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REVIEWS
Further
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PSYCHOLOGICAL DEFENCE.
PHYSIOLOGICAL DEFENCE .
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Protective equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
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Decay..............................................................
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RESTORATION MEASURES. . . ... . . _ ..... ............. .... .. ... . ... .... . . '
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INTRODUCTION
Sciences as a working document for the Pugwash Study Group on Biological Warfare,
Marienbad, May 11-12, 1967.
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HEDN
641
Assembly of the United Nations declaring that disarmament is the most important
Only the scientists can create this body of opinion. They can speak with an author
ity which the
ordinary citizen,
to which he
the generals or
endeavour to avert the
is compelled to listen. Since they cannot hope for much help from
the ministers, they must act by
t hemselves, in a supreme
An indication that the dangers j ust mentioned might well include bio
logical warfare is given by the attitude of the superpowers.
Statements by leading Soviet military and political authorities are re
garded as indications that they are prepared to use, inter alia, biological wea
pons in a future war (4, 5) , but doubts about this interpretation have also
been expressed (6). It is reported that Defence Minister G. K. Zhukov said,
in February 1956, that a future war would li ke ly be fought with, inter alia,
nuclear, chemical, and biological (ABC) weapons. A Russian colonel added
in 1959 that "from results of comparative studies of the losses of life from
conventional weapons, war poisons, and atomic energy on one side and losses
from biological weapons on the other, it is believed today that a biological
war would have the greatest effect of all" (7). It has even been suggested
that BW might play a very important part in the Russian long-range offen
sive planning (7). Under all circumstances, Russia has set up a highly efficient
organisation for BW defence (8) and for the training of civilians in ABC pro
tection (9).
The United States was claimed to be behind the USSR both offensively
and defensively in 1962 ( 10) , but a five-year plan then existed which would
close the gap. As i ndicated by recent studies (11, 12), scattered i ndications,
like the use of 1236 monkeys in a determination of the median lethal dose of
i nhaled anthrax spores (13). and earlier reports on the American (14, 15) ,
British ( 1 6) , and Canadian ( 1 7) efforts in the field, the latter is attacked with
so much vigour that it would be most remarkable if no important develop
ments were to occur. After all, "the combining of military techniques and
science makes it easy to apply scientific principles to kill people-who are
not strong structures" ( 18) . Some of the results of purely basic research in
microbial genetics, molecular biology, and bioengineering also cast a sinister
light over Man's future as far as biological warfare is concerned. Add to this
the great advances made in microbiological laboratory personnel protection
(19-23) and the fact that equipment ranging from elaborate protection hoods
to fermentors suitable for the propagation of pathogen s ar e n o w co mmer
ci ally a va il a ble, a n d it s houl d become obvious that it is increasingly difficult
to neglect the BW d efence problems.
642
HEDEN
BIOLOGICAL WARFARE AS A WEAPONS SYSTEM
became available during the second world war and in the Korean campaign,
infectious diseases caused several times more noneffectiveness among the
United States troops than battle injuries (24-26). Obviously, the deliberate
introduction of infectious diseases among troops would gain for the enemy
a military advantage, but BW has-with few exceptions (27)-been at
tempted in a crude way only, and never as a major weapons system (28) .
As late as the autumn of 1958, the American civil defence authorities re
garded the risk of biological and chemical attack as slight. Since then, how
ever, there has been a re-evaluation of the situation in that country, illus
trated i n a number of special i nvestigations ( 1 1 , 12, 29, 30) , which particu
larly considered the advances made in the handling of biological aerosols,
and put biological and chemical weapons in the same class as nuclear wea
pons. It was pointed out, for example, that military-political issues were be
coming more and more dependent upon civil defence pote nti al , which no
longer had the same secondary significance a s obtained during the era o f the
piloted bomber aircraft and conventional weapons. Also, experimental data
from human as well as animal studies provided background for such authori
tative statements as "the offensive use of biological agents is feasible" (26) ,
and "biological agents exist which can b e used strategically to cause casual
ties in an area the width of a con ti nen t " (31, 3 2) . Doubts concerning the
striking power of isolated infectious agents actually began to be dispelled dec
ades ago in tests on humans with, for example, Rickettsia tsutsugamushi (33)
via the skin , Plasmodium vivax via the blood stream (34), and Brucella
abortus (35) , i ntestinal bacteria (36, 37) , and poliomyelitis virus (38)
via the mouth. Of particular interest in this connection is the fact that the
aerosol dose of FranciseUa tularensis on humans could bc fixed at about 25
cells (39, 40). In the case of Q-fever, even a single inhaled parti cle (Coxiella
burnetii) might be sufficient to cause infection (41) , so that, in theory, a gram
of inoculated e m bryonic chicken tissue might hold no less than a billion hu
man infectious doses (42).
The possibility of dissemination over very large areas has also been dem
onstrated in field tests involving fluorescent particles (43) and bacterial
spores (44) . For instance, a cloud of 2/L zinc-cadmium sulphide particles
(450 pounds generated along a 15 6-mile stretch of coast) spread out over
about 34,000 square miles of land, where a minimum dose of 15 and a maxi
mum dose of 15 ,000 particles per minute were inhaled. I n the cited experi
ment with spores, 130 gallons of a suspension of Bacillus subtilis var. niger
was aerosolized from the deck of a ship running on a two-mile course about
two miles offshore. The dissemination line was at right angles to an onshore
wind, and meteorologically the situation was characterized by a certain tend
ency to vertical dilution. I n spite of this, the cloud could be followed for
about 23 miles, gi vi ng viable cell densities inside buildings corresponding to
643
"infectious doses, " over some 100 square miles. Of course, a test of this sort
can be downgraded insofar as it concerned a spore, but guinea pigs have ac
tually been infected with vegetative bacteria which had travelled in an aero
sol nearly 15 miles (44, 45) .
A n ordinary aerosol generator, yielding a cloud in which only 5 per cent
of the particles were in the most infectious size range [1 to 5p. (46, 47) ], was
used in the spore experiment mentioned. If it had involved Bacillus anthracis,
of which, incidentally, 4130 spores is the LDoo for cynomolgus monkeys (13) ,
the size distribution would certainly have influenced the infectious dose,
since it is known from animal experiments that particles which are 12p. in
diameter give an infectious dose which is at least 17 times greater than that
which is required by a single cell aerosol [in this case which concerned guinea
pigs, about 23,000 cells (44)]. With regard to other types of disease agents
F. tularensis, C. burnetii, and Venezuelan equine encephalomyelitis) , there
may be a difference of many ten thousands in the requisite infectious dose
if one compares aerosols with 12 and 1p. diameters, respectively (44). The
latter types of particles are chiefly generated from dilute suspensions sub
jected to great force in fine nozzles and are consequently rare in nature (48,
49).
From the foregoing it should be obvious that the offensive use of infec
tious clouds is intimately linked with the technology of generating fine-part
icle aerosols in which the virulence is maintained. If this technology is ade
quate, even the limited quantities of material which could be handled covert
ly might give disastrous results when disseminated over large areas.
Obviously, the size of aerosol generators which would be used in limited
attacks (on parliament buildings, military staff headquarters, etc.) would be
so small that they could easily be concealed by a saboteur. He could also
arrange to leave the scene in ample time before cases start to appear; in the
case of an attack with F. tularensis it would, for instance, take some two to
five days before the disease sym ptoms (fever, headache, malaise, sore throat,
muscular ache, and chest pains) would begin to make themselves felt (40).
The conventional image of biological warfare, the covert " man with the
suitcase"-poisoning water supplies and ventilation systems-may seem to
have been discarded (11), but this attitude might well prove to be premature,
at least if one considers specific situations; for instance, a sanitary break
down caused by nuclear attack or mobilization, when the psychological re
percussions of a covert BW attack might be very severe. It should not be
forgotten that as early as 1917 an agent succeeded in infecting 4500 donkeys
with Malleomyces mallei (27), and that a number of tendencies in a modern
society pave the way for sabotage acts: 1. extensive and rapid communica
tions, increasing the "coverage"; 2. urbanization; concentrating people an d
pr odu ction units in small areas ; 3. increasing the size of slaughter houses,
dairies, food processing industries and waterworks; 4. more efficient agricul
ture, i.e., extensive use of monocultures, large herds, and centralized fodder
manufacture; 5. central ventilation systems in command centres, subways,
644
HEDtN
645
aerosol attack on man or animals, carriers like crystal needles might help
viruses to penetrate the epidermis of plants (27) , elimination of chlorination
would permit or simplify an attack via water, and so on. I t is obviously
very difficult to discuss the BW defence problems in anything but a hand
book, so the following text has been limited to microbiological agents with an
emphasis on aerosol warfare, antipersonnel weapons, and the international
aspects of BW defence. With regard to the defence against toxins from other
than microbiological sources, defoliating agents, plant hormones, etc., the
reader is referred to the more general texts which also give many additional
details on antipersonnel weapons (27, 53-56).
PSYCHOLOGICAL DEFENCE
However, at the same time he should beware of the dangers inherent in the
of strategies which tends to alter the concrete nature of certain mili
tary problems by turning them into abstractions (overkill, megadeath,
megacorps, etc.), thus disguising the real nature of the operations from those
who take part in them (3). In this connection, the scientist has a special re
sponsibility, namely, to provide reminders that, for instance, "to restore a
situation with nuclear fire" might mean adding to the military chaos, and
"counter-force strategy" would mean destruction of enemy cities and the
eradication of their population. Although when, in outlining the dangers of
strategic jargon, Sir Solly Zuckerman emphasized nuclear war, he might have
pointed out that biological warfare of the genocidal type would certainly
create a similar situation.
Planning for conceivable BW situations is much more difficult than pre
paring for other types of disaster stich as earthquakes or train accidents, for
which there are precedents. With regard to BW, superstition has a tendency
jargon
646
HEDtN
to appear, and we hope that the threat will disappear if we adopt the ostrich
method of sticking our heads in the sand. This steals from an educational
effort the time which should be spent not only to induce watchfulness among
military, ci vil defence, customs, and target-indus try personnel, but also to
provide knowledge and experience with "exotic" infections to doctors, veter
inarians, plant pathologists, and microbiologists. The planning for defence
must again be pointed out that Koch's postulates have been confirmed in
Man many times for many disease agents as the result of inhalation of labor
atory-prepared materials"
(58).
among defence planners for many years. The subject of air-borne infection is
now a vast one and several excellent reviews and conference proceedings pro
vide a detailed treatment of the subject (59-63).
Aerosol weapons have a great diffusion capacity and they consequently
possess a "search" capability which is considerable. As with normal infec
tions, th e response of the i n dividual , however, varies within wide limits, in
dicating that much can be gained by increasing resistance at the physiologi
cal level, specifi c ally or nonspecifically (64).
Another infection route frequently discussed in BW reviews is via vec
tors. This is logical since the outcome of many wars has been determined by
such diseases as malaria and typhus. In fact, charges that this type of war
fare has been used against China have appeared on several occasions
(27, 65,
66). Military biologists are also reported to have achieved a great deal in the
end of the war, there were even plans for producing four times this quantity.
No less that 2000 arthropod vectors have been stated to transmit more
than 100 diseases to man (67), and this hints at some of the defence prob
lems to be found in this particular BW area. An effect on the vector as well
as on the infectious agent might be sought for at the physiological defence
level.
In one experiment claimed to have been carried out in a relatively mos
quito-free district in Florida (51), 200,000 mosquitoes were liberated, and it
was found that a large portion of the personnel at an airbase suffered several
stings in the space of a couple of days. If these insects had carried yellow
647
ches, the respiratory bronchioles, there is, however, no lining, and particles
deposited in this region [preferentially the 1- to 5-p. range (7 7-80)] persist for
a considerable time.
A third line of defence is the phagocystosis which occurs in the depth of
the lung (73, 81). If this defence is overcome or bypassed, either by the viru
lence factors of the microorganism or by other influences on the host [a pre
vious virus infection, hypoxia and acidosis, ethyl alcohol, or tobacco smoke
(8 1)], there may be either an initial local involvement as in tularemia (82)
and psittacosis (83) , or the microorganisms enter the vascular system directly
as in Q-fever (41 ) . Phagocystosis may, however, be a factor in penetration as
well as in protection. The former case is illustrated by the finding that cells
which loose their Vi antigen-and thus become more easily ingested-also
infect laboratory animals via the respiratory tract more easily (84).
The fourth line of defence-nonspecific immunity and specific antibodies
-can hardly be called a line because it operates throughout the organism of
the host, on the nasal mucosa (85) and deep in the tissues, even if bactericidal
powers in the blood are the most dramatic. This defence can often be
strengthened through immunization, a possibility which should always be
considered when there is sufficient time for a response.
Immunization may play a role in the defense against a large number of
648
HED:EN
649
has great possibilities but in some cases such as tularemia, aerosol vaccina
tion seems to be an attractive field technique (92, 95-102) which would theo
retically be preferable where the expected challenge will be via the respira
tory route (103, 104). In fact, it may well develop into one of the most im
portant vaccination techniques of the future ( 1 05). However, systemic reac
tions may occur (92, 96, 106, 107); the dosage presents a problem (92) and
more knowledge regarding a conceivable dissociation of viability and viru
lence is required (58). Also, the interesting possibility of increasing the
response to inhaled toxoids (108-111) with the aid of adjuvants (112) needs
further investi gation. Particularly, the Russian studies of aerogenic immuni
zation of animals and man with dried living vaccines mainly against anthrax,
brucellosis, plague, and tularemia (107, 113, 114), and American studies on
mixed tularemia and Venezuelan equine en ceph alitis vaccines (115, 1 1 6) are
highly relevant in the context of this review.
PHYSICAL AND CHEMICAL DEFENCE
650
HED:EN
651
includes F. tularensis (40, 91) , C. burnetii (41), R. prowazekii, and the causa
tive agents of psittacosis, Venezuelan equine encephalomyelitis (140-142) ,
and Russian spring summer encephalitis, t o name a few. However, the agent
would also have to be suitable for large-scale production, storage, and dissem
ination. Review articles (44, 143-147) actually list a large number of micro
organisms which the identification laboratory should be able to recognize
(d. al so table in section on chemoprophylaxis and treatment) . This list com
prises about a dozen bacteria [for instance, those causing anthrax (148, 149) ;
plague (150) ; tuberculosis (151) ; glanders, brucellosis, cholera, and dysen
tery], some fungi [causing coccidioidomycosis (152, 153) ; histoplasmosis
(154, 155)]. protozoa (malaria); and a group of viruses and rickettsia (146)
[for instance, those causing influenza (156-158); smallpox, yellow fever (159);
Rift Valley fever (159); Japanese B encephalomyelitis, foot-and-mouth dis
ease, and Rocky Mountain spotted fever (158, 160)], apart from those men
tioned earlier. In addition, there are a number of toxins, i.e., botulinum toxin,
which may be even more effective in the aerosol form than if the same dose
were taken orally (161, 162). However, some of the agents can be placed far
down the list of probable weapons and this simplifies the situation. There are
652
HEDtN
several reasons for this. For example, it is unlikely that an aggressor would
wish to create a permanent memorial to his BW campaign by using such dis
figuring diseases as smallpox (5 1) which, in most cases, can also be dismissed
because of the extensive use of vaccination. A reason making an agent un
likely as a weapon is that effective prophylactic methods are available.
The identification laboratory must bear in mind the possibilities of char
acter manipUlation, but the development of microorganisms which would
produce entirely new diseases may not be as important as current speCUla
tion would indicate. " New, " i.e., previously unreported virus diseases, con
tinually appear (d. Chikungunya and O'Nyong-Nyong fever) , and they
might be j ust as suitable for BW purposes as any product of laboratory
manipUlation. However, virulence can occasionally be increased, character
istic identification features can be eliminated, and antibiotic resistance can
easily be induced (163, 164) , and it is therefore certainly foolish to down
grade the conceivable military applications of modern microbial genetics, in
particular, transduction with resistance transfer factors. The possibility of
infection by streptomycin-resistant F. tularensis ( 165) could be mentioned,
but it is likely that a wide spectrum of potential biological weapons already
exist in, or could be produced in, an antibiotic-resistant form.
Speed in the identification process is essential, since large groups of indi
viduals would have to be detained, and also because occasionally it might be
too late to institute treatment by the time a clinical diagnosis is made. In the
case of i nhalation anthrax, treatment should start when the symptoms are
vague and before the condition becomes alarming ( 166). Pneumonic plague
has a mortality close to 100 per cent if treatment is not instituted within 20
to 24 hours after exposure ( 167-169) , and early treatment is also important
in the case of tularemia (170) . Obviously, the speed of identification required
in such cases is a challenge to the microbiologist who would have, only under
exceptional conditions (recovery of defective munitions, expended spray de
vices, vector containers, etc.) more than a minute amount of material avail
able for study immediately after an attack. Actually, there is room for much
research on microcultivation techniques (171), improved growth media (172)
phage techniques, fluorescent tagging of antibodies and antigens, blocking
antibody determinations, testing of sera for viral antigens instead of anti
body, specific gamma globulin consumption tests, and microserological
techniques in general ( 173) , together with all of the supporting instrumenta
tion needed to improve accuracy and to simplify operation (174). Gas chro
matography (126) and nucleic acid hybridization methods (175, 176) might
also deserve attention, but most efforts seem to be concentrated on the fluo
rescein-labelled antibody technique ( 124) which can be automated ( 177) and
brought to a remarkable sensitivity. It has, for instance, been possible to
identify tularemia organisms on glass slides from a cascade impactor which
had operated for only two minutes at a concentration of 1 bacterium per 5
litres of air (178) . The same technique has also been successfully employed
for the identification of aerosolized Venezuelan equine encephalomyelitis vi-
653
rus ( 1 79). This agent as well as the virus causing Rift Valley fever could also
be detected in tissue cultures within 24 hours of propagation ( 1 79) . I n addi
tion, the technique has proved to be superior to conventional staining meth
ods in the search for the Negri bodies of rabies ( 1 80) . In comparison to iso
tope- and ferritin-labelling of antibodies, the fluorescent antibody technique
seems to offer considerable promise, particularly for identification after pri
mary isolation of many potential biological weapons ( 1 79, 1 8 1 ) .
The existence of sophisticated methods should not exclude the parallel
use of conventional techniques ( 1 7 1 , 182, 183) such as the direct staining of
sputum which might disclose cases of pneumonic plague. In most cases, rel
atively large numbers of bacteria are required for microscopic examination to
be effective. Even in the case of viral diseases, the conventional methods will
probably constitute the backbone of laboratory diagnosis for a long time to
come ( 1 80, 184, 185) .
Protective equipment.-Protection against aerosols will, to large extent,
depend upon the availability of efficient masks or over-pressure ventilation
with filtered air. Military masks normally remove all particles (or 99.99 per
cent in the i-to 5-}.' range) . M any filter materials have been shown to remove
microorganisms very effectively ( 1 86), but the complete mask should be thor
oughly checked for leaks by biological simulants ( 1 8 7 ) . I n many countries
excellent masks are also available for the civilian population, and even in
fants can be protected in a special tent-like structure ( 1 1 7 ) . I f masks are not
available, a man's handkerchief folded as thick as possible and held tightly
over the mouth and nose might remove more than 90 per cent of the organ
isms that would otherwise be inhaled ( 1 88) . The common hospital type mask,
on the other hand, removes only 20 per cent ( 1 89) .
Special positive-pressure shelters can make masks unnecessary and pro
visional sealing of rooms may be helpful, but normal buildings offer very
little protection (45, 1 1 7) .
I n case of suspected vector attacks, different types of repellents, bed nets,
protective clothing, etc., are important ( 67 ) .
Decay.-All disseminated infectious agents are subject to a relatively
rapid loss of viability and virulence, and the rate of decay must be estimated
if the protection and decontamination measures are to be given proper scope.
At the moment of aerosolization, the microorganisms in a suspension are
subjected to considerable stresses i n the form of heat, pressure, and shearing
action, and their preparation in the form of a powder, which can be aeroso
lized, is attended by similar forces ( 190) . The viability of vegetative cells con
sequently drops rapidly, particularly if they are not properly protected ( 1 9 1 ,
192), and it decreases even further during the short period in which they
equilibrate with the humidity in the air. Quite small changes in relative hu
midity may, in fact, drastically affect the viability of air-borne bacteria ( 193,
194), and it has been suggested that the movement of bound water in and out
of the cell results in a collapse of the protein structure ( 195, 196) . However,
oxygen also plays a significant role ( 197) and metabolic processes probably
65 4
HED:EN
take part. Some organisms are very sensitive to extremely high or low humid
ities (76, 198) , but spores and some rickettsia seem to be relatively resistant,
as indicated by outbreaks of Q-fever and some plant diseases far removed
from the points where the particles became air-borne (199, 200) . However,
even within one group of such microorganisms as the rickettsia, the aerosol
stability varies from relatively high for Q-fever to the relatively low for R.
rickettsii and R. prowazekii suspensions (201). Some viruses, like Coxsackie
A-2 1, might decay at a rate of 25 to 50 per cent per minute depending on the
particle size (202) , but with the proper suspending fluid, survival can occas
ionally be increased (203) .
During their journey in a cloud, microorganisms are also exposed to oxy
gen and irradiation. Since most pathogens suffer a rapid reduction of viability
when exposed to light (204, 205), dissemination would probably be limited to
the hours of darkness and preferably to cool weather when decay is slower
(206). Photoprotection is a possibility which might be used in the case of
smaller particles.
Beside the "biological decay," which is attributed to such factors as those
mentioned, an aerosol cloud is also subject to "physical decay, " i.e., a reduc
tion in the effective particle concentration resulting from dilution, settling
out, rainfall, and impaction upon surfaces.
655
656
HEDEN
the roentgenologists (227) might give useful hints in aerosol attacks involv
ing agents such as F. tularensis ( 1 65 , 2 28) , P. pestis (229, 230) , B. anthracis
( 1 66) and C. burnetii (42, 231).
Biological weapons might well present a clinical picture which is n ew and
unexpected since exotic or mixed diseases may be induced, or because the
agents may circumvent the normal routes of entry. I t
that certain mixed infections could present a clinical picture that might de
lay the institution of proper therapy.
alert in diagnosing the first few human cases after a small-scale aerosol at
tack with yellow fever virus, as one would be in a region where the presence
of the vector induces a watchful attitude. In the latter case, one would look
for suspicious cases and might even have a routine for histological examina
tion of the livers of people dying within 10 days after the onset of any febrile
disease (233). J u dgi ng from American studies on Macaw mulatta, needle
biopsy in combination with fluorescent antibodies might even give a diag
nosis of yellow fever during the first few days of illness. The bleeding ten
dency associated with this disease (234) would, however, not permit a wide
spread use on humans, but the approach might be very useful for obtaining a
pointer both in this and in other infectious diseases (179) .
Other potential aerosol weapons which might offer difficulties similar to
those encountered with yellow fever, are the normally arthropod-borne
agents of Venezuelan or other equine encephalomyelitis, Rift Valley fever, and
Rocky Mountain spotted fever. This type of weapon is particularly i mpor
tant in
BW defence since one must assume that an attacker would regard the
aero
sols would cause diseases that are more easily recognized : psittacosis, Q
fever, smallpox, histoplasmosis, and coccidioidomycosis (74) .
Chemoprophylaxis and treatment.-It would be impractical, wasteful, and
dangerous to use the "shotgun" approach of placing everyone on prophylac
tic antibiotics in anticipation of an attack (137) . However, the situation
might change somewhat with the appearance of long-acting antibiotics (232) ,
and there should always be a stock of broad spectrum antibiotics available
for use when an attack h as occurred and the agent has been identified. Con
657
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HEDN
TABLE I
Dir.
conta- Lethalityb
gious8
Adenovirus infections
Albo virus infections
Chikungunya fever
Dengue fever
Eastern e uine ence halitis
Japanese -encepha tis
Murray Valley encephalitis
Rift Valley fever
RSSE complex
Venezuelan equine encephalitis
Western equine encephalitis
West Nile fever
Yellow fever
B-virus infection
Influenza
Po iomye itis
Rabies
Small'p'ox
+++
<1
5-6
<1
3-12
< 1- 1 0
60-75
10-80
43-70
+
+
+
+
+
<1
3-40
<1
+
+
+
+ ++
+++
Incubation
period
days"
ll
++
7-20
<1
5-40
100
1-3
A BW ATTACK ON HUMANS
5-15
4-6
4-7-10-14
2-5
4-5-10
2-3-6
3-6-1 0
10-2 1
1-3
+++
1-30
Psittacosis (oruithosis)
+++
10-60
4-7-15-28
Boutonneuse fever
Q-fever
Rocky Mountain Spotted fever
+
+
+
<1
<1
20-80
1-60
<1-7
10-70
+
+
Scrub typhus
Siberian typhus
hus (epidemic)
o hyuian fever
Bacterial Diseases:
Anthrax (pulmonary)
Brucellosis
Cholera
Diphtheria
<1
++?
+
100
2- 10
+++
++7
++ +
++7
8r;::J!:sry
Leptospirosis
Listeriosis
Melioidosis
Paratyphoid
+
++?
+++
Plague (pulmonary)
Tularerma
Typhoid
Fungal Diseases:
Coccidioidomycosis
Histoplasmosis
Protosoan Diseases:
Malaria (Plasm<Jdium jalciparum)
2-10
100
5-75
30-60
2-20
50-100
5-30
<80
80-100
1-2
5-7-9
14-18-21-28
2-3-7-14
6-10-18-21
2-3-5-6
6-10-12-15
14-30-60
1-5
3-7-21-90
1-1-3-5
Z-4-1 4
1-2-4-7
1-4-8-2 1
2-7-13-19
7-28
1-2-5-14
+++ 100
1-7
+
++ +
10-25
3-4-5
+
+
10-21
5-10-18
20-25
Vacc.
iA
Antibiotics
Chernothemp.
3-5-8-15
5-15
3-7-JZ-21
6-30-60-360
6-12-22
+++
Routine rOPhylaxiS
and t erap
1-3-7-10
3-10-14-23
X
(X)
X
(X)
X
X
X?
TC
X
X
X
X
X
(X)
(X)
(X)
X
9-11-14
TC, CA
TC, CA
CA, TC
CA, TC
TC, CA
CA, TC
CA?, TC?
PAB A
PABA
P, TC, CA
N?
TC
TC, S
SU
TC, ( +)S
TC, CA
P
SU
P, TC?
CA
S, CA, TC
S, TC, CA
SU
CA, TC
AMPH-B
AMPH-B
CH
a The estimation of contagiousity is based on the assumption of overcrowding and primitive conditions,
+++ considerable, ++ not serious, + small or none. b Limits based on known outbreaks in nonvaccinated
populations not treated with ant b otiC chemotherapeutics, or sera. 0 Limits based on known outbreaks with
the commonly accepted times italicize . d Ant biotics listed in order of preference: AMPH-B =Amphotericine B, CA = Chloramphenicol, CH = Chloroquine, etc., N =Neosalvarsane, P =peuicillin, PABA =p-Aminobenzoic acid, S =Streptomycin, SU =Sulphonamides, TC =Tetracycline.
ii
659
diseases such as African swine fever, hog cholera, Rift Valley fever, rinder
pest, foot-and-mouth disease, fowl plague, and Newcastle disease, or he
might employ the bacteria which give rise to anthrax, brucellosis, or glanders
(145). The problems of type and subtype identification for vaccine produc
tion can be illustrated by foot-and-mouth disease, which offers considerable
difficulties even in peacetime.
The defence measures required range from crop destruction and large
scale slaughtering to insect control and specific treatment, so they could be
covered only in a handbook. I n general, much can be gained by having stand
by facilities for the preservation of food and fodder, based on material from
diseased animals and plants.
The strain on the personnel resources would be considerable, as indicated
by the USSR plans for protection of cattle against ABC warfare (244). This
presupposes a need of seven men per one hundred animals. I n peacetime, a
special organization prepares different protection measures, stocks vaccines
and disinfectants, and executes a training program. Where an urgent readi
ness is required, the cattle are transported to the safest possible location. I n
the case of a biological attack special measures such as quarantine and de
contamination are taken, depending on the agent and the method of spread
ing.
WATER, FOOD, AND DRUG PROTECTION
I n the protection of a nation's water resources and its food and drug pro
duction against BW, security checks and special training of all personnel hold
ing key positions in sabotage-vulnerable establishments are essential ( 143,
245). Food processing industries, dairies, ice cream factories, and waterworks
are at the head of a long list of vulnerable establishments.
Considering modern water purification methods and the close supervision
of the water supply which is the rule with military units, the water contami
nation problem is primarily one for civilian authorities to consider (246). Con
taminated water should be filtered, boiled, or exposed to high-grade chlori
660
HED:f:N
ic foci of endemic disease be established? Would it create the basis for pos
sible genetic evolution of agents in new directions with changes in virulence
for some species? Would i t establish some post-attack public health and en
vironmental problems that are unique and beyond our present experience?"
Bearing such questions in mind, it is certainly wise to be prepared for control
measures (for example, mosquito destruction) aimed at restoring the normal
ecological balance. Without such possi bilities, even the most perfect physical
protection of man would be inadequate, since he might become a victim of
newly established disease reservoirs.
ADMINISTRATIVE MEASURES
l ogi cal
information received.
661
662
HEDN
tacks might reach far beyond national boundaries and effective limitation
might require efforts of a magnitude which would exceed the capabilities of
many nations. Such countries should be able to buy an "insurance policy"
which would guarantee immediate airmail deliveries of substantial quantities
of vaccines and antibiotics in case of attack, beside providing personnel and
advice (252).
Several of the United Nations specialized agencies have a certain compe
tence in the BW defence area, however. As mentioned above, WHO can be
expected to have an interest in the public health aspects but, in addition, the
Food and Agricultural Organization should be concerned with plant-animal
protection, and UNESCO in the associated basic microbiological research,
documentation, and science policy. From this point of view but also consid
ering the political dangers of impromptu appointments of international com
mittees to study cases of BW allegations, the establishment of an indepen
dent International Microbiological Agency as a parallel to the I nternational
Atomic Energy Agency (IAEA) has also been considered (254) . This would
tie a control function in BW to the peaceful applications of microbiology, in
the same way as the control of reactor fuels is tied to the peaceful uses of
atomic energy within the IAEA.
Planning of biological warfare defence.-I n addition to an effective system
for a nation-wide reporting of infectious diseases, the planning of BW
defence should involve the preparation of stand-by legislation for compulsory
immunization, stockpiling of therapeutics, preparations for extra produc
tion of broad-spectrum antibiotics, microbiological research and, finally, the
spread of knowledge about unusual infections (52) . The administrative mea
sures and the training of personnel such as police, customs officers, etc., must
vary from country to country, but Sweden can be chosen as an illustration of
the use of an approadi which is natural to a small country (255-257).
There is, in Sweden, a commission on medical catastrophes which comes
under the Department of Health, and which coordinates all activities re
quired by maj or fires and traffic accidents, explosions, accidental release of
chemicals, nature catastrophes, etc. This commission is also responsible for
the necessary emergency measures to be taken against major epidemics as
well as against poisioning via air, water, and food. The production of detailed
action plans, on the other hand, is the responsibility of special regional and
hospital committees. These committees prepare detailed catalogues of mea
sures to be taken in a number of conceivable situations. The regional com
mittees consider matters like sounding the alarm, the distribution of cases
among available treatment facilities, internal communications, possible iso
lation of the stricken area, providing it with personnel and transport facil
ities, etc. The hospital committees, on their part, plan for the 1Llarming of
hospital personnel, for the distribution of responsibilities, for the use of med
ical supplies, for information to relatives, press, and radio, for the relocation
of patients under care before the emergency occurred, and, finally, for the
registration, sorting, and treatment of mass casualties.
663
is it that biological weapons which would leave the material resources of the
attacked country undamaged and even spare the production potential, have
not been used on a large scale? This is a very difficult question to answer, but
the following points may be considered :
that critical problems in the production, storage, and delivery of some
agents, judged necessary to make up a fully operational system, have
not yet been solved ;
2. that the attacking country's own BW defence is not adequate or has
not been fully tested.
The existence of a sophisticated aerosol warning system in a country
might not be enough to induce that country to use infectious aerosols
offensively, since this would invite biological sabotage acts which would
circumvent that particular type of defence;
3. that the popular conception of biological weapons as terror agents
makes their use most distasteful, at least in countries with a free press
and a democratic system of government;
4. that the value of such weapons is relatively less to the nuclear armed
powers, which have a great BW development potential, than to the
smaller nations which have a limited BW capability ;
5 . that all of the tactical/strategic implications, for example, the oppor
tunities for small groups to bring about devastating reprisals, have not
yet been given serious attention in military-political discussions;
6. that the exact target area and the long-range ecological consequences
are very difficult and occasionally impossible to predict ;
7. that there exists a sort of pactum turpae based upon the unpredictability
and complicated consequences of BW. These must introduce very dis
turbing elements in the mathematical mode of military thinking.
1.
How long a period of grace may last when it rests on as complex a founda
tion as this, is impossible to tell, but the psychological factors which underlie
the Geneva protocol of 1925 still seem to exert a strong inhibitory influence.
However, the time available for talks about BW disarmament may not be
very long because one should not disregard the forces which give substance to
such remarks as the following: "The mores of a society vary with the degree
to which its existence is threatened" (58), and "frustration and a sense of
futility can make even desperate measures seem attractive. What is 'un
thinkable' at one moment may be policy the next" (12).
The case for disarmament.-A rewarding aspect of BW defence is that it
will improve the possibilities of coping with naturally occurring diseases.
Where those possibilities are already good and budget considerations do
not set a ceiling that is too low, the defence problems may not be insoluble
"if approached unemotionally, with adequate knowledge and sound reason
ing" (58) . Whether an ultimate state of nation-wide, semicontinuous protec-
664
HEDtN
tion will ever become acceptable from the social and medical points of view is,
however, another matter. In the developing parts of the world and, in some
smaller countries, on the other hand, the outlook is less "bright" and multi
lateral or international collaboration might be required (252) . In such areas
the risks are probably greater also, because the building of a nuclear capabil
ity is apt to be a slow process, and biological weapons might offer a tempting
strategic alternative. Since this could well upset the delicate power balance
which now affords a precarious but fundamentally important stability in the
world, the superpowers might have a very real interest in BW disarmament
and contro!' They should be in a position to know that the biological weap
ons are likely to remain erratic and difficult to handle as part of military
games theory, the more so, the cruder the technology. One simulated attack
has, for instance, been claimed to have killed or incapacitated some 600,000
friendly or neutral civilians at the same time that 75 per cent of the opposing
troops were eliminated (51). Finally, the superpowers should know that a
fully effective defence program will i nvolve almost prohibitive costs and con
stitute a drain on a professional group which has many critical functions in
society and might also be of considerable significance for the aid programs
which are now an important part of their foreign policy.
Since the power balance seems to offer the only available road toward a
distant goal of world order preserved by some sort of world government, a
disarmament agreement should also be acceptable to such smaller nations
that have reached a certain state of maturity. When a responsible superna
tional authority has eventually been established (258), there might be reason
to reconsider the situation (3 1). This is because-as soon as the risk of escala
tion is eliminated (see below)-the use of incapacitating biological weapons
in previously mass-vaccinated areas might offer the ultimate answer to the
control of subversive infiltration and to certain other problems with which a
world government might find itself confronted.
Like most political problems, the matter of BW disarmament is a multi
factorial equation, in which the distribution of attitudes toward the weapons
enters as a very important element. These attitudes range from efforts to
classify BW weapons as the most humane among arms, to condemnations
full of repugnance and moral indignation. As long as we accept conventional
methods of warfare, there is obviously no simple answer.
Discussions on the relative moral merits of napalm burning, saturation
bombing, and nuclear warfare versus the use of infectious aerosols actually
seem pointless without a careful balancing of the long-range interests in terms
of self-expression and happiness, both as far as the attacker and the attacked
are concerned. Such a type of penetrating analysis is difficult for anybody
and particularly for the military man and the average politician. Superfici
ally, the biological weapons might seem preferable, because they include a
wide range of incapacitating agents [for instance, Rift Valley fever (31)], and
they do not have the obvious genetic effects that we associate with nuclear
665
weapons. However, this is hardly enough to open the door to their use, since
the young, the elderly, and the infirm may become fatalities and the range
proceeds further to include agents of high mortality [for instance, A ctinobacil
lus mallei or botulinum toxin (31)1. Large-scale deployment of viruses might
also, according to J. Lederberg (259) , be a potential threat against the whole
species as uncontrollable mutant forms could well develop. Once the use, of
biological weapons became acceptable, the " human" aspects would also be
offset by an almost inevitable escalation. In fact, this is the strongest argu
ment for disarmament and for control ill the BW area ( 122) , an argument
that would seem to cancel out even the seemingly most acceptable reasons
for developing offensive biological weapons. Among the arguments for BW
disarmament is the one that must also emphasize the relatively unselective
effects of biological weapons on large-target populations.
Until Homo sapiens develops a global conscience, men will obviously con
tinue to die believing that they fight for freedom from want and freedom from
fear. The hunger and fear of the 20th Century seems indeed to be a mockery
of this belief, and all educated adults who accept the growing gap between
rich and poor nations with indifference, take a share in the responsibility for
the conflicts which now seem inevitable. Such conflicts might well breed wea
pons which are copied after Nature's own ecological system. Man's success
with biological control of pests and insects indicates a road which is certainly
appalling, although not necessarily because biological agents are invisible and
lack smell and taste, or because a perfect defence will never exist except in
the minds of some theoreticians. What determines the attitude of the author
is rather the fact that those weapons will never be selective enough to spare
the individuals who are not responsible for the situation which breeds them.
As M orris West has put it (260) : "A child has no politics. A child has no
nationality. He has only the right to live, the right to hope. If these rights
are denied him, it is a crime against humanity, and every honest man must
raise his voice against it." The same argument can, of course, be used against
any of the modern mass destruction weapons, but there is a very special rea
son against the development of biological weapons. It is that they come from
some of the largest and best operated establishments for applied microbio
logy in the world of today and, unlike other military establishments, they
would'require no major reorganization in order to switch most of their activ
ities to a highly constructive path, where the first steps have in fact already
been taken (261) . The potential of military microbiology is illustrated by its
civil "spin-off" : vaccines against Newcastle disease, fowl plague, and rinder
pest, improved diagnostic and therapeutic methods, and so on (2, 15),
The American center for BW research, Fort Detrick, near Fredrick in
M aryland, has a scientific staff of 120 Ph.D's, 1 10 M .Sc's, 320 B .Sc's, 34
D.V. M's and 14 M . D's. It occupies 1300 acres of land and is housed in a
building complex valued at $75,000,000 ( 1 1 ) . This indicates that applied
microbiology would probably gain much by a shift in emphasis. As far as
666
HEDN
667
668
HEDl!:N
quire contacts that would help to reduce the mistrust among nations and
they would tend to reinforce the international conscience in the field (122).
International and regional agreements aimed at neutralizing the political
dangers of BW allegations and at limiting the spread of weapons technology
would then logically follow. I n such a process statesmen would be exposed to
the u npleasant facts of human ecology, and they would also receive a forceful
reminder of the fact that war is rapidly becoming obsolete as a means of
solving i nternational disputes. The political ideas arising at the turn of the
century when masses of people were regarded as a military advantage, do not
ring true in the age of "megacorps" and "overkilL" It is sad that we must
live with such terms until we learn to think in global terms as far as man's
human and material resources are concerned.
ACKNOWLEDGEMENT
669
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