A Seminal Event: A Review of Recounting the Anthrax Attacks

It has been almost 18 years since the anthrax attacks in which 22 people were deliberately infected with the deadly bacteria to which 5 people succumbed. To many of those who do not work in the field, this event has likely faded from memory. In lectures to medical students a few years ago, anthrax was described as some sort of “panic” that occured post-9/11 with little appreciation that it was an actual attack. Given this context, a new book by an FBI agent (and PhD scientist) who worked the case is a welcome retelling of the events from a law enforcement and forensic vantage point. R. Scott Decker’s Recounting the Anthrax Attacks: Terror, the Amerithrax Task Force, and the Evolution of Forensics in the FBI is an easily accessible book that recaptures the environment of 2001 and details the birth of microbial forensics.

Decker does an excellent job recounting the ups and downs of the investigation . However, for someone familiar with the investigation I was disappointed to see several key elements not discussed. For example, Decker describes in detail the wrongful pursuit of Steven Hatfill and mentions a civil lawsuit regardings leaks but does not mention the fact that the https://www.theatlantic.com/magazine/archive/2010/05/the-wrong-man/308019/ on television and that taxpayers had to oay him millions of dollars for their (literal) dogged pursuit of him. Decker also gives just brief mention to the National Academies report on the forensic scientific approach used to reach their conclusion regarding the ultimate identity of the anthrax mailer, which I believe strongly delimits what the microbial forensics was able to conclude. No where does Decker mention the baffling approach the government took to defending itself in the lawsuit filed by the widow of the first victim in which they stated, in a court filing, that the identified anthrax mailer “did not have the specialized equipment” needed to commit the attack. (For more on the merits of the case I refer you to this PBS Frontline piece).

Despite what I think are serious omissions, I do think that the book is compelling reading as it underscores the threat of biological weapons, provides a great deal of information on how the investigation progressed, discusses how the government had to develop the wherewithal for such an unprecedented attack, and shows the birth of microbial forensics. The book also revisits tantalizing coincidences such as 9/11 hijackers renting an apartment from the first victim’s colleague’s wife as well as the activities, the tracing of the repositories that held the Ames attack strain, the legal travails of an anthrax vaccine manufacturer, and numerous other incidents that are important to understanding the complexity of a bio-attack. For these I think it is recommended reading for those in the field and who have an interest in this topic.

Viruses, DNA Cages, and Tigers, Oh My! A Review of Tiger Tiger

In a world in which daily headlines announce breathtaking advances in genetic engineering and synthetic biology that have the promise to eradicate disease and lengthen lifespans, it is not surprising -- and actually prudent -- that there efforts to understand how such technology could be misused. So called, dual use research of concern, is not something that is specific to biologic advances it applies to literally everything. Any technology can be misused from a drone to a fishing rod. However, it is the threat of bioterrorism coupled to rapid advances in biology that have motivated much concern and debate. Naturally, this debate has spilled into popular culture with a planned television show centered on the gene editing technology CRISPR in the works and several books, including a fiction thriller I just finished.

Tiger Tiger, the second novel in author Joann Mead's Underlying Crimes series of bio-thrillers, is the story of a biological attack on the United States and efforts to stop it. This attack is not accomplished using the usual suspects of anthrax, smallpox, plague, or botulism. It is accomplished using engineered influenza viruses -- inspired by the controversial influenza gain-of-function experiments -- for which there is no vaccine readily available. The perpetrator of the attack, an overtly nihilist philosophy professor, seeks out unscrupulous and disturbed scientist from whom to purchase these tiger influenza viruses which are derived from strains that had caused an outbreak in zoo tigers (something that has really happened). The delivery system for these viruses is no crop-duster by DNA molecular cages -- a major advance in nanomedicine.

The plot oscillates between the nefarious actors attempting to initiate their attack and the efforts of a secret group of government agents and other experts (the Partners)  to discover what is occurring after the first test infections are "successful". As they race to unravel the etiologies of these infections in order to stop them before a bigger wave of infection occurs, Mead emphasizes how open source intelligence gathering from social media, for example, can be harnessed in such endeavors as her namesake character run down various clues.

I enjoyed reading the book, less for its literary value (and multiple unusual sex scenes), than for its presentation of how a bioterrorism attack might look in the world of nanotechnology, CRISPR and synthetic biology. When it comes to these technologies, I view them as pathbreaking technologies with enormous value that far eclipses any potential downside from improper use -- which isn't as easy as it might seem in a novel, a movie, or a government report. I also enjoyed a science-driven plot that was not completely fantastical and well-informed by the actual issues, the science, and the technology of the day.

The theme of Tiger Tiger may be the relative ease with which a bioterrorist attack can be executed and the increasing realization of that fact by those who would seek to do harm -- something which almost everyone in my field would agree is true.

What are the Barriers to Bioweapons? A review of Sonia Ben Ouargham-Gormley's Important Book

Rapid advances in science which have simplified the skill set needed to perform what once were sophisticated experiments coupled with the ubiquity of biological agents in the environment comprise the standard narrative regarding the risk of of biological weapons development. The threat of these banned weapons as assessed through the lens of the standard narrative led to the dire prediction in 2008 by The WMD Commission that an attack using, most likely, a biological weapon would occur by 2013. 

This is a narrative I have presented countless times when lecturing on the topic. I do add in that a lot of tacit knowledge, an identification made by Kathleen Vogel in her book, is needed as biological weapons manufacturing, even on small scales, is not as easy as making crystal meth. Almost invariably, I am asked by an audience member why, if this process is so easy,  a large-scale biological attack has not occurred. I don't usually give an answer that I myself find satisfactory.

However, I never appreciated how potentially limiting the "standard narrative" is to how the world approaches counter threat activities and how I answer the above question. George Mason University's Sonia Ben Ouargham-Gormley's 2014 book Barriers to Bioweapons: The Challenges of Expertise and Organization for Weapons Development convincingly illustrates how a new conceptualization -- inductively derived from the experiences of the US, Soviet, Iraq, South African, and Aum Shinrikyo biological weapons programs -- of the risk provides a new path to positively augment current counter threat activities and answers the question frequently posed to me.

Throughout this book Professor Ben Ouargham-Gormley challenges the premise that the formative stage of a bioweapons program is the most crucial to the acquisition of biological weapons capacity. She argues that the formative stage, which involves the acquisition of biological material and technology, is not nearly as important as the sustenance phase of a program in which the actual production, scale-up, and viable weaponization occur. Nuclear counterproliferation, she further argues, is much more suited to a focus on the formative stage and this paradigm is not wholly applicable to the biological realm.

As she writes,“in the bioweapons field, expertise and knowledge—and the conditions under which scientific work occurs—are significantly greater barriers to weapons development than are procurement of biomaterials, scientific documents, and equipment.”

The quick retort to her might be that the deadly anthrax attacks of 2001, the almost monthly reports of someone home-brewing the assassination tool ricin, and the continual "white powder incidents" demonstrate that the threat of biological weapons at any scale is dangerous enough to provoke calamity and fear. Additionally, Project Bacchus, in which 1 kilogram of an anthrax simulant was made from off-the-shelf materials in a 2 year US government project shows what is possible. These points are definitely true but miss the point of this work as they are not the exact subject of the book nor the intended focus of much of our preparedness activities, the large breadth and scope of which are aimed at larger scale use of biological weapons. Similarly, it is not that her thesis is that no large scale bioweapon production could ever occur, but that it is most likely to occur in a certain contexts.

Professor Ben Ouargham-Gormley provides ample evidence for her thesis from several known biological weapons programs, concretizing that even in the most adept programs difficulties arose because of suboptimal organizational and managerial practices. The book heavily documents such practices and provides much evidence, as well as many important anecdotes involving Soviet bioweapons scientists as well as the infamous Iraqi scientists Dr. Germ and "Chemical Sally".

My understanding of the topic has been greatly deepened by this work and this scholarly treatment of a vital national security issue is a welcome addition to the field.

Living Weapons: A Scholarly Analysis of Biodefense

In many ways the field of biodefense is young and still developing a robust amount of scholarly materials from which the foundations of the discipline will develop and new work flourish. There are, however, several books which, in my estimation, are worthy of being described as foundational in their approach.  I read almost everything in this field and usually find my knowledge deepened and better integrated by the process so each latest book is progressively less impactful. George Mason University's Gregory Koblentz's Living Weapons: Biological Warfare and International Security (2011) is one such book that bucks the trend in a good way and is a book that I highly recommend to those in the field.

Koblentz's book is a comprehensive overview of the field of biological weapons that is not a mere cataloging of the pathogens and the history. The book provides extensive analysis of the field and is especially illuminating when it comes to the problem of intelligence gathering in this realm. This, to me, was the chief value of the book.

Using the historical examples of biological weapons programs in the Soviet Union, Iraq, and South Africa Koblentz meticulously analyzes what western intelligence knew and what they did not and why. The book includes important tables that basically score intelligence agencies on whether they correctly identified a biological weapons production facility or not. 

The other aspect of this book is a very in-depth critique of the intelligence shortcomings that led to the mistaken conclusions regarding Iraq's post-Desert Storm biological weapons capabilities and intentions. Koblentz approaches this task not with a partisan aim but to better understand the nuances of infamous informer Curveball's revelations in order to improve intelligence capabilities in the future (in 2003 just 6 analysts in the CIA were devoted to biological warfare). His ideas for intelligence improvements are reflected in some of the newly released recommendations for the Blue Ribbon Study Panel on Biodefense. 

For those wanting an intellectually rigorous overview of a fascinating field that provides a foundation for a viable path forward, Living Weapons is a great addition to one's library.

Preparing Minds for Bioterrorism

I often give interviews to the press on various infectious disease topics and a few months ago I was talking to a journalist and referenced the anthrax attacks of 2001. The journalist replied, “Oh yeah, the anthrax 'scare' back then.” I replied, “it wasn’t a ‘scare’ it was an attack in which 22 people were infected and 5 murdered via spores being sent through the US Postal System.”

That 14 years have now passed since the Amerithrax attacks means that those horrific times have faded from people’s memory and that’s not a good thing because the threat remains.

With that context in mind, my colleagues and I wrote a clinical review paper with the aim of refreshing clinician’s minds with new information on these important infectious diseases (anthrax, plague, botulism, tularemia, and smallpox). We were ecstatic when the most prestigious medical journal in the world, The New England Journal of Medicine, accepted it for publication.

The subtext of the entire update is that it is vitally important for clinicians—the front-line defense against these pathogens—is armed with the knowledge necessary to recognize and treat these diseases as well as know when to sound the alarm.

As my hero Louis Pasteur famously said, “chance favors the prepared mind” and our hope is that our paper will prepared the minds of those crucial to protecting this nation from another bioattack.