The Lancet Infectious Disease
Jun 2012 Volume 12 Number 6 p423 – 496
The rise and fall of bioterrorism research
The Lancet Infectious Diseases
In the months after the September 11, 2001, attacks in New York, USA, the world was on heightened awareness for terrorist attacks of all kind. The anthrax scares in the USA in the final months of that year led to a focus on bioterrorism. A decade ago this threat was viewed as one of the key areas for infectious disease research: the topic dominated the agendas at academic and clinical conferences at the time, and governments devised plans to address the threat of bioterrorism, often involving substantial investments in research. But a decade on, are we any more prepared for bioterrorist attacks, and what have we gained from the huge resources invested in the research?
Bioterrorism is defined by the US Centers for Diseases Control and Prevention as “the deliberate release of viruses, bacteria, toxins or other harmful agents used to cause illness or death in people, animals, or plants”; although this clearly leads to a murky distinction from biological warfare, and research into both goes hand in hand. Attempts in the early 20th century to weaponise biological agents quickly led to the realisation of the potency of such tactics as terrorist devices. And an arms race developed with governments simultaneously aiming to produce weapons with these agents and the countermeasures to use when faced with their deployment.
Despite a long history of research, the use of biological weapons in warfare and terrorism has been uncommon: the major downsides to their use are their lack of specificity and an inability to contain an infection within a target population. An infectious agent used against one group will almost inevitably infect unintended victims, even those who originally deployed the weapon.
However, in the late 20th century the face of terrorism changed, from one of targeted attacks to the use of indiscriminate tactics, in which the collateral damage of deaths on the aggressor’s side was accepted. In the late 1990s, the threat of bioterrorism was generating serious interest. The topic was a key theme at the 1998 International Conference on Emerging Infectious Diseases, at which experts warned that the growing interest in and proliferation of biological weapons was not being matched by investment in research to counter the effects of such attacks. But the watershed moment was the 9/11 attacks on New York.
The following year, the World Health Assembly agreed that a concerted effort to address bioterrorism was needed. One of their acts was to drop the 2002 deadline for the destruction of smallpox virus stocks. The USA established several initiatives to address potential bioterrorist threats. Among them, the National Institutes of Health launched the National Science Advisory Board for Biosecurity (NSABB) to monitor potential dual-use research and the Department of Defense launched the Transformational Medical Technologies Initiative (TMTI), a US$1·5 billion initiative to sequence the genomes of key microorganisms with bioterrorism potential and to develop one-size-fits-all measures against them.
For all the international concern and efforts to prepare, there has been no major bioterrorist attack. The TMTI has introduced no new antibiotics into clinical trials, the three drugs that have entered clinical trials are for single pathogens rather than providing multifaceted solutions, and now many of its projects have been redistributed to other defence departments. The NSABB has assessed just six papers. Furthermore, bioterrorism has dropped off the programmes of scientific conferences.
Nonetheless, the fear is still present, even if the threat has not materialised. In this month’s Newsdesk, Kathryn Senior discusses two recent bioterrorism scares involving Bacillus anthracis spores, and the case of research in which investigators generated strains of H5N1 transmissible between mammals spawned much debate about dual-use research—as well as providing the NSABB with two of the six papers.
Groups that would willingly instigate a major bioterrorism attack undoubtedly exist. The consequences of widespread dissemination of anthrax spores or a haemorrhagic fever virus such as Ebola, or release of an engineered highly infective and highly pathogenic influenza are almost too dire to contemplate. However, bioterrorism research is perhaps a diversion—resources invested in combating bioterrorist threats would be well invested in research into the real and present damage of these pathogens in nature. Such research need not be viewed as a separate effort, but a much needed integrated effort in biodefence, since undoubtedly it would provide vital information, vaccines, and drugs for the fight against bioterrorism as well as combating natural infections.