Feature Article

Biological Warfare

Lester C. Caudle, III, MD

Despite the end of the Cold War, the United States still faces a range of serious national security issues. One at the forefront is the issue of the proliferation of biological weapons, and the accelerated development of the capabilities to design and produce biological weapons on the part of many Third World nations.(1) The Committee on Armed Services of the U.S. House of Representatives, in their Special Inquiry Into the Chemical and Biological Threat, concluded that despite the demise of the Soviet Union, with its sizable chemical and biological arsenal, the threat has increased in terms of widespread proliferation, technological diversity, and the probability of use.(2)

Of the nations currently believed to have an offensive biological warfare program, only a few are candidates for a direct armed conflict with the United States. The most likely route for the United States or our allies to become involved in a biological conflict would be as third parties in regional conflicts, whether as members of a United Nations peacekeeping force or through an act of terrorism.1 This is due to our increased participation in low intensity operations, however, and does not diminish the threat that biological warfare poses to our forces fighting a conventional war.

North Korea and China

During the 1990s, hostilities have mounted in North Korea over allegations that evidence of nuclear weapons activities is being hidden from international inspectors. This is the kind of future conflict that could involve the United States. In 1993, the Russian Foreign Intelligence Service, successor to the Soviet Union's KGB, released a statement that said, in part:

North Korea is performing applied military-biological research in a whole number of universities, medical institutes and specialized research institutes. Work is being performed in these research centers with inducers of malignant anthrax, cholera, bubonic plague and smallpox. Biological weapons are being tested on the island territories belonging to the DPRK (Democratic Peoples Republic of Korea).(3)

Mr. Gordon Oehler, director of the CIA's Non-Proliferation Center, confirmed this Russian report.(3) The use of smallpox in a weapon, whether the use be tactical or strategic, would have disastrous effects, as the military and civilians are not immunized against this disease nor have they been for many years.

In his last message to congressional leaders on January 19, 1993, outgoing President George Bush revealed intelligence reports (previously highly classified) that China still has an active biological warfare program --- despite their having signed the international treaty banning such weapons.(4) Even as recently as May 1994, a reporter investigating China's military-industrial complex stated that arms sales, especially unreported sales and transfers of weapons of mass destruction to some of the most dangerous governments in the world, are part of the dark side of China's commercial activities. The newspaper report went on to state: "China has violated every non-proliferation pledge it has ever made, including its pledge not to engage in an offensive biological warfare program."(5) This is alarming, especially as we consider the close relationship between China and North Korea.


As reported by the Department of Defense in 1992,(6) by the time Iraq invaded Kuwait, Iraq had developed the most extensive biological warfare program in the Arab world (despite having been a signatory to the 1972 Biological Weapons Convention outlawing such endeavors). After the Persian Gulf War (1990-1991), Iraqi authorities admitted the program included anthrax bacteria and botulinum toxin.(2) Then in August 1995, Iraq revealed to United Nations inspectors that it had had a far more extensive and aggressive biological warfare program prior to the Persian Gulf War than had previously been admitted. The Iraqi authorities claimed production of thousands of liters of botulinum toxin and of Bacillus anthracis. Additionally, they stated that unspecified amounts of both agents were loaded on Scud missile warheads and aerial bombs. In this same revelation to United Nations inspectors, the Iraqis claimed to have destroyed the agents during the January-February 1991 time frame, but they have yet to produce evidence to support their claim.(7)

Iraq's biological capabilities, described as "a sizable stockpile,"(8) by William Webster, former Director of Central Intelligence, caused the coalition forces to procure large quantities of special biological warfare vaccines (against anthrax and botulinum) for their military personnel. These vaccines were in extremely limited supplies, forcing commanders to allocate vaccine only to troops they believed were at greatest risk to the use of these agents. Situations like this require commanders to make ethical decisions, as it was not known definitively who was at greatest risk.

The anthrax vaccine, which is licensed by the FDA, was given to approximately 150,000 military personnel (25%-30% of the deployed U.S. forces ).(9) The botulinum toxoid vaccine was given to approximately 8,000 military personnel (1% of deployed U.S. forces ).(9) The biological weapons threat posed by Iraq during this crisis has been characterized as the most serious such threat faced by U.S. forces since World War I.(2) During January 1991, the image of a scared, shaking television reporter wearing a gas mask and the trembling of his voice as he reported the detonation of an incoming Iraqi Scud missile near Tel Aviv, Israel, brought home to all a frightening view of the increasing sophistication of the chemical and biological threat and the apparent vulnerability of soldiers and civilians alike.

The reasons why Iraq did not use these weapons during the Persian Gulf War, the subject of much speculation, will probably never be known with certainty. However, this Iraqi threat highlighted the problems posed by the pro-liferation of weapons of mass destruction among Third World nations and the potential threat posed to U.S. forces as well as other nations. On April 3, 1991, the United Nations Security Council passed Resolution 687, which required that:

° Iraq's chemical, biological, and nuclear weapons be registered;

° these weapons and all production and research facilities be destroyed, rendered unusable, or removed;

° Iraq disclose all its holdings and programs and allow unhindered on-site inspections, and destroy the weapons-making potential on its territory itself or permit those weapons to be destroyed.

In conjunction with a longer-term verification regime established by United Nations Resolution 715, Iraq was also required to renounce the possession of any weapons of mass destruction. On April 6, 1991, Iraq accepted the terms of Resolution 687. However, the Iraqi government has steadfastly refused to accept Resolution 715 and regards the resolution as an unwarranted infringement on its sovereignty.

The Security Council entrusted implementation of the resolution to a special commission known as UNSCOM (United Nations Special Commission), which was set up by the United Nations Secretary General in May 1991. UNSCOM has carried out a series of inspections of Iraqi facilities, but relations with Iraq have been marked by frequent instances of misinformation, concealment, lack of cooperation, and obstruction and harassment of the inspection teams. Before the 1995 admission by Iraq of having weaponized biological agents, inspections into two suspected key Iraqi biological warfare facilities --- Salmon Pak and Al Hakam --- found no conclusive evidence of an Iraqi offensive biological program. However, evidence (such as Iraq's inability to explain the use of tons of growth media suitable for biological agent production) strongly pointed to the existence of a program. Furthermore, the inspection teams had only obtained an admission by Iraqi officials that Iraq had carried out a program of biological research for military purposes.(2) The UNSCOM experience underscores the difficulty of monitoring compliance with the Biological Weapons Convention.

Foreign and Domestic Terrorism

Although biological warfare is most often discussed in terms of weapons of mass destruction, usually in the context of war, terrorist use of biological agents cannot be excluded. Biological warfare agents are, for the most part, inexpensive and readily obtainable, and "cookbook" approaches are readily available. One such book is Silent Death, by an author who calls himself Uncle Fester.(10) Other titles from the same publisher include The Poisoner's Handbook and Crimes Involving Poisons.

Unfortunately, recent examples of possible intent to use are not difficult to find. A laboratory in a safe house of the Red Army Faction in Paris, France, was found to have made quantities of botulinum toxin; it is believed that none was used.(11) More alarming were the actions of the Aum Shinrikyo cult in Japan in early 1995. In addition to releasing the nerve agent sarin in the Tokyo subway on March 18, 1995, cult members were preparing vast quantities of Clostridium difficile bacterial spores for terrorist use.(12) Although possibly not producing large numbers of casualties, the use of even small amounts of such an agent would almost assuredly create major panic.

In March 1989, the most intensive food safety investigation in FDA history took place when a terrorist threatened to poison this nation's fresh fruit supply, to focus attention on the living conditions of the lower classes in Chile. The terrorist made good on his phone call to the FDA, as two grapes were found laced with small amounts of cyanide. Fortunately no one was poisoned, but the incident cost millions of dollars to investigate in this country, and had a significant impact on Chile's national economy, where fruit and vegetable exports are second in importance only to copper.(13) A biological toxin could have been used just as easily as cyanide in this instance.

The amounts of toxin needed to obtain the desired effect are exceedingly small. "For example, about 30 grams of the toxin ricin, easily concealed in a pocket, would be sufficient to lethally poison one batch of 150 pounds of meat, enough to pro duce 1,500 hot dogs."(14) The threat is real. And the knowledge required is not esoteric:

To engage in bioterrorism requires only the type of knowledge that Kateuas found in his herbals - that is, a sophisticated understanding of the properties of various edible plants, medicinal herbs, toxins and venoms, and infectious and pharmaceutical agents.(15)

The use of biological agents in domestic terrorism has been attempted on several occasions in recent years, causing alarm and illustrating the ease of obtaining these agents. In May 1995, the American Type Culture Collection (ATCC), a nonprofit organization in Rockville, Maryland, that supplies biological specimens to scientists all over the world, shipped a package containing three vials of Yersinia pestis to the home of a white supremacist in Ohio.(16) (This organism, which causes plague, killed one quarter of the population when it struck Europe in the 14th century and wreaked havoc in India as recently as 1994.[17]) The American Type Culture Collection has tightened its controls on whom it will provide hazardous materials to, but even terrorists can produce legitimate request documents: the white supremacist is a qualified microbiologist. When his house was searched, police reported finding hand grenade triggers, homemade explosive devices, and detonating fuzes.(16) Fortunately, he was caught prior to any intentional use.

Two members of the Minnesota Patriots Council were convicted in 1995 for planning to use a lethal biological agent against U.S. marshals and Internal Revenue Service agents. According to trial testimony, they planned to poison U.S. agents by placing ricin toxin on doorknobs.(18)

Lastly, in March 1992, a Tyson's Corner, Virginia, man was arrested and charged with malicious wounding in a hoax in which he sprayed his roommates with a fluid that he claimed contained anthrax bacteria. The house was placed under quarantine immediately after the incident, and while awaiting test results, 20 people --- one a pregnant woman --- were treated for possible exposure to anthrax.(19)

The threat that terrorists will use biological agents cannot be ignored and we have to remain strong, vigilant, and determined to defeat this form of terrorism as we do every other act of terrorism.


International proliferation of biological warfare programs broadens the range of agents that members of the U.S. armed forces may encounter. Ironically, the modernization of many Third World nations --- with the subsequent development of industrial, medical, pharmaceutical, and agricultural facilities needed to support these advancing societies --- provides the basis for development of a biological weapons program, should a nation decide to pursue such an endeavor. A biological weapons program can easily be concealed within legitimate research-and-development and industrial programs, even by countries that are signatories to the 1972 Biological Weapons Convention. Actions such as these are grave threats to our national security.

Biological warfare agents may be more potent than the most lethal chemical warfare agents, and provide a broader area coverage per pound of payload than any other weapons system. The proliferation of technology and of scientific progress in biochemistry and biotechnology has simplified production requirements and provided the opportunity for the creation of exotic agents. This could involve the tailoring of pathogenic microorganisms capable of creating a novel disease, perhaps on an epidemic scale. Humans need not be the only target of biological weapons. These weapons might be meant to attack a country's revenue or food crop, animal herds, or even a supply of a material that is vital for revenue or defense.

Despite the end of the Cold War, the United States still faces serious national security issues. One at the forefront is the issue of the proliferation of biological weapons, especially in Third World nations that have compelling military, technical, economic, and political incentives to pursue this capability. The use of biological agents in future wars and actions by terrorists --- foreign and domestic --- is a legitimate issue of concern. Resolution of this problem should be given the highest priority.


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Dr. Caudle is a Lieutenant Colonel in the Medical Corps, U.S. Army; formerly, Command Surgeon, On-Site Inspection Agency, Dulles International Airport, Washington, DC; currently Assistant Chief, Department of Retrovirology, U.S. Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.

Reprinted/Adapted with permission from Textbook of Military Medicine (TMM). Caudle LC. The Biological Warfare Threat. In Sidell FR, Takafuji ET, Franz DR, eds. Medical Aspects of Chemical and Biological Warfare. Washington, DC: Dept of the Army, Office of The Surgeon General, Borden Institute; 1997:461-464.

Originally published in the Medical Sentinel 2001;6(4):123-125. Copyright © 2001 Association of American Physicians and Surgeons (AAPS).