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Microbes are the foot soldiers of the 21st Century
Jeremy Rifkin (quoted by Thatcher)1
B
IOTERRORISM
(the deliberate use of biological weapons
by a terrorist group) has become a major concern of medical,
government and military agencies over the past two to three
years. Various reputable newspapers and journals now talk
of “Bioarmageddon”,2“Bioterror”3 and “germ weapons”,4
and terrorists with biological weapons have been the subject
of popular novels, from John Case’s The First Horseman5to
Tom Clancy’s Rainbow 6 (which imagines bioterrorism at
the Sydney Olympic Games).6While response planning to
a bioterrorist attack has been a major issue in the United
States since 1996,7Australia is only now coming to terms
with the issues involved and the possibility of Australia
being a target.
The threat of bioterrorism is increasing in Australia and
other countries around the world. The dimensions of this
threat, from capability to intent, need further exploration to
enable a realistic appreciation of the response required. The
United States has committed a budget of $1.4 billion to
address the problem.8Australia is unlikely to devote com-
parable resources to the task, so a critical review of the issue,
from both an Australian Defence Force and civilian infra-
structure perspective, is required.
Biological weapons
Biological weapons have been used in one form or another
for over 2000 years.9Despite advances in detection and ther-
apy, biological warfare remains a threat on the modern bat- tlefield. The Russian and Iraqi biological warfare programs
have shown their utility and the ease with which covert pro-
grams can be hidden.10 There have also been historical
attempts of a more covert or terrorist nature to spread dis-
ease. In 1495, Spanish soldiers gave French forces wine
mixed with blood from leprosy patients11 and, in 1763, the
British gave smallpox-inoculated blankets to various tribes
during the French–Indian War.12
Te r r o r i s m
There are many definitions of terrorism. One of the more
succinct defines terrorism as “politically or religiously moti-
vated acts of violence causing non-combatant casualties.”13
Australia, like the United States in the 1970s and 1980s, has
ADF Health Vol 1 1 September 2000 99
Bioterrorism — an Australian perspective
Commander Andrew Robertson, CSC, MB BS, MPH, MHSM, FAFPHM, FRACMA, RAN
Synopsis
◆The possibility that biological agents will be used for
terrorist purposes is growing as the necessary skills and
technology become more widely available.
◆Biological warfare agents have been developed in several
national military programs.
◆Agents of concern could include anthrax, brucella, plague,
tularaemia, typhoid, botulinum toxin, ricin and Q-fever.
◆Although production of agents is easier than mass
dissemination, both are more difficult than is popularly
portrayed.
◆The keys to defence against bioterrorism are intelligence
gathering (to identify threatening groups and activities),
counter-acquisition strategies (to deter nations and groups
from developing or using biological weapons),
epidemiological surveillance systems (to identify biological
attacks promptly) and consequence mitigation (to reduce
the impact of any attack).
◆Since the Gulf War, the ADF has increased its
preparedness for countering biowarfare.
◆In 1998, the Australian Medical Disaster Coordination
Group identified major deficiencies in civilian preparedness
for a chemical or biological terrorist attack and has set
out, with Emergency Management Australia, to rectify
these deficiencies.
ADF Health 2000; 1: 99-106
Commander Andrew (Andy) Robertson
has served as a full-time medical officer
with the Royal Australian Navy since
1984. A public health physician and
medical administrator, he has served in
various ships and establishments in
Australia and overseas. He has
completed three tours to Iraq with
Operation Blazer, including three
months as the Chief Inspector of the
Biological Weapons Monitoring Group in
1996. He is currently the adviser on
nuclear/biological/chemical hazards to
the Defence Health Services Branch.
100 ADF Health Vol 1 1 September 2000
been relatively immune to the spread of terrorism.14 Cer-
tainly, Australia has not seen anything on the scale of the
World Trade Centre or the Oklahoma City bombings and
there were no major terrorist incidents in Australasia in
1998.13
Australia, however, has not been totally immune. Small
scale terrorist attacks have included the bombing of the
Sydney Hilton in 1978, the assassination of the Turkish
Consul-General by the Justice Commandos of the Armenian
Genocide in December 1980, and the bomb
attack on the Israeli consulate-general’s offices
by 15 May Organisation in December 1982.14
Australia has also been the focus of various
extortion attempts and hoaxes over the last 30
years. These include the “Mr Brown” Qantas
extortion in 1971, the Woolworths bomb extor-
tions in 1975,14 and the Coca-Cola extortion
attempt in 1998.
The terrorist threat is changing. Bruce Hoffman,
in a seminal article, reviewed the terrorist threat
from the 1970s until the present day.15 Hoffman
noted that terrorist groups, while politically radi-
cal, have generally been conservative in the way
they have carried out their attacks, being more
“imitative than innovative”.15 Most groups are far
more interested in getting their message across
than in killing lots of people. Consequently, while
a few groups dabbled with the idea of weapons of
mass destruction, the only incidents involved food
tampering as a form of economic sabotage. These
include terrorist attempts at different times to
poison Israeli oranges with mercury and to lace
Chilean grapes with cyanide.15
However, the 1990s saw a fundamental change in terror-
ist operations. Analysis of the Rand–St Andrew’s University
Chronology of International Terrorist Incidents, a database
of over 8000 incidents dating back to 1968, has shown some
disturbing trends.15 While there has been an overall fall in the
number of terrorist incidents, there has been a rise in the per-
centage of incidents with fatalities. In 1995, 29% of all ter-
rorist incidents involved fatalities, compared with 17% of
attacks in the 1970s and 19% of attacks in the 1980s.15
This trend is associated with the growth throughout the
1990s of radical religious terrorist groups. These groups,
arising from a wide spectrum of religious backgrounds, see
violence as a “divine” duty and an expedient way to achieve
their eventual aims.16 The religious terrorist group members
are not inhibited by the political or even “moral” constraints
of the more traditional terrorist groups. Interested only in
themselves, and the small religious group they represent,
these groups are not interested in defending a perceived
aggrieved constituency, but instead aim to radically change
the existing order.15 As outsiders, the religious terrorists are
able to contemplate far more destructive and deadly attacks
to fulfil this aim.16 As such, the religious terrorist groups
have come closest to the effective use of weapons of mass
destruction. The deliberate infection of the populace of The
Dalles, Oregon, with Salmonella typhimurium in 1984 by the
followers of the Bhaghwan Shree Rajneesh was to be a fore-
runner to the Aum Shinrikyo cult’s more deadly 1995 nerve
gas attack on the Tokyo subway,17 a historical watershed in
terrorist tactics. Hoffman and many others believe that attack
was a harbinger of things to come.15,17,18
Front portion of an R400 aerial bomb, used for biological agents by
Iraq, recovered from the Euphrates River in December 1995.
A castor bean plant growing at the Fallujah 3 castor oil production facility near
Fallujah, Iraq, January 1996. The bags in the background contain castor beans.
The oil production facility can be seen in the top right corner. Aside from castor oil,
ricin is derived from the castor bean.
Bioterrorism
Biological weapons may have great utility for terrorist
groups. The Aum sect has both researched and tried to use,
unsuccessfully, anthrax and botulinum toxin.2Other terror-
ist groups, like Osama bin Ladin’s organisation, have indi-
cated a strong interest in acquiring these agents as
weapons.19
Bioterrorism-related incidents can be divided into threats,
attempts to acquire and actual use. While there have been
several suspected cases, no major terrorist attack with bio-
logical weapons has yet occurred.20
Threats have included the January 1984 threat to release
foot and mouth disease in Queensland, and threats during the
Gulf War to release biological weapons in Europe and
Canada.20,21
Attempts to acquire biological weapons have included an
attempt to blackmail a US Army officer for pathogens in the
1970s and an attempt by two Canadians to acquire botulinum
toxin in 1984.20,22 Chicago members of the right wing group
“Order of the Rising Sun” were arrested in 1972 for pos-
session of 30–40 kg of typhoid culture. The typhoid was
intended for use in the water supplies of Chicago and St.
Louis.20
Alleged use of biological weapons includes the biological
contamination of water holes during the Rhodesian war and
small scale biological attacks by South Africa’s Roodeplaat
Research Laboratories against the African National Congress
and other opponents.21
Various authors claim that there are many potential bio-
logical weapons occurring naturally in the environment or in
legitimate medical research. They also claim that they can
be developed with limited technical expertise, are easily con-
cealed and transported, and can be disseminated with low
technology devices.20 Some argue that biological weapons
may be the ideal terrorist “poor man’s atomic bomb”.21 Much
of this reasoning is based in fact, but the final conclusion
needs closer analysis.
Purver, in his 1995 paper for the Canadian Security Intel-
ligence Service, has developed an analytical framework to
review the alleged benefits of biological warfare agents for
terrorist groups.20 This framework, which covers acquisition,
likely agents, production, means of delivery, and lack of use,
forms a good basis for review of the potential bioterrorist
menace.
Acquisition
Potential biological warfare agents can be acquired from nat-
ural reservoirs, stolen from medical or research facilities,
bought from legitimate or “black market” suppliers, or pro-
cured from a “friendly” government.20 While acquiring the
agent from a natural reservoir may be advantageous from a
security standpoint, the more advanced technical skills
required to sample, isolate and identify the organism may
militate against its use. As most civilian biological research
facilities have minimal physical security, terrorists could
acquire cultures by subterfuge or theft.22 In Australia,
anthrax, brucella, Q fever, botulinum toxin, melioidosis and
ricin (derived from castor seeds) could be easily acquired
from natural sources, hospital laboratories or research facil-
ities.
Until relatively recently, many biological agents were
readily available from the American Type Culture Collection
(ATCC) and other supply houses.23 In May 1995, Larry
Wayne Harris, a member of the Aryan Nations white
supremacist group, used forged credentials to order Yersinia
pestis (plague) from ATCC. Fortunately, ATCC staff
became suspicious and were able to recover the vials
unopened.24 Closer to Australia, the London Sunday Times
allegedly received a commitment by Indonesia’s Biofarma
vaccine company to supply anthrax and plague cultures, no
questions asked, as recently as November 1998.25
While biological warfare agents are readily available in
various national programs, the countries concerned are
believed to be reluctant to supply terrorist groups because of
fear of serious retaliation if linked to the attack, and a fear
the groups may use them against the supplying country or an
unauthorised third party.20
Likely agents
Biological warfare agents include both pathogenic microor-
ganisms and the toxins produced by living organisms,
including animals, plants and microbes. In selecting a suit-
able agent, a terrorist group would need to consider its avail-
ability or the degree of difficulty in producing it, the ease of
dissemination of the agent and the protection a defined pop-
ulation may have against it. Other factors that may need to
be considered include the robustness of the agent, its
detectability, contagiousness and potential uses.20 The
requirements for an agent designed for a small-scale attack
will differ from those required for a large-scale attack.
So what are the likely agents? Bacterial agents are more
likely to be used than either viruses or rickettsias due to cul-
tivation and production problems with the latter.22 Toxins
have the advantages of stability and, in some cases, toxicity
and ease of manufacture.22 The most commonly agreed
agents of concern are anthrax, brucella, plague, tularaemia,
typhoid, botulinum toxin, ricin and Q-fever.20,21,22 In Aus-
tralia, with the exception of tularaemia and plague, these
agents are available from local sources. Given its availabil-
ity, melioidosis should be added to an Australian list.
There has already been interest in some of these agents by
different groups. Anthrax was one the agents the Aum sect
researched26 and was the basis for a series of hoaxes in the
United States during 1998 and 1999.27 Anthrax has also
been the focus of many articles on bioterrorism.2,3,8 Plague
ADF Health Vol 1 1 September 2000 101
has also been of interest, as highlighted by the arrest of
Harris in 1995. The Aum sect was interested in Ebola virus
(sending an expedition to Zaire in 1992) and botulinum
toxin.17 Cultures of botulinum toxin were seized from a Red
Army Faction safe house in Paris in 1984.22 Ricin has also
been studied by various groups. An Arkansas man was
arrested in December 1995 with 130 grams of ricin, while
two members of the Minnesota Patriots Council, a US anti-
tax group, were convicted for the possession of ricin in
1995.15,17,26 Recently, Henderson, the Director of the
Center for Civilian Biodefense Studies, has raised concern
about the use of smallpox as a terrorist weapon.18 Hender-
son cites the previous successful Russian biowarfare
effort to mass produce smallpox weapons, noting many of
the scientists involved have moved on to other countries,
some with their own biological weapons programs.18
On a positive note, most analysts
believe that, at present, the terror-
ist use of genetically engineered
organisms is unlikely, as greater
technical skills would be required
and the classical agents remain
highly effective.28
Production
While opinions vary, most authors
believe that an individual or indi-
viduals with a modicum of tech-
nical skill could acquire the
necessary expertise to produce bio-
logical weapons.20 While terrorist
groups in the past may not have
had the necessary technical exper-
tise,15 the previously esoteric skills
required are now readily available.
American industry employs around
60 000 biologists and there are nearly 1900 biotechnology
companies in the United States and Europe.24 This expertise,
coupled with that available from scientists from past bio-
logical weapons programs, gives terrorist groups a plethora
of capable people.18
Taking these biological agents to the next stage, the apoc-
alyptic “bioarmageddon” scenario, is considerably more dif-
ficult. The necessary skills and equipment needed to identify
a particularly pathogenic agent, to produce that agent in large
quantities and to install that agent in weapons are far more
difficult to procure.8,18 The two possible exceptions are
anthrax and smallpox, which are easily produced and hardy
microorganisms.18 Small amounts of agent could also be
used successfully in more discreet attacks or assassination
attempts, as highlighted by the murder of Georgi Markov in
1978 with a ricin-tipped umbrella.20
Means of delivery
There are many means of delivering biological weapons.
They could include dispersal of the biological agent as a
vapour or aerosol, contamination of food or drink, direct con-
tact (by injection or inoculation) or even by inoculating
insect or other vectors.20 However, most authors agree that
effective delivery of a biological agent is more difficult than
its production.24 The drying and milling of the agent is con-
siderably more difficult and has the potential to make the ter-
rorist the first victims if not performed correctly.24
Poisoning of a large water reservoir is not as simple as
sometimes postulated. An attack would require large quan-
tities of agent and still may not be successful due to problems
with access to the site, hydrolysis and chlorination.20,29 An
alleged South African attempt in 1989 to contaminate water
supplies in Namibia with cholera was reported to have been
foiled by the high chlorine content
of the water.21
Tampering with food, particu-
larly on the production line, may be
a more viable option, but food
processors’ concentrated efforts to
prevent normal background chem-
ical and biological contamination
mean that food tampering is likely
to have limited effect.
The use of vectors is both ineffi-
cient and difficult, as the terrorists
are faced with two organisms that
need to be maintained and con-
tained.30
The most commonly proposed
means of terrorist delivery is by the
use of some sort of aerosolisation
process. Scenarios include the use
of planes, trucks, and even ships,
fitted with some type of cheap
aerosoliser, spreading a biological
cloud over a city.2,22 This process,
fortunately, is more difficult than it first appears.31 There are
significant technical problems in keeping a biological agent
in a cloud viable for long enough to infect or intoxicate the
victim.21 Humidity, sunlight, smog, temperature and winds
will all impact on the final dose received.30 Even with a good
technical background, the Aum Shinriyko terrorist group was
unable to successfully aerosolise anthrax and botulinum
toxin in Tokyo, despite a number of attempts.31,32 The vari-
ability of climactic conditions also means that it is difficult
for terrorists to be sure of hitting their intended target by this
means. An attack on the West Bank would be equally deadly
to the Arab and Israeli communities.22
A smaller scale attack confined to an enclosed area,
including buildings with air-conditioning systems, domed
sports stadiums and subway systems, is more feasible.20
Indeed, the US Army demonstrated the effectiveness of
102 ADF Health Vol 1 1 September 2000
Blue-green algae produces a nasty hepatotoxin,
microcystin.
spreading biological agents in simulated attacks on airports,
bus stations and subway systems during the 1950s and
1960s.33
The two biological agents cited as being of most concern
are anthrax and smallpox. Anthrax is simple to produce, very
stable in a dried form, easy to disperse and lethal.34 In 1979,
an accidental release of spores from a military bioweapons
facility in Sverdlovsk, Russia, led to the death of 66 people.
Meselson, in his review of this incident, estimated that less
than one gram of anthrax spores was released.35 Release of
larger quantities could be devastating. Smallpox, given its
highly infectious nature and the current lack of protection
against it, would be even worse. While smallpox is not read-
ily available, there are concerns that there may be other stor-
age sites for the virus apart from the Russian State
Research Centre of Virology and Biotechnology facility in
Koltsovo, Novosibirsk, and the Centers for Disease Control
and Prevention in Atlanta, Georgia.34,36 Should smallpox
become more available, its role as a possible bioterrorism
agent would have to be reassessed.
Lack of use
Various theories have been proposed for the lack of use of
biological weapons by terrorists. Hoffman cites a lack of
innovation in the groups and a desire to limit the number
killed.15 Purver contends that the inherent unpredictability of
biological weapons, personal fear of biological agents, fear
of collateral damage to friends, anticipated governmental
response to an attack and a general satisfaction with current
measures have all contributed to the terrorist’s reluctance.20
Most analysts agree, however, that with the growth of reli-
gious terrorism and availability of agents this situation is
unlikely to last.18,20
ADF Health Vol 1 1 September 2000 103
Effects, prophylaxis and treatment of biological warfare agents
Incubation Symptoms
Agent period and signs Prophylaxis Treatment
Inhalation anthrax 1–6 days Fever, severe respiratory US licenced vaccine Ciprofloxacin, doxycycline
distress, widened mediastinum
Botulinum toxin 1–5 days Ptosis, cranial nerve signs, US Investigational Trivalent antitoxin
symmetrical descending New Drug vaccine
flaccid paralysis
Brucella 5–60 days Irregular fever, headaches, No vaccine Doxycycline and rifampicin
arthralgias, myalgias
Cholera 4 hours–5 days Vomiting, abdominal cramping, Australian vaccine Tetracycline, doxycycline,
voluminous diarrhoea — limited efficacy ciprofloxacin
Glanders 10–14 days Fever, pleuritic chest pain, No vaccine Sulfadiazine
papular-pustular rash
Pneumonic plague 2–3 days Fever, headache, Australian vaccine Streptomycin, doxycycline
severe respiratory distress — limited efficacy
Q-fever 2–14 days Fever, cough, pleuritic chest pain Australian Q-Vax Tetracycline, doxycycline
vaccine
Ricin 18–24 hours Fever, cough, pulmonary oedema No vaccine No specific therapy
Smallpox 7–17 days Fever, headache, pustular Vaccinia vaccine Vaccinia immune globulin
centrifugal rash
Tularaemia 1–21 days Fever, headache, prostration, US Investigational Streptomycin, gentamycin
weight loss New Drug vaccine
Source: Eitzen E, Pavlin J, Cieslak T, et al. Medical management of biological casualties handbook. 3rd ed. Fort Detrick: USAMRIID, 1998.
104 ADF Health Vol 1 1 September 2000
Potential results of bioterrorism
A successful bioterrorist attack might be disastrous. Even a
relatively small attack might quickly overwhelm medical
capabilities.37 Death and disease would be only part of the
problem. The panic, quarantine, evacuations, rioting and
looting that might follow would impact greatly on the infra-
structure and operations of any country. In 1994, over half
a million people fled the Indian city of Surat because of a
suspected pneumonic plague outbreak.3The economic
impact might also be monumental. Kaufmann has modelled
the economic impact of a bioterrorist attack, showing that for
every 100 000 persons exposed the financial impact could
range from $477.7 million for a brucella attack to $26.2
billion for an anthrax attack.38
Defence against biological terrorism
Defending against biological terrorism is a daunting task.
Unlike chemical or nuclear weapons, the current
biodetection systems are limited in their scope and
availability, so emphasis has to be placed on other
measures. Sensitivity analysis has shown that pre-
ventive programs are cost-effective in defending
against biological terrorism.38 Defensive measures
can be grouped into four main areas.20
Intelligence gathering
This intelligence gathering, with appropriate fund-
ing,3should focus on monitoring terrorist groups of
concern and their state sponsors, the movement of
microbiological equipment and the cataloguing of
epidemics as a baseline.39,40 The ProMED internet
epidemic surveillance system has been very effec-
tive in establishing baseline data. Links should be
established between intelligence agencies and the
medical community,39 and all agencies should
ensure that information is shared to assist in creating
a coherent picture of the problem.40
Counter-acquisition strategies
Countries must both threaten, and be willing to carry out,
massive retaliation against terrorists and their state sponsors
should biological weapons be used.40 Economic and moral
pressure should be brought on “rogue” states to comply with
international conventions, including the Biological Weapons
Convention.3 The availability of dangerous microorganisms,
including smallpox, must be tightly controlled and attempts
to trade in this area should be universally condemned.25,41
Police and customs officers also require the necessary train-
ing to identify these biological agents and the equipment
required for their production and transport.20
Passive protection
New, innovative and rapid biological detection systems are
a cornerstone of early and appropriate response.40 Similarly,
effective disease surveillance systems are critical. Adequate
epidemiology and pathology resources are key facets of this
surveillance.42 As Cohen et al eloquently argue, funding of
national and international public health systems which can
adequately detect natural disease outbreaks will be far more
beneficial than narrowly focused and ill-conceived
antibioterrorism programs.43 Protection should also cover the
stockpiling of vaccines and therapeutic agents; improved
water supply, air-conditioning and food production security;
development of better individual protection equipment; and
increased research into medical defences against biological
weapons.20,26
Consequence mitigation
Finally, there must be work on measures that mitigate the
effect of an attack. These measures should include better and
more specific biological disaster planning, public health
coordination, and evacuation planning.20 Above all, the emer-
gency and medical services require education and training in
responding to bioterrorism.26,42
A staff member at the US Army Medical Research Institute of Infectious Disease
working in a fully encapsulated suit in the biosafety level 4 laboratory.
ADF Health Vol 1 1 September 2000 105
Overseas response
With some notable exceptions, very few countries have grap-
pled seriously with the threat of bioterrorism.32 In the United
States, Congress unanimously approved the setting up of a
Department of Defense Domestic Preparedness Program in
1996, with an initial budget of $150 million.41,44 The Chem-
ical and Biological Defense Command was tasked to help
cities and State governments get ready for a chemical or bio-
logical terrorist attack. Simulations have already shown the
various and potentially devastating problems posed by
bioterrorism.41 National Guard rapid response teams have
been established and Defense is training first-response teams
in 120 of the largest US cities.45
The US military already has considerable chemical/bio-
logical counterterrorism technology expertise. The Techni-
cal Escort Unit (TEU) provides worldwide expertise in
recovering and neutralising chemical and biological
weapons, while the Chemical/Biological Antiterrorism
Team is responsible for developing the hardware for TEU
and other units to carry out their role.46
Despite this investment, both the Congress and the Gov-
ernment Audit Office are concerned that the money allocated
for terrorism defence is not being appropriately targeted
towards biological and other terrorist threats.41,47 Many
believe that a biological terrorist attack in the United States
is inevitable and that the country remains unprepared.
The Australian perspective
Australia faces the challenge of many developed nations: the
face of terrorism is changing and Australia, like most coun-
tries, is unlikely to be immune in future. The move to reli-
gious terrorism increases the probability that future terrorist
attacks will involve biological or chemical weapons.
Improved technical skills and equipment make a bioterror-
ist attack both more probable and more likely to be suc-
cessful, particularly if done on a small scale. Australia has
been underprepared for biological terrorism but is now
addressing the problem. Given the imminent Olympic
Games in Sydney this year, it is a problem that requires due
consideration.
The Australian Defence Force has made substantial
progress in this area since the Gulf War. The ADF is able to
decontaminate and render safe chemical and biological
munitions while protecting its forces through detection sys-
tems, protective equipment, medical countermeasures and
research. Doctrine for the management of biological muni-
tions and casualties has been developed, and instructors,
specialist advisers and medical officers have been trained.
Such preparations are focused on troops in the field and not
on terrorist threats.
The civilian community, however, has been generally
underprepared. Until relatively recently, there was no policy,
training or planning in this area. An effective epidemic sur-
veillance and national public
health network were the only
preparations. In 1998, the Aus-
tralian Medical Disaster Coordi-
nation Group identified major
deficiencies in the preparations for
a chemical or biological terrorist
attack and has set out, with Emer-
gency Management Australia, to
rectify these deficiencies. Doctrine
for the management of chemical
and biological casualties is being
developed and a training program
for medical staff commenced late
last year. Various States have
looked at the contingency plan-
ning, training, protective equip-
ment and detection requirements
of such preparations.
Sharp, in his review of medical
preparedness for the 1996 Atlanta
Olympics, outlined the resources
available to counter a biological
weapons attack.48 They included a
specialist site assessment team, a
science and technology centre to
provide technical support, stock-
piles of antimicrobials, specialised
Training in ADF mark 4 suits and S10 masks, December 1998 — part of medical officers’ nuclear,
biological and chemical defence training.
106 ADF Health Vol 1 1 September 2000
training for first-responders, enhanced public health sur-
veillance, and a Chemical Biological Incident Response
Force to decontaminate and stabilise casualties.48 The Aus-
tralian bioterrorism emergency response infrastructure is
being progressively developed and should be equal to
world’s best practice by the time of the 2000 Olympic
Games.
Bioterrorism will not disappear as a potential problem and
will remain an area of political and media interest. Fortu-
nately, the successful completion of even a small scale attack
is far more difficult than portrayed by much of the media.
Yet even a very limited attack may have a major effect,
because the resultant panic may severely hamper emergency
responses. The Australian medical and emergency response
communities have finally started to face the threat and will
be better prepared to face both the bioterrorist and emerging
exotic disease challenges of the new century.
References
1. Thatcher G. Poison on the wind: the new threat of chemical and biologi-
cal weapons. Christian Science Monitor 13 December 1988: B1-B12.
2. MacKenzie D. Bioarmageddon. New Scientist, 19 September 1998; 159
(2151).
3. Crowley M. Bioterror. The Boston Phoenix, 18-25 March 1999.
4. Wade N. Germ weapons: deadly, but hard to use. New York Times, 21
November 1997.
5. Case J. The first horseman. London: Century, 1998.
6. Clancy T. Rainbow 6. Harmondsworth: Penguin Books, 1998.
7. Starr B. Chemical and biological terrorism. Jane’s Defence Weekly 1996;
26: 16-21.
8. Russo E. Bioterrorism concerns heightened. Scientist 1999; 13(6): 1.
9. Robertson AG, Robertson LJ. From asps to allegations: biological warfare
in history. Mil Med 1995; 160: 369-373.
10. Seelos C. Lessons from Iraq on bioweapons. Nature 1999; 398: 187-188.
11. Grmek MD. Les ruses de guerre dans l’antiquite. Rev Etude Grec 1979; 92:
141-163.
12. Division of Health Mobilisation. The doctor and disaster medicine (part 2).
Clin Med 1963; 70: 277-291.
13. Gestern O. Terrorism in the region during 1998. Asia-Pacific Defence
Review (Annual Reference Edition) 1999: 28-30.
14. Cronin J. Australia: the terrorist connection. South Melbourne: Sun Books,
1986.
15. Hoffman B. Terrorism and WMD: some preliminary hypotheses. The Non-
proliferation Review 1997. Spring-Summer: 45-53.
16. Hoffman B. Intelligence and terrorism: emerging threats and new security
challenges in the post-cold war era. Intelligence and National Security
1996; 11: 207-223.
17. Cole LA.The specter of biological weapons. Sci Am 1996; 275: 60-65.
18. Henderson DA.The looming threat of bioterrorism. Science 1999; 283:
1279-1282.
19. Tenet GJ. Dangers and threats to the US: speech delivered to Senate Armed
Services Committee, Washington, DC. Vital Speeches of the Day. 2 Feb-
ruary 1999: 293-299.
20. Purver R. Chemical and biological terrorism: The threat according to the
open literature. Ottawa: Canadian Security Intelligence Service, 1995.
21. Ventner AJ. Biological warfare: the poor man’s atomic bomb. Jane’s Intel-
ligence Rev 1999: 42-47.
22. Douglas JD, Livingstone NC. America the vulnerable: the threat of chem-
ical and biological warfare. Lexington: Lexington, 1987.
23. Arthur C. The lunatic with anthrax. The Independent 26 November 1998.
24. Taylor R. All Fall Down. New Scientist 1996; 150 (2029): 32.
25. Leppard D, Hastins C, Berry J. Killer germs on sale for just £600. The
Sunday Times (London), 22 November 1998: 8.
26. Stephenson J. Confronting a biological Armageddon: experts tackle prob-
lem of bioterrorism. JAMA 1996; 276: 349-351.
27. Bioterrorism alleging use of anthrax and interim guidelines for manage-
ment — United States, 1998. MMWR Morb Mortal Wkly Rep 1999; 48: 69-
74.
28. Cousin J. Preparing to counter an invisible adversary. US News and World
Report, 22 February 1999: 61.
29. Roberts B. Biological weapons: weapons of the future. Washington: Center
for Strategic and International Studies, 1993.
30. Hall R, Cameron S, Givney R. Biological weapons. Recent Adv Microbiol
1998; 6: 1-30.
31. Abel D. US knowledge of bioweapons largely obsolete. Defense Week
1999; 20(10): 7.
32. Stern J. Taking the terror out of bio-terrorism. New York Times, 8 April
1998.
33. Harris R, Paxman J. A higher form of killing. New York: Noonday Press;
1982.
34. Henderson DA. Bioterrorism as a public health threat. Emerg Infect Dis
1998; 4: 488-492.
35. Meselson M, Guillemin J, Hugh-Jones M, et al. The Sverdlovsk anthrax
outbreak of 1979. Science 1994; 266: 1202-1208.
36. Breman JG, Henderson DA. Poxvirus dilemmas — monkeypox, smallpox,
and biologic terrorism. N Engl J Med 1998; 339: 556-559.
37. Goldsmith MF. Preparing for medical consequences of terrorism. JAMA
1996; 275: 1713-1714.
38. Kaufman AF, Meltzer MI, Schmid GP. The economic impact of a bioter-
rorist attack: are prevention and post-attack intervention programs justi-
fiable? Emerg Infect Dis 1997; 3: 12-25.
39. Wise R. Bioterrorism: thinking the unthinkable. Lancet 1998; 351: 1378.
40. Mann P. Terrorism needs massive response. Aviation Week Space Technol,
1 March 1999: 54-55.
41. Boyce N. Nowhere to hide. New Scientist 1998; 158 (2127): 4.
42. McDade JE, Franz D. Bioterrorism as a public health threat. Emerg Infect
Dis 1998; 4: 493-494.
43. Cohen HW, Sidel VW, Gould RM. Prescriptions on bioterrorism have it
backwards [letter]. BMJ 2000; 320: 1211. <http://bmj.com/cgi/content/full/
320/7243/1211>
44. US terrorism crackdown. Jane’s Defence Weekly 1996; 26(4).
<http://jdw.janes.com/subscribe/archive/jdw96/jdw01278.html>
45. Experts: US unprepared for bio-terrorists. CNN 14 Apr 1998.
<http://www.cnn.com/us/9804/14/infectious.threats/index.html>
46. Counter-terrorism technology. Jane’s Defence Weekly 1996; 26(7): 18.
47. McCutcheon C. Lawmakers say Clinton’s plans for combating terrorism
lack urgency and coherence. CQ Weekly, 13 March 1999: 627.
48. Sharp TW, Brennan RJ, Keim M, et al. Medical preparedness for a terrorist
incident involving chemical or biological agents during the 1996 Atlanta
Olympic Games. Ann Emerg Med 1998; 32: 214-223. ❏
