Foto Ansa   In the history of humanity every new scientific discovery has been accompanied by the risk of a dual-use purpose – for peaceful use or for war purposes. In the field of non-conventional weapons (chemical, biological and nuclear), the recent development of biotechnologies, complex informatics technologies, new techniques in bioengineering and the utilization of nanosciences and nanotechnologies has opened the way to a series of innovative instruments which are able to counter this type of threat and strengthen the defensive capacity of protection and decontamination and the development of new combat instruments, but, at the same time, these instruments represent threats that are even more insidious and difficult to counteract. In particular, the risks associated with the deliberate release of lethal biological agents and the need for an efficient health care system, together with the necessity of more security for the populations to fight such threats opens new scenarios of response and preparation at the transnational level. The numbers printed in the article refer to the publications and internet sites cited in the bibliographical list.

Introduction

Although defined as an infrequent event because of the sporadic episodes in the past, today, the potential use of noxious biological agents represents a disturbing issue, also in light of the growing social and political instability and the increase in the number of conflict zones in many nations.
Many States are at the risk of internal conflicts of a religious and ethnic nature and, often, they are also characterized by an extreme vulnerability due to the uncontrolled growth of the populations, to the aging of the populations themselves, to the poverty, to the misdistribution of the populations in areas at risk of natural disasters, to deteriorated urban areas caused by uncontrolled processes of urbanization and to social exclusion, in conjunction with an inadequate preparation in terms of solutions to such emergencies.
Furthermore, if we take into consideration the new infectious pathologies, those emerging and re-emerging, we shall find that we are confronted with a complex and difficult phenomenon and the risk of having to combat new pandemic and epidemic forms is no longer remote.
The management of complex contagious emergencies such as the pandemic diseases of the 2009-2011, the tuberculosis resistant to many of the existing drugs, and the last epidemic of E.Coli O104H:4, which struck Germany and France in July 2011, are a clear example (1).
Such infectious emergencies have spurred many Nations to review their public health care systems in order to prepare national plans in response to such threats, to actively participate in projects of international cooperation to increase their expertise in the field of early diagnosis of biological agents, for the purpose of preparing rapid and efficient responses intended to strengthen the plans of public health care and create a network of early alert and response, in the meantime seeking the interdisciplinary collaboration in the fields of defense, the government forces and the Intelligence. (2, 3, 4).
In the last twenty years, we have seen the discovery of more than 30 new infectious diseases and the identification of new viruses, among which we include the detection of the acquired immune deficiency virus HIV, the Ebola virus, Hepatitis C, the Hanta viruses, the Rota viruses, not to speak of the re-emerging pathologies such as cholera, diphtheria, malaria, yellow fever, the multi-resistant tuberculoses, often caused by the influence of altered environmental factors, e.g. the deforestation of wilderness areas, or to demographic factors, such as an increase of the urbanized areas and an increase in global travelling and commerce (2.5).
Well known examples are represented by the pandemic, product of the influenza virus, in 1918, which was characterized by a very high mortality rate, circa 100 million persons lost their lives, of which 500,000 alone in the United States of America. During the epidemic of 2009-2010, again in the United States alone, out of the approximately 59 million people affected – of which 265,000 patients were hospitalized – 12,000 deceased were recorded between 2009 and 2010 (2,6, 7).
AIDS has killed more than 11,7 million people in the world, (1, 7, 12). Certain sicknesses lend themselves better than others to be used as non-conventional weapons, due to the facility with which they can be managed, incubated or released into the environment, as well as for characteristics such as high rates of sickness or mortality.
Therefore, we find ourselves facing a possible use of biological agents as non-conventional weapons of mass destruction for terrorist or war purposes, which represent an important risk factor implicated in the disasters produced by man and his interaction with the surrounding environment (8, 9, 10, 11, 12).


The deliberate use of biological agents

The biological weapons (bacteria, viruses and other microbes) are, today, placed in the category of the so-called “dreaded risks”, i.e. those risks able to evoke disproportionate fear in man. Among the elements which make a specific risk factor particularly disturbing, we can cite: invisibility; the delayed effects of a biological agent; the difficulty of knowing how many people have been exposed or infected; foreseeing long-term effects, and the poor knowledge of the action mechanisms of risk (13).
Historically, the professional codes of behaviour adopted by the military in times of war, provided for the prohibition of the use of biological agents and micro-organisms to strike populations. Since ancient times the behaviour codes have always respected such principles, from the Saracen code based on the Koranic laws, to the Lieber code in 1863 in the United States of America, up to the Geneva protocol in 1925: all of them prohibited the use of biological agents against the populations (12). But the 21^st Century has been witness to the deliberate use of biological agents as weapons of mass destruction. The year 2001, a week after the 11^th September attacks, saw the beginning of the anthrax attacks via mail, addressed to two senators and exponents of the mass media. These attacks provoked an overall total of 22 cases of anthrax sickness, with 5 deaths. The suspected cases of contagion were estimated at 32,000 and, of these, over 10,000 patients had to undergo prophylaxis with antibiotics for 60 days to avoid contagion. The collateral effects were enormous. A series of post offices and sorting centers had to be decontaminated which, in turn, created serious difficulties for the United States postal system, entailing a slowdown of operations, with downstream effects on the entire economy, not to mention the activity which involved the total public health care system and the security, in order to ensure the care and safety of the population.
There were strong effects on the society, on the economy and on the social and governmental structures of an entire Country, which created social disruption and disorder. The anthrax attack demonstrated how the potential risk tied to the bioterrorism was able, not only to cause death and disability, but to create a serious problem at the level of the entire social and economic structure of a Country. Similar concern had already come from the danger of smallpox, which had been defeated. In fact, smallpox was officially defeated in 1979 and the vaccination campaign was subsequently suspended at world level, after the eradication. But the fear still remains that leaving a population unimmunized could create a generation of people that could be stricken by a fresh outbreak of the illness or following a deliberate attack entailing the utilization of such agents.
In 2003, SARS and, subsequently, the pandemics of the last three years confirm the fears deriving from a new pathogenic agent, from a possible danger of bioterrorism, since the impact of a new and unfamiliar pathogenic agent could have profound implications in the national and international social life of numerous Countries, in terms of public health, but above all, of national safety. SARS, in particular, defined new problems, classifying a pathology of international implications, dangerous for the security of one or more Nations and dangerous for public health systems at a global level: with person to person contagion, without the necessity of a carrier, without geographical borders, with a silent incubation period of more than a week and, often, simulating the symptoms of other sicknesses and confusing the diagnoses, involving and contaminating entire hospitals, creating problems that have to be resolved rapidly, problems not only of public health care, but of international security. The deliberate use of biological agents not only creates a potential risk for public health, but can cause mass global panic and hysteria.
The most real danger is to counter the global society. If you compare the chemical and nuclear weapons with biological weapons, the latter requires
a lower technological complexity to convert and acquire the raw materials. However, not all microorganisms can be used as noxious biological agents (bioterrorism weapons). It depends on their characteristics of virulence, infectiousness and lethalness; the facility, or not, of production; their stability, or not, in the environmental conditions, the susceptibility in a vulnerable population and the loss or inadequacy of means of prevention. If compared to the technology of nuclear science and the data released in the international ambit, information on how to use or produce biological agents is easily acquired from literature and from international scientific publications on the subject (2, 3, 8, 12, 13).
In the last decades hundred of pathogenic microorganisms have been investigated for their potential military use, but in reality, only about 40 have been found able to respond to such requisites. The Centers for Disease Control and Prevention of the United States (CDC) have classified such substances into 3 categories, according to suitability for use as biological weapons (A; B; C) (8).
Cat. A. The category of the highest risk. The biological agents are easily diffused, with high mortality, of serious medical impact on the public health; they can cause social panic and destruction, and require specific actions of response in the area of Public Health. Smallpox, anthrax, the plague, botulism, tularemia and hemorrhagic viruses belong to this category.
Cat. B. The category of intermediate-risk. Relatively easy to disseminate, characterized by moderate sickness and low mortality; Coxiella Burneti; Brucella species, Burkholderia Mallei, Epsilon toxin (CI Perfrigens), Staphylococcus , Enterotoxins, B Salmonella and Shigella.
Cat. C. Emerging pathogens that can be genetically modified or projected to become weapons of mass destruction. Belonging to this category are the Nipah virus, the Hanta virus, Rickettsiosi hemorrhagic fever, viral meningoencephalitis, Crimea-Congo virus, Omsk hemorrhagic fever, yellow fever virus, multi-existing tuberculoses.
Only a few years ago, an attack with biological agents seemed unthinkable. Unfortunately, the threat of bioterrorism is growing and becoming increasingly real. The diffusion of a biological agent for aerosolisation seems a difficult and rare event to prepare because of the technical impediments and, therefore, is precluded from success, but it is necessary to consider these events as low probability in their actuation, but of extremely high social and impact should they be verified. They should not be over or underestimated, but submitted to correct observation (8).


The impact of the new technologies and the “Dual Use” scientific research


The modern technologies of genetic manipulation open new scenarios for the production of new biological agents. The utilization of the biotechnologies has offered opportunities to better the conditions of public health and nutrition of the populations, but also offers a dark side represented by the possible use of such knowledge for harmful purposes, for the production of more aggressive and lethal agents by modifying the genetic properties of the microorganism, making it more virulent, more resistant to specific therapies, and more difficult to identify by routine examinations. Furthermore, genetic engineering makes it possible to render more accessible toxic substances which were, in the past, detected in quantities too small to be hostile. For example, the recombinant technology was used to insert genes in non-pathogenic microorganisms, in such a way as to render them highly pathogenic if modified in the genetic expression and in order to produce them on a large scale. However, in their turn, also the new vaccines and the biological agents can be developed and modified to fight the harmful biological agents.
The World Health Organization has taken part in the International discussions on bioterrorism, underlining that the surest way to effectively counter the bioterrorist risks, or the deliberate release of harmful biological agents, is the reinforcement of the monitoring and detection system, which is the same used in the case of the discovery of infectious diseases, and proposing an alert and response network to biological threats (GOARN – Global Outbreak Alert & Response Network). In other words, a network of technical collaboration of the existing institutions and networks that combine human resources and technologies for the rapid identification, confirmation and response in the case of contagion or infectious diseases at an international level (11, 14).
Such scenarios are the result of scientific research aimed at scientific and human progress for peaceful purposes, but are, unfortunately, often accompanied by belligerent intentions; this double peaceful/belligerent spirit is defined as “the dual use dilemma” of the biological agents.
At the moment, a lively debate is taking place in the scientific community on what is lawfully publishable to favour the progress and the scientific discoveries and what cannot be published and can even be censured for reasons of National and world security, as well as security limits on the scientific freedom. But the scientists, while obviously understanding the possible dangers deriving from their discoveries, defend their work, convinced of the necessity of having sufficient intellectual academic freedom to be able to continue their experiments freely. It is hoped that the scientific community understand how certain publications play a crucial role in alerting the scientific community of the importance of developing systems of protection of the scientific information, especially protection of the most dangerous information. However, the will to self-censorship on the part of the scientific community itself is very difficult to realize (4, 15, 16, 17).
Promoting security in the service of science will be the key to ensuring that the dual use of the science is balanced and can promote new scientific discoveries in respect of human rights and the security of the populations.


Conclusion


The dual use of science is certainly ethical in its intrinsic value. At the moment, bioethics are prevalently directed to the ethical researches and to the moral, social and legal implications of genetics, that is, it is focused on issues that concern the protection of man and the animals in the research environment, but places very little attention on the concepts of the dual utilization of research for peaceful or belligerent purposes, in the ethical and security area. Science is never evil in itself, but the use that derives from it can be so.
The medical community is the essential component of a multidisciplinary system involved in the mechanisms of planning, prevention, identification and response in the event of biological emergency. The organization and the mechanisms of response need to be planned with great care and must take into account the vulnerabilities of each specific nation; the local policies of public health; legislation concerning disasters and maxi-emergencies; technological and administrative problems, as well as involving the institutions in the field of national security. Certain Continents such as Asia and Africa, for example, are more at risk compared to others and have often been the breeding ground of new infectious pathologies. All nations have a public health system that responds in the case of epidemics and institutes the measures of control, prevention and response. Any possible biological attack is managed by the same institutions that are involved during a non-intentional contagion. In the initial phase, it can be very difficult to differentiate between non-intentional and “intentional” contagions, the latter meaning those deriving from deliberate release of harmful microorganisms. There is certainly a need, in many nations, to test and validate systems of alert, response and defense and to arrange in advance infrastructural platforms which will cooperate in a synergic way during such occurrences. In some Countries rapid response teams have been instituted to promptly begin countermeasure operations.
In 2000, a global system of alert and response (GOARN) was created by OMSU to help nations make a more rapid response in the case of contagion. GOARN is connected with more than 130 networks, institutions and international experts in order to give all necessary support to the international community and single Countries involved. For example, Canada has instituted the Global Public Health Intelligence Network (18), a research engine that continually scans the Web in search of reports and information, also not verified. This network is used by OMS, as for all the nations, to acquire added information concerning a contagious event, whether natural or deliberate. The advanced informatics technology is used with success to create virtual networks of experts and institutions which can, in their turn, collect and consolidate global experience and the fight against emerging or little known pathologies. The acquisition of know-how and knowledge in this very specific matter and the updating of the professional competence is a dynamic process and in continual evolution, both for the continued development of the microbial world and its relating to the scientific community, and for the scientific and technological progress taking place in our society.
The application and implementation of the International Regulations of Public Health proposed by the World Organization of Health (IHR) begun in 2005-2006 and reviewed in successive years, will facilitate the containment of infectious diseases and the international regulatory measures in such matters (19, 20).
Epidemiology in the area of the formative processes must be continually programmed and predisposed by the entire international community and by the scientific communities of the various nations at a local and transnational level.
It is necessary to integrate the multi-disciplinary and inter-disciplinary concepts which take into account the problems of National security, the security of the Net itself, providing for an interdisciplinary involvement of all the civil and military components, through the use of institutional resources – central and peripheral – also drawing on new instruments of research from the academic world, from study groups dedicated to drawing up specific guidelines and training programmes, as well as civic-health education programmes. This, for the purpose of supplying adequate means of effective and timely response, with the intention of safeguarding the welfare of the stricken populations.
The hope for the future is that the management of the biological risks are centered on the “global management of the event”, from the points of view of organization, dedicated policies, search for funds that involves all the institutions at National and supranational levels with a multidisciplinary approach. Therefore, it is necessary to recover and develop concepts of humanitarian and civil protection, with particular attention to the psycho-social needs of the populations, to guarantee human rights and civil freedom and to apply the concepts of neutrality, impartiality and independence in the name of an ever growing ethical requirement in the globalized world.

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The author advises

Pandemics and Bioterrorism Author:A.Trufanov, A.Rossodivita, M.Guidotti Editor: IOS Press, 2010