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Battling Bioterrorism

January-February 2002

When people started dying of inhalation anthrax in 1979 in Sverdlovsk, in the former Soviet Union, it took "six days to discern the outbreak, and nine days to confirm the diagnosis," wrote Jeanne Guillemin '68 in her 1999 book, Anthrax: The Investigation of a Deadly Outbreak. More than 60 people died. The fact that a nearby military-research facility was the source of the aerosolized spores was rumored but not proven until the 1990s, when Guillemin and a team led by her husband, Cabot professor of the natural sciences Matthew Meselson, gathered enough information about the incident to document its epidemiology. How to know when a bioterror attack has occurred remains a challenge even today, agreed a panel of experts, including Meselson, who spoke as part of a two-day symposium on bioterrorism at the Harvard School of Public Health (HSPH). Most weaponized biological agents cause flu-like symptoms in their initial stages, so doctors need to unlearn the old medical school adage "When you hear hoofbeats, don't think zebra, think horse." Physicians today, said Margaret Hamburg '77, M.D. '83, vice president for biological programs at the Nuclear Threat Initiative in Washington, D.C., must "at least rule out zebras."

T-meselson
Biologist Matthew Meselson, encountering unaccustomed interest in his expertise on anthrax, advocated public-health measures and basic research to combat terrorism.
Jon Chase / Harvard News Office

Biological weapons are "cheap to make" and technical know-how and materials are accessible, said David Franz, former commander of the army's Medical Research Institute of Infectious Diseases, explaining why terrorists might choose to use them. They have also been around a long time. "In 1346," said HSPH dean Barry R. Bloom, "the Tartars took people who died of plague and threw them over the [walls of] the city of Kaffa on the Black Sea, hoping to create an epidemic. [That] became the origin of the Great Black Death that wiped out 7o percent of the urban population of Europe. In contrast to many other kinds of warfare," he summed up, "biological weapons are not so easy to control."

Meselson urged a three-pronged public-health response to the threat of biological weapons: prevention, shielding, and treatment. Prevention is difficult. A fermenter used to create a live-virus vaccine, for example, is producing a dangerous biological agent right up to the last stage of the process, when the virus is killed. Monitoring such "dual-use" facilities, Franz emphasized, is extremely difficult. Reducing access to serious pathogens and improving our intelligence capacity should be a high priority, Hamburg urged, but she said that the scientific community should lead the way in drafting proposals for any controls, to ensure that research into new vaccines and treatments is not slowed by new restrictions. And Meselson, who codirects the Harvard Sussex Program on Chemical and Biological Weapons Armament and Arms Limitation, felt that no amount of prevention could be totally successful. He urged adoption of an international biological weapons convention that would allow extradition and punishment of perpetrators among signatory nations. Shielding can be achieved by simple means like improved hygiene and air filtration, in addition to vaccines, said Meselson. But we don't even know the dose of anthrax required to cause an infection in humans, he noted. More basic research that could help with vaccine development and treatments is necessary.

Hamburg emphasized the need to strengthen the public-health infrastructure to deal with a biological attack. Monitoring could provide the first clues that an attack has occurred. Better communication with the public would benefit from behavioral research into the dynamics of people's response to such an attack. Teaching healthcare providers about the now-rare diseases they need to look for will be important, she added. Given the downsizing of hospitals and their staffs, we need to look closely at the "surge capacity of the healthcare system," she warned. And we must coordinate the local and national responses to a bioterrorism threat.

She closed by noting that investments in public health are "dual use in the most positive sense": they will help us even in the absence of a bioterror attack. "Public health is public safety," she underscored, "and is now also an important pillar of our national-security framework."