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APPENDIX D
Excerpts from “Bioterrorism: A National and Global Threat”

Gennady G. Onishchenko*

Ministry of Health of the Russian Federation

According to a study conducted by U.S. researchers in 1994, there have been more than 244 incidents involving the use of biological and chemical weapons since the end of World War I.1 A total of 110 additional suspicious episodes were later identified in which terrorists or members of criminal groups used, acquired, threatened, or displayed interest in biological weapons.2 There are only scattered cases of the use of biological agents for terrorist purposes from the standpoint of the current definition of terrorism. Until recently, the only proven case was the 1984 contamination of salad bars in a U.S. city through the addition of Salmonella typhimurium to the salad dressings.3

Experts had been predicting the growing threat of bioterrorism long before the events of September 11, 2001. Russian foreign intelligence services noted in 1993 that “the evident trend toward the broad proliferation of biotechnologies (which as a rule are dual use in nature) and the difficulties in controlling the production and use of biological agents and toxins increase the likelihood that ‘third-world’ countries will use biological weapons in local military conflicts as well as for sabotage and terrorist purposes.”4 The report also emphasized the advantage of biological weapons over nuclear and chemical weapons in that they make it possible to inflict serious economic damages on the enemy by the initial-

*  

Gennady G. Onishchenko, First Deputy Minister of Health and Chief Public Health Physician of the Russian Federation; Lev S. Sandakhchiev, General Director of the Vector State Science Center for Virology and Biotechnology; Sergei V. Netesov, Director of the Scientific Research Institute for Molecular Biology, Vector; Raisa A. Martynyuk, Deputy General Director for the Coordination of Scientific Research, Testing, and Design, Vector. Translated from the Russian by Kelly Robbins. Full article originally published in Vestnik Akademii Nauk [Herald of the Russian Academy of Sciences] 73(3):195-204, March 2003; reprinted with permission.



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Terrorism: Reducing Vulnerabilities and Improving Responses - U.S.-Russian Workshop Proceedings APPENDIX D Excerpts from “Bioterrorism: A National and Global Threat” Gennady G. Onishchenko* Ministry of Health of the Russian Federation According to a study conducted by U.S. researchers in 1994, there have been more than 244 incidents involving the use of biological and chemical weapons since the end of World War I.1 A total of 110 additional suspicious episodes were later identified in which terrorists or members of criminal groups used, acquired, threatened, or displayed interest in biological weapons.2 There are only scattered cases of the use of biological agents for terrorist purposes from the standpoint of the current definition of terrorism. Until recently, the only proven case was the 1984 contamination of salad bars in a U.S. city through the addition of Salmonella typhimurium to the salad dressings.3 Experts had been predicting the growing threat of bioterrorism long before the events of September 11, 2001. Russian foreign intelligence services noted in 1993 that “the evident trend toward the broad proliferation of biotechnologies (which as a rule are dual use in nature) and the difficulties in controlling the production and use of biological agents and toxins increase the likelihood that ‘third-world’ countries will use biological weapons in local military conflicts as well as for sabotage and terrorist purposes.”4 The report also emphasized the advantage of biological weapons over nuclear and chemical weapons in that they make it possible to inflict serious economic damages on the enemy by the initial- *   Gennady G. Onishchenko, First Deputy Minister of Health and Chief Public Health Physician of the Russian Federation; Lev S. Sandakhchiev, General Director of the Vector State Science Center for Virology and Biotechnology; Sergei V. Netesov, Director of the Scientific Research Institute for Molecular Biology, Vector; Raisa A. Martynyuk, Deputy General Director for the Coordination of Scientific Research, Testing, and Design, Vector. Translated from the Russian by Kelly Robbins. Full article originally published in Vestnik Akademii Nauk [Herald of the Russian Academy of Sciences] 73(3):195-204, March 2003; reprinted with permission.

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Terrorism: Reducing Vulnerabilities and Improving Responses - U.S.-Russian Workshop Proceedings ly covert use of biological weapons against crops or livestock. Such actions could also be carried out for the purpose of “economic warfare.” Whereas potential chemical weapons agents are well studied, and methods to counter most of them have been created, the situation is fundamentally different for biological agents. It is important to recall that biological agents do not act immediately but have an incubation period during which the carrier of an illness could end up in completely different geographical conditions from the location where the biological agents were released. Such cases are very difficult to detect and differentiate from natural outbreaks; therefore, comprehensive and potentially time-consuming epidemiological analysis is required to prove that an outbreak is of a bioterrorist nature. In the case of the contamination of the salad bars with salmonella, it was only after a year that it was proven a terrorist act, and the U.S. public learned of the incident only many years later.5 Neither should we forget that the natural environment that surrounds us is an inexhaustible source of microorganisms—viruses, bacteria, and fungi—that cause diseases in humans, plants, and animals. The World Health Organization (WHO) deems infectious diseases to be the world’s second leading cause of death and the leading cause of premature death. According to WHO estimates, 2 billion people annually suffer from infectious diseases, of whom 17 million die. Some 50,000 deaths per day result from infectious diseases, and half of the world’s population is threatened by epidemic diseases.6 There are also other reasons for which biological agents could be a preferred tool for terrorists, primarily including their accessibility; their ease of preparation, storage, and shipment; and their capacity for covert use. The threat of bioterrorism requires the health care sector to maintain an exceedingly high level of readiness to detect the most dangerous agents and eliminate the consequences of their intentional use. • • • Russia began taking measures to counter bioterrorism in 1997. The Interagency Antiterrorism Commission of the Russian Federation was created to handle operational matters, and it includes a section on bioterrorism, the members of which are specialists from a number of ministries and agencies. In 1999, on the initiative of the Russian Ministry of Health, the commission was presented with a concept describing how state agencies are to act in the event of emergencies due to terrorism involving the use of biological or chemical weapons. The same year saw the approval of the Federal Targeted Program on the Creation of Methods and Means of Protecting the Population and the Urban Environment from Dangerous and Especially Dangerous Pathogens in Emergency Situations of Natural and Industrial Origin during 1999–2005 (hereafter referred to as the Pathogens Defense Program). This program sets forth the following priorities: basic research on pathogens; forecasting of infectious disease outbreaks; and specific

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Terrorism: Reducing Vulnerabilities and Improving Responses - U.S.-Russian Workshop Proceedings methods for detecting, diagnosing, preventing, treating, and protecting against pathogens (means and methods of infection). The Center for Special Laboratory Diagnostics and Treatment of Dangerous and Exotic Infections was created, and the Federal Interagency Center for the Training of Specialists and the Testing of Means and Methods of Detecting Especially Dangerous Pathogens was organized.7 After the events of the fall of 2001, amendments to the Law on Combating Terrorism were drafted in our country, and a number of ministries are working on the Concept for the Biological Security of Russia.7 The Russian Academy of Medical Sciences and the Russian Ministry of Health are developing a program featuring a plan of actions for rendering medical and psychological assistance to the population during potential bioterrorism threats. The plan includes special training for medical personnel as well as guidance for the population on how to protect themselves against the threat of bioterrorism.9 Created in 2000, the national Program of Basic and Applied Research on the Smallpox Virus is becoming increasingly significant. The current generation of doctors has no experience diagnosing or treating this infection. Modern diagnostic methods and treatment medications are lacking, and the vaccine supply is limited.10 The Russian Ministry of Health has prepared a Concept for Reviving the Smallpox Vaccination Program and submitted it for government review in 2002. A substantial share of Russian scientific and organizational measures to counter bioterrorism are being carried out in conjunction with the existing system for combating infectious diseases. The main objectives in this system are increasing the effectiveness of epidemiological monitoring of infectious diseases on the basis of comprehensive use of computerized information and analytical systems, environmental monitoring, and collective immunity of the population developing regulations and methodologies for infectious disease prophylaxis implementing federal and regional programs to promote the sanitary-epidemiological welfare of the population improving the infectious disease vaccination system expanding the public information system for persuading the population to take personal and societal measures for infectious disease prophylaxis strengthening the material and technical infrastructure of laboratories in the treatment and prophylaxis institutions and centers of the State Sanitary-Epidemiological Observation Service, providing them with the necessary equipment, and introducing modern methods for detecting infectious disease pathogens (PCR and others) increasing scientific research in diagnostics, epidemiology, treatment, and prophylaxis of infectious diseases11

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Terrorism: Reducing Vulnerabilities and Improving Responses - U.S.-Russian Workshop Proceedings Readiness for possible acts of bioterrorism will be enhanced by having infectious disease hospitals equipped at the necessary biosafety level (at least P-3) and operating on a 24-hour basis in major regional centers, especially those with international airports. Regional clinical microbiological and immunological laboratories that must cooperate with infectious disease hospitals and relevant scientific research institutes should also be equipped at the same biosafety level. Complementing the existing system for combating infectious diseases, this set of measures for countering the threat of bioterrorism is intended to improve the health care infrastructure, enhance the quality of biomedical research, and promote better cooperation among the various ministries and agencies, institutions of the Sanitary-Epidemiological Service, and relevant scientific research institutes. • • • In the wake of the events of the fall of 2001, it became even more obvious that more international cooperation is needed in the fight against the threat of bioterrorism. Work is under way at various levels to consolidate the efforts of states in this struggle. The presidents of Russia and the United States issued a joint declaration in November 2001 stating that the two countries will work together to counter the threat of bioterrorism. The two sides declared their adherence to the 1972 convention banning the development, production, and stockpiling of bacteriological, biological, and toxin weapons and calling for their destruction.12 Also in November 2001, the United States and six other countries joined the Ottawa Plan, which calls for increased international cooperation in preventing acts of biological terrorism. The countries agreed to establish joint cooperation in supplying vaccines and antibiotics, to participate in a constructive dialogue on harmonizing laws and regulations on the creation of vaccines, particularly the smallpox vaccine, and to provide further support for the existing World Health Organization disease monitoring network and for WHO efforts to develop a coordinated strategy for curbing disease outbreaks. The plan also calls for exchanging plans for preparing for and recovering from emergency situations, reviewing opportunities for joint personnel training, and organizing exchanges of observational data from national medical laboratories, information on actual or threatened incidents of food contamination, and strategies for food supply security.13 The theme of joining forces to fight terrorism was discussed by officials from the U.S. and Russian ministries of foreign affairs, defense, health, and science at a working conference held in Moscow in May 2002.14 The question of actions to be taken by the public health care sector in response to the intentional use of biological, chemical, or radiological weapons was considered at the Fifty-fifth World Health Assembly in May 2002. The assembly secretariat noted the

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Terrorism: Reducing Vulnerabilities and Improving Responses - U.S.-Russian Workshop Proceedings importance of fighting epidemics arising under natural conditions, for example, Ebola. Special attention was devoted to measures for protecting water and food products from contamination with chemical and biological agents.15 The world possesses resources to fight infectious diseases, and these resources can be used to counter bioterrorism. In 1997 an international network for data collection and monitoring of outbreaks of the most dangerous diseases was created based on national centers and laboratories collaborating with the WHO. There are hundreds of WHO centers specializing in specific infections, as well as a network of laboratories of the Pan-American Health Organization, the International Clinical Epidemiology Network, the network of Pasteur institutes, and the network of research centers under the U.S. National Institutes of Health, which also includes universities.16 Much attention is currently being devoted to creating an automated system for epidemiological detection and response. The United States has already implemented several systems for improved monitoring both of infectious diseases and of cases of bioterrorism in major cities. The so-called Lightweight Epidemiology Advanced Detection and Emergency Response System (LEADERS) is operational at 79 U.S. military hospitals.17 An automated system has been developed to process information from patient visits and telephone calls to doctors’ offices and clinics.18 Modern geographic information systems, or GIS technology, could provide substantial help in analyzing various epidemic situations. The first epidemiological research conducted in Russia with the help of GIS technology showed that they facilitated the study of infectious disease distribution patterns, the prediction of the future course of outbreaks, and the analysis of potential consequences of acts of bioterrorism.19 Special teams (epidemiological brigades) created under WHO auspices have traditionally been used to deal with disease outbreaks. They quashed epidemic outbreaks of Marburg hemorrhagic fever in the Congo in 1999, encephalitis caused by the Nipah virus in Malaysia in 1999, Rift Valley fever in Saudi Arabia in 2000, and yellow fever in Liberia in 2001.20 To enhance the effectiveness of the struggle against infectious diseases, Donald A. Henderson, chief scientific adviser to the U.S. secretary for health and human services, proposes the organization of a network of 15 regional centers. These centers should have infectious disease clinics, diagnostic research laboratories, and epidemiological brigades operating as an epidemiological intelligence service and monitoring a region with 2–5 million residents, and educational and training facilities for domestic and international personnel. This network should cooperate with organizations such as the U.S. Centers for Disease Control and Prevention (CDC), the U.S. National Institute of Allergy and Infectious Diseases, and other centers. To ensure their legitimacy and operational stability, the regional centers must be closely linked to the WHO and to governmental departments and agencies in the countries where they are located.21 Efforts are currently under way to organize a single European Center for Infectious Diseases, which will begin operating in 2005. Similar to the U.S.

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Terrorism: Reducing Vulnerabilities and Improving Responses - U.S.-Russian Workshop Proceedings CDC, the European center will coordinate scientific research work, monitor infectious diseases, and conduct professional training. It is expected that the new center will help to optimize the activities of existing national structures in Europe such as the Pasteur Institute (France), the Karolinska Institute (Sweden), and the Robert Koch Institute (Germany), and enhance Europe’s readiness to counter the threat of bioterrorism.22 A unique system designed for combating and monitoring infectious diseases is already functioning in Russia, and it is unlike any other in the world. The State Sanitary-Epidemiological Service has 89 regional and 1,700 district centers. An antiplague system, including 5 scientific research institutes, 11 stations, and 14 brigades, operates in areas where plague is endemic.23 Considering foreign experience, the idea of creating regional infectious disease centers in Russia based on relevant existing scientific research centers and institutes is of interest. Under the leadership of the Russian Ministry of Health, these regional centers could carry out programs aimed at detecting and eliminating natural or terrorist-caused outbreaks of infectious disease in their territories. The geographical zones such centers would serve should be determined based on the economic and geopolitical significance of the various regions to Russia’s national security. Later, these Russian regional centers could become part of the international biological security network.24 Success in countering biological and chemical terrorism is impossible without coordinating the efforts of the various departments and agencies involved, for example, the Russian Ministries of Defense and Health, the Russian Academy of Medical Sciences, the Russian Academy of Sciences, and the Russian Academy of Agricultural Sciences. The experience accumulated by these institutions can serve as a foundation for creating a national system for countering terrorist acts. Attention should also be focused on the system developed by the Russian Ministry of Agriculture for monitoring especially dangerous and little-studied exotic diseases, including zooanthroponotic infectious diseases of animals.25 An obvious condition for ensuring Russia’s biological security is sufficient and stable state funding for basic and applied biomedical research aimed at developing a new generation of diagnostic tools and medications for treatment and prevention.26 At the Eighth Congress of Epidemiologists, Microbiologists, and Parasitologists, which was held in Moscow in March 2002, participants emphasized the need for fundamental expansion of scientific research, design, and testing efforts in the following areas: new rapid pathogen detection methods and tools based on cutting-edge research in the fields of biotechnology and nanotechnology new-generation vaccines and live recombinant vaccines based on viral vectors developed through genetic engineering methods, live polyvalent antiviral vaccines, and DNA vaccines new chemical substances and formulations of new disinfectant agents27

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Terrorism: Reducing Vulnerabilities and Improving Responses - U.S.-Russian Workshop Proceedings Efforts should also be continued to search for, test, and organize production of more effective preparations for treating infectious diseases. Further study of the molecular diversity and molecular variability of infectious agents will facilitate not only the rapid identification of a variety of infectious agents causing outbreaks but also the forecasting of the appearance of new pathogens based on their natural evolution or as a result of the covert actions of bioterrorists aimed at artificially changing their properties. In conclusion, we believe it is necessary to reemphasize that the state’s capacity to counter the threat of bioterrorism—one risk factor for the appearance and spread of infectious diseases—is determined by the condition of the health care system and its readiness to detect, localize, and eliminate infectious outbreaks regardless of the origins of the pathogens causing them. Another key factor in state preparedness is the quality of basic and applied research conducted both to study pathogens at the molecular and epidemiological levels and to create the diagnostic, prophylactic, and therapeutic tools necessary for preventing or eliminating disease outbreaks. Undoubtedly, Russia’s entry into the international biological security system that is currently being formed will promote a successful outcome in the struggle against bioterrorism. NOTES 1.   McGeorge, H. J. 1994. Chemical and biological terrorism: Analyzing the problem. Applied Science and Analysis Newsletter 42 (June 16). 2.   Carus, S. J. 1998. Bioterrorism and biocrime: The illicit use of biological agents in the twentieth century. Washington: Center for Counterproliferation Research, National Defense University. 3.   Chemical and biological terrorism: Research and development to improve civilian medical response. 1999. Washington: National Academies Press. http://www.nap.edu. 4.   The new post-cold war challenge: The proliferation of weapons of mass destruction. 1993. Open report of the Russian Foreign Intelligence Service (SVR). http://svr.gov.ru/material/2-1.html. 5.   Martynyuk, R., S. Netesov, and L. Sandakhchiev. 2002. International centers as a foundation for combating infectious diseases and countering bioterrorism. Nuclear Control 2. 6.   Ban, J. 2001. Health, security, and U.S. global leadership. Special Report 2. http://www.cbaci.org. 7.   Onishchenko, G. G., L. S. Sandakhchiev, S. V. Netesov, and S. V. Shchelkunov. 2000. Bioterrorism as a national and global threat. Journal of Microbiology, Epidemiology, and Immunobiology 6. The epidemiological situation in the Russian Federation and basic areas of activity aimed at stabilizing it. Materials for the report of G. G. Onishchenko, chief state public health physician of the Russian Federation, at the VIII All-Russian Congress of Epidemiologists, Microbiologists, and Parasitologists, Moscow, March 26–28, 2002. Moscow: Ministry of Health of the Russian Federation. 8.   Scientists’ response. 2001. Meditsinsky Vestnik [The Medical Herald] 31. http://www.medvestnik.ru/Gazeta/2001/031/p02-03.html. 9.   Russia developing national action program for possible bioterrorism threats. 2001. http://www.strana.ru/stories/01/10/16/1776/86465.html. 10.   The specter of smallpox: Efforts to implement national program for creating defenses against fatal infection. 2002. Izvestia, http://www.izvestia.ru/science/article17850.

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Terrorism: Reducing Vulnerabilities and Improving Responses - U.S.-Russian Workshop Proceedings 11.   The epidemiological situation in the Russian Federation and basic areas of activity aimed at stabilizing it. Materials for the report of G. G. Onishchenko, chief state public health physician of the Russian Federation, at the VIII All-Russian Congress of Epidemiologists, Microbiologists, and Parasitologists, Moscow, March 26–28, 2002. Moscow: Ministry of Health of the Russian Federation. 12.   Fact sheet: U.S.-Russian cooperation against bioterrorism. 2001. Website of the U.S. Department of State, http://usinfo.state.gov/topical/pol/terror/01111314.htm. 13.   U.S. joins Ottawa Plan to fight bioterrorism. 2001. Website of the U.S. Department of State, http://usinfo.state.gov/russki/topics/terror/1113t-bio.htm [in Russian] or http://usinfo.state.gov/topical/pol/terror/01110807.htm [in English]. 14.   Reducing the threats from weapons of mass destruction. Building a global coalition against catastrophic terrorism. Working for a safe world. Moscow, May 27, 2002. 15.   Deliberate use of biological and chemical agents to cause harm. 2002. WHO 55th World Health Assembly. A55/20. 16.   Martynyuk, R., S. Netesov, and L. Sandakhchiev, op. cit. 17.   Zaitsev, K. Medical news: a hospital leader. http://www.medlinks.ru/article.php?sid=1470&mode=thread&order=0&thold=0 [undated]. 18.   Lazarus, R., K. Kleinman, I. Dashevsky, et al. 2002. Use of automated ambulatory-case encounter records for detection of acute illness clusters, including potential bioterrorism events. Emerging Infectious Diseases 8(8). 19.   Boyev, B. V., V. M. Bondarenko, A. A. Vorobyov, and V. V. Makarov. 2002. Problems of protecting against acts of bioterrorism under current conditions. Agrarnaya Rossiya [Agrarian Russia] 2. 20.   WHO report on global surveillance of epidemic-prone infectious diseases. 2002. http://www.who.int/emc/surveill/index.html. 21.   Martynyuk, R., S. Netesov, and L. Sandakhchiev, op. cit. 22.   Tibayrenc, M. 2001. A European center to respond to threats of bioterrorism and major epidemics. Bulletin of the World Health Organization 79(12). 23.   Website of the Russian Ministry of Health, http://www.minzdrav-rf.ru. 24.   Martynyuk, R., S. Netesov, and L. Sandakhchiev, op. cit. 25.   A system for epizootiological monitoring of especially dangerous, exotic, and little-studied diseases including zooanthroponotic diseases of animals. 2001. Moscow: All-Russian Research Institute of Veterinary Virology and Microbiology. 26.   Paltsev, M. A. 2002. Biological weapons: A problem for Russia’s national security. Natsionalnaya Bezopasnost [National Security] 5. 27.   The epidemiological situation in the Russian Federation and basic areas of activity aimed at stabilizing it. Materials for the report of G. G. Onishchenko, chief state public health physician of the Russian Federation, at the VIII All-Russian Congress of Epidemiologists, Microbiologists, and Parasitologists, Moscow, March 26–28, 2002. Moscow: Ministry of Health of the Russian Federation.