BIOLOGICAL WARFARE : Are we ready?

In the aftermath of the terrorist attacks, a shaken nation struggles to get back on its feet, but with the grim realization that its enemy ignores the recognized rules for waging war. Fear increasingly focuses on the possibility that such an enemy might one day turn to biological weapons. On September 24, the World Health Organization (WHO) issued a warning that modern technology has made it possible for terrorists to kill millions of people with biological or chemical weapons. Even though the threat is small, WHO said, the potential effects are devastating. Recent news reports that the terrorists who attacked New York and Washington had made inquiries about crop-dusting planes underline the danger.

It is a threat that the United States has been slow to engage, perhaps because the use of such weapons has been too terrifying to contemplate. In the last year, various levels of government have staged mock crises and devoted considerable time and money to preparing emergency personnel for such attacks. Still, our leaders have failed adequately to provide the medical vaccines and treatments needed to protect both civilians and the military against potential deadly bacteria, viruses, and toxins. Sent forth to ferret out the shadowy terrorists, U.S. troops would go woefully unprotected against biological weapons.

The threat is not new. A decade ago, personnel deployed to the Persian Gulf faced potential stockpiles of Saddam Hussein's biological weapons but were largely unshielded against them. (Iraq later admitted to UNSCOM that it had produced 8,500 liters of concentrated anthrax bacillus and 19,400 liters of concentrated botulinum toxin, which could have afflicted thousands.) In August 1990, an intelligence warning went out: "Iraq, the first nation to use nerve agents on the battlefield, probably would not hesitate to use BW [biological warfare] agents in extreme situations." The same month, the decision was made to vaccinate our troops against anthrax and botulism. But the response was too little and too late.

The Department of Defense (DOD) arranged with a single lab, the Michigan Department of Public Health, to provide the needed vaccines. When it realized that a single producer could not meet such a demand, DOD scrambled to generate an adequate supply. Project Badger, a tri-service task force, was initiated to find additional suppliers, but it turned out that commercial manufacturers were not interested. Lacking enough anthrax vaccine to go around, the U.S. Central Command then allocated doses to those personnel thought to be at greatest risk of exposure. As a result, only about one hundred and fifty thousand out of nearly seven hundred thousand troops who headed to the Persian Gulf received one or more doses of the anthrax vaccine, and an estimated eight thousand received one shot of the botulism vaccine.

It is questionable how much protection even these shots provided. A large portion of the military personnel didn't get them until early 1991 when they were already in the Gulf, too late for the full recommended regimen. Anthrax shots were to be reduced to two injections about two weeks apart, in the hope that this would provide at least partial immunity. (Food and Drug Administration [FDA] guidelines call for six anthrax shots over an eighteen-month period; its botulism vaccine schedule is three shots in twelve weeks.) Even with those lowered doses, vaccine supplies proved insufficient and anxiety quickly developed among those not on the priority list.

Military leaders later acknowledged the seriousness of the problem in a secret after-action report. Even though the threat and countermeasures were well known long before Desert Storm/Desert Shield, a 1991 Central Command report declassified in 1996 says that "the United States Army Medical Department was ill-prepared for medical defense against biological warfare agents." The full extent of this failure is difficult to determine because many service members' medical records were found, on investigation, to be missing or incomplete. It seems DOD failed not only to protect its troops against biological weapons but--either out of an attempt to cover up its shortcomings or out of just plain negligence--to keep the required records.

That was a decade ago. Today, little has changed. Experts now estimate there may be as many as fifty or more agents that are potential biological weapons, yet DOD only requires that military personnel be vaccinated against anthrax. Only one U.S. lab makes the vaccine--the same Michigan lab that produced the vaccine for the Gulf War, now owned by a company called BioPort Corporation--which has not yet been able to comply with FDA guidelines. As a result, release of new anthrax vaccine has come to a halt.

Furthermore, vaccines against a large number of other potential biological agents have never been developed or remain strictly in the research stage.

The time has come, then, for acknowledging our failures and considering a fast-track Manhattan-style project to develop and produce vaccines. The Defense Advanced Research Project Agency is supporting some innovative responses to the problem. But research related to biological weapons is often controversial because of the fine line between offensive and defensive work, as illustrated by the recent controversy over a government proposal to genetically engineer an especially potent anthrax-causing bacterium in order to assess whether the current vaccine would be effective.

Even if we are fortunate enough never to face a future where biological agents are used against us, research efforts could dramatically contribute to the treatment and prevention of disease at a time when emerging diseases are a growing threat. Furthermore, the attacks of September 11 are a chilling reminder that changing times demand changing responses. The United States must now take seriously the threat of a potential enemy who might employ lethal viruses and bacteria.

Margaret Davidson, a medical journalist, is chair of the journalism department at the University of Wisconsin Oshkosh.