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nerdgirl

Bioterrorism, smallpox vaccines, & another WMD Commission report

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Being an old geezer, I was vaccinated against smallpox as a child.



Same here, but as Marg says, there's a distinct possibility that those vaccinations have expired.

Incidentally, how did they administer the Cow-Pox Vaccine when you were a child? Did you, like, have to visit a farm, or did they bring a cow to your school?

Mike.



Received the vaccination as a child and also had it re-administered a few years ago. Since I had received it before, I received something like 15 pricks and those who had never had it administered received 2-3 pricks with a needle that had been dipped in the vaccine. The site it was administered in itched a little bit but never got bigger than a mosquito bite. Some coworkers developed the typical ulcerated weeping wound that needed to be covered but those were usually those who did not receive the vaccination as a child.
"It's just skydiving..additional drama is not required"
Some people dream about flying, I live my dream
SKYMONKEY PUBLISHING

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Incidentally, why Smallpox?

Wouldn't the terrorist bio-weapon of choice be pneumonic or bubonic for it's greater mortality & spread wheras smallpox is more of a debilitator?

Just a thought...



It’s a good question.

There are lots of reasons to choose it. For the exercise in which I participated, it was largely driven by modeling on the Atlantic Storm exercise. The latter itself was not directly modeled on but was influenced by the Dark Winter exercise. It was designed and executed by the same folks.

Why smallpox? Lots of reasons. It’s a near-universally feared infectious disease. It has a history of being used for asymmetric warfare (by British against Native Americans [e.g., see letters between COL Bouquet & Lord Amherst]). Smallpox was weaponized as part of the former US and former Soviet weapons program. Some of us still wonder what happened to the stocks of weaponized smallpox that the Soviets had on ICBMs. These are terrorism scenarios as well. The most terrifying agent does not necessarily equal the most effective agent. Smallpox is a very effective agent to use for raising awareness and garnering media and policy maker attention.

There are other reasons to argue for pneumonic plague. You’re right about the mortality rates of untreated pneumonic plague being greater (basically 99% die). Both pneumonic & bubonic are largely treatable. Y. pestis has less of a history w/r/t known & suspected offensive weapons programs. It is also still a disease found around the world. Heck, there are a dozen or so cases, usually bubonic, in the US every year in the southwest ‘four corners’ region. Lots of prairie dogs carry Y. pestis. Y. pestis was part of both the former US & Soviet weapons programs, however.

Scenarios between smallpox & pneumonic plague are both fairly grim … or add in a hemorrhagic fever or a genetically manipulation measles strain. Measles is *much* *much* more transmissible than vaccinia variola major, Y. pestis, or any of the VHFs.

Also one of the experts affiliated with the group that designed & led both the Dark Winter and Atlantic Storm is DA Henderson, i.e., the physician who led the eradication of smallpox.

One could make a similar argument/ask a similar question w/r/t distribution of therapeutics post-pneumonic plague terrorist event … altho’ it’s more complicated because of multiple different antibiotics that can be used to treat. There is a vaccine for plague, which was used by the US military during the Vietnam war til recently, but it is not FDA approved.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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Thank you.

I did wonder if part of this exercise was an assessment of the American position toward Europe; Globalism Vs. Isolationism. In effect, would the US increase the risk to it's own population mitigating the risk to the European (or target) population, and to what degree would they do so?

Mike.

Taking the piss out of the FrenchAmericans since before it was fashionable.

Prenait la pisse hors du FrançaisCanadiens méridionaux puisqu'avant lui à la mode.

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I was unaware of that, so does one just go down to the doctors office and request one?



Officially the federal government did not recommend vaccination for all US citizens and residents after the Dec 2002 National Smallpox Preparedness Program policy was implemented. As the vaccine program was phasing its way through first responders, hospital workers, and other health preparedness related individuals, yes, you would likely have been able to get a vaccination, however. Probably not through your local primary care physician but through a State public health department or large hospital.

It would be more challenging for the “average citizen” to get vaccinated now. One generally needs to be part of certain groups: first-responder, ER team member, part of a smallpox response team, certain military and federal civilians, variola researcher, or clinical trial participant.

Today, the US maintains that it has over 300M doses of the smallpox vaccine, enough for every US citizen. These are also not the old ‘grown on the side of a cow’ versions of the vaccine; all of those in the US stockpile were destroyed.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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I dunno, maybe this particular excercise was specifically meant to investigate a smallpox outbreak but was only one of many excercises that together cover many threats.

Anyway, pneumonic and bubonic plague are both curable with early treatment and there are only limited supplies of antiboiotics available. In general, I think many of the responses to smallpox would be applicable to lots of other outbreaks too. But I'm no expert.



Yes, for the reasons detailed in my response to Mike, smallpox was particularly chosen for this exercise. As I noted in my OP Stan Foster, who led the efforts to eradicate smallpox in Bangladesh and parts of Africa was also involved. When you’ve got one of the world’s experts (who’s also a *really* cool human) involved, it’s strategic to use that expertise. B|

Additionally, with smallpox one can administer the vaccine post-exposure and it still provides protection. Earlier is better. Most other vaccines don’t work that way.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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Here's the most terrifying thing to me. Assuming there was a mass dispersal of smallpox on December 6. When would population symptoms start to appear? The 8th or 9th? By then itd be too late, wouldn't it?



Symptoms typically appear within 7 to 14 days depending on the strain. The first symptoms are "flu-like." The characteristic rash appears a few days later.

By the time, the first patients exhibit symptoms, yes it would be too late for ~30% of them. (~60% of folks survive with varying degrees of disfigurement). It's consequence management to stop the spread of the infectious disease.

One is distributing vaccine for two groups: the uninfected/unexposed and those who may be exposed/infected but are not yet exhibiting symptoms. Isolate the ill-infected, and quarantine those who may be exposed but are not yet symptomatic.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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Personally I am not a fan of vaccinations, especially for infants and small children.



Depends on the vaccine.

At this point, I would not recommend vaccination against smallpox or Hepatitis, for example, for most children. Personally, I don’t like the tendency toward anti-bacterial soap/whatever and not letting kids get dirty.

Otoh, over the last 5-10 years, the US has seen significant increases in incidence of measles (in the UK too) and mumps largely due to parents electing to not have children vaccinated for a wide set of beliefs … some that are dubious at best.

With the original post/thread, I was less interested in giving a tutorial on smallpox, bioterrorism, or vaccines, than curiosity w/r/t folks response to the original question regarding opinions on sharing vaccines in the event of a terrorist release. Do you have an opinion on that? I'd be curious to hear. :)
VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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I did wonder if part of this exercise was an assessment of the American position toward Europe; Globalism Vs. Isolationism. In effect, would the US increase the risk to it's own population mitigating the risk to the European (or target) population, and to what degree would they do so?



The exercise itself, no.
Some of the questions going through my squishy gray matter and some of the impetus for the thread here, probably. My thinking was more the balance between domestic politics and most effective policy, tho.

It's even more complicated than what you suggest. By *not* sharing the vaccine, the US may actually be *increasing* the risk to the US. (Sounds counterintuitive at first, eh?)

Ring vaccination, which would not require mass vaccination of all US citizens, has been used successfully and is backed by all the science. The US could share the vaccine, still protect the US, and prevent spread of disease further ... including to additional US cities.

But, science very rarely drives policy, tho. So it's the tension between what might be the best policy (ring vaccination & share) versus what I though was likely via domestic politics. And frankly, I'm not sure that any other state would behave differently than how I suspect the US would. Not a democratic one at least. Autocratic ones likely would not even consider the question. Within the exercise, one piece that comes out is German citizens (as that was one of the notional sites for relese) trying to get out of Germany and (again notionally) Polish citizens trying to come into Germany in order to get the vaccine.

That brings up additional issues of securing/closing borders, quarantine, and pragmatics of distribution logistics. (Even more complicated than the original question I posed.) From a real world outbreak of pneumonic plague in India, the issue was dealt with by winthdrawing all antibiotics to the central health district. Therefore, people were compelled to not leave.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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There is a vaccine for plague, which was used by the US military during the Vietnam war til recently, but it is not FDA approved.



Plague vaccine is still administered to certain deploying military service members, has been for as long as I can remember and have been receiving it (20 yrs).

EDIT: To address and play the game. The US would combine a small percentage of the vaccine with other nations vaccines to help slow the spread in the hottest areas of the out break. Boarders and influx of people from outside the US would be regulated and quarantine centers would be used to help control those coming into the country. In the meantime, the US and other nations capable would increase the production of the vaccine as fast as possible and administer it to their populations as well as to other affected countries incapable of producing the vaccine.

So yes, the US would share a small portion of its vaccine in order to keep the problem from getting bigger and buy time to immunize the population and produce more vaccine to make up for shortages and or send to other nations to keep it from spiraling out of control globally. There are other considerations and factors but thats the cliff note version of how it would unfold IMO.
"It's just skydiving..additional drama is not required"
Some people dream about flying, I live my dream
SKYMONKEY PUBLISHING

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On Tuesday, the (latest) WMD Commission released their findings in which they assert that a biological terrorism attack (not necessarily smallpox) is “more than likely” within the next 5 years.



I read this report when it came out, and I was unimpressed.



Concur that there are reasons to be critical of the latest report.


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Chemical is de facto included, but the focus of the report was bio or nukes.


The Commission explicitly elected to not include chemical (& radiological), so it is not de facto included. Representatives of the Commission and the Commission staff have publically stated a reason why they made that choice. While I can speculate on the underlying reasoning for choosing to focus solely on biological and nuclear terrorism, I disagree *strongly* with the choice. Nuclear terrorism is the only WMD that is likely to pose a threat to the Republic. By disregarding the threat of chemical (& radiological terrorism), however, a potential vulnerability is created. When I think about risk, I consider both the “probability” and “consequence” components. The probability of use of a chemical agent by foreign or domestic terrorists is the highest across the WMD spectrum in my opinion.



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Nuclear isn't that hard to justify either - you've got "real" nukes, and "dirty nukes" (which are much easier to make). Since Iraq had yellow-cake, they could have made a dirty nuke.



Point of clarification: having yellow-cakes uranium and a dirty bomb are not the same thing. A dirty bomb is not related to a nuclear device, even tho' they occasionally get 'mashed' together colloquially. Dirty bombs are radiological dispersive devices (RDD). Incorporate isotopes with much shorter half life than Uranium, e.g., Cobalt-60 or Strontium-90. Uranium would be a very poor choice for a dirty bomb.



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But none of these scenarios means that a terrorist state has the capability to launch an ICBM across the ocean to the middle of an American city and cause WW3.



Concur. I know of >$110B that has been spent toward reducing that risk, which one can argue whether that has been the most effective use of taxpayers dollars.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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The probability of use of a chemical agent by foreign or domestic terrorists is the highest across the WMD spectrum in my opinion.



Unless it is state sponsored terrorism, the probabilities are low that an organization could produce a chemical agent that was highly effective. The two major areas that make this a low probability are the difficulties with production and delivery methods. While small to medium size events could be carried out, the effected population/area would be localized and the casualties would be similar to what we see when a train car tanker derails or an industrial warehouse with chemicals in it catches fire. Most chemicals also have a short duration time before their effectiveness deteriorates and or can be neutralized.

Conversely, it is easier for an individual or group to produce a bio agent in their basement, aerosolize it and walk down the street and spray it into a crowd unnoticed and let people spread the disease exponentially. Even this method , as easy as it sounds, has some inherent difficulties that make the production and effectiveness of the agent less likely to work as designed and also limit the types of bio agents that could be used/considered.

Again, thats a very short cliff note explanation.
"It's just skydiving..additional drama is not required"
Some people dream about flying, I live my dream
SKYMONKEY PUBLISHING

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Plague vaccine is still administered to certain deploying military service members, has been for as long as I can remember and have been receiving it (20 yrs).



Don’t doubt that. As I wrote, until recently, the plague vaccine was administered. It wasn’t just available to military either. Also available to federal civilians and non-federal researchers.

There is no FDA licensed plague vaccine that provides protection against the pneumonic form of the disease. For a long time, the military used the old plague vaccine under guidelines that allowed it to be used as “investigational drugs.” Older generations of a plague vaccine exist, but they never were, or no longer are, licensed in the US, Canada, or the UK. The old vaccine was used for years.

In 2009, the DoD's Joint Vaccine Acquisition Program (JPEO-MO) through the CBDP plans to start buying a new plague vaccine developed jointly w/UK & Canada. These vaccines aren’t procured through the Military Health System, as most (all?) other medical treatments are. (The services refuse buy BW vaccines themselves post-anthrax vaccines ‘issues’/court-cases/etc; there’s a fight/rice-bowl battle among OSD(Health Affairs), the CBDP[under USD(AT&L)], and the services.) Medical chemical and medical radiological countermeasure research are ~1% of the total budget – don’t expect any finished products within the POM.


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The US would combine a small percentage of the vaccine with other nations vaccines to help slow the spread in the hottest areas of the out break.

You make it sound so easy. B|
How would you propose dealing with domestic politics?


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Boarders and influx of people from outside the US would be regulated and quarantine centers would be used to help control those coming into the country.

How? Are you familiar with the TOP-OFF 3 national full-scale exercise? That exercise incorporated release of poorly-weaponized Y. pestis (plague) w/an international component. A biological terrorist event does not automatically trigger the Stafford Act much less use of Title 10 forces.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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Again, thats a very short cliff note explanation.



Thanks. :D


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Unless it is state sponsored terrorism, the probabilities are low that an organization could produce a chemical agent that was highly effective.



On what do you base that assessment of probability? (Or your assessment of ease of weaponization and dissemination of a biological agent?) I'm always curious as to process behind one's thinking.

How different is ‘street chemistry’ of IED production from the street chemistry of simple improvised chemical devices?

Are you familiar w/the Mubtakkar device? (Call NGIC not Ron Suskind.)

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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Again, thats a very short cliff note explanation.



Thanks. :D


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Unless it is state sponsored terrorism, the probabilities are low that an organization could produce a chemical agent that was highly effective.



On what do you base that assessment of probability? (Or your assessment of ease of weaponization and diseemination of a biological agent?)

How different is ‘street chemistry’ of IED production from the street chemistry of simple improvised chemical devices?

Are you familiar w/the Mubtakkar device? (Call NGIC not Ron Suskind.)

VR/Marg


yes,yes and yes. I even have the T-shirt with hood and all the geeky security badges that go along with it. ;)But I don't think this really is the place to discuss and get into the weeds on this topic. Which is why I only offered "cliff notes". Besides, I am between loads and don't have time to talk "shop".
"It's just skydiving..additional drama is not required"
Some people dream about flying, I live my dream
SKYMONKEY PUBLISHING

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Which is why I only offered "cliff notes".



The problem is that your 'cliff notes' version is problematic.

And one doesn't need to go to JWICS to discuss it.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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WRT effectiveness, wouldn't infecting several people and flying them into heavily populated areas have the same (admittedly rough) effect?



yes and there are several fictional books out there that use that scenario,some better than others in their application. Which is why bio is a concern IMO.
"It's just skydiving..additional drama is not required"
Some people dream about flying, I live my dream
SKYMONKEY PUBLISHING

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Depends on the agent.

Scenarios of folks walking while infective w/VHFs (e.g., Ebola) are completely notional.

VR/Marg



I definitely wasn't thinking Ebola (wasn't that the premise behind one of Clancey's "Jack Ryan" novels?) but more on the lines of smallpox or similar.
Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

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WRT effectiveness, wouldn't infecting several people and flying them into heavily populated areas have the same (admittedly rough) effect?



yes and there are several fictional books out there that use that scenario,some better than others in their application. Which is why bio is a concern IMO.



Again, it depends on the agent. Is it the most likely scenario? No. Look to the Aum Shinrikyo and Bacillus anthracis for a likely scenario. Would it be a very effective scenario? Not likely, regardless of fictional accounts.

(And by the way, the question wasn't whether biological agents should or shouldn't be of concern ... but should chemical (& radiological) be dismissed/disregarded/ignored.)

The simple measure of transmissibility is the R0.

If R0 is less than zero, one person infects less then one other person -- the disease does not spread. Getting an R0 of zero is a combination of the characteristics of the bug and the success of public health intervention efforts (vaccination, quarantine).

If R0 equals 1, 1 person infects 1 other person.

If R0 is greater than 1, than the infection can potentially be exponential.

Measles pre-vaccine R0 was 14-18.
Polio is 5-7.
Tuberculosis is 2-5.
Ebola is 1.34 - 1.8.
AIDS is 0.34 - 1.5
Pneumonic plague is 0.8 - 3.0.
Smallpox is 1-3. The Dark Winter folks used an R0 of 10 and were (appropriately, imo) excoriated for it.

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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It is not necessary to cause mass casualties or even a single casualty to create an effective event. NBC of any type is quite possible to cause a general panic, and the the easiest is chemical followed by nuclear and then biological.

I think Scott makes some good points but they are more militarized application scenarios. Achademic and medical folk like to discuss these events in terms of WHO or CDC protocols for deseases. You can make good copy with some biological agents, but those that are relatively easy to obtain in nature that carry a significant psycological impact are most likely (IMO). These are most likely smallpox or anthrax. Of those two smallpox is the easiest to manage.

The point of terrorism is not to kill people, it is create chaos and uncertainty. Killing people just seems to underscore events. Take away the chaos and uncertainty and you immunize the populace against the specific terroist tactic being discussed.

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It is not necessary to cause mass casualties or even a single casualty to create an effective event. NBC of any type is quite possible to cause a general panic, and the the easiest is chemical ....



*Exactly*

That's where weighing probability versus (potential) consequence is important.

It's also where fictional and fictionalized (read: Ken Alibek post his first 3 months of debriefing) scenarios can become highly problematic. What is feasible and by whom is not as explicitly clear as some might like to suggest.

While difficult, dealing with military-scenarios is comparatively less complicated (still complicated but just a little less so) than civilian scenarios. From the very basic recognition that the active duty are federal. With civilians there's a tremendously important issue of States. As I wrote, use of a biological agent does not automatically trigger the Stafford Act nor allow domestic use of Title 10 forces (i.e., the active duty military).

VR/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

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. . . use of a biological agent does not automatically trigger the Stafford Act nor allow domestic use of Title 10 forces (i.e., the active duty military).



Well, not as we know it, but looking at the political environment today it's hard to imagine a scenario where a significant perceived threat would not cause a political knee jerk event similar to that we are seeing with the economy. Congress seems to be very easily maniputlated of late.

I perceive a vulnerability in DC that would amplify any event that is even moderately successful.

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Every day is a bonus - every night is an adventure.

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