Bioterror

America's leaders are taking the threat of biological warfare very seriously. So should you.

by Michael Crowley

IT BEGINS WITH a few sneezes. On a Wednesday in March, dozens of patients show up at hospitals around Providence complaining of high fever and headaches. Many are coughing up phlegm. Most are diagnosed with the flu and told to drink fluids and rest. By Thursday, more people are showing up at area hospitals. Their symptoms are worsening. Some have shaking chills, delirium, and fevers of up to 103 degrees. Patients aren't responding to standard treatments. Many who had been treated are returning. The sickest are coughing up blood. Some are dyingfrom circulatory collapse and respiratory failure. Doctors suspect an outbreak of pneumonia.

By Friday morning, local hospitals are full. Now several doctors, nurses, and EMS workers have taken ill. Mayor Vincent "Buddy" Cianci and other city officials convene an emergency meeting. Fifty people are dead.

Things begin spiraling out of control. Dozens of people are dying in and around Providence. Callers can't get through to EMS; hospitals are overrun. CNN and the national networks lead their evening broadcasts with news of a mystery epidemic in Providence. People begin to panic. Thousands rush to hospitals. Thousands more flee the city, snarling routes 6, 195 and 95 in a sustained rush hour of fear.

Health officials, who have determined that many early patients had attended a P-Bruins hockey game on Tuesday night, refer to the unknown illness as "Hockey Fever." Then, on Saturday morning, lab tests identify the disease. It is Yersinia pestis. Bubonic plague. Transmittable through a simple cough, plague kills 100 percent of its untreated victims.

An act of biological terrorism at the Civic Center is suspected. The finding touches off an unprecedented chain of events. Governor Lincoln Almond declares a state of emergency and calls in the National Guard. T.F. Green is shut down. Police try to keep people off the streets.

On Saturday afternoon, a militia group takes responsibility for the attack. That night, President Clinton delivers a national address to reassure the public, but the media are in a frenzy and the airwaves are filled with reports of varying accuracy. Possible plague cases start to emerge across the country. Riots break out as people learn that supplies of vaccines and antibiotics are severely limited. Black markets for medicine spring up. A nationwide panic sets in. America is changed forever.

NEEDLESS TO SAY, this scenario is fiction. But it is exactly the type of bioterrorist attack that Rhode Island -- indeed, the entire nation -- is preparing for at this very moment (see "Target: Providence").

For most people, biological weapons are an abstract, even far-fetched, concept. But Thursday's exercise -- one of dozens being conducted nationwide -- is just a glaring confirmation that America has moved beyond debating whether the threat exists. We are now preparing for it. With the support of billions of dollars in new spending, hundreds of the nation's top policy experts, health officials, and military officers are now focused full-time on the threat of bioterrorism. Unnoticed by most ordinary people, they are developing vaccines, training local officials, and scrutinizing illness patterns. In its scope, urgency, and, perhaps, futility, this new national effort is reminiscent of the civil-defense programs of the early Cold War. Indeed, the people who know biological weapons best say they present a threat to the United States unseen since the Berlin Wall fell. Former CIA director James Woolsey speaks for these people when he calls bioterrorism "the single most dangerous threat to our national security in the foreseeable future."

Far deadlier than chemical arms, much simpler and cheaper than nuclear bombs, there is a vicious simplicity to germ weapons. They are invisible. They have no odor or taste. They are extremely lethal. A hundred pounds of anthrax, effectively dispersed, could kill 100,000 people. Twice that amount, spread over a wider area, could leave a million dead in a week. An infectious germ, such as smallpox, might spread throughout the country within days. With panic and chaos complementing sickness and death, the impact of a major bioweapons attack could be equivalent to that of a limited nuclear exchange.

Americans have lived with the threat of nuclear Armageddon since the 1950s.That danger still undoubtedly exists, but the collapse of the Soviet Union has clearly diminished it. Now the nuclear threat has been replaced with something that is even more frightening, because it is easier to imagine its happening. Bioterrorism, Senator Jay Rockefeller (D-West Virginia) said this week, "is as great a threat or a greater threat than the Soviet Union posed to us."

And so we will begin to adopt a new lexicon for a new kind of evil. The names of the living weapons will inevitably become familiar to us: anthrax, Ebola, Q fever, smallpox, botulism, plague, dengue fever. Just as we once confronted the horrible details of the thermal pulse, the blast wave, and radioactive fallout, now we must acquaint ourselves with words like pathogen, incubation, transmittability. Where we once dealt in kilotons and megatons, now we will count in grams and kilograms. This is the vocabulary of the new "unthinkable."

BIOLOGICAL WEAPONS kill in particularly cruel ways. Where the violence of a bomb is instant, a germ weapon brings death slowly and gruesomely. The US military acknowledges about two dozen unclassified varieties of bioweapon. But an especially deadly few stand out as prime threats.

Anthrax may be the best known of the germ weapons. Its name is taken from anthracis, the Greek word for coal, because of the running, black-scabbed sores that appear on the body before it causes shock, coma, and death. Anthrax kills 80 percent of its untreated victims, and even a few microscopic spores can be lethal. When a gram of anthrax was accidentally released from a Soviet bioweapons plant in 1979, 68 people downwind died.

Smallpox kills only about a third of its unvaccinated victims. But, unlike anthrax, it is contagious. And its symptoms are even more gruesome. Smallpox victims spew black vomit, bleed internally, and develop flesh-scarring pustules across their face and body. Smallpox is untreatable, and the world stopped making vaccines in 1980, when the disease was eradicated from nature. But it lives on in loosely guarded Russian labs.

Immortalized in Richard Preston's 1995 book The Hot Zone, Ebola is one of a family of awful diseases known as viral hemorrhagic fevers. These are perhaps the scariest of all the potential bioweapons, although they are thought to be the hardest to harness. The strain of Ebola that killed 245 people in Zaire in 1995, for instance, causes virulently infectious blood to pour from every orifice, including the pores of the skin, which essentially liquefies. No vaccine exists for Ebola, which killed 92 percent of its victims in Zaire, and which can be transmitted with a simple cough.

Although the United States and Soviet Union conducted hundreds of Cold War-era tests to convert diseases like these into weapons, it hardly takes a world superpower to make a deadly germ weapon. A single germ attack, though, can be enough to cripple a superpower.

There are three basic steps to developing bioweapons. First, you need to acquire germ samples, which can be ordered from many labs with some bogus credentials and a few thousand dollars. Next, you must weaponize your germs, typically by making a dried powder of tiny particles that will float through the air and be inhaled by your victims. A bioengineer with some basic -- and perfectly legal -- agricultural lab equipment can handle that. Finally, you need a way to spray your brew into the air. Again, slightly modified agricultural equipment will do.

Once you've built your killer device, delivery can be as simple as donning a mask and driving your van through a downtown area for an afternoon. Then, sit back and wait a couple of days for the first panicky news bulletins. What is most triumphantly evil about biological weapons is that an attack from them is apparent only once sick people start pouring into hospitals. And by then it's often too late to save the dying.

No, it's not easy to launch a bioattack. But it's easy enough that the threat is worth taking very seriously. Easy enough that Bill Clinton himself told the New York Times in January that he's spent some late nights anxiously imagining how a crop duster might spray germ weapons over a mass gathering on the Washington Mall.

Of course, a terrorist might prefer to attack a specific building. It's an easier feat to pull off -- no worries about wind and weather, for instance. And in an enclosed space, the mortality rate can quadruple. A few dozen liters of liquid anthrax piped into the ventilation system of the Civic Center during a sold-out Billy Joel show, for instance, could easily kill 13,000 people.

And remember that anthrax is noncontagious, meaning that only people who had actually breathed the initial germ weapon would fall ill. The consequences of dispersing a furiously contagious virus such as Ebola at New York's Kennedy Airport -- from which unknowingly infected victims would be spread out to every corner of the globe -- are nearly impossible to grasp.

Death is only part of the formula, however. A major act of bioterrorism would almost certainly touch off panic, riots, and looting. Entire urban populations would evacuate -- in 1994, 500,000 people fled a feared plague epidemic in the Indian city of Surat. The very rule of law would be jeopardized.

Over the longer term, medical and other costs would be staggering, possibly running into the billions. And, finally, America would confront massive psychological fallout. New restrictions on civil liberties might well be demanded or simply imposed. Shock, paranoia, and xenophobia would alter our society. Daily life would never be the same.

THE VITAL question, then, is whether anyone is both able and willing to unleash biological weapons on an innocent civilian population. Nobody knows for sure. But a mounting pile of evidence suggests that the answer is yes.

Biological weapons are hardly new. They can be traced back as far as the ancient Greeks, who threw rotting animal corpses into their enemies' wells. Fourteenth-century Tartar soldiers catapulted the dead bodies of plague-infected comrades over their enemies' city walls. In 1763 the British commander Sir Jeffrey Amherst tried to whittle down America's native population by giving smallpox-infested blankets to Indian tribes.

During World War II, Japan used an elaborate bioweapons program to attack Chinese cities and fatally infect some 10,000 prisoners. Even the US has seen bioterrorism: in 1984 an Oregon cult spread salmonella on restaurant salad bars, sickening 750 people in a weird scheme to disrupt an election.

Today, most nations have renounced the use of biological weapons. America shut down its own extensive program in 1972. But around the world, bioweapons still exist by the tons -- enough to kill billions of people.

Russia is the world's leading holder of these germ weapons. The former Soviet Union is believed to have produced more than 30 tons of dried anthrax spores, tons of smallpox, and dozens of varieties of other bioweapons -- perhaps even nightmarish, specially engineered germ strains that could combine, say, the virulence of Ebola with the infectiousness of smallpox; Ken Alibek, a former head of the Soviet bioweapons program, says Russia has developed just such an "Ebolapox." The Soviets even mass-manufactured a bioweapon from blood and tissue samples of a government scientist who was mortally infected by an Ebola-like virus he had been experimenting with. So who's keeping an eye on all this stuff? In many cases, scientists and guards who may be disgruntled, underpaid -- and easily bribed.

We also know that by 1995 Iraq had produced half a million liters of such biological agents as botulinum, anthrax, ricin, and aflatoxin -- theoretically enough to wipe out entire nations. The Iraqis mounted anthrax and botulinum on bombs and missiles, and had designed a remote-controlled jet outfitted with aerosol sprayers. By the time United Nations arms inspectors became aware of the scope of the Iraqi program, all evidence of it had vanished. It is thought to be hidden somewhere in the desert.

Meanwhile, almost every enemy of the United States, including Iran, Libya, Syria, and North Korea, is in pursuit of bioweapons. But using bioweapons against the US is a high-stakes risk for a foreign nation, which could expect a swift nuclear retaliation.

Terrorists, on the other hand, are harder to trace and are a nearly impossible target for retaliation. And the ominous fact is that bioweapons technology is becoming easier for individuals and small groups to acquire. This is a dark side of the biotechnology revolution of the mid-1970s: technological advances have made bioweapons development cheaper and safer. Samples of bacteria and viruses can readily be acquired from "germ banks" created to aid research. The number of scientists with the right background to develop bioweapons is booming. Many of them are in the former Soviet Union, where they may be willing to peddle their services to the highest bidder. But you don't even need a PhD to build a germ bomb. "Biological agents don't require rare finances, they don't require rare resources," Princeton University professor Steven Block explained this month at a congressional hearing on bioterrorism. "They don't even require rare intelligence."

As for the criticism that to publicize the threat -- in an article such as this, for example -- encourages would-be terrorists, the authors Richard Falkenrath, Robert Newman, and Bradley Thayer make a salient point in America's Achilles' Heel (MIT Press, 1998): "[i]t would be a rare [terrorist group] that is intelligent enough to carry out a covert [nuclear, biological, or chemical] attack successfully, yet stupid enough not to have thought of the possibility on its own."

The spread of biotechnology is alarming at a time when a new breed of terrorism seems to be emerging, one committed less to traditional political goals and more to pure violence, death, and anarchy. Religious fundamentalists, political radicals, and millennial Armageddonists all come to mind. The most frightening example of all is the Japanese cult Aum Shinrikyo, the group responsible for the 1995 nerve-gas attack in the Tokyo subway that killed 12 people and sickened 5500. Aum's goals were simple: to kill millions of people, create global anarchy, and take over the world. Well funded and well organized, the group managed to build up giant stockpiles of chemical and biological weapons without detection until it actually staged an attack. (Aum was not broken up after the Tokyo subway incident. It still has some 18,000 followers in Russia and assets of more than a billion dollars.)

We don't know how many groups like Aum may exist. We do know that America has no shortage of zealous enemies, such as the Saudi superterrorist Osama bin Laden. Saddam Hussein may be helping bin Laden acquire bioweapons, and recent reports suggest that bin Laden may have mail-ordered deadly germs from labs in the former Eastern Bloc.

It's true that there are few historical examples of major terrorist attacks on American soil. But the end of the Cold War, and the proliferation of technology and information, limit the relevance of historical examples. We have already seen the beginnings of the change, not just with Aum Shinrikyo but with the World Trade Center bombing in 1993 and the Oklahoma City bombing in 1995. As former Georgia senator Sam Nunn put it after the Tokyo attack, "The world has entered a new era."

Or listen to the president himself. Bill Clinton told the Times that a threatened or actual chemical or biological attack in this country is "a near-certainty." While such a catastrophe is not necessarily imminent, Clinton says, it is "likely to happen sometime in the next few years."

SITTING IN a Pennsylvania warehouse is the entire US stockpile of smallpox vaccine. It amounts to less than 10 million doses.

That might sound like a lot, until you consider that smallpox vaccinations ended more than 20 years ago. And since smallpox inoculation isn't permanent, virtually none of the country's 270 million people are immune to the fast-spreading disease. A major smallpox outbreak would force the president to make agonizing choices about how to distribute the lifesaving doses.

Our supplies of other vaccines and antibiotics are just as inadequate. The country's limited supplies of anthrax vaccine are reserved for military and government personnel. As the New Republic reported last week, the Pentagon must approve every individual civilian request for vaccination (which it rarely does). And for many potential germ weapons, the US has no vaccines at all.

The president and Congress have been trying to address these potentially catastrophic shortcomings through vast amounts of new spending and preparation. Clinton's latest budget would double spending for preparedness against chemical and biological weapons to $2.8 billion, including nearly $400 million to research pathogens and develop vaccines and more than $50 million to build the nation's vaccine stockpiles. He has created a new "anti-terrorism czar" to oversee America's defenses against chemical, biological, and nuclear attacks. All 2.4 million members of the US military are now being vaccinated against anthrax (the president won't reveal whether he himself has been inoculated). The Pentagon has even asked Clinton to create a new military unit that would manage a domestic terrorist crisis.

But not everyone is convinced that the bioterrorism threat merits so much money, effort, and alarm. Some experts argue that the ease of making and using bioweapons has been exaggerated.

"We're not talking about minimally trained biology students cooking up this stuff in their bathtub," says Michael Moodie of the Chemical and Biological Arms Control Institute in Washington, DC. "Maybe growing the agent is not a particularly difficult process, but that's not nearly the same as a weapons capability."

"I think there's still a tendency to cast this publicly in thriller-writer terms," adds Moodie, who is perhaps thinking of The Cobra Event, Richard Preston's best-selling 1997 novel imagining an Iraqi-sponsored biological attack on New York City. President Clinton was reportedly so alarmed by the book -- in which victims of an engineered "supervirus" eat their own tongues and gouge out their eyes -- that he ordered a report on its plausibility.

And while there has never been a successful act of bioterrorism, we do know of some bungled attempts. On at least nine occasions, Aum Shinrikyo tried and failed to use germ weapons; these efforts included a 1990 plan to spray botulinum toxin on the Japanese Parliament and a botched 1993 attack on the wedding of Japan's crown prince. Considering that Aum was competent, well financed, and determined to cause a biological catastrophe, its failures are reassuring.

The evidence is also limited that terrorist groups actually want bioweapons. Experts suggest that terrorists may be daunted by cost, technical complexity, the consequences of getting caught, or the fear of getting sick themselves. And even terrorists might have moral boundaries: in 1995 an Aum Shinrikyo member who was supposed to fill sprayer-fitted briefcases with botulinum for a planned subway attack was struck by a guilty conscience and substituted water for the toxin.

Given these caveats, some are asking whether the new bioterrorism scare is simply the newest bogeyman to be trotted out by a Pentagon seeking to justify its budget in a post-Cold War world. "How much of the alarm is feeding the beached threat experts of the Cold War?" the journalist Peter Pringle recently asked in the online magazine Slate. "How much . . . is the threat industry acting like a new military-industrial complex of which we should beware?"

SUCH COLD War shibboleths seem out of place in this debate, however. Bioweapons come with their own set of rules unlike anything we've seen before. Although the shadow of nuclear annihilation cast a permanent chill on life during the Cold War, the logic that governed superpower confrontation always provided a strange security. Mutual Assured Destruction was fittingly derided by its acronym: MAD. It defied imagination and threatened the existence of life on earth. But in the end, it kept the missiles in their silos.

Biological weapons involve no such logic. "This is quite the opposite of `Mutual Assured Destruction,' " Princeton's Steven Block testified last week. "This is David and Goliath. . . . One guy in a garage can take down a giant."

Nothing is assured any longer. America must start coming to terms with a new reality: we are vulnerable. Try as we might, we can never police every little basement laboratory, every amoral mercenary with a bioengineering degree.

But there's much we can do to mitigate a potential attack, and perhaps even to dissuade would-be terrorists by putting up a façade of readiness. Clinton has wisely begun this work. But much more money is needed for medical training and equipment, as well as for biodetection technology. Speedy identification and treatment of an anthrax attack could raise the survival rate from 20 percent to 90 percent.

Real progress will also require Republicans in Congress to overcome their small-minded isolationism and budget millions more to secure germ weapons in Russia, redouble American intelligence overseas, and apply economic and moral pressure through treaties, sanctions, and trade incentives to promote vigilance in other countries. Harvard University's resident terrorism expert, Philip Heymann, recommends that the UN publicize huge rewards for information about bioterrorist activities. US leaders must also educate the public about the danger, especially when it comes to explaining why American lives are at risk in the skies of Iraq.

Still, we can never fully eliminate the threat -- or completely prepare for it. An act of bioterrorism in an American city would profoundly alter our national psyche. It would drape a new shroud of fear over every simple bout with the flu. The familiar expression "Something's been going around" would suddenly become loaded with terrifying implications. It's almost enough to make one pine for the brutal simplicity of Mutual Assured Destruction. But then, the Devil is always changing his form.

Michael Crowley can be reached at mcrowley[a]phx.com.