Although bioterrorism might seem a problem beginning in the late 20th century, a short story, `written by H.G.Wells in 1894, portended the threat of an attack with biological agents. It tells the tale of an anarchist who steals a vial of what he believes to be cholera bacilli to poison the water supply of the city of London.
As predicted by Wells, several incidents of bioterrorism have been witnessed the world over, but there has not been a single documented case of bioterrorism in India to date. But there have been few incidents in the past that might have been biological attacks, given the fact that it is tough to differentiate natural epidemics from biological attacks.
During the Indo-Pakistan war of 1965, a scrub typhus outbreak in northeastern India came under suspicion. Other cases which could not be officially confirmed as events of bio-terror include, the spread of bubonic plague in Surat in 1994 which caused several deaths, dengue hemorrhagic fever in Delhi in 1996, anthrax in Midnapur in 1999 and encephalitis in Siliguri in 2001 and an anthrax scare in 2001 at Mantralaya in Mumbai.
Recent Nipah Virus outbreak which happened in 2018 in Perambra, Kerala has the physical attributes to serve as a potential agent of bioterrorism. The first human outbreak of Nipah virus was reported from Malaysia among pig farmers in 1998. The virus was named Nipah after the name of the village of “Sungai Nipah”, in Malaysia. There were several outbreaks in Bangladesh and the first reported outbreak was in 2001. There was an outbreak in Nadia, West Bengal in 2007. The present epidemic in India after nearly 11 years with a high case fatality rate indicates that there is a total lack of health care systems preparedness and surveillance strategy.
India also appears ill-equipped to face the threat of bioterrorism, as was evident from the recent H1N1 epidemic, which claimed over 2,300 lives. We must know and get acquainted with this form of terror before it becomes an enormous challenge to our Health Department. Early detection and quick response to bioterrorism are contingent on close cooperation between public health authorities and law enforcement; however, such collaboration is currently lacking.
The threat of bioterrorism is the most probable when compared to other weapons of mass destruction (WMDs), owing to rapid advancements in the field of synthetic biology besides the existence of hostile neighbours like Pakistan and Bangladesh. In 2002 at Kandahar, Afghanistan, the Pentagon detected anthrax at a suspected Al-Qaeda biological weapons site together with equipment conventionally used in biowarfare programme. Later some sketches and calculations to make helium-powered balloon bomb filled with anthrax was discovered in the Kabul office of an NGO headed by Bashiruddin Mahmood, one of the two Pakistani nuclear scientists arrested in Islamabad for questioning on their alleged links with Osama Bin Laden.
The links of Al Qaeda with four terrorist groups in India are well established. These groups are Lashkar-e-Taiba, Jaish-e-Mohammad, Harkat-ul-Jihad-ul-Islami and Harkat-ul- Mujahidin. On account of the close link of these terrorist groups with Al -Qaeda, there is a real risk of these terrorist groups launching a biological attack in India in the future. Besides the above state actors, there are numerous non-state actors in India and her neighbourhood as well.
High population density, subtropical climatic conditions, coupled with poor hygiene and inadequate sanitation facilities make India extremely susceptible and suitable for the spread of infectious diseases. Inadequate medical facilities and non-availability of medical services in remote areas make the circumstances still more ideal for contagious diseases to run like wildfire. It’s shocking but true that on an average a single government doctor serves nearly 12,000 people.
On top of it all, any battle with bioterrorism is fraught with numerous challenges, the first and foremost challenge being the collection or isolation of the microbes and their identification. It’s challenging to pinpoint the origin of infection or the site of an outbreak or arrive at a realisation that a bioterrorism attack has been unleashed on the population. Without such information, it would be challenging to combat the assault as we would fail to press into action the concerted efforts of various agencies entrusted with the responsibility. Insofar as preparedness of India to a bioterrorist attack is concerned, it’s incredibly deficient from the viewpoint of infrastructure, trained personnel, scientific expertise and public education. The existent institutional mechanisms lack proper coordination to counter any bioterrorism attack.
The fact of the matter is that we have not had any bioterrorism attack so far, which could be the reason why we find ourselves complacent, making our country that much more vulnerable to unsuspecting attacks, thereby considerably endangering the lives. It’s imperative that we learn and gear up fully before such an eventuality occurs and becomes a massive challenge to us. Early detection and rapid response to bioterrorism hinges upon close cooperation between public health authorities and law enforcement. However, we seem to be lacking such collaboration at the moment.
To keep India battle ready to counter a bioterrorism attack, the National Disaster Management Authority (NDMA), Govt. of India (GoI) has proposed a model instrument where participation of both government and private sectors is a sine qua non to defeat any such attack. As epidemics have the potential to wreak havoc on a large scale like chemical and nuclear weapons, a multi-sector approach has been envisaged to be adopted. In India, several nodal ministries have been earmarked for dealing with epidemics caused by bioterrorism.
The central departments which are involved are Ministry of Health and Family Welfare (MoH and FW) which is one of the main ministries tasked with providing directions and technical support for capacity building, surveillance and early detection of an outbreak. Health ministry also helps in the deployment of Rapid Response Team’s, human resources and logistic support. The Ministry of Home Affairs (MHA) is another nodal ministry which works in conjunction with MoH and FW. MHA is responsible for the assessment of the threat, intelligence inputs and implementation of preventive mechanisms. National Disaster Response Force (NDRF) is a specialised force constituted under MHA to deal with chemical, biological, radiological and nuclear (CBRN) attacks. It consists of 12 battalions, three each from the BSF and CRPF and two each from CISF, ITBP and SSB.
Each battalion has 18 independent specialist search and rescue parties of 45 personnel each including engineers, technicians, electricians, dog squads and medical/paramedics. The total strength of each battalion is 1,149. All the 12 battalions have been equipped and trained to respond to natural as well as human-made disasters. Battalions are also trained and equipped for response during CBRN emergencies. Besides, the Ministry of Defence (MOD) manages the matters and consequences of biowarfare. Clinical case management is backed by the Indian Army, as they have several hospitals nationwide. They use ambulances, aircraft and ships to handle casualties. The Defence R&D Organization (DRDO) is actively pitched into developing protective systems and equipment for troops to contend against nuclear, biological and chemical warfare.
The other ministries which are also responsible are the Ministry of Environment, Forests and Climate Change for evaluation of short and long-term consequences, the Ministry of Agriculture, the Department of Animal Husbandry, Dairying and Fisheries, Urban or Rural Development Ministry and Department of Drinking Water Supply, Indian Railways etc. NDMA has been made responsible for promulgating policies on management and approving plans of different ministries. And the National Crisis Management Committee (NCMC) coordinates and monitors responses in crises especially in disasters. It provides strong coordination and implementation of relief measures during disasters.
In order to enhance the preparedness of India towards bio-terror attacks, we should emulate the West and formulate training exercises and implement technologies that are being adopted in countries like the USA and Europe. For instance, the state of New York in September 2016, held the fourth edition of its massive emergency response training exercise called the Excelsior Challenge, which is a training exercise designed for police and first responders to become familiar with techniques and practices should a real incident occur. “In 1999, the University of Pittsburgh’s Center for Biomedical None Informatics deployed the first automated bioterrorism detection system, called Real-Time Outbreak Disease Surveillance (RODS), which collects data from many data sources and uses them to detect a possible bioterrorism event at the earliest possible moment.
The city of New York has developed unique software to combat bioterrorism. The tool called the New York City Syndromic Surveillance System tracks disease progression throughout the City of New York. We would do better if we conduct exercises like “Dark Winter” to know our preparedness and inadequacies in overcoming bio-terror attacks.
Bioterrorism is a low-probability, high-impact event. Biological agents imperil human, livestock and crop health, and thereby hurt the Indian economy. It’s therefore imperative that we enhance our understanding of them with the intention of dealing with them effectively. Political awareness and public participation are indispensable for threat alleviation. In a country like India, where the population is on the increase by the day and has exceeded a billion, preventive strategies and efforts against bioterrorism require to be strengthened, improved and made useful. Such preparedness against bioterrorism will also capacitate our populace against natural epidemics, thus transforming India into a resilient society.
Author Damian Mark Smyth says, “We’re One, we’ve always been One, we’ll always be One until we think we are not.” And herein lies our challenge, we are one, but we think we are separate; we have forgotten our Oneness. As a result of our mistaken belief that we are separate, we have created an imaginary world of duality which is leading to terrorism, war, conflict and suffering. When all the people on this planet realise they are one, there will be nothing to fight against and no strife....