Bioterrorism: Fear and Reality
Authors: Inder M. Verma
Journal: Molecular Therapy (2001)

Like many Americans, I am suffering from “CNN-itis.” Worried about terrorist attacks and anthrax, I thought watching the news or reading newspapers would offer some clue as to the perpetrators. Then I got a call from a newspaper reporter inquiring if gene therapy could be used for bioterrorism. Can viral vectors containing toxins or lethal viral genes be disseminated into the air or water? Could one generate and release a recombinant adenovirus containing deadly cargo, which could then be inhaled like a common cold virus? Is it possible to isolate the polio virus RNA from live vaccine, convert it to cDNA, make it more virulent, and disseminate it? Can the currently available vaccinia DNA be converted to a virulent pox virus? My first reaction was “no, it is not possible,” but further thought lead to the sinking feeling that if someone deliberately wanted to make these awful biologics, they could. And they could spread it. Take smallpox as an example. Smallpox spreads by contact and the pustules are usually infectious. Individuals willing to die for a cause would presumably be willing to be infected and then walk around in crowded areas. Although the infected individual would be very sick, he or she may escape detection, particularly if aided by vaccinated colleagues. There is a history of deliberate attempts to spread smallpox by infected blankets and the water supply. It is ironic that the World Health Organization's proudest moment was worldwide smallpox eradication. As of November 10, 2001, there were 17 confirmed anthrax (Bacillus anthracis) infections, 10 inhaled and 7 cutaneous, and 4 confirmed deaths (all from inhalation). Because of the uncertainty of who may have been exposed to anthrax spores, over 32,000 people are taking the FDA-approved antibiotic Cipro: it is good news that an aggressive antibiotic dosage can treat inhaled anthrax. But there is great fear of the unknown: where and how will they strike next? Sadly, the health organizations in this country were caught completely unprepared. Just days before the first confirmed anthrax-related death, the Secretary of Health and Human Services confidently proclaimed to the Senate that the government was fully prepared to meet any biological terrorism attack—despite the considerable apprehension of several senators. The much-venerated Centers for Disease Control (CDC) were clueless, and law enforcement agencies, in their zeal for decontamination, lost valuable samples that could help track the criminals. Indeed, all the relevant government agencies appeared completely bewildered at times. No wonder the average citizen suffers bouts of panic. We cannot engage a faceless enemy in rational discussion. We have to find new ways of fighting bioterrorism. We have to redouble our efforts to make and deliver safe and efficacious vaccines. We may have to establish laboratories that can quickly identify the genetic composition of a pathogen, or at least develop biosensors that can detect the known pathogens. We need greater investment in the public health system to keep records of possible sources of known pathogens and to train personnel to handle emergencies. The public needs assurance that adequate supplies of medicine exist to counteract the outbreak of at least the known pathogens. The international scientific community has to be more vigilant in preventing the dissemination of pathogens to rogues. We are living in a very uncertain period and are still coming to grips with the horrible aftermath of the terrorist acts of September 11th. We have to believe that good will eventually prevail over the evil use of science. The year 2001, which started with such great promise, is fast becoming annus horribilis. Let us hope that 2002 will restore faith and goodness in humanity.