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Bioterrorism: Threat and Response Michael L. Moodie Chemical and Biological Arms Control Institute Since the sarin gas attack by Aum Shinrikyo in the Tokyo subway in March 1995, the United States has been debating the dangers and risks posed by the potential use by terrorists of chemical and biological weapons. With respect to biological weapons in particular, a debate has ensued as to how serious those risks are. Some analysts argue that the threat has been "hyped." Others contend that it is severe and imminent. However, neither argument, as publicly articu- lated, is all that helpful for decision makers who confront hard choices about planning, programming, and allocating resources to address the biological weap- ons threat. Emphasizing the potential impact of biological agents that might be weap- onized produces vulnerability assessments that suggest virtually limitless dan- gers. Focusing on only the most horrendous events, however, overwhelms any estimates of their likelihood. But the possibility of occurrence the likelihood- is a critically important factor in planning efforts. It does little good to engage in elaborate preparations for an event that is not likely to happen to the exclusion of addressing those contingencies that are likely. On the other hand, it is not necessarily the case that the future will resemble the past. The historical record, however, provides scant evidence on which to make hard judgments. Faced with a paucity of data, one cannot be confident that looking at history will alert us in advance to what will happen in the future. A strong argument can be made that the threat of bioterrorism will increase. Several reasons account for this heightened concern. Interest in bioterrorism is increasing because it has become less expensive, it is highly destructive, and it is psychologically devastating. Over the next several years, the world will witness incredibly rapid and 102

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BIOLOGICAL TERRORISM 103 profound changes in biology and biotechnology. These advances could have a major influence on prospects for bioterrorism. Biological weapons are based on a technology that is now almost 70 years old. Yet remaining obstacles are not trivial. Genetic modification, biomolecular engineering, and enhanced biopro- duction technologies may make it easier for terrorists to overcome barriers that have inhibited acquisition of biological weapons in the past. Terrorism of the future will be in response to broad trends such as globaliza- tion, accelerating interconnectedness, and population dynamics, but it is also likely to entail narrow psychological elements from marginalization to "techno- rage" to revenge for real or imagined wrongs. As motivations move away from the traditionally political, the special mindsets of terrorists become more impor- tant. A refined understanding of the threat of bioterrorism demands special atten- tion to these distinctive mental topographies. Equally important is the require- ment to understand how these unique psychologies interact with circumstances, capabilities, and opportunities to take potential terrorists down particular paths, including the one that leads to bioterrorism. Classic terrorists used violence like a volume control knob (to use Brian Jenkins's term) to generate fear in order to extract political concessions. New terrorists do not calculate thresholds of pain and tolerance in society, or they seek to exceed them, uninhibited by the need to shape behavior, unmotivated to spare innocents. They are less interested in concrete political goals and more motivated to win an immediate reward emotional or physical or to achieve a long-term goal. The structure of terrorist organizations is changing also. Today terrorist groups are more transnational, network-based entities, rather than traditional hi- erarchies. Traditional arguments for methods of dealing with terrorism are insuffi- cient. Neither the "laid-back" approach nor the one that hypes the threat is ade- quate. Both define the threat too narrowly by focusing on only a single factor. What is needed is a multifactor threat assessment. Factors to consider are the actors, agents, operational requirements, and targets. Each of these categories is divided into many subcategories; for exam- ple, actors could be from traditional political groups, religious radical groups, individuals acting alone, or the right wing. Agents could include anthrax, plague, smallpox, and so forth. Some combinations of factors could produce dramatic results; others may produce no results at all. It is essential, therefore, to trace how the factors interrelate. Only by doing so can one make a determination of which outcomes are most and least likely. This focus on relationships and inter- actions of factors creates "plausible threat envelopes." As a terrorist seeks higher casualties with biological weapons, fewer paths are available to achieve that objective. Those that remain are more difficult. Therefore, the degree of risk declines as the level of desired casualties increases, insofar as the threat becomes less likely.

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104 HIGH-IMPACT TERRORISM Few terrorist organizations have the necessary combination of size, resourc- es, skills, facilitative ethos (willingness to experiment and accept failure), or appropriate organizational capacity to achieve mass casualties. Traditional agents capable of inflicting mass casualties are difficult either to acquire, cultivate, and produce or to disseminate effectively. Likely targets do not necessarily facilitate mass casualty outcomes given the other requirements for conducting an effective attack against them, including technical knowledge (e.g., of airflows in large arenas) or operational skills (surveillance, finance, planning). We do not know at what point the response system will become overbur- dened and stressed to the point of collapse. This point is probably not very difficult to reach. Therefore, while events that produce casualties in the tens of thousands are unlikely, lesser contingencies even those with casualty levels in the hundreds are likely to have major consequences, not least of which will be a severe psychological impact. Terrorism analysis tends to exclude actors allied with foreign governments in times of conflict because such actions are considered acts of war. This is shortsighted for several reasons: The consequences are no different. State-sponsored entities are among the few actors who could assemble the requisite skills and materials to conduct a successful attack. A particular U.S. concern is pursuit of "asymmetric strategies" by hostile states. Among the actors who now define contemporary terrorism, those who might be most attracted to use of biological weapons include the following: Non-state actors inspired by religious ideals, Groups from the extreme political right wing, Actors with millennial world views combined with notions of "cleans- ing" society through violence, Transnational networks less constrained by central authority, and Radical single-issue groups. A bioterrorism attack could take an almost infinite variety of forms. There- fore, a "one-size-fits-all" approach to response will not work. Rather, an effec- tive response must be built around a flexible package of capabilities that can be "mixed and matched" according to circumstances. In dealing with bioterrorism, effective health responses are especially criti- cal. This means, in particular, better disease surveillance, monitoring, reporting, and epidemiology. Shaping an effective response to bioterrorism will be neither easy nor cheap. Many players must be integrated into a genuinely strategic approach that is

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BIOLOGICAL TERRORISM 105 based on a range of sometimes complex capabilities. An effective response re- quires demanding planning requirements, many actors from many agencies, ongo- ing training, complex communication capabilities, and organizational adaptability. The Department of Justice Cities Program is intended to promote training in the 120 largest metropolitan areas in the United States. Its approach emphasizes "training the trainers." The program, however, tends to focus on law enforce- ment and emergency management, and it often stresses a chemical scenario rath- er than a biological one. The Department of Defense support role takes many forms, including in- volvement from the U.S. Army Medical Research Institute of Infectious Diseas- es, Naval Medical Research Institute, Chemical/Biological Incident Response Force, and National Guard Weapons of Mass Destruction (WMD) Civil Support Teams. Some elements, however, are controversial. The plan to create National Guard WMD Civil Support Teams, for example, has prompted a debate about just what such units could contribute to response capabilities, particularly in a biological event. As argued, the health dimension of a bioterrorism response capability is especially important. The United States has a number of its leading public health assets focused on enhancing capabilities in this area, such as the Department of Health and Human Services (National Medical Response Teams for WMD and the Metropolitan Medical Response Systems); the Centers for Disease Control and Prevention, with a focus on the Bioterrorism Preparedness and Response Program; and the National Institutes of Health (NIH). Responding to bioterrorism has created the following policy lessons: Draconian measures are not warranted; U.S. budgets are generally moving in the right direction; Cataloging and covering vulnerabilities is a fool's errand; a better alter- native is to set priorities and work incrementally; Choose things desirable to do anyway, particularly in terms of enhancing the public health infrastructure; Do things that make a difference in time of crisis; and Do not focus on a short-term fix; make long-term solutions a priority. A constant dynamic exists between terrorists and those who fight them. The relationship is constantly in flux, and it is difficult to define precisely at any one point in time. There is certainty only if we do nothing, and it is the certainty that we will lose. Risk is unavoidable; the challenge is to reduce it to a manageable level.