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Source: The Lancet, Feb 10, 2001 v357 i9254 p481.

Title: Facing the biological weapons threat.(Letter to the Editor)
Author: Douglas Holdstock, Tara O'Toole and Thomas V Inglesby

Full Text COPYRIGHT 2001 The Lancet Ltd.

Sir--That prevention is better than cure must be among the oldest of adages, but is especially applicable to the threat of biological warfare discussed by Tara O'Toole and Thomas Inglesby (Sept 30, p 1128),(1) and for which Ali Khan and colleagues (Sept 30, p 1179)(2) describe US preparations.

O'Toole and Inglesby end by noting that prevention of biological warfare demands new approaches to arms control. They mention in passing the 1972 Biological and Toxin Weapons Convention, which declares the stockpiling and use of biological weapons illegal, but seem unaware that negotiations to add an effective verification protocol to the convention are at an advanced stage.(3) This change surely provides just the new approach required; it calls for regular inspection of civil and military facilities where biological weapons might be produced, as well as in response to warnings of possible breaches of the convention. The new protocol is based on that agreed in the 1993 Chemical Weapons Convention, which seems to be working adequately.(4)

The record of the USA for arms control treaties has been widely criticised, and there are fears that it is obstructing progress on the Biological Weapons and Toxins verification protocol. This record may be because of resistance to inspection, with its implications for commercial confidentiality, by the biotechnology industry, which is most advanced in the US. Is this why O'Toole and Inglesby do not mention the new protocol? As they note, there is doubt as to whether terrorist groups, which are not party to conventions, could mount an effective biological weapons attack, and a verification protocol would not entirely remove the threat from states of concern (apparently downgraded from rogue states). Its achievement, for which the active support of the US is essential, would, however, surely do far more for deterrence against biological warfare(5) than the elaborate and untestable public-health programme in a single country described by Ali Khan and colleagues. Douglas Holdstock Medact, London N19 4DJ, UK

(1) O'Toole T, Inglesby TV. Facing the biological weapons threat. Lancet 2000; 356: 1128-29.

(2) Khan AS, Morse S, Lillibridge S. Public health preparedness for biological terrorism in the USA. Lancet 2000; 356: 1179-82.

(3) Pearson G. Preventing deliberate disease. Med Confl Surviv 2000; 16: 42-59.

(4) Developments in the Organization for the Prohibition of Chemical Weapons. CBW Convention Bull 1999; 43: 2-10.

(5) British Medical Association. Biotechnology, weapons and humanity. Amsterdam: Harwood, 1999.

Authors' reply

Sir--Douglas Holdstock refers to the efforts underway to negotiate an effective verification protocol to the 1972 Biological and Toxin Weapons Convention, and suggests that these efforts will provide the new approach required for the control of biological weapons. Discussion of the Biological and Toxin Weapons Convention and arms control for biological weapons was beyond the scope of our commentary on the Centers for Disease Control and Prevention Bioterrorism Response Program, but we will offer some brief observations.

The Biological and Toxin Weapons Convention, as an instrument to control proliferation of biological weapons, has substantial shortcomings. Two signatories to the convention, the former Soviet Union and Iraq, have large biological weapons programmes;(1) several additional signatories are believed to have offensive biological weapons programmes that would place them in violation of the treaty.(2) It is widely agreed that the lack of verification and enforcement measures for the convention have limited, if not doomed, its effectiveness.

A review conference of the convention is scheduled for 2001, at which time it is hoped that a protocol addressing its existing limitations will be ready for consideration. Several important disputes remain to be settled before the review happens.(3) Some people qustion whether the protocols under consideration effectively address current treaty limitations and raise questions about the feasibility of implementation.(4)

It remains to be seen whether new protocols to the Biological and Toxin Weapons Convention will be sufficient to address the need for arms control that confronts us. Whether and how the potential to create as well as quell epidemics of fatal disease can be constrained is not clear. What is apparent, however, is that any effective control of "biological" weapons must include the sustained attention and active participation of bioscientists, physicians, and public-health professionals of all nationalities.

While we must seek the means and muster the will to prevent the development or use of biological weapons, we must simultaneously construct systems and programmes that could reduce the consequences of biological-weapon attacks should prevention fail. Tara O'Toole, [*] Thomas V Inglesby Johns Hopkins Center for Civilian Biodefense Studies, Johns Hopkins University, Candler Building, Suite 850, 111 Market Place, Baltimore, MD 21207, USA

(1) Inglesby TV, O'Toole T, Henderson DA. Preventing the use of biological weapons: improving response should prevention fail. Clin Infect Dis 2000; 30: 926-29.

(2) Cole LA. The specter of biological weapons. Sci Am 1996; 275: 60-65.

(3) Moodie M. Fighting the proliferation of biological weapons: beyond the BWC protocol: disarmament forum. "Disarmament Forum," UN Institute for Disarmament Research, 4th Quarter (Winter), 2000.

(4) Taylor ER. Strengthening the biological weapons convention: illusory benefits and nasty side effects. Cato Policy Analysis, No 355, 1999.

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