Chemical and Biological Terrorism: Prevention Strategies

Introduction to CBRN Terrorism

The United States Government has identified the potential of chemical, biological, radiological, and/or nuclear (CBRN) terrorism as a serious national security concern, especially in the wake of the September 11 attacks. Alarm grew after Sarin was used in a Tokyo subway by Aum Shinrikyo in 1995 and following the anthrax attacks in November 2001. The likelihood of terrorists resorting to these agents is considerable given their advantages over conventional methods. Most organizations fighting terrorism are not sufficiently equipped to detect such chemicals, and a closed container can help most agents escape discovery. The low cost involved in their production increases the danger manifold. Since most of these agents affect the human body directly, they are essentially more efficient than conventional warfare.

Knowing this, the United States must comprehend the consequences of potential future attacks and take steps to prepare and act proactively against new and unconventional forms of terrorism. The advent of the 21st century has transformed the nature of terrorism beyond traditional wars and bombs, making chemical and biological weaponry some of the most potent options available for future attacks.

Types of Chemical and Biological Agents

Chemical weapons have four major classifications. Choking agents are intended to be fatal and are easily accessible; phosgene is one such industrial chemical agent. Blister agents are meant to incapacitate their victims rather than kill them outright — mustard gas and lewisite are two examples used in World War I. Most blood agents are cyanide-based (such as hydrogen cyanide) and are directed at individuals rather than large groups. The final category, nerve agents — including Sarin, Tabun, and Soman — are considered significantly more potent than the others and can easily inflict casualties across large populations.

Biological weapons involve infectious agents such as bacteria (inhalation anthrax, tularemia, pneumonic plague, and Q-fever), viruses (smallpox, Marburg fever, and Venezuelan equine encephalitis), and toxins (botulism, ricin, and staphylococcal enterotoxin B intoxication). The breadth of agents available to would-be terrorists underscores the complexity of developing a comprehensive national defense strategy.

Overt vs. Covert Attacks and the Role of Healthcare Providers

To properly foresee the consequences of potential attacks and adequately implement successful preventive security measures, the inherent differences between chemical and biological terrorism must be identified and accounted for. The key distinction between these two forms of attack lies in the conspicuousness of their effects. Chemical terrorism is largely overt in nature, meaning its effects can readily be observed without a prolonged incubation period. Typical homeland security measures have usually focused on such overt attacks, since the effects of chemical agent absorption — through the skin, inhalation, or mucous membranes — are readily apparent and either fatal or incapacitating within a brief time. Such attacks call for the expedient mobilization of law enforcement authorities, emergency medical personnel, and both public and private healthcare officials.

The more insidious — and potentially more effective — form of terrorist attack is the covert variety. The vast majority of biological warfare can be classified as covert, for the simple reason that there is typically a significant incubation period between the launch of a biological offensive and the manifestation of its effects. As a result, the initial signs of a biological terrorist attack are likely to be identified by primary healthcare providers such as physicians, who ideally will be trained to notice patterns of unusual symptoms or diseases. This possibility explains why disease surveillance measures must be enforced at local and statewide levels, so that epidemiologists and other physicians will be alert to shared symptoms that may indicate a covert biological attack.

The following quotation emphasizes the importance of healthcare providers in identifying and containing covert biological warfare: "…in the event of the covert release of the contagious variola virus, patients will appear in doctors' offices, clinics, and emergency rooms during the first or second week, complaining of fever, back pain, headache, nausea, and other symptoms…By the time the rash becomes pustular and patients begin to die, the terrorists would be far away and the disease disseminated through the population by person-to-person contact" (Khan, Levitt, & Sage, 2000, p. 7). The role of physicians as the first line of defense is readily apparent: it would fall to them to identify symptom patterns, recognize disease progression, and quarantine patients to prevent further spread. Prevention strategies could include "mass vaccination or prophylactic treatment" (Khan, Levitt, & Sage, 2000, p. 7), among other methods, and could mean the difference between an isolated incident and a sweeping series of fatalities with national or global effects.

It should also be noted that although most chemical methods of warfare are overt, covert chemical offensives are possible as well. Chemical poisoning of food and water supplies is one such example, and may take several months to be detected — during which time large portions of the population are exposed to its toxic effects. Again, the most effective defensive mechanism would be healthcare providers recognizing a pattern of similar symptoms in patients, combined with examination of possible contamination sources and appropriate quarantine measures.

Surveillance, Preparation, and Laboratory Networks

Despite the differences between chemical and biological attacks, the methods of vigilance and response are largely identical. Early detection is the integral component for effectively countering such offensives, requiring adequate preparation at municipal and state levels as well as coordination at the federal level. One of the primary purposes of the U.S. public health surveillance and response system is to defend the public against any unusual public health crisis (Nsubuga, Nwanyanwu, Nkengasong, Mukanga, & Trostle, 2010, p. 1). The most prudent initial measure is to bolster epidemiologic identification and response capabilities for biological and chemical attacks, which can be accomplished most effectively through the distribution of "diagnostic reagents to state and local public health agencies" (Khan, Levitt, & Sage, 2000, p. 9). Diagnostic testing for biological and chemical agents provides a method of surveillance and heightens awareness of the diseases likely to result from these substances.

Adequate preparation also involves generating and maintaining a list of the most likely and most devastating chemical and biological agents that could be used in a terrorist attack against the United States. Such lists currently exist and are generally organized by past usage frequency and by the level of population vulnerability to each agent. These lists must be frequently updated to include the latest biological and chemical developments and adjusted to account for the specific capacities of local populations and the resources available in a given area. Of particular importance in prioritizing substances is their potential for dissemination — especially agents that are "highly contagious or that can be engineered for widespread dissemination via small-particle aerosols" (Khan, Levitt, & Sage, 2000, p. 8).

Of equal importance is ensuring that the proper authorities who will respond to such outbreaks receive adequate education and training. These personnel include law enforcement employees in police and fire departments, as well as various military branches. Healthcare officials — including physicians, nurses, and technicians — must also be kept current on developments in biological and chemical warfare, all in service of aiding the rapid detection of any potential offensive.

Preparation measures specific to healthcare professionals include the procurement of vaccines and antidotes relevant to a particular outbreak. The prioritization of these curative measures correlates with the hierarchy of potential threats found in the lists described above. Specially prepared laboratories have also been created to investigate the presence of these substances, particularly those not indigenous to the United States. The Centers for Disease Control and Prevention has proposed a network of multilevel laboratories that will "link clinical labs to public health care agencies in all states, districts, territories and selected cities and counties and to state-of-the-art facilities that can analyze biological agents" (Khan, Levitt, & Sage, 2000, p. 13). These laboratories will transfer technology and results to one another, exchange information with agencies such as the U.S. Environmental Protection Agency, and provide routine examination and preparation for bioassays — which may assist in treating injuries from chemical warfare — as well as molecular-level surveillance of microbial strains.

Communication is another integral element of preparation for chemical and biological terrorism. The CDC-proposed laboratory network facilitates information sharing between agencies across states and the country. The news media — via the internet, television, or mobile phone applications such as text messaging — is an essential component for alerting civilians to the presence of future terrorist activity and advising them how to respond. Other response measures include the mobilization of law enforcement and relevant agencies such as the fire department and Emergency Medical Response teams to secure outbreak areas and treat victims. Federal supplies of curative means for counteracting biological and chemical agents may also be accessed, while CDC terrorism response teams can supplement local healthcare and law enforcement efforts (Khan, Levitt, & Sage, 2000, p. 16).

Conclusion: The Case for Unified Interagency Communication

The relative convenience and ease of deployment of biological and chemical weaponry makes their usage one of the most likely methods of terrorism to be employed against the United States. Prudent evaluation of the likelihood of these substances, their potential effects, and the means by which they may be delivered is one of the most valuable defenses Homeland Security has against such a threat. A common theme across all methods of biological and chemical attack, however, is the integral role of early detection and awareness in mounting an adequate response to protect targeted citizens. In light of this, the most valuable recommendation presented here is to unify the communication system among the various agencies responsible for protecting the general population. There must be a free flow of information between healthcare centers such as doctors' offices and hospitals, law enforcement agencies, federal powers such as the executive branch and the Pentagon, and scientific laboratories and clinics — so that the nation as a whole can provide a unified response to any terrorist action taken against it.

As things currently stand, too many disparate agencies function independently of one another, which can only slow the response time to any biological or chemical aggression. Some may also argue that communication with the public is similarly fragmented, and that a means should be devised to streamline communication across the internet, television, newspapers, and mobile media. The lessons drawn from the aftermath of the 2001 terrorist attacks in New York City indicate that the containment of information within separate agencies — without sufficient sharing among those with the authority to act on it — remains the greatest barrier to a swift, successful response to or prevention of terrorist acts. Only by encouraging and unifying interagency communication among the relevant areas of expertise can the threat of biological and chemical terrorism be reduced to a tolerable and manageable level. Until that uniformity of communication is achieved, the country remains no better protected than it has been at previous points in its history.