Historically, naturally occurring endemic diseases have significantly affected military personnel and impacted operations.18,19 Specifically, diarrhea and respiratory infections have resulted in the most morbidity and lost days of work during deployments.20,21 The totality of the potential biothreat environment is summarized in Figure 2. Medical intelligence can provide situational awareness of biothreats for the operational environment. Given the unique problem set and due to space constraints, this documents’ focus will primarily be on biowarfare agents directed at humans as a base, but including endemic and emerging diseases. Biowarfare agent characteristics will be summarized to aid understanding in later sections. For more detailed information, see the references for this section.
Specific biothreats have been identified by their innate characteristics to pose an increased risk to national security, and have been termed Category A, B, and C agents/diseases by the Centers for Disease Control and Prevention (CDC).22 For example, Category A agents/diseases pose a risk to national security given that they: can be easily disseminated or transmitted from person to person, result in high mortality rates, have the potential for a major public health impact, might cause public panic/social disruption, and require special action for public health preparedness.22 Category A agents include:
Note that these biothreats can generally be encountered in nature as endemic diseases or toxins produced/encountered via exposure to natural sources with the exception of smallpox, which has been eradicated from the human population.
Biothreats can be produced, weaponized, and disseminated via simple or complex means, depending on the agent and goals/capabilities of the adversary.23-26 Specific biothreats can be chosen to cause incapacitation, death, fear and to degrade the mission with deniability. Biothreats can be noncontagious, with effects limited to individuals directly exposed or contagious, to enable secondary spread to other units, allied and partner forces, host nation civilians, or the U.S. civilian population.3 Goals of use could range from targeted assassination to widespread disruption of key areas (logistics nodes, command and control centers, and hubs needed for force flow) during a military operation thereby reducing combat power in units at critical phases of conflict.3,24,25 Medical and public health personnel should have an understanding of dissemination mechanisms of biowarfare agents to enable recognition of a deliberate biological incident, guide surveillance, triage, and medical evaluations. Potential dissemination mechanisms described in published open sources could include:23,24,27
The threat of biowarfare agents is further augmented by the rapid evolution of scientific fields and technologies such as synthetic biology. Synthetic biology is a rapidly growing field with the potential of revolutionizing the medical field. According to the CDC, synthetic biology may have significant consequences because engineered modifications could: