Infectious diseases pose a threat from multiple avenues—naturally occurring events such as outbreaks, accidental incidents like lab errors, and intentional acts of bioterrorism. Globalization, growing populations, and increasing encroachment of humans onto animal habitats have increased the risk for spillover and natural outbreaks. From the laboratory side, the threat is a mixture of biosecurity and biosafety. Biosecurity measures are those that seek to protect the organisms from nefarious actors, while biosafety practices look to protect investigators (or the public) from accidental exposures. The Ebola outbreak in 2014 and 2015, the Zika virus epidemic of 2015 and 2016, findings of smallpox vials in National Institutes of Health laboratory freezers in 2014, and continual lab errors involving mishandling and shipping of live select agents all highlight the threat of natural and accidental events. Although these recent occurrences have reinforced the need for preventive and responsive measures, the threat of bioterrorism can seem a bit distant; however, with advances in biotechnology and global travel, we must remain vigilant.
The 2001 Amerithrax attacks easily come to mind when discussing the threat of bioterrorism. Following the September 11, 2001, attacks, letters laced with anthrax added a new horror to the United States, a country that was already vulnerable. The Amerithrax attacks killed 5 individuals and sickened 17 and are considered the worst biological attacks in US history.1
The decontamination costs alone were estimated to be $320 million, and challenges with postexposure prophylaxis recommendations and compliance only added to the chaos.2
Perhaps one of the most unexpected aspects of this attack was the conclusion that US Army Medical Research Institute of Infectious Diseases biologist and anthrax expert Bruce Ivins, PhD, was considered the most likely culprit (he later took his own life prior to charges being filed).3
Typically, bioterrorism is thought of in terms of attacks like the ricin release by Aum Shinrikyo in the Tokyo subway and the poisoning of salad bars with Salmonella
by the Rajneeshee cult in Oregon.4
All these attacks involved fanatical groups and revealed deep-rooted challenges with the science of acquiring, growing, weaponizing, and disseminating complex biological weapons. The Amerithrax attacks were different because the anthrax was delivered in a fine powder that ensured easy inhalation exposure. Many were surprised that the threat came from not only a scientist but also an American researcher working at an infectious disease institute aimed at protecting the United States. Moreover, Dr. Ivins had the means and capacity to make the attack exponentially worse but simply had chosen not to.3
It was during this time that significant gaps were found within the United States’ response to such an attack. Whether it was who was responsible for decontamination, physician capacity to diagnose agents likely to be used for bioterrorism, or the sensationalized news, numerous factors left the United States truly struggling to handle such an event.5
The Amerithrax attacks gave insight into not only the poor American preparedness and response for bioterrorism but also a new source for weapons: skilled scientists.