Weapons of Mass Destruction: Biological

Ross R. Moquin, M.D., Mary E. Moquin, R.N., M.S.N.

Abstract
Humans are susceptible to microbial infections from many sources.
Biological warfare is the use of microbial forms of life to diminish the
capabilities, disrupt the organization, and terrorize the noncombatant
population of an adversary. This form of warfare has been used throughout
history and has gained renewed interest with the current use of
asymmetrical warfare. The civilized world has condemned its use by the
implementation of treaties specifically against it. This is a brief review of
some of the more easily used biological agents such as anthrax, plague,
tularemia, Q fever, and smallpox. Each agent's biology, infectious route,
and disease course will be discussed. Possible delivery systems and signs
of outbreak will also be reviewed. There are few real neurosurgery-related
implications in biological warfare. Neurosurgeons, as members and leaders
of the healthcare community, must have the ability to recognize and initiate
treatment when biological agents have been deployed. If there is
widespread use of these inhumane agents, the neurosurgical community
will not be able to practice the surgical art for which we have trained. New
knowledge must be acquired so that we can best serve our patients and
communities during times of extreme need.

Introduction
Biological warfare has been part of human conflict throughout the ages.
Biological agents were used in many of the conflicts of the 20th century and
their use is now reported daily in the headlines. Crude methods such as
using dead or diseased animals to foul wells or gifts of contaminated
blankets and clothes have been replaced by delivery systems of missiles,
airplanes, and the postal service. Biological agents are gaining status as a
terrorist's weapon of choice.[2]
The possibility that biological weapons will be used against us is no longer
unthinkable. Until recently, healthcare practitioners have considered this
topic suitable for only academic consideration. The importance of education
regarding this subject cannot be overestimated. Before further terrorist
actions occur or our soldiers engage against an aggressor likely to use

1
biological weapons, healthcare providers need to be confident that they
understand both the threat and appropriate medical countermeasures. [4]
There are few neurosurgery-related implications for biological warfare.
Neurosurgeons, as members and leaders of the healthcare community,
must be able to recognize and initiate treatment when biological agents
have been deployed. If there is widespread use of these inhumane agents,
the neurosurgical community will not be able to practice. New knowledge
must be acquired so that we can best serve our patients and communities
during times of extreme need.
Defending against biological agents requires understanding of how an
adversary might use them.[4] Biological agents must be considered in terms
of an evolving world, where advances in modern technology and weapons
delivery systems (long-range cruise missiles with multiple warheads) have
overcome some of their earlier physical limitations. An agent used in
biological warfare need no longer be highly lethal to be effective, because
to incapacitate and confuse a population on a widespread basis may
actually cause greater disruption. Biological weapons may also be used in
combination with other types of weapons, adding to the disruption
produced by conventional weaponry.[6] The method for delivery of biological
warfare agents may be as simple and inconspicuous as attaching an off-
the-shelf spray device to a car, truck, boat, or airplane that appears
harmless to all who might observe the delivery vehicle. Current events
suggest that nonconventional or terrorist use of biological agents is
becoming more likely.
Because initial symptoms caused by a biological warfare agent may be
indistinguishable from those produced by endemic infections, a biological
weapon may be capable of overtaking a military force or civilian population
before the presence of the agent is even suspected. When one member of
a unit or community falls victim, the disease may yet be silently present in
others.[6]
The psychological and demoralizing impact of an infectious or toxic agent is
likely to be more devastating than its physiological effect. Many biological
agents, including bacteria, viruses, and toxins, can be used as weapons.

2
What are chemical weapons?
About 70 different chemicals have been used or stockpiled as Chemical
Weapons (CW) agents during the 20th century. These chemicals are in
liquid, gas or solid form and blister, choke and affect the nerves or blood.
Chemical warfare agents are generally classified according to their effect
on the organism and can be roughly grouped as: Nerve Agents, Mustard
Agents, Hydrogen Cyanide, Tear Gases, Arsines, Psychotomimetic Agents,
Toxins and Potential CW Agents.
Under the Chemical Weapons Convention (CWC) chemicals are divided
into three groups, defining their purpose and treatment:
* Schedule One are those typically used in weapons such as sarin and
mustard gas and tabun;
* Schedule Two include those that can be used in weapons such as amiton
and BZ;
* Schedule Three chemicals include the least toxic substances that can be
used for research and the production of medicine, dyes, textiles, etc.
CW agents mainly used against people are divided into lethal and
incapacitating categories. A substance is classified as incapacitating if less
than 1/100 of the lethal dose causes incapacitation, e.g., through nausea or
visual problems. The limit between lethal and incapacitating substances is
not absolute but refers to a statistical average.
Incendiary agents such as napalm and phosphorus are not considered to
be CW agents since they achieve their effect mainly through thermal
energy. Certain types of smoke ammunition are not classed as a chemical
weapon since the poisonous effect is not the reason for their use. Plants,
micro-organisms, the produced toxins belong to that class. Pathogenic
micro-organisms, mainly viruses and bacteria, are classed as biological
weapons.
* Chemicals that blister: sulphur mustard, lewisite, nitrogen mustard,
mustard-leweisite, phosgene-oxime.
* Chemicals that affect the nerves: VX, Sarin, Soman, tabun, novichole
agents.
* Chemicals that cause choking: cholrine, phosgene, diphosgene,
chloropicrin.

3
* Chemicals that affect the blood: herygem, cynanide, cynaogen chlorine.
* Chemicals for riot control: tear agent 2 (SN gas), tear agent 0 (CS gas),
psychedelic agent 3 (BZ)
Two examples:
* Mustard is an oily liquid with a garlic-like smell. Mustard gas was first
used as a chemical-warfare agent during WWI, when it war responsible for
about 70% of the million-plus gas casualties. Both in vapour and in liquid
form its effect is to burn any body-tissue which it touches. Taken into the
body, it can act as a systemic poison-- deadlier, weight for weight than
hydrogen cyanide. Its burning effects are not normally apparent for some
hours after exposure, whereupon they build up into the hideous picture of
blindness, blistering and lung damage. Its most prominent use after that
war was by Italy in Ethiopia during 1936. During WWII it was produced by
Britain, Canada, France, Germany, Hungary, Italy, Japan, the Netherlands,
Poland, South Africa, the USA and the USSR. It was the CW agent that
was stockpiled in by far the largest quantity on the order of hundreds of
thousands of tons overall but used only by Japan in China. It is probably
still the most heavily stockpiled CW agent today. Its last established use
appears to have been by Egypt intervening in the (North) Yemeni civil war
of the mid-1960s.
* Tabun, or ethyl NN-dimethylphosphoramidocyanidate, otherwise known
as GA, is a liquid that evaporates only half as fast as mustard gas, but is a
powerful poison. Even short exposure to small concentrations of its vapour
can result in almost immediate symptoms, felt first in the chest (as a
persistent contraction of the pupil) and chest (as a tightness or asthma-like
constriction). If a lethal dosage has been induced, either from inhalation of
the vapour or be absorption of the liquid through the skin, a characteristic
sequence of toxic manifestations ensues, some of great violence, including
running nose, sweating, involuntary urination and defecation, vomiting,
twitching, convulsions, paralysis and unconscious.
2. Some instances of use of Chemical Weapons:
* 429 B.C.- Spartans ignite pitch and sulphur to create toxic fumes in the
Peloponnesian War.
* 424 B.C.- Toxic fumes used in siege of Delium during the Peloponnesian
War.

4
* 1456- City of Belgrade defeats invading Turks by igniting rags dipped in
poison to create a toxic cloud.
* April 24, 1863- The US War Department issues General Order 100,
proclaiming "the use of poison in any manner, be it to poison wells, or
foods, or arms, is wholly excluded from modern warfare".
* World War I - the use of chemical agents in WWI caused an estimated
1,300,000 casualties, including 90,000 deaths.
* 1914- French begin using tear gas in grenades and Germans retaliate
with tear gas in artillery shells. This was the first significant use of chemical
warfare in WWI.
* April 22, 1915- Germans attack the French with chlorine gas at Ypres,
France. This was the first significant use of chemical warfare in WWI.
* September 25, 1915 - First British chemical weapons attack; chlorine gas
is used against Germans at the Battle of Loos.
* February 26, 1918 - Germans launch the first projectile attack against US
troops with phosgene and chloropicrin shells. The first major use of gas
against American forces.
* June 1918 - Fist US use of gas in warfare.
* June 28, 1918 - The US begins its formal chemical weapons program
with the establishment of the Chemical Warfare Service.
* 1919 - British use Adamsite against the Bolsheviks during the Russian
Civil War.
* 1922-1927 - The Spanish use chemical weapons against the Rif rebels in
Spanish Morocco.
* 1936 - Italy uses mustard gas against Ethiopians during its invasion of
Abyssinia.
* 1942 - Nazis begin using Zyklon B (hydrocyanic acid) in gas chambers for
the mass murder of concentration camp prisoners.
* Dec 1943 - A US ship loaded with mustard bombs s attacked by Germans
in the port of Bari, Italy; 83 US troops die in poisoned waters.
* April 1945 - Germans manufacture and stockpile large amounts of tabun
and sarin nerve gases but do not use them.

5
* 1962-1970 - US uses treat gas and four types of defoliant, including
Agent Orange, in Vietnam.
* 1963-1967 - Egypt uses chemical weapons (phosgene, mustard) against
Yemen.
* 1975-1983 - Alleged use of Yellow Rain (trichothecene mycotoxins) by
Soviet-backed forces in Laos and Kampuchea. There is evidence to
suggest use of T-2 toxin, but an alternative hypothesis suggests that the
yellow spots labelled Yellow Rain were caused by swarms of defecating
bees.
* 1979 - The US government alleges Soviets use of chemical weapons in
Afghanistan, including Yellow Rain.
* August, 1983 - Iraq begins using chemical weapons (mustard gas), Iran-
Iraq War.
* 1984 - First ever use of nerve agent tabun on the battlefield, by Iraq
during Iran-Iraq War.
* 1987-1988 - Iraq uses chemical weapons (hydrogen cyanide, mustard
gas) in its Anfal Campaign against the Kurds, most notably in the Halabja
Massacre of 1988.
* March 20, 1995 - The Tokyo Subway sarin gas attack killed nearly a
dozen people and incapacitating or injuring approximately 5,000 others.
Thousands did not die from the Tokyo attack due to impure of the agent. A
tiny drop of sarin, which was originally developed in Germany in the 1930s,
can kill within minutes after skin contact or inhalation of its vapour. Like all
other nerve agents, sarin blocks the action of acetylcholinesterase, an
enzyme necessary for the transmission of nerve impulses.
3. What is the Chemical Weapons Convention (CWC)?
The experience of large-scale chemical warfare was so horrifying that it led
to the 1925 Geneva Protocol, which forbids the use of chemical and
bacteriological agents in war. Images of victims gasping, frothing and
choking to death had a profound impact. The text of the protocol reflects
the global sense of abhorrence. It affirmed that these weapons had been
"justly condemned by the general opinion of the civilized world."
The Chemical Weapons Convention (CWC) reinforces aspects of the
Geneva Conventions that also dealt with these agents and was negotiated

6
over a period of 24 years. In 1992, after a decade of long and painstaking
negotiations, the Conference on Disarmament in Geneva agreed to the text
of the (CWC), which was adopted by the General Assembly on 30
November 1992, in its resolution entitled Convention on the Prohibition of
the Development, Production, Stockpiling and Use of Chemical Weapons
and on Their Destruction (A/RES/47/39).
More than 170 countries have signed the CWC, and 139 have ratified it.
The treaty entered into force on April 29, 1997, 180 days after Hungary, the
65th country, ratified. Countries that ratify must destroy all chemical
weapons over a ten year period with the treaty providing a "levelling out
principle" that ensures possessors destroy their stockpiles at roughly the
same time.
Five years after entry into force, destruction of 20% of the stockpile is to be
completed. After seven years, 45% of the destruction should be complete.
Under the treaty countries must to stop any development, production,
acquisition, stockpiling and retention of chemical weapons. The CWC
requires States Parties to report the location of chemical weapons storage
sites, the location and characteristics of chemical weapons production and
research facilities and prohibits trade in certain chemicals with countries not
party to the treaty.
The verification provisions of the CWC not only affect the military sector but
also the civilian chemical industry, world-wide, through certain restrictions
and obligations regarding the production, processing and consumption of
chemicals that are considered relevant to the objectives of the Convention.
The Convention also contains provisions on assistance in case a State
Party is attacked or threatened with attack by chemical weapons and on
promoting the trade in chemicals and related equipment among State
Parties.
For a good article by article summary of the treaty, and a copy of the whole
text go to: http://www.opcw.org.
4. What do individual governments have to do after they sign the
CWC?
Once a government has ratified the Convention, it is required to declare all
of its CW facilities (both commercial and public) within 30 days, and must
destroy stockpiles within 10 years in an environmentally sound manner at
its own expense. States Parties need to ensure that the prohibitions in the

7
treaty are translated from international law, binding only on states, to
Convention specifically requires States Parties to extend their obligations to
private entities, it remain silent on precisely how to achieve this.
States are required to enact penal legislation, prohibiting their private
citizens, no matter where they are on earth, from undertaking any of the
activities prohibited to the state itself by the Convention. Many states have
also enacted laws laying down an obligation to provide declaration required
relating to production, processing, consumption, import and export of
chemicals above thresholds specified in the Convention.
Click here for the Action Plan on Implementation of the CWC, adopted
October 2003.
Another area in which most states have enacted legislation provides two-
year, multiple-entry visa to inspectors who on 48 hours notification can
inspect to clarify and resolve questions of non-compliance. During
inspections they can interview personnel, request samples and evaluate
chemical weapons destruction sites. They can evaluate a site for up to 84
hours.
What is the Organization for the Prohibition of Chemical Weapons?
The Organization for the Prohibition of Chemical Weapons came into
existence on 29 April 1997 and is based in The Hague, Netherlands. The
OPCW is made up about 5,000 staff that monitors the destruction of
chemical weapons and of chemical weapons production facilities. The staff
also implements the complex declaration and short notice challenge
inspections under the verification procedures, undertakes routine
inspections and trains inspectors. The staff are accountable to all
signatories and an Executive Council made up to 41 member states. In
May 2000, the Director-General Mr. Jose Bustani was confirmed for a
second term of four years starting 13 May 2000.
The Executive Council:
Elected for two years (2000-2002): Austria, Canada, Netherlands, Spain,
Sweden, Chile, Cuba, Panama, Peru, Poland, Russian Federation,
Slovenia, Indonesia, Islamic Republic of Iran, Pakistan, Sri Lanka, Algeria,
Morocco, Namibia and South Africa.
Elected for two years (1999- 2001): France, Germany, Italy, UK, Northern
Ireland, US, Argentina, Brazil, Mexico, Romania, Ukraine, Bangladesh,

8
China, India, Japan, Republic of Korea, Saudi Arabia, Cameroon, Cote
d'Ivoire, Ethiopia, Tunisia, and Zimbabwe.
6. Who are the two biggest Chemical Rogues?
Russia
The Russian Federation possesses approximately 40,000 tonnes of CW
agents stored at seven sites. The arsenal consist of the nerve agents sarin,
soman and V-gas, the vesicants lewisite and mustard, and the choking
agent phosgene. Approximately 80% of the stockpile consists of nerve
agents.
As of 11 April 1992, Russia did not have a comprehensive destruction act.
Although the State Duma unanimously passed such a bill on 27 December
1996, the Federation Council rejected it the following month. Nevertheless,
plans for CW destruction continue to be developed. A comprehensive
destruction act is needed to provide the legal basis for destruction,
irrespective of Russia's ratification of the CWC.
Chemical weapon destruction efforts were hindered by a lack of funding
($3.35 billion is needed). The most significant assistance thus far is the US
funding for the construction of a pilot CW destruction facility at Shchuchye
(an estimated $600 million). US destruction aid is closely associated with a
continuing joint evaluation of Russia's two-stage nerve agent destruction
technology: the Russian-US Joint Evaluation Program. It is being
conducted within the framework of the 1990 Bilateral Destruction
Agreement and a 1994 Plan of Work addendum.
The United States
The US stockpile consists of over 30,000 tonnes of unitary CW gent and
approximately 700 tonnes of binary components. It includes the nerve
agents sarin and VX and the vesicant mustard. They are stored at the nine
locations: Johnston Atoll in the Pacific Ocean; Edgewood, Maryland;
Anniston, Alabama; Blue Grass, Kentucky; Newport, Indiana; Pine Bluff,
Arkansas; Pueblo, Colorado; Tooele, Utah; and Umatilla, Oregon. The cost
of destroying the US stockpile is currently estimated at approximately $12.4
billion. Large-scale destruction operations began at the Johnston Atoll
Chemical Agent Disposal System (JACADS) in 1990. The second
destruction facility at Tooele, Utah, began operation in August 1996.

9
Incineration continues to be the US Army's baseline destruction technology,
but alternative destruction technologies are also being considered because
of the opposition be some parties to incineration. The US Army is required
by law to consider alternative destruction technologies for the destruction of
bulk agent. Three proposals by private industry plus two developed by the
Army have been evaluated by the National Academy of Sciences.
In addition, the research, development, test and evaluation inventory
comprises approximately 4400 kg, and recovered munitions and similar
"non-stockpile" items amount to approximately 6100 kg. The programme
for items which are not part of the US CW stockpile deals with recovered
chemical munitions, chemical agent detector kits and miscellaneous
chemical material stored at an estimated 65 sites. The destruction of non-
stockpiled CW material will cost estimated $15.2 billion.
7. Which other States have or are suspected of having Chemical
Weapons?
China - ratified the CWC on 25 April 1997; China has declared possession
of former chemicals weapons production facilities; initial inspections have
been conducted.

Egypt - has not signed the CWC.

Ethiopia - ratified the CWC on 13 May 1996.

India - ratified the CWC on 3 September 1996; India publicly announced

itself to be a chemical weapons possessor on 26 June 1997; initial
inspections have not been conducted.

Iran - ratified the CWC on 3 November 1997, initial inspections have

begun.
Iraq - has not signed the CWC.

Israel - has signed, but not ratified the CWC.

Libya - has not signed the CWC.

10
Myanmar - has signed, but not ratified the CWC.
North Korea - has not signed CWC.

Pakistan - ratified the CWC on 28 October 1997; initial declaration

submitted.
South Korea - ratified the CWC on 28 April 1997.

Syria - has not signed the CWC.

Taiwan - has not signed the CWC.

Vietnam - has signed but not ratified the CWC.

8. How are Chemical Weapons Destroyed?
Former Methods of Destruction
Previously the most common disposal methods for chemical weapons were
land burial, sea dumping, detonation (firing or exploding the munitions) and
open-pit burning. These methods may have been thought to be quite clever
at the time (out of sight, out of mind), but their danger has since become
starkly apparent.
Buried munitions pose problems environmentally. Once the munitions
begin to corrode and leak, the agents can contaminate the surrounding soil
and even get into water sources. Sea dumping of chemical munitions is
another method of disposal that has caused a number of problems. Some
of these dumping operations have occurred in relatively shallow water in
the Baltic Sea and off the coast of Japan. In both of these regions, dumped
chemical weapons caused serious problems for the fishing industry.
Fishermen in the Baltic and off the coast of Japan still haul old chemical
weapons up in their nets, and are sometimes exposed to still-active agents.
Destruction Methods of Today
There are two major confirmed technologies for destroying chemical
weapons acceptable under the CWC limits today, incineration and chemical
degradation. However, there are dozens of alternative technologies, and
the number is growing.

11
Under the Baseline incineration process, chemical weapons are first taken
to the demilitarization facility, where the chemical agent is removed from
the munitions or bulk containers by automated equipment. This puts the
workers at the demilitarization plant at a very low risk of contamination.
Chemical degradation (or chemical neutralization) technologies also take
many different forms. There are a number of chemicals, namely alkalis and
oxidants, which reduce and often negate the toxicity of chemical agents.
The Chemical Weapons Destruction Challenge
While the technologies for destroying chemical weapons do exist, in
practice there are many factors that may come into conflict when the
destruction process is carried out. The issues that must be considered
include the high costs of destruction, safety, and environmental, legal and
political factors.
Although environmentalist groups have legitimate concerns that the
weapons be disposed of in an environmentally safe manner, weapons
experts generally agree that it is environmentally much more dangerous for
the weapons to remain in storage for the additional years required to
develop alternative methods of destruction.
Safety must also be carefully considered in the destruction of chemical
weapons. This entails precautions and regulations that protect not only
employees working in the destruction facility, but also the civilian population
surrounding the facility. Highly sensitive monitoring equipment must be
used in order to ensure there is no leakage of toxic agents.
The United States claims it has 12,000 tons of chemical agents in
munitions and another 19,000 tons in bulk storage. Russia, the sole in-
heritor of the former Soviet Union's chemical weapon stockpile, officially
reports its stockpile to be 40,000 tons. These two countries are the only
signatories to the CWC that have admitted to possessing chemical
weapons. In 1994, the United Nations Special Commission on Iraq
(UNSCOM) declared that Iraqi chemical weapons capabilities had been
destroyed, leaving Iraq with no surplus (or any) chemical weapons stocks.
A large number of old and abandoned chemical weapons still exist in a
number of countries. The total amount of chemical weapons and old and
abandoned chemical weapons that must be destroyed worldwide is
daunting. The original 1985 cost estimate for the destruction of the US

12
chemical weapon stockpile was US $1.7 billion. Today, the estimated cost
of destruction is about US $9 billion and growing.
9. Chemical Weapons Proliferation
One must also consider the threat of proliferation when it comes to
reducing arsenals. In the case of chemical weapons, the threat of
proliferation is much smaller than that of nuclear or conventional weapons.
This is true for several reasons. First of all, many of the chemical weapons
of today's arsenals are aging and dangerous to transport. Second, it would
be cheaper in most cases for a country desiring chemical weapons to
produce them than to try to buy them on the illegal arms trade market.
Third, the quantity of chemical weapons needed to pose a significant threat
is large, especially when compared to nuclear weapons. An illegal transfer
of a significant quantity of chemical weapons would be very difficult to hide.
Finally, a country would not want to import chemical weapons unless it had
a sufficient chemical protection gear and training for its own forces, a costly
undertaking. Unfortunately, virtually every country has the technology to
produce some of the simple agents used during World War I. In sum, if a
country really wants a chemical weapons arsenal, it would be easier to
build one itself rather than to import stocks.

13