Weapons and Hope

We Live in a Nuclear World

In our world of nuclear headlines, biological threat issues continue to get very little relative attention from the media, public, and government.  Nuclear weapons certainly pose a very, and viscerally, immediate threat.  Their very physical existence poses tremendous risks regardless of who controls them.  On top of that, there may be nothing more popularly terrifying than nuclear weapons in hands of ‘rogue’ states and terrorist organizations.  Nonetheless, many within the nonproliferation world have dedicated themselves to the less-known but emerging biological threat.  Although the public today is much less interested than it had been during the heights of the Cold War, the controversies over Iran’s and North Korea’s nuclear programs have caused nuclear nonproliferation and nuclear terrorism discourses to increasingly register in the public consciousness.  However, the public has not gotten very far down the road of engagement with bioterrorism discourses.  Since the Amerithrax letters in 2001, the government has dramatically bumped up spending for biosecurity and biodefense projects.  Nonetheless, there has been very little public engagement with these measures implemented by the Department of Homeland Security and Department of Health and Human Services.  This is incredibly unfortunate because the public could, in fact, benefit more greatly from understanding the nature of bioterrorism than from understanding nuclear terrorism.

The Prevention vs. Preparedness Dichotomy: Nuclear vs. Biological

As explained in last week’s post about infodemiology, there are two approaches to confronting the low-risk but high-impact threats, such as those presented by terrorist activities.  The first is prevention, which is aimed at identifying and thwarting the processes of the threat before the threat can actually materialize.  The second is preparedness, which assumes that a threat of this nature cannot necessarily be prevented and, thus, must effectively be dealt with after its materialization with the objective of mitigating the impact as fully as possible.

One of the Amerithrax Letters. The FBI alleges that Bruce Ivins, an American biodefense laboratory researcher, was the culprit behind these 2001 bioterrorist attacks.

The approach to the nuclear terrorism threat has focused on prevention—ensuring that fissile material, nuclear components, or entire bombs or warheads do not fall into the hands of terrorists.  Once a nuclear device is detonated, death and destruction are immediately felt, and there is little that can be done to mitigate effects after the fact.  Preparedness is certainly valuable, as moving people away from the direction of fallout would save lives and protect health.  Nonetheless, the major damage is immediate, making prevention critical.  This focus on prevention is reflected in the centrality of the global nonproliferation regime, counterproliferation efforts such as the Proliferation Security Initiative and the Global Initiative to Combat Nuclear Terrorism, and comprehensive bilateral efforts between the U.S. and Russia to secure loose fissile material and nuclear components throughout all the ex-Soviet territories.

In contrast, the approach to bioterrorism has revolved around preparedness, reflected most specifically by President Bush’s Project BioShield and Project BioWatch.  There are a few reasons for this difference of approach.  The first is the tremendous difficulty involved in monitoring, securing, and controlling biological materials (pathogens) as opposed to fissile materials.  As pointed out in an earlier post, biological sciences are simply more prolific and easier to pursue than nuclear physics, all countries have the right to research and have better access to research in the biological sciences, and the pursuit of understanding and improving human health is culturally more entrenched worldwide.  Moreover, hazardous biological materials can be found in nature—and they are capable of self-replication in nature.  Thus, if terrorist organizations desire to do so, it may be incredibly easy for them to acquire hazardous biological agents.  Below is a table included in an article by Dr. Jonathan B. Tucker, Senior Fellow and biological and chemical weapons expert with the James Martin Center for Nonproliferation Studies, which lucidly outlines the differences between fissile and biological materials:

Keeping hazardous biological materials out of the hands of terrorists is a virtually impossible task, thus leading to a greater focus on preparedness biosecurity strategies.

On his change.gov website, President Obama had pledged to “strengthen U.S. intelligence collection overseas to identify and interdict would-be bioterrorists before they strike,” thereby adding to the prevention approach.  A recent White House bioterrorism meeting confirmed this intention; reporting by the NTI’s Global Security Newswire indicated that the focus was on the prevention of biothreats rather than crisis management.

Nonetheless, President Obama on change.gov also indicated that he would continue and strengthen the already established preparedness campaign by “Build[ing] Capacity to Mitigate the Consequences of Bioterror Attacks,” “Accelerat[ing] the Development of New Medicines, Vaccines, and Production Capabilities,” and “Lead[ing] an International Effort to Diminish Impact of Major Infectious Disease Epidemics.” Preparedness techniques help against both naturally occurring epidemics and bioterror attacks, and every indication points to the fact that President Obama, like President Bush, believes in the fundamental need for preparedness vis-à-vis bioterrorism.

In addition to the tremendous difficulty involved in monitoring, securing, and controlling biological materials, the nature of the biological threat also alters the distinction between prevention and preparedness techniques.  In fact, because of the properties of biological threats (pathogens), preparedness is uniquely a form of prevention in the biological realm.  Bob Graham and Jim Talent, chairmen of the 2008 Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, explain this relationship in an article in the most recent issue of Biosecurity and Bioterrorism:

The Report of the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism

There is, indeed, a great deal of work to do, but biological weapons give the good guys opportunities that nuclear weapons don’t: a biological weapon can be prevented from causing mass lethality after an attack. This cannot happen after a nuclear detonation, but it is theoretically possible to significantly limit the loss of life after the deliberate infliction of disease. It may be an expansion of what is normally thought of as prevention, but it capitalizes on the unique traits of biology. There may be a time period after an attack when a prepared, efficient response could limit the size and scope of the attack by orders of magnitude. A well-prepared nation can use the incubation period of a disease-causing agent to its people’s advantage.

In the biological realm, a focus on preparedness is not simply a half-hearted, lazy attempt to protect the population.  Instead, it is indeed a form of prevention—prevention not necessarily of the hypothetical attack, but prevention of the consequences of that attack.  The luxury of this approach does not exist in the nuclear realm.

True Preparedness Involves Public Action

A post last week made the argument that a truly effective infodemiological program would need to involve public engagement.  That argument is extended here: a truly effective program of preparedness against bioterrorism involves public engagement.  In order for the preparedness-prevention capability described by Graham and Talent to work, in addition to the development of medical countermeasures, those medical countermeasures must be distributed (1) quickly, (2) widely, and (3) smoothly in the immediate wake of an attack.  The countermeasures are useless unless used on an individual basis in a timely manner.

Quick distribution is achieved through rapid identification of an attack.  This requires effective monitoring on all levels of the public health system as well as biological agent detectors, such as those of Project BioWatch.  Thus, this first criterion is resolved through institutional and technical fixes, both of which can continue to be improved.  For example, the detectors currently in place under Project BioWatch cannot detect for the almost infinitely wide range of pathogenic threats.  Undoubtedly, detection technology will continue to improve and solidify capacities for rapid identification of an attack.  Wired’s Danger Room and Popular Mechanics each have recent articles illustrating the progress promised in this area by metamaterials and nanotechnology.

Wide distribution is achieved by an effective mechanism of distribution.  This is a product of logistics.  Somehow, medical countermeasures need to get from their preliminary location and into the hands of individual people in order for preparedness-prevention to be achieved.  Over the past eight years, authorities have considered ways in which to accomplish this.  Currently, one of the leading plans is to utilize the Federal Postal Service to strategically deliver countermeasures according to pre-planned routes while encouraging private citizens to remain in their homes and patiently await deliveries.

According to a 2008 New York Times profile of the new plan—which has been designed specifically with an eye toward what the authorities consider the most likely bioterrorist attack, an anthrax attack—at least 72 major cities have adopted this strategy and devised plans to deliver prophylactic antibiotics in the case of an anthrax attack.  The strategy has shown to be remarkably superior to the past approach:

The traditional approach to dispensing medical supplies to a large population is to place the medicines in schools and other public places and instruct people to pick them up. The main shortcoming of this “PODs” approach (for “points of dispensing”) is labor: there are not enough public health workers to distribute the antibiotics quickly, and cities would have to rely largely on volunteers to perform unfamiliar (albeit simple) tasks in unfamiliar settings. A better way is to let residents stay home and have mail carriers, escorted by police officers, go door to door delivering antibiotics. This can be done within eight hours, trials in Seattle, Boston and Philadelphia have shown.

Though designed specifically as a counter to an anthrax attack, this strategy can certainly be applied to bioterrorist attacks using other biological agents.

Perhaps the most difficult, uncertain, and least considered criterion is the third: smooth distribution.  Technical, institutional, and logistical planning can certainly be complex, but are afforded with technology, bureaucratic structure, and contingency awareness that ensure efficacy.  On the other hand, planning to deal with potentially chaotic social dynamics is quite another task.  In the wake of a bioterrorist attack, it would be reasonable to expect a breakdown in social order, even before symptoms begin to set in on a large scale.  Overrunning of health facilities, a mass exodus out of the victim city, and activities like looting that are characteristic of social disorder would be all be potential consequences.  In such an atmosphere, how do the authorities implement their well-crafted strategy?

The key is public cooperation during the post-attack process.  And the only way to ensure cooperation during that process would be to inform and prepare the public in advance for this hypothetical misfortune.  The New York Times explains that “Mathematical models suggest that such a well-executed and well-supplied approach to delivering antibiotics would result in half the number of deaths as would occur using the traditional PODs approach.”  However, without smoothness of distribution—that is, without cultivating public cooperation during the process—any sort of advantage presented by the new distribution strategy would be made negligible, and ultimately, the entire ordeal would likely be unsuccessful depending on the magnitude of social disorder.  This chaotic situation could be averted through pre-planned public engagement.  The public must be made aware of the hypothetical threats, the epidemiological properties of those threats, the planned preparedness-prevention strategy, and the rationale for that strategy.  The public must be made aware that the authorities’ plan is, indeed, in their best interest.

Promoting Public Cooperation

This sort of awareness does not require an incredibly in-depth or esoteric scientific understanding.  Science can be complex, but it is easily translated into all levels of lay language.  Right now, there are serious information gaps throughout the public, partially having to do with insufficient public outreach by the authorities, and partly with public apathy.  How can those information gaps be filled in?  The public cannot simply be forced to sit down and study the information pertinent to a bioterrorist attack—an event that may very well never occur in individual cities.

But this task does not necessarily require a methodical campaign of public education.  Instead, small-scale actions could be taken to promote an overarching culture of responsibility and awareness that would contribute in the end to organically smooth implementation of bioterror preparedness-prevention strategies.  For example, measures could be taken to promote greater access to the pertinent information on the internet, there could be greater media coverage, and acknowledgement of the threats and instruction could be provided in school classes.  Individually, each one of these things may not amount to much.  But as a collection of mutually reinforcing elements, they would form a cultural “web of significance” effectively enforcing smooth public handling of a bioterrorist attack.