Assessing the threat of bioterrorism: are we ready?

Biological Threats and Weapons of Mass Destruction H ealth officials have long considered the possibility of bioterrorism, but since September 11 preparation for the possibility has gained greater urgency. Efforts to avert or cope with this threat have raised a number of concerns about the need to coordinate governmental activities, strengthen federal, state, and local programs, supplement the pharmaceutical stockpile, and examine regulatory and legal policies. Bioterrorism is the release—or simply the threat of releasing—biological agents, such as viruses or bacteria, in order to influence government or intimidate civilians. Biological terrorism is one within a class of so-called weapons of mass destruction (WMD) that also includes nuclear and chemical agents.Weapons of mass destruction are defined as those able to harm or kill a large number of people at one time. Until the recent anthrax attacks, the one known instance of bioterrorism in the United States occurred in 1984, when a religious cult in Oregon poisoned salad bars with Salmonella. The sarin attack in 1995, by a religious cult in the Tokyo subway system, is the one known chemical attack. Biological weapons may be transmitted by people or animals, food or water, or in the air (aerosol). Aerosol transmission has the greatest potential for harm. The Centers for Disease Control and Prevention (CDC) has classified as “Category A” those biological agents that pose a great threat because they cause easily transmitted diseases, result in many deaths, and may produce social panic. Anthrax and smallpox are two such diseases, as are plague, tularemia, and viral hemorrhagic fever.The CDC’s Categories B and C diseases pose progressively lesser threats. Chemical threats include those classified as nerve (such as sarin), blister (such as mustard gas), and blood (hydrogen cyanide). The Commonwealth Fund is a private foundation supporting independent research on health and social issues.