The role of risk analysis in understanding bioterrorism

Anthrax revisited: how assessing the unpredictable can improve biosecurity

B. anthracis is one of the most often weaponized pathogens. States had it in their bioweapons programs and criminals and terrorists have used or attempted to use it. This study is motivated by the narrative that emerging and developing technologies today contribute to the amplification of danger through greater easiness, accessibility and affordability of steps in the making of an anthrax weapon. As states would have way better preconditions if they would decide for an offensive bioweapons program, we focus on bioterrorism. This paper analyzes and assesses the possible bioterrorism threat arising from advances in synthetic biology, genome editing, information availability, and other emerging, and converging sciences and enabling technologies. Methodologically we apply foresight methods to encourage the analysis of contemporary technological advances. We have developed a conceptual six-step foresight science framework approach. It represents a synthesis of various foresight methodologies including literature review, elements of horizon scanning, trend impact analysis, red team exercise, and free flow open-ended discussions. Our results show a significant shift in the threat landscape. Increasing affordability, widespread distribution, efficiency, as well as ease of use of DNA synthesis, and rapid advances in genome-editing and synthetic genomic technologies lead to an ever-growing number and types of actors who could potentially weaponize B. anthracis. Understanding the current and future capabilities of these technologies and their potential for misuse critically shapes the current and future threat landscape and underlines the necessary adaptation of biosecurity measures in the spheres of multi-level political decision making and in the science community.

A Systematic Review of Risk Analysis Tools for Differentiating Unnatural From Natural Epidemics

Introduction: In the era of genetic engineering of pathogens, distinguishing unnatural epidemics from natural ones is a challenge. Successful identification of unnatural infectious disease events can assist in rapid response, which relies on a sensitive risk assessment tool used for the early detection of deliberate attacks (i.e., bioterrorism). Methods: A systematic review was conducted according to the outline of Preferred Reporting Items for Systematic Reviews. Published papers related to the detection of unnatural diseases were searched in MEDLINE (January 1927–April 2016), EMBASE (January 1937–March 2016), and Web of Science (January 1978–March 2016). Full texts were reviewed for the selection of studies on scoring systems specially designed to discern between unnatural and natural outbreaks. Results: A total of 1,753 papers were reviewed, of which we identified the following five scoring systems specifically designed for detecting unnatural outbreaks: (1) the Grunow–Finke epidemiological assessment tool, (2) potential epidemiological clues to a deliberate epidemic, (3) bioterrorism risk assessment scoring, (4) and (5) two modified scoring systems based on (3). Various criteria ranging from the information on perpetrators, type of agents, spatial distribution, and intelligence of deliberate release were involved. Of these systems, the Grunow–Finke assessment tool remains the most widely used, but has low sensitivity for correctly identifying unnatural epidemics when tested against actual historical outbreaks. Others were applied into a few scenarios but provided different perspectives for bioterrorism detection and bio-preparedness. Conclusion: There are few risk assessment tools for differentiating unnatural from natural epidemics. These tools are increasingly necessary and valuable, but improved scoring systems with higher sensitivity, specificity, timeliness, and wider application to biological attacks must be developed.

A New Method of Differentiation Between a Biological Attack and Other Epidemics

The main obstacle in identifying a biological attack (BA), while preventing false alarms, epidemics of panic and unnecessary expenditures is the insufficient data on which to rely. Тhis new method of outbreak analysis is based on our original model of bioterrorism risk assessment. The intention was to develop a model of quick and accurate evaluation of an unusual epidemiologic event (UEE) that would save time, money, human and material resources and reduce confusion and panic. This UEE analysis is a subtle and detailed differentiation through assessment of BA feasibility in comparison with three other types of outbreak scenarios. There are two types of differences between these four scenarios: qualitative and quantitative. Qualitative and quantitative differences are defined with 23 and 10 indicators, respectively. Both types of indicators can have three different values: N/A, 0 or 1. We have carried out a feasibility analysis for subtle and detailed differentiation among four outbreak scenarios. As a tool for feasibility analysis we have introduced a “system of elimination”. System elimination is applied if one component contains all indicators scored with 0 or as N/A – the related scenario is then eliminated from further consideration. The system was applied to four UEEs: (1) an intentional attack by a deliberate use of a biological agent (Amerithrax), (2) a spontaneous outbreak of a new or re-emerging disease (“swine flu”), (3) a spontaneous outbreak by an accidental release of a pathogen (Sverdlovsk anthrax), and (4) a spontaneous natural outbreak of a known endemic disease that may mimic bioterrorism or biowarfare (Kosovo tularemia). It was found that “agent” was the most important and the most informative UEE component of the new scoring system. This system might be helpful in the analysis of unusual epidemic events and a quick differentiation between biological attacks and other epidemics.

Risk-based objectives for the allocation of chemical, biological, and radiological air emissions sensors

This article addresses the problem of allocating devices for localized hazard protection across a region. Each identical device provides only local protection, and the devices serve localities that are exposed to nonidentical intensities of hazard. A method for seeking the optimal allocation Policy Decisions is described, highlighting the potentially competing objectives of maximizing local risk reductions and coverage risk reductions. The metric for local risk reductions is the sum of the local economic risks avoided. The metric for coverage risk reductions is adapted from the p-median problem and equal to the sum of squares of the distances from all unserved localities to their closest associated served locality. Three graphical techniques for interpreting the Policy Decisions are presented. The three linked graphical techniques are applied serially. The first technique identifies Policy Decisions that are nearly Pareto optimal. The second identifies locations where sensor placements are most justified, based on a risk-cost-benefit analysis under uncertainty. The third displays the decision space for any particular policy decision. The method is illustrated in an application to chemical, biological, and/or radiological weapon sensor placement, but has implications for disaster preparedness, transportation safety, and other arenas of public safety.

Why people believe they were exposed to biological or chemical warfare: a survey of Gulf War veterans

The study sought to understand better how people come to believe they have been exposed to biological and chemical warfare. We conducted telephone interviews with 1,009 American veterans (65% response rate) deployed and not deployed to the Gulf War, a conflict during which there were credible threats that such warfare could be used. Only 6% of non-Gulf War veterans reported exposure to biological or chemical warfare, but most of Gulf War veterans reported exposure (64%). The majority of these were unsure whether the exposure was chemical or biological in nature. The most commonly reported exposure indicators were receiving an alert from the military and having physical symptoms. Veterans who were certain of the type of exposure (biological or chemical) were more likely to recall having been told by the military and to recall physical symptoms. Future communications with soldiers and the general public about biological and chemical warfare may need to emphasize the uncertain nature of such risk information. Evaluations of exposure diagnostic technologies should take into account the problem of people initially believing, but not later discounting, false positive results.