Biological weapons
Advice on what to do cannot come too soon
Most people find the concept of war horrifying.
The idea that war can be “just” and have its
own set of laws is confusing. There is a huge
body of such law: including a ban on the use of biological
weapons. Cynics, such as myself, may question
whether that law has really stopped the world from
using these weapons or whether their intrinsic difficulty
and danger has been a more effective deterrent.
At its recent meeting in France the council of the
World Medical Association spent several hours
discussing biological weapons and bioterrorisim.1
Coming as it did just three weeks after the bombing of
the World Trade Center in New York outsiders might
have thought this was a response. Far from it. It represented
some months of work by the American Medical
Association preceded by several years of report writing
by the BMA.2,3
The death of a newspaper worker from
inhalational anthrax, and the evidence of infection of
his workplace, raises the possibility than an attack has
already occurred.
The concepts behind the report are essentially
simple and relate closely to observed public health
dilemmas worldwide. Put simply, nowhere on earth
could we cope effectively with a massive epidemic of a
deadly disease. Our ability to cope can be enhanced by
various public health measures. But prevention of such
an epidemic is far more desirable and effective than
attempts to manage it. However, we will continue to
need management plans for dealing with major dis?
asters including biological or chemical weapons attack.
There has been widespread public concern that a
future terrorist attack on one of the great cities of the
world might be imminent. Has the risk really risen suddenly
or is it simply that our perception of that risk has
risen? How real is the risk and how immediate? We can
even question whether this concern has been fuelled to
aid some hidden agenda.
We have real cause for increasing concern with the
development of biological and genetic technology and
recent events in New York. So what are these develop?
ments? And what can we do to keep the world
protected?
Firstly, the handling of potential biological
weapons is essentially dangerous. If they are suitable
for use as weapons the biological agents must be easily
absorbed or otherwise readily enter the body in a form
to have a biological effect. Thus a toxin must be easily
ingested or inhaled or permeate through intact skin or
mucus membranes. Similarly, viral and bacterial
agents must be resistant to environmental factors such
as drying, heat, or cold and readily enter the body.
Laboratories that are legitimately handling dangerous
biological agents do so under strictly controlled
circumstances, designed to make sure that laboratory
workers are safe and that the risk of accidental release
is also limited. Advances in biotechnology make
handling organisms easier because techniques are
more heavily automated. The technology is still
advancing; as it develops our experience suggests that
the equipment needed will get smaller, cheaper, more
portable, and more readily accessible. Thus the
technology will not be limited to large state controlled
laboratories but will be increasingly accessible to
private individuals and well funded organisations.
The developments in genetic technology that
are allowing researchers to manipulate agents—for
example, in attempts to make better vaccines—can also
be put to malign use.45
They can be used to make more
resistant, more readily absorbable or more lethal
agents. Distinguishing what is being done in a
laboratory will require considerable skills.
Many natural pathogenic organisms are not
environmentally resistant and often have limited ability
to penetrate mucus membranes; it is these factors
which prevent the development of frequent deadly
epidemics. Efforts to contain outbreaks caused by
agents such as Ebola virus are about limiting contact
between infected or exposed people and others.
Prevention of epidemics from bioweapons must be
UNP considered in the same ways as prevention of any other
type of epidemic. Prevention includes considering the
possibility of vaccinating those at risk and of reducing
the likelihood of exposure to agents. In addition to
“medical” methods we must also consider prevention
of the use of such weapons and not simply rely on
customary law.
Vaccination has limited value; we cannot predict
the organisms that might be used, they might be
genetically engineered to make current vaccines
useless, and there are few proved effective and safe
vaccines available to currently postulated weapons. Even
where good vaccines are—or have been—available,
such as smallpox vaccine, far too few doses are likely to
be available.6
Traditional epidemiological techniques offer more
help—early detection of odd clusters of illness, perhaps
spread across the globe because of travel patterns, is an
essential tool in disease management and harm reduction.
But these same travel patterns will mean global
disease overwhelming health care and other systems.
The poorest countries in the world will face the most
problems and are unlikely to be able to contact trace
and isolate infected individuals effectively, especially if
help is not forthcoming from the more developed and
wealthier nations.
How do we prevent the use of bioweapons? If we
cannot rely on the intrinsic difficulty in handling the
agents, or in preparing them for release, we must
ensure that we can reduce the likelihood of the science
being used.
We must attempt to build up a consensus among
scientists worldwide that they will not cooperate in
production of such weapons and that they will inform
on colleagues who ignore this consensus.3
We must have systems in place to identify those who are capable
of performing the scientific tasks and who have the
technology. Having identified them we must also have
the legal power to enter laboratories and seize suspect
material and equipment. This needs international law
in the form of a verification protocol to the Biological
and Toxin Weapons Convention. This means that the
government that participates in reviewing the part of
the law of war which specifically makes using biological
weapons illegal must also put in place law which will
allow the United Nations to inspect laboratories. Such
a protocol already exists in relation to the law prohibiting
the use of chemical weapons (nerve gases and the
like) but is not part of the law on biological agents.
Several years of discussion on just such a protocol
(paper presented at the Chemical and Biological
Weapons Protection Symposium in Stockholm on 10
May 1998) recently ended in disarray over concerns
about the commercial confidentiality of data from, for
example, pharmaceutical research designed to produce
new antibiological agents. Recent events may
have readdressed the balance between such concerns
for confidentiality and concerns for public safety. There
is an urgent need for governments that have previously
vigorously supported the development of a protocol to
renew their efforts.
At the general assembly of the World Medical
Association in the autumn of 2002 in Washington, DC,
the American Medical Association will put participants
through a scenario planning exercise. For those of us
concerned about public safety, such help cannot come
too soon.
Vivienne Nathanson, head, BMA's professional resources and research group
Email: vivn@bma.org.uk
studentBMJ 2001;09:399-442 November ISSN 0966-6494
- World Medical Association website: www.wma.org
- British Medical Association. The medical implications of chemical and
biological warfare. London: BMA,1987.
- British Medical Association. Biotechnology, weapons and humanity.
Amsterdam: Harwood Academic Publishers, 1999.
- Wetherall D. Science and the quiet art: medical research and patient care.
Oxford: Oxford University Press,1995.
- Turney J. Probing the great divide. Times Higher Education Supplement 27
February 1998:23.
- Preston R. Discuss biological weapons. International Herald Tribune 22 April 1998:3.
