The world continues to wrestle with the enormous consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel virus that caused the COVID-19 pandemic. The drastic and long-term effects and impacts of the novel virus have continued to affect the world on numerous fronts for a duration significantly longer than expected by almost anyone in February 2020. With additional waves, there appears to be no clear end in sight.
It is still up for valuable and heated discussion if SARS-CoV-2 was a black swan event. For many with a background or interest in the study of public health, homeland security, novel pathogens, and pandemics, this world-changing event was utterly expected and predictable as were the obvious failures to plan for it. It appears that the world shall be responding to SARS-CoV-2 and COVID-19 for quite some time to come as months may transition into years. During these most challenging times, it does not appear terribly promising that communities will have the energy, time, focus, or resources to adequately plan and prepare for a larger and much more dangerous biological threat – be it either naturally occurring or man-made.
Bioterrorism & Biodefense
Bioterrorism and biowarfare continue to be significant threats to national and homeland security, if appreciated it or not. As clearly demonstrated by COVID-19, a natural or man-made public health crisis can have incalculable health, social, financial, economic, political, and so many other immediate and lasting impacts on a country and the world. This portfolio of contemplation could be consolidated under an umbrella of biodefense to include biological weapons.
According to the World Health Organization, “biological weapons are microorganisms like virus, bacteria, fungi, or other toxins that are produced and released deliberately to cause disease and death in humans, animals or plants.” These weapons can cause serious disruption, illness, and death in a very short amount of time without warning. The threat is not limited to a few pathogens. The Centers for Disease Control and Prevention provides a long list of bioterrorism agents/diseases on their website to include the plague and viral hemorrhagic fevers.
The Blue Ribbon Study Panel on Biodefense issued its critical and detailed report in 2015 entitled A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts. The report was comprehensive and thought-provoking by identifying and re-enforcing numerous vulnerabilities and inadequacies regarding planning and preparedness for a myriad of biosecurity, biodefense, and public health threats. The report, in conjunction with numerous other studies and articles, reinforced that future failures would not be from a lack of knowledge or warning, but prioritization, planning, and preparedness.
The United States has developed various national strategies and plans to prepare for these unthinkable threats over the past few decades. One of the latest has been the 2018 National Biodefense Strategy. The document begins with the timely and relevant opening statement:
It is a vital interest of the United States to manage the risk of biological incidents. In today’s interconnected world, biological incidents have the potential to cost thousands of American lives, cause significant anxiety, and greatly impact travel and trade.
The strategy states that biological threats are some of the most serious threats facing the nation, and disease outbreaks can cause catastrophic harm on a massive scale. During these times, that statement may sound all too familiar. The magnitude of these biological threats may not have sufficiently been understood and appreciated to one’s own peril. Surprisingly, the looming threat may continue to not be fully realized.
Advocating Action Through Transition
DomPrep discussed the serious concerns regarding preparedness for biological attack or bioterrorism in 2017 with a focus on the challenges of staying on point from one presidential administration to another. On 15 November 2016, the President’s Council of Advisors on Science and Technology (PCAST) released a letter report to the president on Action Needed to Protect against Biological Attack. The letter stated that biotechnology has been growing at an exponential rate over the past several decades with both great benefits and serious potential for destructive use by both states and individuals. PCAST urged the president to take immediate action to ensure that the nation has the ability to meet these challenges with near-, medium-, and long-term goals.
PCAST outlined the federal government’s approach to defending against biological threats over the past two decades with a review of some of the relevant congressional acts, strategies, and plans. Unfortunately, these governmental actions may not have evolved at the same rate as the threats. Technology, research, and nature have created risks and challenges beyond previous expectations.
Bioterrorism and biowarfare continue to be significant threats to national security. Imagine COVID-19, only much worse with a more serious and threatening pathogen.
The PCAST letter was released at the very end of the administration’s second term (not long after the previous national election), which did not permit a sufficient amount of time for action. However, it was quite relevant for the next and future administrations in a world of vast biotechnology and biosecurity vulnerabilities – the new landscape according to PCAST.
Unfortunately, as feared in 2017, the PCAST letter appeared be added to, or lost in, the vast pile of numerous reports, studies, and collaborations calling for action and preparedness for a global public health threat. This thoughtful letter advocating action, in addition to many other critical recommendations by others since that time, may be lost again in a time of political transition and tremendously divisive politics.
Some may ask during a time of an immense and continuing pandemic and so many other competing homeland/national security issues whether the nation has the bandwidth to worry about larger so-called black swan threats with possibly much more serious consequences at this time. The answer is yes because it can get much worse. The response should be to care due to the possible morbidity and mortality rates that could be a great deal more devastating than SARS-CoV-2. Previous failures and inaction have been clearly demonstrated by COVID-19, and the nation is paying a horrible price on every level.
Repeated declarations over the decades of lack of sufficient planning and preparedness for life-threatening pandemics and biothreats have not been overly successful in driving and sustaining change. They are often lost in the expanding noise and stiff competition for limited resources. Maybe a true story from 2010 that sounds more like a movie thriller or streaming video series could provide an antidotal justification for prioritized concern and motivation for action. When overwhelmed by the dense forest, look at a tree for an example.
In 2003, an American scientist reported 30 vials of the bacterium Yersinia Pestis, which causes pneumonic, septicemic, and bubonic plague, missing from his university laboratory. He was reportedly an expert on the plague at a major university in the southwestern United States. As anticipated, the loss of the bacteria resulted in the immediate response of 60 task force investigators to the university to find the answers and the vials. The 9/11 and anthrax attacks were fresh and frightening at that time.
The scientist was later indicted for various charges involving the improper handling, control, and transportation of the plague samples. This preeminent authority on infectious diseases was charged with allegedly smuggling samples of plague into the United States, improperly transporting them within the country, and lying about them to authorities. Additional charges of theft, embezzlement, and fraud were added in a second indictment against him.
The scientist was convicted on 47 of the 69 federal charges that he faced associated with the mishandling of the pathogen, but was acquitted on charges of lying to federal authorities, smuggling plague samples into the United States and illegally transporting samples. He was convicted of theft, embezzlement, and fraud in connection with his concealed contracts with drug companies. As a result of the convictions, he was sentenced to two years in prison, fined $15,000, and surrendered his medical license. The actions of the scientist also resulted in administrative proceedings against him by the Department of Commerce for reportedly importing the plague from Tanzania without adhering to the appropriate protocols and reporting requirements.
The missing plague vials were reportedly never located or recovered during the investigation. The plague samples may have been destroyed by the scientist or improperly shared with others. Due to the widely documented incident and his licensing issues, the scientist reportedly located employment outside of the United States.
Welcome to Miami
In 2010, the same scientist entered the United States in the late evening from Saudi Arabia via London at the Miami International Airport. He was reportedly employed as a professor at a university in the Caribbean and teaching in Saudi Arabia at the time. The scientist apparently cleared customs border inspection without incident and transitioned to screening by the Transportation Security Administration (TSA) for a flight to Puerto Rico. While his luggage was being screened by TSA, a suspicious object was located via their scanning technology. Suspicious was an understatement. The object was a metal pipe with threaded metal end caps on both sides resembling a common pipe bomb. It looked exactly like the pipe bombs seen in the media or a movie.
As expected, the location of the possible pipe bomb in a piece of luggage next to the main exit of the federal inspection station to the rest of the massive airport caused a rather serious incident. The entire area of the airport was closed immediately affecting thousands of international and domestic passengers. The responding police and bomb squad evacuated four of the six airport terminals, which was not a simple undertaking. Police, fire, and hazardous material personnel and vehicles were parked and staged all around the airport as part of the coordinated response. The media took notice.
The impact of the response rippled throughout the entire airport to include the security identification display area and public landside area resulting in the stopping of all of the approaching traffic to the entire airport and numerous flights. Miami International Airport is definitely not a quiet place, but it became one that night. It was also one of the most difficult places to discover and respond to the possible pipe bomb at the airport for operations, but it would end up even getting worse.
As the bomb squad and other officials executed their response plans, the scientist was interviewed by local and federal officials to ascertain what was inside the enclosed metal tube. At that point, the scientist was just another traveler with a very strange and concerning item in his baggage. As the interview progressed at the airport police station, the bomb squad focused on assessing and addressing the potential threat. Although always professional and well-trained, it would be quite naïve to think that the bomb squad was not under strong pressure to resolve the issue as soon as safely possible to reopen the economic engine of Miami-Dade County.
Prior to discovering the worrisome history of the scientist in the early morning hours of the hectic incident and interview, the local police bomb squad attempted to disable the possible explosive device by forcefully removing one of the end caps. They were successful. The suspect device was rendered safe and opened to the air for a careful inspection.
Shortly after rendering the object safe from possible explosion, information was received by the bomb squad regarding the arrest history of the scientist and missing vials of the plague, which resulted in an elevated concern about the liquid-like contents of the metal pipe. The investigators and bomb squad learned after opening the suspicious device that the scientist was reportedly an infectious disease instructor in Saudi Arabia and the Caribbean. No one knew what the visible liquid media was at that time, which definitely increased already heightened tensions.
To compound the concerns even further, the suspect device was reportedly unintentionally opened by force in the area of a rather sizable heat, air ventilation, and cooling (HVAC) intake zone that was linked to several airport terminals. If a serious biological threat had been accidently released during the response to the possible pipe bomb threat, the impact could have been catastrophic with the possible number of exposed passengers in the process of travelling around the country and the world from such a busy airport.
The impact on the airport’s infrastructure would have resulted in vast financial and economic consequences throughout the county, state, region, and country. The cost of possibly closing two or more large terminals for months or years to mitigate a possible hazardous threat in the HVAC system and throughout the terminals was estimated at hard-to-fathom numbers.
Thankfully, the contents of the pipe were reportedly deemed not to be a known public health threat. It was apparently part of the scientist’s unidentified research. Imagine the cost of a highly contagious pathogen spreading around the state, nation, and world if it were a serious public health threat. The level of preparedness and available medical countermeasures at the time may not have been as robust as needed – and this would not have even been an intentional bioterrorism attack.
Envision if the suspicious device contained one or more of the missing plague vials or something even more dangerous. The scientist may not have had any ill intentions, but the proper and logical actions of the bomb squad with the information they possessed at the time could have resulted in a disastrous event for life and property. They could have unknowingly participated in a biological release.
Imagine if a state or non-state actor wished to do harm via bioterrorism or biowarfare. This almost routine incident was a learning opportunity for the first responders to think outside the box along with maybe those who wish to do harm. This is not a new threat scenario since the 9/11 and anthrax attacks, but it has likely been forgotten or overtaken by so many other competing and consuming events. This story of the scientist and his later airport incident were well-published for all to read and contemplate. Bad actors have the internet too.
The current response to a zoonotic pathogen has not resulted in the level of confidence in previous planning and preparedness that everyone should expect and demand. If the nation was not adequately prepared for SARS-CoV-2 after fairly recent experiences with other well-known troubling abbreviations such as SARS, MERS, and H1N1, it would likely not fare well with an intentionally released aggressive pathogen today. From the current COVID-19 experience, it may not be the nation’s finest hour. A novel pathogen resulting in enhanced levels of contagiousness, morbidity, and mortality through gain-of-function experimentation could make current pandemic issues appear manageable and preferable. Horrifyingly, the response and situation today with COVID-19 could be the “good old days” compared to what may be coming.
The story of the missing plague vials and incident at the Miami International Airport may be fascinating to those unfamiliar with the scientist. More importantly, the story provides an opportunity to mull over the ramifications of an intentional attack in this or hundreds of other settings around the nation. This was not a bioterrorism attack, but think about the possible outcomes if it were one. It is an important tree for focus and consideration in the vast biodefense forest of concerns.
Pandemic and other public health threats from zoonotic sources have been a constant threat and challenge that have been regularly ignored or overtaken by other pressing issues. The nation is now paying a monumental price with its indisputable lack of adequate planning and preparedness. Envision the cascading consequences of a shrewdly designed and executed bioterrorism attack. Of course, that black swan could never happen – just like SARS-CoV-2.