Anthrax: Two Years Later

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In October of 2000, ABC News broadcast a television horror story depicting terrorists pitching bottles of anthrax spores onto the tracks of an American city's underground railway, releasing an invisible cloud of deadly bacteria that would kill 50,000 people within a week. The show served its purpose, horrifying viewers, so much so that ABC had to publicly clarify that the program was pure fiction. One year later, in October 2001, hypothetical bioterrorism became grim reality with one person at ABC's New York headquarters, the child of a producer, among the infected.

anthrax2003 Fast forward two more years to today's stories: large-scale smallpox vaccination plans, terrorism drills, anthrax cleanup efforts, talk of botulinum toxin (commonly known as the anti-wrinkle agent Botox) as a potential bioterror weapon all making headlines with seeming regularity. What a remarkably different world we now find ourselves living in.

The 2001 anthrax attacks killed five Americans and infected eleven more with the often deadly inhalational variety. The attacks paralyzed the U.S. postal system and shut down the U.S. Senate. All this, in addition to inflicting unquantifiable trauma on the minds of Americans already on edge in the aftermath of September 11. Two years later, it seems an appropriate occasion to review lessons from the 2001 anthrax attacks.

The Perils of Complacency

Complacency isn't justified by what we know about anthrax. The 2001 attacks, though disruptive and costly, served as a greatly watered down demonstration of the grave lethality of anthrax. Had the anthrax been effectively dispersed using an aerosol-delivery system inside buildings or over large outdoor areas, an anthrax exposure and subsequent infection could have occurred without our knowledge. Such an event occurred in the former Soviet Union in 1979 when an invisible cloud of anthrax spores accidentally leaked from a secret biological weapons plant known as Compound 19, resulting in at least sixty-six deaths. It is estimated that a well-executed anthrax attack in a concentrated urban area poses a threat comparable to that of a nuclear device.

While it is true that antibiotics are readily available to treat anthrax infection, there is an important caveat. Treatment with the antibiotic ciproflaxin hydrochloride (Cipro) or other antibiotics (e.g., doxycycline) would be of very little use if not administered promptly. If left untreated, anthrax is often fatal. What this means is that if there were an aerosol release of weaponized anthrax spores, which have the potential to travel miles before dissipating, it's possible that we might not know exposure has occurred until people with serious respiratory distress start turning up at hospitals. In most cases, administration of antibiotics would then be of little use.

There is a licensed anthrax vaccine available. However, because of the limited stockpile of the vaccine, it has been restricted to use on military personnel or reserved for use by emergency responders. The vaccine is generally considered to be safe and effective in preventing the onset of the disease, though it takes at least two weeks before it begins providing protection. Currently, the vaccine is not available on the open market. Given the potential enormity of the damage a well-executed anthrax attack could inflict, civilian stockpiles of this effective vaccine ought to be increased for distribution in the event of an emergency.

Putting Risk in Proper Perspective

From looking at the relative amounts of attention various bioterrorism agents receive, one might conclude that smallpox is our foremost concern. Yet it is at our own peril that we downplay the real threat of anthrax. For the most part, smallpox was eradicated in 1977. Officially, the United States and Russia hold the only remaining stocks of the smallpox virus. While much has been made of rogue nations possibly possessing the virus, there isn't any hard evidence available to support this allegation. Anthrax is a different story: As of 1995, seventeen countries had biological weapons programs, and of those seventeen, Iran, Iraq, North Korea, and Syria are believed to possess weaponized anthrax, according to a 2002 report by the Center for Nonproliferation Studies at the Monterey Institute of International Studies in California.

According to experts at the U.S. Army Medical Research Institute of Infectious Diseases at Ft. Detrick, MD, anthrax constitutes the single greatest biological warfare threat that we face. The 2001 anthrax attacks (which remain unsolved) confirm the threat, yet the federal government's stress on the still-hypothetical risk posed by smallpox has overshadowed this reality.

Preparing for the Possibility of Subsequent Attacks

The best thing that you can do to prepare for the possibility of subsequent anthrax attacks is to arm yourself with information, rather than naively purchase items such as anthrax test kits and "safe-room" components. Get started by familiarizing yourself with ACSH's report Anthrax: What You Need to Know. Facts mitigate the fear that arises from ignorance, hype, and misinformation. Information alone won't prevent another round of anthrax attacks, but it will help to combat widespread panic and help us decide where our limited resources are best invested.

Joshua Lederberg, an esteemed biologist and Nobel laureate, reported to the U.S. Senate Committee on Foreign Relations less than two months before the 2001 anthrax attacks that "biological warfare is probably the most perplexing and gravest security challenge we face." In the aftermath of the 2001 anthrax attacks, we appear to have adjusted to this new reality with disturbing ease, leaving one to wonder whether or not we really understand the seriousness of the threat we still face.