Focused Question

BIOTERRORISM:
THE INVISIBLE
ENEMY
AN EXPERTISE FORUM CONTRIBUTING TO EUROPEAN
ARMIES INTEROPERABILITY SINCE 1953

This paper was drawn up by Ms. Ludovica

Serafini, European Defence researcher, under
European Army Interoperability Center the supervision of the Permanent Secretariat.
 This focused question is a document
that gives an initial reflection on the
Finabel annual theme 2018-2019. The
content is not reflecting the positions
of the member states, but consists of
elements that can initiate and feed the
discussions and analyses in the domain
of the theme. It was drafted by the Per-
manent Secretariat and is supported by
the organization.

INDEX INTRODUCTION

I
Introduction2 n 1832, the Prussian General and mil-
itary theorist Carl von Clausewitz was
Section 1. writing: “War is to use the right amount
Bioterrorism: origins & characteristics 5 of force at the right time and at the right
place”. How could we read this sentence
Section 2. nowadays? Would it still be relevant in the
Bioterrorism examples & 21st century?
the north korean case 8
The method of fighting a war has changed
Section 3. over time. Especially, the rapid develop-
France & israel: how the aremd ment of biological science, particularly bio-
forces are dealing with bioterrorism? 11 technology and synthetic biology, as well as
the fast accessibility to networks, resources,
Section 3.1. and expertise in these last 25 years led to an
The french armed forces’ experience 11 increase in the proliferation and the use of
more deadly weapons for massive civil dis-
Section 3.2. ruption by both a number of states and non-
The israeli armed forces’ experience 13 states actors. These kinds of lethal weapons
are characterised by Chemical, Biological,
Section 4. Radiological and Nuclear (CBRN) materi-
Conclusions & recommendations 16 als which pose a serious, unique, and global
threat to all nations’ security, endangering
Biography19 public health and damaging economics. For

2
 the purpose of this paper, only the biological have signed the Convention, 6 States (Cen-
agents will be taken into consideration, due tral African Republic, Egypt, Haiti, Somalia,
to the fact that changes inUse
theofglobal
Chemical, Biological, Radiological and Nuclear Weapons by Non-State Acto
security Syria, Tanzania) have not ratified yet, and 10
context suggest the urgency of reinforcing Countries have refused to sign it: Chad, Co-
Introduction
and strengthening the current biosecurity moros, Djibouti, Eritrea, Israel, Kiribati, Mi-
and biodefence globally. cronesia, Namibia, South Sudan, Tuvalu.

The international community banned the Unfortunately, one of the biggest challenge03
Use of Chemical, Biological, Radiological and Nuclear Weapons by Non-State Actors
use of biological weapons for the first time in of the Biological and Toxin Weapons Con-
1925 enforcing the Geneva Protocol, which vention is the lack of obligatory for Member
Introduction
was limited to asphyxiating, poisonous gases. States to allow external checks on any illegal
Only in 1972, the total elimination of these or suspected stockpiles. Furthermore, is the
lethal weapons was achieved through the BTWC still effective and relevant nowadays?
Biological and Toxin Weapons Convention The history and recent events are showing
(BTWC), which includedFigure the prohibition of biological
1: Chemical, completely
andanradiological
opposite scenario. It could
attacks across the worl
development, production, stockpiling, acqui- be shocking, but as the Global Terrorism
sition, retention, transfer, and delivery system Database reveals from 1970 to 2014 there
of biological weapons. Currently, 181 States were a total of 143 chemical, biological, and
Figure 1: Chemical, biological and radiological attacks across the world from 1970 to 2014

Biological Chemical Biological

Radiological Chemical Radiological

According to the University

Figure 1 of Maryland’s Globaland
According
– Chemical, biological to the CBRNattacksweapons
University
radiological ofacross theare
Maryland’s some
world of 1970
the most
Global
from indiscriminate
to 2014 CBRN andweapon
Terrorism Database, there were a total of 143 attacks – deadly weapons in existence today. Besides the physical
Terrorism Database, there were a total of 143 attacks – deadly weapon
35 biological, 95 chemical, and 13 radiological – using damage they can inflict, they also have the potential
35 biological,
CBRN weapons across the world from 1970 to 2014. 95 chemical, and 13 radiological – using
to inspire fear, provoke panic, and cause significant damage they ca
CBRN
This information is captured in figure 1. ª weapons across the world from
economic andBioterrorism: 1970 to 2014.
societal disruption.³
theFortunately, to
theinspire
Invisible Enemy use fear,
3 This information is captured of CBRNinweaponsfigure 1. byªstates and non-state actors economic
has and
Insurance is available to cover some of the effects of remained relatively rare to date. Nevertheless, the ofrisk
CBRN weap
the use of chemical, biological, radiological
Insurance is available presented
and nuclear to cover by theseofweapons
some is notofzero, and insurers
the effects remained relat
radiological attacks all around the world Too many questions need an answer, not only
(The Royal Institute of International Affairs, for today but especially for the future. It is
2016). time to cope seriously with biological weap-
ons! It is time to take action!
Just for giving few examples of biological at-
tacks since the enforcement of the BTW Con- The paper is structured as follows. Section 1
vention, in 1984 fanatic members of the In- provides an overview of the meaning and the
dian guru Bhagwan Shree Rajneesh used Sal- origin of the term bioterrorism. Section 2 il-
monella bacteria for poisoning salad bars and lustrates recent examples of biological agents
other restaurants in Oregon to influence local weaponized. Especially, the case of North Ko-
election by preventing residents from voting. rea is brought to the attention of the reader
The cases of gastroenteritis were 751, with 43 for two main reasons. Firstly, North Korea
people hospitalized, and no deaths. In 1995, gained international attention and concern
the followers of Aum Shinrikyo attacked in in these last years due to the several securi-
different times the Tokyo subway with several ty challenges it is posing globally. Secondly, I
agents, such as sarin, botulinum, and anthra- wanted to avoid repetitions of already known
cis. Luckily, all these attempts failed. In 2001, bioterrorists attacks, such as the Anthrax at-
the American public was exposed to anthrax tack in USA in 2002, for giving space to new
spores as a bio-weapon delivered through actors whose information on their own bio-
the US postal system. Five people died after logical (and chemical) capabilities is still un-
the exposure to the spores, while 17 became certain. Section 3 analysed how armed forces
infected. In 2002, ricin was recovered from are dealing with the risk of a possible bioterror
six terrorists in England, while, only one year attack. Challenges, limitations, and responses
later, terrorists attacked the Russian embassy are outlined, taking in consideration espe-
with the same agent. In March 2018, the for- cially the great simulations and experiences
mer Russian spy S. Skripal and his daughter of French and Israel armed forces. Section 4
Yulia have been poisoned with a nerve agent develops recommendations for enhancing the
in southern England developed in Russia. The States’ response to the challenges posed by a
UK government, as a consequence, concluded possible biological attack as well as improving
that “it is highly likely that Russia was respon- the armed forces’ interoperability and cooper-
sible for the act”. By contrary, Russia denied ation in case of an outbreak.
any responsibility.

How real is a biological attack in Europe?

Which is the level of preparedness and op-
erative capabilities of our armed forces if an
outbreak will occur? Are the Governments’
agenda dealing with biosecurity and biode-
fence policies and regulations, preparing and
implementing possible emergency plans and
fast crisis responses? How could we tackle
and resolve the lack of harmonised national
response and a still fragmentation of respon-
sibilities on a regional, national, and interna-
tional level?

4
SECTION 1 –
BIOTERRORISM: ORIGINS & CHARACTERISITCS

Bioterrorism is considered as “the intention- health impact, may cause public panic, give rise
al use and release of biological agents such as to major socio-economic disruptions, or require
viruses, bacteria, and toxins to cause illness or special action for public health preparedness”
death in people, animals, or plants” (Nikoleli (Nikoleli et al., 2016). This Category includes:
et al., 2016). This is an old war strategy, which
dates back to the pre-historic era when Hittites 1. Anthrax, which is a non-contagious dis-
and Scythians, two ancient Eurasian groups, ease caused by the Bacillus anthracis bac-
exploited around 1600 BC infected rams for terium. An anthrax vaccine does not exist
poisoning their enemies. However, the first and yet, but if detected in an early stage it can
real used of biological agents as a weapon hap- be cured with antibiotics;
pened in 1346 AC, when Tartars, Turkic-speak- 2. Smallpox, which is a high contagious dis-
ing peoples living mainly in Russia and other ease with a high mortality rate (20-40%).
Post-Soviet countries, sent plague victims in the Although smallpox was eradicated in the
city of Feodosia (Ukraine). The consequences world in the 1970s, “some virus samples
were catastrophic as, according to several schol- are still available in Russian and American
ars, this was the incipit of the European Black laboratories, as well as probably in other
Death period, also known as the Great Plague, countries” (Nikoleli et al., 2016);
one of the most devastating pandemics in hu- 3. Botulinum Toxin, which is one of the
man history causing the deaths of an estimated deadliest toxins known produced by the
75 to 200 million people in both Europe and Clostridium botulinum bacterium;
Asia (Krishan, Kaur, & Sharma, 2017). 4. Plague, which is caused by the Yersinia
pestis bacterium and it is transmitted from
Before analyzing the most recent examples of rodents to fleas, and from fleas’ bites to
bioterrorism, it is useful to understand which humans. For a biological attack, “the
are the biological agents that can be weap- weaponized threat comes mainly in the
onized as well as how a bioterror attack could form of pneumonic plague (infection by
be carried out. inhalation)” (Nikoleli et al., 2016);
5. Viral Hemorrhagic Fevers, whose main
Although biological agents can be find in na- example is represented by Ebola Virus
ture, only certain types of bacteria, viruses, which compromises the function of mul-
fungi, and parasites are considered pathogen- tiple organs. “Ebola has fatality rates rang-
ic for humans. These agents could be chosen ing from 50-90%” (Nikoleli et al., 2016);
for bioterror attacks according to “the A, B, C 6. Tularemia, or rabbit fever, which “can be
classification of the Centers for Diseases Con- contracted through contact with the fur,
trol in Atlanta that best defines their impact inhalation, or ingestion of contaminated
on public health” (Leonce, 2013). water or insect bites. The fatality rate is
very low of treated, but can severely inca-
Category A agents are considered of high-prior- pacitate” (Nikoleli et al., 2016).
ity as they “pose a risk to national security, can
be easily transmitted and disseminated, result Category B consists of agents with low mor-
in high mortality, have potential major public tality rates, such as Brucellosis, Food safety

Bioterrorism: the Invisible Enemy

5
 6. Select a method of delivery to disseminate.

Figure 1: Steps needed in order to create biological agents.

Figure 2 – Steps needed in order to develop biological agents (HCSS, 2016)
Steps 1 through 4 are concerned with obtaining the biological agents, which can either be
sourced from nature or produced synthetically, and establishing the infrastructure to
threats (Salmonella
develop species, E.these
them. Previously, Coli O157-H7, gineering
steps would have to be have revealedinthelarger
conducted ease ofscale
synthe-
lab
Staphylococcus aures), Q fever, Typhus, and tizing and recreating “known
environments. Scientific developments described below make the threshold of successful pathogens
water supply
creation threats. lower.
considerably (such as Ebola virus) in the laboratory, as
it has already been demonstrated for po-
Category C, on the other hand, are “emerging liovirus and the Spanish influenza virus”
Subsequently, the biological agent must be weaponized. This process poses more hurdles
pathogens that might be engineered for mass (Tucker & Zilinskas, 2006);
than the first step of creating or getting the necessary agents.10 To use biological agents in
dissemination because of availability, easy to 2. Access knowledge and information about
warfare,
produce sufficient volumesorhave
and disseminate, mightto possess
be acquired bioweapons.
and the agents should
All this be processed
information is avail-to
remain viable long
high mortality or aenough.
major In this step,
health pathogensable
impact” acquire properties
on public online to be heatorresistant
databases due to
(Nikoleli et al., 2016), such as SARS, Nipah networks of scientists and/or exchange
virus, HIV/AIDS. students, who come back to their home
8 Jeffrey Hays, “Biological weapons and terrorism | Facts and Details,” Biological Weapons and
countries once finished to study. For in-
Terrorism, July 2012, http://factsanddetails.com/world/cat58/sub384/item2384.html.
9How might a bioterror attack be developed stance, “the producer of the Pakistani nu-
Washington Post, “The Making of a Biological Weapon,” The Making of a Biological Weapon, 2004,
and carried out? Above all, which is the pro- clear bomb, Abdul Qadeer Khan, received
http://www.washingtonpost.com/wp-srv/nation/daily/graphics/wmdbio_123004.html.
cess
10 for developing
Warner biological
et al., “Analysis of the warfare
Threat ofagents? university
Genetically Modified degrees
Organisms forin Germany
Biological and the
Warfare.”
Netherlands as well as working experience
As described by The Hague Centre for Strate- in a nuclear facility in the Netherlands
gic Studies (HCSS, 2016), six are the steps for before returning to Pakistan” (Sweijs &
8creating biological agents: Kooroshy, 2010). Consequently, “in con-
trast with nuclear program, developing
1. Acquire the pathogenic agent, which does basic biological capabilities is affordable
not require much effort nowadays due to by any State with a sufficient pharmaceu-
the advances in biological research and tical, medical, and industrial apparatus,
technology. Especially, the latest develop- inflicting at the same time catastrophic
ments of synthetic biology and genetic en- effects” (Martens, 2016);

6
3. Buy the needed equipment. Again, the costs plosives. On the other hand, in close spac-
for working with biological agents have es air condition system is the most danger-
dropped significantly during these years. ous point as it could be used for the cir-
In 2001, “the incomplete determination culation and release of biological agents.
of the sequencing of human genomes 7. The ingestion strategy, instead, takes in
took roughly ten years and cost $3 billion, consideration the spreading of pathogenic
while in 2008 the complete sequence of agents through the contamination of food
the human genome was determined in or waste supplies. Nevertheless, this mean
just 4 months and cost less than $1billion” is not so easy to perpetrate as firstly “it re-
(Wheeler, 2008). As a consequence, what quires large quantitates of water-resistant
about today?; agents” (HCSS, 2016). Secondly, “water
4. Grow the pathogenic agent in stable envi- supplies are closely monitored and any
ronmental conditions, avoiding a direct contamination can be controlled through
exposure to air, humidity, and UV light. increased chlorination” (Leonce, 2013).
“This can be done in three ways: biolog- 8. Finally, the cutaneous way requires a di-
ical agents may be freeze dried, processed rect contact or inoculation. It could be the
with chemical additives, or micro-encap- possibility to use infected insects as a vec-
sulated” (HCSS, 2016); tor for spreading the disease from animals
5. Weaponize the biological agent. Probably, to humans.
this is the most difficult step to achieve
especially with low quality equipment. Not only buying and developing biological
In fact, “sufficient volumes have to be ac- agents have become easier and easier in these
quired and the agents should be processed last years, but also other important criteria
to remain viable long enough” (Warner et “make infectious diseases more suitable and
al., 2011). This difficulty, however, does powerful as a means of biological terrorism”
not imply its impossibility; (HCSS, 2016), such as:
6. Decide which method is the most effective
for carrying out a bioterror attack. Sever- 1. High morbidity and potential high lethal-
al are the modus operandi for spreading ity;
the biological agent: inhalation, inges- 2. High infectiousness or high toxicity;
tion, or cutaneous contact. The inhalation 3. Suitability for mass production and stor-
strategy, the most effective ones, consists age without loss of pathogenic potential;
in airborne dissemination of the agent, 4. Suitability for wide-area delivery;
which needs to be “concentrated, dried, 5. Stability in the environment after dissemi-
and made into small particles. As path- nation, long enough to infect humans;
ogens are sensitive to sunlight, dispersal 6. Suitability for being a biological agent,
would be best at night” (HCSS, 2016). In improved by genetic engineering and the
open environment, the distribution of the weaponization process.
biological agent could require airborne
tools such as “small aircraft, Unmanned
Aerial Vehicles (UAV), drones equipped
with dusting equipment or even balloons
designed for exploration (e.g. al-Qaida)”
(Leonce, 2013). Only anthrax spores can
be effectively distributed by means of ex-

Bioterrorism: the Invisible Enemy

7
SECTION 2 –
BIOTERRORISM EXAMPLES & THE NORTH KOREAN CASE

Reaching our contemporary years, several are States and non-State actors? It could be es-
the examples showing the use of biological timated, but “it is difficult to gauge the ex-
agents as weapons. During the Sino-Japanese tent of biological weapons development since
War between 1930s and 1940s, the Japanese biotech knowledge is mostly freely available,
forces “filled bombs with cholera, shigella, and governments have little control over biotech
plague-infected fleas and dropped them from innovation, and production facilities require
airplanes onto two Chinese cities, causing the little space and are not easy to identify” (Mar-
deaths of 580,000 Chinese people” (Martin tens, 2016). Several are the known biological
et al., 2007). In 1984, fanatic members of the program that occurred in the past years. For
Indian guru Bhagwan Shree Rajneesh used instance, from 1949 the US Army’s Biological
Salmonella bacteria for poisoning salad bars Warfare Laboratories developed a program
and other restaurants in Oregon to influence for producing and weaponizing biological
local election by preventing residents from agents as anthrax and botulinum toxin. The
voting. The cases of gastroenteritis were 751, program ended in 1969, shifting from the
with 43 people hospitalized, and no deaths. study of biological agents as weapons to the
In 1995, the followers of Aum Shinrikyo at- use of biological agents for defensive meas-
tacked in different times the Tokyo subway ures, especially immunization and response.
with several agents, such as sarin, botulinum, Furthermore, the former Soviet Union de-
and anthracis. Luckily, all these attempts veloped its own bioweapons program at least
failed. In 2001, the American public was until the 1990s, producing large quantities of
exposed to anthrax spores as a bio-weapon smallpox virus and anthrax weapons. There
delivered through the US postal system. Five are proofs of this program as in 1979 “an
people died after the exposure to the spores, accidental release of small amount of weap-
while 17 became infected. In 2002, ricin onized anthrax from a military research fa-
was recovered from six terrorists in England, cility led to at least 70 deaths” (Ouagrham,
while, only one year later, terrorists attacked 2003). Again, in 1990s Iraq as well has been
the Russian embassy with the same agent. Fi- discovered by the United Nations to have
nally, in March 2018, the former Russian spy produced “thousands of tons of concentrat-
S. Skripal and his daughter Yulia have been ed botulinum toxin and to have developed
poisoned with a nerve agent in southern Eng- bombs to deploy large quantities of botuli-
land developed in Russia. num toxin and anthrax” (the National Intel-
ligence Council, 2012). Nowadays, the status
The aforementioned examples represent con- of the Iraqi government’s biological program
crete biological attacks or attempted attacks is unknown, in the same manner as that one
that happened throughout the history. Nev- of other Nations suspected of continued bio-
ertheless, bioterrorism goes beyond a simple logical warfare programs such as Afghanistan,
attack, which is the result of something big- Pakistan, China, Iran, North Korea, Russia,
ger and more hidden: a bioweapon program. Syria, and Cuba (Martin et al., 2007). Fur-
How many secret biological experiments thermore, in 2002 Eckard Wimmer, a Ger-
using microbial agents needed for biological man American virologist, developed the first
weapons are carrying out daily from both chemical synthesis of poliovirus, an organism

8
harmful for humans, revealing consequently that possibly tens of billions of dollars have
“that viruses like poliovirus no longer exist been invested into bioweapons laboratories”
only in nature, but also in computers. Vi- (IISS, 2015).
ruses, therefore, can be synthesized using the
information stored in computers” (Rados- Nowadays, Non-State actors are the biggest
avljevic et al., 2017). Currently, more than concern for the international community due
2500 genomes of viruses are available in pub- to their intention to develop and/or buy bi-
lic databases, arising one more time the issue ological weapons for causing “considerable
of “Dual Use Research” or “Dual Use Di- damages at the economic (financial losses),
lemma”, in which “same technologies can be societal (disruptions, psychological impact),
used for the good of humans and misused for or physical level (highly contagious and dead-
bioterrorism” (Radosavljevic et al., 2017). As ly, mass casualties” (HCSS, 2016). In fact,
a consequence, “there is a growing risk that terrorists in particular “want a lot of people
biological weapons might be obtained and watching and lot of people dead, justifying
used by non-State actors, considering the fact the deployment of biological agents by the

Figure 3 – Kim Jong Un touring the Pyongyang Bio-Institute in June 2015.

The photo shows fermenter and bioreactors (Loria, 2017)

Bioterrorism: the Invisible Enemy

9
occurrence of diseases in religious texts” (Bri- 3. A biological program may not exist at all;
an, 2006). The best example is represented 4. A biological program is keeping complete-
by the rise of Daesh in Iraq and Syria, which ly secret.
have the stated intention to acquire biological
weapons as “they kill indiscriminately with a Interesting is an abstract of Parachini’s re-
delayed impact, can be confused with natural search (2018) stating: “In 1997, the Cen-
disease outbreaks, or rather than kill, incapac- tral Intelligence Agency (CIA) assessed that
itate” (Martens, 2016). North Korea was capable of supporting a lim-
ited biological weapons effort. In 2005, CIA
Unfortunately, another actor is raising con- reported that North Korea has active chemi-
cern among the international community for cal weapons and biological weapons programs
the uncertain possession of biological (and ready for use. Since 2014, the US intelligence
chemical) weapons: North Korea. Although community have dropped North Korea from
there are some similarities with “what we the list of suspect programs, although in 2012
knew about Iraq’s weapons of mass destruc- the South Korean Department of National
tion programs before 2003, in the North Ko- Defense assessed that North Korea likely has
rean case we do not know much about the the capability to produce a variety of biolog-
past, and sourcing on the present is far from ical weapons including anthrax, smallpox,
certain” (Parachini, 2018). From the 1960s to plague, tularemia, and hemorrhagic fever
the 1970s, North Korea started a large pro- virus. However, no proofs or evidences have
duction of biological capabilities, especially been provided”. What about nowadays? How
“nerve agents, blood agents, chocking agents, many secret biological programs are develop-
and riot-control agents estimating nowadays ing while you are reading this paper?
a stockpile of chemical weapons range from
2,500 to 5,000 tons” (Parachini, 2018). Con-
cerning biological weapons, it is still unknown
the amount of North Korean capabilities, a
threat that need to be calibrated for allocating
precious armed forces and resources, as well as
for reducing the possibility for North Korea
to use them against military operations and
heavily populated areas.

Why does the international community know

so little about the biological capabilities of
North Korea? According to Parachini (2018),
four are the main reasons:

1. North Korea may hide its biological ac-

tivities through the “Dual-Use” nature of
biological and engineering researches;
2. North Korea may have never developed
such modern biological tools due to the
difficulty of managing an effective pro-
gram;

10
SECTION 3 – FRANCE & ISRAEL:
HOW THE ARMED FORCES ARE DEALING WITH BIOTERRORISM?

Which is the level of preparedness and op- epidemiological surveillance prototype, espe-
erative capabilities of our armed forces if a cially “the early detection of biological health
bioterror attack will occur? Are the Govern- threats, the evaluation of their potential im-
ments’ agenda dealing with biosecurity and pact on the forces’ operational capability, the
biodefence policies and regulations, preparing providing of information to assist medical re-
and implementing possible emergency plans sponses, the evaluation of the value of such a
and fast crisis responses? system compared to traditional surveillance,
and the identification of interoperability cri-
Bioterror defence and security is dealt with teria for allied cooperation” (Lt Col Meynard
diverse amount of resources and effort by the et al., 2009).
different armed forces. For the aim of under-
standing how bioterror surveillance is faced How does it work the French real-time epide-
within the military, two main examples from miological surveillance prototype? It consists
different areas of the world are explained: the of two interdependent networks: a recording
French and the Israeli armed forces’ experience. and an analysis network. The recording net-
work gathers all the health-related informa-
tion provided by doctors, nurses, and para-
SECTION 3.1 – medics. Once the data are collected, they are
THE FRENCH ARMED analyzed in real time by the second network,
FORCES’ EXPERIENCE the analysis network, which uses a geographi-
cal information system (GIS) and the Current
Past Experience Graph (CPEG) for revealing
“This is the price to pay to take “health information ready for use by health
part everywhere, and every time, commanders and military public health prac-
for the preservation of the armed titioners” (Lt Col Meynard et al., 2009) as
forces operational capacity” well as “answering to the question: “Knowing
the average number of expected events during
(Lt Col Meynard et al., 2009) a period time, is the current situation unusu-
al?” (Lt Col Meynard et al., 2009). The results
of the two networks give three different pos-
Since 2004, French Guiana has been the base sible situations:
for a real-time epidemiological surveillance
model for early warning during military de- 1. Normal situation, which is coded 0 and
ployments. This model has been developed in represented by green indicators;
French Guiana as “it is a country with high 2. Pre-alarm situation, which is coded 2 and
incidence rates of tropical diseases” (Lt Col represented by orange indicators “if the
Meynard et al., 2009), and it takes into ac- observed data are outside the historical
count “medical, technological, human, and limits” (Lt Col Meynard et al., 2009);
organizational aspects that may be very differ- 3. Alarm situation, which is coded 3 and
ent from the civilian situation” (Lt Col Mey- represented by red indicators if a biolog-
nard et al., 2009). Several are the aims of the ical threat has been detected.

Bioterrorism: the Invisible Enemy

11
Generally, the results of this real-time epi-
demiological surveillance model used by the
French armed forces are extremely positive
due to the fact that the model “dramatically
increases the epidemiologic response time-
liness in comparison with traditional epide-
miological surveillance; it enables a quicker
public health response from the armed forc-
es; it allow permanent enhancements of the
recording tools, the training of stakeholders,
the feedback system, and the production of
control boards easily and directly usable by
the commanders. This approach provides a
permanent development dynamic” (Lt Col
Meynard et al., 2009).

On the other hand, limitations and disadvan-

tages of the prototype have been encountered
as well (Lt Col Meynard et al., 2009). Espe- Figure 4 – Organization of the real-time
cially: epidemiological surveillance prototype
(Lt Col Maynard et al., 2009)
Limitations with the screen format and size,
which have been tackled using new laptops
adapted to extreme conditions;

1. System reliability due to technical reasons; 5. The urgency of developing different sur-
2. Communication limits due to technical veillance tools according to the stakehold-
reasons, such as bad steadiness and poor ers and the situations;
quality, as well as human reasons as “60% 6. The necessity of training and creating a
of actors reported not completing their “multidisciplinary team to deal with tech-
regular tasks” (Lt Col Meynard et al., nical and informatics constraints in the
2009); quickest amount of time” (Lt Col Mey-
3. Lack of specificity due to too many false nard et al., 2009);
positive and lack of a reference method. 7. The need of developing “other statistical
These obstacles highlighted the impor- methods than the one already used, allow-
tance of integrated the modern epide- ing the deployment of the analysis capac-
miological surveillance prototype with ity in new areas for which no historical
traditional surveillance tools for a better surveillance data are available” (Lt Col
approach; Meynard et al., 2009).
4. Financial and temporal burdens. In
fact, “the challenge is to provide non-
medical decision makers with appro-
priate information in a form that is
easy to understand and can be used di-
rectly” (Lt Col Meynard et al., 2009);

12
SECTION 3.2 – Aran, 2015). This first phase is critically
THE ISRAELI ARMED challenged by the difficulty in early de-
FORCES’ EXPERIENCE tecting an unusual morbidity. Therefore,
it is essential that primary care experts
Every year in Israel, a real-life simulation is are aware of the clinical presentation of
executed in different part of the country in an unusual biological threat, especially
order to prepare military and non-military “in a military setting, where consultants
organizations in dealing with man-made bi- and laboratory services are limited” (Lion,
oterror attack. In fact, Israel is characterized Kassirer, Aran, 2015);
by numerous army bases located in relative 2. Operational level, which aimed to the
proximity to nearby communities. In 2011, a maximum cooperation among all the in-
preparedness build-up project called Orange volved organizations, which have the task
Flame 6 drill (OF-6) has been developed and to “practice their own contingency plan
carried out in Israel by the synergy between (clinical guidance, protective equipment
the Ministry of Health and the Home Front guidelines, infectious patient movement
Command, which is subordinate to the Israel procedures, medical headquarters ac-
Defence Forces (IDF). The aim of this capaci- tions, and military plan for post-exposure
ty-building project is “to prepare civilian, mil- prophylaxis deployment) as well as learn
itary, medical, and non-medical organizations how to communicate and cooperate to
to appropriately respond in case of an unusual investigate and establish the exact place
biological event, challenging the coordination and time of the biological agent dispersal”
between the various organizations involved (Lion, Kassirer, Aran, 2015);
in the management of a possible outbreak as 3. Strategic level, which deals with strategic
well” (Lion, Kassirer, Aran, 2015). The OF-6 elements carried out by the armed forces
“included combat forces, as well as opera- for containing every possible catastrophic
tions and logistic headquarters. The extensive effect of an outbreak. Examples are to im-
non-medical military involvement in OF-6 pose quarantine on civilians, or to main-
provided unforeseen insights into the predict- tain public order avoiding social chaos
ed effect of an unusual biological event on and disruption.
the military. It also enables analysis of oper-
ational performance and containment during The simulation lasted for two days, involv-
an outbreak and challenged the coordination ing more than 1,000 stakeholders who had
and collaboration between the IDF and civ- to deal with and cooperate among each other
il emergency organizations” (Lion, Kassirer, for tackling a dispersal of two category A bio-
Aran, 2015). terror agents: Botulinum and Bacillus Anthra-
cis bacteria. The following part describes in
How did the OF-6 work? The OF-6 pro- depth the drill scenario military and non-mil-
ject helped to prepare and train medical and itary organizations had to deal with:
non-medical staff on three different levels:
“On November 21, a terrorist arrived in Israel
1. Tactical level, which includes individual by civilian flight. Four days later, de deployed
and the units for “the identification, early anthrax in a shopping mall and in the fields of a
management, infection control, epidemi- rural settlement near an air force base. The an-
ologic investigation, and local contain- thrax spores contaminated these places, including
ment of the outbreak” (Lion, Kassirer, family housing in the air base. A second terrorist,

Bioterrorism: the Invisible Enemy

13
who worked in a salad factory, scattered material headquarters, including medical staff, mental
containing Botulinum bacterium in vegetables. health specialists, and both medical and logistic
The drill began on November 30 with the detec- equipment. A suspected unusual biological event
tion of the unusual morbidity among patients was declared, and logistic information was com-
arriving at the civilian and military clinics. The municated among the population. Activity was
initial assessment revealed fever, cough, shortness reduced to the bare necessities.
of breath, and nuchal rigidity. The hit patients
remained isolated in the examination room. The Later that day, the clinical case definition was
public health officer instructed that the patients updated; by noon a confirmatory diagnosis of
be evacuated to the nearest hospital while wear- anthrax infection was made; in the early after-
ing surgical masks and that an initial epidemio- noon the diagnosis of anthrax and botulinum
logical investigation be conducted to identify all bacteria was affirmed. The anthrax dispersal
contacts. Medical staff was instructed to wear mechanisms were located and removed. The
full personal protective gear against contact, source of botulinum bacterium was suspected
droplet, and airborne transmission. Personal de- to be a line of industrialized salads. Revised
tails were taken from the clinic’s staff and visitors infection control instructions were distributed.
who had been potentially exposed. A staff mem- The level of protection was reduced to standard
ber was appointed to monitor staff health; some precautions and all industrialized salads were
patients passed away and the cause of the death banned for consumption.
was related to the same unknown agent. The
training included handling the deceased accord- The military Epidemic Management Team rec-
ing to a prewritten protocol and the relocation of ommended a prophylactic treatment against an-
the body to a military morgue for identification, thrax for all servicemen and civilians who might
without carrying out an autopsy. The areas were have been exposed to the spores. The treatment
clearly marked and had separate entrances and was supplied on the second day of the drill”
exits, thus enabling one-way traffic of patients. (Lion, Kassirer, Aran, 2015).
As the number of patients increased, the squad-
ron base commander became more and more Which were the final conclusions achieved by
involved. The military base was put under quar- the several participants and departments in
antine. Movements into and out of the base were
prohibited. Areas suspected to be contaminated
were mapped and closed. A protected firefighter
team was instructed to inspect family housing
and kindergartens in the search for additional ill
individuals. Members of all units were instruct-
ed to avoid drinking tap water until the source
of contamination was identified. Air condition-
ing was shut down, and people were instructed
to avoid gathering. Military police were request-
ed to set up barricades in order to limit access
to the military base. Additional assessments were
made, such as revised case definition, reports of
other clinical cases in proximity to the base, and
animal mortality. An urgent request for rein- Figure 5 – Israel’s simulation for preventing and dealing
forcement was launched to the air force medical with possible biological attack (Dreamstime website)

14
 However, limitations and challenges were vis-
ible during the two days exercise, revealing
new needed strategies and perspectives for
involving military preparedness and operative
capabilities:

1. Operational limitations, due to the fact

that an unexpected biological attack can
cause quarantine, “delay of operation-
al missions, and social distancing with-
in military units” (Lion, Kassirer, Aran,
2015), therefore leading to manpower
shortages;
2. The important role of an epidemiological
investigation team. In order to assess ear-
lier a possible outbreak, it is essential not
only to modernize the investigative tools,
but also “to integrate military and civilian
public health professionals, and data must
be pooled together” (Lion, Kassirer, Aran,
2015);
3. The critical role of a military epidemic man-
agement team, “to act as a distant consult-
ing body for sustaining operations” (Lion,
Kassirer, Aran, 2015);
4. Logistics importance for increasing “med-
Figure 6 – Israel’s simulation for preventing and dealing ical and mental health personnel, equip-
with possible biological attack (Dreamstime website) ment, and clean food and water supplies”
(Lion, Kassirer, Aran, 2015);
5. The importance of infection control “for the
this simulation? Surely, one of the main ele- containment of an outbreak while main-
ments that were emphasized was that “unu- taining the safety of medical personnel”
sual biological events can occur anytime and (Lion, Kassirer, Aran, 2015);
anywhere without prior notice” (Lion, Kassir- 6. Mortuary in an outbreak, meaning that au-
er, Aran, 2015). Furthermore, “the close rela- topsy on dead people during a biological
tionship between Israeli military and civilian attack exposes staff to unwarranted risks.
emergency systems allowed coordinated and As a consequence, “autopsies should be
cooperative response. For instance, this prox- done with full protective equipment only,
imity enabled samples to reach the laboratory and only after, considering their necessi-
within two or three hours after being taken, ty or only under special circumstances”
thus saving the need for designated laboratory (Lion, Kassirer, Aran, 2015);
services in the field. It also mandates military 7. Military information center, in order to
and civilian teams to carry out a joint epi- “provide distinct military call center for
demiological investigation” (Lion, Kassirer, giving quick and effective responses to
Aran, 2015). callers” (Lion, Kassirer, Aran, 2015).

Bioterrorism: the Invisible Enemy

15
SECTION 4 -
CONCLUSIONS & RECOMMENDATIONS

“There is no technical solution As other researches and studies, the aim of

to the problem of biological weapons. this paper is to emphasize the urgency for
It needs an ethical, human, military, non-military, and governments all
and moral solution.” around the world to deal with biological ter-
rorism, or biological warfare. In fact, the real
(Joshua Lederberg, issue is not how many possibilities there are to
1998 Nobel Prize in Medicine) be threatened by a biological attack. Rather,
the questions are: when and how to effectively
respond to these deadly offensives, whose cat-
Figure 7 – Sailors train for chemical astrophic consequences and impacts could be
and biological warfare. Photo: U.S. Navy

16
particularly devastating for people, animals, tive man-related attacks? The answers are
plants, the environment, the public health ambiguous and unfortunately not clear yet.
system, and the whole economy of the affect- There is a still lot to do for working together
ed nation. Particularly, the real success of a in a more efficient and effective way, and sure-
biological attempt is defined by the measure ly further studies are needed.
of societal disruption and panic, and not nec-
essarily by the number of victims. One possible solution to prevent biological
attacks could lead to a deadly disease outbreak
Are we ready enough for facing a possible bi- like a flu epidemic, has been implemented last
ological outbreak? Is the interoperability and month (July 2018) by the UK Government.
cooperation among the several armed forces, The plan consists in building up health ser-
not only in Europe, but in the whole globe, vices in the poorest countries of the World in
strong enough for sharing in timely manner order to secure the UK’ long term national
essential information for containing destruc- security. In fact, biological attacks and the re-
sulted outbreaks of diseases are often spread
by global migration and international travels
as these diseases are not limited by interna-
tional borders.

A second strategy could be the direct training

of special groups within the armed forces in
working with real biological agents in realistic
conditions. At the beginning of August 2018,
Spain for the first time implemented this pos-
sible solution, leading a multinational tactical
group in “Precise Response”, carrying out a
mission of personnel and material coming
from a contaminated area with real agents.
One of the best side of this exercise was the
international cooperation with allied coun-
tries, such as France, Norway, and Denmark,
showing one more time how interoperability
is the key to succeed within the invisible, un-
predictable, and destructive CBRN threats,
risks, and attacks.

The following are possible recommendations

that need to be implemented for preventing
ad dealing with a bioterror attack:

1. Ensuring the respect of international and

national regulations against biological
weapons, avoiding them to become trag-
ically normalized. Therefore, new leader-
ship, stronger unity, international coop-

Bioterrorism: the Invisible Enemy

17
 eration, more efficient intelligence and 8. Developing standard disinfection meth-
security measures, epidemiological sur- ods and techniques;
veillance, better standards of biosecurity 9. Encouraging people and citizens to regis-
and biosafety, a superior strategy on how ter and get trained for a national disaster
to act in case of crisis managements and management team, through the massive
crisis communications, and the end of use of social campaigns, internet and mass
impunity are needed by the international media as well;
institutions and community; 10. “Free teaching camps should be organized
2. Training and updating primary doctors, for community preparedness in border ar-
nurses, physicians, infectious disease spe- eas where the population is more at risk”
cialists, hospital epidemiologists, state (Krishan, Kaur, & Sharma, 2017);
and local health officers in early detec- 11. Mass level immunization may be offered,
tion of the most common and important especially for the most vulnerable people;
biological outbreak. The best strategy 12. Building community disaster resilience
could be developing a trained biological as a source of human capital for response
disaster quick response team regularly and recovery;
updated; 13. Creating a standardize database and cod-
3. Increasing the funds for biological re- ing scheme, using key words commonly
searches and joint international research used by health officers, military, and civil-
programs, improving at the same time the ian in order to save time and finding easier
vaccines capabilities, especially for small- and faster the needed information.
pox and anthrax;
4. Educating civilians, military, and policy-
makers globally about the authentic reali-
ties of a biological attack;
5. Involving all relevant institutions at a
local, regional, and international level
(health, police, civil defence units) in the
process of preparation, treatment, and re-
covery;
6. Developing more and more developed bi-
osensors with higher sensitivity and speci-
ficity, smaller, portable, and cost-effective.
It could be possible “to use Genetically
Modified plants that change colour with
the presence of biological agents” (Leonce,
2013);
7. Forensic techniques should be strength-
ened to detect the origin or presence of bi-
ological weapons. For instance, it could be
useful to utilize “sophisticated, rapid and
ultra-sensitive methods like mass spectros-
copy, Raman spectroscopy, biosensors, or
other molecular techniques” (Krishan,
Kaur, & Sharma, 2017);

18
BIOGRAPHY
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• IISS (2015) “The BWC: issues for the 2016 ological weapons: handle with sufficient and
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• Leonce, C. (2013) “Bioterrorism: can we • The National Intelligence Council (2012)
and should protect ourselves from it?” “NIC Global trends 2030”
• Lion, P., Kassirer, M., & Aran, A.A. (2015) • The Royal Institute of International Affairs:
“Implications drawn from a military bioter- “Use of chemical, biological, radiological, and
ror exercise in Israel” nuclear weapons by non-State actors”, Emerg-
• Loria, (2017) “Everything we know about ing Risks Report 2016, Innovation Series,
North Korea’s bioweapons program” Chatham House
• Lt Col Jean-Baptiste Meynad, et al. (2009) • Tucker, JB. & Zilinskas, RA (2006) “The
“Advantages and limits of real-time epidemi- promise and perils of synthetic biology”
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• Martens, M. (2016) “Chemical, Biological, • Wheeler, D. A. (2008) “The complete ge-
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tention”

Bioterrorism: the Invisible Enemy

19
Created in 1953, the Finabel committee is the oldest military organisation
for cooperation between European Armies: it was conceived as a forum for
reflections, exchange studies, and proposals on common interest topics for the
future of its members. Finabel, the only organisation at this level, strives at:

• Promoting interoperability and cooperation of armies, while seeking to

Responsible publisher: Mario BLOKKEN - Finabel Permanent Secretariat - QRE - Rue d’Evere,1 - B-1140 Brussels - +32 (0)2 441 79 38
bring together concepts, doctrines and procedures;
• Contributing to a common European understanding of land defence issues.
Finabel focuses on doctrines, trainings, and the joint environment.

Finabel aims to be a multinational-, independent-, and apolitical actor for the

European Armies of the EU Member States. The Finabel informal forum is based
on consensus and equality of member states. Finabel favours fruitful contact
among member states’ officers and Chiefs of Staff in a spirit of open and mutual
understanding via annual meetings.

Finabel contributes to reinforce interoperability among its member states in the

framework of the North Atlantic Treaty Organisation (NATO), the EU, and
ad hoc coalition; Finabel neither competes nor duplicates NATO or EU military
structures but contributes to these organisations in its unique way. Initially
focused on cooperation in armament’s programmes, Finabel quickly shifted to
the harmonisation of land doctrines. Consequently, before hoping to reach a
shared capability approach and common equipment, a shared vision of force-
engagement on the terrain should be obtained.

In the current setting, Finabel allows its member states to form Expert Task
Groups for situations that require short-term solutions. In addition, Finabel is
also a think tank that elaborates on current events concerning the operations of
the land forces and provides comments by creating “Food for Thought papers” to
address the topics. Finabel studies and Food for Thoughts are recommendations
freely applied by its member, whose aim is to facilitate interoperability and
improve the daily tasks of preparation, training, exercises, and engagement.

Quartier Reine Elisabeth

Rue d’Evere 1
B-1140 BRUSSELS

Tel: +32 (0)2 441 79 38

GSM: +32 (0)483 712 193
E-mail: [email protected]

You will find our studies at

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