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Update on the Bioterrorism Threat

By Michael Mair, M.P.H., May 2, 2005

The National Intelligence Council recently released Mapping the Global Future: Report of the National Intelligence Council’s 2020 Project, an unclassified report for U.S. policymakers that takes a long-term view of how events may unfold over the next 15 years in order to help identify areas that may require action.1

Mapping the Global Future found that the threat of a “major terrorist attack” with a weapon of mass destruction (WMD) will increase due to continued terrorist interest in such weapons. The authors note that their “greatest concern [is] that terrorists might acquire biological agents or, less likely, a nuclear device, either of which could cause mass casualties” and that “[b]ioterrorism appears particularly suited to the smaller, better-informed groups.” This assessment is based, in part, on the ongoing revolution in biotechnology which will continue to make biological weapons a potential reality for an increasing number of terrorists. The authors conclude that “[t]errorist use of biological agents is therefore likely, and the range of options will grow.”

Mapping the Global Future also notes that states as well as nonstate actors will continue to pose an increasing biological weapons threat in an effort to counter the unmatched military superiority of the U.S. The report found that future adversaries “will try to circumvent or minimize U.S. strengths and exploit perceived weaknesses, using asymmetric strategies, including terrorism and illicit acquisition of WMD.”

With regard to the current threat situation, the U.S. Central Intelligence Agency (CIA) has recently released its Unclassified Report to Congress on the Acquisition of Technology Relating to Weapons of Mass Destruction and Advanced Conventional Munitions, 1 July Through 31 December 2003. Iran, North Korea, and Syria are listed as states that potentially have offensive biological weapons capabilities. With respect to terrorist group interest in WMD, the report states that “many of the 33 designated foreign terrorist organizations and other nonstate actors worldwide have expressed interest in using CBRN [chemical, biological, radiological, and nuclear materials]; however, most attacks will probably be small-scale, incorporating improvised delivery means and easily produced or obtained chemicals, toxins, or radiological substances.” The report notes that “al-Qa‘ida’s [biological weapons] program is primarily focused on anthrax for mass casualty attacks, although the group most likely will pursue opportunities to produce and use other biological agents in smaller-scale attacks.”

Reference: Mapping the Global Future: Report of the National Intelligence Council's 2020 Project. National Intelligenc Council, U.S. Central Intelligence Agency. Available at: http://www.foia.cia.gov/2020/2020.pdf. Accessed February 10, 2005.

Will We Have a Vaccine for an Influenza Pandemic?

By Eric Toner, M.D.

In his recent interview in Biosecurity and Biodefense: Biodefense Strategy, Practice and Science, David Fedson, a leading expert on influenza vaccination, discussed the threat of an H5N1 influenza outbreak and issues related to the availability of vaccine during the pandemic that may ensue. Fedson asserts that if the current avian influenza strain circulating in Southeast Asia were to develop efficient human-to-human transmission and retain even a fraction of its current lethality, “[it] would be a tsunami-like event that would hit every community in the world. It would be the most telling human challenge we’ve ever faced.” With luck, there would be some warning that would allow the possibility of producing a vaccine; however, there is “no global plan for doing this and no logistical framework for distributing the vaccine.”

Fedson points out that NIH has contracted for 16,000 doses of H5N1 vaccine for clinical trials. However, 600 million doses of vaccine are needed to cover the U.S. population, and the U.S. has the industrial capacity to produce only 180 million doses per year. Capacity could be improved if antigen sparing alum-adjuvant were added to the vaccine, but there has been little research on and no current experience with adjuvant influenza vaccine.

Worldwide, the influenza vaccine production capacity of 900 million monovalent doses per year is enough to cover just one fourteenth of the world’s population. Alum could stretch the supply 8-fold to cover 50%, but the global supply of syringes totals just 60 million. Furthermore, only 9 counties produce 95% of the vaccine now. According to Dr. Fedson, history suggests that in the face of a pandemic, production will be nationalized , leaving 88% of the world’s population uncovered, while the 12% who live in countries with manufacturing capacity may be vaccinated.

At the first sign of a flu pandemic, it would take 10 days to produce a seed strain and 3 months to start producing significant amounts of vaccine. Cell culture technology may allow for more rapid production, but this technology is not likely to be ready for another 5 to 10 years. Clearly, making more vaccine more rapidly will not solve all of the problems likely to arise in the face of pandemic H5N1 flu. The entire process of vaccine delivery must be scaled-up, encompassing not just the manufacture, transport, and storage of vaccine and syringes, but also increased availability of trained personnel to administer vaccine.

While funding of long term research on new vaccine technologies and strategies are worthwhile, there is an urgent and immediate need for practical research on candidate pandemic vaccines and international cooperative planning.