of infections are described. The last section tries to estimate future trends in research on biological warfare agents.

The role of genomics in the identification, prediction, and prevention of biological threats

In all likelihood, it is only a matter of time before our public health system will face a major biological threat, whether intentionally dispersed or originating from a known or newly emerging infectious disease. It is necessary not only to increase our reactive “biodefense,” but also to be proactive and increase our preparedness. To achieve this goal, it is essential that the scientific and public health communities fully embrace the genomic revolution, and that novel bioinformatic and computing tools necessary to make great strides in our understanding of these novel and emerging threats be developed. Genomics has graduated from a specialized field of science to a research tool that soon will be routine in research laboratories and clinical settings. Because the technology is becoming more affordable, genomics can and should be used proactively to build our preparedness and responsiveness to biological threats. All pieces, including major continued funding, advances in next-generation sequencing technologies, bioinformatics infrastructures, and open access to data and metadata, are being set in place for genomics to play a central role in our public health system.

The command of biotechnology and merciful conquest in military opposition

Biotechnology has an increasingly extensive use for military purposes. With the upcoming age of biotechnology, military operations are depending more on biotechnical methods. Judging from the evolving law of the theory of command, the command of biotechnology is feasible and inevitable. The report discusses some basic characteristics of modern theories of command, as well as the mature possibility of the command theory of military biotechnology. The evolution of the command theory is closely associated with the development of military medicine. This theory is expected to achieve successes in wars in an ultramicro, nonlethal, reversible, and merciful way and will play an important role in biotechnological identification and orientation, defense and attack, and the maintenance of fighting powers and biological monitoring. The command of military biotechnology has not become a part of the virtual military power yet, but it is an exigent strategic task to construct and perfect this theory.

Trends in detection of warfare agents. Detection methods for ricin, staphylococcal enterotoxin B and T-2 toxin

An overview of the different detection methods available for ricin, staphylococcal enterotoxin B (SEB) and T-2 toxin is presented here. These toxins are potential biological warfare agents (BWA). The aim of this review is not to cover all the papers that had been published but rather to give an overall picture of the trend in the detection methodologies for potential biological warfare agents as we do see the emerging threats from these three toxins. The advantages and disadvantages of each methodology as well as the detection limit will be reviewed. It seems that mass spectrometry has created a niche for analysis of proteinaceous toxins, ricin and SEB as well as molecular toxin, T-2 toxin given its high sensitivity, high selectivity, high specificity and capability to identify and quantify unknown agents simultaneously in a short time frame. But its main drawbacks are its sophisticated instrumentation and its high cost. Improvised immunoassay may be an alternative.

Weapons of mass destruction: Overview of the CBRNEs (Chemical, Biological, Radiological, Nuclear, and Explosives)

The events of September 11, 2001, made citizens of the world acutely aware of disasters consequent to present-day terrorism. This is a war being waged for reasons obscure to many of its potential victims. The term "NBCs" was coined in reference to terrorist weapons of mass destruction, i.e., nuclear, biological and chemical. The currently accepted acronym is "CBRNE" which includes Chemical, Biological, Radiological, Nuclear, and Explosive weapons. Non-nuclear explosives are the most common terrorist weapon now in use. Nuclear and radiological weapons are beyond the scope of this publication, which focuses on the "CBEs", i.e. chemical, biological and explosive weapons. Although neurologists will not be the first responders to CBEs, they must know about the neurological effects in order to provide diagnosis and treatment to survivors. Neurological complications of chemical, biological and explosive weapons which have or may be used by terrorists are reviewed by international experts in this publication. Management and treatment profiles are outlined.

Emerging natural threats and the deliberate use of biological agents

Over the past several years there has been an increasing awareness and interest by the medical community, the media, and government at all levels regarding the need to plan for and defend against biological weapons. This article offers an overview of various new and emerging natural biological threats.

The challenge of preparation for a chemical, biological, radiological or nuclear terrorist attack

Terrorism is not a new phenomenon, but, in the contemporary scene, it has established itself in a manner which commands the most serious attention of the authorities. Until relatively recently, the major threat has been through the medium of conventional weaponry and explosives. Their obvious convenience of use and accessibility guarantees that such methods will continue to represent a serious threat. However, over the last few years, terrorists have displayed an enthusiasm for higher levels of carnage, destruction and publicity. This trend leads inexorably to the conclusion that chemical, biological, radiological and nuclear (CBRN) methods will be pursued by terrorist organisations, particularly those which are well organised, are based on immutable ideological principles, and have significant financial backing. Whilst it is important that the authorities and the general public do not risk over-reacting to such a threat (otherwise, they will do the work of the terrorists for them), it would be equally ill-advised to seek comfort in denial. The reality of a CBRN event has to be accepted and, as a consequence, the authorities need to consider (and take seriously) how individuals and the community are likely to react thereto and to identify (and rehearse in a realistic climate) what steps would need to be taken to ameliorate the effects of such an event.

[Scientific progress and new biological weapons]

The biological weapons are different from conventional weapons, because living germs hold an extraordinary and predictable potential for multiplication, propagation and genetic variation during their dissemination in a susceptible population. Only natural pathogens (1rst generation weapons) have been used in the past (smallpox virus, plague, anthrax, toxins...). However, new threats are emerging, due to the rapid progress of scientific knowledge and its exponential worldwide diffusion. It is possible to synthesize microorganisms from in silico sequences widely diffused on Internet (poliovirus, influenza...), thus resulting in the accessibility of very dangerous virus confined today in high-security laboratories (virus Ebola...). It is possible also to "improve" pathogens by genetic manipulations, becoming more resistant or virulent (2nd generation weapons). Finally, one can now create de novo new pathogens by molecular breeding (DNA shuffling), potentially highly dangerous for naive populations (3rd generation weapons). Making biological weapons does not require too much technological resources and appears accessible to terrorists, due to low cost and easy use. Although the destructive consequences are difficult to predict, the psychological and social damages should be considerable, because of the highly emotional burden in the population associated to the transgression by man of a taboo of life.

The potential of antibody-mediated immunity in the defence against biological weapons

Antibody-mediated immunity (AMI) has been used for the treatment and prevention of infectious diseases for > 100 years, and has a remarkable record of safety, efficacy and versatility. AMI can be used for defence against a wide variety of biological weapons, and passive antibody (Ab) therapy has the potential to provide immediate immunity to susceptible individuals. Recent advances in the Ab field make it possible to generate Abs with enhanced antimicrobial functions. There are significant gaps in our understanding of Ab function, such that the development of Ab-based strategies remains a largely empirical exercise. Nevertheless, the advantages inherent in the therapeutic and prophylactic use of AMI provide a powerful rationale for continued development that will undoubtedly yield many new vaccines and therapeutic Abs.

Developing vaccines to counter bioterrorist threats

Large and innovative research programs are underway to define the immune parameters for vaccines against a wide array of pathogens considered to represent a potential bioterrorist threat. However, the development and utilization of such vaccines presents a number of predicaments that have not previously been addressed by the field of vaccinology.

Biological warfare--an emerging threat

As we approach the 21st century, there is an increasing worldwide awareness and threat regarding the use of biological warfare agents both for war and terrorist attack. Biological agents include microorganisms or biological toxins that are used to produce death in humans, animals and plants. They are characterized by low visibility, high potency, substantial accessibility and relatively easy delivery. Biological warfare agents are unconventional weapons that can be delivered by unconventional means like aerosol sprays, food and water contamination, conventional explosive munitions or by covert injections. Because of their concealed delivery, easy transportation and difficult identification they are readily adaptable for terrorist operations or to gain political advantages. The detection of such attack requires recognition of the clinical syndromes associated with various biological warfare agents. Diagnosis can be made on clinical grounds and on investigations. Protective measures can be taken against biological warfare agents. These should be implemented early (if warning is received) or later (once suspicion of agent use is made). After the confirmation of diagnosis emergency medical treatment and decontamination are performed in rapid sequence. Patients are then evacuated and specific therapy is given according to the agent involved. Appropriate emergency department and hospital response could significantly limit the morbidity and mortality of biological warfare agents.

Hospital preparedness for possible nonconventional casualties: an Israeli experience

Since 9/11, hospitals and health authorities have been preparing medical response in case of various mass terror attacks. The experience of Tel Aviv Sourasky Medical Center in treating suicide-bombing mass casualties served, in the time leading up to the war in Iraq, as a platform for launching a preparedness program for possible attacks with biological and chemical agents of mass destruction. Adapting Quarantelli's criteria on disaster mitigation to the "microinfrastructure" of the hospital, and including human behavior experts, we attempted to foster an interactive emergency management process that would deal with contingencies stemming from the potential hazards of chemical and biological (CB) weapons. The main objective of our work was to encourage an organization-wide communication network that could effectively address the contingent hazards unique to this unprecedented situation. A stratified assessment of needs, identification of unique dangers to first responders, and assignment of team-training sessions paved the way for program development. Empowerment through leadership and resilience training was introduced to emergency team leaders of all disciplines. Focal subject matters included proactive planning, problem-solving, informal horizontal and vertical communication, and coping through stress-management techniques. The outcome of this process was manifested in an "operation and people" orientation supporting a more effective and compatible emergency management. The aim of article is to describe this process and to point toward the need for a broad-spectrum view in such circumstances. Unlike military units, the civilian hospital staff at risk, expected to deal with CB casualties, requires adequate personal consideration to enable effective functioning. Issues remain to be addressed in the future. We believe that collaboration and sharing of knowledge, information, and expertise beyond the medical realm is imperative in assisting hospitals to expedite appropriate preparedness programs.

Proliferation of biological weapons: challenges and responses

The threat posed by the proliferation of biological weapons (BW) confronts all strata of our society, from the individual, the nation, or the region to the truly international. The history of state-run offensive BW programmes and the attacks in the United States with powdered anthrax demonstrate that existing measures fall short of addressing this threat. This article examines the current regime and the concerns that confront it in order to suggest possible responses across the social strata that may mitigate future proliferation of BW.

Ethical issues in modern biological technologies

Today's biology-based technologies have emerged from a historical imperative and as an inevitable consequence of developments in modern biology beginning in the last half-century. They can be classified into almost 30 different areas, ranging from the use of gene therapy for human beings, enzyme engineering, stem cells and cloning, to marine biotechnology, bioinformatics, nanotechnology and biological warfare among many others. Many of them have major sociopolitico-economic, moral, ethical and legal implications. They include genetic engineering, gene therapy, tissue culture, stem cell work, the new DNA technologies, commercialization of traditional plant-based drug formulations, assisted reproduction techniques, cloning technologies, organ transplantation, bioinformatics, and biological weapons. Examples of the ethical implications of several of these items will be considered. They will be assessed with special reference to ethical implications in respect of assisted reproduction techniques, of worldwide importance today, particularly for a country such as India.

Genome projects and gene therapy: gateways to next generation biological weapons

Genomic and gene therapy research promise important gains into the treatment of human, animal, and plant diseases. However, there is a military aspect to this research that must be recognized. This research enables a new form of biological warfare named genomic warfare. This is the first peer-reviewed scientific article to discuss this threat in-depth. This article advocates that we begin to deal with this threat. Despite that the United States and many signatories of previous bioweapons treaties have agreed not to use biological weapons, mankind has a track record of using all of the weapons at its disposal. This article has a review of the literature and a basic overview of genomic research and gene therapy, which is followed by a discussion of how this therapy can be weaponized. How genomic warfare weapons might be deployed, how deployment may be detected, and the policies and research that would reduce this threat will be described. It is the aim of this article to clearly articulate that this risk exists and to encourage public health, scientific, political, and military leaders to take action to deal with the risk.

Strengthening the BTWC. The role of Biological and Toxin Weapons Convention in combating natural and deliberate disease outbreaks

The role of the Biological and Toxin Weapons Convention in combating natural and deliberate disease outbreaks

Genetic engineering and biological weapons. New technologies, desires and threats from biological research

New technologies, desires and threats from biological research

[Consequences and challenges due to bioterrorist attacks]

Ever since the terrorist attacks of 11 September 2001 and the cases of inhalational anthrax and other types of anthrax caused by attacks with anthrax spores, responsible authorities and experts must reckon with bioterrorist attacks conducted with much greater criminal "drive" and greater financial resources than had been imagined so far. This consideration triggered cautionary measures in Germany and Europe as briefly summarised here. For more detailed information please refer to internet (www.rki.de) and see the references given below.

Fifth annual conference on new and re-emerging infectious diseases

The fifth annual Conference on New and Re-Emerging Infectious Diseases was hosted on April 18–19, 2002, by the College of Veterinary Medicine, University of Illinois at Urbana-Champaign (UIUC). The conference featured 8 speakers and 35 poster presentations.

Overview: cause and prevention in biowarfare and bioterrorism

Bioweaponry is rooted in the ancient past. It became a science in the early 20th century following the breakthrough discoveries in microbiology and immunology of the late 1800s. The 20th century, with its major and minor wars, saw the research and development of biological weapons capable of immense destruction of life, which were used both by nations in preparation for military warfare and by individuals who engage in asymmetric warfare. Treaties, international agreements, and political pursuits have not been able either to control or to rid the world of bioweapons. The tools for specific defense against bioweapons consist of vaccines against both viruses and bacteria, and of antibiotics and drugs against bacteria. Vaccines and antimicrobials are of limited usefulness because of the large number of possible microbes that can be used for weapons, because of antimicrobial resistance to drugs and antibiotics, and because of limitations in technical feasibility for developing vaccines and antibacterials against certain of the agents. Induction of non-specific innate immunity by immunostimulatory vaccines (at one time licensed) needs to be explored for possible immunoprophylactic-therapeutic activity when administered immediately following exposure to bioweapon pathogens. The ideal solution to the bioweapons problem lies in measures to end their development and application throughout the world. Emphasis was made at the recent World Economic Forum of the need to end poverty and hunger in the world as a means to reduce the incentive to engage in warfare. Added to this is betterment of health, focused mainly on preventable diseases. A further solution to the problem may lie in the development of modern robotic systems for rapid forensic detection of development and production of bioweapons by "rogue" nations and even by individuals. This review deals with the specifics of the development of bioweapons and their control by vaccines, by therapy with antibacterials, by non-specific immunostimulants, by advanced systems for detection of development and deployment of biological agents of destruction, and by political and health-giving initiatives.

Biological terrorism: understanding the threat, preparation, and medical response

The thought of an outbreak of disease caused by the intentional release of a pathogen or toxin in an American city was alien just 10 years ago. Many people believed that biological warfare was only in the military's imagination, perhaps to be faced by soldiers on a far-away battlefield, if at all. The "anthrax letters" and the resulting deaths from inhalation anthrax have changed that perception. The national, state, and local governments in the United States are preparing for what is now called "not if, but when and how extensive" biological terrorism. In contrast to the acute onset and first-responder focus with a chemical attack, in a bioterrorist attack, the physician and the hospital will be at the center of the fray. Whether the attack is a hoax, a small food-borne outbreak, a lethal aerosol cloud moving silently through a city at night, or the introduction of contagious disease, the physician who understands threat agent characteristics and diagnostic and treatment options and who thinks like an epidemiologist will have the greatest success in limiting the impact of the attack. As individual health care providers, we must add the exotic agents to our diagnostic differentials. Hospital administrators must consider augmenting diagnostic capabilities and surveillance programs and even making infrastructure modifications in preparation for the treatment of victims of bioterrorism. Above all, we must all educate ourselves. If done correctly, preparation for a biological attack will be as "dual use" as the facility that produced the weapon. A sound public health infrastructure, which includes all of us and our resources, will serve this nation well for the control of the disease, no matter what the cause of the disease.

Smallpox--eradicated, but a growing terror threat

Smallpox is a disease that followed humanity for thousands of years up until 30 years ago. It was possible to eradicate, because an effective live vaccine from crossreacting vaccinia could be developed. Twenty years have passed since vaccinations stopped and very few people are protected against the disease today. Variola today has become an object of discussion due to the possibility that it can be used as a bioweapon. Due to the number of complications that can be expected a general vaccination is probably not possible. Research is ongoing to develop new vaccines. Many countries are improving their capabilities to respond to a renewed threat of a smallpox epidemic.

Bioterrorism: responding to an emerging threat

Only a few years ago bioterrorism was considered a remote concern but few today are complacent about the possibility of biological agents being intentionally used to cause widespread panic, disruption, disease and death. By its very nature, the biological weapons threat - with its close links to naturally occurring infectious agents and disease - requires a different paradigm than that for conventional terrorism, military strikes or attacks caused by other weapons of mass destruction. This evolving threat presents the medical, public health and scientific communities (importantly including biotechnology) with a set of difficult and pressing challenges. This article provides a brief overview of the threat from biological weapons, the nature of a bioterrorist attack and some of the issues that need to be addressed if we are to make meaningful progress to prevent or contain this disturbing and potentially catastrophic danger.

The impact of anthrax attacks on the American public

CONTEXT

Incidents involving anthrax (Bacillus anthracis) through the mail in 4 metropolitan areas have raised concerns about the public's response nationally and locally.

OBJECTIVE

To examine public response to these incidents and what it reveals about the demand placed on health professionals and public health officials nationally, in affected areas, and by affected people.

DESIGN

Random-digit-dialed telephone surveys of samples of households nationally and in 3 specific metropolitan areas where cases of anthrax were reported: the District of Columbia; Trenton/Princeton, New Jersey; and Boca Raton, Florida.

OUTCOME MEASURE

Respondents were asked a series of questions measuring their level of concern and their behavior in response to threats of anthrax and potential bioterrorist acts.

RESULTS

The lives of a large share of people were affected in 3 metropolitan areas where anthrax incidents occurred. Residents of those 3 areas and people there who were affected by the incidents expressed a higher level of concern and took more precautions handling their mail. However, these incidents did not lead to great demands on the health system.

CONCLUSIONS

The incidents of anthrax created anxieties, especially in areas where incidents occurred. There was some increased demand on the health system, but the demands were not large-scale. In the event of a major outbreak of disease, most Americans will rely heavily on their own physician for advice. Both national and local systems of population-based information gathering about the public's response to bioterrorist attacks are needed.

Closing loopholes in the Biological Weapons Convention

The Biological and Toxin Weapons Convention (BTWC) received two major blows in the past months. Negotiations for a protocol to strengthen the BTWC came to a halt and the Fifth Review Conference was unable to reach agreement on a final declaration. In addition, ongoing research projects, predominantly in the United States, are threatening to undermine the comprehensive ban on the development, production and use of biological weapons. This article provides two examples of research that exploit perceived loopholes in the BTWC or impinge on the scope of the Convention, namely the planned use of biological agents for forced drug eradication and the development of anti-material agents.

The potential for abuse of genetics in militarily significant biological weapons

Concern has been expressed at successive Review Conferences of the Biological and Toxin Weapons Convention (BTWC) regarding the possible misuse of new biological knowledge; this article reviews some of these developments. Genetic manipulation, and genomics in particular, would modify existing pathogens and render previously harmless organisms pathogenic. Viruses could be modified as vectors to alter their pathogenicity in animals and man or act as carriers for genes or toxins. Plant pathogens, particularly fungi, could be modified as biological warfare agents against crops. An effective verification protocol for the BTWC is an essential part of the web of deterrence against these developments.

The Department of Defense chemical and biological defense program: where we are going

This article provides an overview of the Department of Defense (DoD) Chemical and Biological Defense Program (CBDP). This article highlights the mission and objectives of the DoD CBDP, the general capabilities of systems and technologies being developed or employed to defend U.S. forces against the threat of chemical and biological warfare agents, and improvements made in defensive systems in the years since Operation Desert Storm.

Biological agents: weapons of warfare and bioterrorism

The use of microorganisms as agents of biological warfare is considered inevitable for several reasons, including ease of production and dispersion, delayed onset, ability to cause high rates of morbidity and mortality, and difficulty in diagnosis. Biological agents that have been identified as posing the greatest threat are variola major (smallpox), Bacillus anthracis (anthrax), Yersinia pestis (plague), Clostridium botulinum toxin (botulism), Francisella tularensis (tularaemia), filoviruses (Ebola hemorrrhagic fever and Marburg hemorrhagic fever), and arenaviruses Lassa (Lassa fever) and Junin (Argentine hemorrhagic fever). The pathogenesis, clinical manifestations, diagnosis, and treatment of these agents are discussed. Rapid identification and diagnosis using molecular diagnostic techniques such as PCR is an essential element in the establishment of coordinated laboratory response systems and is the focus of current research and development. Molecular techniques for detection and identification of these organisms are reviewed.

Genomics and future biological weapons: the need for preventive action by the biomedical community

There is an increasing concern within both the scientific and security communities that the ongoing revolution in biology has great potential to be misused in offensive biological weapons programs. In light of the 11 September tragedy, we can no longer afford to be complacent about the possibility of biological terrorism. Here we review the major relevant trends in genomics research and development, and discuss how these capabilities might be misused in the design of new bioweapons. We also discuss how the breakthroughs that have come from the genomics revolution may be used to enhance detection, protection and treatment so that biological warfare agents are never used.

Terrorist attacks: do we know how to assess the results?

On September 11, 2001, terrorists destroyed the World Trade Center (WTC) in New York City. Explosions and fires resulted in the complete collapse of the two WTC towers. The collapsing towers served as enormous point sources of gaseous and particulate air pollution, seen as huge plumes of smoke and dust. The smoke contained volatile organic compounds and fine particles and aerosols. The dust fraction contained parts of ceiling tiles, carpets, concrete, adhesives, asbestos, chromium, lead, titanium, and many other elements and materials. Whether there were unusually toxic ingredients in the plumes is largely unknown.

Recent challenges in infectious diseases. Biological pathogens as weapons and emerging endemic threats

This article reviews emerging and re-emerging infectious diseases and provides insights regarding the evolution of our understanding of natural diseases and how that knowledge impacts the development of plans and methods for defending against the deliberate use of biological agents. Also discussed are forensic and legal issues for the pathologist concerning agents of biological terrorism and biological warfare, the concept of chain of custody, transport, storage, and biosafety levels. It defines the importance of the pathologist in managing the threat posed by biological weapons.

The emerging impact of genomics on the development of biological weapons. Threats and benefits posed by engineered extremophiles

During the past decades, representatives of Archaea, Bacteria, and Protista have been found thriving in many newly discovered extremely hostile habitats, which hitherto were regarded as too harsh to harbor life. To illustrate how an extremophile could be targeted for development as a biowarfare agent, an example is presented describing current advances in engineering Deinococcus radiodurans. Using a generally applicable combination of conventional genetic engineering and genomic informatics, this extremely radiation-resistant and environmentally robust bacterium is being developed for biotechnology.

Non-lethal weapons technologies--the case for independent scientific analysis

Various technologies have been proposed for non-lethal weapons (NLW), some of them credible, or at least plausible, but strong claims were made for others without evidence or references. Five such technologies are examined. For the chemical and biological examples, detailed information is lacking but the diminishing number of such claims over time and general scientific knowledge suggest that fulfilment of the promises is improbable. For acoustic weapons, a detailed study found that many of the claims are plainly untrue. In this case, even wrong values for physiological thresholds were presented. Civil and military NLW programmes in the USA put their main emphasis on simple, short-term technologies rather than exotic ones. In order to avoid dangers arising from unrealistic promises, the concept of preventive arms control should be applied to NLW. Its first step is a scientific analysis, investigating the new weapons, the propagation of their effects and the effect on the targets. Such detailed studies are needed for each proposed NLW technology.

Bioterrorism: a threat for which we are ill prepared

Of the weapons of mass destruction, the biological ones are the most feared and bioterrorism has become one of the most vicious threats to civilized society in recent times. Biological weapons have been sporadically used for centuries. Despite international regulations, there has been a global re-emergence of the threat of biological warfare. As many as 17 countries are suspected of either including or developing biological agents in their weapons programmes. In the past decade, a number of terrorist organizations with access to bioweapons technology have emerged. Current surveillance systems may be inadequate to detect biological attacks. The onset of illness is often delayed, thus the timing and location of such an event may be extremely difficult to identify. We are unfamiliar with most of the agents of biological warfare and are ill-equipped to handle the consequences of such an attack. In addition, there is no apparent coherent policy to handle a biological terrorist incident. Given the enormity of what is possible in the event of a biological attack, we must be prepared to detect, diagnose, epidemiologically characterize and respond appropriately to biological weapons. Of the potential biological weapons, smallpox and anthrax pose the greatest threats.

Precautions against biological and chemical terrorism directed at food and water supplies

Deliberate food and water contamination remains the easiest way to distribute biological or chemical agents for the purpose of terrorism, despite the national focus on dissemination of these agents as small-particle aerosols or volatile liquids. Moreover, biological terrorism as a result of sabotage of our food supply has already occurred in the United States. A review of naturally occurring food- and waterborne outbreaks exposes this vulnerability and reaffirms that, depending on the site of contamination, a significant number of people could be infected or injured over a wide geographic area. Major knowledge gaps exist with regard to the feasibility of current disinfection and inspection methods to protect our food and water against contamination by a number of biological and chemical agents. However, a global increase in food and water safety initiatives combined with enhanced disease surveillance and response activities are our best hope to prevent and respond quickly to food- and waterborne bioterrorism.