Vaccine 21 (2003) 582–585
Editorial
Bioterrorism and the biotechnologist
1. Humans and infectious disease As humans we are fascinated by the flames of a fire, the crack of an explosion or the expression of raw power in whatever form it comes. It goes with the territory. The taming of such powers to human benefit has enabled us to increase our populations to unprecedented levels; and for a substantial minority of those people it has brought wealth and well-being beyond imagining. But with each power we master we become subject to its harmful use by those whose intentions are to deploy that selfsame power to perpetrate damage, destruction and despair. It was ever so and it remains so yet. We and all the other living organisms on our planet live in a plethora of fitful and fateful interactions. It is not an equilibrium because both the number and nature of the components change with time; it is a system in constant tension whose elements vary in quality, size and number depending on environmental conditions that cannot be controlled. The interaction of the system components is further complicated by the necessity of many of the included entities to survive by the elimination and assimilation of other members of the biosphere. Humans do not exist above this fray. Indeed we are deeply embedded in its machinations. Our existence depends on the production of fungal, plant and animal resources for our consumption. Furthermore, bacteria help us digest and acquire the selective nutrients that are essential for our survival. It would seem that viruses are our mortal enemy in whatever form they come. But we cannot ignore the evolutionary advances resulting from the genetic engineering effected by the viruses in transferring genes and packets of genetic material between all the members of the biosphere: this was going on billions of years before Cohen and Boyer (and many others) gave us in vitro methods for effecting similar tasks some 25 years ago. Nevertheless, we have to accept that the cost of this process is that, from time to time, we have to suffer illnesses and disease that we would otherwise seek to prevent. It is not only ourselves that are subject to such predations. Our domesticated animals and plants are also stricken as they are part of the same biotic system as ourselves. Infectious diseases of humans borne by bacteria, viruses, protozoans, fungi, helminths and nematodes have, over the
last couple of centuries, become less of a human survival issue than they had been previously. Whereas smallpox in most years accounted for about 10% of the deaths of the children of London the periodic bouts of plague (Yersinia pestis) might wipe out ca. 30% of an infected population. Smallpox was eliminated from the world in 1979 and today the plague is largely unknown in the developed world and is relatively rare in the less developed countries. These and other successes in the war against infectious disease have relied on the provision of clean water, food sterilised by cooking, juices preserved by fermentation and personal cleanliness (hand washing) as much as the development of vaccines, antiviral and antiparasite drugs and antibiotics. We were riding high on these successes until we realised that unscrupulous states or individuals might deliberately turn to the infectious disease causing microorganisms to cause death and debilitation in the cause of progressing war aims or advancing a socio-religious ethical position.
2. Enter the bioterrorist The bioterrorist, an individual, whether state supported or a loner, who intends to terrorise particular sectors of society by the actual and/or threatened distribution of disease causing infectious microorganisms seeks to take advantage of the relatively disease free state of modern societies. (The history of bioterrorism and descriptions of the agents and antidotes to existing or putative infectious organisms have been well reviewed in refs. [1–6].) In this he or she is now fortified by abilities to genetically modify organisms for whose progenitors we have effective antibiotics, antiviral drugs or vaccines to produce new and more devastating plagues. In addition, the technology for the large scale production of entities that could be used as agents of the bioterrorist is both well documented and provisioned with the necessary software and hardware that may be ‘purchased off the shelf’. Much of the material is already available on the internet as shown by E. Wimmer who made a live Polio virus based on a net derived sequence and the purchase of materials and reagents from internet based suppliers [7]. There is also no lack of well trained personnel who could be turned to such ventures. How are our societies going to meet this challenge to their well-being?
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Editorial / Vaccine 21 (2003) 582–585
3. Responding to the threat: doing the obvious It is obvious that all the techniques and methods that we have used historically to combat naturally occurring infectious disease causing microorganisms will be fully extended and deployed. Although, we may not know which particular organism is the one that is to be used, we can build up defensive positions in diagnostic systems, vaccines and antibiotics to all the known and conjectured possibilities. In this I would expect biotechnologists to turn their best efforts to make the necessary new and conventional diagnostic, preventive and curative agents that are effective, affordable, consistent in quality, safe, storable, deliverable, versatile, cross-reactive, stable under normal conditions, sensitive, definitive and can be easily used or applied by lay persons or auxiliary technically trained medical personnel. The magnitude of the challenge to such individuals is massive. Indeed the needs of the society will not be met unless there is a sea-change in the funding of this preventive and responsive area of health-care. Whereas many developed societies have been content to deploy less than 10% of their biomedical research and development resources to vaccines and prevention, if we are to meet the challenge posed by the contemporary bioterrorist this proportion has to be radically changed so that we spend more than 50% of these monies on the tasks that I have just delineated for the biotechnologists.
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vanced and exhaustive diagnosis, generate epidemiological data and inform local, regional, state, national and international authorities and communicable disease centres) and alert members of the community or society who are specially trained and prepared to meet with unusual diseases that could be the results of a deliberate effort to infect the community with a terrorising infectious agent. Ideally, supplies of vaccines, antibiotics and anti-infections agent drugs would be held locally or at the regional level (for visualisation let us consider a region to contain say 1–10 million people). The provision, maintenance and use of these materials needs to be planned and structured well in advance of the need to use them. Continuous upgrading of training and strategic planning will also be required. Emergency exercises involving the whole community will be needed on a regular (say annual) basis and there should be opportunities for society wide continuing discussions and debates about the best ways we could respond to posited threats. These are not cheap options. Resources derived from levies or taxes have to be hypothecated to meet these new needs. Some degree of lessening of expenditures on unnecessary luxuries will necessarily be engendered: but it will be worth it, as we will emerge with stronger and more coherent societies, confident in their mission and courageous in facing the unknown.
4. Responding to the threat: getting society on board
5. Responding to the threat: surveillance and suspicion
But this is not all we can do. Most of the recent commentators on the issue of bioterrorism have confined their attention to the science and technology that can be brought to bear on the disease causing agents [1–6]. The other dimension that needs to be engaged is that of the society at large. Each community is responsible for the provision of some level of health-care. Neighbours are often the first to know when something is amiss on the adjacent territory. Others too who also may be sensitive to the state of health of an individual are teachers, school or work mates, friends and regular associates. All such people have to be sensitised, trained and educated in what to do next. Normally, this would be to seek professional help at the nearest health-care practice while taking simple precautions that could include a simple breathing mask for the suspected case of illness. When it comes to communicable diseases, each and every member of the community is on the front line and has a duty to become trained and educated in the appropriate responses to illness. In this regard I contend that we are wholly unprepared to meet the threats posed by the bioterrorist. The local general practitioner will be at the forefront of exposure to any disease that has stricken a community member. The first question that each and every such encounter should pose is: is that disease unusual? If not, then proceed as normal. If there are unusual aspects, then take the appropriate actions (hospitalisation, isolation, samples for ad-
There is yet more to do. Here we need the vigilance of all biotechnologists. The bioterrorist is a person. He or she will have been trained as a biotechnologist in one laboratory or several. It is likely that such individuals will be known to one or other member of the community of biotechnologists. Biotechnologists, therefore, have a unique responsibility for the detection of the intentionality of a bioterrorist in the making and before that individual actually perpetrates a harm. This requirement of the biotechnologist makes it more urgent that the biotechnologist becomes a fully fledged professional and signs up to abide by a code of practice that includes provisions for the maintenance of the high reputation of the profession. This would imply whistleblowing on fellow biotechnologists who are suspected or known to be engaged in developing, with the intent to use, weapons to cause terror. There are several scenarios that emerge. One is that of an autocratic state who sends out its fledgling biotechnologists for training in a country with a reputation for the production of biomedicals and genetically engineered microorganisms. These individuals once educated and proficient return to their sponsoring state and become subsumed into the laboratory structure (overt or covert) that has been prepared to receive them. They are then told to make an agent that is to be used in a bioterrorist operation. (This could be an overt admission or it could be kept secret from the operative who may be told that the organism they are required to grow is a
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dangerous pathogen that is required for the production of a vaccine. Any biotechnologist with an iota of common sense would immediately suspect an alternative use if the amounts required are considerable and there is little animal work to support the development of a prophylactic agent.) A second scenario is that of an individual who has obtained supplies of a formulated bioterror weapon from a country that has had a major program to make such weapons and which has now publicly and officially rescinded the use of such weapons. Such a person would be ‘in the know’ in relation to the where, how and what of potential weapons. Amongst other possibilities, a theft of such material is thought to be responsible for the anthrax outbreaks caused by contaminated letters in the USA in the aftermath of the 9/11 tragedy (http://www.nytimes.com/2002/08/02/national/ 02SEAR.html). In the former USSR large scale facilities were used for the production of agents that were intended for biowarfare purposes and some 60,000 people were involved in this effort [6]. The material and knowledge generated by this machine would be difficult to destroy in its entirety so that remaining residues could fall into the hands of people whose malicious intentions would give serious cause for concern. In Japan and America data and descriptions on the experiments that were conducted by the Japanese Unit 731 (1935–1945) [8] on the production and use of agents for biowarfare are available. As a third scenario, it must be possible for such information to be used by any party interested in developing such weaponry. This might lead to the production of a lethal infectious agent by an individual working alone or a small company with a biotech capability as envisaged in the novel The Cobra Event by Preston [9].
6. Responding to the threat: inducement This leads us to consider what preventive actions we might adopt. Individuals who are set in their intents to do great damage are motivated by forces that do not respond to reason. Appeals, arguments, supplications will be of little use. But each such individual has, perforce, to interact with some, few, others in order to live and prepare for the vile deed they seek to effect. The supply people could be the Achilles Heal of the bioterrorist. If they or others who are in a position whereby they may suspect that something is ‘not quite right’ can be induced to come forward with their suspicions by a well publicised and massive reward (in excess of US$ 100,000,000) much larger expenses would be saved. Alternatively, we have to rely on the biotechnologists to come forward with this genre of information.
7. Responding to the threat: enhanced professionalism Most professions are self-policing. Individuals who style themselves professionals are required by their code of con-
duct to maintain the high reputation of their profession. This may on occasion mean that they report malfeasance by other members of their profession so that the profession as a whole does not come into disrepute. If such should constitute ‘spying’, then it is clearly spying in a good cause. Biotechnologists have not yet come to this pass. Efforts to show them the way by this author are yet to bear fruit [10,11]. Nevertheless, at this juncture it is incumbent upon all members of society and the biotechnologists in particular to be particularly aware of what it is that their fellow human is up to. We have to encourage ‘nosiness’. We may well have town centres redolent with CCTV (closed circuit) cameras with similar devices in all public and many private places that we may or may not know about. But this is not sufficient. The need is to meet and engage with all people who have the means to produce bioweapons. At conferences, trade exhibitions, public lectures, town meetings, weddings and funerals the bioterrorist will make him or herself vulnerable to observation and possibly suspicion.
8. The ethics of privacy Some may argue that every individual has ‘a right to privacy’. Such rights are embedded in the Universal Declaration of Human Rights published by the United Nations in 1948 (at Article 12 we have: “No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.” and we have in the Council of Europe “Convention for the Protection of Human Rights and Fundamental Freedoms as amended by Protocol No. 11” Article 8: Right to respect for private and family life. 1. Everyone has the right to respect for his private and family life, his home and his correspondence. 2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others. In both of these documents the privacy of an individual is granted as a right. But can we allow individuals to exploit this right to prepare to do harm to our societies? The Council of Europe is more forthright in this regard and will not allow individuals the right of privacy if “interests of national security, public safety, . . . prevention of . . . crime, . . . protection of health” are or are about to be impugned.
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9. Ethics and our human future Other arguments stem from notions of the ‘dignity of man’ which impute that a human has to be treated with respect rather than suspicion. Although, a counter ethic would have it that we should act in ways that maximise human happiness or utility or survival. If we look to sacred texts we will find that, given a sufficiently subtle hermeneut, any form of behaviour can be justified. The last ethical system that I recognise is that of the ‘Golden Rule’ that states: “Do unto others as you would have others do unto you”, or “Do not do unto others that which you would not have others do unto you”, or (as Kant would have it) “Act in a way that you would wish all other members of your society to act”. This puts us all on the spot. Would we each wish to be regarded with suspicion by our fellow biotechnologists as we would be duty bound to regard them? Maybe we have to answer this question in the affirmative. But as we so respond, we have also to recognise that trust in friends and acquaintances cannot be abolished. This is the delicate balancing act to which we are doomed. How we perform this feat will determine the quality of our future world. References [1] Barnaby W. The plague makers: the secret world of biological warfare. Pub. vision paperbacks. London: Satin Publications Ltd.; 1997. p. 199.
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[2] Schweitzer GE, Dorsch CC. Superterrorism: assassins, mobsters and weapons of mass destruction. London: Plenum Press; 1998. p. 363. [3] Lederberg J, editor. Biological weapons: limiting the threat. London: MIT Press; 1999. p. 351. [4] Geissler E. Biological and toxin weapons today. Oxford: Oxford University Press. p. 207. [5] Falkenrath RA, Newman RD, Thayer BA. America’s achilles’ heel: nuclear, biological, and chemical terrorism and covert attack. London: MIT Press; 1998. p. 354. [6] Hilleman MR. Overview: cause and prevention in biowarfare and bioterrorism. Vaccine 2002;20:3055–67. [7] Williams P, Wallace D. Unit 731. London: Hodder and Stoughton; 1989. p. 366. [8] Cello J, Paul AV, Wimmer W. Chemical synthesis of poliovirus cdna: generation of infectious virus in the absence of natural template. Published online 11 July 2002 10.1126/science.1072266 (Science Express Reports). [9] Preston R. The cobra event. Pub. orion mass market paperback fiction (new edition), 1999. p. 456. [10] Spier RE. Chartered status for biotechnologists. In: Griffin M, Walker V, editors. Harmonisation of postgraduate qualifications in biotechnology across western Europe. UK Biotechnology Education Group 1955, The Nottingham Trent University, Nottingham, 1995. p. 33–40. [11] Spier RE. Some questions and answers on the need for chartered status for biotechnologists. Genet Eng Biotechnol 1995;15:69– 76.
R.E. Spier School of Biological Sciences University of Surrey, Guildford Surrey GU2 7XH, UK E-mail address:
[email protected]