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Terrorism, War, or Disease?

Stanford University Press

Chapter One

Identifying Biological Agents, Characterizing Events, and Attributing Blame

ANNE L. CLUNAN

The use of biological warfare (BW) agents by states or terrorists is one of the world's most frightening security threats. Killers such as anthrax, smallpox, botulism, tularemia, viral hemorrhagic fevers, and plague, and incapacitating diseases such as brucella, salmonella, typhoid, and shigellosis—the diseases commonly listed as BW agents—are invisible. Their effects may take days to manifest. BW agents can vary widely in the effects they can produce on humans—from incapacitating a population to causing mass deaths—and on animals and agriculture. Those who use BW may have impact without detection, and this possibility makes it more difficult for states to deter other states and terrorists from using biological weapons.

The risk that BW attacks might never be traced back to a particular source is greater than for nuclear or even chemical attacks, in part because BW attacks may look like those of naturally occurring disease. Historically, attributing blame for BW use has been fraught with controversy and may take a very long time. Only in 2002, for example, did a court in Japan formally acknowledge the Imperial Japanese Army's deliberate infection of Chinese prisoners and citizens with bubonic plague in 1940-42. Controversy still exists about aspects of many other alleged cases of BW, including the "Yellow Rain" episode in Southeast Asia. Even for other incidents known to be biological warfare or terrorism, such as the 2001 anthrax letters in the United States, the perpetrator remains un known (see Table 9.1 for a summary of twentieth-century BW incidents, claims, and attempts).

The difficulties involved in determining whether terrorism, warfare, or disease is the source of a biological event may give the initiators of a BW release confidence that they might get away with a BW attack without being blamed or even suspected. Improved capabilities for accurate and rapid attribution of BW use are therefore central to the two key strategies available to policymakers: deterring an attack through the threat of retaliatory punishment, and deterring through denial of impact, by mitigating the consequences of an attack on the state and society.

Deterrence may require government capabilities to determine, first, what the agent of disease might be; second, whether a biological outbreak is terrorism or warfare, or is instead a naturally occurring disease; and third, if so, who is to blame. These are the three elements of the process of attribution, which are spelled out later in this chapter. First, however, I spell out how BW deterrence works, before explaining how the process of attribution works and how it may contribute to deterrence. The chapter then concludes with an overview of the rest of the book.

BW Mitigation and Deterrence

Enhanced mitigation of the effects of BW should have a deterrent effect on potential BW attackers: societies that are clearly capable of substantially limiting the consequences of a biological attack are much less likely to be targeted, since the desired outcome of the attack is less likely to be achieved. To succeed at such deterrence by denial, governments must be capable of determining, quickly and accurately, which biological agent has been used (this is step one of the three-step attribution process). Identification of the agent can increase the effectiveness of medical intervention, minimizing the public disruption and damage that are the aims of would-be attackers. Knowing whether the attack was deliberate and understanding the motives behind it (the second element of the attribution process) may also help emergency responders and public-health officials allocate appropriate resources and capabilities during the outbreak, and to prepare for further outbreaks. Capability of making such a determination may thus contribute to deterrence by denial, and is essential to deterrence by punishment.

Deterrence by punishment hinges on knowing whom to blame, the third element of the attribution process. Although nuclear weapons bear the unmistakable "signature" of the countries that manufactured their nuclear material, biological agents are unlikely to carry such signatures. Biological warfare agents could be found "in the wild," and rapid advances in biotechnology mean that new biological agents are being created in the commercial and scientific spheres that could also be used as weapons.

Knowledge Makes for Better Policy

In the face of such challenges, the literature on biological warfare attribution is underdeveloped. Further, most of it predates the 2001 anthrax attacks in the United States and the Bush Administration's decision to withdraw from negotiations on a verification protocol for the Biological and Toxin Weapons Convention (BWC). Some studies have examined the nature of the BW threat, offered histories of state and non-state actors' BW programs, and explored the potential and the pitfalls of biological defensive efforts. Some have focused on assessing the threat posed by biological weapons. Notable is Biological Weapons: Limiting the Threat which, however, focuses on BW challenges primarily from a public-health perspective. Other works examine how biological warfare might be carried out, and inter-state efforts at arms control and nonproliferation. Toxic Terror concentrates on the types and nature of sub-state actors, such as terrorist groups, that have used biological or chemical weapons. One recent work, Scientific and Technical Means of Distinguishing Between Natural and Other Outbreaks of Disease, focuses only on part of the BW attribution problem—distinguishing between natural and deliberate attacks—but does not examine the many sociopolitical factors that affect the attribution process.

Much of this literature points out that the difficulty in identifying a biological warfare attack and accurately attributing its use hinders public-health responses, and also impedes deterrence of BW attacks, since deterrence requires knowing whom to blame. Little attention, however, has been devoted to understanding how to improve attribution of BW events, and much of that has focused on the scientific and technical difficulties and on biological, technical, legal, and criminological issues. Yet, as this book shows, BW attribution is as much a political problem as it is a scientific one.

This book seeks to fill the gap, addressing political, military, legal, and scientific challenges involved in determining when biological weapons have been used and who has used them. Internationally recognized experts offer detailed analyses of the most significant allegations of BW use from the Second World War to the present, assess past attempts at attribution of unusual biological events, and draw lessons from these cases for current attribution policy. They identify political, social, and economic as well as scientific factors that affect when, how, and with what success states may undertake attribution. A major contribution of this book, and the substance of this chapter, is to offer a definition of the multifaceted problem of tracking down the perpetrators of biological warfare, and analysis of the forces that shape each phase of the attribution process. This chapter next outlines the three steps that make up the process of attribution.

The Three Steps of the Biological Weapons Attribution Process

The problem of identifying an intentional use of biological weapons and knowing whom to blame has three interrelated parts, each with its own particular requirements: identification of the biological agent(s) responsible for an event; characterization of the event as intentional or unintentional; and attribution of use to a specific perpetrator. These three parts—identification, characterization, and attribution—make up what is referred to in this volume as the BW attribution process. For example, in the U.S. anthrax cases (see Chapter 2 by Leonard Cole), identification of the agent as anthrax was the first step, and the most important in terms of public-health response. It was relatively simple to identify the agent used in the attacks and to characterize the event as deliberate, since the envelopes containing the anthrax also contained letters announcing its presence. As in most cases, however, attribution to a specific perpetrator is more difficult. Questions still remain about the strain of anthrax used and the method by which it was processed. Answering those questions would significantly narrow the field of possible perpetrators, but the case remains unresolved as of this writing.

In the event of an overt attack with military-grade weapons, the three-part process of attribution might be relatively uncomplicated. However, a covert attack or one using non-military-grade strains of a BW agent would make the attribution process much more difficult. The nature of biological agents, as well as the politics that surround characterization and attribution of a biological event, contribute significantly to the attribution problem. The cases described in this volume suggest that any effort to attribute BW use must attempt to accomplish the three elements of the attribution process within some agreed range of how much of the inevitable uncertainty is acceptable, aiming to avoid bias and preserve public trust.

The question of the degree of acceptable uncertainty highlights the crucial issue of what standards of evidence are necessary for BW attribution. In all three parts of the attribution problem, both legal-scientific and political standards for information are important. Throughout the BW attribution process, actors must attempt to meet legal and scientific standards for the collection of evidence if any attribution of use is to be credible internationally or in a court of law. In the United States, for example, public-health agencies may conduct searches without judicial warrants, but resulting evidence might be excluded from criminal cases if deemed the fruit of warrantless or unconstitutional searches. Legal evidentiary standards may govern search and seizure, wiretapping, or other forms of information collection. Close cooperation between law-enforcement and public-health officials is therefore required in order to meet appropriate standards for the collection of evidence and the custody of evidence. Scientific standards require, among other things, the replicability of tests by independent researchers and establishing a degree of confidence in the results of analysis linking agent with disease and disease with intentional attack.

Both legal and scientific standards require that the evidence is demonstrably not tampered with. However, ensuring a properly documented chain of custody of evidence can be extraordinarily difficult in BW cases. Samples, control samples, and physical evidence must be collected, preserved, and transferred in such a manner as to protect them from contamination, to document where they came from, and to make it clear that they have not been tampered with. Yet in many cases, the first responders to a biological event may not know that it may become the subject of a BW investigation. The first people to collect what may become evidence may be the victims, or humanitarian relief workers operating in refugee camps, or emergency room doctors and primary-care physicians. As Chapters 4 and 5 on Yellow Rain in this volume make clear, there is considerable potential for controversy regarding the scientific validity of data, for both scientific and political reasons.

Charges of BW use must also be politically persuasive. The standard of proof must be sufficiently high that it allows a decision maker to make a well-informed decision on whether or not to take steps to apprehend or retaliate against the perpetrator. As deterrence rests on credible threats to retaliate, attribution must achieve a degree of certainty that allows policymakers to respond, but such responses must be widely viewed as legitimate, not misplaced or politically motivated. Given the domestic and international need for any retaliation to be seen as legitimate, meeting very demanding legal-scientific standards should be the goal in all cases, even though it may not be reached. Particularly in cases where a state alleges that a foreign actor used BW, the state must, at a minimum, act on the basis of a scientifically valid preliminary attribution process and show its willingness to have its investigation and methods reviewed by outside experts, and even better, to accept a multilateral investigation of the alleged attack under international auspices such as those of the United Nations. Only under these conditions are allegations of a biological weapons attack likely to be credible. If the accusing state has conducted its own investigation according to rigorous scientific standards, then it will have little reason not to invite outside scrutiny of its charges. Such standards would also serve to discourage states from making false allegations, such as those highlighted in Chapters 6 and 7, in the hopes of politically shaming an opponent, as any allegation that is not accompanied by openness to independent and multilateral investigation would be suspect.

Identification of the Disease Agent

The key biological agents most associated with warfare and terrorism, according to the World Health Organization (WHO), are Bacillus anthracis (anthrax), Clostridium botulinum (botulism toxin), Yersinia pestis (bubonic, septicemic, and pneumonic plague), Francisella tularensis (tularemia), and Variola major virus (smallpox). The U.S. Centers for Disease Control and Prevention (CDC) lists these and viral hemorrhagic fevers (filoviruses such as Ebola and Marburg, and arenaviruses such as Lassa and Machupol) as the disease agents of most concern because of their ease of human-to-human transmission (contagiousness), high mortality rates, potential for public panic and social disruption, and specialized public-health requirements. Less dangerous agents that are also listed by the CDC as potential BW agents include Brucella (brucellosis or undulant fever), Clostridium perfringens (epsilon toxin), Salmonella typhimurium and Salmonella entriditis (salmonella), Escherichia coli O157:H7, Shigella sonnei, flexneri, and dysenteriae (shigellosis), Salmonella typhi (typhoid fever), Vibrio cholerae (cholera), and emerging infectious diseases such as Nipah virus and hantavirus.

The central issue in identifying a BW agent is distinguishing signals—pertinent information—from background noise, such as poor public-health and poor environmental conditions, the presence of diseases with symptoms similar to potential BW outbreaks, and the normal disease patterns of the locale. As Leonard Cole notes in Chapter 2, in the U.S. anthrax case, the flu-like symptoms associated with inhalation anthrax led to many misdiagnoses of infected postal workers, despite widely broadcast signals that anthrax had been found in letters. In this case, first responders did not separate signals from noise, the disease was misidentified, and deaths resulted. Many of the diseases listed as BW agents have symptoms that may be confused with other common or endemic diseases, making it difficult to identify the disease agent correctly, especially as diagnosticians are trained to focus on the most likely hypotheses for the appearance of symptoms, rather than on rare or exotic causes.

Identification of the agent causing a disease is largely a medical and scientific issue. The primary actors are likely to be emergency room doctors, poison control centers, primary care physicians, veterinarians, humanitarian aid workers, epidemiologists, disease specialists, and biologists. Scientific knowledge, and especially technological advances in DNA sequencing, now allow pathogen identification at the strain level, which should generally meet law-enforcement standards of evidence. However, developments in genetic engineering mean that new agents, or agents that do not conform to known epidemiological patterns, may be created that would make characterization and attribution much more difficult. In such cases, information from public-health officials, academic experts, and the biotechnology community may be necessary to identify where a particular strain originated. However, as Chapters 4 and 5 on Yellow Rain suggest, it may be neither easy nor simple to reach agreement on what biological or toxic agent may be involved, even within the medical and scientific community let alone the political community.

A biological agent, once introduced, generally first manifests as a health problem, and is only detected if victims seek medical care. Healthcare professionals are therefore the frontline forces in biological terrorism and thus in BW attribution, particularly at the identification stage. These would include veterinarians or, in the case of plant pathogens, plant biologists. Such first responders will probably be the ones to notice that an unhealthy patient, animal, or crop presents particular symptoms, and to identify and report disease outbreaks. 17 Domestic detection of a disease outbreak requires pooling information gathered by healthcare providers or other first responders, infection control practitioners, and health departments. Internationally, this list includes disease surveillance systems, national health ministries, international agencies such as the WHO and the Animal Health Organization (OIE, Office des Epizooties), and non-governmental organizations (NGOs), particularly humanitarian aid organizations, as well as environmental monitors (who may be the first to note the appearance of endemic, novel, or genetically modified organisms).

(Continues...)

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Excerpted from Terrorism, War, or Disease? Copyright © 2008 by Board of Trustees of the Leland Stanford Junior University. Excerpted by permission of Stanford University Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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