World at Risk: The Report of the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism by Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, Bob Graham, Jim Talent

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Table of Contents

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Biological Risks

They were agents on a mission and they came not at night, which might have looked suspicious, but in broad daylight. Hiding in plain sight on a city street in Atlanta, they walked the perimeter of one of America's five biological laboratories where scientists worked on the world's most deadly pathogens. They had come to this lab at Georgia State University in 2008 as part of their assignment to quietly case facilities designated as Biosafety Level 4 (BSL-4) labs, the highest level of biological containment, required for work with the most dangerous viruses. They were looking for even the slightest security vulnerability--anything that might give an edge to terrorists seeking to steal small quantities of Ebola virus or other lethal disease agents for which there are no treatments, no known cures.

These individuals discovered that in a number of places, the lab was unprotected by barriers and that outsiders could walk right up to the building housing these deadly pathogens. Around back, they watched and took notes as a pedestrian simply strolled into the building through an unguarded loading dock.

On another day, the same people went to San Antonio to check out another BSL-4 lab, the Southwest Foundation for Biomedical Research. They discovered that the security camera covered only a portion of the perimeter, and that the only barrier to vehicles was an arm gate that would swing across the roadway. The guards assigned to protect this facility were unarmed. Once again, these individuals walked the perimeter. This time they spotted a window through which, standing outside, they could watch the scientists as they worked with top-security pathogens. Nowthey knew exactly where the world's most deadly pathogens were kept.

This was precisely the lethal trove that al Qaeda's terrorists had been seeking for years. But luckily, these operatives on this mission were not from al Qaeda--they were from the Government Accountability Office (GAO), the investigative arm of the U.S. Congress, and they visited five of America's labs that are designated BSL-4. For more than a decade, U.S. government inspection teams have traveled to facilities in the former Soviet Union and reported back on the poor security and lax practices used in storing biological pathogens. Now, this latest study by GAO has shown that when it comes to materials of bioterrorism, America's vulnerability may well begin at home.

The GAO report gave high marks to three of the five facilities investigated. The investigators measured how the labs fared in 15 security control categories, and these labs met the standards for, respectively, 13, 14, and all 15. Among the 15 security controls were having armed security guards visible at all public entrances to the lab, full camera coverage of all exterior entrances, and closed-circuit television and a command and control center so that any security breach could be instantly known throughout the facility.

But the two lowest-scoring BSL-4 labs passed in only 3 and 4 of the 15 categories--a score that is even more troubling because, as GAO noted, both still met the requirements of the Division of Select Agents and Toxins of the Centers for Disease Control and Prevention (CDC).

Despite these shortcomings, the United States is actually at the forefront of laboratory security in the world today and has by far the most stringent regulations to restrict access to dangerous pathogens. Most developing countries, in contrast, have largely ignored the problem of biosecurity because of competing demands for their limited budgets. Security gaps at laboratories that store and work with dangerous pathogens, both in the United States and around the world, are worrisome because of continued interest in biological weapons. Director of National Intelligence Michael McConnell said in a recent speech, "One of our greatest concerns continues to be that a terrorist group or some other dangerous group might acquire and employ biological agents . . . to create casualties greater than September 11."

Al Qaeda has long sought to obtain biological and chemical weapons. One of its leading experts in the quest for such weapons was Midhat Mursi al-Sayid Umar, an Egyptian also known as Abu Khabab al-Masri. According to media accounts, he was killed in July 2008 by an airstrike over Pakistan's northern tribal area.

On July 17, 2008, the Afghanistan National Police arrested Aafia Siddiqui, a Pakistani woman believed to have ties to al Qaeda, who reportedly had been acting suspiciously outside the governor's compound in Ghazni province. Educated at the Massachusetts Institute of Technology and at Brandeis University, where she earned a Ph.D. in neuroscience, she had been wanted by the FBI since 2004--the first woman sought by the law enforcement agency in connection with al Qaeda. According to media accounts, when arrested she had in her possession a list of New York City landmarks, documents describing how to produce explosives, and details about chemical, biological, and radiological weapons. She was extradited to New York for trial on charges of attempted murder and assault of U.S. officers in Afghanistan.

The world is fortunate that al Qaeda to date is not known to have successfully stolen, bought, or developed agents of bioterror. But scenarios of just how such an incident might occur have been developed for planning purposes. The Homeland Security Council has created a chilling scenario of how terrorists could launch an anthrax attack in the United States--and the horrific chain of events that would follow:

This scenario describes a single aerosol [anthrax] attack in one city delivered by a truck using a concealed improvised spraying device in a densely populated urban city with a significant commuter workforce. It does not, however, exclude the possibility of multiple attacks in disparate cities or time-phased attacks (i.e., "reload"). For federal planning purposes, it will be assumed that the Universal Adversary (UA) will attack five separate metropolitan areas in a sequential manner. Three cities will be attacked initially, followed by two additional cities 2 weeks later.

It is possible that a Bio-Watch [atmospheric sensor] signal would be received and processed, but this is not likely to occur until the day after the release. The first cases of anthrax would begin to present to Emergency Rooms (ERs) approximately 36 hours post-release, with rapid progression of symptoms and fatalities in untreated (or inappropriately treated) patients.

The situation in the hospitals will be complicated by the following facts: The release has occurred at the beginning of an unusually early influenza season and the prodromal [early] symptoms of inhalation anthrax are relatively non-specific. Physician uncertainty will result in low thresholds for admission and administration of available countermeasures (e.g., antibiotics), producing severe strains on commercially available supplies of medications such as ciprofloxacin and doxycycline, and exacerbating the surge capacity problem.

Social order questions will arise. The public will want to know very quickly if it is safe to remain in the affected city and surrounding regions. Many persons will flee regardless of the public health guidance that is provided. Pressure may be placed directly on pharmacies to dispense medical countermeasures directly, and it will be necessary to provide public health guidance in more than a dozen languages.

The attack results in 328,848 exposures; 13,208 untreated fatalities; and 13,342 total casualties. Although property damage will be minimal, city services will be hampered by safety concerns.

In September 2001, an American public already reeling from the worst terrorist attack in U.S. history was stunned by news that envelopes containing anthrax had been delivered via the U.S. mail to targets in the news media. A week after September 11, letters containing 1-2 grams of dried anthrax bacterial spores were sent to three major television broadcast networks, the New York Post, and American Media International (AMI) in Florida, a publisher of supermarket tabloids. On October 5, the tainted letters claimed their first victim: Robert Stevens, a photo editor at AMI, died of inhalational anthrax. On October 9, two more letters bearing the same New Jersey postmark and containing a more refined preparation of dried anthrax spores were mailed to the Washington, D.C., offices of Senators Tom Daschle and Patrick Leahy.

During their journey, the anthrax letters passed through automated mail-sorting machines that forced the microscopic anthrax spores out through tiny pores in the envelopes, thereby infecting a number of postal workers. The tainted sorting machines also cross-contaminated other letters, which were delivered and sickened some of their recipients. By November 2001, 22 people in New York, New Jersey, Connecticut, Florida, and the District of Columbia had contracted anthrax, half of them through the skin (causing cutaneous anthrax) and the other half through the lungs (causing inhalational anthrax). Five of the 11 victims who contracted inhalational anthrax died.

Former NBC news anchor Tom Brokaw, who was one of the targets of the anthrax letters, testified about his experience at the Commission's public hearing in New York City. About a week after September 11, 2001, Brokaw said, two of his assistants handled a letter addressed to him that contained a granular powder. Several days after coming in contact with the powder, both women developed fever, malaise, and ugly black skin lesions. Their mysterious illness touched off several days of confusion and missteps. Three times Brokaw was told by various health officials, including experts at the U.S. Army's biodefense research center at Fort Detrick, in Maryland, that his assistants' skin lesions had been caused by the bite of a brown recluse spider. Finally, nearly three weeks after the initial exposures, officials from the U.S. Centers for Disease Control and Prevention (CDC) made the correct diagnosis of cutaneous anthrax. Prior to this diagnosis, Brokaw recalled, there was "kind of an unsettled feeling in the [NBC] building, but we're confining it because we don't want to cause undue panic. You know, we're operating based on what we've been told by very authoritative sources. Well, when we're told that it is in fact an anthrax attack, that [my assistants] have cutaneous anthrax, all hell broke loose at 30 Rock. There were no [response] systems in place."

In August 2008, the Department of Justice declared that it had identified the perpetrator of the 2001 anthrax attacks as Bruce E. Ivins, a government biodefense scientist who had worked for decades at the U.S. Army's biodefense research laboratory at Fort Detrick. Ivins had committed suicide shortly before he was to be indicted for the crime.

The anthrax mailings revealed serious gaps in U.S. preparedness for bioterrorism that have been only partly addressed over the past seven years. Since 2001, however, no further bioterrorist attacks have occurred. What is the risk of another incident? How worried should the public be? And in the future, how will the bioscience revolution and the globalization of the biotechnology industry change the nature of the biological weapons threat?

What Are Biological Weapons?

Biological weapons are disease-causing microbes (chiefly bacteria and viruses) and toxins (poisonous substances produced by living creatures) that have been harnessed for the purpose of incapacitating or killing humans, livestock, or crops. Examples include the bacteria that cause anthrax and plague, the viruses that cause smallpox and Ebola hemorrhagic fever, and poisons of natural origin such as ricin and botulinum toxin.

Each of these agents has distinct characteristics that affect its suitability for use as a weapon. These are infectivity (the ability to infect a human host and cause disease), virulence (the severity of the resulting illness), transmissibility (the ability of the disease to spread from person to person), and persistence (the duration of a microbe's survival after its release into the environment).

The process of turning a natural pathogen into a WMD begins with acquiring a sample of a disease-causing microbe from a natural source (such as a person or sick animal) or stealing it from a laboratory or culture collection. But just as a bullet is a harmless lump of lead without a cartridge and a rifle to deliver it, so most pathogens and toxins are not effective weapons in their natural state and must be processed ("weaponized") and combined with a delivery system to make them capable of producing large numbers of casualties.

The anthrax bacterium is considered an ideal biological warfare agent because it is relatively easy to grow, highly lethal when inhaled, and able to transform itself into a hearty spore that can persist in soil or contaminate a target area for years. If an individual is treated with antibiotics shortly after inhaling anthrax spores, the infection can usually be cured. If treatment is delayed, however, the bacterial toxins will be released, and extraordinary medical intervention is then needed for the victim to have any chance of survival.

Despite the small quantity of dried anthrax spores used in the 2001 letter attacks--a total of about 15 grams--the ripple effects of the mailings extended far beyond those sickened or killed. Professor Leonard Cole of Rutgers University has estimated the total economic impact of the anthrax letter attacks at more than $6 billion. If only 15 grams of dry anthrax spores delivered by mail could produce such an enormous effect, the consequences of a large-scale aerosol release would be almost unimaginable.

As deadly as anthrax can be, it fortunately is not contagious. Because persons infected with the disease cannot transmit it to others, only those who are directly exposed to anthrax spores are at risk. Contagious diseases such as plague or smallpox, in contrast, can be transmitted through person-to-person contact, turning the initial set of victims into secondary sources of infection.

Many factors would affect the outcome of a biological attack, including the type and strain of agent; the time of day that it is released, and the prevailing wind, weather, and atmospheric conditions; and the basic health of the people who are exposed to it. Also important are the speed and manner in which public health authorities and medical professionals detect and respond to the resulting outbreak. A prompt response with effective medical countermeasures, such as antibiotics and vaccination, can potentially blunt the impact of an attack and thwart the terrorists' objectives.

The State Threat

During the Cold War, both the United States and the Soviet Union produced and stockpiled biological agents. But in November 1969, the Nixon administration renounced the U.S. offensive biological weapons program and then began to destroy its stockpile. This unilateral action opened the way to the successful negotiation of the 1972 Biological Weapons Convention (BWC), a multilateral treaty banning the development, production, and stockpiling of biological and toxin weapons.

Although the BWC was supposed to end all efforts by states to develop the capability to employ disease as a weapon, it has unfortunately failed to achieve this goal. Because the materials and equipment needed to produce biowarfare agents also have legitimate uses in scientific research and commercial industry, it is difficult to verify the BWC with any degree of confidence. A number of countries have secretly violated the treaty. The most egregious case was that of the Soviet Union, which created a massive biological weapons development and production complex employing more than 50,000 scientists and technicians.

Today, several important countries--Egypt, Israel, and Syria among them--remain outside the Biological Weapons Convention.