Which biological agents would be included in a disaster plan for a possible terrorist attack?

Paediatr Child Health. 2003 Feb; 8(2): 93–96.

Language: English | French

Abstract

Health emergency planning for preparedness and response against acts of terrorism, including the malfeasant threat or actual release of biological agents designed to harm others, has assumed a higher level of concern for most western nations, including Canada, following the explosive attacks in the United States on September 11, 2001. These terrorist attacks were followed by an outbreak of anthrax infections. The Bacillus anthracis spores in these attacks were dispersed by using regular postal services in the United States. In addition to the unsettling sense of social vulnerability that resulted from these attacks, a greater appreciation that the integration of public health, emergency health and social services with security activities was required to fully address the need to protect the health and other interests of the citizens. Collaborative work among regional, provincial, territorial, federal and international authorities within these domains is emerging as an effective response to the risk management of bioterrorism. The following is a brief description of the health framework for preparedness and response, and the biological agents of major concern in terrorism.

Keywords: Bioterrorism, Health emergency

Résumé

La planification des interventions sanitaires d’urgence afin d’être préparé et de réagir à des actes de terrorisme, y compris les menaces malfaisantes ou la dissémination d’agents biologiques conçus pour porter préjudice aux autres, est devenue plus préoccupante dans la plupart des nations occidentales, y compris le Canada, depuis les attaques explosives du 11 septembre 2001 aux États-Unis. Ces attentats terroristes ont été suivis par une flambée d’infections à l’anthrax. Les spores de Bacillus anthracis utilisées dans le cadre de ces attaques ont été dispersées par l’entremise des services postaux réguliers aux États-Unis. Outre le sentiment troublant de vulnérabilité sociale qui a résulté de ces attaques, il était nécessaire de mieux comprendre comment intégrer la santé publique, les interventions sanitaires d’urgence et les services sociaux aux activités de sécurité pour traiter à tous égards du besoin de protéger la santé et les autres intérêts des citoyens. Des travaux coopératifs entre les autorités régionales, provinciales, territoriales, fédérales et internationales émergent dans ces domaines comme une réaction efficace à la gestion du risque de bioterrorisme. L’article qui suit est une brève description de la structure sanitaire en matière de préparation et de réaction, de même que des agents biologiques les plus inquiétants pour le terrorisme.

Terrorism is an illegal act with the purpose of creating uncertainty and instability in the existing social fabric by disturbing and disrupting normal patterns of life, including the perception of safety and security. Violence and the threat of violence have been traditional modern approaches used by terrorists. There is a fine line differentially defining that which is an act of terrorism versus war. Terrorism is not State-sanctioned or -sponsored, but comes from individuals and groups without official political State affiliation. Whereas war is State-sponsored, and is associated with formal rules of declaration, engagement and diplomacy.

Threat assessment, in some form, is undertaken by all members of society, but the threat of a terrorist event is most actively undertaken in the public and private sectors, including all levels of government and corporate domains. Threats of terrorism carry with them an element of credibility, requiring a response by security and public health authorities to preserve and protect the targeted population. The conversion of a threat assessment to risk includes three steps: risk identification, risk assessment and risk management, which in itself includes the development of consequence management principles related to the threat and defined risk.

Unannounced acts of terrorism, such as the attacks on the World Trade Centre and the Pentagon (1) in the United States on September 11, 2001, create an enormous public response of shock and disbelief, and resets the level of credibility that acts of terrorism can be perpetrated in what was believed to be a secure and safe public environment. Although these terrorist attacks occurred in the United States, citizens of all nations, including Canada, experienced the negative sociological impacts that define the very nature of terrorism.

Explosive, chemical, biological and radionuclear are the usual agents used in terrorist threats and acts. Bioterrorism is the use of biological agents, or their products and toxins, to achieve the same purpose of public uncertainty and instability. The anthrax attacks in the United States (2), following the explosive attacks on September 11, 2001, further shook the public confidence in health and security capacities to protect the interests of the population in general, and specific groups within that population.

Although many, if not all, of the microbiological agents could be used in an act or threat of terrorism (3), only a few of these are believed to represent a credible threat to public health and population security. The determination of credibility of a bioterrorist agent posing a threat involves several considerations, including the following: is the agent known to exist; is it available; to whom is it available; and can it be ‘weaponized’? These agents are often referred to as the category ‘A’ agents. The characteristics of the category A agents are the potential to be weaponized, including at least one of the following: the ability to obtain or produce sufficient quantities of the agent to mount a significant attack on the public; the potential for highly effective delivery mechanisms of the agent to the target population; transmissibility from person-to-person; high morbidity or mortality; difficulty in clinical diagnosis due to a protean presentation; ill-defined or multiple syndromic presentations; or unfamiliar clinical signs and symptoms. In addition, manipulation of the agent to produce a change in classical clinical presentation, an ability to evade laboratory diagnostic techniques, and/or to resist previously effective medical therapies (such as antimicrobial resistance) would be characteristics of a high potential agent for weaponization. Some characteristics of these agents are presented in Table 1, with greater detail in the provided references (3–8).

TABLE 1

List of category A biological agents of terrorism

HEALTH EMERGENCY PREPAREDNESS AND RESPONSE – RISK MANAGEMENT

The majority of health emergencies will start as a local event and depending on the nature of the occurrence and the agent may evolve slowly or rapidly to exceed regional, provincial or territorial capacity to become a national or international emergency. Coordination and cooperation in planning the pre-event preparations, during event responseand postevent recovery phases is essential for a complete and successful public health strategy (Table 2).

TABLE 2

Phases of emergency preparation and response

The coordination of counter terrorism activities between and among health and security authorities requires the integration and harmonization of contingency planning, and exercise testing of generic and specific emergency health response plans, as well as implementation and recovery plans. The Centre for Emergency Preparedness and Response, Population and Public Health Branch was specifically created and designated in the realignment of Health Canada branches in July 2000, to act as a Departmental resource to provide a focus for national health emergency coordination (http://www.hc-sc.gc/english/epr/centre.html). This centre consists of five interactively related offices: the Office for Emergency Planning, Preparation, and Training (self-evident roles); the Office for Emergency Services, responsible for emergency social services, the Health Canada Emergency Operations Centre and the national emergency stockpile system; the Office for Laboratory Security, that has responsibility for biosafety and level III and level IV laboratory certification, issuing permits for the importation of dangerous human pathogens, transportation of dangerous goods training and guidelines, training and delivering on the emergency response assistance program, and level III laboratory testing support; the Office for Public Health Security, with three divisions responsible for counter terrorism coordination and health information networks; quarantine, travel and migration health; and the national health emergency response teams; and the Office for Emergency Coordination Services responsible for financial planning and management, and coordination of the Director General’s office that provides administrative and corporate support, federal, provincial, territorial and international health liaison, as well as health intelligence and policy direction between the offices and to senior departmental administration.

By addressing the public health supply and service requirements, diagnostic laboratory network needs and the development of clinical guidelines for national health emergency preparation, the national response to a bioterrorist event will include all essential and necessary elements in supply, laboratory, organization response and training (Table 3).

TABLE 3

Supply, laboratory, organizational and training preparedness for biological terrorism*

FETAL-MATERNAL AND CHILD CONSIDERATIONS

Special host considerations are complex in explosive, chemical, biological and radionuclear counter terrorism preparation and response, and especially so in the host considerations of pregnancy and childhood. Biological counter-terrorism planning for fetal-maternal and childhood risk management includes the characteristics of host susceptibility, outcome and risk for transmissibility or host-vector capacity related to each agent. As well, special considerations are given to associated groups, such as the caregivers of these two groups. Planning deliberations for prevention and mitigation of a bioterrorist event and the impact on fetal-maternal and child hosts include surveillance systems, pre-event supply procurement and strategic positioning of stockpiles, and response implementation planning and exercising. An example of these principles includes the consideration of the safety and effectiveness of antibiotics and vaccines in the maternal-child host.

Finally, planning for the psychosocial impact of an act of terrorism and the threats that create uncertainty and instability on all members of the population, including children, is an important component of health emergency preparedness. In all disaster events, whether due to natural causes such as severe environmental events (eg, storms, floods, fires, earthquakes) or man-made, either accidental (chemical spills, nuclear radiation leaks) or malfeasant (war or terrorism), there is a renewed appreciation of the need for health emergency planning, preparation, response and recovery consideration, and investment in capacity to protect the health and safety of all Canadians.

Footnotes

Internet addresses are current at time of publication. The views expressed in this paper are solely those of the author and do not represent the position or views of Health Canada, the Government of Canada, or any other institution or organization.

REFERENCES

3. World Health Organization . Health Aspects of Chemical and Biological Weapons. Geneva: World Health Organization; 1970. pp. 75–6. [Google Scholar]

Articles from Paediatrics & Child Health are provided here courtesy of Oxford University Press