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.

On Wednesday, Michael E. Ruane of The Washington Post published an article entitled “Flu Trackers Encourage Patients to Blog About It,” describing public health agencies’ growing use of the internet social interactions to track flu outbreaks.  This has been made particularly relevant today as a result of H1N1 fears, but this type of internet monitoring (part of the rubric of “infodemiology”) has not popped up as a result of H1N1.  Ruane’s article is significant in that it is a small step towards popularizing the term “infodemiology” in mainstream consciousness, which could in the future present invaluable assistance to the public health and response system.

However, the infodemiology world could greatly benefit from a slight transformation: it should increasingly promote active citizen participation.

The Rise of Infodemiology

The term “infodemiology” was coined in a 2002 American Journal of Medicine editorial entitled “Infodemiology: The Epidemiology of (Mis)information” by Gunther Eysenbach, MD, a health policy professor at the University of Toronto.

In a later article, Eysenbach more lucidly explains infodemiology:

Dr. Gunther Eysenbach

Infodemiology can be defined as the science of distribution and determinants of information in an electronic medium, specifically the Internet, or in a population, with the ultimate aim to inform public health and public policy.

Potential infodemiology indicators and metrics include automatically aggregated and analyzed data on the prevalence and patterns of information on websites and social media; metrics on the “chatter” in discussion groups, blogs, and microblogs (eg, Twitter); and activities on search engines, etc.

…infodemiology is rooted in the idea that—at least for some areas and applications—there is a relationship between population health on one hand, and information and communication patterns in electronic media on the other, and if it were possible to develop robust metrics or “infodemiology indicators” which reflected these information and communication patterns in real-time, then all kinds of useful public health applications could be developed.

Eysenbach traces infodemiological studies back as far as 1996, but the term has yet to truly enter into mainstream consciousness.

Google’s Flu Trends and Boston-based HealthMap are two examples of current, public-access infodemiological systems.  Flu Trends monitors google search queries (locations and volume) with the assumption that there is a correlation between searches and experience of symptoms.  HealthMap crawls the internet looking for relevant epidemiological information, and consolidates that information into a real-time mapping interface.

Passive Participation

Most infodemiological techniques only involve citizens passively.  They certainly require alertness on the part of citizens, but do not necessarily solicit action on the part of citizens.  Instead, they monitor the public’s web presence looking for signs of increased interest in illness without most individuals actually being aware that this is happening at all.  The Washington Post article quotes Alessandro Vespignani, professor of informatics at Indiana University, explaining the concerns of this type of monitoring:

The Internet has been . . . a major scientific revolution… [With] all huge scientific revolutions there are enormous potential dangers. And confidentiality, privacy, is probably the first major issue at stake here.

Privacy is a contentious concern because of the status of citizens as unknowing (and by extension, perhaps unwilling) in regard to being monitored.

A Screenshot of HealthMap

There is a simple solution that would overcome the privacy problem while, even more importantly, greatly strengthen the efficacy of infodemiology: active and cognizant citizen involvement.  Instead of simply being the objects of monitoring, citizens can also become individual protagonists in helping a vast health network to confront and prepare for threatening epidemics.  As Ruane explains, some infodemiological programs already utilize active citizen help, such as Maryland’s “Resident Influenza Tracking Survey,” which requires citizen volunteers to fill out weekly surveys.  However, as August 2009, only 740 people had signed up in Maryland.

Greater efforts to bring responsible individual citizens actively into the contemporary challenges of infectious diseases will not only contribute to the public health battle against naturally occurring epidemics, but will also help to defend against potential bioterrorist attacks.  Infectious disease tracking is made quite complicated by unpredictable social interactions.  Real-time information provided to a consolidated infodemiological public health network would make tracking and preparedness much more reliable, and could thus save countless lives.  And in the case of a bioterrorist attack, rapid and real-time information would be even more critical to save lives and to maintain social stability.

The Preparedness Campaign

In Biosecurity Interventions: Global Health and Security in Question, sociology professor of UC Berkley Andrew Lakoff  discusses a transformation occurring within national security doctrine.  As Lakoff explains, in contrast to the traditional approach of dealing with preventable risks, U.S. government institutions now increasingly model risk management strategies around a postmodern, ambitious, and formalized agenda of preparing for (and thus mitigating) unavoidable risks.

These unavoidable risks come in two categories.  The first type of risk is man-made.  The power of modern science and technology—most archetypically represented by nuclear physics—has resulted in the simultaneous potential for remedial and destructive effects.  German sociologist Ulrich Beck has coined the term “manufactured risks” to refer to the unintended consequences of modern progress (Ulrich Beck, World Risk Society, 1999). The second type of risk is natural.  These risks, such as environmental disasters and natural disease epidemics, are beyond human control.  The threat of bioterrorism spans across both types of risk.

The agenda of preparedness has become as, if not more, important than the agenda of prevention.  Lakoff refers to this strategy as “vital systems security” and explains that

…this form of security is oriented to a distinctive type of threat: the event whose probability cannot be calculated, but whose consequences are potentially catastrophic. (Lakoff 2008: 403)

These threats cannot be effectively measured, and our means of knowing if and when they will transpire are exceptionally limited.  The justification for expending incredible amounts of time and money to establish preparedness against these risks lies in their “catastrophic” nature.

It is in this vein of preparedness that the Bush administration, in the wake of the September 11^th and consequent anthrax letter attacks, decided to bulk up its spending on biodefense.  On June 12, 2002 during a live televised address, President George W. Bush signed the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (the Bioterrorism Act), stating:

Bioterrorism is a real threat to our country. It’s a threat to every nation that loves freedom. Terrorist groups seek biological weapons; we know some rogue states already have them…It’s important that we confront these real threats to our country and prepare for future emergencies.

According to a 2008 article from The Washington Post, from 2002 to 2008, over $57 billion was spend on the U.S. biodefense program.  Most of this spending went to preparedness approaches, such as the production and stockpiling of vaccines and drugs (Project BioShield), the establishment of a network of detectors in more than 30 American cities (Project BioWatch), and training for mass infection and casualty response.

It has recently been contended that in contrast to the previous administration, the Obama administration plans to focus more greatly on prevention efforts.  Global Security Newswire reported on a recent White House bioterrorism meeting, in which the focus was on the prevention of biothreats rather than crisis management.

However, this does not mean that the importance of preparedness will be neglected.

Moreover, as evidenced by infodemiological programs, the preparedness culture seems to be spreading into a new realm: public awareness.  Preparedness does not need only include an expensive vaccine production industry, state-of-the-art biomonitoring equipment, and recondite hospital protocols.  Preparedness need not only originate in government programs and related industry.  The preparedness agenda can, perhaps most effectively, benefit from the most abundant and powerful source: individual citizens.

The Role of the Citizen

The most recent report by the Congressional Commission on the Prevention of WMD Proliferation and Terrorism, entitled World at Risk, emphasized the power of importance of citizen involvement:

A well-informed and mobilized citizenry has long been one of the United States’ greatest resources.  While much of this report has focused on what the U.S. government much do to prevent the use of weapons of mass destruction, it is also important to recognize the contribution that all Americans can make in preventing such an attack against our country. (pg. 108)

Although the report does not discuss infodemiology, its tone and recommendations for the “role of the citizen” is directly relevant to infodemiological potential.  The national (or even global) cyber-info community can help to overcome the effects of epidemics, whether naturally or nefariously caused.  Engaged online communities can help to defeat terrorism.  However, at this point, as explained above, infodemiological systems have not fully capitalized on the role of active, engaged citizens; instead, they have focused on the perhaps more convenient route of utilizing the public’s passive web presence.  Both types of engagement must be pursued.

But in order to get to the point where the public can better help the government defend against these types of hazards, many things need to happen to also help the public toward that end.  For example, there must be more public information published that explains the properties of specific threats, what constitutes suspicious activity, and how to inform authorities.  The public and government must more intimately engage each other in an information-sharing partnership.

But Beware of Misinformation and Disinformation

As indicated by the term, infodemiology demands information—real-time information.  This is its source of greatest strength, but also a troubling source of vulnerability.  In a study on the reliability of infodemiological practice for the American Medical Informatics Association, Eysenbach concluded:

Systematically collecting and analyzing health information demand data from the Internet has considerable potential to be used for syndromic surveillance. Tracking web searches on the Internet has the potential to predict population-based events relevant for public health purposes, such as real outbreaks, but may also be confounded by “epidemics of fear”.

Although Eysenbach has identified infodemiology as having “considerable potential,” he also notes that its efficacy can be greatly undermined by misinformation.  As described above, one type of misinformation would be the result of fear, which would confound the vision of infodemiological programs.

Another type of misinformation not covered by Eysenbach could come from intentional interference (disinformation).  Pranksters, hackers, and general rabble-rousers could exploit infodemiological systems as tools of disruption, purposefully inputting false information that would result in mis-diversion of public health resources and attention.

Ruane of The Washington Post quotes Ashley Fowlkes, an epidemiologist with the CDC, saying:

You’re always going to have to have [infodemiological results] verified against a system that’s physician-based.

Cross-referencing of different public health tools such as described by Fowlkes would certainly mitigate the dangers of infodemiological disinformation.  Nonetheless, as infodemiological systems become more powerful and involved, information-reliability safeguards of some sort may have to be built in.

Concluding Thoughts

Moving towards an infodemiological model that incorporates a more active citizenry (as opposed to the currently passive use of citizens) would have several benefits:

1. Infodemiological programs would produce a greater wealth of more reliable information;
2. Individual citizens would be exposed to the importance of responsible involvement in communally defending against infectious disease; and
3. As an extension, individual citizens would be introduced to their own potential in defending against terrorism

Although it is the official job of the government, the citizenry should also try to take more active role in protecting itself.  Through partnerships between citizens, the public health system, and the government, 21^st-century biological threats will be significantly mitigated.  And the lessons learned could be applicable to other types of threats as well.

Another troublesome element of the biological dual-use dilemma, which I did not develop in my earlier post here, is the possibility of dangerous international competition.  National research agendas, aimed at maintaining technological parity or advantages, could push the pace of advancements in the biological sciences at an incredible speed, perhaps thrusting research programs into areas that would otherwise be designated off-limits.

Such a situation is complicated by inconsistencies in international standards for research, which could be the result of two things.  The first would be intentional decisions on the part of individual nations to disregard the terms of the Biological Weapons Convention (BWC), which could prompt other nations to follow suit.  The second is a cultural issue: the lack of global cultural standards on what should and should not be permitted, particularly as advances are made in biotechnology and synthetic biology.  A global scientific culture of responsibility is vital, but it is unclear how consistently such a “culture” manifests itself into standards around the world.  The BWC is somewhat ineffective on many levels because of the vagueness of what exactly is illegal vis-à-vis the dual-use dilemma and the lack of a verification protocol.  These complicated shortcomings in the BWC have led to divisive issues surrounding biodefense programs, and may lead to similar dynamics surrounding biotechnology in the future.

The Biodefense Transparency Problem

In line with the dual-use dilemma, biodefense programs involve many of the same types of technologies and materials that a nefarious biological weapons program would involve.  Biodefense programs study and experiment with dangerous pathogens, sometimes they may genetically alter pathogens, and sometimes they may experiment with aerosolization—these are some of the primary earmarks of an offensive biological weapons program.  However, in biodefense, all of these activities are performed with the final purpose of developing countermeasures and therapeutics.  Nonetheless, it is not necessarily clear to outside observers that these biodefense programs are involved exclusively with biodefense goals.  In fact, the U.S. is suspicious that several countries may be developing offensive biological weapons under the disguise of biodefense, pharmaceutical, or life sciences research programs because of research elements that appear to have pertinence to offensive biological weapons capability.  As articulated by the U.S. Department of State Compliance Report of 2005, the U.S. suspects this may currently, or in the past, be the case with the following countries: China, Cuba, Iran, Iraq, Libya, North Korea, Russia, and Syria.  However, the U.S. itself has the most far-reaching and comprehensive biodefense, pharmaceutical, and life sciences research programs in the entire world.  In an interview on Wednesday with the Nuclear Threat Initiative, independent analyst Gerald Epstein indicated that the U.S. is “by far the most transparent on [bio]defense issues.”  See here.  Nonetheless, the U.S. certainly does have many research elements, such as those described above, that could be considered from the outside as pertinent to an offensive biological weapons program.  Can we expect other countries to not have the very same suspicions of us?

Domestic Suspicions Emerge

On November 25^th, 1969, Richard Nixon’s made an unprecedented announcement, unilaterally renouncing biological weapons and thereby leading to the first ban in history of an entire class of weaponry.  In his speech, Nixon explained:

Biological weapons have massive, unpredictable and potentially uncontrollable consequences. They may produce global epidemics and impair the health of future generations. I have therefore decided that:

• The United States shall renounce the use of lethal biological agents and weapons, and all other methods of biological warfare.
• The United States will confine its biological research to defensive measures such as immunization and safety measures.
• The Department of Defense has been asked to make recommendations as to the disposal of existing stocks of bacteriological weapons.

Prior to Nixon's announcement, Fort Detrick was the center of the U.S. offensive biological weapons program

Nonetheless, despite the U.S. founding and maintaining unflagging commitment to the BWC, suspicions of an offensive biological weapons program continue to exist in our society.  The extent of these suspicions became very clear during my thesis research on the political controversy surrounding a high-containment biodefense laboratory complex recently constructed in Boston—the National Emerging Infectious Diseases Laboratories (NEIDL), operated by the Boston University Medical Center and funded in large part by the National Institutes of Health.

The controversy has become an extremely complicated struggle between different interest groups that straddles a wide variety of political and social dynamics.  However, the foundation of the controversy, its raw fuel, revolves around the hypothetical risk that situating this particular laboratory (a Biosafety Level 4 facility) poses to the surrounding community.  The conceptually precarious nature of the NEIDL’s research agenda, characterized by its uppermost biocontainment classification of Biosafety Level-4 (BSL-4), serves as the primary stimulus for disagreement and dissent over both the hypothetical impact and underlying purpose of the NEIDL.  The beneficence of the NEIDL’s intended research has been questioned.  Discourses and ideas within the NEIDL controversy show that the NEIDL’s research agenda and the BSL-4 status are understood not only within their scientific context but also within a cultural context of connotations, experiences, and beliefs held by members of society.  This interconnected web of meanings has led many within the anti-NEIDL opposition group to contend that the NEIDL will undertake biological weapons research.

In formulating ways to institute an effective biodefense program for the nation, U.S. policy-makers have identified the need to implement a fusion of national defense and public health approaches.  However, this fusion, although seemingly suited to the intricate challenges presented by biological weapon and biosecurity threats, has resulted in its own shortcomings for the biodefense program.  Renowned journalist Laurie Garrett describes the contact between these two different institutional cultures, that of national defense and that of public health, as a “conflict of interest” that jeopardizes society’s trust in the public health system’s openness and beneficence:

But the fear of bioterrorism threatens to destroy that vital social contract, which is not shared by law enforcement and defense officials. The closer a public health system draws to the other two systems, the greater the danger that it will lose credibility in the eyes of the public… Some public health advocates are convinced that no marriage between their profession and law enforcement could ever work and have denounced all efforts to heighten concerns about bioterrorism. (Laurie Garrett, 2001, “The Nightmare of Bioterrorism”, Foreign Affairs 80(1): 76-89.)

In the eyes of the anti-NEIDL community, the NEIDL lacks credibility as a safe and integral component of the public health system—it undermines the “vital social contract” of public health—because of its association with a federal, national defense agenda.  Criticisms of the NEIDL’s development end up going beyond the alleged compromise of openness and transparency.  The NEIDL’s connection to national defense and homeland security, which is represented by both its official mandate and its funding from the NIH through a targeted Homeland Security budget, has incited a pervasive accusatory paranoia about biological weapons research, particularly amongst citizens who are cynical and disdainful of the Bush administration’s record.

In an attempt to understand and mitigate public opposition to the NEIDL, the NIH established a Blue Ribbon Panel.  The following is an excerpt taken directly from the 14 October 2008 Blue Ribbon Panel public community meeting in one of the Boston neighborhoods bordering the NEIDL:

Adel Mahmoud, Chairman of the Blue Ribbon Panel: This question has been on the minds of everybody and in Boston, and I want to respond to it.  And hopefully we are responding according to the laws of the country; we are not making a story.  The development of bioweapons is forbidden by the United States and international law.  This is the law.

Audience members laugh mockingly.

Now you can laugh, and I can laugh back at you, but that’s not the issue.  The issue is, do we live in a country that has got laws that are respected or not?

Audience: No!

You need to give me the courtesy to complete my answer, just as I give you the courtesy to say your questions, ok?  Anyone who develops bioweapons can be subject to criminal prosecution in keeping with those laws and restrictions.

A member of the audience verbally mocks Mahmoud.

I really don’t appreciate that, I really don’t appreciate it.  Boston University has publicly pledged that research on bioweapons will not take place at the NEIDL.  Furthermore, bioweapons research is very different than biodefense research.  Bioweapons research involves the development or production of biological agents or toxins for use as weapons.  Please try to appreciate this definition.  Biodefense, on the other hand, involves the development of protective interventions…I really, really plead with you to try to appreciate the difference between those two because if we continue on the same six years of debate, we’re not going to get anywhere.

The NEIDL in Boston

The pro-NEIDL interest group and many experts on the issue do not believe such accusations to be credible.  But regardless of its level of validity, this argument has become an unyielding element of the NEIDL controversy; that bioweapons research will occur in the NEIDL is a perceived reality for many people observing the NEIDL’s development.  Compliance and noncompliance with the BWC is a matter not only of practice but also of perception.  This is the case for domestic audiences, as well as for foreign nations examining one another.

Fears of a Biological Arms Race

Several experts on the matter have asserted that the biodefense research, with its focus on national defense, creates the precarious possibility of a foreign bioweapons arms race as foreign nations will also perceive biodefense facilities, such as the NEIDL, as bioweapons development facilities.  This includes Boston University School of Public Health Professor Dr. David Ozonoff and medical anthropologist Jeanne Guillemin, both of whom have been very involved in the NEIDL political controversy and in biodefense discourses in general.

Despite controversy surrounding any single particular laboratory, biodefense research will continue in the U.S., whether in university laboratories or government laboratories.  It is difficult to gauge just exactly how real the threat of bioterrorism or use of biological weapons actually is, since we do not have full access to information on the capabilities and intentions of terrorist groups and foreign governments.  However, it is perfectly clear that technically feasible use of biological weapons could result in horrific and catastrophic losses of life and social stability.  Biological weapons could theoretically also be deployed as genocidal weapons.  In this scope, biodefense seems perfectly warranted despite the concerns surrounding it.

Thus, there is a tremendous need for transparency and accountability in biological research programs around the world in order to mitigate mutual suspicions and prevent a competitive, self-perpetuating biological arms race.  The Center for Arms Control and Non-Proliferation has identified this challenge, expressed in a report (released yesterday) that explains the need for more effective compliance processes.  The report was the result of a “meeting, held in Washington, DC on 25 February 2008, [that aimed] to facilitate information sharing and discussion among a small group of governmental and nongovernmental experts about the processes used by various governments and government agencies to ensure their compliance with the BWC.”  The underling significance of the report is its contributions to the understanding of how to strengthen compliance with and confidence in the BWC.

There are several things about the BWC that are important to keep in mind when considering how to implement compliance:

1. The standards of the BWC may be interpreted vaguely, with intention being extremely important in the determination of what is legal and what is not legal
2. Lack of a verification protocol and lack of clear, automatic consequences of noncompliance has made the BWC a treaty of norms, requiring the building of credibility and confidence between nations, and revolving around perceptions
3. The ultimate intent of biological research programs is impossible to know definitively

The Center for Arms Control and Non-Proliferation report discusses the compliance procedures in place for several countries as well as delving into the challenges to credibility of the BWC.  The report expressed a general positive consensus among the meeting participants over two particular treaty interpretation principles:

The first principle was that compliance assessments should proceed from the presumption that biodefense activities must be shown to be justified under the terms of the BWC, rather than from the presumption that biodefense activities must be considered compliant unless shown to violate the terms of the Treaty.

and…

Second, it was proposed that in order to justify an activity under Article I.1 of the BWC, the activity should be shown to be both useful and critical for a prophylactic, protective or other peaceful purpose, the more so the greater the compliance concern.

A CDC Vaccine Researcher in a BSL-4 Laboratory

These two principles put the burden on individual countries to demonstrate they are in compliance, rather than putting the burden on others to prove individual countries are not are not in compliance.  There is a push to implement this approach for nuclear activities as well.  Although such an approach is not necessarily fair in terms of domestic civil punishment, this is a strong approach for an international treaty like the BWC, which tends to be based on normative action and mutual confidence and does not result in automatic punishment.  Such an approach promotes greater transparency and positive accountability, which are essential for mitigating the risk of a biological arms race.

A Trickier Future with Biotechnology

The BWC does not cover international competition in biotechnological research that does not deal with pathogens and toxins.  As discussed in my earlier post, the hypothetical threats of biotechnology include social hazards in addition to the physical hazards caused by pathogens.  The social hazards may expand into the international realm, particularly since, as already mentioned, there is a lack of global cultural standards on what should and should not be permitted.  Thus, one nation’s standards, and attempts to prohibit seemingly socially divisive or risky technologies, would not necessarily be followed by other nations.  How would one nation respond to a second nation pursuing cutting-edge biotechnological research that the first nation had decided was too ethically and socially sensitive to pursue, particularly if this research could present some sort of economic or even military advantage over the first nation?  National security, economically and militarily, are topics that often trump all other arguments.  The concept of morality and social stability often seem too abstract and impractical to focus on in the minds of strategic policymakers.  Such a situation could undermine individual nations’ attempts to practice responsible and moderated biotechnological research.

On 19 June 2008, the House Committee on Foreign Affairs, Subcommittee on Terrorism, Nonproliferation and Trade held a meeting entitled “Genetics and Other Human Modification Technologies: Sensible International Regulation or a New Kind of Arms Race?”  One of the expert witnesses called for testimony was Jamie F. Metzl of the Asia Society.  Metzl explained that in the face of a country, corporation, or group moving forward with an aggressive program in a biotechnological field, particularly one that is socially and politically taboo (genetic enhancement, for example), others would have the choice of responding in four ways:

1. Doing nothing and accepting a deteriorating relative position
2. Beginning the same program in order to keep up
3. Working to halt the offending program
4. Seeking to develop a global governance structure to produce uniform conduct and application

Metzl supported the fourth choice.

Concluding Thoughts

Many consider nuclear weapons to be a paramount gauge of international eminence.  As the global disarmament agenda proceeds, and nuclear weapons are hypothetically abolished, what will take the place of nuclear weapons as a measure of international status?  Biotechnological capabilities are certainly a possibility, and it could be a possibility equally as dangerous as nuclear weapons.  The nuclear and biological technologies have many differences and their uses in society include distinct contexts.  Nonetheless, as biotechnology, synthetic biology, nanotechnology, and even robotics continue to advance at an explosive pace, lessons learned from the international nuclear voyage can certainly be applied so that the general challenges and dangers presented by nuclear weapons can be prevented in these other fields of science before they even arise.