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Enteric Outbreak An outbreak is suspected whenever there are a greater than usually expected number of cases with similar signs and symptoms in the same geographical area in a 24-hour period. If you have any questions or concerns that require a response, please contact Health Connection directly. May 20, 2014 The use of bioweapons is not a new concept, having been employed since at least ancient Greece as a mechanism for attacking enemy populations.
Contributing author Saskia van Rijn, MPH examines the barriers that non-state actors face when contemplating, designing, and deploying biological weapons in the United States and the impact such barriers have on the attractiveness of bioweapons for terrorist groups. Biological weapons have been probably utilized at least since the time of the ancient Greeks as a means to kill or weaken enemy populations. Internationally and domestically, bioterrorism is considered by some as a very real threat, with the United States being considered especially vulnerable.
The heightened sense of vulnerability after the 2001 anthrax attacks in the United States attacks has brought bioterrorism to the forefront of public attention (Koblentz, 2009). The anthrax attacks of 2001, coined the Amerithrax attacks, revealed a deep-seeded vulnerability within the U.S.
Many subject matter experts have pointed to the instantaneous wave of federal support that biodefense received after the Amerithrax attacks, and that while this support was needed, there was little assessment into the realities of the bioterrorist threat.
The most popular example Rogers points to is the unsuccessful attempt to improve sanitation and health in Peru during a health two-year health campaign. This thesis seeks to point out the substantial hurdles non-state actors face when attempting to use bioweapons.
In the Weapons of Mass Destruction Commission’s 2006 Bioterrorism and Threat Assessment, threat assessment is broken down into a diagram as shown in Figure 1 (Ackerman, 2006). This analysis will focus on the capabilities and motivations of potential bioterrorists and assess their impact on actual usage of bioweapons. Figure 1 presents these components, indicating the relationship between the intention and capability of an attacker.
Bioterrorism has several definitions, but the most prevailing understanding is, “the use by non-state actors of microorganisms (pathogens) or the products of living organisms (toxins) to inflict harm on a wider population” (Ackerman, 2006). Category A agents can be easily disseminated or transmitted from person to person, result in high mortality rates and have the potential for major public health impact. Category B agents are moderately easy to disseminate, result in moderate morbidity rates and low mortality rates, and require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance.
Category C agents include emerging pathogens that could be engineered or disseminated in the future due to their availability, ease of production and dissemination, and potential for high morbidity and mortality rates and major health impacts.
Biological weapons are unique in their capacity not only to cause delayed morbidity and mortality as a result of their incubation periods, but also to spread disease.
Should the motive be to inflict injury and create a drain upon the medical system, all of these agents are especially effective in causing physical harm, but two in particular cause substantial damage. The Category A agents are all unique in their manifestation, but several of them initially manifest like influenza, which can delay treatment and increase the risk of exposure and death. More recently, in 1763 European settlers gave smallpox-laden linens to Native Americans in America, wiping out entire communities due to of a lack of immunity (Oldstone, 2010). While the BWC has helped prevent states’ use of bioweapons, a few individuals and groups have continued seeking bioweapons to use for their purposes. Carus in his study noted that, “to date, few terrorists have demonstrated an interest in bioterrorism, and fewer still tried to acquire biological agents. Rajneeshees – In 1984, the Rajneeshees cult carried out one of the largest bioterrorist actions in U.S. After several defeated electoral attempts, two of the prominent female members, Sheela and Puja, began to consider the use of biological weapons as a means to alter voter turnout. Puja field-tested the pathogen on August 29, 1984 by contaminating the water of three county commissioners, all of whom fell ill.
The Rajneeshees salmonella outbreak is considered by the FBI to be the only confirmed case of bioterrorism by a terrorist group operating in the U.S. Aum Shinrikyo – Aum Shinrikyo was a Japanese group that is most famous for their release of sarin nerve gas in the Tokyo subway system. Aum’s use of bioweapons started in 1990, with their attempts to develop the botulinum toxin that could be used to infect state officials and others they deemed enemies. While they did extensive research, Aum actually made several attempts to field test and attack enemies with their manufactured weapons. This particular failure pushed Aum to use sarin nerve gas, which is not a bioweapon but a chemical warfare agent (Carus, 2002). Amerithrax Attacks of 2001– After the terrorist attacks on September 11, 2001, letters containing anthrax spores were sent through the United States Postal System (USPS). From the beginning, the perpetrator was suspected to be an adult male who worked in a laboratory or had extensive scientific experience.
Richard Spertzel, a researcher working on bioweapons at Fort Detrick, Maryland, and Head of the Biological Weapons Inspections from 1994 to 1998, testified to the House Committee on International Relations in 2001 that the anthrax used in these attacks had to have been produced by a non-state group with ties to a state-sponsored weapons program.
While the culprit in the Amerithrax attack is still unknown, in 2008 the Department of Justice and the FBI brought charges against Dr. Additional cases – There are three additional cases that are worth mentioning, but not heavily analyzed as there is little evidence available (Carus, 2002). The cases addressed in this thesis reflect those that have substantial data and background information to truly determine hurdles encountered in bioweapon utilization. For the rationale of this analysis, attention will be spent on the terrorist activity involving bioweapons.
Many in the scientific community believe that the lone-wolf nature of the Amerithrax attacks and general intent behind them do not match terrorist habits (Thompson, 2006; Leitenberg, 2006). While many studies have focused on vulnerability to bioweapons attack, this analysis will focus on the capabilities that non-state actors must possess to use bioterrorism.
The majority of current literature also fails to point out the epidemiological components of these pathogens; from communicability to public health response, there is a general gap that this analysis hopes to fill. One of the technical hurdles in bioterrorism, after a group has decided upon that route, is to actually obtain the pathogen. One of the most shocking aspects of the Rajneeshees investigation was that the purchase orders for such pathogens also revealed that they could order tularemia, shigella dysentery, and typhoid fever, which are all extremely dangerous bacteria (Thompson, 2006). The medical clinics and facilities that both Aum Shinrikyo and Ranjeeshees retained allowed them to legally acquire these pathogens, but smaller non-state actors, like Larry Wayne Harris (a Christian Identity Church member who purchased y. The last acquisition method is through manufacturing the pathogen or isolating it from a naturally occurring reservoir. Another method for obtaining a pathogen “naturally” is by acquiring it from its natural source, i.e. Some simple attempts involved using a whole castor bean (with no manufacturing to isolate the toxin) as means to poison a person. Overall, acquiring these agents, whether through purchase, theft, or manufacturing via a natural source, has inherent risk and requires both technical knowledge and connections. Beyond the accessibility and availability of biological agents is the hurdle of having financial means to acquire them.
Once a non-state actor has made it past the first hurdle and acquired an agent, the real work begins. Bacteria are probably the easiest of the pathogens to isolate and cultivate, but viruses are considerably more difficult. Viruses may require genetic engineering, which becomes considerably more taxing on both technical knowledge and equipment.
The technical hurdles associated with pathogen cultivation make this one of the greatest roadblocks for non-state actors with limited resources, technical knowledge, and temporal restrictions. The technical knowledge and experience necessary for isolating, cultivating, and weaponizing pathogens for bioweapons is a particular hurdle that has prevented several terrorist organizations from being successful.
The Amerithrax attacks highlight the extensive expertise that is needed for large-scale, complex biological attacks.
There are several routes of dissemination, but the one most attempted and of most concern to biosecurity experts is aerosolization.
The Amerithrax attacks were a good example of aerosolization in the most rudimentary, non-technical delivery form. The slurry form of a pathogen can quickly clog spraying canisters or fall to the bottom of the container, rendering it ineffective. Overall, aerosolization is the most effective dissemination strategy, but also has the largest number of complications. Food terrorism and water contamination are also often considered or used by terrorists to disseminate pathogens. Modern sanitation and food processing practices (such as pasteurization, boiling and cooking) would render most agents useless. Incubation period is the time elapsed between exposure to a pathogenic organism, a chemical or radiation, and when symptoms and signs are first apparent.
In some diseases, as depicted in this diagram, latent period is shorter than incubation period. While latent or latency period may be synonymous, a distinction is sometimes made between incubation period, the period between infection and clinical onset of the disease, and latent period, the time from infection to infectiousness.
The terms, "intrinsic incubation period" and "extrinsic incubation period" are used in vector-borne diseases. For example, once ingested by a mosquito, malaria parasites must undergo development within the mosquito before they are infectious to humans. For many conditions, incubation periods are longer in adults than they are in children or infants.
In vivo and in vitro effect of bendiocarb on rabbit testicular structure and spermatozoa motility. Krockova J, Massanyi P, Toman R, Danko J, Roychoudhury S.Sourcea Department of Animal Physiology , Slovak University of Agriculture in Nitra , Nitra , Slovak Republic. In this study the effect of bendiocarb on the rabbit testicular structure and spermatozoa motility was investigated. Tetanus in adults: Clinical presentation, treatment and predictors of mortality in a tertiary hospital in Ethiopia. Amare A, Melkamu Y, Mekonnen D.SourceAddis Ababa University, Medical Faculty, Department of Neurology, Addis Ababa, Ethiopia. Mononucleosis gets its nickname because people can pass the disease to others through kissing.
By the time an individual turns 18, there is a 90% chance that he or she has been exposed to the Epstein-Barr virus, the agent that causes mononucleosis. Within the mononucleosis incubation period is an extremely short latency period, lasting only a few days. Out of all cases of mononucleosis, there is a small percentage of individuals who never develop symptoms. If one should become infected, bed rest is advised if symptoms should arise after the mononucleosis incubation period.
In the present day, cases like the Amerithrax attacks of 2001 and the Rajneeshees cult’s use of salmonella in Oregon restaurants point to successful use of bioweapons. Scholars credit the first written conceptual account of bioweapon use to stories about Hercules. Experts are divided in this notion, with some positing the realistic threat of terrorists using bioweapons, while others say this threat is wholly blown out of proportion.
In 2008, the Department of Homeland Security (DHS) stated that, “the threat posed by biological agents employed in a terrorist attack on the United States is arguably the most important homeland security challenge of our era. During those attacks, 20 billion anthrax spores were released from half a teaspoon of powder. Attacks like those of the Rajneeshees cult in Oregon, which infected hundreds of people with salmonella, are considered success stories, but cults like Aum Shinrikyo, which had the monetary means to employ these weapons, never experienced that kind of success. The project focused on boiling water and the link between sanitation and illness but was largely deemed a failure because campaign workers failed to identify the social norms and beliefs that saw boiled water as diseased. The diagram in Figure 1 and equation in Figure 2 address the role of threat, likelihood of attack, motivation, capability, vulnerability of assets, hazard posed, and value. The equation demonstrated in Figure 2 also relays the importance of capabilities and motivation in the equation regarding threat of attack. Bioterrorism employs bioweapons (BW) as a means of inflicting harm, morbidity and mortality, economic loss, psychological distress, and general turmoil upon a group of people. By using this categorization, health agencies around the world are able to help first responders and public health personnel to identify and understand biological agents that pose an increased risk for use in terrorism.
They might cause public panic and social disruption, and they require special action for public health preparedness. Unlike a bomb, bioweapons can cause delayed illness and transmission of infection among people. Organisms like anthrax and botulism that cause respiratory failure pose a particularly large burden, as they often require mechanical ventilation and specialist medical care. Several studies have revealed the inability of physicians to correctly diagnosis cases of Category A agents, compounding their effects that much more (Cosgrove, 2005). While Hercules is noted to be the first Western literary example, the reality dates back just as far.
Covert missions during World War I by the Germans infected Romanian sheep with anthrax, intending to infect their Russian purchasers (Carus, 2002). Unclassified accounts mention at least 54 cases in which a terrorist group allegedly had an interest in bioweapons, but there is little evidence to confirm most of these cases” (Carus, 2002). A second field test involved an unknown liquid that Puja employed cult members to spread on doorknobs and handles, but no infections were noted to occur.
While this attack made them famous, few know that sarin gas was just one of dozens of chemical and biological weapons they were developing. Aum had a substantial research facility, allowing them to perform advanced microbiology and even to disseminate biological materials from the roof of the facility they owned. In April 1990, they attempted to disseminate botulinum toxin by spraying the toxins from three vehicles when driving through central Tokyo, one of the international airports, and a naval base (Thompson, 2006).
The 1995 sarin attack was carried out in morning rush hour by placing the liquid sarin in punctured packages that looked like bottled drinks onto five cars, across three separate subway lines. Coined the “Amerithrax” attacks, this case is noted to be the “worst biological attack in U.S. Barbara Rosenberg of the Federation of American Scientists (FAS), who works on biological weapons, “believes the individual to be an American scientist with access to anthrax or at least instructed to make it by an expert” (Thompson, 2006). Dark Harvest was a group that protested anthrax military testing by the British military during WWII and attempted to contaminate research facilities with anthrax-contaminated soil. The primary cases for discussion are the Aum Shinrikyo attacks from 1990-1995 and those by the Rajneeshees cult. While criminals can be considered non-state actors, the cases associated with such action typically involve small clusters of poisoning (for example, employees poisoning doughnuts to infect coworkers and spouses infecting in-laws) and are not deemed terrorist incidents. While there are valid points to both sides, the attacks will be referenced, but the lack of information regarding the perpetrator and attack methodology is not conducive for this analysis.
The capability criteria are derived from both commonalities between cases, knowledge of epidemiological factors and public health response capabilities, and existing literature on non-state actors and their consideration or use of bioweapons. By focusing on threat, capabilities (ability or potential to develop and disseminate bioweapons), intent, and epidemiological components of bioweapons, this thesis will provide a capabilities assessment of previous bioattacks to understand why bioterrorism never reached heightened popularity. The Minnesota Patriots Council, an anti-government activist group, was found to subscribe to a publication that held advertisements for “Silent Tool of Justice” kits that included “an inexpensive assassination kit based on ricin” (Tucker, 2000). Carus noted that four of the 33 cases of acquisition by non-state actors involved stealing a biological agent from a research or medical facility. Of the 33 acquisitions on Carus’s list, 12 involved manufacturing the agent or acquiring it from a living host without any processing. Obtaining an agent is not enough, but rather the non-state actor must have the medical facilities and laboratory to house and work on the pathogen. Aum Shinrikyo had considerable options, as they were one of the most well funded terrorist organizations.

Weaponizing an agent through cultivation (the process of growing biological pathogens) and dissemination (spreading the pathogen to individuals for disease transmission) are two of the most technically demanding and failure-prone components of bioterrorism. Rosenau noted that, “botulinum toxins are extremely difficult to purify, particularly in large quantities, and are highly unstable in pure from. Anthrax is naturally occurring in soil and does not cause illness (except in livestock and rare cases of humans), but isolating and transforming specific B.
Both Rajneeshees and Aum Shinrikyo had considered obtaining and utilizing viruses like Ebola (a viral hemorrhagic fever) and HIV (Carus, 2002; Tucker, 2000).
Influenza, while a naturally occurring virus, frequently mutates or has antigenic drifts, which is the reason for new flu vaccines every year. Aum Shinrikyo spent years working on weaponizing their agents, which began to erode morale, monetary resources, and interest in bioterrorism. Given the technical difficulty in housing, cultivating, and weaponizing an agent, the need for persons trained in virology, pathology, or microbiology is crucial.
Anthrax, as previously discussed, is extremely volatile and difficult to weaponize, which is why the suspect was believed to be an extremely experienced microbiologist with years of experience not just in the field, but also with that particular organism.
Laboratory equipment, especially that needed to isolate and weaponize mass quantities of bacteria or virus, is extremely complex and can be dangerous.
Tucker has noted that although “persistent chemical agents such as sulfur mustard and VX nerve gas are readily absorbed through the intact skin, no bacteria or viruses can enter the body by any route unless the skin is already broken.
Aerosolization is a means of creating a cloud that contains the infectious agents via microscopic droplets for victims to inhale.
The perpetrator did not develop an aerosolization method, but rather the spores were so finely prepared that they easily traveled in the air.
To spread an agent through the air, it must be in either liquid (slurry) or dry form, which in and of itself is an arduous task. Aerosolization, while the most appealing as it can lead to higher efficacy if done correctly, poses the largest amount of technical obstacles for non-state actors to overcome.
The potentially far-reaching implications for a massive food or water supply contamination could be just as considerable as for aerosolization if done on a large-scale basis. The Rajneeshees also attempted to infect several water supplies in Oregon, but were unable to as a result of security measures (Thompson, 2006). Large-scale attacks using water supplies would be extremely difficult as the organisms would be highly diluted and picked up via filtration and treatment processes.
This approach has the most cases of illness associated with it as a result of the Rajneeshees attack in Oregon, which sickened 751 people. In a typical infectious disease, incubation period signifies the period taken by the multiplying organism to reach a threshold necessary to produce symptoms in the host. With respect to viral infections, in clinical latency the virus is actively replicating.[1] This is in contrast to viral latency, a form of dormancy in which the virus does not replicate. The intrinsic incubation period is the time taken by an organism to complete its development in the definitive host. The time required for development in the mosquito ranges from 10 to 28 days, depending on the parasite species and the temperature. When possible, it is best to express the mean and the 10th and 90th percentiles, though this information is not always available. Afterward, an individual is extremely infectious until a few weeks after symptoms of mononucleosis cease. Though they themselves never suffer any ill effects, these individuals are still extremely infectious to others. Limiting activity reduces the chances of severe side effects: jaundice, hepatitis, splenic rupture and meningitis. Many bacteria and some viruses and parasites are capable of producing enteric illness in people. The mythological Greek hero, after slaying the Hydra, dipped his arrows in its toxic blood.
Tucker states that “much of the discussion to date has focused on the vulnerability of large cities to terrorist attacks, while neglecting a careful assessment of the threat” (Tucker, 2000). Even if there are fewer casualties, additional second-order consequences (including psychological, social, and economic effects) would dramatically compound the effects” (Radosavljevic, 2009). Infecting 22 known people and resulting in 5 deaths, this case of bioterrorism cost roughly $6 billion (Thompson, 2006). Indeed, because it is impossible to completely defend against all attacks, threat assessment is crucial. Non-state actors have in the past, and will continue in the future, to consider and employ the use of bioweapons. Rogers pointed out that the societal habits and norms within a society will outweigh the innovation regardless of its benefit to them (Rogers, 1983).
An analysis of specific historical cases of bioterrorism through such a capabilities assessment will demonstrate the prevalent deterrents terrorists face when considering and deploying bioweapons. In the past, assessments of bioterrorism have focused on only a small section of these variables, mainly the consequences of attacks, value of assets being defended, and vulnerabilities. This equation points to the role of intent, vulnerability, and capabilities in regards to the threat of an attack (Thompson, 2006). Examples: Anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers (VHF). A delay in illness due to an extended incubation period might allow an infected person to travel and potentially expose hundreds or thousands of people, as some illnesses allow a host to be infectious before they are symptomatic. These pathogens are capable of causing an incapacitating illness and preventing individuals from performing their daily duties, but only a few are communicable between people. Overall, the pathogens considered as possible bioweapons all pose devastating health consequences to the infected person, and some of them create unique challenges for clinicians regarding both diagnosis and treatment.
The Greek historian Herodotus in the 5th century BCE described Scythian archers using poison-tipped arrows against their enemies. After several other experiments and cases during World Wars I and II, the Biological Weapons Convention (BWC), also called Biological and Toxin Weapons Convention (BTWC), was negotiated.
Of these 54 cases, only 27 have more than minimal evidence that a terrorist group actually acquired, attempted to acquire, or threatened to use a bioweapon.
Attempting to sway local elections in Oregon, they contaminated several restaurants with Salmonella typhimurium, which was responsible for infecting 751people with gastroenteritis (Carus, 2002). Mengeles”, controlled the Rajneesh Foundation International medical facilities and pharmacy. During August of 1984, the cult attempted several times to contaminate the water system, however, none were successful. From 1990 to 1995, Aum Shinrikyo worked to develop biological agents to support their apocalyptic religious goals.
The sarin attack was deemed successful by Aum, as it killed 12 people and caused over 6,000 to seek medical attention (Fletcher, 2012).
Studies revealed that the soil had low levels of anthrax spores that were unable to cause illness. While this thesis will refer to other non-state terrorist organization attempts, there is insufficient evidence that they represent actual attempts to use bioweapons.
According to Carus, motives of criminal cases were narrow and primarily involved targeting individuals or extremely small groups, not on instigating fear or social disruption on a large scale. The discussion will include some general information regarding the complexity of the Amerithrax case, since despite its disputed motives, this biological attack is nonetheless considered the largest in U.S. Previous analyses, like those of Carus, Thompson, and Tucker, have been case specific, choosing to focus on the cases and then to identify the roadblocks.
Aum Shinrikyo, for example, thought that they could acquire the live Ebola virus, considered to be one of the deadliest pathogens known to man, by traveling to Zaire during an outbreak.
Carus noted that of the 33 cases involving acquisition by non-state actors (including terrorists, criminals, and “others”), 11 obtained their pathogens from legitimate suppliers. Carus found that, “almost all of the thefts involved people who had legitimate access to the facilities where the biological agents were kept” (Carus, 2002). These changes make legally and illegally acquiring pathogens considerably more difficult for non-state actors, especially those of smaller organizations that do not own medical facilities or that face tightened security measures in laboratories they were hoping to infiltrate. This specific method does not involve any processing, but rather extracting blood or other potentially infectious materials from an infected source and directly infecting a person.
Rajneeshees member Puja was suspected of injecting a fellow cult member with HIV, but it was never proven.
Even if one has access to their own facility and has extensively trained technicians or pathologists, the access to these agents has reportedly become increasingly tightened, making it far more difficult for individuals or groups to acquire them. With roughly $1 billion in funds, they owned several buildings, including hidden medical facilities, and were able to fund bioweapon trials (Thompson, 2006). While terrorists with financial resources can gain access to laboratory equipment for weaponizing, as it is technically “dual-use”, this does not guarantee proficiency using it. Viruses like those that appeal to terrorists are extremely difficult to isolate and grow, as the required host cells must be living.
Antigenic shifts are major changes in the virus’s proteins, which make novel influenzas a risk for pandemics, as there is no immunity to such massive gene segment changes. The mental degradation of Aum Shinrikyo members through drug use and paranoia is suggested to have severely reduced their ability continue such technically proficient work (Tucker, 2000). Acquiring a lethal strain of anthrax or botulinum is especially difficult as there are several strains that can be harmless. Equipment misuse or poor technique can be devastating to the individual working on the experiment. Respiratory inhalation is the most dangerous form for both plague and anthrax, which underscores the appeal that aerosolization has for terrorists. While this route of dissemination is the most appealing, it also had the largest technical hurdles.
Those preparing it must then address both physical issues (to ensure the sprayer nozzles do not become clogged) and biological issues (to ensure that the organisms can survive once aerosolized).
The delivery system requires substantial technological prowess, but also the form of the pathogen can alter the efficacy of the aerosolization.
Intentional food and water contamination is extremely difficult on a large-scale, however, it incapacitates victims rather than killing them, meaning that for terrorists it has costs that potentially outweigh the benefits when compared to other dissemination methods. The difficulty in waterborne distribution is that the agent must be able to survive in water (despite chlorination and other treatments), have relatively high virulence (be able to cause illness with few particles, versus thousands, as it will be diluted in large water supplies), and be undetectable by water filtration systems.
Also, municipal water centers have security in place, which may deter potential terrorists. Contamination of the salad bars by the cult went unnoticed by officials as intentional contamination, which again may run counter to organizational goals (if the organization wishes to acquire media attention, unlike the Rajneeshees, which remained anonymous). A person may be a carrier of a disease, such as Streptococcus in the throat, without exhibiting any symptoms.
The extrinsic incubation period is the time taken by an organism to complete its development in the intermediate host.
The values below are arranged roughly in ascending order, although in some cases the mean had to be inferred.
One is that the latency period, the period between initial infection and ability to infect others, is much shorter than the mononucleosis incubation period; an individual with mono can infect many other people before symptoms appear.
For teenagers and young adults, symptoms of fatigue, fever and loss of appetite occur for roughly two to three weeks after the mononucleosis incubation period. Therefore, for most of the incubation period, there is a high chance that an infected individual will infect others. In fact, as they never have to remain home due to illness, they have more chances to infect other than if they had become sick. Over-the-counter pain killers can help relieve the muscle aches associated with the condition. Terrorism of any form has both pros and cons, but given the historical use of bioterrorism and its success, why has it not steadily increased in application like suicide bombings? From this, some historians say, the first depiction of bioterrorism was introduced into the Western world (Mayor, 2003). The threat of bioterrorism and capabilities of those considering its utilization are components that must truly be addressed to better respond to and prevent such events. In effect, this theory discusses the question of why certain ideas become popular while others never take off. On the other hand, the ability to spread disease from person to person is a wholly unique component of bioweapons. Organisms like anthrax, tularemia, and botulism are not known to spread between individuals beyond bloodborne pathogen exposure. The ability to transmit disease and have delayed presentation makes these weapons especially sinister and potentially all the more appealing to terrorists. The Scythians would also create a mixture of decomposed venomous snakes and dung, sealed and made especially potent over time, that they would cover their arrows in. If bioterrorism has occurred since Carus’s analysis, there has been little to no unclassified information to document it.
Eight of these cases produced evidence that the terrorist group actually acquired the agent, but in only five cases did terrorists confirm the use or attempted use of biological weapons (Carus, 2002).
The Rajneeshees were originally an Indian cult that moved to Oregon to distance itself from notoriety in India. Even after wide public attention, this outbreak was not associated with bioterrorism until late 1985, when Rajneesh, the cult leader, emerged and stated he believed Sheela and 19 other leaders (including Puja) were responsible for crimes including the salmonella outbreak (Carus, 2002).
Ebola is considered one of the world’s deadliest viruses and was such a prize item for Aum that members traveled to Zaire in 1992 on a “humanitarian mission” during a local outbreak to supposedly acquire the virus in the wild (Thompson, 2006). Later that year, they attempted to spread anthrax using a sprayer system on the roof of a building they owned, as well as trying to contaminate the area around the Diet using the similar truck methods (Carus, 2002).
Despite all of these bioweapon attempts (10 in total), they were all met with failures (Tucker, 2000). An estimated 10,000 people were exposed and 22 people experienced illness, of which five died.
Rosenberg, as Thompson noted, “falls into what some call the ‘Bioevangelist Camp’, believing an American scientist with experience in the realm of bioweapons thought the U.S.
The Mau Mau African independence movement group was believed to be responsible for poisoning livestock with a plant toxin, but little information is available.
Several cases involved laboratory technicians, graduate students, or hospital staff stealing cultures. Natural acquisitions from animal or human hosts also account for 6 of the 12 cases identified by Carus as manufacturing or natural source acquisitions (out of 33 total cases of groups actually acquiring the agent).
This was also the intent of Aum Shinrikyo when they traveled to Zaire in hopes of acquiring the Ebola virus from a living host (Thompson, 2006; Carus, 2002). Nordmann pointed to the recommendations made by the 2008 Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism to increase biosecurity, but the reality is that these measures could take time to be enacted (Nordmann, 2010).
While individuals like Larry Wayne Harris were able to pay for these organisms online, the availability of these pathogens has been regulated in recent years to prevent such events from occurring (Tucker, 2000). Dual use refers to the fact that the equipment needed for creating bioweapons is the same equipment needed to help isolate pathogens for vaccine or treatment research.
The difficulty of producing a sufficiently pure toxin is compounded by the fact that the protein-destroying enzyme is generated at the same time as the toxin. The spore itself is highly resistant to environmental stresses but is also very unstable in its vegetative state, which requires extensive microbiological knowledge and experience to cultivate spores and not kill them when they are in the vegetative state. Consider the weaponization of influenza, which is easier to obtain naturally than any other category A or B agent. Zubay has noted that, “key characteristics of good bioterrorist weapons are ease of production and ease of obtaining the pathogens” (Zubay, 2006).
Enemark pointed out that, “it is simply not enough to be able to grow a biological agent that makes people sick. While drug use and paranoia was rampant in Aum, these matters were coupled with general technical hurdles that required substantial scientific experience to solve the issues.

Only an experienced researcher or laboratory microbiologist would know how to isolate and cultivate the lethal strains.
Tucker found that “because of sloppy laboratory practices, members of the Aum Shinrikyo cult reportedly became infected with Q-fever, a rickettsial disease they were prepping as a biological weapon. A biological weapon must have a means of transmission, and to be effective, this transmission should reach as many people as possible. Aerosolization also has the capacity to infect large numbers of people over substantial geographical spaces. For effective inhalation, the particles in an aerosol cloud have to be roughly 1-5 microns (one-millionth of a meter) in size (Carus, 2002).
An agent in liquid form can be aerosolized using a modified commercially available sprayer, but problems remain. The bacteria slurry, which was actually a harmless anthrax strain, was not refrigerated until the very last minute, so the slurry settled at the bottom (Tucker, 2000). Dry or slurry format can create problems in the actual delivery device, as well as efficacy for the pathogen to stay within 1-5 microns in size and travel considerable distances.
Organisms like Cryptosporidiosis (a protozoa very resistant to chlorine), giardiasis (protozoa found in untreated water), Vibrio choloerae (cholera), Shigella dysenteriae (dysentery), and Legionalla pneumophila (legionellosis) are all common waterborne diseases that are monitored (Heymann, 2008). Food terrorism (or agroterrorism involving the contamination of crops or livestock) on a large scale is labor intensive, as the pathogens have to essentially reach food at the production or distribution level and survive long enough to infect people. Depending on the disease, the person may or may not be contagious during the incubation period. HIV may at first have no symptoms and show no signs of AIDS, despite HIV replicating in the lymphatic system and rapidly accumulating a large viral load. If a female mosquito does not survive longer than the extrinsic incubation period, then she will not be able to transmit any malaria parasites.
In these cases, symptoms force infected individuals to refrain from school or work for a period of time. Though mononucleosis is known as the "kissing disease," its transfer through saliva makes it possible to infect others through other means.
As it may be impossible to tell who has the virus, remembering to wash one's hands and not share cups are two ways to prevent becoming infected. In many ways, this mythological depiction became a reality when plague-infected corpses were thrown over the city walls of Kaffa and English settlers gave smallpox riddled blankets to Native Americans (Alchon, 2003, Oldstone, 2010). Bruce Ivins, was the main suspect for the Amerithrax attacks, there continues to be fake attacks involving baby powder and other faux anthrax. Leitenberg points out that “within 4 years, almost $30 billion in federal expenditure was appropriated to counter the anticipated threat. Diffusion-of-innovation studies address why and at what rate new ideas (such as technologies) spread throughout a culture or society. The emphasis on capabilities and motivation is the driving force behind this analysis in order to provide a better understanding of terrorist capabilities when pursuing bioterrorism. Consider the Category A agents: several of them are highly contagious, such as pneumonic plague and smallpox.
Plague, VHF, and smallpox however, are extremely communicable, making their ability to cause downstream effects substantially more significant. Signed in 1972, it entered into force in 1975 and worked to end state-sponsored bioweapons programs. The few recent ricin cases that have been received media attention involved individuals sending castor beans (non-weaponized ricin) to federal officials and gun control organizations.
The five cases of bioterrorists Carus mentions are the Rajneeshees, Aum Shinrikyo, Dark Harvest, Mau Mau, and the Polish Resistance. Indeed, food terrorism is perhaps the most difficult form of bioterrorism to identify as intentional, as the pathogens are commonly occurring and biocrimes can easily be masked as large outbreaks. The truck drive-by method was also employed again in mid 1993 during an attempted attack around the Imperial Palace in Tokyo (Carus, 2002). The sarin nerve gas attack was their only source of success, pointing to the unanticipated difficult nature of bioterrorism.
Anthrax is an extremely potent pathogen when inhaled, and with approximately 20 billion total spores released in the letters, this attack cost an estimated $6 billion in response measures (Thompson, 2006). A biodefense expert whose personal emails stated his willingness to hurt, kill, and terrorize, he was a microbiologist who worked with anthrax for decades at USAMRIID (Shane, 2010). Lastly, there are reports that during WWII, Polish resistance organizations used biological weapons to produce a claimed 200 German deaths. The reasoning for this general exclusion is the debated classification of the Amerithrax attacks as truly terrorist attacks. The ATCC told Harris that to order cultures and have an account, he had to run an established lab with a letterhead (Tucker, 2000). The anti-government group Weather Underground attempted to obtain agents by blackmailing soldiers at Fort Detrick, Maryland, however, this tactic was not successful. Nonetheless, there is a substantial push to make biosecurity measures more secure and universal. Acquiring an agent via theft can also be monetarily taxing, as bribes and the equipment to transport the pathogen could be costly.
Figure 3 provides a clear view of how dual use can work to the bioterrorist’s advantage (Thompson, 2006). Maintaining the toxicity of the material as it is purified is extremely difficult” (Rosenau, 2001). In addition, the agent must be kept alive, it must be of a strain that is lethal to humans” (Enemark, 2006). Aum’s head microbiologist and bioweapons specialist, Seiichi Endo, was unable to cultivate a lethal strain of botulism, which most likely was a result of his inexperience in microbiology (Rosenau, 2001). Even cult leader Shoko Asahara is believed to have acquired the debilitating illness” (Tucker, 2000). Particles larger than 5 microns will be caught through the respiratory tract filter and often are too heavy to travel, thus they fall quickly and are not as effective voyagers. A pathogen in liquid or slurry state is also more difficult to aerosolize, as its size is larger, so it tends to fall more quickly. The distinctiveness of waterborne or foodborne attacks is that they naturally occur and tend to go unnoticed as intentional, which may run counter to the terrorist organization’s goals. After a mosquito successfully transfers the parasite to a human body via a bite, the parasite starts developing. Though limiting contact with others during this time reduces the chance of more infections, the nature of the preceding incubation period makes an individual extremely infectious.
For example, the close proximity of students at a school gives rises to many occasions when accidental infection can occur. Many bacteria, viruses and some parasites are capable of producing respiratory illness in people. In modern times, non-state actors have used bioterrorism as a means of swaying political votes, instilling fear in people, and reinforcing apocalyptic ideology. This response took place in the absence of virtually any threat analysis” (Leitenberg, 2005).
This thesis will attempt to do this through an analysis of the hurdles that inhibit utilization.
Bioweapons like plague are both endemic (naturally occurring) and transmissible through droplets, creating an exposure within six feet of the infected individual. The most commonly acknowledged case of bioweapons use is from the late 14th Century CE, in the city of Kaffa. Several experts have pointed to the over-hyped attention these cases have received, especially since these attempts yielded no illness and were using non-toxic substances (Garza, 2013). The most prominent cases are the Rajneeshees and Aum Shinrikyo, which experienced the most success. The cult would routinely bring in homeless people from all over the country to vote in local elections, hoping to sway land laws in their favor.
Other cult members stated that she also considered more severe bioweapons like HIV and giardia (Carus, 2002). The CDC estimates that 751 people became ill after eating at salad bars within these restaurants (Carus, 2002). Overall, the Rajneeshees salmonella event is considered to be one of the largest case studies in biocrime history. The leader, Asahara, was a highly charismatic man, establishing a cult of roughly 40,000 members worldwide. Lastly, in March 1995, Aum planted three briefcases in the Tokyo subway to release botulism. Whether the result was a failure of dissemination, the virulence of the pathogen, or internal collapse within the group, Aum is a prime example of the dedication some organizations have to employing bioweapons, but also the roadblocks that prevented their success. Bacillus anthracis exists in roughly 89 known strains, but this particular strain was known as Ames (Thompson, 2006). The attacker demonstrated bioterrorism’s potential and blamed it on a large threat – Al Qaeda. Carus’s 2002 assessment does not include the Amerithrax attacks, most likely a result of the limited information at the time of print, and its classification as a terrorist action is disputed (Carus, 2002). The Rajneeshees actually purchased their salmonella cultures legally from the supplier, VWR Scientific, as well as several other pathogens from American Type Culture Collection (ATCC) (Tucker, 2000). Harris was able to resolve this dilemma by going to a local print shop and having stationary made using a fake lab name and his home address (Tucker, 2000). Cases of theft have been mostly by individuals or small groups, but most cases caught the attention of other lab technicians or coworkers, who alerted authorities. It is not possible to manufacture a virus or bacteria, but one can produce toxins from manuals like the Poisoner’s Handbook, Silent Death, Catalogue of Silent Tools of Justice, and the Anarchist’s Cookbook. Although this initial roadblock is currently most likely one of the easiest to overcome, as time progresses and the concern for bioterrorism grows, restrictions will also tighten on legally purchasing these organisms and on access to facilities that house them. Attempting to isolate a pathogen naturally is also extremely expensive, requiring all the necessary laboratory equipment, which in the case of viruses, is extensive.
However, it has not been utilized like bacteria as a bioweapon, which may reflect substantial specialized knowledge needed for such a task. Endo was trained as a molecular biologist, not a microbiologist, so as their head of bioweapons he significantly lacked the necessary technical expertise. Aum Shinrikyo is one particular group that attempted to use aerosolization in the truest technical form (Carus, 2002).
Rosenau also noted that bacteria tend to die more quickly in a slurry form as they are aerosolized (Rosenau, 2001). The time between the injection of the parasite into the human and the development of the first symptoms of malaria is its intrinsic incubation period.
Al Qaeda leader Abu Hamza al-Muhajir stated in a 2006 audiotape that he implored scientists and experts to join al Qaeda in the testing and creation of biological weapons (Thompson, 2006).  The attention that bioterrorism garners has far reaching consequences that cause economic, psychological, and political disruptions. Vulnerability is an ongoing reality, but one must also consider whether the threat of bioweapons is as great as the U.S. During their besieging of the city, the Tartar army catapulted the bodies of plague victims over the city walls. Signatory states were to provide annual reports related to BWC data, research centers and vaccine production.
To understand the roadblocks they nonetheless encountered, it is crucial to understand how these two organizations functioned and attempted to employ bioweapons. Interestingly, the individual responsible for preparing the suitcases had moral trepidation and replaced the contents with a placebo (Thompson, 2006).
Despite the resources Aum Shinrikyo had, in most cases they were unable to effectively use biological agents.
The scientist brought attention to the problem, finally summoning sufficient assets to focus on the issue” (Thompson, 2006).
Ivins was specifically working on vaccines for anthrax, revealing his extensive knowledge and access to the pathogen.
Fox noted that restrictions on microorganisms have greatly tightened since the Amerithrax attacks.
Manufacturing these toxins, especially ricin, is extremely dangerous, and if done by an inexperienced person who is not extremely careful, can lead to death. The only alternatives will increasingly be to acquire them naturally, which is extremely technically intensive and demanding.
Beyond the technical know-how needed for this method, the purchasing of the equipment alone is a major deterrent. After purchasing the equipment (glassware, desktop fermenter, and standard nutrient media) and obtaining the pathogen, the ability to isolate and grow the pathogen comes into play. There are several bacillus species, but identifying and growing the correct one requires years of knowledge. The ability to transfer and grow bacteria, especially salmonella, is far easier than that of botulinum or anthrax, but still requires a basic understanding of the laboratory practices. By developing delivery systems like sprayers that aerosolize pathogens into a cloud, terrorists can discretely release large amounts of bioweapons into a wide geographical area. Rosenau also noted that to truly cause massive casualties, an aerosolized cloud, not just sprayed material (like Windex), is needed (Rosenau, 2001). Perhaps one of the biggest issues with aerosolization is the fact that the pathogens tend to lose their toxicity not only in the aerosolization process, but also as they enter the atmosphere. Inhabitants and travelling merchants became infected with plague, bringing the deadly disease back to Italy and sparking the spread of the Black Death, killing an estimated 30-60% of the European population (Alchon, 2003). It is estimated that at their peak in 1995, Aum had roughly $1 billion in net worth, making it one of the most well funded terrorist groups (Tucker, 2000).
While the Amerithrax attack does not have an obvious terrorist culprit and motive like those by Aum Shinrikyo or Rajneeshees, it continues to worry biodefense experts regarding apparent U.S.
Legally acquiring agents has become more difficult since the Amerithrax attacks and the focus on bioweapon security, but there is still an obtainable capability to purchase these pathogens with an established laboratory account. He found that accessibility of many microorganisms has become stricter and the process for working with certain agents involves extensive reporting, review, and security (Fox, 2002). There have been cases in Maricopa County, Arizona, where people attempting to make ricin caused extreme chemical reactions leading to property damage or death (Evans, 2013). States like Arizona are habitats for animals like prairie dogs that carry the infected fleas, which cause plague cases. Viruses are the most difficult in that they cannot live outside a living cell, but require fertilized eggs in which to grow. Toxins especially degrade quickly when exposed to sunlight and air, which means they can lose their efficacy by a rate of 4% per minute (Rosenau, 2001). Once the correct bacteria is isolated, awaking it from the dormant state becomes progressively challenging, as it requires heat or chemical shock without killing the pathogen (Zubay, 2005; Roseanu, 2001). Environmental conditions, which will be discussed later, pose serious risks to the viability of pathogens. A case definition can be altered as the outbreak progresses and further information is discovered. The Armageddon mentality further pushed the group to develop weapons at a rapid pace, with an increasingly violent attitude as a result of growing paranoia they became increasingly dependent on narcotics. Just as Aum Shinrikyo attempted to isolate toxin strains of botulism from soil, they ran into the necessity for technical knowledge needed to isolate large quantities via enrichment materials (Thompson, 2006; Tucker, 2000).
The Health Unit investigator reviews the new information daily and will call to confirm that the data were received.

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