Presentation Issued: 20/08/03 Page Update: 20/08/03 Geneva

Presentation by Drs. Jill S. Dekker-Bellamy, Senior Project Advisor
European Group for Non-Proliferation Studies
at the BWPP Lunch Seminar
Geneva, Switzerland, 20 August 2003

Introduction

Since the 2001 Anthrax attacks in the United States, international attention has been focused on preventing a full scale attack with Category 1 pathogens. Category 1 pathogens such as Anthrax and Smallpox are recognized for the catastrophic consequence which would result in their use. This category of pathogens is typically referred too as weapons of mass destruction. The European Union began preparing for an attack with Category 1 pathogens in October of 2001. The Member States of the EU have since stockpiled vaccines and antibiotics. Historically the Member States of the EU, have taken a moderate approach to foreign policy in regions of the world where proliferation and terrorism are a concern. One result of preventative diplomacy and intervention policy has been to reduce the threat of a full scale attack with Category 1 pathogens.

Category 2 pathogens and in particular, zoonoses such as salmonella and e-coli which jump from animals to humans pose a real and present threat to EU bio-security. Their potential use by criminals or terrorist to cause deliberate disease in humans is a great concern. The regulations to counter deliberate disease and prevent deliberate food-borne zoonoses are not yet complete. Compliance with existing bio-security legislation has not been achieved.

People generally associate Category 2 zoonotic pathogens with food-poisoning.

Deliberate food-poisoning has occurred throughout history, in different societies and for different reasons. Typically itıs been considered an aberration and not terribly relevant to bio-security policy. It has also been associated with Œagro-terrorism.ı This association is incorrect as a strike with Category 2 pathogens is not intended to kill animals or plants for economic gain but to infect and kill humans.

Historically EU bio-safety regulation has been intended to prevent accidental contamination. EU bio-security law in contrast to bio-safety has sought to incorporate limited regulations to prevent deliberate attacks on public health. Bio-security legislation covers a broad range of possible threats to animal and human health. It remains limited however, in adapting to the threat of deliberate Category 2 disease.

As the European Union enlarges in 2004, it will border states known to intelligence establishment as Œhot spotsı for transnational criminal syndicates. These syndicates are active throughout the Confederation of Independent States and east central Europe. Should criminal syndicates or terrorist, decide to use biological agents to extort concessions from governments, the type of Category 2 pathogens they could acquire are numerous.

Category 2 Pathogens

Category 2 pathogens which include zoonoses (zoonoses are diseases transmissible from animals to humans), can cause wide spread outbreaks of severe food poisoning. The most prevalent food borne diseases are salmonella, listeria, e-coli and campylobacter. These pathogens are fairly contagious. Several are resistant to heat. Infections can occur with a low bacterial count, making them attractive pathogens for causing deliberate food-poisoning. Natural outbreaks of Category 2 pathogens are notoriously difficult to control. The micro-organisms involved in food-borne diseases are found everywhere and very difficult to eliminate from the food chain. Preventing natural contamination requires stringent adherence to regulations designed to control them. In order to prevent deliberate disease an assessment of regulations to prevent imported animal disease and food-safety must be conducted.

Category 1 zoonoses such as Foot and Mouth Disease (FMD) can have a devastating effect on production animals and cause severe economic losses. For this reason, it is the focus of EU regulation with well established monitoring and surveillance programs. Although it is classed as a Category 1 pathogen, FMD is far less pathogenic in humans. Its deliberate use would be to strike the agricultural sector and create widespread economic losses. Fewer regulations exist to prevent the deliberate use of Category 2 diseases which are far more threatening to human health. Unfortunately within the EU, organisms which do not cause an animal ill health and have no adverse economic impact, such as campylobacter, are often not investigated. Category 2 pathogens are often not monitored or considered notifyable even though their impact on human health can be devastating. It is imperative the EU take a proactive approach to counter Category 2 zoonotic pathogens. It must recognize the threat these pathogens pose and counter this threat with strong bio-security regulation.

Another problem with preventing deliberate disease and enforcing compliance with EU bio-security regulations is that of feasibility. Compliance with EU bio-security regulations requires advanced technologies. For example Member States must have the capacity to participate in EU surveillance networks. Participation in the networks and compliance with regulations to monitor outbreaks of food poisoning is dependant on data base infrastructures. Unfortunately many states are unable to comply with zoonoses regulations because they lack the technical capacity to comply. One example of this is the lack of computers noted in some candidate states. Some national reference laboratories write results on paper and there is no coordinated approach to sharing information on disease outbreaks. If a deliberate attack were to occur it would be difficult to coordinate critical outbreak data. This reflects the very basic requirements for surveillance. Providing the technical capability and expertise to these states in order for them to be in compliance is essential to EU bio-security.

Category 2 pathogens Description/Prevention

If criminals were to choose a biological pathogen to cause deliberate disease salmonella may be at the top of the list. Salmonella alone infects 160,000 EU citizens each year, of which around 200 die. Natural outbreak of salmonella costs the EU 2.8 billion Euro annually. An intentional outbreak would likely be devastating both in economic and human terms. Strain selection could be specific and contamination could be orchestrated to affect several member states. For example infecting industrial poultry flocks, animal auctions or animals in transport will spread this type of disease across several states rapidly.

Approximately 2300 strains of salmonella have been identified. They occur in poultry, cattle, sheep, goats and horses. All strains are contagious to humans. A few strains occur more frequently and would therefore be easier to acquire. With limited expertise, a criminal could select a more pathogenic strain. Of particular concern is a strain known as DT 104. It is especially dangerous to humans because DT 104 has become multi-drug resistant to at least five anti-microbial drugs used to treat it. Compared to 1980, some European countries have witnessed a staggering 20 fold increase in salmonella incidence over the last 10 years. DT 104 could be attractive to criminals and terrorist intent on a biological attack using food-borne zoonoses. The regulations to prevent and contain an outbreak of salmonella are stringent, but there is yet no formal regulation to identify or prevent a deliberate attack with this pathogen.

Verocytotoxigenic Escherichia coli or e-coli is another food-borne disease particularly dangerous to children, the elderly and immuno-compromised individuals. After the bacteria are ingested it can take up to ten days before symptoms appear. Ten days would be ample time to continue to strike the food chain without detection. Consecutive outbreaks over an extended period would cause widespread panic and tax health care systems. E-coli is strongly associated with Haemolytic Uremic Syndrome (HUS). HUS is a leading cause of kidney failure and death, making e-coli a very dangerous pathogen.

Although campylobacter is not carried by healthy individuals in Europe, it is often isolated from healthy cattle, chickens, birds and flies. It is also sometimes present in non-chlorinated water sources such as ponds and streams. The infective dose is considered to be small. It would take as few as 400-500 bacteria to cause illness. It is possible such a pathogen could be acquired and cultivated to infect humans.

Finally, Listeria is a serious form of food poisoning which is fatal in 20-30% of cases. Recently 9 people died in France after eating contaminated food. It can survive in extremes of pH (potential for hydrogen) and temperature. The clinical features include meningitis, septicaemia and gastroenteritis among other serious conditions. If used as a pathogen for terrorism it could spread across several nations through food distribution, contaminate numerous products and greatly harm human health.

Regulations to prevent deliberate Category 2 food-borne zoonoses

The regulations to prevent a Category 2 pathogens strike are similar to those employed to prevent natural outbreaks. Unfortunately the main legislation covering zoonosis (Directive 92/117 EC) is applied only to salmonella and only two types of salmonella (type S. typhimurium and S. Enteritidis.) Its application is limited to poultry flocks, although salmonella regularly occurs in cattle, goat, sheep and horses. New legislation is however being developed which will broaden the scope of salmonella surveillance and notification. This is an important step in preventing natural outbreak. It also offers potential recognition of the threat from deliberate disease. Zoonoses legislation has been reintroduced in order to strengthen the instruments of regulation. However, problems, particularly with regard to candidate state compliance on zoonoses remain.

Border Inspection Posts

If we consider the methods criminals may use to infect animals with food-borne illness and how to prevent this, one of the most important measures is imported animal inspections. In order to stop deliberate imported disease border inspection plays a vital role. Border inspection posts provide routine testing for imported animal diseases. The EU has proposed a total of 285 posts to be established along the new eastern border. The incoming states have proposed 51. The current state of Border Inspection Posts is well below what the EU considers minimal to bio-security. This type of regulatory gap must be closed or the risk from natural and intentional illness is likely to increase. It is imperative the EU develop regulations and monitor compliance in order to close this type of gap. It must increase efforts to train veterinary epidemiologist in Category 2 pathogen identification.

Conclusion

Criminal syndicates using Category 2 pathogens to cause infectious disease outbreak, could pose a serious threat to public health. The clear and present risk to the EU, far from a direct attack with a Category 1 pathogen such as Smallpox, could well come from salmonella, listeria, e-coli or campylobacter contaminants. If such a strike were subtle in its inception, using a pathogen strain with a long incubation period and highly contagious, the effects will be devastating. The EU could serve as the testing ground for implementing policy strategies and regulations not yet widely employed on the counter terror and non-proliferation front. Yet the regulations to prevent an intentional attack with this type of pathogen are immature.

The EU has not formally developed a specific policy for dealing with terrorist threats involving Category 2 pathogens, although it is evaluating this threat within the food safety, animal and public health sectors. It must incorporate Category 2 pathogens into itıs plan for responding to biological threats. Crucially it needs to provide adequate resources to incoming candidate states so they can comply with bio-security law. If the EU neglects natural outbreaks of Category two zoonoses and the regulations to control it, a deliberate full scale strike is unlikely to be identified or contained at an early stage.

Clearly countering the threat posed by Category 2 pathogens will require an integrated approach to food security, border protection and pathogen surveillance. If the EU tightens bio-security regulations and includes the threat of deliberate Category 2 diseases, it could serve as the testing ground for regulations not yet widely employed on the counter terror and non-proliferation fronts.

This report was presented at the lunch seminar on "National implementation legislation and biosafety issues", Palais des Nations, Geneva, Switzerland