Biological weapons: what role should environmental health specialists take in protecting our communities?

The history of war has been punctuated by incidents of and allegations about the use of biological weapons. The allegations and incidents have continued even in recent years, despite the Bacteriological and Toxin Weapons Convention of 1972. The treaty that resulted from that convention prohibits the development, possession, and stockpiling of pathogens or toxins in quantities that cannot be justified by prophylactic, protective, or other peaceful purposes. Recently, however, the significance of the threat posed by biological weapon research and production in the Persian Gulf region has been much discussed.

It is a widely held belief that Iraq, for example, maintains the capacity to research and produce biological weapons, although there was no evidence of the use of biological weapons during the Persian Gulf War. The Tokyo subway incident in 1995, involving the chemical agent sarin, demonstrated the potential impact of toxic materials and the relative ease with which they can be used by terrorists. In 1984, salad bars in Oregon restaurants were intentionally contaminated with Salmonella typhimurium, which demonstrated that the United States is not immune from terrorist acts. The incidents in which biological agents have been used as offensive weapons of war or terrorism have been few, but the threat is nonetheless real.

In the case of an incident of terrorism in the United States, it is likely that local emergency response will involve environmental health specialists, particularly those who have been trained in disease investigation and/or hazardous materials incident response. Response to a threat that a population will be exposed to a biological agent requires a few basic preparations.

Historically, biological agents developed and used for warfare have been those that are likely to cause death in a high proportion of persons exposed. The earliest on record also showed some morbid ingenuity. For example, in the 14th century, the Tatar forces, at war with what is now the Ukraine, experienced an outbreak of plague and responded by catapulting cadavers of the deceased into the city of Kaffa to cause a plague outbreak. Smallpox was introduced to Native Americans during the French and Indian War to reduce the threat against the British. Bacillus anthracis (anthrax) has also been commonly described as a biological threat in war. Until 1971, the United States stockpiled pathogens such as B. anthracis, Clostridium botulinum toxin, Brucella sp., Staphylococcus sp., encephalitis virus, and other lethal, incapacitating, or anticrop agents.

In contemporary times, it has been reported that Iraq admitted to researching offensive biological weapons including B. anthracis, rotavirus, camelpox virus, aflatoxin, C. botulinum toxins, mycotoxins, and an anticrop agent.

Biological weapons present a threat when used on the battlefield. The greatest risk, however, might be delivery of such pathogens through terrorist acts. Several characteristics unique to biological agents necessitate a proactive response to the threat these agents pose. They are, for example, characterized by low visibility, high potency, relatively easy accessibility, and easy delivery. Such factors make the general population vulnerable.

A localized terrorist act is the most likely scenario in which the expertise of environmental health specialists would be called upon. The framework for effective response to such incidents includes six components:

* Trained first responders who can assess the potential for the presence of pathogens or chemicals may be able to reduce the potential others in the area will be exposed or take steps to contain the release.

* Laboratory support for rapid analysis of chemical and biological agents is imperative.

* Effective administration of antidotes or other treatment, assessment of risk to the population, and mitigation of that risk require positive identification of the agent involved.

* Sources of technical advice and support should be identified.

* Specialists in environmental health, emergency medicine, infectious disease, and chemical hazard should all be available to support local responders.

* Training of responders and other state and local officials is imperative to ensure a coordinated and efficient response to an incident.

Public-information support is critical, especially to manage high levels of emotion or even panic that are certain to accompany a terrorist incident. Communicating risk effectively, providing information about public protection, and gathering information from the public are all critical to timely and effective follow-up. Follow-up also requires trained counselors to manage the psychosocial response to the terror in terrorism, especially if there is potential for a widespread effect on the population or if the risk is not well known.

One might ask why we should be concerned about biological warfare. After all, such agents have not been widely used throughout history. Nonetheless, the risk cannot be ignored. As recently as the summer Olympic games in Atlanta, Georgia, preparations were made to respond to incidents of chemical and biological terrorism. The Department of Defense has also responded to the threat by developing state-of-the-art biodetectors and creating military units with expertise in medical response, including vaccine and antibiotic development, hazard reduction, and decontamination. Furthermore, the Defense Against Weapons of Mass Destruction Act of 1996 is intended to improve the national readiness against potential incidents by enabling the federal government to support state and local response and prevention efforts. Primary prevention of the use of biological agents falls into the hands of law enforcement agencies, diplomats, and the military. The preparedness of communities to respond, however, also is imperative.

Environmental health specialists should consider acquiring an understanding of the threat of biological weapons and the nature of the risk and potential impact of a release in their communities. The skills needed for routine environmental health activities are significantly transferable to follow-up after release of a pathogen. For example, what if the community water treatment plant failed and pathogens were suspected in the finished water? What action might be taken to protect public health? Readiness for response to incidents of biological terrorism involves the fundamental skills of investigation, problem solving, and intervention based on analysis of available facts. With knowledge of the nature, risks, and methods of effective response to biological agents, environmental health professionals will be able to function within the emergency response structure in the community and mitigate the threat that exposure to dangerous pathogens poses for the population.

While it is often said that familiarity breeds contempt, it is also important not to let the unfamiliarity of a threat, like that of biological agents, breed neglect.