Medical Aspects of Biological Warfare

This update to the 2007 version of Medical Aspects of Biological Warfare is an excellent, comprehensive, and thorough scientific and historical review of biological weapons pathogens. It is written by some of the foremost experts in the field; most of the contributors are current or former researchers at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), an institution that is devoted to protecting soldiers from biological threats. The Department of the Army published this volume as part of their series Textbooks of Military Medicine. It is available in print and online at the Borden Institute Web site [1]. The text would be useful for any biological researcher interested in the complete historical narrative of research on many organisms of potential biodefense importance, and it provides many valuable references. Smallpox, anthrax, plague, viral hemorrhagic fevers, botulinum toxin, and a handful of other diseases are covered in individual chapters. In addition, the larger issues involved in responding to a biological weapons attack are explored, including laboratory identification of biological threats, the epidemiology of biowarfare and bioterrorism, consequence management, and the development of medical countermeasures to biodefense threats. This volume also describes subjects important to the practice of biodefense research, including biosafety principles and the ethical and legal dilemmas associated with such research. Readers looking for an in-depth discussion of the problems posed by genetically engineered threats or policy dilemmas in civilian response may be disappointed, although those topics are introduced. Most of this book is useful for both civilian and military readers interested in clinical, epidemiological, or scientific information about biodefense. Some chapters, however, are more focused on the military than on civilian concerns. A chapter on laboratory identification of biological threats describes the network and capabilities of military clinical and field laboratories, including Air Force biological augmentation teams and the Navy’s forward deployable preventive medicine units. The linkages of these military laboratories to the laboratory response network for bioterrorism sponsored by the Centers for Disease Control and Prevention are described and may be useful to the civilian reader. The Army’s “biosurety” program for security of biodefense research is also described at length. This program entails a strict set of requirements for handling dangerous pathogens that are categorized as Select Agents by the Centers for Disease Control and Prevention and US Department of Agriculture (and as defined in 42 Code of Federal Regulations Part 73). The basic tenets of biosurety, modeled after Army nuclear and chemical surety programs, include physical security measures, such as locks, key pads, and biometric readers; biosafety principles; biological agent accountability and record keeping; and personnel reliability. The Personnel Reliability program requires all those who have access to select agents to submit to medical evaluations and random drug testing, as well as scrutiny of work habits, financial history, and behavioral history. Not surprisingly, the “rigorous screening process and continuous intrusive monitoring” may lead to “the possibility of losing talented and well-trained researchers to other facilities and non-Department of Defense agencies with less stringent programs” [p. 552]. However, in light of recent Federal Bureau of Investigation allegations that an USAMRIID employee was responsible for the anthrax attacks in 2001, it is unlikely that Army biosurety program restrictions will be loosened, even if researchers move to less restrictive fields or research institutions. One disturbing theme that runs throughout the volume, but that is particularly evident in the chapter on medical countermeasures, is the decreasing availability of Investigational New Drug vaccines to protect biodefense researchers. Some vaccines for biodefense pathogens have not been manufactured in decades, and the dwindling supplies are losing potency. Although research on new vaccine methods may be ongoing, the old vaccines may not be generally available to protect biodefense researchers in the meantime. Currently, the vaccines are only available through the Special Immunizations Program at USAMRIID; non–Department of Defense users can buy into the program, but researchers often do not budget for these vaccines. This mistake could lead to unnecessary laboratory infections. For example, Francisella tularensis, the causative agent of tularemia, has a very low infectious dose of 10–50 organisms. It was the most common laboratory-acquired infection during the 25 years of the US Biological Warfare Program. Since 1959, researchers at USAMRIID have been administered a live-attenuated vaccine (NDBR 101) under an Investigational New Drug protocol