Wednesday, April 30, 2014

What Syrian Officials say about their own Biological Weapon Capability

Long before war broke out across Syria, bio-defence analyst worried that along with Syria's best kept secret: its known chemical weapon stockpiles, Syria's biological weapon programs silently advanced mainly at the SSRC in Damascus supported of course by a substantial pharmaceutical industry. Western intelligence services quietly worried that Assad was building deployment platforms for one of the most dangerous class of weapon of mass destruction: biological. All was hush hush and the non-proliferation community worked equally hard to dispel such concerns and dismiss data in some instances, related to Assad's BW programs. After Iraq, many perceived it to be politically incorrect to discuss any nation suspected of working on BW, lest this usher in military intervention. Unfortunately this gave the green light to states of concern: Iran, Syria, the DPRK, Venezuela, Cuba among others who have been working along with no fear of intervention since Iraq weapon inspectors could not present their findings adequately to the public and press.

Interestingly, while some in the bio-defence community risked condemnation for even thinking Assad may have a BW program, the regime had already admitted to this in 2006. No notice was taken as the focus had been set on Iran's nuclear program and the disastrous NIE of 2007.  

Far from speculating on what Assad may or may not possess in the way of a biological weapon program, it is interesting to consider what the regime states about its own programs and capabilities. In 2004, an online publication called the Wednesday Report Canada's Aerospace and Defence Weekly noted the following: "Syria together with Iran, Iraq, Libya, Israel, North Korea, South Korea, Taiwan, China, and Russia is currently considered to be a biological weapons possessor or developer by the United States. The Syrian military is also beginning to plan the eventual integration of biological weapons in its tactical and strategic arsenals. In April 2000, Syrian defence minister General Mustafa Talas published a lengthy article entitled "Biological (Germ) Warfare: A New and Effective Method in Modern Warfare." (Interestingly, the article was published in Persian translation in Tehran, the key Muslim strategic ally of Damascus.) All indications suggest that Syria's ultimate objective is to mount biological warheads on all varieties of long-rang surface to surface missiles in its possession. This is a goal that can probably be achieved within a few years, and it may already have been realized in part. 

This statement was republished in an article which appeared in the Middle East Quarterly in 2002, entitled: Poisoned Missiles: Syrian's Doomsday Deterrent", the author of this article was Dr. Dany Shohom, an internationally recognized expert on Syria's WMD.

Foreign Ministry spokesman Jihad Makdissi

On July 24, 2012 the Wall Street Journal reported that "Foreign Ministry spokesman Jihad Makdissi said Damascus wouldn't use unconventional arms against its citizens. "Any stocks of WMD or any unconventional weapons that the Syrian Arab Republic possesses will never be used against civilians or against the Syrian people during this crisis in any circumstance, no matter how the crisis should evolve," he said.
In confirming the existence of such weapons, Damascus also issued a challenge to foreign governments that it has accused of meddling in its crisis.
"All of the stocks of these weapons that the Syrian Arab Republic posses are monitored and guarded by the Syrian army," Mr. Makdissi said. "These weapons are meant to be used only and strictly in the event of external aggression against the Syrian Arab Republic." See:
Reluctance by Western non-proliferation NGO's to acknowledge Syria's biological weapon program, given it's own statements on its programs is highly concerning. While some may hold the US government and specifically the Bush Administration, responsible for efforts to decommission Saddam Hussein's biological weapon program, run mainly under the cover of his bio-pharmaceutical industry, this in no way translates into discounting that other nations run sophisticated offensive biological weapon programs; particularly when a country such as Syria admits it does. While UN inspectors continue to monitor the regime's use of chemical weapons in numerous attacks we should have no doubt biological weapons are just another weapon class which might be used in the near future against Syrian civilians. Unfortunately for the international community, biological warfare agents have the potential to spread and increase the risk of pandemic and epidemic disease outbreaks. Assad has proved over and over again, he makes no moral distinction in his selection of weapons for use in war against civilians. While the regime stated it would  not use chemical or biological weapons it has used chemical on several occasions, thus negating these statements.
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Wednesday, April 23, 2014

China SARS Containment Strategy: Lessons for MERS and Ebola?

Due to its vast industry and population density, China has often been at the forefront of disease containment strategies, from which we in Europe, could benefit. By all accounts the emergence of SARS (Severe Acute Respiratory Syndrome) was something the global health community had not foreseen and was not prepared to counter. China, a country which was ground zero for SARS-CoV is in many ways an ideal case study of how to conduct rapid disease containment particularly, as was the case at the time, when an unknown emerging and highly pathogenic disease struck. While China was heavily criticized at the the time for delays in identification and containment, any nation would have struggled, given the location of the index case and the fact that this was a completely unknown virus at the time. It is easy perhaps to criticize with hindsight the handling of this outbreak, but the Chinese response was highly effective and essential in containing SARS-CoV. Had it not been for their efforts it is highly likely SARS-CoV would have become a pandemic. In contrast to Germany, which has struggled to identify and contain disease in some instances (see:, China has a robust response strategy worth reviewing, as we face Ebola in Guinea and Liberia. SARS-CoV is a zoonotic viral resperatory disease. Between November 2002 and July 2003, an outbreak of SARS in southern China resulted in 8,273 reported cases and 775 deaths across several countries. 

In the case of China, both quarantine and isolation were effectively utilized. In Beijing, construction workers built a hospital to isolate up to 1,000 suspected cases and recovering SARS patients.Beijing authorities ordered public entertainment facilities closed to contain the spread. "Several important lessons can be gained from the experience of countries where large-scale quarantine measures were imposed in response to SARS. First, when the public was given a clear message about the need for quarantine, it was well accepted--far better in fact than many public health officials would have anticipated. Indeed voluntary quarantine was effective in the overwhelming majority of cases. As SARS unfolded in China, containment strategies were developed and implemented. Yanzhong Huang writes in a publication entitled "Learning from SARS: Preparing for the Next Disease Outbreak,"  See:

"On April 17, an anti-SARS joint team was created for the city of Beijing, which included leading members from the Ministry of Health and the military (Xinhua News, 2003a). On April 23, a task force known as the SARS Control and Prevention Headquarters of the State Council was established to coordinate national efforts to combat the disease. Vice Premier Wu Yi was appointed as commander-in-chief of the task force, and similar arrangements were made at the provincial, city, and county levels. On May 12, China issued a set of Regulations on Public Health Emergencies. According to these regulations, the State Council shall set up an emergency headquarters to deal with any public health emergencies, which are referred to as serious epidemics, widespread unidentified diseases, mass food and industrial poisoning, and other serious public health threats (Xinhua News, 2003b)." []interactions between the state and society unleashed dynamics that prompted the central party-state to intervene on society’s behalf. The direct involvement of the Party strengthened authority links, increased program resources, and maximized the potential for interdepartmental and intergovernmental cooperation. In this manner, the party-state remains capable of implementing its will throughout the system without serious institutional constraints. The government’s capacity for crisis management has been further enhanced by a series of measures taken in the post-SARS era. Since the SARS outbreak, China has made significant investment in its public health infrastructure and increased its coordination of public health response. 

EU Response

While China was indeed ground zero for SARS and therefor was determined to mount an aggressive approach with regard to containment, the EU in contrast was rather removed in its initial approach. In May of 2003, the European Health Ministers convened a meeting in Brussels to discuss the threat of SARS. At that moment, France, Britain, Germany, Italy, Ireland, Sweden, Poland and Spain have so far recorded probable or confirmed SARS cases. "A UK Government spokesman said there was no specific new plan on the table.
"The Commission is doing an excellent job in its role monitoring communicable diseases, and so far there are few cases of Sars in Europe. " See:
While the EU may have been prepared certainly to compare measures taken is like comparing apples and oranges. The EU at the time was considering plans for a European centre for disease prevention and control - loosely modelled on a US equivalent. The European Commission has a centre should be established by 2005. ECDC is now established but its function remains limited. 


In terms of emerging, reemerging and unknown pathogens such as Middle East Respiratory Syndrome (MERS) and Ebola, response requires many of the same actions taken by China during the SARS-CoV outbreak. With both MERS and Ebola, the EU has been somewhat distant in its approach to what could become epidemic or pandemic outbreaks of disease. While MERS appears limited to the ME and Ebola has now crossed into Liberia and hit the capital of Guinea, it is time the EU step up its game and consider some of the instrumental actions, taken by China in the initial phase of SARS and not the fog in the boiling pot of water approach. 

Note: As of 24 April, 2014, Saudi Arabia announced 11 new cases of MERS in the capital Riyadh including one in the Holy City of Mecca.  Several new cases have been reported in Jeddah the second largest Saudi city. The latest cases bring the total number of confirmed cases in the Kingdom to 272, of whom 81 have died. MERS emerged in the Middle East in 2012 and is from the same family as SARS virus. "Although the worldwide number of MERS infections is fairly small, the more than 40% death rate among confirmed cases and the spread of the virus beyond the Middle East is keeping scientists and public health officials on alert." See: 

Meanwhile the Ebola outbreak in Guinea and Liberia has now claimed 142 lives of 208 clinical cases reported in Guinea. See: The EU's response to what could become quite a critical health issue since Ebola was identified in the capital is this: "Following the recent outbreak of Ebola in West Africa, the European Commission is giving €500 000 to help contain the spread of the deadly virus in Guinea and neighbouring countries. The Commission has also sent a health expert to Guinea to help assess the situation and liaise with the local authorities.  "We are deeply concerned about the spread of this virulent disease and our support will help ensure immediate health assistance to those affected by it," said Kristalina Georgieva, EU Commissioner for International Cooperation, Humanitarian Aid and Crisis Response. "It's vital that we act swiftly to prevent the outbreak from spreading, particularly to neighbouring countries." Should we see cases in Europe one would hope a rapid protocol would be instituted across the EU to swiftly contain it these public health threats.

For further interest see:
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Monday, April 21, 2014

South Africa's Project Coast: Building a Biological Weapon Program

Concerns about 'bio-terrorism' and bio-warfare (BW) arose for much of the public, out of the 2001 US anthrax attacks and several incidents in Europe, which brought the reality of the subject to the masses. While the US was ground zero for anthrax attacks, and for a time focus was squarely set on Afghanistan and Iraq, its easy to forget that nations other than the Soviet Union, ran sophisticated BW programs. Outside the very small world of bio-defence and non-proliferation treaty's, little however is known by the public about South Africa's 'Project Coast.' It has remained relatively obscure in the public mindset with regard to how biological weapon programs are developed by states. While it is obscure, far more obscure than Biopreparat and the Iraqi BW programs discovered by UNSCOM, Project Coast has a lot to offer in terms of insights into offensive, clandestine program development. Some years ago I delivered a presentation at the UN during a UN BTWC sidebar in Geneve with one of the primary researchers of Project Coast, Chandre Gould presenting in session ( While I don't agree with every interpretation provided in the report, the facts are accurate and provide invaluable insights. 

Historical Context

"From the 1960's until the 1990's, apartheid South Africa was an isolated state that felt threatened by growing domestic unrest, as well as by a more powerful state actor, the Soviet Union, which was supporting hostile regimes and liberation movements in southern Africa, (although the extent of which this actually played a role is debatable). One response of the apartheid regime to changing threat perceptions outside and inside South Africa was to develop a new and more sophisticated chemical and biological warfare program, code-named "Project Coast." The CBW decision -making process was secretive and controlled by the military and enabled a very sophisticated program to be developed with little outside scrutiny. Military and police units used chemical and biological agents for counter-insurgency warfare, assassination, and execution of prisoners of war." See:

"The Rhodesian Civil War was not the first conflict in Africa in which poisons were used as weapons for war, since as early as 1960's the Portuguese Army reportedly deployed defoliants and napalm, poisoned wells and waterholes and drugged prisoners and threw them out of airplanes, in their actions to counter the actions of Angolan (and possibly Mozambican) guerrillas.(10) However the Rhodesian security forces used chemical and biological agents in some novel ways and exerted a much more direct influence on their South African counter-parts. Faced with a deteriorating security situation as the 1970's wore on Rhodesian authorities resorted to increasingly extreme counterinsurgency methods to resist nationalist guerrillas including "pseudo operations," psychological warfare, covert executions and the deployment of ingenious booby-traps and toxic substances. (11) On the basis of insider accounts there can be no doubt whatsoever that the Rhodesians employed:

  1. poisonous chemical to impregnate clothing, canned food, drinks and aspirin and
  2. lethal biological agents such as cholera bacteria and anthrax bacteria to contaminate water supplies and farmland (12)
Although one former member of the Special Branch of the Rhodesian national police--a force that was still designated, quaintly, a the British South African Police (BSAP)--claimed that he and his colleagues were aware of the use of poisons as early as 1973, the first clear evidence of this dates from 1975 or 1976, when the Rhodesian Central Intelligence Organization (CIO) apparently asked doctors and chemists from the University of Rhodesia to identify and test a range of  chemical and biological agents that could be used as a 'fear factor'  in the war against 'nationalist guerrillas.'(13) See: 

Building a Clandestine Biological Warfare Program

"In a top secret November 1989 military report prepared by Basson on the privatization of Project Coast, he explicitly acknowledged the many offensive dimensions of the program. Among other things he said it was designed "To conduct research with regard to basic aspects of chemical warfare (CW) conduct research with regard to basic aspects of biological warfare (BW) offensive... to conduct research with regard to covert as well as conventional delivery systems....To establish an industrial capacity with regard to the production of offensive and defensive CBW equipment [and] To give operational and technical CBW support offensive and defensive." (33) See: Basson was essentially tasked with developing a proof of concept. After his return from trips abroad, where he established contacts, he informed "members of the Defence Command Council that foreign CBW programs utilized 'civilian' front companies to conduct all offensive R and D up to the point of actual weaponization. Although his claim was not entirely accurate the South Africa Defence Force (SADF) nonetheless decided to create new front companies rather than use its own components or the existing structures under its control."(38)

It should not come as a great surprise, given the clandestine nature of previous programs, such as Project Coast, that states like Syria and Iran run robust, sophisticated military programs supported by a civilian pharmaceutical infrastructure. As with Project Coast, Syria's BW programs are maintained in separate units at the SSRC but also in other locations related in some instances to CW and missile programs. Eventually, Syria's BW programs will come to light in much the same way Biopreparat, the Iraqi BW programs and South Africa's Project Coast and in much the same way the non-proliferation community who consistently deny such programs exist, will again have to acknowledge hard facts.
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Sunday, April 20, 2014

Overcoming the Cold Chain Problem in Vaccine Storage and Distribution

One of the major problems faced during epidemic and pandemic outbreak of disease is overcoming the 'cold chain' issue both in the storage, as well as the distribution of vaccines. Bio-defence vaccines are no different, however, the circumstances of their distribution may increase risks associated with cold chain standards. Imagine a deliberate outbreak of smallpox in a remote village in the Congo or worse during conflict, which poses more extreme obstacles in terms of epidemiological trace-back, delivery of vaccines and ultimately vaccination. While disruptions in the cold chain protocol result in millions of lost dollars and vaccines, future biologicals are swiftly overcoming this problem.

"Cold chain management is the process of preparing temperature-sensitive medical products for shipment utilizing standardized systems and procedures, maintaining required temperatures during all phases of distribution from the time it leaves the manufacturer until administration of the vaccine to the patient. Vaccines are sensitive biological substances that can lose their potency and effectiveness if exposed to heat, extreme cold, and or light. For example, certain vaccines lose potency when exposed to room temperature for as little as 30 minutes and freezing damages almost all refrigerated vaccines. Failure to adhere to proper storage temperatures may reduce vaccine potency, resulting in an inadequate immune response and protection against disease. Once lost, vaccine potency cannot be reversed.

"Roughly 1.5 million children die each year from vaccine-preventable diseases like tuberculosis. This is due in part to the sensitive nature of the vaccines themselves, which spoil if they're not kept at precise temperatures from manufacturing to use. The cold supply chain is well established in many parts of the world, but poor infrastructure and unreliable power prevent vaccines from reaching many developing countries."

Soligenix is a pharmaceutical company manufacturing bio-defence vaccines, but its their 'thermostability technology' which caught my eye. Typically, bio-defence vaccines are vaccines developed to treat the probability of a wide spread outbreak of diseases we generally don't see in annual epidemic outbreaks. These vaccines tend to be more costly to research and develop and investiment in both the U.S. and EU has come, to a large extent, from government agencies (Bio-Shield, BARDA, NIAID). As I wrote my previous pieces on the Ebola outbreak in Guinea and the Strategic National Stockpile, I recalled my engagement some years back with WHO. Vaccine stockpiling and certainly distribution is a core activity during an outbreak of highly pathogenic diseases like we see in Guinea. In this specific case, not only has it been difficult to inspire interest to develop a vaccine candidate against VHF and Crucell (See: has been working on this for years, but the cold chain problem in storage and distribution remains a significant issue. Typically pharmaceutical firms are reluctant to launch into drug development for illness which either do not occur, occur with extremely limited frequency or used only during relatively small outbreaks. Bio-defence vaccines face a number of challenges which vaccine candidates for diseases like mumps, measles and rubella simply do not. Moreover, even in terms of force protection, many of these vaccines are not even on a Milivax schedule for our forces. Added to this, any disruption in the cold chain management of vaccines is a quite serious and significant issue.

I was quite excited when I spotted their announcement that "Recent studies have demonstrated the potential for heat-sensitive vaccines formulated using this technology to withstand temperatures exceeding 40 degrees Celsius (104 degrees Fahrenheit) for up to one year. The underlying work has been conducted with the Company’s proprietary ricin toxin vaccine (RiVax™) as part of a continuing program to evaluate the effectiveness of protein subunit vaccines to withstand extremes of temperature and other environmental stress conditions.(See: Their website states the following: "Soligenix's proprietary thermostability technology, ThermoVax™, is a novel method of rendering aluminum salt, Alum, adjuvanted vaccines stable at elevated temperatures. Alum is the most widely employed adjuvant technology in the vaccine industry. The value of ThermoVax™ lies in its potential ability to eliminate the need for cold-chain production, transportation, and storage for Alum adjuvanted vaccines. This would relieve companies of the high costs of producing and maintaining vaccines under refrigerated conditions. The World Health Organization (WHO) reports that 50% of all vaccines around the world are wasted due to thermostability issues. This is due to the fact that most Alum adjuvanted vaccines need to be maintained at between 2 and 8 degrees Celsius ("C") and even brief excursions from this temperature range (especially below freezing) usually necessitates the destruction of the product or the initiation of costly stability programs specific for the vaccine lots in question. The savings realized from the elimination of cold chain costs and related product losses would in turn significantly increase the profitability of vaccine products. Elimination of the cold chain would also further facilitate the use of these vaccines in the lesser developed parts of the world. On the Vaccines/BioDefense side, ThermoVax™ has the potential to facilitate easier storage and distribution of strategic national stockpile vaccines in emergency settings."

While I would generally review other pharmaceuticals competing in this technology, Soligenix in fact seems to be much further along than others and have a more promising candidate technology. For bio-defence and European/NATO Member State stockpiling, the technology is quite exciting. WHO and Medicine sans Frontiers must certainly be waiting in the wings.

Saturday, April 19, 2014

The 1972 Smallpox Outbreak in Yugoslavia: A Comparison to Current U.S. Biodefense - SEST-555.Fall2004

The 1972 Smallpox Outbreak in Yugoslavia: A Comparison to Current U.S. Biodefense - SEST-555.Fall2004

Aralsk-7: What a Biological Weapon Accident can Teach us about Containing Disease during Conflict

As the Ebola outbreak in West Africa unfolded I wrote this piece on containment, isolation and quarantine. I will be up-dating this shortly, with a focus on Russian efforts to end the most devastating outbreak of Ebola the international community has ever witnessed.

The potential of loosing command and control of a clandestine military laboratory infrastructure, due to conflict and war, such as exists today in Syria, increases the risk of theft, diversion and the potential for accidental release of highly pathogenic agents into the environment. Where few resources exist to contain epidemics or treat exposed persons, global public health is at increased risk. Modern air travel which can ferry in disease as we have seen with the WPV1 (polio) outbreak in Syria, or carry it out as we see with the Ebola outbreak in Guinea place the intentional community at some risk. Conflict and disease share a long history, but what if an outbreak occurred during a field test where no risk to command and control existed? Containment, in what can only be described as perfect conditions, teaches us about containment during conflict. Two examples stand out: one an 'accident' and the other, a naturally occurring event. In the first instance, in 1971, the Soviet's suffered an accident during a BW test which unfortunately resulted in the deaths of three people. While any loss of life is significant, its worth noting that this was a relatively limited accident, in part due to the immediate measures taken by the Soviet's. Wikipedia has a nice outline on the Aralsk-7 incident which has been widely research to the point of evisceration, but for the purpose of this blog, the basics noted are relatively accurate (see:

The deserted complex of Aralsk-7

"According to Soviet General Pyotr Burgosov (Peter Burgasov), field testing of 400 grams of smallpox at Renaissance Island caused an outbreak on July 30, 1971.(6) Burgasov, former Chief Sanitary Physician of the Soviet Army, former Soviet Vice-Minister of Health and a senior researcher within the Soviet BW program, described the incident: 'On Vozrozhdeniya Island in the Aral Sea, the strongest recipes of smallpox were tested. Suddenly I was informed that there were mysterious cases of mortalities in Aralsk (Aral). A research ship of the Aral fleet came to within 15 km of the island (it was forbidden to come any closer than 40 km). The lab technician of this ship took samples of plankton twice a day from the top deck. The smallpox formulation--400 gr. of which was exploded on the island--'got her' and she became infected. After returning home to Aralsk, she infected several people including children. All of them died. I suspected the reason for this and called the Chief of General Staff of Ministry of Defence and requested to forbid the stop of the Alma-Ata-Moscow train in Aralsk. As a result, the epidemic around the country was prevented. I called (future Soviet General Secretary Yuri) Andropov, who at the time was Chief of KGB, and informed him of the exclusive recipe of smallpox obtained on Vozrashdenie Island.(7)(8). It may never be known whether the release of smallpox was purposeful, but the research ship Lev Berg inadvertently traveled into the plume of this bioweapons release, initiating the smallpox outbreak in Aral. (Some have contended however, that Burgasov was wrong and that the first patient may have contacted the disease while visiting Uyaly or Komsomolsk-on-Ustyurt, two cities in what is now Uzbekistan where the boat docked." (9)(10)

While the outbreak itself has been analyzed to the point of exhaustion, mainly to focus attention on the Soviet BW program, response to the Aralsk-7 outbreak has been relegated to second place, when in fact, the response has quite a bit to offer in terms of 'lessons learned,' and extracting this from whatever political sensitivities one may hold regarding offensive open air field testing, which many states engaged in prior to the 1970's including the United States.  

Medicins Sans Frontieres (MSF) staff attend an Ebola patient inside an isolation ward in Bundibugyo December, 12, 2007 in this picture released by MSF.

"A massive public health response to the smallpox cases in Aral ensued once the disease was recognized. In less than 2 weeks, approximately 50,000 residents of Aral were vaccinated. Household quarantine of potentially exposed individuals was enacted, and hundreds were isolated in a makeshift facility at the edge of the city. All traffic in and out of the city was stopped, and approximately 54,000 square feet of living space and 18 metric tons of household gods were decontaminated by health officials.(15). ( Johnathan B. Tucker and Raymond A. Zilinskas wrote an outstanding and comprehensive analysis of the Aralsk smallpox outbreak in their paper entitled: The 1971 Smallpox Epidemic inAralsk, Kazakhstan, and the Soviet Biological Warfare Program," available at: I highly recommend their publication it is the best analysis I have ever read on the Aralsk incident.  To touch upon the highlights of Soviet containment strategies, Tucker and Zilinskas provide the following:

"Strict quarantine measures were the only way of stopping the further spread of the disease beyond the city, because of late hospitalization and isolation of patients, late diagnoses, and the inability to establish the source of infection. Up until September 26, the quarantine measures were enforced by the police, then beginning at 00 hours on September 26, by the military units of the local garrison and by a SAVO-64411 unit.11 The total length of the cordon around the city was 20-21 km, with soldiers placed at intervals of 700 to 800 meters; in other words, where they were directly visible to each other. The cordon was manned by 23 posts with a total of 200 soldiers. According to Directive No. 4, issued by the district ChPK on September 26, procedures for leaving and arriving at the locale were established, as well as a procedure for tracking and registering outgoing economically vital shipments, whether by road, sea, or rail. " (

"In order to monitor vaccinations and trans-shipments, a total of 5 checkpoints and medical control points were set up near roads leading to Aralsulfat, the Aralsk collective farm, railway junctions No. 86 and 87, and the seaport. Each checkpoint and medical control point was provided with 2 tents for a shift of 4 people and for the medical personnel (2 nurses). Each checkpoint shift was supplied with boiling water, fuel, disinfection equipment and supplies, and hot food. The cordon posts, each of which had 3 personnel, were similarly equipped. The medical control point personnel consisted of 14 nurses and 1 physician. The following work was done at the medical control point: examination and vaccination of 620 people arriving in the city and involved in shipping activities; examination of 82 vehicles with various types of cargo; and disinfection of 32 vehicles. Twelve ships and barges were also monitored. While the quarantine was in effect, several people were detained for violating the quarantine. Ten people were fined, while five were arraigned and had their drivers’ licenses revoked. Internal quarantines covered a zone of medical and preventive facilities, where smallpox patients were identified; i.e., departments of surgery and infectious diseases, skin and venereal disease clinics, as well as newly organized special facilities. The police were responsible for maintaining the quarantine over the hospital, the field hospital, the isolation ward, and the observation facility. A total of 7 posts with 23 personnel were set up. Round-the-clock security was provided for office buildings, with shifts 8 to 12 hours in length." See: From a purely public health perspective, Soviet efforts were impressive as were efforts undertaken by Tito during a smallpox outbreak in 1972. Unfortunately today such strategies would no longer be allowed under most civil society/democratic state law. It is worthwhile to consider that both the Aralsk-7 outbreak and the Yugoslav outbreak were 'accidental.' The use of HPA in a deliberate attack with modified pathogenic agents would present challenges to containment, most states are not willing, let alone prepared to consider. 

The second notable outbreak of highly pathogenic disease, from which lessons can be learned, occurred in Yugoslavia in 1972. Maria Ikovic wrote an excellent comparative analysis entitled: "The 1972 Smallpox Outbreak in Yugoslavia: A Comparison to U.S. Bio-defense," while the paper was written some time ago, the facts remain the same and offer us a chance to consider how gaps in containment strategies today may well effect our ability to contain outbreaks of disease, particularly in conflict zones. pa Ikovic's excellent piece notes the following points: 


  • Over the course of human history, smallpox killed hundreds of millions of people, more than plague and all the wars of the twentieth century combined. It has a 30% fatality rate and severely disfigures most survivors.
  • Smallpox is an orthopox virus that is spread from person to person. There are no known animal or insect hosts.
  • The virus is most transmittable in cold weather.The Yugoslavian outbreak occurred during February-April, after a single infected person (the index case) returned from a Muslim pilgrimage inSaudi Arabia, passing by bus through Iraq (infected with smallpox at the time).
  • The incubation period (from the moment of infection until the onset of symptoms) lasts 7 to 17 days. Persons with the virus are not contagious during the incubation period. No one else on the bus to Yugoslavia contracted smallpox (there were 25 other passengers on the bus).
  • After the incubation period patients spread smallpox primarily to household members, friends, and hospital workers. This is due in part to the fact that transmission of the virus occurs in conjunction with the onset of symptoms including fever and rash. In other words, the virus is communicable only when a person is typically bedridden. The Yugoslavia case confirms this generalization: Muzza infected 38 people, all but one of whom were hospital contacts. However, the index case experienced a mild form of the disease; he was not bedridden and was therefore able to spread it to Muzza.
  • Once communicable after the incubation period, the virus spreads primarily through droplet nuclei oraerosols expelled from the host by exhaling or coughing. When the virus is breathed in it infects the respiratory passages, spreading to the lymph nodes and elsewhere.
  • Infection may also occur through contaminated bed linen and clothing.
  • Rates of transmission are disputed: Some estimate that each infected person infects a further 10-13; others estimate that each infected person infects 1-3 others. The Yugoslavian transmission ration was 1:13. Other studies, however, looked at past outbreaks and estimated average rates of transmission to be lower than 2.
Photo taken of smallpox patient in Kosovo, 1972
  • Diagnosis is often difficult, particularly when healthcare providers are not familiar with symptoms. In Yugoslavia prior to the 1972 outbreak, the last death from smallpox was registered in 1926. As a result healthcare providers were unfamiliar with the disease. When Muzza was hospitalized (at various hospitals in Yugoslavia) doctors misdiagnosed him as having an allergic reaction to penicillin, when in reality he was affected with a highly fatal form of smallpox.
  • After the incubation period the patient first experiences influenza-like symptoms, such as fever, malaise, and prostration. This is followed by the onset of a rash, the bumps of which are in the skin, not on it. The rash becomes severe, turning into pustules that are hard and round.
  • Smallpox is often confused with chickenpox. However, the smallpox rash is centrifugal: it is concentrated more on the head, hands, and feet than it is on the trunk. The chickenpox rash is the opposite: it appears primarily on the trunk, and never on the palms or soles of hands and feet. 
  • The rash eventually turns into scabs that fall off and typically leave deep pits on the skin. The person is considered contagious until the last scab separates.
Control of Outbreaks:

Checking immunization reaction, Kosovo, 1972
  • The Vaccine is extremely effective, but gives the recipients full immunity from smallpox for 3-5 years, with decreasing immunity thereafter. The Yugoslavian index case likely experienced a mild case of smallpox because he had been immunized just months before.
  • Vaccination complications: For every one million people inoculated, one will die, 14 will be infected with life-threatening illness, and 48 will suffer less serious illnesses. 
  • Two main ways to inoculate during an outbreak:Mass Vaccination and Ring Vaccination. With the latter, only suspected contacts are vaccinated. The former method was used in Yugoslavia: a state's entire population is vaccinated (or as was typically the case in Yugoslavia revaccinated)
Key points in the Yugoslavia Epidemic
  • It was a natural outbreak
  • There was a high transmission rate DESPITE PRIOR VACCINATIONS. One infected person infected     13 others, on average. The high transmission rate was probably aggravated by winter temperatures and late diagnosis.
  • Containment strategy=Mass (re)vaccination and Quarantine.
  • Tito was ruling at the time; political system (authoritarianism) was suited for draconian measures. Emergency procedures included the isolation of Dakovica province, shutting down borders, quarantining all persons suspected of coming into contact with the virus, and prohibiting public events, meetings and weddings. 20 million people were vaccinated and 10,000 contacts were quarantined.
  • Over a 9 week outbreak, 175 people were infected, 35 died. OUt of 175 affected persons, 105 (60%) had been previously vaccinated against smallpox, whereas 37.7% had not been immunized; the vaccinal status was unknown for 2.3% of the affected persons. See:
"West Africa is seeing the 'most challenging' outbreak of Ebola virus since the disease was discovered 40 years ago. It comes as the death told reaches over 101, the World Health Organization reported. This is the most challenging Ebola outbreak we have ever faced," Keiji Fukuda, Assistant Director General of the World Health Organization (WHO) told a news briefing. See:

Considering the recent outbreak of Ebola in Guinea, there have been 21 reported cases in Liberia with 10 fatalities, and 9 suspected cases in Mali. Most concerning are the 20 cases reported in Conakry, the capital, 16 of which have been laboratory confirmed. "Médecins sans Frontières (MSF/Doctors without Borders) is helping the Ministry of Health of Guinea in establishing treatment and isolation centers in the epicenter of the outbreak. In Liberia, several international organizations including the International Red Cross (IRC), Pentecostal Mission Unlimited (PMU)-Liberia, and Samaritan’s Purse (SP) Liberia are aiding the Ministry of Health of Liberia by supporting awareness campaigns and providing personal protective equipment (PPE) for healthcare workers. The Institute Pasteur in Lyon, France, the Institute Pasteur in Dakar, Senegal, the European Consortium mobile laboratory, and the Metabiota/Tulane University laboratory in Kenema, Sierra Leone, and CDC Atlanta are some of the laboratories collaborating to test samples. To date, 56 cases from Guinea and Liberia have been laboratory confirmed by PCR for Ebola virus. CDC is in regular communication with its international partners, WHO, and MSF regarding the outbreak and a 5 person CDC team is currently in Guinea assisting the Guinea MOH and the WHO-led international response to this Ebola outbreak."Based on Guinea’s MoH Epidemiological Bulletin, Liberia’s MoH, and the WHO update 5 April, 2014. 

A brief note on the difference between isolation and quarantine, provided on the HHS website:    Isolation and quarantine are public health practices used to stop of limit the spread of disease. Isolation is used to separate ill persons who have a communicable disease from those who are healthy. Isolation restricts the movement of ill persons to help stop the spread of certain diseases. For example, hospitals use isolation for patients with infectious tuberculosis. Quarantine is used to separate and restrict the movement of healthy persons who may have been exposed to a communicable disease to see if they become ill. These people may have been exposed to a disease and do not know it, or they may have the disease but do not show symptoms. Quarantine can also help limit the spread of communicable disease. 

Similar to Ebola, outbreaks of smallpox, which swept across Europe killing over 300 million in the Twentieth Century alone, caused panic and loss of life. Fortunately, smallpox is now a vaccine preventable disease, Ebola is not. The utility of quarantine should not be underestimated particularly in the absence of a vaccine or other medical counter-measures.
In contrast to perfect conditions where quarantine, isolation and vaccination can be swiftly implemented with few civil rights issues,  outbreaks which happen in conflict zones are cause for far greater concern. When we consider outbreaks of disease in Syria or even the recent outbreak of Ebola in Guinea, containment strategies utilized in Aralsk and Yugoslavia, which include isolation, quarantine and if possible vaccination (only experimental vaccines are available for Ebola), are enviable. Today it would be nearly impossible to institute such effective strategies.  Inability to impose strict isolation and quarantine, make research and development of medical countermeasures all the more urgent. Providing public health care during war requires modelling which thus far has not been terribly impressive, even in states with adequate resources. 

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Friday, April 18, 2014

Syria's Biological Warfare Infrastructure

“According to an unclassified U.S. Department of State report in 2005, nations suspected of continued offensive biological warfare programs in violation of the BWC [Biological Weapons Convention] include China, Iran, North Korea, Russia, Syria, and possibly Cuba” (Martin et al., 2007).See:

Most highly pathogenic agents suitable for weaponization are zoonotic, meaning they are transmissible from animal to human. From a bio-defence perspective, veterinary vaccine facilities have typically comprised a significant part of state biological weapon/warfare complex i.e. the Soviet Biopreparat program (multiple institutes and facilities), Iraq's BW program comprised of Salman Pak, Al Hakum, and Al Manal (the Foot and Mouth Disease Center), South Africa's Project Coast (Roodeplaat, Research Laboratories, Roodeplaat Breeding Enterprises, Compression Laboratory), all conducted much of their clandestine work via veterinary facilities. Generally, clandestine offensive BW programs run in parallel with a legitimate research cover and an illicit offensive research and development infrastructure. Aside from affording complimentary investigational research on zoonotic diseases, veterinary vaccine manufacturing processes are difficult, until the very end of the process, to identify as having an offensive use, essentially weaponized capability. While it is relatively easy to identify chemical weapon manufacturing plants and suspected nuclear facilities, the same does not hold true for biological weapon infrastructures. Both the Soviet Union and Iraq ran robust biological warfare programs which went under the radar for years and years.

Beyond a robust pharmaceutical industry which both Iran and Syria posses, with the later having one of the most advanced pharmaceutical industries in the Middle East prior to the outbreak of war, what constitutes a biological warfare capability? The Federation of American Scientists in their 'Introduction to Biological Weapons', see: provides this analysis:

"Biological weapon production can be divided into several, general stages: 1) A biological agent must first be chosen and acquired. In the case of toxins, the production method must be acquired. 2) After growing and multiplying to sufficient quantities, various selection and modification procedures can alter certain traits and characteristics of the microorganism. 3) The agent is then prepared for delivery.

Choosing an agent requires matching the desired results of an attack with an agent's characteristics. Those characteristics may include: how much of an agent can cause disease (pathogenicity); time between exposure and illness (incubation period); how debilitating the resulting disease is (virulence); its lethality; and how readily the disease spreads to others (transmissibility). Countermeasures to the disease such as treatment and vaccination are also considered.

A pathogen can be obtained from two major sources: its natural environment and a microbiology laboratory or bank. When acquired from environmental sources such as soil, water, or infected animals, enough of the microorganism would have to be obtained to allow purification and testing of its characteristics. The difficulty in acquiring agents stored in labs and banks, such as the American Type Culture Collection, depends on accessibility to the pathogens, security for the facility, or security measures for the bank's ordering process. These agents are purified and of a known quality.
An alternative to acquiring agents is creating them. Toxins can be produced by adding the DNA coding for its production to bacteria. Also, advances in biotechnology have made it possible to synthesize certain viruses based on its genome, or an organism's genetic instructions, and using basic materials such as DNA. Dr. Eckard Wimmer first demonstrated this by re-creating the poliovirus in 2001, which was followed by Dr. Craig Venter's synthesis of the bacteriophage Greek symbol phiX174 in 2003 and the 2005 re-creation of the 1918 flu virus by Dr. Jeffrey Taubenberger and Dr. Terrence Tumpey.
Anthrax fermenter
Fermentation vessel used for the production of anthrax. (Source: United Kingdom Security Service MI-5)
Growing microorganisms requires providing optimal conditions. Living cells are required for the replication of viruses and some bacteria. Fungi, most bacteria, and other microorganisms can be grown in Petri dishes or fermentation vats. Although growing large amounts of an agent is possible, it can be limited by factors such as equipment, space, and safety concerns that arise from handling dangerous germs without appropriate safeguards. However, large amounts of an agent may not be necessary if the target population is small.

Modification of microorganisms through selection techniques and advances in genetic engineering could alter an agent so it will function in a particular manner. Agents modified for increased pathogenicity and a shorter incubation period could result in a more severe, fast-acting disease. Microorganisms that, under normal circumstances, do not infect potential targets could be modified to do so. Other changes could make treatments, vaccines, or the body's immune system useless.

Delivering an agent requires preparing it to remain effective when outside of its optimal growing conditions. Exposure to environmental stresses such as temperature, ultraviolet radiation, and drying can reduce the agent's activity. Some pathogens, like the anthrax bacteria, can encapsulate itself into a hardy, long-lasting spore not easily susceptible to those conditions.

Other agents require further processing that minimizes damage to it and allows it to retain its activity when dispersed. These procedures include: direct freeze drying (lyophilization); formulation into a special stabilizing solid, liquid, or gaseous solution; deep freezing; and powdering and milling. Once stabilized, the pathogens are ready for dispersal.

Many of the above manipulations require techniques and procedures that have been published in scientific literature. In addition, the equipment required for most procedures is available since legitimate researchers require them as well. This represents the "dual-use" problem, where the same knowledge and equipment used for beneficial work could also be used for more malevolent deeds."

I agree with the processes listed by FAS, the scale appears more reflective of the Soviet Biopreparat program, while Syria has sought, according to the Canada's Aerospace and Defence Weekly, Wednesday Report,  'a more agile BW program.' The Wednesday Report, and this was from their 2004 issue, so one can imagine the advances made until fighting in 2010 probably impacted this somewhat, notes the following:  

"In regard to anthrax, Syria has some ongoing experience in the industrial cultivation of germs and viruses for the civilian production of anthrax (and smallpox) vaccines. And while evidence is sketchy, Russian experts hired by Syria are reportedly engaged in cultivating a highly virulent anthrax germ for installation in missile warheads.While Syria has concentrated on anthrax and cholera germs, it has also done work on the brucella germ, establishing a biohazard facility for this pathogen as well as isolating it from sheep. Pasteurella, another bacterial pathogen related to the causative agent of bubonic plague, has also been investigated in Syria. The smallpox virus, which is considered a very reliable and effective biological weapon, last visited Syria in 1972. It is assumed that with its development and production as a biological weapon by Russia, it was secretly delivered to Syria. It is believed that production facilities for chemical weapons, in the Aleppo area and at other sites, also include wings for biological weapons. An additional facility for biological weapons has been reported in the village of Cerin, alongside facilities for the development and production of medicinal preparations. Syria has also shown great interest in dispersal methods. At the SSRC, a high capacity sampler for aerosol particles was developed that was used in fieldwork that dealt with the analysis of micronic particles. Such samplers are extremely useful in field testing biological weapons. Knowledge with operational value on dispersal techniques was also acquired in the framework of research on the packing, release, and effects of weed-controlling material in a polymer format. This technique, called micro-encapsulation packing (in tiny capsules), enables the controlled and ongoing dispersal of biological (and chemical) warfare agents under unfavorable environmental conditions. Scientists from Aleppo University and Germany worked on the project. In fact, Syria has had rudimentary biological weapons in its possession since the early 1990's. Syria together with Iran, Iraq, North Korea, South Korea, Taiwan, China, and Russia is currently considered to be a biological weapons possessor or developer by the United States.  The Syrian military is also beginning to plan the eventual integration of biological weapons in its tactical and strategic arsenals. In April 2000, Syrian defence minister General Mustafa Talas published a lengthy article entitled, 'Biological (Germ) Warfare: A New and Effective Method in Modern Warfare." (Interestingly, the article was published in Persian translation in Tehran, the key Muslim strategic ally of Damascus.) All indications suggest that Syria's ultimate objective is to mount biological warheads on all varieties of the long range surface to surface missiles in its possession. This is a goal that can probably be achieved within a few years, and it may already have been realized in part." See:

Free Syrian Army fighters walk with weapons at Tameko pharmaceutical  factory, Image:

"The Syrian pharmaceutical industry emerged in the 1990's as one of the strongest in the Middle East, exporting to an estimated 52 different countries making Syria the larges supplier in the region. The market was valued at $620 million, more than $400 million of which served the local market and supplied 91 percent of the nation’s pharmaceutical needs. The remainder – which cost anywhere from 30 to 70 percent less than comparable products in neighboring markets – was exported to approximately 52 countries, making Syria the second-largest drug supplier in the region. Syria's pharmaceutical industry is heavily concentrated in Aleppo and has been decimated by fighting over the past three years. 'At least 25 Syrian pharmaceutical plants have been completely destroyed by the fighting or taken over by militias, and most of the others have been forced to suspend production due to sky rocketing costs, the difficulties of transporting, distributing, and storing pharmaceutical shipments across the country, and the inability to access raw materials, according to a representative of one international NGO operating on the ground in Syria [ ]. A handful of factories continue to operate sporadically at barely a third of their pre-crisis capacities, but overall pharmaceutical production in Syria has dropped 75% since 2010, according to the most recent Syria Humanitarian Assistance Response Plan released by the United Nations in June. Demand for medicine has surged during the same period, and as a result, the country has experienced critical shortages of pharmaceutical products since July 2012, the SHARP report said." See: 

Today, although war has increasingly diminished Syria's civilian bio-pharma industry, the SSRC is alive and well and protected possibly by IRGC. While it is speculated that around 70% of labs have been looted, the SSRC retains command and control over Assad's military BW sections, which form the core and remain intact. Erosion of the bio-pharmaceutical infrastructure, although likely to contribute to military programs run out of the SSRC, will have been compensated for due to the highly compartmentalized structure of Syria's BW complex. While there was some speculation that an Israeli attack on a convoy may have destroyed a section of the SSRC, notably a BW unit, there is no open source or secondary source reporting to substantiate this claim. It is likely that legitimate sections of Syria's bio-pharmaceutical industry has been heavily impacted by war but that efforts have been taken to insure the continued development of its clandestine military programs. It is highly unlikely Syria's biological weapon programs will be either destroyed through conflict or negotiated away in any kind of UN inspection (partly due to the fact that there is no verification protocol or inspection regime under the  BTWC), as has occurred with Syria's vast chemical weapon arsenal. Moreover, aspects of the pharmaceutical infrastructure which have suffered the greatest damage are not critical to military weapon programs so it is likely civilian public health infrastructures will continue to be diminished without negatively impacting Assad's BW programs. 
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Wednesday, April 16, 2014

Looting the Labs: Syria's Biological Weapon Program and Al Qaeda

Since 911 and the U.S. anthrax attacks, focus has been placed on 'bio-security.' Bio-security' has a number of situational-dependent meanings. For the purpose of this article, 'bio-security' will be defined as: 

"[ ]encompass(ing) the prevention of the intentional removal (theft) of biological materials from research laboratories. These preventative measures are a combination of systems and practices put into its place at legitimate bio-science laboratories to prevent the use of dangerous pathogens and toxins for malicious use, as well as by customs agents and agricultural and natural resource managers to prevent the spread of these biological agents in natural and managed environments.[1] More recent definition with advances in technology also involves oversight of dual-use research (Koblentz, 2010). Dual-use research has the potential to create new health security issues. The most inclusive definition of all would be biosecurity as "security against the inadvertent, inappropriate, or intentional malicious or malevolent use of potentially dangerous biological agents or biotechnology, including the development, production, stockpiling, or use of biological weapons as well as outbreaks of newly emergent and epidemic disease" as defined by The National Academies of Science (Koblentz, 2010). This definition is analogous to that of health security. Although security is usually thought of in terms of "Guards, Gates, and Guns", biosecurity encompasses much more than that and requires the cooperation of scientists, technicians, policy makers, security engineers, and law enforcement officials." see:

Syria today possesses a number of dual use facilities and laboratories which comprise sections of a highly compartmentalized biological weapon program. In July, 2012, Jihad Makdissi, Syria's spokesman for the Ministry of Foreign Affairs announced on Syrian state television that the regime would not use chemical or biological weapons against its civilian populations, confirming what had long been suspected by Western intelligence agencies. See: and Highly concerning is Assad's potential loss of command and control over his bio-pharmaceutical infrastructure, which supports and contributes, to this weapon complex. The SSRC which is the core research center for Assad's WMD programs contributes as well, however the SSRC is relatively well protected with hardened labs and some estimates suggest it is partially now guarded by IRGC/Quds.

Serious concerns remain however, with regard to the looting of some laboratories and one estimate, from a source who has previously provided highly accurate, in country accounts, on a number of facilities, estimates the looting to be at around 70% of Syria's laboratories and veterinary vaccine facilities. The source is a highly credible NATO citizen, whom I've personally had direct contact with for over seven years. The source has provided ample documentation and photographic evidence from inside the labs.  The looting has occurred in sections where Al Qaeda has been fighting. In one incident, five members of Hezbollah were killed. While Hezbollah would likely be privy to direct transfers of laboratory equipment and or pathogenic agents, Al Qaeda generally would not, as they are not a state sponsored entity, although there is evidence to suggest they work on occasion with what would appear to be counter-interests. In my view, as BW expert, there is a risk that Al Qaeda, given their lengthy track record of not only calls to acquire and use BW/WMD as a religious duty, but their long term recruitment of experts trained in Western universities, could divert materials and pathogenic agents; possibly skirting it to AQLIM or Islamic Jihad of Yemen. It is possible AQ, well aware of Syrian laboratory infrastructures, could  divert such materials in areas where it is fighting and has access to these facilities. An  geospatial analysis of areas where Syrian labs now under ISIS controlled zones, paints an increasingly concerning picture. It is not a coincidence that Yazid Sufaat, Al Qaeda's long time BW expert who ran Al Qaeda's anthrax program then set up his own private facility, 'Green Laboratory',  was recently rearrested for planning terrorist activities in Syria and is currently being held under ISA detention. Israel too, aware of the threat both Hezbollah and Al Qaeda's possession of biological warfare agents and dual use related materials (lab stocks) poses, has interned a known biological weapon expert for Al Qaeda. Samar Halmi Abdel Latif Al-Barq was recruited by  Ayman al-Zawahiri, now head of Al Qaeda and the same recruiter of Sufaat under Osama bin Laden. Al Barq's, detention has no doubt  removed a major Al Qaeda biological weapon threat form the region however, the looting of Syrian laboratories is very concerning. See:

Syria is long suspected of conducting work on botulinum, anthrax, smallpox, ricin, T2, among other agents and toxins. Laboratories working on vaccines would be a target of AQ  and fighting near those labs gives ample opportunity. The labs have not been destroyed by bombings or damaged by mortar rounds, but looted of their equipment. Assad does not need to loot his own labs and one has to question to what extent he maintains command and control over this deadly infrastructure.  Will update shortly.
Jill Bellamy is an internationally recognized expert on biological warfare and defence. She has formerly advised NATO and for the past seventeen years has represented a number of bio-pharmaceutical and government clients working on procurement strategy between NATO MS and Washington DC. Her articles have appeared in the National Review, The Wall Street Journal, The Washington Post, The Sunday Times of London, Le Temps, Le Monde and the Jerusalem Post among other publications. She is a CBRN SME with the U.S. Department of Defence, Chemical, Biological, Radiological and Nuclear Defence Information Analysis Center and CEO of Warfare Technology Analytics, a private consultancy based in the Netherlands. She is an Associate Fellow with the Henry Jackson Society, UK.