November 2002 (vol. 19, #1)
1601 N Tucson Blvd #9, Tucson AZ 85716
c 2001 Physicians for Civil Defense


Smallpox and anthrax weapons are already 25 years old, stated Dr. Igor Shafhid, formerly of the Soviet Army and now with Bechtel Nevada, speaking at the Metropolitan Medical Response System (MMRS) conference in Tucson, Nov. 20-22. Third-generation weapons are now the sum of all fears.

Biological weapons that defeat vaccines were developed 7 or 8 years ago, Dr. Shafhid claimed, and genetically engineered anthrax, released in microencapsulated form, was tested in Chechnya in March, 2002.

``Twister agents'' that deceive diagnostic tests and evade the immune system; microencapsulation to improve survivability of an organism in the environment and complicate detection and identification; supertoxins such as ricin or botulinum toxin that can be delivered by aerosol without the need for an umbrella; and cocktails of organisms such as smallpox mixed with anthrax are other diabolical possibilities. Ethnically targeted weapons, from which the aggressor would be safe, were developed and tested in the mid 1980s, Dr. Shafhid stated.

Chimeras, with lethal genes inserted into the DNA of totally unrelated organisms, are reality, he stated-not just the stuff of fiction such as The Cobra Event by Richard Preston.

What if the gene for the lethal factor of anthrax could be inserted into E. coli? Or what if variola major could be inserted into bacteria, so that antibiotic treatment for dysentery could release the fatal virus?

If any of these allegations are true, the national pharmaceutical stockpile could be irrelevant, and first responders could simply be the second group of casualties.

Scary fictional scenarios, on the other hand, could greatly facilitate the main purpose of terrorism: terror. They could discourage necessary and beneficial preparedness for real threats. They could serve as propaganda to justify a ``preemptive strike'' against an enemy, or Orwellian surveillance of the population. Some public health authorities do not take such possibilities seriously because of technical difficulties or dangers to supposedly rational, nonsuicidal perpetrators.

However, former U.S. Defense Secretary William Cohen stated in 1998: ``Genetic engineering for biological agents? There'd be no protection. These are the weapons of the future and the future is coming closer and closer'' (Mangold T, Goldberg J, Plague Wars, St. Martin's Griffin, 1999).

Lack of preparedness heightens our vulnerability to attack: ``so far, most of what we have done has been to react to incidents'' (Osterholm M, Schwartz J, Living Terrors, Delta, 2000). Professor Osterholm of the School of Public Health, University of Minnesota, advocates more of the standard public health response: surge capacity, stockpiles, public health ``infrastructure,'' table-top exercises and live drills, better news coverage, better government organizational charts. Strengthening the capacity for a centralized public health response may be necessary and desirable. But ultimately, the outcome will depend on individual Americans and local actions. By the time national ``assets'' can be mobilized, an epidemic can be raging out of control. If those assets are targeted and destroyed, or simply overwhelmed, federal help might never arrive. And if the available drugs or vaccines are impotent against the threat, sending people to a central dispensing or vaccination center could just multiply the casualties.

Of the most urgent importance is research on early detection of widespread illness by nonspecific means such as nitric oxide or other simple molecules in exhaled breath (see DDP Newsletter Sept 2002); nonspecific ways to enhance immune response; nonconventional means of treating bacterial infections; better decontaminants; and portable instruments for rapid, state-of-the-art biochemical analysis.

Of equal importance is the rapid dissemination of knowledge and technology. The key advantage of biological aggressors is the ability to work in small, easily hidden laboratories. The industrial complex needed to assemble a nuclear weapon is much more easily detectable. This means that biological defenders must be dispersed rather than concentrated in the equivalent of a Cheyenne Mountain.

There has never been a greater need for individual ingenuity, resourcefulness, and unconventional thinking-or for the rapid deployment of ``beta'' technology.

And there have never been greater cultural and legal obstructions-lock-step school curricula; rigid governmental controls on research funding; pervasive bureaucratic (``regulatory'') controls on industry and medicine; and unlimited legal liability for products-except when used exactly as directed by government.

There has never been a greater need for local civil defense -for individuals and communities to detect and shield themselves from a lethal but transient threat. Nor has there ever been greater dependence on centralized assets and information flow.

The best defense against panic is not deployment of squadrons of mental health counselors; it is equipping people with the knowledge and skills to protect themselves. Keeping secrets will not thwart terrorists. Ken Alibek stated that ``the extensive and exquisitely detailed instructions for the cultivation of killer bugs and the weapons to deliver them-twelve volumes for smallpox alone-were placed on microfilm, making them highly portable'' (Osterholm & Schwartz, op cit.)

Americans are being taught to turn on the radio and await instructions-from authorities who have been in deep denial for decades about the threat of biological weapons and from news media that foment hysteria about trivial hazards while blacking out the real threats. They are forbidden to have a smallpox vaccination now, but could be forcibly vaccinated later if the U.S. Secretary of HHS deems it ``advisable.''

Some say the terrorists will have won if the Americans surrender their freedom. The terrorists of the new millennium may not care in the least about such abstractions or even about gaining political power. The goal may simply be maximum destruction and death-to wipe out the infidel, the Great Satan, the Jew, or the human virus that pollutes Planet Earth. Ideology that justifies or promotes this goal may be taught in an Islamist mosque. Or it may be taught by deep ecologists in American government schools, while Western Civilization is demonized.

If Americans surrender their freedom and self-reliance-so essential for defense against this threat-it is very likely that they will lose their lives as well.



The 1972 smallpox epidemic in Yugoslavia started with an Albanian Muslim from Kosovo, who was infected during a pilgrimage to Mecca. He had been vaccinated two months prior and had a very mild case for which he sought no medical assistance. One of the strangers that he apparently infected in the marketplace was a 30-year-old teacher named Ljatif Muzza. Treated initially with penicillin for a fever, Muzza was presented to medical students as a case of penicillin allergy after admission to the main hospital in Belgrade with skin bruises that had turned almost black. Muzza died in the intensive care unit with uncontrollable intestinal bleeding. The duty physician listed the cause of death as penicillin allergy. At the time, no one suspected that in a week-long journey Muzza had seeded smallpox throughout Yugoslavia. The hemorrhagic variety (``black pox''), which is invariably lethal, causes victims to emit large quantities of aerosolized virus. Roadblocks and quarantines were set up throughout the country, and almost the entire population was vaccinated. The epidemic caused 175 cases and 34 deaths (Tucker JB, Scourge, Atlantic Monthly Press, 2001).

The term ``blackpox'' is now being used to refer to a genetically engineered combination of Ebola virus and smallpox, combining the lethality of Ebola with the contagiousness of smallpox. There is no known prevention or treatment.

According to Dr. Ken Alibek, former assistant director of the Soviet biowarfare program, the Soviet Union and Iraq were both at work on the recombinant Ebolapox virus during his tenure. Has the effort succeeded? Opposition Iraqi National Congress leader Ahmad Chalabi recently warned that Saddam Hussein has ``produced and engineered biological weapons which contain a combination of viruses such as smallpox and Ebola'' and that he ``is working very hard to position people and to move with biological and chemical terrorism across the important centers of the world'' ( Nov 2002).

In his recent book, Dr. Alibek wrote that Dr. Peter Jahrling of USAMRIID has called Ebolapox ``sheer fantasy.''

``I have no way of knowing whether a combined Ebola-smallpox agent has been created,'' Alibek states, ``but it is clear that the technology to produce such a weapon now exists....

``Throughout my career, I had worried that American scientists would surpass us. Now I find myself struggling to persuade them how far the science of germ warfare had come'' (Alibek K, Biohazard, Delta, 2000).

What are the implications for exercises such as the MMRS Tucson exercise that Battalion Chief Les Caid called ``the mother of all disaster drills''? ``Everything we have now is absolutely inapplicable,'' Dr. Alibek told an EmergencyNet interviewer. The current level of U.S. preparedness is, in his assessment, ``very low'' (

An attack on Iraq could lead Saddam to unleash his biological and chemical arsenal, warned a report in Jane's Terrorism and Security Monitor (11/12/02). In the worst-case scenario, weapons are already deployed within warehouses in the U.S., awaiting release via aerosol.


Smallpox Vaccine: Adverse Event Rates

Studies done in 1968 showed the following rates of adverse reactions (in cases/million primary vaccinees over 1 year old): death, 1; vaccinial encephalitis, 2.4-8.6; vaccinia necrosum, 1.0-1.7; eczema vaccinatum, 10.6-41.5; generalized vaccinia, 17.7-223; accidental auto-inoculation, 27-532. Most deaths and complications occurred in children under 10.

Contraindications include: a history of eczema or atopic dermatitis; other skin conditions if currently active; HIV; organ transplant; generalized malignancy; agammaglobulinema; autoimmune diseases; treatment with radiation, corticosteroids, or other immunosuppressants; and pregnancy. Contraindications should be considered both in the vaccinee and in household contacts (

How often is vaccinia transmitted accidentally to a contact, causing severe reactions or death? In the 1960s, contact vaccinia occurred in 2 to 6 per 100,000 primary vaccinations, never in revaccinations; the rate of eczema vaccinatum (EV) in contacts was 1 to 2 per 100,000. In all studies, close contact was required, and transmission rarely occurred outside the home. EV resulted in one death in contacts in the U.S. in 1968, when 5,594,000 primary vaccinations were administered. The rate of adverse reactions is expected to be higher today; one reason is that the prevalence of atopic dermatitis in children may have increased from 3%-6% to 6%-22% during the past three decades (Neff et al., JAMA 2002;288:1901-1905).


Viruses for the Defense

As noted in a Letter to Nature, ``The dormant and durable spore form of Bacillus anthracis is an ideal biological weapon of mass destruction.... Natural and genetically engineered antibiotic-resistant bacilli amplify the threat of spores being used as weapons, and heighten the need for improved treatments and spore-detection methods....''

Viruses that infect bacteria (bacteriophage) direct the cell's machinery to make enzymes called lysins that break down the cell wall, releasing the viral progeny. The components targeted by lysins are generally necessary for viability, so that lysin resistance is rare. ``Considering the staggering global population of [double-stranded] DNA phages (estimated to be more than 1030), lysins are already one of the most ubiquitous and successful antimicrobial agents on Earth. Bacteriophages ... represent an enormous untapped pool of agents with which to control human pathogens.''

The PlyG lysin isolated from the lambda phage of B. anthracis has been shown to kill both vegetative cells and germinating spores of anthrax and related bacilli. The lytic specificity of PlyG can also be exploited for a rapid detection method (Schuch R, et al., Nature 2002;418:884-888).

Bacteriophage therapy is thus making a comeback in the West. It got off to a flying start in 1919, after a preparation isolated from feces cured a severe case of dysentery. Sinclair Lewis popularized it in his novel Arrowsmith, in which a doctor used it against an epidemic of bubonic plague. Mixed results, and problems such as contamination of preparations with endotoxins, were grist for a damning critique by the AMA in 1934. After the discovery of penicillin, the idea was relegated to the dustbin-except in Russia. With Stalin's support, research thrived. Phage therapy was successfully used against gas gangrene, Pseudomonas, Streptococcus pyogenes, and Staphylococcus aureus, and was much cheaper than antibiotics.

Aside from bioterrorism, phage therapy offers hope in vancomycin-resistant infections, osteomyelitis, diabetic ulcers, and other recalcitrant conditions. If bacteria become resistant to the phage, a new variant can be quickly isolated. The most formidable barrier to rapid development: ``regulatory uncertainty'' (the FDA) (Stone R, Science 202;298:728-731).