Infectious diseases were recognized for their potential impact on
people and armies as early as 600 bc
Polluting wells and other sources of water of the opposing army
was a common strategy that continued to be used through the many European wars,
during the
American Civil War, and even into the 20th century.
The plague pandemic, also known as the Black Death, swept through
Europe, the Near East, and North Africa in the 14th century and was probably
the most devastating public health disaster in recorded history. The ultimate
origin of the plague remains uncertain:
During the same 14th-century plague pandemic, which killed more
than 25 million Europeans in the 14th and 15th centuries, many other incidents
indicate the various uses of disease and poisons during war.
Another disease has been used as an effective biological weapon in
the New World: smallpox. Pizarro is said to have presented South American
natives with variola-contaminated clothing in the 15th century
Transmission of smallpox by fomites was inefficient compared with
respiratory droplet transmission.
The description of these historical attempts of using diseases in
biological warfare illustrates the difficulty of differentiating between a
naturally occurring epidemic and an alleged or attempted biological warfare
attack—a problem that has continued into present times.
During World War I, reports circulated of attempts by Germans to
ship horses and cattle inoculated with disease-producing bacteria, such as
Bacillus anthracis (anthrax) and Pseudomonas pseudomallei (glanders), to the
USA and other countries
Other allegations of attempts by Germany to spread cholera in
Italy and plague in St. Petersburg in Russia followed
Other allegations occurred during the post—World War II period
(11):
The Eastern European press stated that Great Britain had used
biological weapons in Oman in 1957.
The Chinese alleged that the USA caused a cholera epidemic in Hong
Kong in 1961.
In July 1964, the Soviet newspaper Pravda asserted that the US
Military Commission in Columbia and Colombian troops had used biological agents
against peasants in Colombia and Bolivia.
In 1969, Egypt accused the “imperialistic aggressors” of using
biological weapons in the Middle East, specifically causing an epidemic of
cholera in Iraq in 1966.
During the 1970s, biological weapons were used for covert
assassinations. In 1978 a Bulgarian exile named George Markov was attacked and
killed in London, England. This assassination later became known as the
“umbrella killing,” because the weapon used was a device disguised as an
umbrella
In the late 1970s, allegations were made that planes and
helicopters delivering aerosols of different colors may have attacked the
inhabitants of Laos and Kampuchea (1, 7). People who were exposed became
disoriented and ill. These attacks were commonly described as “yellow rain.” In
fact it was highly controversial whether these clouds truly represented
biological warfare agents. Some of these clouds were believed to comprise
trichothecene toxins (e.g., T-2 mycotoxin
Biological weapons are unique in their invisibility and their
delayed effects. These factors allow those who use them to inculcate fear and
cause confusion among their victims and to escape undetected. A biowarfare
attack would not only cause sickness and death in a large number of victims but
would also aim to create fear, panic, and paralyzing uncertainty. Its goal is
disruption of social and economic activity, the breakdown of government
authority, and the impairment of military responses. As demonstrated by the “Anthrax letters” in the aftermath of
the World Trade Center attack in September 2001, the occurrence of only a small
number of infections can create an enormous psychological impact-everyone feels
threatened and nobody knows what will happen next.
The choice of the biowarfare agent depends on the economic,
technical, and financial capabilities of the state or organization. Smallpox,
Ebola, and Marburg virus might be chosen because they have a reputation for
causing a more horrifying illness. Images on the nightly news of doctors,
nurses, and law enforcement personnel in full protective gear could cause
widespread public distraction and anxiety.
Bio warfare attacks are now a possibility. The medical community
as well as the public should become familiar with epidemiology and control
measures to increase the likelihood of a calm and reasoned response if an
outbreak should occur. In fact, the principles that help clinicians develop
strategies against diseases are relevant as the medical community considers the
problem of biological weapons proliferation. For the medical community, further
education focusing on recognition of this threat is both timely and necessary.
Primary prevention rests on creating a strong global norm that
rejects development of such weapons. Secondary prevention implies early
detection and prompt treatment of disease. The medical community plays an
important role in secondary prevention by participating in disease surveillance
and reporting and thus providing the first indication of biological weapons
use. In addition, continued research to improve surveillance and the search for
improved diagnostic capabilities, therapeutic agents, and effective response
plans will further strengthen secondary prevention measures. Finally, the role
of tertiary prevention, which limits the disability from disease, shall not be
forgotten. Unfortunately, the tools of primary and secondary prevention are
imperfect. While the BWC is prepared to assist those nations that have been
targets of biological weapons, the medical community must be prepared to face
the squeal should the unthinkable happen.
