Bioterrorism: Applying the Lens of COVID-19 Report 2021

Bioterrorism: Applying the Lens of COVID-19 – Report 2021 1 Bioterrorism: Applying the Lens of COVID-19 Counter Terrorism 5 Report 2021 is published by the Counter Terrorism Preparedness Network (CTPN). Preparedness Network

CTPN is an international collaboration governed by the CTPN International Board, facilitated by London Resilience Group and hosted by the 1 Executive Summary 6 London Fire Commissioner. Context and Terminology 8

Lead Author Alex Townsend-Drake 2 Naturally Occurring Diseases Head of Programme v Weaponised Bioagents 10 Counter Terrorism Preparedness Network Diseases and Pandemics 10 The Evolution of Bioweapons 14 Co-Authors Dr Donell Harvin Bioweapons and Terrorism 16 Chief, Homeland Security and Intelligence Executive Director, National Capital Region Threat Intelligence Consortium Homeland Security and Emergency Management Agency, 3 Bioterrorism: Washington DC An Accelerating Threat 18 Dr Chloe Sellwood Attacks on Humans Deputy Head of Emergency Preparedness, Resilience and Response (London) and Communities 19 UK National Lead for Pandemic Influenza, Attacks on Livestock or Crops 22 National Health Service, England Summarising the Threat Profile 25

Independent Reviewers Daniel Cartwright Deputy Assistant Commissioner, London Fire Brigade 4 Enhancing Preparedness UK Fire and Rescue Service National Resilience Deputy for Bioterrorism 30 Lead for CBRN(e) Political and Strategic Leadership 36 Graham Finnigan Capabilities Advisor and NILO Coordinator Multi-Agency Preparedness UK National Ambulance Resilience Unit (NARU) and Public Health 43 Rachel Flowers Informing and Influencing Director of Public Health Community Behaviours 51 London Borough of Croydon Dr Michèle Gemünden Senior Researcher, Swiss and Euro-Atlantic Security Team Center for Security Studies (CSS), ETH Zurich 5 Conclusion 58 Dan Kaszeta Recommendations 62 Associate Fellow Royal United Services Institute Lee Kendrick 6 References 64 Head, National CBRN(e) Centre UK National Counter Terrorism Policing HQ Jeffrey Muller CBRN(e) Expert Consultant United Nations Office of Counter Terrorism

Professor Nick Tyler CBE Chadwick Professor of Civil Engineering Director, Centre for Transport Studies University College London Wiktor Wojtas Policy Analyst, Counter Terrorism Unit European Commission

Bioterrorism: Applying the Lens of COVID-19 – Report 2021 3 Who we are Counter Terrorism Preparedness Network The Counter Terrorism Preparedness Network (CTPN) is an international collaboration that brings together strategic leaders, practitioners and academics to inform city-level policies and practices that build resilience to help keep our cities and communities safe from terrorism.

CTPN aims to influence and develop the multi-agency arrangements of cities in preparing for, responding to and recovering from terrorism.

What we do CTPN aligns with strategies and priorities at local, national and international levels to deliver:

Research We bring together academic literature and official reports with the knowledge and experience of CTPN members. We combine these with analyses from subject-matter experts and incorporate case studies to propose recommendations for city authorities.

Events We convene and facilitate international conferences, bespoke seminars and scenario-based exercises that enable the exchange of learning and practices, develop connections, and inform approaches to counter terrorism preparedness, resilience and consequence management.

Projects We deliver projects according to the CTPN work programme, report recommendations and emerging needs (including those generated by wider strategic partnerships and commissions) as governed by the CTPN international board. Member Cities

Why we do it Terrorism is a global, networked and persistent threat that requires a global, networked and persistent response. CTPN fills a need for a multi-national, multi- agency and multi-disciplinary network at the city level.

Cities are the backbone of urban security. The response Barcelona Boston Dublin Greater Manchester London Montreal to terrorist attacks, as with most emergencies, happens first and foremost at the local or city level.

Cities are essential building blocks for achieving the delivery of grand strategy. Cities that develop arrangements and policy in an integrated manner can use this as a lever in developing resilience.

Security and development are mutually dependent; one demands the other. This requires an integrated Munich New York Rotterdam Stockholm Washington DC Zurich and holistic approach at all levels.

4 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 5

1 Executive Summary

The weaknesses Terrorism remains at the top of the This is underscored However, COVID-19 could heighten political agenda locally, nationally and by the Global Health the potential of bioweapons as a and lack of internationally. This is accompanied terrorist methodology because of Therefore, the main objectives of this report are to: preparedness by the ever-present threat posed Security Index, which the preparedness gaps that have by the intentional or unintentional found health security to been exposed. Argue that the threat of bioterrorism is accelerating against 1 exposed by this release of bioagents or outbreaks be fundamentally weak the backdrop of COVID-19 and advances in technology This is a view endorsed by both the pandemic provide of naturally occurring diseases. The around the world, with and biosciences; World Health Organisation (WHO) United Nations Secretary General over 80% of countries 8 a window onto how tracks approximately 7,000 signals and the Council of Europe. scoring in the bottom tier Contrast the vulnerabilities and consequences exposed by of potential outbreaks every month,2 a bioterrorist attack It is important to emphasise early 2 COVID-19 with those of bioterrorism to highlight the similarities and pandemic influenza has been for indicators related to 5 on that the threat of bioterrorism is and differences; might unfold and rated as a high risk for years. Yet malicious biothreats. generally considered to be relatively many nations have struggled to may increase its low. Terrorism is, of course, just one Propose that preparedness for bioterrorism will inevitably raise respond effectively to the coronavirus COVID-19 has unveiled vulnerabilities of many threats to contend with and 3 capabilities to cope with public health crises and vice versa, risks. Non-state disease (COVID-19) pandemic.3 on a global scale, and it is generally bioterrorism just one component. if an integrated approach is applied; accepted as a generation-defining groups could gain The WHO declared COVID-19 It must be kept in perspective and moment with an impact even more be considered proportionately. access to virulent a Public Health Emergency of varied and profound than 9/11. The Present recommendations for city authorities to enhance International Concern (PHEIC) on Bioterrorism has, however, been 4 preparedness and capabilities for bioterrorism and therefore strains that could widespread loss of life has been highlighted as a concern,9 driven by 30 January and a pandemic on joined by a major economic downturn public health crises. pose similar 12 March 2020. COVID-19 is of an array of strategic consequences and drastic changes in societal accelerated by COVID-19 and global and historic significance and norms. International relations are devastation to continues to exert a significant impact advances in technology and the changing, as is the balance between biosciences. The means, motives and societies around on geopolitical and socio-economic 6 To facilitate this, the report will citizens and their governments. opportunities are apparent; ensuring realities as well as government explore the differences between the globe. This is against the backdrop of global an appropriate level of preparedness decision-making. It has arguably naturally occurring diseases and the population growth, urbanisation is clearly justified. become the biggest crisis the planet and globalisation. There are also intentional release of weaponised has faced since the Second World the risks associated with biological The point here is that COVID-19 bioagents; review the threat of War and it will probably have impacts and technological advances; must be recognised as a lesson bioterrorism; and analyse the on international security in ways that Antonio Guterres, shifting health challenges including in the potentially potent impact of vulnerabilities demonstrated by are difficult to anticipate and are not 7 growing antimicrobial resistance; weaponised bioagents. Although COVID-19 to consider these in the United Nations yet fully understood. 1 political uncertainty; the spread of not intending to overstate or mislead context of a bio-attack (on the basis Secretary General that bioterrorism could cause a A recent report highlighted misinformation; and climate change. in terms of the threat, this report public health crisis far more impactful that COVID-19 offered an outlines the need and opportunity All these factors accelerate the threat than COVID-19). It subsequently opportunity to test and assess the for a comprehensive, robust and profile and complexities in the context underlines the importance of political strength of national security and integrated approach towards of public health crises and terrorism. and strategic leadership; multi- governance but exposed profound preparedness for public health Due to the higher likelihood of agency preparedness and public shortcomings that reflected crises and bioterrorism, which conventional terrorism, preparedness health; as well as informing and significant gaps in preparedness.4 show similarities and overlaps in for unconventional terrorism (e.g. their consequences. influencing community behaviours. bioterrorism) has often received Recommendations are listed on relatively little attention. pages 62-63.

Bioterrorism: Applying the Lens of COVID-19 – Report 2021 7 1 Executive Summary continued

Context and Terminology The report further stresses the is used in isolation, it is intended as This is an international report importance of holistic investments a neutral expression where natural designed for an international that can contribute to preparedness or malicious threats may apply. audience and it is, therefore, and public health as well as city The word “pathogen” is also used relatively high-level in order to enable operations. Financial instability after as appropriate. This is simply an transferability. By bringing together COVID-19 means that incorporating organism that causes disease. academic literature, official reports new security and preparedness The report recognises that some and open-source information with measures will be a luxury. Rather, biothreats can spread between analyses from professionals and approaches towards security and people (e.g. Ebola) and others may subject-matter experts this report preparedness need to be not (e.g. Anthrax). As the lens of will argue that preparedness for combined with wider benefits, COVID-19 is being applied, the report bioterrorism and public health such as infrastructural development is primarily considering biothreats crises should be viewed as mutually and public health. Measures that that do spread, while acknowledging dependent and must be intensified. can be absorbed or incorporated into wider societal projects those that may not. This, of course, The report recognises city-level (e.g. regeneration projects) and has implications for planning that preparedness to be a critical building vice versa may maximise cost would need to be analysed locally. block for national preparedness and efficiencies and increase their appeal. In terms of emergency preparedness collective resilience. It recognises that and response, weaponised city administrations wield significant To demonstrate this, the report bioagents often fall within chemical, influence in this regard and are contrasts naturally occurring biological, radiological, nuclear increasingly recipients of devolved disease outbreaks and biological (explosive) planning. On occasion powers. It notes a duty upon city (bio) agents released in a terrorist the abbreviation CBRN(e) is used to authorities to prepare for crises, attack. It therefore combines naturally refer to this group within the report. protect their citizens and safeguard occurring diseases and weaponised their economies. Indeed, the new bioagents into the term “biothreats”. counter terrorism agenda of the Unless referring to a specific disease European Commission highlighted (e.g. COVID-19) or weaponised the importance of strategic dialogue bioagent (e.g. Anthrax), the terms between cities, describing them as “naturally occurring diseases” and the backbone of urban security.10 “bioagents” are used to make a As such, the report incorporates distinction. The term “bioagents” some case studies from CTPN refers to those agents that already members with a view to sharing exist and are unmodified, but that experiences, practices and initiatives. could be intentionally disseminated Reflections are relevant for both as a bioweapon. The report later national and local stakeholders, refers to “engineered biology”, but city-level authorities are the which is the modification of such target audience. agents. Where the term “biothreats”

8 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 9

2 Naturally Occurring Diseases vs Weaponised Bioagents

Catastrophic Diseases and Pandemics In some cases (e.g. COVID-19), biological threats Daily life involves almost constant the effects may not be immediately contact with biothreats including apparent because someone who highlight the bacteria, viruses, plant and animal has been contaminated by a virus inextricable link irritants, pollutants, toxins and or bioagent may not present visible others. Although most exposures symptoms for some time after 15 between security result in no significant adverse exposure (a period referred to effects, those that do can trigger as incubation) and therefore may and public health 16 outbreaks. These are often defined unknowingly infect others. This concerns. These by their geographical range, which creates a somewhat fluid chain threats, whether can include a community, a country reaction that is significantly influenced or even the entire globe (called by rising population densities, the naturally occurring, a pandemic).12 They are caused ease of global travel and social intentional, or by high-consequence infectious interconnectivity, as well as limits on diseases (HCIDs), acute illnesses public health and medical systems. accidental, have the that spread rapidly from person to potential to cause person at a rate above that usually When complex interlinked seen in the population, and often loss-of-life and rising faster than the disease can be systems are pushed too sustained damage controlled. These collectively result far from their natural in the greatest proportion of human equilibrium by external to the economy, morbidity and mortality.13 factors, such as diseases, societal stability, A pandemic can occur at any time then a system failure and global security. and originate from anywhere in the can cause a cascade world. It may manifest over one or of impacts and become more waves in a human population highly unpredictable. that has little or no immunity and therefore global spread is highly This is because when the unexpected United States likely. All ages may be affected. happens a relatively small change Government Illness is likely to present variously, to the system can cause runaway ranging from asymptomatic cases effects that become uncontrollable, Accountability to patients with mild symptoms to Office Report11 leading to unpredictable outcomes those resulting in hospitalisation, with global impacts.17 The uncertainty intensive care or death. It is possible about the scale, severity and pattern that people without symptoms – or of development of any pandemic those with minimal symptoms – could makes them complex and dynamic, spread the pathogen. The exact requiring a highly specialist and pattern only becomes apparent centrally coordinated response. as the pandemic progresses and The invisible nature of a biothreat may not be fully understood until also adds extra layers of complexity 14 some years after it ends. This may and is psychologically demanding for depend on the disease and whether responders and society itself. its characteristics are already known or not, which makes a significant The COVID-19 pandemic, caused difference to understanding its by the SARS-CoV-2 virus, has pattern and implications. demonstrated how the transmission

Bioterrorism: Applying the Lens of COVID-19 – Report 2021 11 2 Naturally Occurring Diseases vs Weaponised Bioagents continued

of a naturally occurring disease can It also precipitated the urgent issues That virus has now embedded in the communities was reported as key.22 in certain conditions, such as A core challenge with COVID-19 – have unprecedented global impacts. of testing, contact tracing, vaccination human population and circulates the Beyond these experiences, the WHO climate variance or mutations in one that would apply to weaponised The outbreak of this airborne virus, and treatment programmes. globe annually as one of the influenza has considered scenarios where an infectious agent, may make bioagents – is that there are also which began in Wuhan, China, in Furthermore, steep rises in strains causing seasonal epidemics. millions of people could succumb their spread more effective and/or multiple relationships that can December 2019, continues to present unemployment, social deprivation and Epidemics and pandemics can arise to influenza before it is brought treatment more difficult.23 It is those enhance or hinder the proliferation significant challenges for the entire food poverty have been evident, giving quickly or gradually, be halted or under control. Yet, preparedness for conditions determined by physical, of the outcome that are not world. Globally, on the morning of 16 way to a plethora of ripple effects, persist for decades. COVID-19 proved to be insufficient. social, economic and environmental necessarily a cause or an effect. March 2021, the WHO COVID-19 such as impacts upon mental health, factors or processes that increase COVID-19 has demonstrated broad dashboard reported 119,791,453 critical/palliative care and the widening Reviewing lessons from the Ebola This is not to ignore the inevitable the susceptibility of an individual, a interdependencies with negative cases of COVID-19, including of societal and health inequalities. 2014–16 outbreak in West Africa, the complexities and challenges of community, assets or systems to emergent properties. This is why 2,652,966 deaths. Some of the most WHO highlighted the importance of responding to a pandemic. It is the impact of biothreats. The main COVID-19 has had such a profound complex political, social and economic Other notable examples that have integrating research, social science worth noting that some regions may consequence of this is a cycle in effect all over the world, and issues experienced in generations caused (and continue to cause) and community engagement into be more vulnerable or susceptible which the vulnerability of a system differently in different places. have been generated or exacerbated, concern include pandemic influenza, the heart of the response. The need to biothreats for reasons outside makes it more sensitive to risk.24 fundamentally shifting how society SARS (Severe Acute Respiratory for the quick turnaround of test of the technological and medical operates. It has disrupted health Syndrome), MERS (Middle East results, licensed vaccines, advances advancement of the population. This means different groups can COVID-19 and naturally and socialcare services and led to Respiratory Syndrome), Ebola and in Ebola care/treatment, support for experience different impacts at the occurring diseases serve AIDS. The AIDS pandemic persists a survivors, fast-acting emergency Factors such as human behaviour; same and different times. In other the implementation of widespread healthcare coverage and accessibility; as powerful reminders of pharmaceutical and societal full 35 years after the discovery of the response structures and funding words, different communities, regions causative agent, the HIV virus, while mechanisms were also noted.20 biopolitics (the administration of the and nations may be confronted by the damage that disease interventions in a bid to contain processes of life at the aggregate level can cause and highlight and delay its spread. This included the SARS epidemic (2003–04) was However, despite warnings of the different phases simultaneously, controlled through an international Ebola epidemic, it was only reframed of the population); and geopolitics (the creating waves within waves. This the importance of being harnessing existing and available interconnectivity between territories medical treatment options and public health effort. It has been as a global security threat once it had highlights how human existence and adequately prepared to and alliances at a state level) play 26 facilities; implementing mechanisms to estimated that the most recent infiltrated urban areas and crossed the world that surrounds it forms a respond to a bio-attack. 21 pivotal roles that can hinder or enable control further spread of the disease influenza pandemic caused by the borders. In response to SARS, complex relationship of cause and the spread of an outbreak. Changes 25 (including quarantine and social H1N1 virus (referred to colloquially as the timely dissemination of accurate effect that can be intensified in distancing); public education; and “swine flu”) killed 151,700–575,400 and scientifically based information such crises. 18,19 disease prevention. people worldwide in 2009–10. and training to health officials and

Categories of Health Security Overlaps in Phases and Impacts (Adapted from the Global Health Security Index 2020) Note: this portrays how short, medium, long-term impacts may emerge simultaneously and overlap. These may differ subject to national and local contexts creating waves within waves across communities. Risk Environment Prevention Overall risk Prevention of the environment and emergence or realese vulnerability to of pathogens biological threats

Compliance with Norms Commitments to Detection improve national and Reporting capacity, finacning For epidemics plans and adhere of potential to global norms international concern

Health System Sufficient and Rapid Short term Medium term Long term robust to treat Response Days – Weeks Weeks – Months Months – Years the sick and To and mitigation protect workers of the spread of an epidemic

12 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 13 2 Naturally Occurring Diseases vs Weaponised Bioagents continued

The Evolution of Bioweapons conducted extensive research on from the most dangerous viruses the Soviet Union’s anti-agricultural These facilities are driven by the agent Novichok in 2018; and the Just as there are examples of the use of bioagents as a wartime and bacteria available. The work warfare programme employed 10,000 same kind of geopolitical competition unsuccessful poisoning of the naturally occurring diseases weapon against humans, attacking included engineering multi-drug- people and targeted poultry, livestock that triggers war rather than a desire Russian opposition leader, Alexei throughout history (e.g. the Spanish 11 Chinese cities with a range resistant bacteria and producing and crops. More recently, during to serve public health needs,42 and Navalny, in 2020. Such transnational flu of 1918), there is ample literature of bioweapons. These included and stockpiling bioagents, such the Iran–Iraq War of the 1980s, Iraq raises issues of laboratory safety and hybrid activities are highly political that points to how bioweapons have poisoning more than 1,000 water as Anthrax. Further evidence was developed fungal agents to attack security. This poses the insider threat and referred to as the “grey zone”, in evolved that provides important wells to study the effects of cholera provided by an accidental release of Iran’s staple food crops.36 as a significant security challenge.43 which states may seek to showcase context. Examples include the and typhus outbreaks and releasing Anthrax spores from a production Fortunately, security measures limit their power and exert influence. poisoning of water wells with human thousands of plague-infected fleas by facility in Sverdlowsk which, propelled Despite the introduction of the who can work with certain pathogens 28 corpses in Tortona, Italy, in 1155; air over Chinese cities. by a slow wind, killed more than Biological Weapons Convention and in which laboratories, but this The use of state-sponsored 31 the spread of plague victims in Caffa 60 people. After the collapse of as a supplement to the 1925 doesn’t remove the threat. bioweapons, although beyond the Other states began developing on the Crimean Peninsula in 1346; the Soviet Union, nearly all research Geneva Protocol to prohibit the use remit of this report, is a dilemma their own offensive bioweapons and in 1495 the mixing of wine and production was halted. Little is of bioweapons, several nation- The rise in high-containment that should also be transferred into programmes. Throughout the Cold with the blood of leprosy patients known about the bioweapons that states are known to maintain these laboratories is akin to an arms race, preparedness for direct or hybrid War, the United States Biological 37,38 to sell to French soldiers after they were produced or where they are capabilities. North Korea, for on the premise that such capabilities bio-attacks at all levels. Weapons Program continued 32,33 invaded Naples. Native Americans stored today. example, has allegedly weaponised may equate to deterrence through research that entailed conducting Bio-attacks could be designed to have been described as one of the 13 different agents. These included a stalemate or mutually assured open-air tests; exposing animals, Historically, biowarfare programmes inflict maximum fatalities, casualties, earliest victims of biowarfare through Anthrax, cholera, typhoid, yellow paralysis (via the perception of volunteers and unsuspecting that target human health have been and/or disruption to society. They the devastating release of smallpox fever, botulism, Korean haemorrhagic mutually assured destruction). This, civilians to pathogenic and non- extended to target crops and farm may be hostile acts from foreign and measles.27 The list of legendary fever, smallpox and bubonic plague. as Kofi Annan emphasised, creates pathogenic microbes, including animals to deny food to the enemy, It has been suggested that such a vacuum that can be exploited.44,45 states, serious organised crime narratives and historically verifiable 47 bacterial aerosols in public places cause economic damage or sap groups or terrorist cells. incidents goes on. bioweapons can be more lethal than Consider, for example, the such as bus stations and airports.29 morale. During the First World War, nuclear weapons.39 assassination of Bulgarian Georgi The Scottish island of Gruinard was German saboteurs in the United Fast-forward to the 20th century, Markov in 1978 on a London In 2020, national security and advances in bacteriology and contaminated in 1942–43 when it States used Anthrax and glanders to street via a micro-engineered pellet scientific research developed the was used as a UK government test infect more than 3,500 horses before It is no surprise that there containing ricin,46 or how this principle challenges were growing threat from intentionally spreading centre for bioweapons (specifically they were shipped to the British and has been a sharp increase translates to the maintenance of in severity and complexity, natural disease pathogens to bombs containing live Anthrax French armies, rendering them unfit in high-containment chemical and radioactive weapons. while the terrorist threat weaponised bioagents. In the early spores). It was not until 1987 that for service when they arrived. During laboratories in operation More recent examples include the persisted at scale.48 1900s, the focus of research was the ground was declared Anthrax- the Second World War, the United poisonings of Alexander Litvinenko 30 or being built across Asia, aimed at destroying crops and free. The Soviet Union established States and Canada developed anti- by radioactive Polonium-210 in 2006; a biowarfare project of its own, livestock agents such as rinderpest, Africa, Europe, Russia livestock. This culminated during 40,41 Sergei Skripal and his daughter the height of the Second World War, dubbed “Biopreparat”, a large- a highly lethal disease of cattle that and the United States. Yulia Skripal by the chemical nerve 34,35 when the Imperial Japanese Army scale secret project that sought to was declared eradicated in 2011. develop and produce bioagents From the mid to late 20th century,

14 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 15 2 Naturally Occurring Diseases vs Weaponised Bioagents continued

Bioweapons and Terrorism A bio-attack could also result in an • Terrorist attacks result in sharp with the remaining fear that it could This is a highly sensitive space It is proposed In extremis, the use of weaponised epidemic or pandemic, for example if shifts in societal behaviours and be used maliciously. to navigate. Bioweapons and that the threat of bioagents can be considered as Ebola or Lassa viruses were used as attitudes, often experienced terrorism raise extremely difficult 53 Proliferation of bioweapons, bioterrorism is an act of war (consider NATO the bioagents. through psychological impacts, questions about peace, security, international terrorism and pandemics Articles 4 and 5). It was famously a rise in community tensions human rights, the international accelerating, with Detecting releases and containing and hate crime. have been highlighted as key system and the vulnerability of even potentially severe stated that war is a continuation 64 their spread is key. The UK Biological challenges for national security. 66 of politics by other means, an act the strongest states. Similar can consequences. Security Strategy is committed to • Bioagents could be engineered In conflict zones, advances in of violence to compel the enemy be said about a pandemic, where a rapidly and effectively detecting, to be highly potent and fatal. weapons technology have allowed to fulfil a will.49 Their use could be nexus of global, national, regional and characterising and reporting the They may be released in mass, the use of weapons over much wider Indeed, the threat of a bioagent part of an ideological, political or local impacts and interdependencies presence and nature of harmful whether overtly or covertly, geographic areas than in the past. designed to maximise transmission perhaps religious contest for control are also witnessed. 67 biological material that could targeted or otherwise, and have Recent events, such as the use and lethality warrants attention. of the state, usually between the represent a significant risk or threat.54 the potential to cause more of chemical weapons on civilians Both pandemics and terrorist attacks Just like pandemics, a large-scale government and a rebel group.50 disruption and kill or incapacitate by terrorist groups in Syria have are widely considered to be high-risk terrorist attack can shock systems This relates to bioterrorism as the 68 Similarly, the United States public significantly more people.56,57 demonstrated a real threat.65 This and high-impact. Although terrorism in in unexpected ways. When focus of this report. health system and primary transfers across to bioagents that, general is considered relatively likely, combined (a bio-attack that healthcare providers are obliged The following table of examples causes a pandemic), the potential Although United Nations members although technically challenging to bioterrorism has been considered to prepare for various bioagents, demonstrate the variance in case is catastrophic. have been unable to agree on a produce and disperse, are becoming to be relatively low likelihood. including pathogens that are rarely fatality rates, which are likely to be definition of terrorism because increasingly accessible. seen in the country. These high- at the higher end if malicious. In of differences in interpreting the priority agents include organisms contrast to a naturally occurring actions of states or those involved that pose a risk to national security disease emerging somewhere, in resistance movements, the most because they can be easily leading to locally increasing cases general usage of the term considers disseminated or transmitted from and spreading from there, a malicious terrorism to be “the unlawful use or person to person; result in high release of the same pathogen could threatened use of force or violence Agent Case Fatality Rate mortality rates and have the potential mean that it appears in more places against people or property to for major public health impact; at the same time or across a wider coerce or intimidate governments or Anthrax might cause public panic and social geographical area. Even without Varies depending on clinical features, societies, often to achieve political, + 58 disruption; and require special action engineering, this would create a 10 -50% highest for inhalation (historically up to 85%). religious or ideological objectives”.51 for public health preparedness.55 situation quite different from a natural Put simply, an act of terrorism can outbreak and could begin with a be understood as a premeditated, Although the consequences of a comparatively higher level of impact. politically motivated attack through Botulism Incidence is low but mortality can be high terrorist attack using weaponised This is, of course, dependent on a variety of means and methods, without prompt diagnosis and appropriate, bioagents could unfold like a whether the bioagent can spread 5 -10% including bioagents (bioterrorism). immediate treatment.59 pandemic such as COVID-19, there between humans or not. are clear distinctions to be made: INTERPOL define bioterrorism as, Anthrax offers a case in point. It “the intentional release of biological • A bio-attack is both intentional is a zoonosis caused by Bacillus Plague A severe disease, particularly if it causes agents or toxins for the purpose of and malicious. It is therefore Anthracis, where one deep breath 30 -100% a systemic infection or is in its pneumonic harming or killing humans, animals 60 considered to be an act of war of weaponised aerosol may lead form. It is invariably fatal unless treated early. or plants with the intent to intimidate or terrorism. It is highly political to septicaemia, rapid progression or coerce a government or civilian and invokes bespoke and to shock and respiratory failure. population to further political or specialist structures at local, Mortality rates are substantial Smallpox Variola minor has a mortality rate of 1%, social objectives”.52 national and international levels even with access to full intensive 1-30% whereas the more common major has a that shift the approach of mortality rate of 30%. 65–80% of survivors A bio-attack is, therefore, the care facilities, which would not be governments and agencies. are marked with deep, pitted scars.61 intentional release of a pathogen sustainable in a large-scale attack. Although Anthrax is very unlikely to Both were declared as eradicated. (disease causing agent) or biotoxin • Management of societal and spread between people, smallpox (poisonous substance produced by health impacts would be has proven potential as a highly a living organism) against humans, accompanied by the need to Viral Average 50%: A rare, but severe and contagious malicious bioagent even 62 plants or animals. This may be activate significant intelligence haemorrhagic 25-90% often fatal disease. before any engineered enhancement. through weaponised bioagents or and investigative apparatus, as fevers International stocks of vaccine are engineered biology. These can pose well as the associated sensitive (e.g. Ebola) acknowledged to be inadequate, and complex public health challenges, and time-critical operations the WHO urged countries to consider causing large numbers of deaths necessary to apprehend the means of increasing these stocks,63 while being difficult to contain. terrorists themselves.

16 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 17

3 Bioterrorism: An Accelerating Threat

While terrorism Attacks on Humans following intensive care. A further and Communities 31 people tested positive but did continues to The Council of Europe noted how not become ill, most likely because pose a threat to COVID-19 has uncovered the of the widespread administration of vulnerability of societies to the prophylactic antibiotics, which were the whole world, intentional use of a pathogen or administered to tens of thousands of CBRN(e) terrorism other bioagent, highlighting that people as a preventative measure. such may prove highly effective and In addition, at least 42 buildings is of particular cause damage on a far grander scale were contaminated with Anthrax concern for than traditional terrorist attacks.70 spores because of the handling This is possible because some and transportation of envelopes Member States and living organisms have a capacity and the easily aerosolised nature the international for amplification and propensity of the spores. This demanded a to spread, with drastic effects. significant and protracted process community. We Bioterrorism, like all CBRN(e) threats, of decontamination, which was both 75 must remain vigilant occurs with little warning. It is often disruptive and costly. invisible and unknown, as are the Recently, Europol noted how as any possibility of perpetrators and their plans.71 terrorists accessing technological advances alongside Historically, several non-state actors knowledge shared online have and using CBRN(e) have obtained and deliberately used reduced barriers to accessing 76 weapons and bioagents to injure or kill civilians. bioagents and their associated In Oregon, a religious commune costs. To put this into context, materials poses was responsible for a deliberate a serious threat to outbreak of salmonella that sickened the sequencing of the more than 750 people over a month international peace and was part of a larger plan to DNA strains used in the and security. incapacitate voters for an upcoming Anthrax attacks cost local election. In 1993, Aum Shinrikyo several thousand dollars attempted to disperse a liquid and took three months to 72 suspension of Anthrax in Tokyo. accomplish. Now, a typical In 1995, the group conducted a sarin microbiology researcher Vladimir Voronkov, attack inside the Tokyo subway that could do the same for United Nations killed 13 people and hospitalised thousands. The subway attack approximately $200 in Under-Secretary-General followed failed botulism and Anthrax 77 69 half a day. for Counter Terrorism assaults near the Imperial Palace, an airport and two United States military During 2019, a pro-ISIS group bases, as well as efforts to acquire launched a campaign promoting 73,74 the Ebola virus. the use of bioweapons, including instructions on how to produce and In 2001, an attack using a small deploy them.78 Genetic maps of amount of Anthrax in powder form deadly viruses, bacteria and other caused widespread panic. Distributed microorganisms are also available in envelopes via the United States in the public domain, although to Postal Service shortly after 9/11, it reconstruct a virus from a sequence caused 22 people to become sick (while theoretically possible) would from exposure and 11 were seriously be highly sophisticated. ill. Five died and six recovered

Bioterrorism: Applying the Lens of COVID-19 – Report 2021 19 3 Bioterrorism: An Accelerating Threat continued

Obtaining a sample of a virus, The upsurge in Islamist extremist In the words of the INTERPOL countries don’t consider it to be COVID-19 has The threat of terrorism 104 however, is relatively uncomplicated. activity online and inspired material Secretary General, Jürgen Stock, hasn’t abated, rather it is an illicit act, which creates an been described as There has been a case of a malicious is further demonstrated by ISIS in its “Terrorists have sought to profit exploitative vacuum. becoming more complex, the perfect storm organisation managing to access Al-Naba edition of 19 March 2020, from COVID-19, to make money, vials of the bubonic plague bacteria, which explicitly called for attacks strengthen their base and to with multiple actors of The WHO highlighted that “the for the spread of for example.79 while opponents were vulnerable fuel division”.93 diverging motivation use of biological agents is a as a result of the pandemic.87 and allegiance.100 serious problem, and the risk of misinformation, owing Terrorist groups have openly spoken Although globally the total number of using these agents in a bioterrorist to its inherent and of acquiring bioweapons.80 The logic The world’s focus on COVID-19 deaths from terrorism has declined, attack is increasing”.105 This is behind this is clear: if COVID-19, may lead terrorists to seek even falling by 15% to 13,826 deaths in Concerns about “dirty bombs” being endorsed by INTERPOL, which persistent uncertainty. which has a lethality of approximately more attention-grabbing targets or 2019 over a five-year period,94 NATO used in urban areas also persist. noted that Terrorist groups have 1% among those infected, can techniques. On 24 March 2020, a reported that terrorism remains A sophisticated plot to detonate cause global turmoil, consider an white supremacist attempted a car responsible for the death of more military-grade explosives on a flight been able to capitalise engineered virus as infectious as bombing at a Kansas City medical Allied citizens than any other security from Australia in 2017 uncovered “the threat from coronavirus but with the lethality of centre. According to reports, the threat in its history.95 In the West, further plans for a chemical attack in bioterrorism is real, with on this through 101 Ebola.81 Terrorist groups have also timing of the attack was accelerated ISIS directed or inspired at least 78 Sydney. Three terrorist plots current reports indicating countless forms of involving CBRN(e) materials were been reported as contemplating following the COVID-19 outbreak attacks between 2014 and 2019, that individuals, terrorist the release of a pathogen into local as the medical centre now “offered resulting in 471 fatalities.96 also disrupted in Paris, Sardinia and propaganda platforms, 102 groups and criminals water systems, which could have more casualties”.88 There was a Cologne during 2018. including social media disastrous consequences.82 Three further attempt against a hospital In 2019, Europol noted that a total have both the capability The case in Cologne was a terrorist jihadist propaganda documents from ship in the United States, and the of 119 completed, failed and foiled and intention to use and the dark web, plot involving ricin. It was the first time the series “Knights of Lone Jihad” arrest in Tunisia of two men who were terrorist attacks were reported by biological agents to 97 an ISIS-affiliated terrorist had both of which published in 2017 promoted reportedly planning to infect security 13 EU member states and, more 106 successfully produced the bioagent cause harm to society”. 89 recently, attacks have been witnessed CBRN(e) food and water forces with COVID-19. 103 transcend borders. 98 in the West. In addition, there are contamination as a tactic. in France, Austria and Germany. hundreds of independent biology labs The key message here is that In February 2021, an unidentified The real or perceived failures of Speaking in October 2020, the MI5 across the globe where individuals terrorists are likely to develop or computer hacker attempted to the response to COVID-19 have Director-General, Ken McCallum, also provided terrorists with an cited 27 late-stage terrorist attack or small organisations can conduct obtain chemical and biological poison the water supply of a city in 107 their own do-it-yourself biology weapons, and this threat Florida by remotely increasing the opportunity to fill a “void” by plots that were disrupted in Great 99 experiments. There isn’t a common is accelerating. amount of sodium hydroxide.83 using public services as a vehicle Britain alone since 2017. to accelerate their agendas.90 regulation for this, and many A United Nations report noted that Terrorist groups including the COVID-19 had created a captive Taliban, Hezbollah and al-Shabaab audience for terrorist cells. An have provided services in lieu of increase in time spent online has governments, which allow them to been accompanied by a rise in acquire and consolidate a form of cybercrime that could also lead to political legitimacy and expand their increased connectivity between footprint. Simultaneously, right-wing terrorist and criminal actors. It noted extremists project hate, racism and the furthering of terrorist narratives, conspiracy theories about the origins with a wide variety of terrorist and purpose of COVID-19, blaming groups integrating COVID-19 into ethnic or minority groups for the virus. their propaganda, seeking to exploit There is a growing and increasingly current events.84 transnational threat from extreme right-wing terrorism.91 One of the Indeed, COVID-19 has been described major fallouts from COVID-19 is as the perfect storm for the spread of the loss of millions of jobs, which misinformation, owing to its inherent fuels uncertainty and anger that 85 and persistent uncertainty. Terrorist far-right extremists may exploit groups have been able to capitalise for recruitment.92 on this through countless forms of propaganda platforms, including social media and the dark web, both of which transcend borders.86

© Tomas Oneborg

20 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 21 3 Bioterrorism: An Accelerating Threat continued

Attacks on Livestock or Crops “One Health” (interpreting animal – a naturally occurring disease in Consideration of bioterrorism and human health as a continuum) cattle – in the UK during 2001 were typically focuses on direct attacks is essential. Expansion of public wide-reaching and extended beyond against human populations. However, health infrastructure beyond passive direct impacts to agriculture and the many bioagents are zoonotic (a surveillance of animal disease towards food chain (£3.1 billion). Additional disease that normally exists in active surveillance and intervention to estimates of impacts to the tourism animals but that can infect humans) detect and control ongoing outbreaks industry because of fewer visits to 114 and could have a considerable is a step towards this. the countryside were put at between impact on agriculture as well as £2.7 and £3.2 billion. Many of the on human health.108 costs to agriculture were met by the government through compensation Urbanisation and the proximity of One Health for slaughter and disposal and humans and animals provide a vector “One Health” is an approach towards “clean-up” costs. However, for zoonotic diseases. This underlines to designing and implementing agricultural producers were estimated the fact that human health cannot programmes, policies, to have suffered losses of £355 be separated from the health of legislation and research million (20% of the estimated total plants and animals. Approximately in which multiple sectors income from farming in 2001). 60% of all human diseases and 75% communicate and work Overall, the net effect of FMD is of all new and emerging infectious together to achieve better estimated to have reduced the gross 109 diseases are zoonotic in origin. public health outcomes. The domestic product in the UK by areas of work in which a One <0.2% in 2001.117 The impact of a An attack on livestock or crops could Health approach is particularly hostile release of a disease such as cause significant economic damage, relevant include food safety, the FMD, on top of the current economic social unrest or loss of confidence control of zoonoses (diseases impacts the world is facing due to the in government. “Agroterrorism” that can spread between COVID-19 pandemic, might not be could also be effected more easily, animals and humans, such as so easily managed or absorbed. requiring less specialised technology flu, rabies and rift valley fever), or expertise, because of the In June 2020, identification of a new and combatting antibiotic openness and vulnerability of variant of SARS-CoV-2 in mink in resistance (when bacteria farming operations.110,111 Denmark led to widespread culling mutate after being exposed across 289 affected farms (17 million to antibiotics and become The goal of agroterrorism is generally mink) after interventions were unable more difficult to treat).115 not to kill animals or plants but to to prevent the spread of infection cause the secondary impacts of from farm to farm, or from animals terror and human health disruption. to humans. Mink farming, including In 2008, the United States Federal Of the highest priority agents import and export, was subsequently Bureau of Investigation, Food and identified by the United States Centre banned in Denmark until 31 Drug Administration, Department of for Disease Control and Prevention, December 2021. Economic support Homeland Security and Department the only disease that does not affect packages were established for those of Agriculture, jointly published a animals is smallpox, which was affected but the full impact will not be “Criminal Investigation Handbook for declared as eradicated in the 1970s, known for some time.118 Agroterrorism”,112 which highlighted thanks to worldwide vaccination.116 its importance. For example, in 2011, The successful eradication of The significant economic impacts of a calf’s leg was found in silage used smallpox brought immediate avian influenza outbreaks in poultry to feed heifers on a farm in Northern public health benefits, however the populations and SARS are also Ireland, an apparent attempt to remaining spectre that it could be well documented.119 These were deliberately infect the cattle herd used maliciously as a bioweapon natural outbreaks of animal disease, with brucellosis, a serious is a threat that many governments coupled with relatively low levels of veterinary disease.113 take very seriously, and maintenance global human illness and death, but of stockpiles of smallpox vaccine there was nevertheless an impact Some bioterrorism bioagents in persists to varying degrees. on food supply and major economic animal populations could spread ramifications through loss of earning widely through animal-to-animal The potential economic impacts from agriculture and tourism because transmission and prove difficult must also be realised. The impacts of travel restrictions. to control, thus the concept of of foot and mouth disease (FMD)

22 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 23 3 Bioterrorism: An Accelerating Threat continued

Approximately This provides an opportunity to The direct and hostile release of Summarising the Threat Profile societies’ dependence This is coupled with rapid scientific reflect on how animals could be genetically modified crops into an At the highest level we have on overwhelmingly and technological advances that used to spread/act as sentinels for area without prior authorisation may can be exploited and may shape an entered an era of unprecedented complex and bioagents. For some bioagents, pets, also present a threat, as could the change. The world order is shifting, entirely different landscape in the wildlife or domestic livestock could sabotage of a previously approved superpowers are changing and interconnected years to come. Biotechnology could 120 60% provide humans with early warning crop. Industrial crops such as needs and threats are evolving. systems increases enable viruses to be engineered to of all human diseases of an exposure risk. Of course, rubber or cotton could also be Regional groupings, founded for their vulnerability optimise the impact of bioweapons. and 75% of all the converse is true, with disease targeted, with significant results. peace, are breaking because of and susceptibility to Genetic modification could also potentially manifesting in humans increasing geopolitical fragility, and biothreats of all kinds, make pathogens more resistant to new and emerging before animals. It is also worth medication and vaccines, and could Extrapolation of the trust in democratic institutions is as demonstrated considering how naturally impacts of disease and declining. Demographic shifts are boost transmission and virulence. infectious diseases occurring diseases can mutate, by COVID-19. Synthetic biology could change disruption to animal and being triggered by climate change are zoonotic in origin. as happened with COVID-19. and competition for diminishing human physiology in unpredictable With avian flu, the fear that it might plant crops (for food and natural resources, intensified by a Records show that bioagents ways, such as by engineering become air transmissible resulted non-food purposes) could backdrop of population growth and have been used intentionally and autoimmune disorders; attacking in experiments on its transmissibility be a secondary target urbanisation. This is accompanied by maliciously throughout history. the microbiome with significant between mammals. This was highly for bioterrorism. an aging population predominantly Historically it has mainly been neurological effects; or making an debated in the context of biosecurity in developed nations, and rising religiously motivated or right-wing operative immune to a bioagent. and biosafety. In this respect, terrorists could numbers of disaffected young terrorists who have been most A report on “Advances in Science potentially spread a bioagent over people in much of the developing attracted to using bioweapons and, and Technology in the Life Sciences: The malicious genetic modification a large geographical area without world who will be facing poorer in the West, these are currently Implications for Biosecurity and of a crop with perhaps reduced being detected, causing significant employment prospects and the dominant terrorist movements. Arms Control” offers a more technical resistance could also cause 127 disruption without extensive planning, unfulfilled expectations.123 Following COVID-19, the emergence analysis of these evolving threats. significant impacts on yield. The resources or technical knowledge. or resurgence of a range of terrorist release of antibiotic/pesticide- In 1918, the German army spread This is compounded by the persisting groups is possible. There are strong When bioterrorism is viewed through resistant crop pathogens could Anthrax and other diseases through conflict between secularism and long-term concerns that nations this lens, many different scenarios similarly devastate crop foods and, imported livestock and animal feed.121 commercialism on one side and rigid weakened by the serious economic are imaginable. Such sophisticated in areas already facing food stress, More than 100 years later, such belief systems on the other, which consequences of the pandemic human experimentation is technically increase the likelihood or impact actions would require relatively little fuels the pool of disaffected that will become more vulnerable.125 much harder to do (enabled by of shortages, leading potentially to effort,122 and may be increasingly become vulnerable to radicalisation. Although prohibited under international a range of expertise and other hunger, famine and even conflict. impactful given crop monoculture. In addition, hostile states are using law, it is likely that some states and technologies) but it still needs to hybrid means to maximise their non-state actors will continue to be acknowledged as a threat. influence and non-state actors are develop, stockpile and use chemical Biotechnology presents opportunities becoming increasingly powerful. and bioweapons.126 to advance the life sciences, but that same technology in the wrong hands Bioagents are both economical could be used to create crippling It is predicted that there and difficult to detect, making them bioweapons.128,129 will be more ungoverned appealing to terrorists. A broad range of biological toxins or infectious Technologies including unmanned spaces and CBRN(e) aerial vehicles (UAVs) or drones, the capacity will proliferate.124 agents, such as bacteria, viruses and fungi, could be used, all of which dark web, malware, synthetic biology are living organisms or replicating and 3D printing have also been This high-level view is important entities. This is not to ignore the highlighted as increasing the risk because geopolitical fragility, of non-state actors’ access to, significant efforts to restrict access 130 conflict and inequality will continue to, and deter potential terrorists and use of, CBRN(e) weapons. to create a breeding ground for from bioagents, rather to note that terrorism. Population growth, The role of modern technology with appropriate access, equipment in terrorism was illustrated by the migration flows and urbanisation and knowledge some bioagents will increase density, creating fertile extreme right-wing terrorist attack on may be relatively easy to produce. a synagogue in Halle, Germany, in environments for attacks. The Unmodified pathogens would also proliferation of bioweapons will 2019, where the attacker constructed be very dangerous in the context of several guns using 3D printing.131 also make their use more likely. an intentional release (e.g. Ebola) if It is already known that cultivation and release were achieved.

24 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 25 3 Bioterrorism: An Accelerating Threat continued

Drones are also a prime example of how technological advances have manifested in physical and weaponised form (ISIS first began attacking coalition troops with drones in 2014) and could be used for the dispersal of malicious agents. Cheap, commercially available drones en masse could overwhelm defences.132 The rapid pace of innovation and easy access to drones means that this threat is likely to grow.133 One bioterrorism scenario is the airborne dispersion of pathogens over a population. Crop-dusters, for example, are ready-to-use drones able to do exactly this. They are agricultural drones that are pre- configured for spraying operations.

Some nations have adopted bespoke drone guidance in response to both physical attack against a site (e.g. carrying an improvised explosive or chemical/bioagent) and fears of hostile reconnaissance that may then be used to develop an attack plan. The threat posed by the malicious use of drones, the changing threat profile and advances in biotechnology mean that countermeasures must continue to evolve.134

Other means of dispersal could include aerosol generators mounted in fixed locations or on vehicles or boats. Agents could also be delivered directly into ventilation or air-conditioning systems, via letters or parcels, or through insects, crops and livestock. Suicide attacks could also be extremely effective for disseminating diseases such as smallpox or Ebola.135

26 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 27 3 Bioterrorism: An Accelerating Threat continued

A further threat to the biosphere and terrorist groups and how This view is endorsed by the “If one considers the interdependencies pertains to cyber-biosecurity because this could be countered. The European Union’s counter terrorism of the increasing connectivity and increased use of the darknet chief, who noted that COVID-19 between human technological advances and dependence between digitalised to acquire, transfer or smuggle would exacerbate extremism on both the equally impressive progress that biological platforms and systems. This biological material or weapons was the right and the left, with people includes consideration of emerging noted as becoming a major concern driven to their respective ideological and health sciences have made... we should or converging technologies, like the for the law enforcement community corners during this period.142 There already conclude that the likelihood of a future use of artificial intelligence to predict worldwide, as was the rising threat is a real risk that social divisions will modifications to pathogens that could posed by the criminal and terrorist intensify, and community tensions terrorist using a highly potent, clandestinely cause harm. This requires separate use of drones.136 will increase,143 while terrorist groups produced, difficult to detect/identify/track, easily research as part of a wider analysis carve a more hospitable environment on the impacts of cybercrime and NATO’s 2030 strategy highlighted for action than before. transportable and dispersible, and quite lethal artificial intelligence on terrorism. how the evolving modus operandi 144 of terrorists, coupled with the As stressed at the beginning of this biological weapon is rising significantly”. These challenges have been spread of emerging and disruptive report, the threat of bioterrorism is recognised by INTERPOL and the technologies, call for adaptive generally considered to be relatively United Nations, which convened and innovative counter terrorism low and the intention here is not to a high-level meeting aimed at strategies, means and methods.140 overstate this. Rather, the summary understanding the transformative The convergence of COVID-19 with offered by the Combating Terrorism ways new and emerging scientific a lack of global leadership combined Center, an academic institution at the and technological developments with politico-socio-economic United States Military, neatly sums up are contributing to global society, instabilities that build upon pre- the position of this report: while also considering their existing societal grievances141 potential misuse by criminals may increase the terrorist threat.

Bioterrorism: An Accelerating Threat CASE STUDY INTERPOL Bioterrorism Prevention

New and The Drivers Advances in Emerging Globalisation of Conflict Biosciences A major part of INTERPOL’s efforts is the facilitation of targeted training for Technologies and Instability law enforcement and relevant national agencies on how to prevent, prepare and respond to bioterrorism. Their range of capacity building and training activities aim to establish collaboration on the national and regional levels, but also seek to promote a multi-agency approach.137

In November 2020, INTERPOL and the United Nations INTERPOL’s Bioterrorism Prevention Unit’s Project Capability and intent of terrorists launched a joint initiative to produce a global threat Pandora was also established to increase capability of (ends, ways, means) study on non-state actors and their CBRN(e) materials. police and intelligence analysts to investigate bioterrorist- By developing strategic threat assessments against related activities using the darknet. This included the CBRN(e) using national law enforcement information, this development of analytical support and intelligence five-year initiative was designed to help the international sharing, by seeking to gather comprehensive data that community counter the threat. It highlighted the value determines trends and anticipates biothreats. INTERPOL’s of establishing a region-by-region threat assessment CBRN(e) and Vulnerable Targets Sub-Directorate also Vulnerabilities on non-state actors involved in sourcing, smuggling, began developing a dedicated Critical Infrastructure exposed by acquiring or deploying CBRN(e) materials.138 Protection Unit regarding the use of drones.139 COVID-19

28 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 29

4 Enhancing Preparedness for Bioterrorism

Global pressures With an estimated 90% of all reported of the impacts and consequences COVID-19 cases, cities and urban of COVID-19 and translate them into that play out at a areas have been described as the the context of bioterrorism. Assessing city scale such as... centre of COVID-19, driven by vulnerabilities to understand population size and their high-level the potential consequences of disease pandemics, of global and local interconnectivity. bioterrorism or public health crises economic The unprecedented growth of cities can inform priorities and approaches in recent decades has intensified towards policy and preparedness. fluctuations, and several of humanity’s most pressing terrorism pose new challenges, heightened by COVID-19. A whole-system approach should It has demonstrated high levels of seek to improve preparedness challenges. The disproportionally and deep-rooted and the operational management scale of urban risk inequalities affecting the most of complexity and resilience. If risk vulnerable in society. This shows the can be understood as the result of is... increasingly critical role local governments have interaction between changing threats unpredictable due in crisis response and recovery, as or hazards, physical systems and well as service delivery, economic society, it follows that risk also evolves to the complexity and infrastructure development. As over time. This interplay of physical of city systems. noted by the United Nations report and behavioural dynamics develops “COVID-19 in an Urban World”, and manifests through the existence of a widespread network of causes and cascading effects.147 COVID-19, there is an urgent for example, has demonstrated how The Rockefeller need to rethink and the nonlinear escalation of secondary 145 transform cities to emergencies can become crises. The Foundation vulnerabilities that cause secondary respond to the reality emergencies to escalate and their of COVID-19, potential respective tipping points or thresholds future pandemics, and by need to be identified. Understanding extension, bioterrorism. this process; the speed at which it can unravel; and the ability to counter This is about building more resilient, it is critical. inclusive, socially cohesive and Mapping causality and consequence, sustainable cities that confront associated interdependencies and these threats, as well as wider ripple effects can enable the crises (such as the climate change identification of those systems or and pollution crises) that challenge 146 assets that are vital to the functioning the viability of cities. This should of society. Further analyses are then encompass the development of needed to grasp how resilience, policies and approaches that seek specific to certain sectors or services, to address unequal distributions of could be built. Cities should wealth, health, prosperity, income therefore consider undertaking and resources. This requires robust deeper and more comprehensive developments in terms of national analyses that can be tailored governance and contingencies, towards their own contexts and city-level policy, multi-agency environments. This system-wide planning, wider initiatives and approach is fundamental to local arrangements. Herein is the understanding resilience.148,149 opportunity to take a high-level view

Bioterrorism: Applying the Lens of COVID-19 – Report 2021 31 4 Enhancing Preparedness for Bioterrorism continued

Impact: Impact: POLITICAL INSTABILITY SOCIAL DISRUPTION

International Border closures relations and security Food insecurity and Increased shortages domestic violence Communication Rule of law and perception and enforcement Education via school Diminished social and university contact and networks Containment Social and economic closures measures safety nets Shielding, quarantine, Impact: Misinformation, and social distancing Credibility and Supply and demand community tensions, legitimacy (e.g. food) PUBLIC HEALTH CRISIS and hate speech Restrictions upon social/outdoor Legislation Consolidating Widening inequalities activity and guidance scientific and technical advice

Impact: Demand on Support to the health services most vulnerable SYSTEM OPERATIONS and specialists and bereaved

Strain on infrastructure Effect on wider health (hospitals, mortuaries, needs and services laboratories) Mental health and Capacity for coordination Community health and Health inequality social-psychology and response social care and disproportionality of impact Medical supplies Information sharing Surge capacity – Impact: and vaccinations and data capabilities resources and personnel Capacity of the ECONOMIC DECLINE death management Community Critical services Budget cuts and processes behaviours and critical national consequences Test and trace infrastructure Rebuilding public, Implications for transport business and and industrial production consumer confidence Government dept Trade contraction and deficits and business Decontamination and Black market and closures resulting cleaning of interior spaces cyber crime Increased in negative GDP unemployment, Personal Protective growth poverty and Equipment deprivation Loss of tourism, travel and industry

32 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 33 4 Enhancing Preparedness for Bioterrorism continued

The vulnerability map on the previous associated risks. It must also be page demonstrates the volume and about how communities are engaged complexity of consequences that NATO’s report recommended and influenced as an inherent part have been derived from COVID-19, a four-pillar approach: of the response. all of which could apply to bioterrorism. COVID-19 epitomises To prevent the increase in The importance and complexity both the transnational dimension of 1 intent and capabilities of of policing in these circumstances biothreats and the individual as a terrorist entities; should also be noted as a high- target in a blatant demonstration profile and sensitive role. During COVID-19, police have been charged that a widened and global security To pursue indicators and agenda is now a fact of life.150 2 warnings of bioterrorism with enforcing laws and regulations These shifting parameters outline the activities; that have, in some settings, raised importance of systematic investment questions of legitimacy. Tensions as part of a transformational resulting from the pandemic and To protect civilians and social lockdowns became interlinked approach, which addresses the 3 critical infrastructure; systemic nature of risks, including with structural inequalities that weaponised bioagents.151 perpetuated this. The need to To prepare for manage spontaneous large-scale 4 bioterrorism.153 public assemblies like protests, The need for this celebrations and unlicensed music has been proven by events added complications. theoretical models of The focus here is preparedness. Some members of the community the deliberate aerosol Preparing for and managing the may call for a robust approach to the release of bioagents consequences of a biothreat has policing of public assembly; others such as smallpox or many similarities, whether a naturally see their rights to freedom being Anthrax in urban settings, occurring disease or weaponised infringed if dispersed forcibly by which have shown that bioagent – it still needs coordinating police. Approaches and tactics that structures, a multi-agency response, enhance perceptions of legitimacy regional infrastructures communications, healthcare, societal with some communities can ironically could rapidly become support/behavioural changes etc. undermine them with others, so the 152 overwhelmed. The response to biothreats of balance is difficult to achieve.154 all kinds would also need to be This report, however, does not focus A report from the NATO Defence underpinned by capabilities such on policing and law enforcement. College noted that the use of as mass-fatality and excess-deaths These, and wider considerations weaponised bioagents by terrorist planning, as well as humanitarian including intelligence, surveillance, groups had been a growing concern assistance, in addition to operational deterrence and counter terrorism for many years but highlighted how plans specific to counter terrorism. operations, sit within the remit and the negative social and economic In either case there would be responsibility of specialist agencies. implications of the COVID-19 significant disruption to communities, Rather, the next section distills and crisis could result in growing businesses and critical services converts the vulnerability-mapping intent by terrorist groups to use with widespread political, social and analysis into three headline areas bioagents. As explored above, economic ramifications. There would for preparedness: political and the potential increase in threat be a need to create mechanisms strategic leadership; multi-agency demands that collective capabilities for surge capacity while prioritising preparedness and public health; are significantly enhanced. support to the most vulnerable and informing and influencing people in society. Preparedness community behaviours. In doing in this context should enable early so, it enables this report to zoom detection and rapid response, in on some of the most prominent coordination and recovery, surge challenges that are within the scope capacity and alternative ways of of city authorities to address with working. It should seek to develop a view to enhancing city resilience. infrastructure and systems that It openly leaves wider areas to be minimise single points of failure considered and developed by the and spread or dilute the threat and appropriate partners.

34 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 35 4 Enhancing Preparedness for Bioterrorism continued

A striking absence of leadership in biosecurity has created additional challenges for city leaders in translating grand strategy, legislation and direction into tangible and meaningful actions at a local level.

Political and Strategic Leadership Bioterrorism, as against COVID-19, regional and global discrepancies The success of this is underpinned arena. Actions and decisions that is highly damaging for leaders 162 Crises that threaten multiple would exacerbate this significantly regarding biosecurity. by investment in public health and must be perceived as reasonable, and political administrations geographical or policy domains – because of the need to navigate emergency response infrastructure, legitimate and consistent; progress at all levels. During COVID-19 Preparedness needs to be transboundary crises – are much between security, investigation, social and economic security, must be visible; and it must also be many “truths” changed over time addressed at all levels. In the case of harder to manage than crises that transfer of information and public as well as mechanisms for well- demonstrated that all is being done as more was known about the radiological and nuclear emergencies, respect borders. These are usually health. Bringing together policy, informed, transparent and to reach solutions as safely, efficiently virus, and recommendations the International Atomic Energy cascading crises, where a crisis in legislation and operational delivery consistent public communications. and effectively as possible. This morphed alongside scientific Agency would lead the international one societal sub-system causes across a wide range of complex and applies in its own way at a city-level evidence. Counter-measures like response. However, there is an disruptions in others. This generates specialist areas in this context is key, just as it does at the national. sociallockdowns, for example, absence of a lead agency mandated Public communications complex layers of threat, urgency as is identifying short and long-term decreased when the projected to coordinate the response to a Effective communication is and uncertainty because the more issues and interdependencies to are important because collapse of health care systems did possible chemical or biological necessary to maintain credibility and complex a system becomes the frame and solve problems. However, accurate and timely not happen, causing a prevention attack at this level.163 Organisations navigate how public perception may harder it is for it to be understood this may be coupled with strategic paradox. With the invisible nature such as the WHO or the European messaging can lead to be shaped by the media and other it in its entirety. This is coupled with, considerations of interorganisational of the threat and its psychological Centre for Disease Prevention and positive behavioural voices on the political stage. It does and subject to, wider geostrategic and intergovernmental politics rather implications, this can fuel the 159 Control otherwise have a wide- change and save not matter that expectations may realities that may be at play. than operational necessities. spread of misinformation or a reaching remit across the breadth of thousands of lives be misplaced – they are real in These require strategic leadership, It may also be complicated by the mindset of denial. communicable (and other) diseases, 167 their political consequences.171 the overall direction of crisis protracted nature of the incident, during security crises. and consequently can contribute to Communicating actions and In this respect, internal responses and the political process like COVID-19, and the need bioterrorism-prevention activities and decisions while foreseeing and communications are equally surrounding these responses.155 for structures to be flexible to However, this requires the building knowledge. Mechanisms such as managing the political consequences important to ensure the safety and accommodate multiple concurrent and maintenance of trust because the Global Outbreak Alert Response is crucial. Communication needs to welfare of personnel as well as an High-level strategic coordination strategic risks. Indeed, responding trust is considered the primary route Network are available to assist with be done diplomatically, tactfully and understanding of an organisation’s is, ultimately, a political activity. to such outbreaks is a difficult to cooperation, and once lost is very early warnings.164 in a timely manner. Messages need strategic direction, associated To create orderly interaction within task, one that is inherently political, hard to regain.168 The feedback loop and among organisations requires transcending societies, sectors to be clear, relevant and authoritative, expectations and how these As noted earlier, the geopolitical provided through public engagement delicate choices about power, and agencies.160 backed by well-informed, evidence- connect with those of partners and legal structures that are in place and scrutiny must be viewed as responsibility, rules of conduct and based decisions that have considered and wider societal parameters. may help or inhibit the spread of an an important tool in driving the division of labour.156 This requires the Coordination challenges have been 169 all options available. Multiple agent. The strength of public health performance of strategic leaders. The Operations Department of navigation of various fault lines. It is evident throughout COVID-19, communication channels are also laws, such as the International Health Munich Police, for example, set about organising and safeguarding which has, in the view of some, The ability to create public confidence essential to engage vulnerable and Regulations (2005) of the WHO,165,166 up the Coronavirus Control Group collaborative processes within exposed a striking absence of in the new status quo can make the hard-to-reach groups. Only then can 161 public health infrastructure and with the aim of ensuring the networks of actors involved in crisis leadership in biosecurity. This has difference between life and death, the benefits of press releases, formal capacity of public health systems can continuity of smooth operations. response and/or recovery. It ranges created additional challenges for city breakdown and resilience.170 Owning statements and campaigns, which translate into social impacts that are It was a point of contact for any from the sharing of information to the leaders in translating grand strategy, the narrative and delivering this are inevitably broadcast through further influenced by the underlying questions on procedures relating to far-reaching integration of operations legislation and direction into tangible effectively to a range of audiences mainstream media, truly health and demographics of the COVID-19 infections, measures and in pursuit of defined strategic and meaningful actions at a local- with widely differing needs, views and be harnessed. targeted or affected populations. operational regulations. It served objectives.157 Delivering effective level in terms of preparedness and frames of reference is fundamental. This is mirrored at a national level Failure to communicate clearly, as a coordinating and information- strategy is about resolving the response. Few, if any, governments Communications must be evidence- through ensuring appropriate whether that failure is real or gathering unit and a reporting tension between foresight and were fully prepared, and COVID-19 based, rationalised and justified legislation, services and pathways perceived, can cause overwhelming mechanism for cases of COVID-19 inherent uncertainty.158 has illuminated significant local, when held to account in a public for decision-making and governance. levels of scrutiny and dissatisfaction for colleagues within Munich Police.

36 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 37 4 Enhancing Preparedness for Bioterrorism continued

Organisations needed to invoke response. The importance of Pooled expertise, The response to COVID-19 has been It is reasonable to anticipate similar ethical (PLANE) approach towards business continuity plans, enhancing and maintaining links resources and data-driven on many levels, which factors in the context of bioterrorism, decisions and actions builds a strong coordinating structures and between local and national structures required large amounts of information albeit in an intensified and more foundation for justification. mechanisms for ensuring staff must not be understated. In the infrastructure can be collation and coordination to inform sensitive form. welfare. In Barcelona, the Fire response to COVID-19 this has effective at all levels. priorities and approaches. COVID-19 Decision-making is based on multiple Prevention, Extinction and Rescue been key, as it would in response This requires an open, is a case in point where the Decision-making in this context factors including the information Service included the development of to bioterrorism. The biosecurity honest and comprehensive necessary information and data was can be difficult, not least because available; impact and scale of new operational procedures and enterprise is the whole combination not always available to authorities (at decisions are multi-dimensional; the crisis; legislation and plans in review of national and they are likely to contain dilemmas place; as well as the knowledge a training programme for all staff of systems at every level of local structures and how least at the beginning of the crisis), on biothreats. government and the private sector creating an evidence gap. This is that can only be resolved through and experience of decision-makers that contribute to protecting nations, they interrelate, alongside the zone of greatest uncertainty for trade-offs; involve scarce and themselves. It follows that strategic All these considerations unequivocally cities, and their citizens. investment in planning, decision-makers.177 critical resources; and they come decisions may be driven by law apply to bioterrorism, which would training, arrangements with major uncertainties and and available data. This highlights 179 have the added complications of Biosecurity should include bio- and associated COVID-19 has caused crises within a potential implications. In short, the importance of structures and time-critical and sensitive counter surveillance and fusion centres at crisis. Recognising impending crises they are high pressure and high mechanisms that facilitate shared terrorism operations alongside the both national and local levels. These infrastructure. is what political leaders, policymakers consequence, further influenced situational awareness in order to increased psychological impact upon are composed of multi-disciplinary and their systems are expected to by the peripheral psychological inform vision, strategy, actions society that emerges with malicious teams that bring together security This would necessitate the do. Separating signals from noise pressures of conformity, groupthink and ownership. acts. This demonstrates the need to and public health responses by comparative development of logistical and translating these into tangible and confirmation bias that add ensure that public health and counter building teams of synthetic biologists, support and operational capability. priorities is, however, a challenge.178 layers of nuance and can derail terrorism messaging can align. biotechnology experts, infectious It is also subject to circumstance, direction without careful processing. disease experts, public health If leaders have the structures in including the speed of the situation, Jointly following decision-making National arrangements and experts, intelligence experts and place that enable them to understand level of credible information available models and taking a proportionate, communications impact upon counter terrorism experts. They quickly and fully the causes, and capacity to manage the process. legal, accountable, necessary and leadership at regional, local or should also include law enforcement, characteristics and consequences organisational levels, where leaders civil protection and operations of an unfolding crisis, they are more must operate within a more granular experts as well as suitably trained likely to reduce its impact. This has context in order to protect the urban and transport planners. As two components: detection (of public, uphold the law, deliver critical biothreats are spread by people in emerging threats and vulnerabilities) services and manage socio-economic and understanding (of an unfolding The “Evidence Gap” in Crisis Management principally urban areas, this additional 176 consequences. The layers of logistical expertise is essential to crisis). The extraction, management governance, infrastructure, systems working out how to enable necessary, and distilling of information is, of and services that are intertwined and reduce unnecessary, movement course, a significant challenge that is create a nexus of interdependence, of people and goods. intensified in dynamic, complex and Demand for information and pace of decision making just as they do at national and time-constrained situations such as Supply of reliable information international levels. Although the It is likely that government biosecurity terrorism or bioterrorism. response to a biothreat requires centres at all levels would be centralised coordination, public health modelled after fusion centres such and security cannot be achieved at as the UK Joint Terrorism Analysis one level alone. It requires cross- Centre (JTAC), which “fuses” the sector and multi-agency engagement combined efforts across different at all levels; the participation agencies.172,173,174 The UK government and discipline of communities, recently established the Joint businesses and service providers; Biosecurity Centre, which modelled as well as the collective capacities itself using these principles. of leadership, communications and Activity and Demand law enforcement. National direction This is key to effectively achieving requires local implementation situational awareness (the state of and local operations, or city-level individual and/or collective knowledge complexities, may require national relating to past and current events, escalation and support. their implications and potential future developments)175 and responding Ensuring connectivity and alignment to bioterrorism. It also enables between cities, regional authorities joint planning to drive a collective Time and central government is critical approach towards preparedness for a proactive and complementary and strategic decision-making.

38 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 39 4 Enhancing Preparedness for Bioterrorism continued

The CTPN report on strategic priorities in terms of developing coordination offered a deeper dive preparedness; and a culture of into these considerations, noting the trust and inclusivity. importance of networks, structures and mechanisms. It highlighted the ways in which strategic leadership The importance of is particularly important in crisis partnership working at management to navigate inherently strategic, tactical and unpredictable, complex and high- operational levels cannot impact situations and requires the be underestimated. disciplined calculation of overarching objectives, concepts and resources It is the bond that turns within acceptable bounds of risk.180 plans into practice.

In the context of bioterrorism, the This provides a segue into the speed at which this needs to be next section on multi-agency applied would be increased. preparedness and public health, It further identified that the success where the direction of political and of strategic coordination was often strategic leaders is also necessary influenced by the level of investment to progress this agenda. in associated infrastructure; planning, training and exercising; full capability assessments that informed strategic

Political and Strategic Leadership

Specialist / Technical Political or Political Priorities Media Advisors Strategic Leader

Strategic Coordination Structures

Specialist Analysis Information / Data Collation and Analysis

Counter Public Mortality Multi-agency Specialist Terrorism Communications Operations Health Management operations sub-groups and Security

40 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 41 4 Enhancing Preparedness for Bioterrorism continued

CASE STUDY Montreal’s Counter Terrorism Advisory Committee

Montreal’s Counter Terrorism Advisory Committee, led by Montreal Police, regularly brings together senior stakeholders from across the police services, emergency medical services, fire department, armed forces, hospitals and public health, as well as transport. Due to the sensitive and strategic nature of the information shared, every member of the committee goes through a security screening process.

The objectives of the group are underpinned by a • To establish and maintain strong working relationships three-year action plan, which is reported against annually and a reliable network that facilitates the exchange of through members’ respective chains of command. information; provides clarity on partners’ responsibilities and area of expertise; and increases collective capacity The objectives are: to purchase equipment;

• To enhance the operational preparedness of agencies • To organise both table-top and full-scale simulation in relation to terrorist threats, including the development exercises to validate protocols, capabilities and of protocols, response capabilities and procedures, as interoperability against different scenarios. This is to well as a joined-up approach towards understanding enable the identification of operational thresholds threat levels and field work; (e.g. human resources, equipment and capabilities etc.) in order to recognise challenges and find solutions.

Multi-Agency Preparedness This ranges from ensuring appropriate Planning should also account for the and Public Health coordination arrangements, plans release of bioagents within health Cross-sector and multi-agency and procedures, resources and facilities or hospitals, which could preparedness underpins the response specialist equipment (e.g. detection, significantly impede the response to and recovery from any emergency identification and monitoring devices and result in more casualties, or crisis including pandemics or and decontamination units), as fatalities and disruption. bioterrorism. It is key to delivering well as training and exercising for CBRN(e) planning and, in the context on, and achieving, directions from responders at all levels (operational, of this report, specifically planning political and strategic leaders. tactical and strategic). This may also include greater cooperation in for weaponised bioagents, needs detection and intelligence activities, to be enhanced. This demands a A cooperative and multi- law enforcement, increased security detailed approach to understand the disciplinary approach measures and integrated efforts to impacts of various bioagents and how they may play out in different that is informed by a counter terrorism, as well as the associated CBRN(e) threats. environments. This is necessary well-established layered to grasp the sometimes-subtle risk assessment and CBRN(e) planning is common at differences in response requirements. management structures international, national and local This involves the application towards countering levels. However, there is a pressing of lessons from COVID-19 in biothreats and events need to increase understanding of combination with evidenced-based the implications and consequences research and testing of bioagents is needed to strengthen of a bio-attack to inform planning to develop the planning process 181 biosecurity operations. and mitigation measures, response and operational capabilities. structures and arrangements, as well as longer-term recovery.

42 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 43 4 Enhancing Preparedness for Bioterrorism continued

The following two points are, and antivirals. The need to erect The national CBRN(e) response unit Overarching Components of Bioterrorism Preparedness therefore, key: and resource additional temporary in the Netherlands, for example, facilities (such as field hospitals and also includes mobile – and therefore • Health promotion and health mortuaries) and procure personal deployable – laboratories for protection go hand-in-hand. S PU protective equipment has provided terrorist attacks. This is for the ON BL I IC AT Ongoing actions to improve the R FA further challenges. It is far more analysis of objects suspected of E C P Public Health Clear I health of any given population and O N difficult to react in a time-pressured, containing chemical and/or biological / infrastructure communications G S P to strengthen the national health M and capacity R politically sensitive environment substances and is of biosafety E O T V S Social and and social care system will Continuity of critical IS against a backdrop of significant level three specification. The unit Y economic support I S O infrastructure and services decrease the impact of any Y N global demand than it is to respond is completely self-supporting and T S 184 I Protective security Containment biothreats that materialise. C by design and measures and with proportionate and appropriate integrates different disciplines, integration of industry enforcement preparedness measures in place. enabling significant time-savings to • Ensuring robust and resilient Influencing community Humanitarian be made in the analysis of an agent. behaviours through assistance healthcare services, hospital and This takes into account the fact that spatial planning laboratory networks has the dual optimal public health is unrealistic, and Infrastructure is the foundation for benefits of readiness in the face communities cannot be vaccinated planning, delivering, evaluating and of malicious bio-attacks while against everything. Robust readiness improving public health. This has Health and social care Intelligence and ensuring an ability to respond to facilities and services threat analysis in healthcare structures, capability, been evidenced by a wide range of naturally occurring diseases. capacity and wider societal systems disparities in health outcomes, raising Resources, training Early warning systems and equipment of Y and verification T is fundamental to responding serious questions around health M emergency services I Preparedness must therefore drive U R 185,186,187,188 L Information, data U successfully to biothreats, whether equality. The success of T PPE, detection and C the public health agenda and I - and needs assessments E A decontamination S natural or malicious, as well as wider public health critically depends on G incentivise investment in equal E & N Mortality management Specialist response M demands. Like the need to enhance the level of cooperation, coordination C S access to healthcare. COVID-19 Y capability and capacity and investigations I R CBRN(e) planning noted above, there and investment at the local and C O A R has shown that the people who 189 PA R is a clear need to enhance pandemic national levels, as well as by B TE IL have been hit the hardest are those IT ER IE T planning. The two, in terms of public authorities and communities S UN with underlying health conditions. CO biothreats, should be hand-in-glove. themselves. It further relies upon Likewise, it has demonstrated that This should include detail such as the interoperability and early-warning highly specialist health capabilities mapping of hospital and laboratory mechanisms. The early identification are required, including epidemiology networks as well as specialist and assessment of outbreaks with and microbiology capabilities in order Developing integrated and wider This means highly functioning, resources in order to understand informed public health assessments Building frameworks that to identify, characterise and respond consequence-based planning and prepared and responsive public system capacity and to identify gaps. and modelling that quickly harnesses bring together counter to the disease; bespoke hospital and arrangements would take this further, health systems coupled with healthy, science, data, experience and terrorism and public health 182 intensive care units to treat patients; as would considering different highly vaccinated communities. Specialist CBRN(e) capabilities are expertise through embedded systems surge capacity in terms of the wider structures with those of scenarios and driving these through COVID-19 has demonstrated available to varying degrees nationally and ways of working can provide a health system, including the delivery urban planning and city a comprehensive multi-agency table- how this demands scrutiny and or within the emergency services. central mechanism to fast-track an of care in the community; and the top and live exercise programme that investment at both national and appropriate response. A bioterrorism operations would develop development of vaccines understanding of the bio- incorporates all relevant elements of, local levels. Indeed, public health response strategy is therefore critical. preparedness puzzle that and stakeholders for, a bioterrorism systems cannot predict which virus and public health response. they will be contending with next needs to connect. and it isn’t possible to vaccinate The fact that there may be limited against all biothreats. The public environment in which prospect of detecting a weaponised biothreats manifest and spread is also bioagent until it has been used in an If, however, developed public a matter for the design and operation attack underscores the importance health infrastructure supports of infrastructure and other operational of planning, training and exercising capacities to prevent disease, systems. The bodies and people in preparation as well as intelligence- promote health and prepare for responsible for these (e.g. transport based operational work in prevention. crisis, it follows that insufficient authorities) need to be integrated public health infrastructure, including Intelligence, counter terrorism and into discussions of public health and healthcare insurance, coupled law enforcement are critical in security. They are key to reducing with the pre-existing conditions prevention, deterrence and bringing transmission; a pathogen travels of communities, can also make offenders to justice. In terms of 183 faster on a bus than on its own. for worse outcomes. societal preparedness, however, one of the best defences against biothreats is public health.

44 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 45 4 Enhancing Preparedness for Bioterrorism continued

CASE STUDY CASE STUDY Bioterrorism Response Strategy Intelligence and Early Warning in Boston

Most cities have some form of CBRN(e) strategic response plan in place, The Boston Regional Intelligence Center is a major fusion which sets out the command and control structures, response framework centre, managed by Boston Police Department and staffed by and levels of specialist and technical support available, as well as the role and sworn investigators, civilian intelligence analysts and liaisons responsibilities of responding agencies. from close partner agencies.

The City of Boston’s strategy includes stakeholders and acquiring pharmaceuticals or supplies of Its mission is to reduce crime and prevent acts of from all levels of government (local, state and federal) protective equipment that become recommended terrorism by serving as the central point for the collection, and leans heavily on the expertise and responsibilities for CBRN(e) incidents. synthesis, analysis and dissemination of strategic and of public health, emergency services, law enforcement tactical intelligence to law enforcement, intelligence, first and intelligence agencies. In response to COVID-19, partners across Greater responder and private sector partners, and to assist the Manchester came together to support communities and federal government as a partner for national security. Coordination for the city strategy falls under the businesses during a complex, sustained and systemic responsibility of Boston’s Office of Emergency emergency. The city provided a system-wide, multi- Liaisons include a medical intelligence analyst who Management, managed through subcommittees. agency response that is transferrable to other biothreats. has access to the electronic patient care reporting Funding is supported by the Department of Homeland This included: system, which allows them to monitor unusual spikes in Security and its Urban Areas Security Initiative. symptoms and notify public safety partners of important The medical surge subcommittee agreed that • The collation, analysis and dissemination of complex trends. The medical intelligence analyst is responsible sustained investment in dedicated first responder data and intelligence, coordinated via a multi-agency for liaising with the broader public health community pharmaceutical stockpiles (antivirals and antibiotics, data and intelligence cell, to support decision-making; and representing the centre in stakeholder groups and public safety networks responsible for informing and not vaccines) was essential. Sustaining this cache • Clear political leadership via the COVID-19 Emergency coordinating the city’s response to CBRN(e) agents was considered vital to the region’s state of Committee, which included the 10 Greater Manchester and other health security threats. preparedness and response operations. political leaders and the Greater Manchester Mayor; Intelligence and early-warning systems are paramount air-monitoring collectors strategically placed throughout Boston Emergency Medical Service established a • The use of a multi-agency communications cell to to an effective bioterrorism response. The City of Boston the city. Air samples are routinely processed and analysed protocol that allowed for the timely delivery of supplies communicate with the public; to partners immediately following an incident. This also partners with the Department of Homeland Security’s by technicians for evidence of bioagents. If a biothreat project sustains the level of supplies, allowing for the • The provision of advice coordinated via a scientific and (DHS) Countering Weapons of Mass Destruction Office, is identified in an air sample, a notification system will procurement of any pharmaceuticals that will expire technical advice cell to help determine risks to public among other federal partners. This is to detect, analyse, alert local, state and federal subject-matter experts and health and outline potential mitigation measures. investigate and mitigate the effects of biothreats through leadership, who will analyse the threat and evaluate the participation in the BioWatch Programme. BioWatch is risk to the community. Boston’s BioWatch programme managed by DHS, supported by other federal agencies has included a variety of training and exercises to improve and operated by a network of scientists, laboratory plans and procedures related to bioterrorism. technicians, emergency managers, law enforcement officers and public health officials. DHS also funded the Securing the Cities Programme that sought to reduce the risk of a successful deployment The combination of detection, rapid notification, of a radiological/nuclear terrorist weapon against a major preparedness and planning helps local, state and federal metropolitan area in the United States by establishing decision-makers take steps to save lives and mitigate sustainable capabilities to detect, analyse, and report damage. The programme provides early warning through nuclear and other radioactive materials.190,191 accurate detection of biothreats via a network of A similar approach could be applied to biothreats.

46 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 47 4 Enhancing Preparedness for Bioterrorism continued

Interoperability between security some commentators and spread among people. This can and public health is critical to have gone as far subsequently inform multi-agency CASE STUDY managing biothreats. Often arrangements as well as city planning operating at local, regional and as recommending and policy, which should integrate Clean Active Ventilation Environment national levels, healthcare providers that governments industry into the development of have a key role in treatment, reclassify pandemic counter-measures and prevention preservation of life and navigating countermeasures as solutions. An example would be the psychosocial impacts upon a matter of national to review technological solutions The CAVE (Clean Active Ventilation Environment) facility is being designed, individuals. State regulation over security in order to such as dry hydrogen peroxide, health is needed to strengthen supply which could dramatically reduce the in response to COVID-19, as a specialised large and controlled interior chains and/or domestic infrastructure enable investment in spread of pathogens in enclosed space in which the effect of air handling on people’s health and wellbeing 192 at all levels (for protective equipment collective biosecurity. facilities. Dry hydrogen peroxide can can be studied. and medical supplies etc.), as well be extremely effective in microbial as the flexibility in capacity and When the similarities in consequence reduction by diffusing through the air. Hosted by University College London to complement expertise to rapidly scale up the management for pandemics and its PEARL (Person-Environment-Activity Research development of state-sponsored bioterrorism are considered, in This should further incorporate Laboratory) initiative, CAVE can directly measure aspects (rather than market-driven) vaccines. many ways this makes sense. In a investment in and support for of air quality; the presence and movement of viruses and This, of course, opens the debate very real way, end-to-end sovereign scientifically based research, the other small particles within the airstream; the effects on on the costly stockpiling and vaccine manufacture has featured in development and delivery of training people of different ventilation strategies; and the effects storage of supplies versus the risk discussions around the COVID-19 and a coordinated approach at all on people of different room shapes, door and window of ordering supplies as required. vaccine and relations between the levels. It follows that collaboration locations and presence or absence of interrupters to air EU and the UK, following the end between public health and local flow (such as internal barriers or objects within the space) Either way, ensuring health is of the Brexit transition period. authority partners also needs to be centrally regulated, funded and amplified. COVID-19 offers a platform that may influence the movement of air. coordinated would also reduce the Experience shows that the label to identify how healthcare systems CAVE is being equipped to study the interactions risk of counterfeit medicine, test attributed to a crisis (e.g. pandemic and the delivery of health and social between exterior and interior environments and can kits and supplies, which intensify or terrorism) normally decides the care services can be improved. reconstruct a wide range of life-size interior spaces, such pharmaceutical and supply chain responsibility for, and therefore It provides stimulus to reconsider as a communal office or waiting room, a clinical surgery, vulnerability. It is worth mentioning the shape of, any given response. shared preparedness measures, such a stairwell or corridor, an airport security channel, public that poorer nations and states may However, both pandemics and as supplies of protective equipment, transport, terraced housing and a theatre or venue etc. not have the funding to develop bioterrorism can have vast and and practices to enhance joint The facility offers the versatility and ability to separate their own treatments or vaccines. overlapping response and public operational approaches when the This could include benign viruses or bioagents in and independently control internal and external climatic Instead, they might have to wait for health implications. They also system is under significant pressure. order to gain a deeper understanding that informs conditions, including temperature and humidity; direction generics to be available, the cost of have extensive implications for preparedness for naturally occurring diseases and volume of air movement within the interior space (for branded products to fall or donor infrastructure design and city This is, of course, non-exhaustive and bioterrorism (note: the CAVE will include a example ceiling-to-floor, floor-to-ceiling, laterally through organisations (such as the WHO) operations. Therefore, pooling and subject to arrangements within sample handling, preparation and containerisation different vents, windows or doors, or combinations of to provide supplies. Even within approaches, where feasible, for the host country, region and city. space, which will be at category biosafety level one these); simulation of external environmental conditions developed countries or cities there preparedness and biosecurity would It is also subject to a local analysis incorporating a level two cabinet); (not including direct wind effects); and the variable can be a disproportionality of access enable the consideration of a more of what worked during COVID-19 filtration of air supply and recirculation. • The responses of people to the different conditions to care or vaccines when offered, collaborative and comprehensive and what did not, as well as consultation with the relevant public and constraints being applied, including factors such with indications of initial lower uptake approach. This is a key point because CAVE is expected to open towards the end of 2021 to health leaders and subject-matter as the ingress of smoke or gases. The facilitation of in some of the more deprived areas efficiencies may also be created enable the assessment of: experts. It is clear, however, that a different “rules of engagement” (for example, direction and in some minority groups. This to offset investments. This goes of movement or physical distancing). Using advanced full review of infrastructure, systems • The movement, resilience and viability of pathogens expands the inequalities mentioned beyond security and public health, physiological measures, this would support analyses and services is necessary in order within the space under different conditions, including previously and could fuel the demanding input and expertise from of behavioural tendencies to inform decisions on the far-right agenda. wider partners and academia. to enhance public health capacity the collection of samples for subsequent analysis. and achieve a fuller understanding design and operation of internal public spaces. Conversely, the vaccine-production Preparedness must embrace existing of how it would cope with any future process may also create a strategic and potential opportunities to pandemic or bio-attack. Public health national security advantage for collaborate and better understand and security will be the locus of a those that develop it first. It is no biothreats. This includes a deeper bioterrorism response, which spans surprise, therefore, that analysis of how pathogens or agents responsibilities at national, city and move, react on different surfaces local levels.

48 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 49 4 Enhancing Preparedness for Bioterrorism continued

There are many stakeholders in This increases the likelihood of The United Nations report on making Informing and Influencing has in the organisations advising they are from another person in resilience and preparedness. They systemic disruptions and their scale, critical infrastructure resilient takes Community Behaviours them what to do. social terms, hence the difficulty 196 interact with each other and are intensity and duration. This highlights this further. Societies, public health organisations in maintaining the desired physical This has most recently been mutually interdependent. Government the need to think carefully about and institutions constantly seek distance. Add in layers of constantly This is about taking a long-term witnessed in the response to functions may operate at a national properly maintaining, repairing and new ways to reduce exposure to changing directives, narratives, mixed and holistic view of preparedness. COVID-19, where behaviour level (e.g. defence and security) enhancing city infrastructure so that biothreats. In the UK, well-known messaging and group dynamics, This means thinking about how the change through social distancing but others may be delivered locally it operates appropriately and communication campaigns such as perceptions of risk can quickly world will be in 10–20 years and and other interventions such as (e.g. policing) or may rely on local smoothly with the people who use “Catch It, Bin It, Kill It”, and recently become misinformed and diluted. 195 beyond, and what this will mean for isolation have come with huge cost authorities to supplement them. it under adverse circumstances. “Hands, Face, Space” or “Stay people and the cities in which they to individuals and societies.198,199 Perceptions of risk and crises Some public services are both Home, Protect the NHS, Save Lives” live and work – not just in terms The application of the Behaviour are subject to culture and can be national and local (the UK’s National have sought to highlight risks and The development of of modernisation and managing Change Wheel has been used to distorted by a range of psychological Health Service is one) and others influence public behaviour. Combined population growth, but also in terms identify options to promote social predispositions and cognitive biases have policy set at a national level appropriate infrastructure with signs, barriers and protective of protecting against a range of risks distancing and shielding of vulnerable that influence how people think and but with most of delivery being that is future-proof must equipment at a street level, these and threats. Investing in appropriate people, including use of education, behave in different situations. This decentralised. Then, from a essentially become behaviour- become part of the infrastructure that is future-proof; persuasion, incentivisation, distortion is fuelled by a phenomenon counter terrorism perspective, modification programmes with an preparedness agenda. enhancing the resources and coercion and enablement.200 called “availability bias”, whereby there may be local, national and emphasis on hygiene and sanitation. international structures.193 Not only will it contribute capabilities of emergency services; Influencing behaviour, however, has examples of things that come to city operations and and starting to shift the frame Mechanisms of management proved difficult in practice. “Social readily to mind are considered more Major infrastructure services are economic prosperity, within which communities view can range from hand-washing to distancing”, for example has been representative than is actually the also of note. Transport, water and but it also has the threats in order to positively influence highly complex vaccines, medical a contradiction in terms. Whereas case. This means, however, that it energy may be delivered by private behaviour are fundamental. The treatments, protective clothing physical distancing means staying a can also cause complacency through entities but are subject to varying potential to significantly future has already arrived and cities minimum distance away from other the “It won’t happen to me” mindset. reduce the impact of a and environmental (air and water) degrees of regulation. Other public across the world risk falling behind filtering,197 but their success often people, social distancing implies Another source is “optimism bias”, necessities like food retail are entirely range of risks and threats, a dangerous curve. hinges on changing how populations that people can still come together. which is the tendency to regard commercial, with some regulations including public health perceive the risk, behave in response If these are confused in their use ourselves as more capable than set nationally but enforced locally. crisis and bioterrorism. and subsequently interact with their by officialdom, this extends to the we are and therefore, to be overly All these infrastructure services are environment. It also relates back to public. People instinctively (and confident in our ability to cope if characterised by their interface with the degree of confidence the public subconsciously) judge the distance the risk does materialise. the general public – both collectively and individually. A holistic view of this landscape is necessary to understand linkages, set priorities for action and enhance preparedness. This would in turn inform policy and arrangements at all levels and reduce the likelihood of failures and crises being propagated from one domain to another with unexpected consequences.194

It is already accepted that, in some cases, cities are working within systems and structures that are degenerative or operating beyond their design thresholds.

50 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 51 4 Enhancing Preparedness for Bioterrorism continued

Further is “prevent bias”, which This may be exacerbated in the as foundations of effective national makes it harder to form sound context of bioterrorism. Exposure security. Risk perceptions influence judgements about how much effort or perceived exposure to bioagents, the psychological and behavioural to invest in preventing or preparing or any CBRN(e) agents, is responses that impact the health, for any given crisis. psychologically demanding because social and economic impacts of it’s involuntary and unfamiliar and extreme events. Some behaviours, This relates to the inability to has unknown health effects. In such as the adoption of hand- and understand how risk accumulates general, the long-term implications respiratory-hygiene advice during over time as people repeatedly for children and future generations an infectious disease outbreak expose themselves to the same may also be unknown, which like COVID-19, will only have a relatively small risk. For example, increases public fear and anxiety. minor impact on day-to-day life. the risk of dying in a single car Others have the potential to have journey or from smoking a single powerful negative impacts. If a cigarette is tiny, but the cumulative It is recognised that small percentage of the population risk from a lifetime of car journeys or CBRN(e) agents can change their behaviour(s) this can 201 smoking is surprisingly large. This cause death and injury shift the demands on the system is demonstrated further by insufficient in quite a large way. This highlights preparedness for COVID-19, or the in strange and prolonged ways,203 and the the need for the development of snowballing climate change crisis, resilient, adaptable response plans and translates to terrorism through psychosocial and procedures built upon a strong the layers of political instability, implications of this understanding of the relationship polarised ideologies, conflict and cannot be overstated. between risk communication, inequality that manifest globally. perception and behaviour.204 Enabling active contributions from The public behavioural response to Risk communication, perception and communities should be part of this. extreme events is often mixed.202 behaviour have been emphasised

Behaviour Change Wheel

Envi es ron lin Soci m de al P en ui la ta G n l ni / Educa n ons tion g cti tri es R P e C rs s l u o a O a e g m r t P s n in Y P i M u e r IT O o m s u L R n a m t I a T r u n c B Physical U k n e o u A r r N e i P i

t c M n v A I t

s T

l n o i a C i

e Social Y n a E t t

R g

i a

c

o

s

s i n

i Psychological Physical

v

i

F

t / M Reflective n

o e

d c

e n l I l i n g Automatic

n R io e rc g E e n u n MO N o io ab TIVATIO C t la l a t em l io ent is n Training g Le

S ervice Provision

52 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 53 4 Enhancing Preparedness for Bioterrorism continued

To change The role of the public as both a Communicable diseases spread Taking a progressive and innovative approach Three headline areas are proposed: target for terrorism and as an actor because of specific interactions towards informing and influencing community 1) shifting the public perception of risk; perceptions of in emergency management is between hosts (the victims), agents behaviour is necessary against the backdrop 2) developing city infrastructure; risk and influence particularly relevant in the context (the diseases) and the environment of population growth, urbanisation and the 3) urban design and spatial planning. of bioterrorism and wider CBRN(e) (the conditions that affect the potency evolving threat landscape. public behaviour, terrorism. In this respect it has been of the disease, the ability to fight it awareness and shown how counter terrorism policies and the routes by which diseases are need to include measures that maintained and transmitted among understanding educate and improve the resilience victims).206 This would also apply to COVID-19 must serve as a springboard Risk communication by public authorities need to be raised of societies and communities in a number of weaponised bioagents. 1 to create the social structures and fabric before, during and after such crises may order to enable them to respond and that support a collective mindset of health significantly influence their impact. Well- and consequences adapt in instances where preventative and security. Enabling understanding and designed and well-timed messages can realised to infiltrate measures fail to stop an attack.205 By designing city spaces, influencing the perception of risk through reduce the uncertainties surrounding the enhancing infrastructure the collective muscle Mindsets need to be shifted towards widespread public awareness, education nature, exposure and consequences of personal security, health and hygiene, and integrating and communication campaigns, as well particular agents, as well as provide effective memory of society. which can be influenced not only technological solutions, as innovative mechanisms for warning and behavioural guidance to the public.207 This is by communications but also the behaviours and informing (for example, signage, mobile not about designing a culture of security- and through urban design. actions of individuals apps, alerting systems and online health-conscious behaviours, rather it’s about and societies could be platforms) are key. proactively providing a framework through 208 influenced to reduce the which such a culture can emerge. spread of biothreats.

Developing city infrastructure can assist threat, as well as the likelihood of a pathogen 2 in future-proofing urban environments by spreading between individuals. serving as force multipliers in terms of city resilience and reducing the impact of Ticketless services/barriers, for example, biothreats. Consider modern air-conditioning are significant because they affect the speed systems that enable the control and filtering at which people can move through an area, of airflow to improve air movement and thus reducing density. Such solutions can quality; non-touch facilities (for example be integrated into the implementation of lavatories, basins and automated doors) to long-term transport infrastructure strategies improve hygiene and sanitation; design of for both transport hubs and the 209 functional systems, and the incorporation of transportation network itself. These technology such as automated barriers in types of developments have the potential busy urban areas (such as transport hubs) to to reduce multiple threats while enhancing reduce crowds and the associated terrorist city operations through the upgrading of infrastructure.

Urban design and spatial planning can These dynamics are interconnected with 3 complement this further. By understanding several other fields, including engineering, how individuals interact with their architecture and sociopsychology, and environment and each other, and how are becoming increasingly prominent pedestrians are likely to move through city factors in city security. Understanding the spaces, the risks associated with densely psychosocial and institutional factors that populated and high-footfall areas (both as explain emotional, cognitive and behavioural targets for terrorism and as vectors for the responses to biothreats and attacks is spread of bioagents) can be reduced. essential to enhancing the resilience of the public against bioterrorism.210

54 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 55 4 Enhancing Preparedness for Bioterrorism continued

Employing evidence-based methods Such approaches can Understanding how individuals CASE STUDY to influence urban design and spatial also align with the smart interact with their environments, planning needs to go far beyond the group dynamics and, by extension, Person Environment Activity Research Laboratory traditional approaches of security cities agenda by seeking public behaviours, city systems by design or the management of to integrate technology can be adapted and designed in crowds (in which the density of with infrastructure and such a way that significantly builds people is assumed to be high enough spatial planning in such a resilience. A deeper understanding PEARL (Person-Environment-Activity Research Laboratory) is located at to cause continuous interactions, or of how bioagents move in different 211 way that could reduce the reactions, with other individuals) spread and transmission environments and contexts, are University College London and enables the detailed research of how people in a busy city centre. Rather it transmitted among people and interact with their environment. It is a multisensory facility in which any given should be understood as influencing of a biothreat. evolve over time can also be applied physical environment (such as an underground station or busy urban area) public behaviour through innovative in such a way that informs the urban design and spatial planning Cities that develop strategic development of infrastructure, city can be reconstructed inside the building as required. that incorporates the analyses of arrangements and explore policy spaces and how public behaviour individual and crowd interactions design and implementation in an is influenced. This must be done The walls of PEARL are pierced with 175 million tiny only facility in the world designed specifically to do this and movements with the disciplines integrated manner can use this as a in tandem with investments holes to reduce the average reverberation time to at life scale. of neuroscience, sociopsychology, lever in developing resilience against in leadership, multi-agency less than one second. This enables the creation of terrorism and public health crises. This enables the analysis of people’s responses using public health and protective security. preparedness and public health. soundscapes ranging from a quiet rural or urban space This is a core principle of the Counter a range of sensors. These include tracking of eyes The principle here is that at night to a rock concert, an aircraft taking off nearby Terrorism Preparedness Network. or an explosion. and neurological processes, electrodermal activity sensors, heart-rate monitors, oxygen-use monitors the holistic modelling In this respect, otherwise costly It has an advanced lighting and sound system that can and physical motion. of urban spaces can security measures are more simulate different scenes or environments. The smoke financially viable and seen as an The findings can subsequently inform the design and influence individual and system allows visibility to be altered to replicate fog or investment if they are embedded implementation of infrastructure systems in and between smoke; the configurable floor can be set up with different crowd movements and into longer-term strategies, such as cities. They could also inform the decision-making and surfaces, gradients and topographies; and an olfaction subsequently add an those relating to the development responses of emergency services to a terrorist attack, system can reproduce environmental smells (including of infrastructure.214 Herein is the for example, and approaches taken towards influencing additional layer to increase cordite, burning flesh, wood smoke, coffee etc.). PEARL force multiplier effect, harnessed to both individual and community behaviours. safety and security. can replicate various environments and scenarios – the strike a healthy balance between The key is to create an environment safety, security and service as part that manages and channels people’s of long-term city development, choice of direction, actions and regeneration and resilience strategies. behaviours through its design and The importance of this approach aesthetic influence. It is about cannot be overstated. In a post- understanding how people think; the COVID environment, financial viability factors that influence their decisions; will underpin all investments. These and then identifying and creating security measures, therefore, must cues that will positively alter that be holistic and integrated to bring a process in order to dilute the risk or multitude of benefits. 212 impacts of any given threat. This is There is significant scope to done by minimising the numbers of streamline and enhance approaches people moving through an area at any and priorities at a city-policy level. one time (or identifying the optimal In order to make cities safer, city number of people that can move administrations need to adapt through an area at any one time rapidly to new developments in given the prevailing circumstances); order to respond better to current dispersing or diluting crowds to and future challenges. Harnessing reduce the density; and providing initiatives such as PEARL, can multiple points of access and egress inform approaches through 213 to increase flow. evidence-based research.

56 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 57

5 Conclusion

Never before The quote to the left, referring to It has been noted how the economic The state should also conduct In this respect, city administrations the wake of the Cold War, is just as and social instability arising from threat assessments and ensure and authorities wield significant has a new world true and relevant today. Beyond the COVID-19 has been capitalised the development of associated 1 influence. Cities have a duty to order had to be immediate human tragedy of the upon by terrorists of all forms, strategy222 that is subsequently prepare for crises, protect their COVID-19 pandemic, economies who have been able to recognise shared with relevant actors The need to understand causality citizens and safeguard their assembled from around the world have ground to a the destructive power that can be including city authorities. and consequence. Overall economies (they account for so many different halt, supply chains are destabilised wrought as a result of a global To be successful however, preparedness requires a holistic approximately 80% of global gross and the cost to governments, health emergency.218 view of how everything connects domestic product).226 Urbanisation perceptions, or businesses and taxpayers will be biosecurity strategy and interacts.225 This translates means that cities will continue to multiples of what preventive global The point, however, is not to overplay must be sure to to cities, which are themselves face significant challenges and on so global a the intent or capability of terrorists to systems of systems, as a public health policies would have integrate traditional may become more of a focal scale. Nor has any cost.216 Furthermore, the disruption develop bioweapons after COVID-19. precursor for city resilience. point for terrorist activity227 after threats with those previous order to routine public health programmes Bioterrorism is generally considered COVID-19. Cities must therefore (such as childhood vaccinations to be a relatively low-likelihood, posed by public health rethink how they plan, build and had to combine and water, sanitation and hygiene high-impact threat (i.e. a relatively crises, to avoid cracks 2 use their environment,228 and how programmes) could secondarily lead improbable event that could have emerging between two preparedness and capabilities can the attributes The need to incorporate the to otherwise avoidable harm in some a disproportionately large impact). governance systems.223 be enhanced. of the historic After all, biothreats are not new principles of public health, countries. The impact on international protective security and social security and terrorism is also evident and terrorists have simpler, more Counter terrorism in this context balance-of-power accessible options at their disposal. Although there are many overlaps psychology into the infrastructure demands the two-pronged approach but yet to be fully understood. development and regeneration between international, national and of security and development – one systems with global plans of cities. This report has brought together the However, bioterrorism has been local structures in both preparedness requires the other. A comprehensive democratic opinion natural phenomenon of COVID-19 recognised as a very real threat and response for public health crises approach towards security must be by international institutions and and bioterrorism, it follows that and the exploding with potential terrorist methodologies 3 accompanied by a developmental to consider how bioterrorism could intelligence networks, and is strategies are only worthwhile if they strategy that seeks to address technology of the materialise. Inspiration for attacks acknowledged within strategies are translated into meaningful actions political, economic and social and risk registers at all levels. and operationalised at the local level. The need for greater strategic contemporary period. often comes from what is viewed as and operational integration issues, both their root causes and Biothreats are becoming increasingly Prominence has been given to the effective and available. Therefore, this between public health, security system vulnerabilities. A flexible complicated and dangerous. This type of horizon scanning is critical if role of local multi-agency emergency- agencies and urban planning at and action-orientated approach, cities and authorities are to be ahead is coupled with the vulnerabilities planning apparatus on the basis that a city-level, coupled with health whereby disincentives for terrorism of the threat. illustrated by COVID-19 and global the response to, and recovery from, security intelligence arrangements (the rule of law) are combined with 215 Henry Kissinger strategic trends, which indicate that an emergency is carried out first and that incorporate effective early- social incentives (a life that’s worth Global strategic trends are pushing many nations and cities may not foremost at the local level. It has warning mechanisms. protecting), is also key to facilitating cities towards a significantly more be sufficiently equipped to handle been highlighted, however, that there change. In this sense, a core strength automated world, where new a bio-attack. can be distinctly uneven levels of of the city approach is the knowledge technologies are fusing the resilience and limited capacity across 4 and ability to reach and connect It is therefore necessary to strengthen 224 physical, digital and biological. different areas. preventive measures and organise a with local communities, as well as The cost of developing bioweapons The need to develop city- vulnerable or harder-to-reach groups. coordinated response to biothreats Therefore, it is important to is likely to fall and advances in level capabilities in support of and their impacts.219 It is the duty understand the vulnerabilities, genetics and biosciences have strategic leadership, multi-agency of the state and its authorities to interdependencies and gaps that arrangements and preparedness, increased the risk of their use do so as part of the social contract must be addressed locally, and as well as mechanisms to inform through new delivery mechanisms between the citizen and the state.220 how strategy can be translated into and influence public behaviours, that make detection hard.217 At the most strategic of levels this practice through a clear, action- particularly in times of crisis. must include the intensification of the orientated plan. Cities are critical global counter terrorism effort and building blocks for the successful consideration of how critical public implementation of grand strategy, health capabilities might be prepared highlighted by this report through and scaled up ahead of time.221 four overarching areas:

Bioterrorism: Applying the Lens of COVID-19 – Report 2021 59 5 Conclusion continued

Preparedness for public weaponised bioagents; reviewed the infrastructure, capacity and health crises will inevitably the threat of bioterrorism; analysed arrangements of cities to better the vulnerabilities demonstrated by prepare for and respond to such raise capabilities for COVID-19 and considered these in the future. To do so, cities must bioterrorism preparedness in the context of a bio-attack to reframe their approaches and and vice versa. propose a series of recommendations weave together initiatives that drive for city authorities. transformative change. This requires These threats must be considered consistent cross-sector partnerships Ultimately, the core challenge is and planned for in an integrated and at all levels, and a collaborative and whether allied networks of counter simultaneous manner. This principle action-orientated approach that terrorism, public health, urban is the foundation of this report. It has continually adapts to new realities. planning and resilience professionals explored the differences between The big risk for cities is not adapting, can intervene in terrorist efforts, 229 naturally occurring diseases and or not adapting fast enough. enhance security, and develop

The Bio-Preparedness Puzzle

STR T AT EN EG M IC ON L R EA VI D N E E R L S A H R IP U T & L L U E C G - I O S I L C A O T I S O

City Systems Public Health N

Preparedness

C Infrastructure Security O M

M S E U I N IT I C IL A B T A IO P N A S C A Y N C N D E B G EH -A A TI VIO UL UR M

© GLA

60 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 61 5 Conclusion continued

Recommendations National and local communication leads communication campaigns and Note: This is an international report designed for an It is also acknowledged that, at the time of publication, 7 should consider risk communication and mechanisms for warning and informing international audience. It is anticipated and accepted COVID-19 is ongoing, and the full extent of impacts and public advice during COVID-19 and how the public in the event of either public that different recommendations will apply to different implications are not yet fully realised. Therefore, these this was perceived. This is with a view to health crises or bioterrorism. cities and organisations subject to context, existing recommendations are non-exhaustive and further scrutiny integrating these lessons into arrangements and any public inquiries. and insight is required.

Cities should develop a high-level health, city operations and communication framework that consolidates and provides structures or mechanisms that need to Cities should consider commissioning or action plan to be overseen at a strategic 8 an overview of the counter terrorism, public connect to affect a bioterrorism response. 1 undertaking a review of city-system level. This should seek to identify and map vulnerabilities through a contextualised and system risks, pinch points or priority areas holistic analysis of interdependencies that that can feed into longer-term city enables the development of an integrated resilience and regeneration strategies. Cities should review and develop local especially in the context of bioterrorism, 9 CBRN(e) and pandemic plans to consider regarding water supplies (scenario of water and apply lessons from COVID-19 in the poisoning) and food retail/supermarkets Cities should harness the expertise and health considerations and protective context of bioterrorism and public health. (scenario of food poisoning) etc. should 2 facilities of academic partners to undertake security can be incorporated into city The importance of engaging and be noted. evidence-based research and exercises regeneration and infrastructure plans to cooperating with the private sector, that can inform city policy and urban build preparedness. design. These should include how public

Cities should review mass fatality and temporary field hospitals and mortuaries to excess deaths frameworks and capture the create scalable plans. Consider how these Cities should consider establishing bio-preparedness and inform decisions 10 operational procedures for establishing may apply in the context of bioterrorism. 3 multi-disciplinary teams that bring together and actions in response. agencies and specialists to drive

Public health and local authority partners and social care services and the availability Cities should review strategic mechanisms that may be required. 11 should consider opportunities to enhance of protective equipment, especially when 4 arrangements to incorporate local lessons Also consider reviewing the strategic healthcare systems, the delivery of health the system is under significant pressure. from COVID-19 and consider these in arrangements of cities/countries that the context of bioterrorism to inform any have performed relatively well during further structural developments or the pandemic. City administrations and lead agencies programme that incorporates all relevant 12 should ensure the delivery of a multi- elements of a bioterrorism response for all Cities should seek to enhance of preparedness, information sharing and agency table-top and live exercise levels (strategic, tactical, operational). 5 communication and collaboration channels response structures. This can vary greatly between local and national levels in terms from country to country and city to city.

Cities should continue to share lessons, infrastructure that will build city-level Cities should connect with national to include processes for joint public health 13 experiences and practices via existing preparedness and resilience to public 6 colleagues to review strategic and counter terrorism messaging. networks in order to inform the health crises and bioterrorism. communication plans and mechanisms development of arrangements and

62 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 63 6 References

1. United Nations (2020). ‘COVID-19 Threatening Global Peace 23. Coppola, D. (2015). International Disaster Management 41. Joint Committee on the National Security Strategy (2020). 63. Beeching, N., Dance, D., Miller, A. (2002). ‘Biological Warfare and Security, UN Chief Warns’. (Accessed online.) (Oxford: Elsevier, 2015), p. 93. ‘Bio-Security and National Security, First Report of Session and Bioterrorism’, Clinical Review, BMJ 324, pp. 337-338. 2019-21’, House of Commons, p. 46. (Accessed online.) 2. Pope, A. (2020). ‘Mitigating Disasters in a Fractured World’, 24. Pescaroli, G., Alexander, D. (2018). ‘Understanding Compound, 64. Lauren, P., Craig, G., George, A. Force and Statecraft: Crisis Response Journal, 15(1), pp. 16-19. Interconnected, Interacting, and Cascading Risks: A Holistic 42. Baptista, E., Lew, L., McCarthy, S. et al. (2020). ‘The Labs Diplomatic Challenges of Our Time (Fourth Edition) (Oxford: Where Monsters Live’, South China Morning Post. (Accessed Oxford University Press, 2007), p. 116. 3. Collins, B. (2020). ‘Strategic Issues: A Discussion Paper’, Framework’, Society for Risk Analysis, p. 2. online.) National Preparedness Commission, p. 4. (Accessed online.) 25. Townsend-Drake, A. (2020). ‘Counter-terrorism in Cities: 65. United Nations Office for Counter Terrorism (2017). 43. Ibid. ‘Ensuring Effective Interagency Interoperability and Coordinated 4. Joint Committee on the National Security Strategy (2020). A Whole-System Approach’, Crisis Response Journal, 15(1), Communication in Case of Chemical and/or Biological Attacks’, ‘Bio-Security and National Security, First Report of Session pp. 94-95. 44. Annan, K. ‘Non-Proliferation and Disarmament: Two Sides p. 3. (Accessed online.) 2019-21’, House of Commons, p. 3. (Accessed online.). 26. United Nations Office for Counter Terrorism (2017). of a Coin’, We the Peoples: A UN for the 21st Century 2014 (United States: Paradigm Publishers, 2006), p. 111. 66. Lauren, P., Craig, G., George, A. Force and Statecraft: 5. Global Health Security Index (2019). John Hopkins Centre for ‘Ensuring Effective Interagency Interoperability and Coordinated Diplomatic Challenges of Our Time (Fourth Edition) (Oxford: Health Security, p. 12. (Accessed online.) Communication in Case of Chemical and/or Biological Attacks’, 45. Lauren, P., Craig, G., George, A. Force and Statecraft: Oxford University Press, 2006), p. 120. p. 3. (Accessed online.) 6. Collins, B. (2020). ‘Strategic Issues: A Discussion Paper’, Diplomatic Challenges of Our Time (Fourth Edition) (Oxford: 67. Cruickshank, P., Rassler, D. (2020). ‘A View from the CT National Preparedness Commission, p. 4. (Accessed online.) Oxford University Press, 2007), p. 275. 27. Patterson, K., Runge, T. (2002). ‘Smallpox and the Native Foxhole: A Virtual Roundtable on COVID-19 and Counterterrorism 7. Joint Committee on the National Security Strategy (2020). American’, American Journal of the Medical Sciences, (April). 46. Rózsa, L., Nixdorff, K. ‘Biological Weapons in Non-Soviet with Audrey Kurth Cronin, Lieutenant General (Ret) Michael Nagata, ‘Bio-Security and National Security, First Report of Session pp. 216-22. (Accessed online.) Warsaw Pact Countries’, Deadly Cultures: Biological Weapons Magnus Ranstorp, Ali Soufan, and Juan Zarate’, CTCSENTINEL, 2019-21’ House of Commons, p. 10. (Accessed online.) Since 1945. Edited by M. Wheelis, L. Rózsa and M. Dando 13(6), p. 4. (Accessed online.) 28. Frischknecht, F., (2003). ’The History of Biological Warfare: (Cambridge: Harvard University Press, 2006), pp. 157-168. 8. Ibid, p. 48. Human Experimentation, Modern Nightmares and Lone Madmen 68. Institute for Economics & Peace (2020). ‘Global Terrorism in the Twentieth Century’, EMBO reports, 4(S1), pp. 47-52. 47. Perez, M. (2002). ‘The Anthrax Attacks 10 Years Later’, Index 2020: Measuring the Impact of Terrorism’, Sydney, p.5. 9. Cruickshank, P. (2020). ‘Covid-19 and Counterterrorism’, Annals of Internal Medicine, 156(41-55), pp. 13. (Accessed online.) CTCSENTINEL, 13(6). (Accessed online.) 29. Ibid. 48. McCallum, K. ‘MI5 Director General Top Priorities and the 69. INTERPOL (2020), ‘INTERPOL and UN Launch Initiative on 10. European Commission (2020). ‘A Counter-Terrorism Agenda 30. Thwaite, J., Atkins, H. ‘Bacillus: Anthrax; Food Poisoning’, Current Threat Landscape’, MI5 Secret Service, 14 October 2020. CBRN(e) Terror Threats’. (Accessed online.) for the EU: Anticipate, Prevent, Protect, Respond’. p. 11. Medical Microbiology (18th Edition). Edited by D. Greenwood, M. (Accessed online.) (Accessed online.) Barer, R. Slack, W. Irving (Churchill Livingstone, 2012), pp. 237-244. 70. The Council of Europe (2020). ‘The Council of Europe 49. Townsend-Drake, A. (2016). ‘Civil Protection in an Age of Continues Working to Enhance International Co-operation 11. Currie, C., Denigan-Macauley, M. (2020). ‘National 31. Meselson, M., Guillemin, J., Hugh-Jones, M., et al. (1994). ‘The Hyper-Terrorism’, Crisis Response Journal, 12(1), pp.56-57. Against Terrorism, Including Bioterrorism’. (Accessed online.) Biodefense Strategy: Opportunities and Challenges with Early Sverdlovsk Anthrax Outbreak of 1979’, Science. (Accessed online.) Implementation’, United States Government Accountability 50. Keen, D. Complex Emergencies (Cambridge: Polity Press, 71. Krieger, K., Brooke Rogers, M. ‘Promoting Public Resilience Office, p. 1. (Accessed online.) 32. Frischknecht, F., (2003). ’The History of Biological Warfare’, 2008), p. 12. Against Chemical, Biological, Radiological and Nuclear Terrorism’, pp. 47-52. Strategic Intelligence Management. Edited by B. Akhgar and S. 12. Coppola, D. International Disaster Management (Oxford: 51. Coppola, D. International Disaster Management (Oxford: Yates (Amsterdam, Netherlands: Butterworth-Heinemann, 2013), Elsevier, 2015), p. 93. Elsevier, 2015). p. 130. 33. Carus, Seth W., (2017). ‘A Short History of Biological Warfare: p. 83. 13. Ibid, p. 133. From Pre-History to the 21st Century’, Center for the Study of 52. INTERPOL (no date). ‘Bioterrorism’. (Accessed online.) Weapons of Mass Destruction. p. 2. 72. Takahashi, H., Keim, P., Kaufmann A, et al. (2014). ‘Bacillus 14. London Resilience (2018). ‘Pandemic Influenza Framework, 53. World Health Organisation (no date). ‘Biological Weapons’. Anthracis Incident, Kameido, Tokyo, 1993’, Historical Review, Version 7.0’. 34. Federation of American Scientists (2011). ‘Biowarfare Against (Accessed online.) 10(1), p. 117. Agriculture’. (Accessed online.) 15. London Resilience (2019). ‘CBRN(e) Framework, Version 3.1’. 54. Joint Committee on the National Security Strategy (2020). 73. Shwartz, M. (2001). ‘Biological Warfare: An Emerging Threat 35. World Organisation for Animal Health (2021). ‘Eradication ‘Bio-Security and National Security, First Report of Session in the 21st Century’, Stanford News Service. (Accessed online.) 16. Coppola, D. (2015). International Disaster Management Isn’t the End of the Rinderpest Story: OIE and FAO Launch Global 2019-21’. House of Commons, p. 16. (Accessed online.) (Oxford: Elsevier, 2015). 74. Cordesman, A., Burke, A. (2001). ‘Asymmetric and Terrorist Action Plan to Keep the World Free of Deadly Cattle Plague. 55. Center for Disease Control and Prevention (2018). Attacks with Biological Weapons’, Center for Strategic and 17. Martin, P., and Giddings, J. (2020). ‘Building Better Resilience’, (Accessed online.) ‘Bioterrorism Agents/Diseases’. (Accessed online.) International Studies. Washington DC. (Accessed online.) National Preparedness Commission, pp. 16-18. (Accessed online.) 36. Federation of American Scientists (2011). ‘Biowarfare 56. Kaszeta, D. (2020). ‘No, the Coronavirus Is Not a 75. Kaszeta, D. (2016). ‘Decontamination of Buildings after an 18. Centre for Disease Control and Prevention (2019). ‘2009 Against Agriculture’. Biological Weapon’, Washington Post. (Accessed online.) Anthrax Attack’, Journal of Terrorism and Cyber Insurance, 1(1), H1N1 Pandemic’. Accessed Online. pp. 47-60. 37. Nuclear Threat Initiative (2015).’ The Biological Threat: Germs 19. Dawood, F., Luliano, D., Reed, C. et al. (2012). ‘Estimated 57. World Health Organisation (no date). ‘Biological Weapons’. Don’t Respect Borders, so Biological Threats – Manmade and 76. Europol (2020). ‘European Union Terrorism Situation and Global Mortality Associated With the First 12 Months of 2009 (Accessed online.) Naturally Occurring – Can Quickly Have Global Impacts. Trend Report 2020’, p. 21. (Accessed online.) Pandemic Influenza A H1N1 Virus Circulation: a Modelling Study, (Accessed online). 58. World Health Organisation (2018). ‘Anthrax Fact Sheet’. The Lancet, 12(9), pp. 687-695. (Accessed online.) (Accessed online.) 77. Warmbrod, K. L., Revill, J., Connell. N. (2020). ‘Advances 38. Ackerman, G.,Jacome, M. (2018). ‘WMD Terrorism: The Once in Science and Technology in the Life Sciences: Implications for 20. World Health Organisation (2020). ‘Ebola Then and Now: and Future Threat’, PRISM, 7(3). (Accessed online.) 59. World Health Organisation (2018). ‘Botulism Fact Sheet’. Biosecurity and Arms Control’. Geneva, Switzerland, p. 5. Eight Lessons from West Africa That Were Applied in the (Accessed online.) Democratic Republic of the Congo’. (Accessed online.) 39. Stockhammer, N. (2020). ‘COVID-19: Is Bioterrorism on the 78. Europol (2020). ‘European Union Terrorism Situation and 60. World Health Organisation (2017). ‘Plague Fact Sheet’. Rise Now?’, European Institute for Counter-Terrorism and Conflict Trend Report 2020’, p. 21. (Accessed online.) 21. Boin, A., Hart, P., Stern, E., et al. The Politics of Crisis (Accessed online.) Management: Public Leadership Under Pressure, (Cambridge: Prevention Policy Brief. (Accessed online.) 79. Sagan, S., Waltz, K. The Spread of Nuclear Weapons: Cambridge University Press, 2017), p. 31. 61. World Health Organisation (2014). ‘Smallpox Fact Sheet’. An Enduring Debate (Third Edition) (New York: W.W. Norton 40. Peters, A. (2018). ‘The Global Proliferation of High-Containment (Accessed online.) & Company, 2013), p. 117. 22. Center for Disease Control and Prevention (2004). ‘Public Health Biological Laboratories: Understanding the Phenomenon and its Guidance for Community-Level Preparedness and Response to Implications’, Scientific and Technical Review Journal, 37(3), 62. World Health Organisation (2014). ‘Ebola Fact Sheet’. 80. Ackerman, G.,Jacome, M. (2018). ‘WMD Terrorism: Severe Acute Respiratory Syndrome (SARS)’. (Accessed online.) pp. 857-883. (Accessed online.) The Once and Future Threat’, PRISM, 7(3). (Accessed online.)

64 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 65 6 References continued

81. Walsh, P. (2020). ‘Rethinking Bioterrorism Post COVID-19’, 100. Europol (2019). ‘European Union Terrorism Situation and 121. Roffey, R., Tegnell, A.,, Elgh, F. (2002). ‘Biological Warfare in 142. Ibid. Global Network on Extremism and Technology. (Accessed online.) Trend Report 2019’, p. 4. (Accessed online.) a Historical Perspective’. Clinical Microbiology and Infection. 8(8), 143. Collins, B. (2020). ‘Strategic Issues: A Discussion Paper’, pp. 450-454. (Accessed online.) 82. Stockhammer, N. (2020). ‘COVID-19: Is Bioterrorism on the 101. BBC (2019). ‘Australian Brothers Guilty of IS Plane Bomb Plot’. National Preparedness Commission, p. 4. (Accessed online.) Rise Now?’, European Institute for Counter-Terrorism and Conflict (Accessed online.) 122 Coppola, D. International Disaster Management (Oxford: 144. Cruickshank, P., Rassler, D. (2020). ‘A View from the CT Prevention Policy Brief. (Accessed online.) Elsevier, 2015), p. 135. 102. Laurens, G., Lenssen, M., Townsend-Drake, A., Coaffee, J. Foxhole: A Virtual Roundtable on COVID-19 and Counterterrorism 83. BBC (2021). ‘Hacker Tries to Poison Water Supply of Florida (2019). ‘Protecting Major Events and Crowded Places’, Counter 123. Collins, B. (2020). ‘Strategic Issues: A Discussion Paper’, with Audrey Kurth Cronin, Lieutenant General (Ret) Michael Nagata, City’. (Accessed online.) Terrorism Preparedness Network, p. 31.. National Preparedness Commission, p. 6. (Accessed online.) Magnus Ranstorp, Ali Soufan, and Juan Zarate’, CTCSENTINEL, 13(6), p. 5. (Accessed online.) 84. United Nations Security Council Counter-Terrorism Committee 103. Flade, F. (2018). ‘The June 2018 Cologne Ricin Plot: A New 124. Ibid. Executive Directorate (June 2020). ‘The Impact of the COVID-19 Threshold in Jihadi Bio Terror’, CTCSENTINEL, 11(7). (Accessed 125. Silke, A. (2020). ‘COVID-19 and Terrorism: Assessing the 145. The Rockefeller Foundation (2014). ‘City Resilience Pandemic on Terrorism, Counter-Terrorism and Countering Violent online.) Short- and Long-Term Impacts’, Pool Re. (Accessed online.) Framework’, p. 3. (Accessed online.) Extremism’. (Accessed online.) 104. European Centre for Disease Prevention and Control (2017). 126. UK Ministry of Defence (2018). ‘Global Strategic Trends: 146. United Nations (2020). ‘Policy Brief: COVID-19 in an Urban 85. United Nations Security Council Counter-Terrorism Committee ‘RAPID RISK ASSESSMENT: Risk Related to the Use of ‘Do-It- The Future Starts Today’ (Sixth Edition), p. 141. (Accessed online.) World’, pp. 2-4. (Accessed online.) Executive Directorate (June 2020). ‘The Impact of the COVID-19 Yourself’ CRISPR-associated Gene Engineering Kit Contaminated 127. Warmbrod. K. L., Revill. J., Connell. N. (2020). ‘Advances 147. Pescaroli, G., Alexander, D. (2018). ‘Understanding Pandemic on Terrorism, Counter-Terrorism and Countering Violent with Pathogenic Bacteria’. (Accessed online.) Extremism’. (Accessed online.) in Science and Technology in the Life Sciences: Implications for Compound, Interconnected, Interacting, and Cascading Risks: 105. World Health Organisation (no date). ‘Biological Weapons’. Biosecurity and Arms Control’. Geneva, Switzerland. A Holistic Framework’, Society for Risk Analysis, pp. 1-6. 86. Townsend-Drake, A. (2016). ‘Civil Protection in an Age of (Accessed online.) Hyper-Terrorism’, Crisis Response Journal, 12(1), pp. 56-57. 128. GAO (2017). ‘Biodefense: Federal Efforts to Develop 148. Martin, P., Giddings, J. (2020). ‘Building Better Resilience’, 106. INTERPOL (no date). ‘Bioterrorism’. (Accessed online.) Biological Threat Awareness’, United States Government National Preparedness Commission, p. 16. (Accessed online.) 87. Silke, A. (2020). ‘COVID-19 and Terrorism: Assessing the Accountability Office. (Accessed online.) Short- and Long-Term Impacts’, Pool Re. (Accessed online.) 107. UK Ministry of Defence (2018). ‘Global Strategic Trends: 149. United Nations (2020). ‘Comprehensive Response to The Future Starts Today’ (Sixth Edition), p.138. (Accessed online.) 129. Warmbrod, K. L., Revill, J., Connell. N. (2020). ‘Advances COVID-19: Saving Lives, Protecting Societies, Recovering Better’. 88. Ibid. in Science and Technology in the Life Sciences: Implications (Accessed online.) 108. Beeching, N., Dance, D., Miller, A. (2002). ‘Biological Warfare for Biosecurity and Arms Control’. Geneva, Switzerland. 89. United Nations Security Council Counter-Terrorism Committee and Bioterrorism’, Clinical Review, BMJ, 324, p. 336. 150. Tardy, T. (2020). ‘COVID-19: Shaping Future Threats and Executive Directorate (June 2020). ‘The Impact of the COVID-19 130. Koblentz, G. (2020). ‘Emerging Technologies and the Future Security Policies’, COVID-19: NATO in the Age of Pandemics. Pandemic on Terrorism, Counter-Terrorism and Countering Violent 109. Joint Committee on the National Security Strategy (2020). of CBRN Terrorism,’ The Washington Quarterly, 43(2), pp. 177-196. Edited by T. Tardy, NATO Defence College. Rome. Issue 9. Extremism’. (Accessed online.) ‘Bio-Security and National Security, First Report of Session (Accessed online.) pp. 14-15. (Accessed online.) 2019-21’, House of Commons, p.47. (Accessed online.) 90. Ibid. 131. European Commission (2020). ‘A Counter-Terrorism 151. Cook, R., Penzini, S. ‘How Covid-19 Unveils the Systemic 110. Wheelis, M., Casagrande, R., Madden, L. (2002). ‘Biological Agenda for the EU: Anticipate, Prevent, Protect, Respond’. p. 3. 91. UN Security Council CTED (2020). ‘Trend Alert: Member States Nature of Risks’, Crisis Response Journal, 15(4), pp. 12-13. Attack on Agriculture: Low-Tech, High-Impact Bioterrorism’, (Accessed online.) Concerned by the Growing and Increasingly Transnational Threat BioScience, 52(7), pp. 569–576. (Accessed online.) 152. Beeching, N., Dance, D., Miller, A. (2002). ‘Biological Warfare of Extreme Right-Wing Terrorism’. (Accessed online.) 132. UK Ministry of Defence (2018). ‘Global Strategic Trends: and Bioterrorism’, Clinical Review, BMJ, 324, p. 338. 111. Federation of American Scientists (2011). ‘The Threat of The Future Starts Today’ (Sixth Edition), p. 143. (Accessed online.) 92. Cruickshank, P., Rassler, D. (2020). ‘A View from the CT Agro-Terrorism’. (Accessed online.) 153. Iftimie, I. A. (2020). ‘The Implications of COVID-19 for NATO’s Foxhole: A Virtual Roundtable on COVID-19 and Counterterrorism 133. European Commission (2020). ‘A Counter-Terrorism Counter-Bioterrorism’, COVID-19: NATO in the Age of Pandemics. with Audrey Kurth Cronin, Lieutenant General (Ret) Michael Nagata, 112. Federal Bureau of Intelligence (2008). ‘Criminal Investigation Agenda for the EU: Anticipate, Prevent, Protect, Respond’. p. 5. Edited by T. Tardy, NATO Defence College. Rome. Issue 9. Magnus Ranstorp, Ali Soufan, and Juan Zarate’, CTCSENTINEL, Handbook for Agroterrorism’. (Accessed online.) (Accessed online.) pp.51-59. (Accessed online.) 13(6), p. 3. (Accessed online.) 134. Laurens, G., Lenssen, M., Townsend-Drake, A., Coaffee, J. 113. Federation of American Scientists (2011). ‘The Threat of 154. UK Scientific Advisory Group for Emergencies (2020). ‘Public (2019). ‘Protecting Major Events and Crowded Places’, Counter 93. Stock, J. (2020). ‘INTERPOL Secretary General – Terrorist Agro-Terrorism’. (Accessed online.) Disorder and Public Health – Contemporary Threats and Risks’, Terrorism Preparedness Network, p. 31. Groups Using COVID-19 to Reinforce Power and Influence’. prepared by Scientific Pandemic Influenza Group on Behaviours 114. World Health Organisation (2017). ‘One Health’. INTERPOL (December 2020). (Accessed online.) 135. Beeching, N., Dance, D., Miller, A. (2002). ‘Biological Warfare (SPI-B), policing and security sub-group. (Accessed online.) (Accessed online.) and Bioterrorism’, Clinical Review, BMJ, 324, p. 336. 94. Institute for Economics & Peace (2020). ‘Global Terrorism 155. Boin, A., Hart, P., and Stern, E., et al. (2017). The Politics 115. Ibid. Index 2020: Measuring the Impact of Terrorism’. Sydney, 136. INTERPOL (2018). ‘International Experts Meet on Potential of Crisis Management: Public Leadership Under Pressure pp. 5-12. (Accessed online.) 116. Center for Disease Control and Prevention (2018). Threat Posed by New Technologies’. (Accessed online.) (Cambridge: Cambridge University Press, 2017), pp. 3-12. ‘Bioterrorism Agents/Diseases’. (Accessed online.) 95. NATO (2020). ‘NATO 2030, United for a New Era’, p. 32. 137. INTERPOL (no date). ‘Bioterrorism: Capacity Building and 156. Ibid, p. 71. (Accessed online.) 117. Thompson, D.K., et al. (2003). ‘Economic Costs of the Foot Training’. (Accessed online.) 157.Ibid, p. 63. 96. Institute for Economics & Peace (2020). ‘Global Terrorism and Mouth Disease Outbreak in the United Kingdom in 2001’, 138. INTERPOL (2020). ‘INTERPOL and UN Launch Initiative on Index 2020: Measuring the Impact of Terrorism’. Sydney, Revue scientifique et technique (International Office of Epizootics), C8RN(e) Terror Threats’. (Accessed online.) 158. UK Ministry of Defence (2018). ‘Global Strategic Trends: pp. 5-12. (Accessed online.) (21), pp.675-87. The Future Starts Today’ (Sixth Edition), p. 3. (Accessed online.) 139. INTERPOL (2018). ‘International Experts Meet on Potential 97. Europol (2020). ‘European Union Terrorism Situation and 118. World Health Organisation (2020). ‘SARS-CoV-2 Threat Posed by New Technologies’. (Accessed online.) 159. Boin, A., Hart, P., Stern, E., et al. (2017). The Politics of Crisis Trend Report 2020’, p. 11. (Accessed online.) Mink-Associated Variant Strain – Denmark’. (Accessed online.) Management: Public Leadership Under Pressure (Cambridge: 140. NATO (2020). ‘NATO 2030, United for a New Era’, p. 32. Cambridge University Press, 2017), p. 39. 98. Sabbagh, D., Grierson, J. (2020). ‘UK Terror Threat 119. McLeod, A., Morgan, N., Prakash, A. (no date). (Accessed online.) Upgraded to Severe After France and Austria Attacks’, ‘Economic and Social Impacts of Avian Influenza’, Food and 160. Coppola, D. International Disaster Management (Oxford: 141. Cruickshank, P., Rassler, D. (2020). ‘A View from the CT The Guardian. (Accessed online.) Agricultural Organisation. (Accessed online.) Elsevier, 2015), pp. 94-95. Foxhole: A Virtual Roundtable on COVID-19 and Counterterrorism 99. McCallum, K. (2020). ‘MI5 Director General Top Priorities 120. Mueller, S. (2019). ‘Are Market GM Plants an Unrecognized with Audrey Kurth Cronin, Lieutenant General (Ret) Michael Nagata, 161. Joint Committee on the National Security Strategy (2020). ‘Bio- and the Current Threat Landscape’, MI5 Secret Service, Platform for Bioterrorism and Biocrime?’, Frontiers in Magnus Ranstorp, Ali Soufan, and Juan Zarate’, CTCSENTINEL, Security and National Security, First Report of Session 2019-21’, 14 October 2020. (Accessed online.) Bioengineering and Technology. (Accessed online.) 13(6), p. 3. (Accessed online.) House of Commons, p. 3. (Accessed online.)

66 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 67 6 References continued

162. Ibid, p. 8. 180. Slettenmark, O., Fetz, M., Townsend-Drake, A., Moffett, H., 199. Michie, S., West, R., Rogers, M.B., et al. (2020). ‘Reducing 212. Ibid, pp. 19-22. Therrien, M.C. (2019). ‘Strategic Coordination’, Counter Terrorism SARS-CoV-2 Transmission in the UK: A Behavioural Science 163. United Nations Office for Counter Terrorism (2017). 213. Townsend-Drake, A. (2020). ‘Counter-terrorism in Cities: Preparedness Network, pp. 13-16. Approach to Identifying Options for Increasing Adherence to Social ‘Ensuring Effective Interagency Interoperability and Coordinated A Whole-System Approach’, Crisis Response Journal (15)1, Distancing and Shielding Vulnerable People’, British Journal of Communication in Case of Chemical and/or Biological Attacks’, 181. White House (2018). ‘National Biodefense Strategy’, pp. 94-95. Health Psychology, 25(4), pp. 945-956. (Accessed online.) p. 3. (Accessed online.) p. 8. (Accessed online.) 214. Laurens, G., Lenssen, M., Townsend-Drake, A., Coaffee, J. 200. Michie, S., van Stralen, M.M., West, R. (2011). ‘The Behaviour 182. Joint Committee on the National Security Strategy (2020). (2019). ‘Protecting Major Events and Crowded Places’, Counter 164. Ibid p. 14. Change Wheel: A New Method for Characterising and Designing ‘Bio-Security and National Security, First Report of Session Terrorism Preparedness Network, p. 29. Behaviour Change Interventions’, Implementation Science, 6, 165. Andrus, J.K., Aguilera, X., Oliva, O., Aldighieri, S. (2010). 2019-21’, House of Commons, p. 33. (Accessed online.) ‘Global Health Security and International Health Regulations’, Article 42. 215. Lauren, P., Craig, G., George, A. Force and Statecraft: 183. Office of Disease Prevention and Health Promotion (2020). Diplomatic Challenges of Our Time (Fourth Edition) BMC Public Health 10. (Accessed online.) 201. Martin, P., Giddings, J. (2020). ‘Building Better Resilience’, ‘Public Health Infrastructure’. (Accessed online.) (Oxford: Oxford University Press, 2007), p. 111. 166. World Health Organisation (no date). ‘International Health National Preparedness Commission, pp. 10-12. (Accessed online.) 184. Joint Committee on the National Security Strategy (2020). 216. Nascimento, D. (2020). ‘Vaccine Investment as a National Regulations’. (Accessed online.) 202. Rogers, B., Pearce, J. ‘Risk Communication, Risk Perception ‘Bio-Security and National Security, First Report of Session Security Matter’, Forbes. (Accessed online.) and Behaviour as Foundations of Effective National Security 167. Joint Committee on the National Security Strategy (2020). 2019-21’, House of Commons, p. 35. (Accessed online.) Practices’, Strategic Intelligence Management. Edited by B. Akhgar ‘Bio-Security and National Security, First Report of Session 217. UK Ministry of Defence (2018). ‘Global Strategic Trends: The 185. Azar, K.M., Shen, Z., Romanelli, R.J., et al. (2020). and S. Yates (Amsterdam: Butterworth-Heinemann, 2013), p. 82. 2019-21’, House of Commons, p. 21. (Accessed online.) Future Starts Today’ (Sixth Edition), pp. 13-18. (Accessed online.) ‘Disparities in Outcomes Among COVID-19 Patients in A Large 203. Krieger, K., Brooke Rogers, M. ‘Promoting Public Resilience 168. Rogers, B., Pearce, J. (2013). ‘Risk Communication, Risk Health Care System in California’, Health Affairs, 39(7). 218. Walsh, P. (2020). ‘Rethinking Bioterrorism Post COVID-19’, against Chemical, Biological, Radiological and Nuclear Terrorism’, Perception and Behaviour as Foundations of Effective National Global Network on Extremism and Technology. (Accessed online.) 186. Ssentongo, P., Ssentongo, A.E., Heilbrunn, E.S., et al. (2020). Strategic Intelligence Management. Edited by B. Akhgar and S. Security Practices’, Strategic Intelligence Management. Edited by ‘Association of Cardiovascular Disease and 10 Other Pre-existing Yates (Amsterdam: Butterworth-Heinemann, 2013), p. 81. 219. The Council of Europe (2020). ‘The Council of Europe B. Akhgar and S. Yates (Amsterdam: Butterworth-Heinemann, Comorbidities with COVID-19 Mortality: A Systematic Review Continues Working to Enhance International Co-operation 2013), p. 70. 204. Rogers, B., Pearce, J. ‘Risk Communication, Risk Perception and Meta-analysis’, Plos One, (15)8. Against Terrorism, Including Bioterrorism’. (Accessed online.) and Behaviour as Foundations of Effective National Security 169. Krieger, K., Brooke Rogers, M. ‘Promoting Public Resilience 187. Karagiannidis, C., Mostert, C., Hentschker, C., et al. (2020). Practices’, Strategic Intelligence Management. Edited by B. Akhgar 220. Collins, B. (2020). ‘Strategic Issues: A Discussion Paper’, against Chemical, Biological, Radiological and Nuclear Terrorism’, ‘Case Characteristics, Resource Use, and Outcomes of 10,021 and S. Yates (Amsterdam: Butterworth-Heinemann, 2013), National Preparedness Commission, p. 4. (Accessed online.) Strategic Intelligence Management. Edited by B. Akhgar and Patients with COVID-19 Admitted to 920 German Hospitals: pp. 66-71. 221. Joint Committee on the National Security Strategy (2020). S.Yates (Amsterdam: Butterworth-Heinemann, 2013), p. 82. An Observational Study’, The Lancet Respiratory Medicine, 8(9), 205. Krieger, K., Brooke Rogers, M. ‘Promoting Public Resilience ‘Bio-Security and National Security, First Report of Session pp. 853-862. 170. Boin, A., Hart, P., Stern, E., et al. (2017). The Politics of against Chemical, Biological, Radiological and Nuclear Terrorism’, 2019-21’, House of Commons, p. 19. (Accessed online.) Crisis Management: Public Leadership Under Pressure 188. Shadmi, E., Chen, Y., Dourado, I. et al. (2020). ‘Health Equity Strategic Intelligence Management. Edited by B. Akhgar and S. 222. HM Government (2018). ‘UK Biological Security Strategy’. (Cambridge: Cambridge University Press, 2017), p. 3. and COVID-19: Global Perspectives’, International Journal for Yates (Amsterdam: Butterworth-Heinemann, 2013), pp. 75-78. (Accessed online.) 171. Ibid, p.13. Equity in Health, 19(1), pp. 1-16. 206. Coppola, D. International Disaster Management 223. Joint Committee on the National Security Strategy (2020). 172. Cruickshank, P., Rassler, D. (2020). ‘A View from the CT 189. Nascimento, D. (2020). ‘Vaccine Investment as a National (Oxford: Elsevier, 2015), p. 352. ‘Bio-Security and National Security, First Report of Session Security Matter’, Forbes. (Accessed online.) Foxhole: A Virtual Roundtable on COVID-19 and Counterterrorism 207. Krieger, K., Brooke Rogers, M. ‘Promoting Public Resilience 2019-21’, House of Commons, p. 40. (Accessed online.) with Audrey Kurth Cronin, Lieutenant General (Ret) Michael Nagata, 190. Homeland Security and Emergency Management Agency against Chemical, Biological, Radiological and Nuclear Terrorism’, 224. Ibid, p. 28. Magnus Ranstorp, Ali Soufan, and Juan Zarate’, CTCSENTINEL, (no date). ‘Securing the Cities Program’. (Accessed online.) Strategic Intelligence Management. Edited by B. Akhgar and 13(6), p. 3. (Accessed online.) S. Yates (Amsterdam: Butterworth-Heinemann, 2013), p. 83. 225. Collins, B. (2020). ‘Strategic Issues: A Discussion Paper’, 191. Laurens, G., Lenssen, M., Townsend-Drake, A., Coaffee, J. National Preparedness Commission, p. 10. (Accessed online.) 173. United States Department for Justice (2011). ‘Health (2019). ‘Protecting Major Events and Crowded Places’, Counter 208. Martin, P., Giddings, J. (2020). ‘Building Better Resilience’, Security: Public Health and Medical Integration for Fusion Centers’. Terrorism Preparedness Network, p. 32. National Preparedness Commission, p. 17. (Accessed online.) 226. United Nations (2020). ‘Policy Brief: COVID-19 in an (Accessed online ) Urban World’, p. 3. (Accessed online.) 192. Nascimento, D. (2020). ‘Vaccine Investment as a National 209. Laurens, G., Lenssen, M., Townsend-Drake, A., Coaffee, J. 174. National Bio-Surveillance Integration Center (2012). Security Matter’, Forbes. (Accessed online.) (2019). ‘Protecting Major Events and Crowded Places’, 227. Townsend-Drake, A. (2020). ‘Counter-terrorism in Cities: ‘Strategic Plan’, United States Department for Homeland Security. Counter Terrorism Preparedness Network, p. 29. A Whole-System Approach’, Crisis Response Journal (15)1, 193. Collins, B. (2020). ‘Strategic Issues: A Discussion Paper’, (Accessed online.) pp. 94-95. National Preparedness Commission, pp. 8-9. (Accessed online.) 210. Krieger, K., Brooke Rogers, M. ‘Promoting Public Resilience against Chemical, Biological, Radiological and Nuclear Terrorism’, 228. UKCRIC (2020). ‘Rethinking Infrastructure and Cities for a 175. Slettenmark Slettenmark, O., Fetz, M., Townsend-Drake, A., 194. Ibid. Moffett, H., Therrien, M.C. (2019). ‘Strategic Coordination’, Strategic Intelligence Management. Edited by B. Akhgar and Covid-19 World: A UKCRIC Prospectus’, pp. 1-9. (Accessed Counter Terrorism Preparedness Network, p. 18. 195. UKCRIC (2020). ‘Rethinking Infrastructure and Cities for a S.Yates (Amsterdam: Butterworth-Heinemann, 2013), p. 79. online.) Covid-19 World: A UKCRIC Prospectus’, pp. 1-9. (Accessed online.) 176. Boin, A., Hart, P., Stern, E., et al. (2017). The Politics of 211. Laurens, G., Lenssen, M., Townsend-Drake, A., Coaffee, J. 229. Townsend-Drake, A. (2020). ‘Counter-terrorism in Cities: Crisis Management: Public Leadership Under Pressure 196. Panda, A., Ramos, N. (2020). ‘Making Critical Infrastructure (2019). ‘Protecting Major Events and Crowded Places’, Counter A Whole-System Approach’, Crisis Response Journal (15)1, (Cambridge: Cambridge University Press, 2017), p. 23. Resilient: Ensuring Continuity of Service – Policy and Regulations Terrorism Preparedness Network, p. 28. pp. 94-95. in Europe and Central Asia’. United Nations Office for Disaster 177. MacFarlane, R., Leigh, M. (2014). ‘Information Management Risk Reduction. (Accessed online.) and Shared Situational Awareness’, Emergency Planning College, p. 6. (Accessed online.) 197. Coppola, D. International Disaster Management (Oxford: Elsevier, 2015), pp. 94-95. 178. Boin, A., Hart, P., Stern, E., et al. (2017). The Politics of Crisis 198. West, R., Michie, S., Rubin, G.R., Amlôt, R. (2020). Management: Public Leadership Under Pressure (Cambridge: ‘Applying Principles of Behaviour Change to Reduce SARS-CoV-2 Cambridge University Press, 2017), p. 44. Transmission’, Nature Human Behaviour, pp. 451-459. 179. Ibid, p. 51. (Accessed online.)

68 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 Bioterrorism: Applying the Lens of COVID-19 – Report 2021 69