Terrorism refers here to the public health consequences and the methods for prevention of the purposeful use of violence or threats of violence by groups or individuals in order to serve political or personal agendas. This article does not include what has been termed "state terrorism," the use of violence by a nation-state without clear necessity for self-defense and without the authorization of the United Nations.
EXAMPLES OF TERRORISM
Use or threat of use of violence has long caused concern among those responsible for public health. Examples include indiscriminate violence, such as the 1993 bombing of the World Trade Center in New York City and the 1995 bombing of the Federal Building in Oklahoma City, and targeted violence, such as attacks on facilities for the termination of pregnancy or on those who work in such facilities. The primary responsibility for response to the health consequences of such violence has resided largely in emergency medical services and the primary responsibility for prevention in agencies concerned with public order and safety, such as the police and the Federal Bureau of Investigation.
Recent instances of use or threatened use of biological or chemical agents in terrorism have
AVAILABILITY OF CHEMICAL AND BIOLOGICAL WEAPONS
Underlying concern about bioterrorism is the long history of use of chemical and biological weapons (CBW) in war. Since World War II, worldwide military forces have built up major stockpiles of such weapons and tested them at a number of sites around the world. Although the Biological Weapons Convention (BWC) and the Chemical Weapons Convention (CWC) outlawed the development, production, stockpiling, and transfer of these weapons, large stockpiles of chemical weapons still await destruction in several nations, and it is alleged that stockpiles of biological weapons are still maintained in a few nations. Although the technical knowledge and materials needed to produce CBW are relatively available, the ability to "weaponize" and target these materials remains extremely limited. The risk of their use appears to be small, but any use constitutes a threat to public health.
TYPES OF BIOLOGICAL AGENTS
There are at least seventy types of bacteria, viruses, rickettsiae, and fungi that can be weaponized, including tularemia, anthrax, Q fever, epidemic typhus, smallpox, brucellosis, Venezuelan equine encephalitis, botulinum toxin, dengue fever, Russian spring-summer encephalitis, Lassa fever, Marburg, Ebola, Bolivian hemorrhagic fever (Machupo), and Argentinean hemorrhagic fever (Junin). Antibiotic resistant strains of anthrax, plague, tularemia, and glanders have allegedly been developed. Viruses and toxins can be genetically altered to heighten their infectiousness, permitting the development of pathogens capable of overcoming existing vaccines. It is estimated that no more than 20 to 30 percent of the diseases the aforementioned agents cause can be effectively treated.
RECENT HISTORY OF CONTROL
In 1994 U.S. president Bill Clinton issued an Executive Order asserting that the potential use of nuclear, biological and chemical weapons "by terrorist groups or rogue states" represents "an unusual and extraordinary threat to the national security, foreign policy and economy of the United States." This Order, renewed annually, makes it illegal for anyone in the United States to help anyone to acquire, design, produce, or stockpile CBW. The Order was amended in 1998 to include penalties for trafficking in equipment that could indirectly contribute to a foreign biological warfare program.
In 1995 President Clinton announced a new policy against "superterrorism"—terrorism involving weapons of mass destruction. The Departments of Defense, Energy, and State, together with the FBI and the CIA, were to oversee a wide network of military and civilian agencies, including the Centers for Disease Control and Prevention, dedicated to identifying CBW attacks and to coping with their consequences. In 1997, a $52.6 million Domestic Preparedness Program was authorized for emergency response teams in 120 selected cities, whereby police, fire departments, and public health officials were to receive special training and equipment to help them combat biological and chemical terrorism.
In 1998 President Clinton announced new initiatives to address bioterrorism. Hearings before a committee of the U.S. Senate in 1998 included witnesses who stated that such proposals were misguided because so many resources were being assigned to military rather than to medical or public health authorities. Ethical questions raised include whether such funds could be better spent on providing adequate public health measures,
LIMITATIONS OF COUNTER-TERRORISM MEASURES
Overall, there is little evidence that specific vaccine programs or other technical defensive programs are effective or ethical preventive measures against the use or threat of use of biologic weapons. Many public health experts argue that the best defenses against use of biological weapons lie in ethical proscription of work on them by health professionals and scientists and protection of the global population against all serious infectious disease, not just diseases caused intentionally, by ameliorating poverty and inadequate nutrition, housing, and education.
As part of this effort, it is argued, industrialized countries should enable developing countries to build capacity for detection, diagnosis, and treatment of all disease by providing technical information and needed resources. Article X of the BWC, encouraging the exchange of information and materials for peaceful purposes, should be strengthened. Research organizations, professional societies, and individual scientists should pledge not to engage knowingly in research or teaching that furthers the development and use of biological weapons. Furthermore, all countries could prohibit the development of novel biological agents that do not have an unambiguously peaceful purpose, even if these activities are promoted for defensive purposes.
An important reason that a few nations, groups, or individuals may continue to develop or stockpile chemical or biological weapons, known as "the poor nation's nuclear weapons," lies in the massive stockpiles of nuclear weapons maintained by the United States and other nuclear powers. As long as these nations fail to recognize their obligations under the 1970 Nuclear Non-Proliferation Treaty to move expeditiously toward nuclear weapons abolition, biological and chemical weapons will remain a threat.
VICTOR W. SIDEL
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