WHAT IS ANTHRAX? Bacillus anthracis is a rod-shaped bacterium that typically appears–when outside a living host–in a dormant state, protected by a hard-shelled spore. Provided it is lodged in rich soil subject to dramatic changes in climate, the organism can and does persist in this form for many decades. As a general matter, anthrax spores germinate to produce multiplying vegetative forms only after infecting a living host. That host is most commonly a herbivore which, grazing in an anthrax-contaminated field, ingests the bacillus along with its feed and is then infected through some preexisting gastrointestinal lesion. Once inside the body of a cow, for example, anthrax spores are carried to its lymphatics, where they begin to germinate. The first vegetative bacilli entering the cow’s blood stream are effectively filtered by the animal’s reticuloendothelial system. But even then the bacilli are releasing toxins, which soon overwhelm the poor beast. As the disease approaches its end stage, the number of anthrax bacteria in a host can double in less than two hours, and this chaotic growth eventually produces massive toxemia that destroys the endothelial cell lining of blood vessels. Death comes with what World Health Organization guidelines rather daintily describe as a “characteristic terminal hemorrhage to the exterior.” Recent newspaper coverage has proved similarly squeamish about the grisly reality of a lethal anthrax case, for the same is true in human patients: Uninterrupted by medicine, the disease causes the vascular system to explode, releasing a horrifying quantity of blood through the victim’s mouth, nose, and other orifices. From an animal corpse lying in a field, this infected blood then soaks into the soil, where bacillus anthracis returns to a sporulated, dormant state–awaiting the next unfortunate herbivore. IS ANTHRAX AS RARE AS THEY SAY? Not in animals it isn’t. Cases of livestock anthrax are reported almost every year throughout the world. Spain, Albania, Italy, and Romania suffer significant outbreaks on a regular basis. Turkey, Greece, and Russia are subject to widespread infections. The Middle East and Central Asia comprise an “anthrax belt” in which severe epidemics are commonplace. Chinese livestock are riddled with anthrax in most sections of the country. Australia experienced a major epidemic in early 1997. The disease is endemic in Mexico, Honduras, Nicaragua, and Costa Rica, and hyperendemic in El Salvador, Guatemala, and Peru. Here in the United States, livestock vaccination and antibiotic prophylaxis have become almost routine during the past few decades, and anthrax outbreaks are recorded at nowhere near the levels they were before World War II. But they are not unheard of; Texas has a particular problem, with 56 separate confirmed incidents between 1979 and 1997. And there and elsewhere, ironically, American veterinary medicine’s increasing inexperience with the disease may well mean that many outbreaks go undiagnosed–and last long enough to threaten surrounding human populations. In its September 15, 2000, Morbidity and Mortality Weekly Report, for example, the Centers for Disease Control described how, two months before, a farmer in Roseau County, Minnesota, had killed, gutted, and skinned a cow that was “unable to rise.” A local vet approved the farmer’s plan to slaughter the cow for consumption, and the carcass was taken to a custom meat-processing plant. Two weeks later, members of the farmer’s family began eating hamburgers and steaks cut from this carcass, and two of them promptly experienced severe gastrointestinal symptoms and/or high fever. Laboratory tests confirmed the presence of anthrax bacilli in the processed meat. The affected family was prescribed heavy doses of precautionary antibiotics and both patients fully recovered. HAS NATURALLY OCCURRING ANTHRAX EVER BEEN A SIGNIFICANT HUMAN HEALTH PROBLEM? Yes. Throughout much of recorded history, anthrax has periodically devastated both rural and urban populations. For instance: The mystery has never been solved definitively, but more than a few medical historians have long believed that the 430-427 b.c. “plague of Athens,” a famously gruesome, eyewitness account of which appears in Thucydides’ “History of the Peloponnesian War,” was a bacillus anthracis pandemic. Certain symptoms Thucydides described–fever, bleeding, and “small pustules and ulcers”–are strikingly consistent with a severe form of cutaneous anthrax infection, in which the bacteria enter the body through abrasions on the skin, which then breaks out into ulcerating lesions and large, scabby “eschars.” It is from the color and discomfort of these characteristic eschars, incidentally, that the anthrax bacillus derives its scientific name, after the Greek word (anthrakis) for “burning coal.” In the third book of “The Georgics,” his idealization of rustic life in first-century b.c. Rome, the poet Virgil paused for a moment to acknowledge that anthrax epidemics were a downside, choking “the very stalls with carrion-heaps that rot in hideous corruption” and afflicting any man who dared come near an infected animal with “red blisters and an unclean sweat”–until “his noisome limbs . . . no long tarriance made, the fiery curse his tainted frame devoured.” For most of the next two thousand years, anthrax outbreaks swept across huge tracts of land from time to time, killing massive numbers of people in 14th-century Germany and 17th-century Central Europe and Russia, for example. In fact, anthrax remained so central to medical consciousness in the late 19th century that modern microbiology was founded specifically on its study. Anthrax was the first disease for which a microbial etiology was firmly established, by Louis Pasteur in 1876. IS NATURALLY OCCURRING ANTHRAX A SIGNIFICANT HUMAN HEALTH PROBLEM TODAY? Yes and no. In certain parts of the world, human cases of cutaneous or inhalational anthrax–nearly all of them resulting from occupational contact with the hides, hair, wool, or bones of infected animals–cannot be called unusual. Peru reports numerous human infections on a more or less annual basis. The infection rate is extraordinarily high in central Spain. Small outbreaks in Russia are common: In a village south of Moscow in 1995, one person died and eight were hospitalized following exposure to diseased cattle, and one year later in a nearby village, a second person died and 23 more were hospitalized. Dozens become ill with anthrax each year in Central Asia and the Middle East. And China reported 1,210 cases of the disease in 1997 alone. In most of the industrialized West, standard veterinary protocols and immunization programs for agricultural and textile workers have now sharply reduced human exposure to the anthrax bacillus, and case numbers have fallen dramatically. During the first few decades of the 20th century, an average of 130 Americans contracted anthrax each year–and there were a total of 755 such cases from 1944 through 1983. By contrast, over the 18 subsequent years, the CDC had reported only 5 anthrax infections in America until the wave that began last month. Several important qualifications must be appended to this generally happy story, however. At this point, except for specialists in veterinary colleges, very few practicing physicians or microbiologists in this country have ever seen anthrax outside of a textbook. So we must assume that at least some human cases of the disease, even when fatal, occasionally go undiagnosed. Moreover, many other proven or likely anthrax infections, because interrupted by pre-symptomatic antibiotics, do not show up in official tabulations of the disease. And, most important, recent events make obvious the extent to which past American experience with anthrax understates the threat to human health posed by this naturally occurring bacterium. In its sporulated form, the organism remains ubiquitous all over the world–representing an almost inexhaustible supply for men such as Osama bin Laden who would deliberately employ it to murderous effect. DELIBERATE, DEADLY ANTHRAX ASSAULTS ARE A BRAND NEW PHENOMENON, RIGHT? Wrong. To begin with, there is chapter nine of Exodus, in which the Lord inflicts “a very grievous murrain”–unmistakably resembling an anthrax infestation–upon the cattle, horses, asses, camels, oxen, and sheep of Pharaoh’s Egypt. This having failed to bring Pharaoh to heel, the Lord then instructs Moses to take “handfuls of ashes of the furnace” and “sprinkle it toward the heaven.” These ashes, the Lord declares, “shall become small dust in all the land of Egypt,” which dust will this time affect not just the beasts but “shall be a boil breaking forth with blains upon man.” There is no suggestion of divine intervention in the modern history of anthrax warfare. Germany established a large and ambitious biological weapons program, very much involving anthrax, during World War I. The Germans managed to infect Romanian sheep exports bound for Russia and Argentinian livestock exports intended for a variety of Allied countries in the West. And though it remains unclear whether the plot was successful, German saboteurs working in the United States attempted to infect horses in particular and to contaminate animal feed in general. Throughout its occupation of Manchuria between 1932 and 1945, imperial Japan maintained an enormous biowarfare facility there, “Unit 731” in the town of Pingfan southeast of Harbin. The bacillus anthracis experiments conducted by Japanese scientists on Chinese prisoners held at Unit 731 are notorious war crimes. And the anthrax weapons those experiments helped produce were employed by the Japanese army against Chinese military and civilian targets until the last days of World War II–with a death toll running into the thousands. Allied governments, too, pursued an anthrax-based biological warfare capability during the early 1940s. The British developed and successfully tested explosive canisters designed to induce inhalation anthrax by means of aerosolized spores. In 1942, British factory girls boxed five million “cattle cakes” laced with sporulated anthracis for a planned “Operation Vegetarian” attack on livestock grazing fields in Germany. And by 1944, engineers at what is now Fort Detrick, Maryland, 30 miles northwest of Washington, had perfected and produced 5,000 anthrax bombs for use by the Army Air Force. None of these devices was ever employed. But at least on the American side, military research into anthrax weaponry continued for more than twenty years–with sometimes dangerous or even deadly results. In 1951, two Fort Detrick employees died after exposure to anthracis bacilli. And the program’s body count might well have been considerably higher. Documents declassified and made public only in the late 1980s revealed that dozens of times in the 1950s and 1960s, military jets flying over the Dugway Proving Grounds near Salt Lake City, Utah, spray-released millions of anthrax spores in liquid slurries. Weather conditions during these test flights sometimes involved wind speeds of up to thirty miles per hour. In at least one case, a large cloud of anthrax spores floated over Highway 40, which is nowadays Interstate 80. Following another deliberate aerosol drop, the anthrax cargo was blown off course–and directly over Wendover, a town on the Utah-Nevada border. American research into offensive biological weaponry was suspended during the Nixon administration, and all associated U.S. stockpiles of bacillus anthracis have since been destroyed. HAVE MAN-MADE ANTHRAX AGENTS KILLED ANYONE DURING THE PAST HALF CENTURY? Yes, on at least one occasion. On April 2, 1979, a large plume of aerosolized anthrax spores was accidentally released into the atmosphere from a military microbiology facility outside the heavily populated Soviet city of Sverdlovsk (now Ekaterinburg). The Sverdlovsk poison factory, “Compound 19,” was illegal under the Biological Weapons Convention of 1972, so Soviet authorities attempted to conceal what had happened by declining to alert local residents and delaying the distribution of antibiotics. It would have been a cataclysm had the wind that day not been blowing south, away from the city. As it was, more than sixty people died of inhalation anthrax over the following six weeks. Moscow maintained that the infection had been introduced gastrointestinally by tainted meat and ordered the KGB to confiscate local hospital records that would have proved otherwise. Not until 1992 did Russian president Boris Yeltsin acknowledge the truth. A gigantic outbreak of anthrax in Zimbabwe during 1979 and 1980–more than 10,738 human cases, 182 of them fatal–continues to puzzle investigators. The disease is ordinarily localized and recurrent in confined geographical areas. But the Zimbabwe epidemic spread to six of eight provinces in a country where anthrax had previously been rare. And it almost exclusively affected black-occupied “tribal trust” properties. Zimbabwe was then concluding a long and brutal guerrilla war during which the white Rhodesian army is known to have employed toxic chemical agents and to have targeted food supplies in insurgent-controlled parts of the countryside. Some suspicions persist–never confirmed–that the 1979-80 anthrax epidemic was the product of a deliberate Rhodesian attack on black-owned livestock. WHERE DID THE ANTHRAX SPORES CONTAINED IN THE CURRENT WAVE OF TERRORIST MAILINGS COME FROM? We may never know. Media reports concerning the spore-filled letter mailed to Tom Daschle’s Senate office have routinely passed on the intelligence that this envelope contained an “especially pure” strain of the anthrax bacillus. This information has not been formally confirmed by federal laboratories, however. And, in any case, it is highly misleading as a piece of evidence. Many different strains of anthracis exist. But they are extraordinarily difficult to distinguish from one another, and even when they can be specified, the identification is of limited utility in tracing a sample’s physical origin. Bacillus anthracis is “one of the most monomorphic species known,” explains the World Health Organization. “That is to say, isolates from whatever type of source or geographical location are almost identical phenotypically and genotypically.” Widespread references to the “weapons-grade” quality of anthrax used in the Daschle attack are of similarly exaggerated evidentiary significance. In order to produce inhalation anthrax, bacterial spores must be of a particular size, between one and five microns wide–small enough to reach the lower respiratory mucosa of an intended victim, but large enough not to be immediately and safely exhaled. Milling an anthrax dust with such precision is not something you can do at home, and even the necessary scientific equipment tends to introduce static electricity that would bind neighboring spores to one another in relatively large and consequently useless clumps. Nevertheless, the manufacture of “weapons-grade” anthrax does not require secret technology in a laboratory run by geniuses. British and American scientists, remember, managed to pull it off more than 50 years ago using purely mechanical techniques. Today, vastly more exact, computerized versions of their equipment are available on the open market for less than the price of an automobile. And information about how to cultivate bacteria like anthracis in quantities sufficient to mount a terrorist assault can be found on the shelves of any reasonably well-stocked public library. In other words: The spore samples now in FBI custody are unlikely all by themselves to tell us much about where they came from. Old-fashioned investigative logic is a more promising tool. Some analysts have speculated that Osama bin Laden operatives may have acquired aerosol-ready anthrax spores from mafia-connected former Soviet bioweapons specialists with access to diverted bacteriological stockpiles. Could be. But a much simpler and more logical reading of motive, means, and opportunity–assuming that donated or purchased bacterial supplies are at issue–points to Saddam Hussein’s Iraq. Iraqi officials have formally acknowledged that their government, until the Persian Gulf War, maintained an extensive and sophisticated arsenal of anthrax weapons, and those same officials have been unable or unwilling to prove that they have since disposed of the stuff. And Iraqi intelligence agents are known to have had personal contact with bin Laden associates like World Trade Center pilot Mohamed Atta, for example. Oddly enough, if the anthrax lately spread by the U.S. mail has indeed passed through Iraqi hands, there is an excellent chance that it was grown from sample cultures original not to Baghdad, but to Rockville, Maryland. Between 1985 and 1989, the American Type Culture Collection, the world’s leading supplier of sample disease strains for use by public health programs, sold 21 different kinds of anthrax bacilli to the Iraqi government–under export licenses approved by the Reagan administration’s Commerce Department. BOTTOM LINE, THEN: HOW TOUGH A SPOT ARE WE IN? The civilian population of the United States is under sustained assault by an organized terrorist enterprise possessing a form of infectious bacteria–finely milled, sporulated anthracis–among the most dangerous on earth. The fatality rate of inhalation anthrax, when the disease is not immediately diagnosed and treated, approaches 100 percent. Biological agents like this, the congressional Office of Technology Assessment concluded in 1993, when “efficiently delivered under the right conditions against unprotected populations would, pound for pound of weapon, exceed the killing power of nuclear weapons.” Thirty kilograms of anthrax spores, delivered to Washington, D.C., by a missile on an overcast day under moderate wind conditions would kill an estimated 30,000 to 100,000 people. Delivered as an aerosol by an aircraft overflight of the same city on a calm, clear night, 100 kilograms of anthrax spores would kill an estimated one to three million people. Against this possibility, America currently has no comprehensive atmospheric warning system in place. And its ability to mount an appropriate medical response to epidemic anthrax infection is far from perfect. According to a recent “consensus statement” published in the Journal of the American Medical Association, “there are no clinical studies of the treatment of inhalational anthrax in humans.” What’s more, “treatment of anthrax infections with ciprofloxacin has not been studied in humans” (though “animal models suggest excellent efficacy”). And existing federal supplies of that antibiotic remain too small for use in a widespread national emergency. Clean-up of large-scale anthrax releases is extraordinarily difficult. During World War II, the British contaminated Gruinard Island off the Scottish coast with anthracis spores to gauge their effect on a test flock of sheep. The sheep died. And so did Gruinard Island. It took British health officials 36 years, 280 tons of formaldehyde, and 2,000 tons of seawater to make Gruinard once again safe for human visitation. Anthrax spores, it turns out, remain remarkably hardy through the fiercest extremes of heat, cold, acidity, desiccation, chemical disinfection, and even irradiation. And guarding public health against prospective anthrax releases isn’t easy, either. It, too, has never really been tested on human subjects, but a vaccine against anthrax does exist. Trouble is, the sole source of that (understocked and controversial) vaccine in the United States is a company called BioPort in Lansing, Michigan, which is currently operating under a license suspended by the FDA as punishment for a history of laboratory contamination, inadequate documentation and staff training, and low manufacturing standards. BioPort’s best known owner/investor is retired Admiral William Crowe. But day-to-day responsibility for the company, for what it’s worth, falls to a German immigrant of Lebanese ancestry named Fuad El-Hibri. Fuad El-Hibri’s father, an international businessman named Ibrahim El-Hibri, is prominently associated with an Islamic charity headquartered in Beirut. IS THERE ANY GOOD NEWS? Maybe, yes. Human beings–especially children, for unexplained reasons–appear to possess some degree of natural resistance to anthrax. Many more people are exposed to the bacillus than ever become sick from it, and a lethal respiratory anthrax infection seems to require many thousands of spores. America is on high alert for signs of such primary airborne infections, and some research indicates that secondary airborne infections are next to impossible. Even the tiniest anthrax particulates weigh enough to drop them out of the atmosphere and onto the ground in fairly short order, and once they’re there, the spores are unlikely to bounce back up. Military studies conducted on surfaces contaminated with one million anthrax spores per square meter suggest that not even heavy truck traffic or backdrafts from helicopters and jet aircraft will kick up an inhalable, lethal quantity of the stuff. Then there’s this reassuring prediction, published during the summer of 1999 in a special issue of the Centers for Disease Control’s Emerging Infectious Diseases journal. Anthrax’s “lack of volatility” and “inability to penetrate intact skin,” wrote two senior researchers at Fort Detrick, the nation’s leading biological warfare laboratory, “make it unlikely, in most cases, that persons coming in contact with letters, packages, and other devices purported to contain anthrax will be at risk for aerosol exposure. Moreover, because energy is required to aerosolize anthrax spores, opening a letter, even if it contained anthrax, would be unlikely to place a person at substantial risk.” Oops. David Tell is opinion editor of The Weekly Standard. October 29, 2001 – Volume 7, Number 7
