21st Century Paradox: Biological Advances Can Lead to Biological Weapons by Anne C. Paine "The events of September 11 were tragic, but 20 years from now, America will be a healthier place because of them," said Dr. D.A. Henderson '50 in his Oct. 5 lecture at Oberlin College. Henderson, who is principal science advisor to the Secretary of Health and Human Services and founding director of the Johns Hopkins Center for Civilian Biodefense Strategies, spoke during the symposium celebrating the dedication of the Oberlin College Science Center. Titled "The Threat and Promise of a New Biological World," the lecture mixed optimism with realism as Henderson traced the development of biological weapons and outlined measures being taken by the federal Office of Public Health Preparedness, which he heads, to improve this nation's public health infrastructure. He also addressed the history of smallpox and the possibility of a biological attack on the U.S. Smallpox is one of Henderson's many areas of expertise: from 1966 to 1977, he led the World Health Organization's successful global smallpox eradication campaign. For this achievement, Oberlin Biology Professor Dick Levin, in his introduction of Henderson, called him "a hero in the archives of life." Henderson is widely recognized as one of this nation's leading public health administrators. Among his numerous awards and honors is the Presidential Medal of Freedom, the highest civilian award given in the U.S., which he received last summer. "The 21st century is the era of biology. We will perhaps be able to control, and maybe even eliminate, certain acute diseases," Henderson declared. Then he posed the paradox. "The darker side of this is the possibility that biological agents will be used as lethal agents. In today's world of global travel and migration, infectious diseases pose a great challenge, and we are ill-prepared to deal with that challenge." The United States has not suffered a serious epidemic since 1918, Henderson said, but last year's anthrax incidents, and their aftermath, showed just how ill-prepared the country is for a public health crisis. "In terms of sheer numbers, [the anthrax scare] was not a very big event, but it had huge ramifications. Tens of thousands of specimens were tested for anthrax. The U.S. mail service was seriously disrupted. The Senate Hart Building was closed. Cipro stocks were sold out. And I don't know how many people now have gas masks," Henderson said. The United States once had the capability to produce many agents that could be used as biological weapons and cause widespread casualties, Henderson said. But under the terms of the 1972 Biological Weapons Convention, called by President Richard Nixon, the U.S. destroyed all those agents. The Soviet Union, however, continued to build its biological weapons program, which U.S. intelligence did not learn of until the early 1990s. The Russians have refused to be open with the U.S. about their capabilities, but Henderson said they have developed virulent strains of viruses and antibiotic-resistant bacteria that could be launched on intercontinental ballistic missiles. The Russians have 30 metric tons of frozen anthrax, he said, and great capacity to produce the smallpox virus. U.S. intelligence received a second shock in 1995, when Saddam Hussein's son-in-law defected and disclosed information about Iraq's extensive biological weapons program. President Bill Clinton responded with a secret directive to all federal departments, ordering them to devise plans to deal with bioterrorism or attacks with weapons of mass destruction. In describing the method likely to be used by a bioterrorist, Henderson quickly put to rest the idea that a biological attack is improbable because it would be technically difficult to accomplish. "It's much more difficult to make a nuclear weapon than a biological weapon," Henderson said. "You could produce everything you need in a two-car garage with four or five people. Everything could be cleaned up very quickly, so no one would ever know what had been taking place there. The knowledge needed to produce biological weapons is widely available." A biological agent would be released clandestinely, probably in the form of an aerosol, Henderson said. People would fall ill over time, and the consequences of such an attack would be national, even international, in scope. In routine emergencies, traditional first responders include fire, police, and rescue personnel, who work on evacuation, decontamination, and recovery, Henderson said. But in a biological attack, medical personnel would be the first to learn about the attack, and then not until several weeks after the release of the agent when people started to become ill. Because our public health infrastructure is poor, he said, consequences could be disastrous. The work of his office, however, has begun to improve the odds, Henderson said. Formed two months after the September 11 attacks, the Office of Public Health Preparedness has already distributed $1 billion to the states. This has helped establish community links among emergency rooms, police, and local and state officials. The office is working to establish 180 laboratories that can test for various microorganisms. At present, 200 million doses of smallpox vaccine are available, compared to 90,000 doses on September 11. A new anthrax vaccine should be on the market in two years. The office is also working with health authorities around the world, and it has mounted a research program on the life cycle of various organisms and the immune mechanisms of humans. The new systems have already been put to the test, and passed with high grades. "With the West Nile virus striking as it did this year, it showed that the systems the states have set up are working. It was a reaffirmation of what we needed to do," Henderson said. Henderson ended his lecture with a brief history of smallpox. The U.S. ended smallpox vaccination in 1972, so no one under the age of 30-or 45 percent of the U.S. population-has been vaccinated, Henderson said. By 1980, the disease had been eradicated worldwide, and vaccine production stopped. The current thinking is that a single, 30-year-old vaccine will no longer protect a person, Henderson said, so "we have a large number of susceptible people." And because smallpox can be transmitted from a vaccinated person to an unvaccinated one, the decision to be vaccinated "is not just a personal decision, it's a societal decision," Henderson said. Smallpox is a serious, deadly disease; 30 percent of unvaccinated people who contract the disease die. But the vaccine also has problems. One person per million who receives the vaccine dies, and 25 people per million have severe complications. People at risk for serious complications include those with eczema or immune deficiencies. Between 10 and 12 days after exposure to smallpox, a person will develop a very high fever, which lasts for about two days, Henderson said. A rash then appears on the face and in the mouth. Transmission of the disease is possible once the rash appears, but the stricken person is by then so debilitated that they must be confined to bed. "So smallpox spreads within families or in hospitals," Henderson said. "The idea of having an infected terrorist come in and spread smallpox is a very unrealistic scenario." Henderson left the audience without clear answers to the paradoxes of our time. "We're making great strides in biology which lead us to more vaccines. But at the same time, we open the door to building more virulent weapons. … How do we handle this? We can't strangle science by limiting publication on advances that might lead to cures," he said. "The problem will be with us always. We'll never get the genie of biological science back into the bottle. "Every night I wonder if there isn't something more we could do to be prepared when the next shoe drops."