A Warning; Flier With Tuberculosis Raises Red Flags About Bioterrorism

A traveler on a transoceanic airplane carries an extremely lethal and contagious disease. Throughout the flight, the airplane's continuous recirculation of breathable air spreads the disease among hundreds of passengers. At the destination, those passengers disperse -- some get on other planes and some go home or to meetings. Everywhere they go, the disease goes with them.

This is the basic story outline of the man who recently flew on two trans-Atlantic flights carrying drug-resistant (and thus incurable) tuberculosis, despite knowledge by the federal Centers for Disease Control and Prevention of his condition and a warning against him traveling. He is now in quarantine, and efforts are under way to track the people who shared his flights. Importantly, his form of tuberculosis is not so contagious that many people need fear contamination.

This disconcerting incident should warn us of a slightly different scenario that is more terrifying. Imagine that 100 people are deliberately infected with a disease that is more contagious than tuberculosis (there are many). Before boarding separate flights and after arrival, each of them strolls through crowded airports, sneezing, coughing and touching common surfaces. Because these people are unknown to authorities, they raise no suspicion. Days may go by before symptoms appear, allowing these people and their victims to fan out around the world.

This bioterrorism nightmare is frightening precisely because groups lacking much technological sophistication could execute it. Essentially, the only limit on how much disease could be spread is the number of suicide carriers willing to spend their last days on airplanes and in airports.

Today, fortunately, there are very few diseases that are both readily contagious and essentially incurable. Nature, although devious and often cruel, rarely produces a disease that perfectly fits a bioterrorist's purposes. But that should offer merely temporary solace: Advances in genomics now could enable many scientists to deliberately mix and match characteristics to instantly make a weapon that might take eons for nature to make.

Scientists predict, for example, that smallpox (humanity's worst scourge that was eradicated decades ago) might be reconstituted in the laboratory -- perhaps in the coming decade. Polio has already been assembled from scratch. The avian flu is a great fear; although in its natural form it is not readily contagious; it will soon be trivial to reassort its genetic makeup to enhance its contagiousness. The 1918 Spanish flu virus, which killed more than 40 million people worldwide, has now been made in laboratories, and its genetic sequence has been widely published.

Even if our medical and public health systems can meet the challenge of a bioterror attack in the United States, how many attacks in foreign cities would it take before international transit comes to a crashing halt. If disease spreads wildly among our less developed friends and allies, sowing panic and interrupting trade, what would be implications for our economy? Even if only a few Americans are actually sickened, a series of strategic acts of bioterrorism could profoundly rattle us all.

Our leaders tell us that they are doing everything possible to meet bioterrorism threats, but these proclamations are disingenuous, deluding us all -- not so much a deliberate lie but a mirage grounded on little more than a wish and a prayer. The more complete truth is that little is being done to prevent bioterrorism, and a reasonably smart criminal or fanatic could inflict a catastrophe.

Internationally, available initiatives to complicate bioterrorism are stalled. In most parts of the world, preparations for an attack could proceed without substantial chance of detection and could inflict unimaginable damage against unprotected populations. A handful of threats receive substantial attention, but many easily accomplishable attack modes are virtually ignored. The dangers are accelerating, but bioterrorism prevention policies are vague, gap-ridden and unsupervised.

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