Abstract
The threat of bioterrorism is the most plausible when compared to other weapons of mass destruction (WMDs), considering the riotous advances in biotechnology. It is a threat for which India is not well prepared as was once again highlighted by the recent H1N1 epidemic, which claimed over 2,300 lives. The precarious security environment in South Asia, rapid rise in fundamentalism and extremist implosion of Pakistan, the cloud of civil war in Afghanistan and the emergence of the Islamic State of Iraq and Syria (ISIS) further accentuate this threat. This article analyses the bioterrorism threat to India and explores strategies, approaches, technological tools and best practices required for surveillance, prevention, response, recovery, decontamination and its attribution. It concludes that bioterrorism is a low-probability, high-impact event. Biological agents are a threat to human, livestock and crop health, as well as to the Indian economy, and their understanding must be considerably improved. Political awareness and public participation are essential for threat mitigation. The preparedness against biological attacks will also prepare our population against natural occurrence of diseases, thus transforming India into a resilient society.
Introduction
Bioterrorism poses a unique challenge and is a looming global security threat. A few individuals with specialised scientific skills, commercially available equipment and access to a laboratory can easily and inexpensively produce a variety of lethal biological weapons. Bioterrorism can be defined as the intentional release of pathogens or toxins by non-state actors to inflict harm on a wide population by infecting humans, crops or livestock. In addition, military research has also been carried out for exploiting the potential of microorganisms to attack specific physical infrastructure, for example, by degrading plastics and rubber.
Pathogens suitable for bioterrorism include bacteria, such as those that cause anthrax and plague, or viruses, including those that lead to smallpox and Ebola virus disease, and toxins, including botulinum toxin derived from a bacterium; ricin derived from the castor bean plant; trichothecene derived from fungi; and saxitoxin derived from marine animals. Diseases like smallpox, which have been eradicated, automatically become potent biological weapons as group immunity wanes (National Disaster Management Authority [NDMA], 2008, p. 3). Bioterrorism can be extremely damaging to the economy and result in large-scale loss of life and disruption to society (National Research Council [NRC], 2002, p. 65].
The concept of biological warfare in primitive forms of bacteriological warfare can be traced far back into pre-history, although probably the first recorded event concerns the defeat of Kirrha by the Athenians, by throwing bundles of hellebore roots into the water supply in 600 BC (Hemsley, 1998, p. 1). In 1346, the Mongols catapulted plague-infected corpses over the walls into Kaffa, forcing the besieged Genoans to flee (Spencer & Scardaville, 2001, p. 2). However, before 2001 anthrax attacks using weapons-grade Bacillus anthracis, the use of biological weapons by non-state actors was largely inconceivable.
Close scrutiny of historical record shows that there have been approximately 200 incidents involving toxic biological materials in the last 100 years (Davis, 2002, p. 125). These include incidents like the air dropping of plague-contaminated fleas against Chinese by the infamous Japanese Army Unit 731 in 1940 and other lesser-known incidents like the introduction of mercury into Israeli oranges by the Palestinian terrorists in 1979. In 1984, deliberate contamination of food by the Rajneesh religious cult in Oregon, United States (US), caused more than 750 people to fall ill. Closer home, Liberation Tigers of Tamil Eelam (LTTE) poisoned tea with potassium cyanide in a bid to cripple the Sri Lankan tea export industry in 1986 (Drell et al., 1999, p. 82). Large-scale biological warfare has thus far remained theoretical, although Japan is known to have employed biological agents against the Chinese in the 1930s; Germans are accused of employing Cholera bacterium and Yersinia pestis against Italy and Soviet Union in World War I; and Soviets used fungal toxin ‘yellow rain’ in Afghanistan, Kampuchea, Vietnam and Laos (Sassoon, 2004).
Biological weapons can be tailored to suit a wide number of terrorist options, ranging from tactical to strategic. These could be communicable infectious agents like Ebola and foot-and-mouth disease (FMD), or non-communicable pathogens that cause disease but are not transmitted from one person to another like anthrax and all toxins. Persistent biological agents can survive in the environment and remain harmful for long after their release. Anthrax can survive in the environment for over 100 years under the right conditions (Davis, 2002, p. 122).
The outcome of a bioterrorist attack depends on the level of preparedness for such eventualities. As per simulation study of an anthrax attack, in case of polished response, deaths decreased to 35,000 as opposed to 120,000 in case of a poor response (Ackerman & Moran, 2004, p. 4). Unorthodox use of biological weapons may result in disease with unexpected symptoms and epidemiology. Until 2001, the possibility of cross-contamination of anthrax through the mail was discounted by most experts (Rhodes, 2003, p. 1).
Advances in biotechnology and microbiology, especially the deciphering of the human genome sequence and that of most pathogens, have increased the understanding of the molecular mechanisms of pathogenesis; and concomitant responses of the immune system have aided designing drugs and vaccines, and also offer new approaches and opportunities for using technology to counter bioterrorist threats (National Research Council [NRC], 2002, p. 65). Unfortunately, the same advances can be misused to create newer agents of mass destruction. According to the British Medical Association report of October 2004 on bioterrorism, threat from biological weapons has outstripped that from chemical and nuclear weapons (Carrell, 2004). Investments in countering the threat of bioterrorism will also help combat naturally occurring diseases, but require advance preparation, adoption of best global practices and new technological tools and approaches.
India’s Preparedness against Bioterrorism: Existing Measures
India’s preparedness to deal with bioterrorism leaves much to be desired. The Ministry of Home Affairs (MHA) is the nodal ministry for countering terrorism, while the Ministry of Health and Family Welfare (MoH&FW) is responsible for handling epidemics. The Ministry of Agriculture (MoA) deals with epidemics in animal and crop. The Ministry of Defence (MoD) has armed forces inherently suitable as first responders. However, there is per se no separate central organisation holistically addressing different facets of bioterrorism threat.
Indian Council of Medical Research (ICMR) is responsible for the formulation, coordination and promotion of biomedical research with National Institute of Virology (NIV) at the apex. Other important facilities under the ICMR include the National Institute of Cholera and Enteric Diseases, National Institute of Epidemiology and Vector Control Research Centre. The National Centre for Disease Control (NCDC), under Director General of Health Services, has numerous specialised laboratories, but presently lacks technical expertise to counter bioterrorism (NDMA, 2008, p. 29).
Defence Research and Development Organisation (DRDO) has an extensive network of laboratories. Defence Research and Development Establishment (DRDE) is engaged in research on hazardous chemicals, biological agents, biotechnology, microbiology, virology and toxicology. Defence Materials and Stores Research and Development Establishment specialises in the production of individual protective equipment (IPE). The Defence Food Research Laboratory specialises in food quality, safety and security.
The Council for Scientific and Industrial Research (CSIR) and the Department of Biotechnology (DBT) are the other research and development (R&D) organisations dealing with biotechnology, drugs and toxicology and are supported by an extensive laboratory network. The Indian Council of Agricultural Research (ICAR) is a premium research institution in the fields of agriculture and animal science.
The NDMA is mandated to plan, prepare and respond to both natural and man-made disasters, with state disaster management authorities (SDMAs) for coordination and monitoring of disaster management (DM) activities down to the district and local levels. National Disaster Response Force (NDRF) is trained as a multidisciplinary force for specialised response to natural and man-made disasters. It consists of 10 battalions, from the Border Security Force (BSF), Central Reserve Police Force (CRPF), Central Industrial Security Force (CISF) and Indo-Tibetan Border Police Force (ITBP), and two battalions from Sashastra Seema Bal (SSB) are in the process of being upgraded (MHA, 2015). Four battalions of NDRF are trained and equipped for chemical, biological, radiological and nuclear (CBRN) emergencies. The main focus of both NDMA and NDRF, however, has remained on post-disaster response to natural calamities.
State of Public Health System in India
India lacks an effective public health system to respond to the threat of bioterrorism. Health care facilities are mainly restricted to urban areas, with only 10.3 per cent medical beds being available for 70 per cent of the rural population (NDMA, 2008, p. 32). Most hospitals in rural areas are poorly maintained and lack basic specialties and services. Infectious disease wards, isolation facilities and emergency support systems for critical care are neglected or non-existent in the district hospitals. Most government hospitals are not equipped to handle mass casualties, lack integrated ambulance network and have no or limited stockpile of drugs, important vaccines, IPE or required diagnostics for surge capacity (ibid.). The government spending for the creation of a preventative health infrastructure is quite low as India spends just 1 per cent of its gross domestic product (GDP) on public health, which is amongst the world’s lowest (Sekhani, 2015).
Integrated Disease Surveillance Programme (IDSP) was launched in 2004, as a decentralised, state-based surveillance programme, with integral communication backbone, for early warning and timely response to impending disease outbreaks. NCDC is responsible for surveillance and monitoring at the national level, along with deputed officers at the state level. IDSP has currently only 12 central labs operating under the NCDC, and nine others under the ICMR, and hardly any capability at the state level (NDMA, 2008, p. 30). IDSP does not reach the grassroots level, has performed unsatisfactorily during recent epidemics and needs major restructuring. It also lacks international networking with generic or disease-specific networks like FluNet and Dengue Net, which is much required.
The revised International Health Regulations (IHR), 2005 is aimed at ensuring that epidemic outbreaks of international concern are detected, investigated and contained promptly. Implementing of IHR requires upgradation and development of core competency for surveillance, effective screening at ports and airports, quarantine facilities, border control of men, livestock and material, etc. The nodal agency for implementing IHR, 2005 is NCDC, with technical support from ICMR. The shortage of medical and paramedical staff at the district levels; an acute shortage of public health specialists, microbiologists, epidemiologists and virologists; underdeveloped IDSP; and lack of epidemiological intelligence to track biological warfare programmes are some of the major impediments in its implementation (Violet, 2013).
Most of current initiatives which can enhance our preparedness against acts of bioterrorism, such as the efforts by NDMA, IDSP and the implementation of IHR, are still at a very nascent stage and, unfortunately, are not being pursued with the vigour warranted, keeping the threat in mind.
Threat Assessment
India does not enjoy a benign security environment in South Asia. It has an unsettled boundary with many nations, and some of India’s neighbours have extremely weak state institutions, which adversely affects security. India has been battling serious terrorist threats. There are more than 800 terrorist modules operating in India (Narayanan, 2008). The case of A. Q. Khan’s nuclear proliferation and the linkages of many terrorist organisations with Pakistani scientists have further heightened the threat.
Security in the Indian context is rather incident based and more reactive than proactive. It was only after the terrorist organisations started misusing ammonium nitrate as a base explosive that access to this material was slowly regulated. Expanding pharmaceutical and biotech industry has meant that bioterrorism is a threat for which India is not well prepared. Doctors, engineers, academicians and information technology (IT) personnel have all been arrested for their links to terrorist groups in India, and the possibility of such men infiltrating sites and a facility containing dangerous materials remains a major concern. In 2009, a disgruntled employee at the Kaiga Atomic Power Station in Karnataka contaminated drinking water with heavy water from the plant resulting in the poisoning of 45 employees (Prashanth, 2009).
The reality of the threat is sharpened by the persistent memory of the terrible plagues which, in the course of history, have taken a far greater toll of human lives than terrorism or war itself. Three million people died in the Bengal famine of 1943, abetted by the British government (Bannerjee, 2002, p. 115). The famine in China after the Great Leap Forward (1959–1961) killed 30 million people and a million people perished in the North Korean famine in the mid-1990s (Gopal & Pollack, 2002, p. 136).
The outbreak of plague, during 1994, in Surat and Maharashtra created panic in the entire country. Epidemiological studies suspected that the plague strain might have been genetically engineered as both outbreaks were from a ‘unique’ unknown strain. A firm called Viva, located in Almaty in Kazakhstan, was known to have several strains of the plague microbes for sale during the same period (Press Trust of India [PTI], 1995). However, many scientists like Dr Kalyan Banerjee of NIV dispute this and even contest that the disease outbreak was not pneumonic plague as pure Yersinia pestis cultures from the infected cases were never found, even by the NCDC supporting the diagnosis or the investigating World Health Organization (WHO) team (Thapa & Koppikar, 1994). However, the committee under Professor Vulimiri Ramalingaswami concluded, through indirect supportive evidence, that the disease was indeed plague (Ramalingaswami, 2001, p. 29).
The Surat plague and the way the complete crisis panned out had some very important lessons for India and highlighted our unpreparedness to deal with such threats:
It prompted the biggest migration of people post independence in India with around 400,000–600,000 residents fleeing Surat city within four days of announcement of the epidemic (Byrne, 2008, p. 542; Pallipparambil, 2003). This was largely due to rumours and misinformation. The migration of infected people from Surat led to the spread of disease to five states (Burns, 1994). Within hours of the outbreak, stock of tetracycline and other broad-spectrum antibiotics were exhausted due to panic buying of medicines not only in Surat but also in Bombay and far-off Delhi (Burns, 1994). The MoH&FW remained a mute spectator and the then Gujarat Chief Minister, Chhabildas Mehta, declared that the plague was pneumonic, and not bubonic, without realising that pneumonic plague was more lethal (Pallipparambil, 2003). Indian and international media triggered unprecedented panic by reporting exaggerated figures of deaths (Hazarika, 1995). More than 6,000 reported plague cases were actually due to other diseases. Final death toll in Surat due to the disease was only 56 and, in totality, 693 suspected plague cases were reported (Byrne, 2008, p. 543). Many flights from India to the nearby Gulf region were suspended and some countries also put restrictions on imports from India. More than 45,000 people cancelled their travel to India. Export restrictions cost Indian economy ₹ 13 billion, besides loss of investor confidence (Pallipparambil, 2003). The total economic cost of plague exceeded ₹ 19 billion (ibid.).
The prevalent internal security challenges and the absence of major biological disaster so far in India are in danger of generating complacency. The plague outbreak in Surat in 1994 and in Himachal Pradesh in 2001; the severe acute respiratory syndrome (SARS) outbreak of 2003; the Nipah outbreak in 2001 and 2007; and the avian influenza outbreak in 2006, 2009 and 2015 have, time and again, illustrated India’s vulnerability to biological threats and the urgent need to strengthen public health system and surveillance measures.
Threat Analysis
As India faces multifarious threats from terrorism, for optimal utilisation of resources, systems approach is needed to holistically assess the threat. Inadequate threat assessment can lead to suboptimal policy decisions and, in turn, to wastage of resources a developing country like India can ill afford. As per ‘Weapons of Mass Destruction Commission’, the initial construction of a bioterrorist threat can be denoted as follows (Ackerman & Moran, 2004, p. 5):
Further,
This construction is supported by ‘Centre for Non-proliferation Studies on Bioterrorism Threat Assessment and Risk Management’ (Raymond, 2003). Various elements constituting the threat exhibit interdependencies and disproportionate emphasis on an aspect can be counterproductive.
The determination of the ‘value of asset being defended’ in terms of human cost, economic worth and imponderables, such as public morale, impact on economy and investor’s sentiment, will depend on the kind of asset targeted. This can be varied and possibly include large sections of population residing in cities, agroterrorism directed at livestock or contamination of a facility of economic importance. A 100 kilogram (kg) of anthrax spores released aerially can contaminate 46–300 square kilometre (sq km) of area, depending on the weather conditions, and cause 130,000–3,000,000 deaths corresponding to population density of 3,000–10,000 per sq km (Cordesman, 1993, p. 54). An aerosol spread of 250 pounds of anthrax spores over Washington, DC, with a population density of 10,528 people per square mile, could lead to three million deaths, more than from a 1 megaton hydrogen bomb (Cordesman, 1993, p. 52).
There are 54 cities in India with a population of more than one million each and metropolitan cities like Mumbai, Delhi and Calcutta have population of more than 10 million and population density of more than 60,000 per square mile (Indo-Asian News Service, 2011). Therefore, the impact of such an attack would be much more on a densely populated Indian city. Other factors such as terrain, topography, temperature, humidity and weather conditions will also play a role.
As per an estimate by Centers for Disease Control and Prevention (CDC), US, the economic impact of a bioterrorism attack employing anthrax could range from ₹ 20.7 billion to ₹ 822.4 billion for every 100,000 persons exposed (Drell et al., 1999, p. 82). This may be even more for a developing country like India whose growth rate can be severely hampered by trade restrictions and withdrawal of foreign direct investment (FDI).
The ‘hazard posed by biological agent’, in addition to its weaponisation state, method of dissemination and mode of infection, depends on its specific characteristics, such as survivability of the agent both in the environment and inside the host, communicability, toxicity, incubation period, symptomatology, mortality rates and the susceptibility to available mitigation efforts (Ackerman & Moran, 2004, p. 5). Biological agents are more efficient in terms of coverage per kg of payload than any other weapons system (NDMA, 2008, p. 3). According to a war game, ‘Dark Winter’, conducted in June 2001, within three months of a biological attack employing smallpox on Oklahoma City, over three million persons could be infected and over a million would be killed (Howard, 2010, p. 128).
The intention of the attacker will largely be influenced by his perception of the ‘vulnerability of the asset being defended’ to biological weapons, which may not always be based on an objective assessment. Terrorists may avoid attacking targets which are not perceived to be vulnerable.
Varied ideological and strategic reasons can act as ‘motivation’ for terrorists to develop and employ biological weapons. In 1998, Osama bin Laden, in an interview with Time’s Rahimullah Yusufzai, remarked that acquiring WMD was a religious duty. The WMD label attached with biological weapons not only holds out the promise of extreme devastation and severe economic damage, but also acts as a lure to terrorist organisations as a status enhancer, publicity generator and a strong blackmail tool.
‘Capability to conduct a bioterrorist attack’ by a terrorist organisation will depend on its organisational capabilities, financial and logistical resources, equipment acquisition and technical expertise. Most technical barriers for production, weaponisation and delivery of biological weapons have eroded, and these weapons are no longer an exclusive domain of the state’s military apparatus (Cordesman, 2001; Steven & Benjamin, 2000).
A small-scale biological weapon programme can be easily hidden in a basement. Many terrorist organisations today have active presence in countries like Afghanistan, Somalia, Iraq and Syria, where monitoring of even larger, well-tucked in facilities may be extremely difficult. Even in India, there are places where clandestine developments will draw minimum suspicion. A limited-scale attack can be carried out by a small group with minimal technical expertise employing commercially available ingredients like that used in brewing beer.
The cost per casualty for atomic weapons was assessed to be ₹ 135,000 and for conventional and chemical weapons as ₹ 29,000, whereas the cost per casualty for biological weapon was assessed to be about ₹ 50 (Gopal & Pollack, 2002, p. 133). Annual military budget of a typical terror outfit, Lashkar-e-Taiba, was known to be ₹ 240 million in 2009, according to the US intelligence (PTI, 2010). The Nationalist Socialist Council of Nagaland (Isak–Muivah) (NSCN-IM) has its annual budget to the tune of ₹ 250 million (South Asia Terrorism Portal, 2015). Finances, therefore, are not a restraining factor. However, finances exclusively are not a sufficient condition for developing biological weapons. Aum Shinrikyo possessed assets valued up to ₹ 35 billion but still failed to develop a viable biological weapon.
Biological weapons are also relatively much easier to produce. A biological arsenal can be built within a 15′ × 15′ room with ₹ 500,000 worth of commercially available equipment (Gopal & Pollack, 2002, p. 133). However, the cost of decontamination in case of a bioterrorism event can be staggering. After the anthrax letter incidents, decontamination of the US Senate office building and postal sorting office cost an estimated ₹ 3.45 billion, and this involved just 22 people, of whom five died (Davis, 2002, p. 127).
Though technical knowledge is available in open sources, there still exists a large gap between theoretical weapons knowledge and practical engineering skills, which involve a learning curve. The seed stocks of biological agents required can be extracted from the environment as many disease-causing microorganisms are endemic worldwide, like anthrax in Andhra Pradesh, Tamil Nadu and Karnataka. Seed stocks can also be purchased. Larry Wayne Harris, a US citizen with dubious motives, purchased Yersinia pestis via mail in 1995. The threat of theft of seed stocks from a state biological weapons programme also exists.
Weaponisation of the agent presents another challenge. A few hundred kgs of a weaponised biological agent can have the deadly potential to wipe out an entire city (Cole & Gurr, 2002). The Bacillus anthracis sent through the mail in 2001, in the US, contained weaponised aerosolisable spores. Pakistan, with a history of providing moral, logistical and financial support to terrorists, is also known to have dabbled with biological weapons (Shoham, 2014, p. 94). An estimated 17 countries currently have ongoing biological weapons programmes, which include sponsors of terrorism (NDMA, 2008, p. 2). The possibility of state support for terrorism extending into the realm of biological weapons cannot be discarded.
India’s Vulnerability to Agroterrorism
Agroterrorism as a subset of bioterrorism can be defined as the malicious introduction of an animal or plant disease or pests to damage the agriculture and food supply industry of a nation with the aim of generating fear, causing economic losses and undermining social stability. Agriculture and allied sectors, including livestock, fishery and forestry, provide employment to 58 per cent of the rural inhabitants and the share of agriculture was 13.9 per cent of GDP during 2013–2014 and 16.1 per cent of the gross value added during 2014–2015 (Indian Brand Equity Foundation [IBEF], 2015; Ministry of External Affairs [MEA], 2015).
India, ranked third in farm and agriculture outputs globally, is the largest producer of spices and pulses and the second largest producer of sugar. Spice exports from India are likely to surpass ₹ 200 billion by 2016–2017 (MEA, 2015). Indian agricultural sector has attracted FDI equity inflow of about ₹ 133.45 billion in the last five years (IBEF, 2015). An act of agroterrorism can severely affect the farm output, drive food prices up, adversely affect food safety and security and seriously damage Indian economy due to loss of export earnings and industry renewal costs, besides having a long-term adverse social impact.
The crop agroterror agents include diseases like potato beetle, cereal rust, soybean rust, rye stem rust, wheat smut and rice blast. Brown spot disease of rice contributed to the Bengal famine in India in 1942–1943 (Kohnen, 2000). The Irish potato blight killed one million people due to famine, besides forced migration of another million (Rogers, Whitby, & Dando, 1999, p. 75). In 1985, the suspension of grape imports by the US from Chile, due to threat of them being contaminated with cyanide, cost Chilean growers ₹ 4.1 billion (Ban, 2000).
Indian agriculture is heavily dependent upon cattle. India has the largest bovine population of over 118 million and the highest total milk annual output of 138 million tonnes (MT) (MEA, 2015). Highly contagious animal diseases, such as the FMD, rinderpest and avian influenza, can be employed as agroterror agents against livestock [(WHO, 2004(a), 2004 (b)]. Cattle are also very prone to the transnational and transcontinental spread of epizootics. The spread of Rift Valley fever in Egypt and African horse sickness in India are well documented (Bannerjee, 2002, pp. 122–123). The chances of spread of other epizootics like FMD in India are immense. The animal fairs at Pushkar in Rajasthan or Sonepur in Bihar attract about half a million animals. Infection deliberately introduced at such fairs can result in a pandemic with long-term consequences (ibid.). In 1996, Taiwan FMD led to the killing of four million hogs, incurring long-term losses of ₹ 274 billion to the economy (Wilson & Tuszynski, 1997). Worldwide, more than 1.35 million cattle have perished due to bovine spongiform encephalopathy (BSE) at a cost of about ₹ 196 billion (Kohnen, 2000).
Mitigating the Threat: Recommendations
A number of urgent measures both at domestic and international levels can help India to be better prepared. The incorporation of global best practices and technology can act as a force multiplier against a bioterrorism threat.
Domestic Measures
Cooperation between Security Agencies, Intelligence Units, Public Health Services, Scientific Community and Industry
All agencies responsible for national security should collaborate and establish stronger linkages with the scientific community and public health services for better intelligence and surveillance against bioterrorism. Coordinating and sharing of information between government agencies at central and state levels needs strengthening. Wide variation in awareness levels and the ability to devote resources in different states needs to be addressed. The threats posed by bioterrorism involve numerous technical challenges falling outside the core competencies of security organisations. The evolution of a new knowledge-empowered community via collaboration between scientific, health and law enforcement agencies can help keep pace with evolving fields of genetics, biotechnology and terrorism (Ackerman & Moran, 2004, p. 17). An integrated approach to plug the weakness in current framework will facilitate expertise, material and facility control. Concerns about intrusive inspections and regulatory checks of industry and private sector should also be collaboratively addressed.
Developing Detection Technology
Security agencies, in collaboration with the scientific community and private industry, should develop, evaluate and deploy rapid, reliable, broad-spectrum, cost-effective, sensitive and selective detection technologies for biological threats (NRC, 2002, p. 73). Innovative approaches, like the use of hydrogen peroxide sprays and ultraviolet light exposure to destroy biological agents in underground metros, biosensors coupled with immortalised rat brain cells to provide early warning of presence of biological agents or, more contemporarily, having passive, lightweight mass spectrometers for real-time detection and destruction of biological agents, are required (Siegrist, 1998, pp. 9–10). Three important projects against bioterrorism threat were initiated by the US after the anthrax attacks (Marburger, 2005). India, faced with multifarious challenges, cannot afford to blindly ape these projects but study of the same can yield some important lessons:
Project Bio-Watch is envisaged as an early warning system for biological threats, with 4,000 atmospheric monitoring stations for the detection of atmospheric pollutants, analysed for numerous biological agents. Project Bio-Sense aims at reducing the lag time between the detection of a possible bioterrorism attack and an appropriate response. It relies upon multiple streams of information to facilitate rapid decision making. Project Bio-Shield deals with stockpiling of drugs, vaccines and treatments as a national security measure against terrorist threats.
National Knowledge Centres Database for Countering Bioterrorism
The knowledge network being implemented by the National Informatics Centre with an outlay of ₹ 59.9 billion to interconnect 1,500 research institutions of higher learning to facilitate knowledge sharing needs to be expedited. This could help collaboration against bioterrorism in the knowledge domain. A bioterrorism information system with central database, containing updated intelligence reports of terrorist groups, their ideology, intent, methodology and capability; sabotage activities and material thefts; and intentional misuse and illegal trading, is required (Rajagopalan et al., 2012, p. 75). The documentation of disease outbreaks in India, including its research and scientific analysis, needs improvement and streamlining.
India also needs to develop databases for pathogens infecting important crops and animal stock. It is essential that the laboratory system with an inventory of all the known pathogens with their deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) sequences, collated in an epidemiologic–epizootic database, is available for rapid detection via comparison. This would require technical equipment and reagent systems for diagnosis and evaluation under field conditions. A standard specimen bank needs to be developed, along with a serum bank for livestock from different parts of the country (Bannerjee, 2002, p. 118).
First Responder Preparedness and Enhanced Public Awareness for Appropriate Response
The preparedness levels of Indian security forces towards bioterrorism threat range from being totally unprepared to being only partially prepared. Training and communication infrastructure at the grassroots levels, especially among the police and first responders of different states, leaves much to be desired. There is an urgent need to impart bioterrorism training to security forces, health services and other first responders like firefighters. Bioterrorism DM should be incorporated in the present curriculum of medical courses; and training of laboratory technicians, epidemiologists, public health officials, veterinarians and plant pathologists is essential for rapid detection, assessment and timely response.
Increased public sensitisation is required towards bioterrorism; its likely manifestation; role of important functionaries like first responders to include local police, fire services, district collector, chief medical officer, etc.; role of public and private hospitals and health centres; responsibilities of national, state and district DM authorities; and information of designated hospitals for biological threat, first aid centres, designated laboratories, decontamination centres and information centres. Earmarked hospitals need to be upgraded and those capable of emergency medical response (EMR) should have suitably equipped ambulance service and stockpile of essential chemoprophylactic and immunoprophylactic drugs, vaccines and IPE.
The NDMA
Though the NDMA continues to evolve, it leaves much to be desired as far as its preparation for mitigation of bioterrorism threats is concerned. State and district DM authorities need to be better trained, strengthened and provided requisite resources to tackle bioterrorism incidents. NDMA guidelines need to evolve into action plans at central, state and district levels and should be legally binding measures. Given the frequency of natural disasters in India, the agency’s focus is primarily on natural disasters, as opposed to the perceived low likelihood of bioterrorism threat. However, here also, it has been struggling to carry out its mandate, as illustrated by its poor response both in Uttarakhand cloud burst and Jammu and Kashmir floods.
Specialist Research Organisation to Counter Bioterrorism
There is a need for a central nodal governmental agency for bioterrorism. NDMA needs to play an important role in responding to bioterrorism incidents, but its focus remains on a post-disaster response. NCDC is not mandated for bioterrorism and, moreover, does not have the requisite infrastructure as well as the expertise as per the present organisation. This central agency should holistically address complex and multivariable aspects of bioterrorist threat and guide policy formulation responses, while forging strong linkages with industry and academic institutes for coordination of cutting-edge research. It should also clearly define the responsibility of different government agencies, like security forces, including NDRF; specialised organisations like NDMA, DRDO, DBT and CISR; different ministries like MoH&FW, MoA, MoD and Ministry of Environment and Forest (MoEF); regulatory organisations like the Central Drug Standard Control Organization (CDSCO) and Food Safety and Standards Authority of India (FSSAI); private institutions to include biotech industry, hospitals, Indian Pharmaceutical Association (IPA) and various non-government organisations (NGOs); and media.
The role of all the stakeholders should be clearly delineated and legislated forming part of a larger action plan at the national level. This agency should also be responsible for funding research for long-term, high-risk, high-payoff projects. Ideally, the new recommended organisation should be small, but have strong interactions with universities and relevant government organisations. Considering the highly specialised nature of the problem, bioterrorism should be identified as a distinct issue and given focused policy attention. The new research organisation will also work to understand pathogenic virulence factors and their effect on mammalian systems, aimed at the development of diagnostics, antiviral and antibacterial drugs and vaccines. This inevitably would have dual-use benefits.
Central Agency for Control and Prevention of Plant Disease
Similarly, an agency with capabilities necessary to deal effectively with agroterrorism threats and coordinate and direct research as well as response with all stakeholders is required.
Food Safety
FSSAI should develop and define the criteria for quantifying hazard to various kinds of food processing facilities due to malicious and deliberate contamination of the food supply. It needs to progress from old quality control (QC) and quality assurance (QA) programmes to newer and better methodologies, such as hazard analysis and critical control point (HACCP), in which food safety is addressed holistically and systematically through analysis at different points in the supply, production and distribution chain, from collection, handling and procurement of raw material to processing, manufacturing, distribution and consumption of the finished product. An interactive system of government officials, industry, NGOs and social workers, with active participation of sensitised community, can improve food safety and security and help detect contamination.
Vaccine Development and Therapeutic Production
Focused research is required in the development of therapeutics and vaccines. Support is needed for basic and clinical research to discover molecular targets in pathogens and to develop broad-spectrum antiviral drugs and antibiotics, and to devise protective treatments. The field of genomics requires enhanced emphasis. Research, development and manufacturing capabilities to produce diagnostics, therapeutics and vaccines, and an oversight laboratory to evaluate, prepare, and standardise methodologies, need to be established based on a public–private partnership model. A stockpile of essential vaccines, antibiotics and other critical medical equipment and supplies needs to be created at the national level.
Improvement in Environmental and IPE
Bureau of Indian Standards (BIS), NDMA, MoH&FW, MoD and MoEF should perform and support research on new technologies that increase the protection factors of such equipment, and ensure oversight and uniform testing for certified efficacy.
Modelling and Simulation
Agencies with relevant expertise, such as CSIR, Centre for Mathematical Modelling and Computer Simulation (C-MMACS), MoD, MoH&FW and NDMA, should develop and support epidemiological mathematical modelling, taking into account a range of incubation periods of different agents, available modes of transmission and effects of varied climate and population, to simulate the release of contagious and non-contagious biological agents. This will aid accurate threat assessment, remove the uncertainties associated with the effects of biological weapons and test the preparedness levels.
Investigations into the Pathogenesis of Infectious Agents
Enhanced knowledge of pathogenesis of all bioterrorist agents, and of host responses to them, needs enhancement by employing latest microbiological tools. Focused research in these areas will enhance our understanding of susceptibility of these threats to useful intervention and will help in developing diagnostics, drugs and vaccines. Genetic engineering and recombinant DNA technologies need to be understood and exploited in India.
Bio-forensics
India needs to develop bioterrorism forensics capabilities. Requirements and capabilities of this new multidisciplinary, multilayered field of bioterrorism forensics require crystallisation. Bio-forensics being totally different from ordinary forensics, India may start by seeking assistance from friendly countries.
Defining Protocols for Responding to Bioterrorist
NDMA, in consultation with DRDE and NCDC, should develop a plan for achieving this objective, and MoH&FW and MoA, through their various agencies, should support the necessary research. Rapid epidemiological assessment of biological disasters can be achieved by ICMR by employing the latest technological tools, which will in turn assist in decision making and timely intervention. IDSP needs to be expanded and strengthened, and should also have linkages with surveillance networks of neighbouring countries as well as internationally, through agencies like Food and Agriculture Organization (FAO) and WHO. It should incorporate technical and operational research tools such as mapping; use of geographical information system (GIS) and new methodologies for risk-based allocation of resources, like threat, vulnerability and consequence (TVC) analysis (NDMA, 2008, p. 31; Linacren et al., 2005).
Development of Disease-resistant Crop and Genetically Modified (GM) Crops
Development of disease-resistant, high-yield varieties of crops such as wheat, rice, sugarcane and pulses should remain a priority for Indian scientists. The methodology to obtain resistant cultivars employing classical genetic methods is slow, but has proven to be useful. New molecular methods are likely to give faster results. Critical assessment of GM crops for their profitability, sustainability and susceptibility/resistance to bioterrorism and naturally occurring diseases should be researched.
Laboratory Standards and Automation for Early Detection
An oversight standards laboratory is required to be established to ensure the availability of standard reagents for government departments, educational institutions and industry. This institution would also be responsible to develop and evaluate appropriate standards for various diagnostic and detection tools and for revision and updating of the same on a continuous basis (NRC, 2002, p. 98). There is also a requirement of laboratory automation to classify and diagnose infections in patients in primary care settings.
Regulatory Exceptions for Development of Therapeutics and Vaccines
CDSCO should consider options and plausible mechanisms for expedited approvals under specific emergent circumstances. For accelerated fielding of new drugs and vaccines that cannot be tested on humans, mechanisms for indemnification in the case of adverse effects, in specific cases justified by the national interest, must also be considered.
Strengthening Legal Framework
India urgently needs a stricter legislation backed by effective enforcement for addressing the bioterrorism threat. The Indian Penal Code is inadequate to deal with bioterrorism. The US, in the wake of the anthrax attacks, passed the ‘Bioterrorism Act of 2002’, which focuses on food, water and drug safety and security. As per the Indian Constitution, health is a state subject. Epidemic Diseases Act of 1897 does not provide any power to the centre to intervene even in case of a biological emergency and should be replaced by the Public Health Emergencies Bill which is still pending. The new act should comprehensively address all biosecurity and biosafety issues and have provisions for the central and state governments and local authorities to act with impunity (NDMA, 2008, p. 13).
Security Standardisation for Biological Facilities
Most critical industries of national importance are protected by CISF and state security police, but there is insufficient manpower to place all industries under surveillance. The number of private security agencies has mushroomed recently, which lack standardisation and have uneven levels of training and expertise. Greater standardisation of site security needs to be achieved based on importance and vulnerability of different industries. The international models that could be adopted include ones developed by the Centre for Protection of National Infrastructure, United Kingdom (UK) (Rajagopalan et al., 2012, p. 75). Security during transport of sensitive material, keeping bioterrorism threat in mind, also needs enhancement.
Role of Industry in Setting Standards
Compliance with industry standards is often higher than compliance with government regulation. Participation in international industry bodies and adherence to industry standards should therefore be encouraged, supported and incentivised. Private industry, multinational companies and trade associations play a strong role in establishing best practices and encouraging compliance across biological industries. Councils within India, such as the Chemical and Allied Export Promotion Council of India (CAPEXIL), the Organisation of Pharmaceutical Producers of India (OPPI), the Indian Chemical Manufacturers Association (ICMA), the IPA and the All India Biotech Association (AIBA), have a major role in promoting and encouraging standards keeping threat from bioterrorism in mind.
Rapid Diagnostics for Plant and Animal Diseases
This should incorporate safe and specialised laboratories for handling pathogens, standardised reagents for diagnosis and trained human resource. Modern genomic and proteomic technologies can help in rapid diagnosis. The development of an efficient system for sample collection and a safe transport system for sending the specimens to the diagnostic laboratory is a very important component of a working diagnostic system (Bannerjee, 2002, p. 118).
Public Information Officer (PIO)
Public panic needs to be controlled by providing reliable dissemination of information to enable the people to take appropriate actions and by ensuring accurate and responsible reporting in the media. Suitable and respected PIO, preferably of a scientific background, needs to be pre-designated as a spokesman.
Health Reserve System and Surge Capacity
There is requirement of a reserve system of doctors, plant pathologists and veterinarians, modelled on the military reserve system, as part of a broader planning process. This, along with the value addition of local, state and national laboratories, will supplement and enhance response capabilities and provide the surge capacity, when required (NRC, 2002, pp. 92–93).
National Bioterrorism Disaster Management Plan
There is no policy on disasters due to biological terrorism at the national level. Even the existing contingency plan of MoH&FW for dealing with biological disaster of natural occurrence is more than 15 years old and needs extensive revision (NDMA, 2008, p. 29). National, state and district biological DM plans need to be prepared, war gamed and known to all stakeholders.
International Measures
Best Practice from Global Forums
Membership in global forums provides access to advice and guidance developed by the organisations, including access to experts, capacity-building programmes and grants and global governance structures. Tangible benefits can be seen from India’s engagement with such global forums. Collaboration and cooperation with international organisations, like the WHO, Office International des Épizooties and FAO, and organisations of like-minded countries like CDC of the US can play a crucial role in epidemic control.
Training and Capacity Building
Considering the current lack of specialised training availability within India, it may be pertinent for Indian police forces to capitalise on links with Interpol to take advantage of the training packages developed by Interpol’s Bioterrorism Prevention Programme and Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) Terrorism Prevention Programme [Interpol, 2015(a), 2015(b)]
Biological Weapons Convention (BWC), 1972
BWC totally banning biological warfare was approved by the United Nations General Assembly in 1971. The absence of any formal verification regime or mechanism to monitor compliance has limited the effectiveness of the Convention, and even after seven review conferences, this clause has not been added. Progress in genetic engineering has further complicated this issue. Vectors of diseases as potential agents of biological warfare should also be included in the BWC.
Strengthen Global Norms against Biological Weapons
International cooperation is important for information exchange, knowledge sharing and extraditing bioterrorists. Universal abhorrence of biological weapons could strengthen key motivational constraints that might dissuade terrorists from conducting biological attacks.
Standardise International Biosecurity Efforts
Institutions that maintain dangerous pathogens for legitimate uses, such as culture collections, academic and commercial research labs and medical facilities, offer the most direct and reliable routes for the acquisition of seed stock needed for a biological attack by terrorists. Numerous such facilities exist around the globe, many of which are minimally secured and regulated. The international community should come to a common understanding on a bioterrorism high-priority agents list, to better safeguard such stocks based on their virulence, effects on health, infectiousness, etc. Additionally, an international biosecurity convention can prevent these seed stocks from being misused (Ackerman & Moran, 2004, pp. 16–17).
Enhance Global Preparedness, Detection, Surveillance and Response Capabilities
An international network for detection and surveillance, making use of IT for real-time reporting and analysis, to rapidly detect new patterns of disease locally, nationally and internationally is required. Adequate preparedness and response capabilities by invoking international cooperation may not prevent bioterrorism, but will minimise the casualties, economic damage and fear psychosis, and further reduce strategic incentives for terrorists.
Identify Public Health as a Key Component of International Security
According to the WHO, at the end of the past century, a quarter of all the world’s deaths and half of all deaths in developing countries were caused by infectious disease. Acknowledging that many poor and developing countries will be unable to address the emerging challenges of bioterrorism alone, the international community should identify public health as a common security concern. Moreover, diseases caused by infectious agents can spread rapidly across borders, as happened in the recent Ebola virus epidemic. The international community must evolve cooperative strategies for improving preparedness and response capabilities. IHR (2005) aimed at prevention, protection, control and responding to public health emergency of international concern (PHEIC), with member states eligible for support from the Global Outbreak Alert and Response Network (GOARN), is a step in the right direction and needs to be further strengthened.
Concluding Remarks
Bioterrorism is a low-probability, high-impact event. Mitigating this threat calls for a robust public health system. Political awareness and public participation are essential components of threat mitigation. Presently, security forces do not have adequate know-how about bioterrorism and require both capacity and capability building. Inclusive and holistic efforts are needed to build a seamless system of preparedness and response to counter bioterrorism. The preparation of India against biological attacks will have dual-use benefit of combating natural diseases, thus transforming India into a resilient society.