It's broke. Can we fix it?
If biowar agents are as scary and dangerous as they sound (stay tuned to meet some of the agents), should we retaliate, regulate or prepare to treat massive casualties?

If, as many experts note, bio-terrorism is only part of the larger picture of deadly terrorism, whatever disrupts and deters terrorists in general should help deter the worrisome biological variant.

Turning specifically to bioterrorism, the presumed reliance on agents and experts from national biowar programs suggests clamping down on those research programs. That, in fact, was done through the 1972 Biological Weapons Convention, which bans development, production, and stockpiling of bioweapons.

But since this scrap of paper didn't deter the Soviet Union from decades worth of intensive biowar preparation (which, indeed, helped place us at risk of bioterrorism), should we strengthen or abandon it?

Barbara Rosenberg, a biologist who heads an observer group dedicated to strengthening the treaty, says it may get teeth. This summer, she points out, the United States rejected changes to "allow international inspectors into countries to make sure they are living up to the treaty."

The move, she says, was "a terrible mistake," which could be rectified at a treaty review scheduled for November. Most other signatories to the treaty had approved the changes.

Fix it or forget it?
Although terrorism expert Richard Pearlstein sees a major biological attack as "almost inevitable," he doesn't think the new treaty language will help, "especially after the experience with the 1972 Convention, when one major signatory clearly violated the treaty."

A second reason for caution emerges from what we might call the "looking-glass" nature of biological weapons -- the close linkage between offensive and defensive research. To test vaccines or antibiotics as defenses, you've got to know what the agents are and how they may be used. (Indeed, the United States may already have infringed the treaty with its "defensive" research -- see "U.S. Germ Warfare" in the bibliography.) The treaty, Pearlstein says, might best be scrapped. "I think we should have the right to deal with the problem. If that means developing the weapons to defend against them, we should have that right."

Vaccilating over vaccine
If regulations are a problematic solution, what about preparations -- keeping your antibiotic powder dry and your vaccinating needle ready?

Face lesions on boy with smallpox.
Photo by Barbra Rice Center for Disease Control

In general, vaccines are an ideal way to prevent disease -- if one is available. Bioweapons such as the botulinum toxin, a paralyzing and extremely deadly chemical made when food spoils in the absence of oxygen, can't be treated with vaccine. Vaccines to anthrax aroused political opposition and suspicion during the Gulf War, when dozens of soldiers risked court-martial by refusing the shot.

There are even problems with smallpox, where the utility of a vaccine couldn't be clearer. Smallpox the first disease prevented with vaccine more than 200 years ago, is the only one eradicated from the wild. And yet, despite revelation that the Soviet stockpile contained dozens of tons of smallpox, little smallpox vaccine is available in the United States.

A few moments of discomfort can prevent a lifetime of suffering from the ravages of disease or death. Now, over 20 diseases can be avoided because of vaccines. Small pox vaccination ceased in 1972.
Center for Disease Control

Infectious disease specialist Dennis Maki says the few million available vaccine doses are reserved for military and emergency-response workers. That's great for them -- but in an attack, million of others would want the jab, particularly since the vaccine can prevent disease even after exposure. Without the vaccine, Maki says, the number of smallpox cases can multiply five- to 10-fold in a few weeks.

Maki says the recent government decision to buy 50 million doses of smallpox vaccine was correct, but observes that they won't all be available until 2004. A similar shortage regarding government antibiotic stocks means they could be quickly exhausted during an attack, or even during a scare.

Defending against the biowar agents that are not susceptible to vaccine or antibiotics is yet more difficult. And beyond their "achievement" in weaponizing a dozen or more pathogens, the Soviets added a disturbing twist: Using genetic manipulation to turn relatively tame pathogens into weapons of mass death.

Sandia National Lab researcher Mark Tucker examines one petri dish with a anthrax simulant, and a second treated with a decontaminating foam developed at Sandia,that starts neutralizing chemical and biological agents in minutes.
Randy Montoya, Sandia National Laboratories

Talk about potential: genetically engineered bio-weapons could, for example, survive longer in the environment or, conceivably, attack only certain races (see "Superbugs" in the bibliography). But biotech is not all menace: the Pentagon's Advanced Projects Research Agency is seeking methods to quickly detect and detoxify biowar agents.

Are we ready?
In the past five years or so, the United States has started taking steps to counter chemical and biological threats. "We are certainly further along than we were three years ago," says Jeffrey Davis, state epidemiologist of Wisconsin, with enhanced surveillance for possible bioterrorism, more capability to identify agents in the lab, and better communications with local health agencies.

But the situation is not perfect by any means. For example, a new survey found "a large proportion of hospitals [in the U.S. Northwest] probably are poorly prepared to handle victims of chemical or biolgocical terrorism" (see "Hospital Preparedness..." in the bibliography).

One logical but not necessarily popular response to an epidemic is quarantine -- isolating patients and exposed people until they can no longer infect others. Large quarantines have not been used in recent years, and may be unpopular, but Davis says, "there has to be the ability to invoke a quarantine when needed." The measuer might involve quarantining people without symptoms, he adds. They would be isolated until the pathogen's incubation period had passed.

A CDC disease surveillance and control systems team in the field combating infectious diseases. Center for Disease Control

Who's in charge?
It's easy to predict panic breaking out at the first hint of a biological attack, but more difficult to say who will be in charge. Health, police and investigative agencies from local, state and national levels are likely to have a hand in the response, and the military may be asked to identify exotic biowar agents.

The U.S. Army does have considerable expertise with nasty bugs, but many health experts says they are not suited to directing a response to biological weapons -- that the public health community is more prepared, in terms of equipment and mindset, to deal with infectious disease.

The first signs of a deliberate epidemic, they say, will appear in clinics and emergency rooms. Doctors and nurses will -- hopefully -- notice something unusual in time to do something about it.

Translated: to protect against bioweapons, you protect against infectious disease generally.

Are all the preparation necessary? Maybe not. Maybe terrorists don't have the wherewithal to mount a real biological attack. As Maki says, "If we didn't have to use [the defenses], and they cost $5 billion, I'd be delighted." But preparation, he says, "could be lifesaving for large numbers of people."

Millions of Americans died when the Europeans came a-calling.