EDITORIAL Benefits of bioterrorism

The devastating events of 11 September 2001 andthe ensuing anthrax release within the USA wereunprecedented, shocking and horrible. Yet humansare remarkably resilient and already there aresigns that people are coming to terms with theseterrible events. The responses of governments tothe perceived threat may even herald a new erain the control of infectious diseases.

The infrastructure required to detect initialcases of an outbreak of infectious disease is dilapi-dated in many industrialised countries, havingsuffered from decades of lack of investment.Clearly, there is now a political will to improvethis situation, with politicians prepared to devoteenormous sums of money for the purpose. Thefact that they are motivated by the desire tocontrol outbreaks started deliberately should notinhibit us from seeking to apply the funds for ageneral improvement in surveillance systems.Thus, the USA President has requested $1.5 billionfor the National Institute of Allergy and InfectiousDiseases for bioterrorism in 2003 [1]. The fundswill be used for some bioterrorism-specific items,such as manufacture of cell culture-grown vacci-nia vaccine to provide a stockpile of doses suffi-cient to immunise each US citizen. There will alsobe a protocol for the evaluation of cidofovir ifhuman cases of smallpox ever appear [2]. Otherfunds will be deployed towards the generalinfrastructure, so there will be improvements inthe ability to detect all outbreaks of infectiousdisease, whether started deliberately (hopefullyuncommon) or naturally (the vast majority). Thishas happened before; it is now 50 years since theEpidemic Intelligence Service (EIS) was estab-lished at the time of the Korean war [3] and appro-ximately 2500 EIS officers have so far supportedthe work done by the Centers for Disease Controland Prevention.

In the UK, the strategic plans of the ChiefMedical Officer to reorganise the way in whichinfectious diseases are dealt with were rapidlyupdated in response to bioterrorism threats

(www.doh.gov.uk/cmo/publications.htm). Thus,a new agency ‘‘The National Infection Controland Health Protection Agency’’ (already renamed‘‘The Health Protection Agency’’) will be respon-sible for biological, chemical and nuclear expo-sures, and frontline staff will be trained to dealwith incidents generically, referring to specialistsonce the nature of any exposure has become clear.Essentially, one of the three sub-agencies willperform the central functions of the current PublicHealth Laboratory Service (PHLS), so providingleadership for the biological aspects of terrorism.This also has a component of deja vu, because thePHLS was set up in 1947 to combat the perceivedthreat of germ warfare in the years after theSecond World War. The precise details of thereorganisation are not available yet, but it appearsthat the diagnostic functions of many of thecurrent 46 local laboratories may revert to controlby local Trusts of the National Health Service. Ifso, it will be important that they continue toprovide epidemiological data to the new sub-agency, and the report plans formally to impose a‘‘duty of reporting’’ on all hospital laboratories.This seems rather heavy-handed; many labora-tories would be delighted to report their data in atimely fashion if only the resources were madeavailable for the necessary staff, facilities andcomputer systems. The ‘‘Jewel in the Crown’’ isseen as the Communicable Disease SurveillanceCentre, responsible for summarising the risksposed by individual infectious agents. Yet, itmust be remembered that colleagues with skillsin epidemiology and mathematical modelling willcontinue to require laboratory specialists toprovide the data they plan to analyse and thatthe expertise of virologists is required to makesense of complex bioinformatics approaches tomolecular epidemiology. The Chief Medical Offi-cer’s report is currently vague on how such essen-tial laboratory staff are to be organised, recruited,trained, motivated and retained, especially sinceMedical Virology in the UK is currently at its

Reviews in Medical Virology

Rev. Med. Virol. 2002; 12: 131–132.Published online in Wiley InterScience (www.interscience.wiley.com).

DOI: 10.1002/rmv.358

Copyright # 2002 John Wiley & Sons, Ltd.

nadir, with the greatest deficit ever between whatcould be achieved and what is routinely availableto patients. However, if significant investmentsare made in a national laboratory infrastructureand staff, then the UK could once again haveworld-class facilities able to investigate andresearch current and future infectious diseasethreats.

Finally, there may be significant spin-offs forrapid diagnosis. We learn that the CIA et al. havedeveloped small, portable devices able to detectenvironmental contamination with selected infec-tious agents rapidly. For obvious reasons, detailedscientific information is not yet available but PCR,biosensors and even rupture event scanning [4]appear to underlie some of the technology. If suchdevices truly can provide rapid diagnoses withhigh sensitivity and specificity, then they could bemodified to address several current concerns ininfectious diseases [2]. For example, they could bebased in pharmacies so that patients with acuterespiratory symptoms could be tested for influ-enza, RSV, picornaviruses, etc. As we have dis-cussed, this could facilitate provision of effectiveantiviral drugs to control these infections andenable the patient to pay for the drug (and thetest) directly [5]. The requirement that the antiviraldrug should be made available through non-medical prescribers has already been met in theUK [6], perhaps illustrating how keen politiciansare to encourage patients to take responsibility fortheir own health ie to pay their own bills. Suchwidespread availability of rapid diagnosis would

be appreciated by the pharmaceutical companieswho developed the neuraminidase inhibitors andwho appear disappointed by sales to date. It couldalso encourage them to invest further in novelcompounds for RSV, which otherwise may not bedeveloped because of a perceived lack of financialreturn on the required investment. The resultingcontrol of diseases which are currently prevalentwould not only benefit patients but would providea cleaner epidemiological background upon whichcases of intentional release of infectious agentscould be identified more readily; a win-win situa-tion for medicine, science, patients and politiciansalike.

P. D. Griffiths

REFERENCES1. Check E. Bush’s budget boost puts NIH on target for

doubled figures. Nature 2002; 415: 459.2. NIAID. Bioterrorism Research Funding. 2002. Inter-

netCommunication.http://www.niaid.nih.gov/dmid/bioterrorism/

3. Centers for Disease Control. 50 Years of the EpidemicIntelligence Service. 2002. Internet Communication.http://www.cdc.gov/eis

4. Cooper MA, Dultsev FN, Minson T, Ostanin VP,Abell C, Klenerman D. Direct and sensitive detectionof a human virus by rupture event scanning. NatBiotechnol 2001; 19: 833–837.

5. Griffiths PD. Will systemic antivirals be sold over thecounter? Rev Med Virol 2001; 11: 71–72.

6. National Institute for Clinical Excellence. 2002.Internet Communication. http://www.nice.org.uk

132 Editorial

Copyright # 2002 John Wiley & Sons, Ltd. Rev. Med. Virol. 2002; 12: 131–132.