We investigate the impact on effective terrorism response of the viability degradation of biological weapons agents in the environment. We briefly review the scientific understanding and modeling of agent environmental viability degradation. In general, agent susceptibility to viability loss is greatest for vegetative bacteria, intermediate for viruses, and least for bacterial spores. Survival is greatest in soil and progressively decreases in the following environments: textiles, water, hard surfaces, and air. There is little detailed understanding of loss mechanisms. We analyze the time behavior and sensitivity of four mathematical models that are used to represent environmental viability degradation (the exponential, probability, and first- and second-order catastrophic decay models). The models behave similarly at short times (<30 min for our example case) but diverge to significantly different values at intermediate to long times. Hence, for a release event in which the majority of atmospheric exposure or deposition occurs over very short times, the current response models likely provide a good representation of the hazard. For longer time phenomena, including decontamina tion, the current model capabilities are likely insufficient. Finally, we implement each model in a simple numerical integration of anthrax dispersion, viability degradation, and dose response. Decay models spanning the current knowledge of airborne degradation result in vastly different predicted hazard areas. This confounds attempts to determine necessary medical and decontamination measures. Hence, the current level of understanding and representation of environmental viability degradation in response models is inadequate to inform appropriate emergency response measures.

We developed a mathematical model of a cows-to-consumers supply chain associated with a single milk-processing facility that is the victim of a deliberate release of botulinum toxin. Because centralized storage and processing lead to substantial dilution of the toxin, a minimum amount of toxin is required for the release to do damage. Irreducible uncertainties regarding the dose-response curve prevent us from quantifying the minimum effective release. However, if terrorists can obtain enough toxin, and this may well be possible, then rapid distribution and consumption result in several hundred thousand poisoned individuals if detection from early symptomatics is not timely. Timely and specific in-process testing has the potential to eliminate the threat of this scenario at a cost of less than 1 cent per gallon and should be pursued aggressively. Investigation of improving the toxin inactivation rate of heat pasteurization without sacrificing taste or nutrition is warranted.

Background: Weaponized Bacillus anthracis is one of the few biological agents that can cause death and disease in sufficient numbers to devastate an urban setting.

Objective: To evaluate the cost-effectiveness of strategies for prophylaxis and treatment of an aerosolized B. anthracis bioterror attack.

Design: Decision analytic model.

Data Sources: We derived probabilities of anthrax exposure, vaccine and treatment characteristics, and their costs and associated clinical outcomes from the medical literature and bioterrorism-preparedness experts.

Target Population: Persons living and working in a large metropolitan U.S. city.

Time Horizon: Patient lifetime.

Perspective: Societal.

Intervention: We evaluated 4 postattack strategies: no prophylaxis, vaccination alone, antibiotic prophylaxis alone, or vaccination and antibiotic prophylaxis, as well as preattack vaccination versus no vaccination.

Outcome Measures: Costs, quality-adjusted life-years, life-years, and incremental cost-effectiveness.

Results of Base-Case Analysis: If an aerosolized B. anthracis bioweapon attack occurs, postexposure prophylactic vaccination and antibiotic therapy for those potentially exposed is the most effective (0.33 life-year gained per person) and least costly ($355 saved per person) strategy, as compared with vaccination alone. At low baseline probabilities of attack and exposure, mass previous vaccination of a metropolitan population is more costly ($815 million for a city of 5 million people) and not more effective than no vaccination.

Results of Sensitivity Analysis: If prophylactic antibiotics cannot be promptly distributed after exposure, previous vaccination may become cost-effective.

Limitations: The probability of exposure and disease critically depends on the probability and mechanism of bioweapon release.

Conclusions: In the event of an aerosolized B. anthracis bioweapon attack over an unvaccinated metropolitan U.S. population, postattack prophylactic vaccination and antibiotic therapy is the most effective and least expensive strategy.

In the late winter of 2003, a number of livestock animals in the Midwest were poisoned due to accidental contamination of a popular commercial feed with a lethal additive. Although all the evidence indicates this incident had no malicious or terrorist intent, it is informative as a case study highlighting potential security implications with respect to a terrorist event directed at U.S. agriculture.

In all the discussions of agricultural terrorism, the threat of deliberate and malicious introduction of a contaminant to animal feed has barely warranted a sentence in policy papers and legislation. Yet the historical record shows that individuals from New Zealand to Kenya to the U.S. have seen contamination as an easy method to kill animals.

In the November 2004 issue of the Journal of Animal Science (the leading peer-reviewed, technical animal science journal), this article discusses the poisoning of livestock alpacas (a smaller cousin of the llama) in early 2003. The animals were killed by accidental contamination of a popular commercial feed with a lethal additive parts per million (ppm) level. Although the absolute number of animals affected was small, if a similar percentage of beef livestock were poisoned, it would correspond to a loss of over 400,000 cattle in the U.S.

The article provides a brief history of incidents of chemical contamination and the political (failure of re-election bid by the Belgian Premier in 2000) and human effects (documented cases of lymphoma, breast and digestive cancers in Michigan among those who ate fire retardant-tainted meat in 1973.) Also addressed are the relative risks to agriculture by biological agent versus chemical agent and concludes with specific recommendations for bringing feed security into the agricultural terrorism dialogue.

The web of measures that comprise the nuclear non-proliferation regime continues to hold at bay the "nuclear-armed crowd" that was part of President John F. Kennedy's alarming vision in 1963. The number of nuclear weapons states in 2004 stands at only eight or nine, and assertive steps may yet keep this number from growing. The proliferation of biological weapons, however, is quite another matter. Biotechnological capacity is increasing and spreading rapidly. This trend seems unstoppable, since the economic, medical, and food-security benefits of genetic manipulation appear so great. As a consequence, thresholds for the artificial enhancement or creation of dangerous pathogens--disease-causing organisms--will steadily drop. Neither Cold War bilateral arms control nor multilateral non-proliferation provide good models for how we are to manage this new challenge. Much more than in the nuclear case, civilization will have to cope with, rather than shape, its biological future.

The third edition has 120 new articles, among them Artificial nutrition and hydration, Bioterrorism, Cloning, Cybernetics, Dementia, Managed care, and Nanotechnology. Some 200 articles have been extensively revised, and 100 additional articles have new bibliographies. The alphabetical entries address a wide range of topics that raise difficult and important questions. Abortion, genetic screening, female genital mutilation, the right to die, health issues of immigration, and corporate responsibility are but a few. The contributors discuss the issues from many points of view. The abortion article includes sections covering medical perspectives, contemporary ethical and legal aspects, and Jewish, Catholic, Protestant, and Islamic religious perspectives. There are also articles about bioethics in Buddhism, eugenics, health policy, women as health-care professionals, whistle-blowing in health care, and veterinary ethics. All of the articles are signed, and all have bibliographies. Ample cross-references help readers find related useful material. A list of all the articles and a topical outline appear in volume 1. A series of appendixes offers codes, oaths, and directives related to bioethics; additional resources; key legal cases; and an annotated bibliography of literary works that have a medical component. A detailed index helps users find material that may be scattered over numerous entries, such as information about surrogate motherhood.