Bioterrorism: Western Preparedness and Consequential Psychological Effects

Bioterrorism attacks pose a significant risk for national security and can elicit severe physical effects, including mass casualties, disabilities, and disease. Bioterrorism is the dissemination of biological agents with the express intent to cause disease, death and/or harm to society and the environment. Growing cause for concern centers on the fact that the utilization of bioterrorism may only require small quantities of biological agents to inflict debilitating harm onto a large population. Along with that, the rapid development of new bioweapons can take up to three years to procure, whereas a vaccine may take up to ten years to generate and distribute.[1]

Image: “Biohazard sticker” by J.N. Eskra, licensed under Wikimedia Commons

The wide variety of biological agents and non-specific medical symptoms makes it difficult, if not impossible, to provide a specific defense against all bioterrorism threats. Because biological agents are unpredictable and incredibly resilient, biological weapons are difficult to control, potentially devastating on a global scale, and prohibited globally under numerous treaties. Symptoms of exposure to biological agents tend to be non-specific and may be falsely diagnosed as a benign disease, as seen with the easily transmitted COVID-19.

Psychological and emotional effects experienced after a major biohazard event, or threat of attack, give cause for concern over heightened levels of anxiety, depression, and hostility towards others. In October 2002, 13 people in South Wales came in close proximity to a suspicious package alleged to be transporting bacterium spores known to cause anthrax. Although the package contained no hazardous material of any kind, researchers determined 45% of individuals who came in contact with the package displayed a significantly higher Hospital Anxiety and Depression (HAD) anxiety score than those who were not directly exposed.[2] Higher depression scores were also reported among the examined group.[3] The following year, amid the SARS outbreak, quarantined patients in Toronto, who were deprived of family visits, experienced emotional and behavioral symptoms such as insomnia, anxiety, and interpersonal friction with medical staff.[4] Studies suggest that if left untreated, the severity of these symptoms may progressively fester.[5]

Another matter for concern is the rising account of persecution and abuse stemming from xenophobia as it relates to biohazard incidents. With the current COVID-19 disease, some individuals of Asian-descent fear they are now targets of racist behavior. Irrational fear linked to the virus’ Asian origin has generated anxiety among non-Asians with regards to immigration, globalization, and bioterrorism. As a result, increasing numbers of people of Asian-descent are reporting being persecuted and abused physically, mentally, and emotionally.[6]

Additionally, biohazard events routinely provoke mass anxiety and lead to loss aversion and panic buying, adversely affecting natural and man-made resources. During crises, people typically overstock on necessary emergency supplies to reclaim a sense of control in a seemingly powerless situation. The threat of the unknown elicits people to draw on perceived similar threats, which may influence individuals to lower one’s risk by gathering resources. Amid COVID-19 anxieties, people have overstocked on resources such as water, hand sanitizer, and surgical face masks—which have risen to more than $100 on sites like Amazon and eBay.

Image: “Mexico City Empty Shelves in a Supermarket Swine Flu”, licensed by Wikimedia Commons

As a result of shortages and gouging, companies like Amazon, have reportedly removed over a million basic-needs products from their site.[7] Furthermore, British pharmacies have rationed the sales of hand sanitizers to two bottles per customer.[8]

Biological threats have also raised public concern over human error within emergency services, namely, misidentification of infected patients during the incubation period. According to a 2009 Canadian study, survey findings indicated that most of the emergency service providers were not adequately trained to identify and work in contaminated environments with chemical, biological, radiological, and nuclear (CBRN) agents.[9] This lack of training and preparation has also been prevalent amid the COVID-19 crisis. In February 2020, one hospitalized patient was not properly diagnosed during the incubation period because his symptoms did not fit the existing Center for Disease Control and Prevention (CDC) criteria. Within the same month, a hospitalized woman in San Diego had tested negative for the virus and was permitted to return to the quarantine area.[10] It was later determined that the infected patient’s samples were misplaced and never tested for the virus.[11] The late diagnoses in both cases may have exposed greater numbers of non-infected individuals to the virus. This serves as an important reminder that more effective crisis management training needs to be implemented. In a March 1, 2020 statement, U.S. Vice President Mike Pence reported the CDC is now taking measures to distribute approximately 15,000 diagnostic tests to state and local health officials.[12] Additionally, the government is cooperating with the private sector to distribute 50,000 more tests.[13]

Currently, U.S. disease detection systems are unable to meet the needs of a potential bioterrorism attack due to antiquated detection technology. The current available systems in the U.S. reflect a gap in detection. These systems fail to address the following criteria: 1) rapid and accurate technology required to identify agents; 2) the capability to identify biothreat agents in extremely low concentrations through various matrices; and 3) portability and efficiency to detect multiple threat agents.[14] Early recognition allows for the minimizing of casualties and the proper allocation of necessary resources; therefore, detection methods will need to improve if a biological incident is to be adequately mitigated.

Image: “Biological team protects Balad Airmen from bioterrorism” by Master Sgt. Bryan Ripple, licensed by

One issue with the current surveillance infrastructure is the over-reliance on passive systems, such as voluntary disease reporting from healthcare providers. This form of information gathering is limited by coverage, timing, sensitivity, and is unsuitable for bioterrorism surveillance needs. Federal agencies, such as the CDC, utilizes passive surveillance systems like the National Notifiable Disease Surveillance System (NNDSS), which does not guarantee early detection. Conversely, active surveillance (i.e. the Sentinel Surveillance Networks) provides more accurate information, however, requires a sufficient number of trained epidemiologists to interpret data and to identify biological agents.[15] This can be an issue in states that have inadequate staffing and inefficient information-sharing practices.[16]

U.S. biodefense experts are pushing to improve the Department of Homeland Security (DHS) BioWatch diagnosis process. Initiated in 2003, following the 2001 anthrax bioterrorism attacks, the BioWatch program is responsible for circulating biological agent detectors throughout the nation.[17] However, medical results can take up to 36 hours to confirm the presence of a biological agent.[18] Experts have urged DHS to replace BioWatch with a more efficient initiative, but have cautioned that proposed DHS substitutes, like the Biodetection 21 (BD21) system, are insufficient.[19] A more logical solution to this gap would be to provide portable sampling units that guarantee faster conclusions. Unfortunately, this technology does not currently exist, and federal, medical, and R&D organizations will need to cooperate with each other to develop an adequate replacement.

Biohazard events have the potential to supersede isolated incidents, making government and private partnerships and shared intelligence essential to preserving critical assets. Information-sharing assists decision makers and stakeholders with threat assessments, preventative strategies, and crisis planning. CTG and AOCs (Agencies, Organizations, Companies) can play a major role by identifying suspicious individuals, or groups, that have the capabilities and intentions to launch an unconventional attack. Additionally, CTG can provide a robust assessment on specific defensive measures to strengthen vulnerabilities and secure assets. AOCs throughout the world are actively searching for new ways to counterattack biological events through scientific research and vaccine development. To address the psychological and behavioral effects of bioterrorism, AOCs should improve public awareness through announcements and open access information. CTG can assist in this task by providing services such as emergency response, risk mitigation, and emergency response training.

Image: “White powder’ prompts bioterrorism exercise” by Kemberly Groue, licensed by

CTG is taking measures to prepare for future biological threats to society, in terms of detection and prevention. CTG watch officers cypher through numerous open source information to monitor the proliferation, transportation, generation, and dissemination of dangerous biological agents. Through CTG’s W.A.T.C.H. program, analysts are better prepared to assist with and discuss possible solutions on how to deter and defeat bioterrorism. Working in coordination with CTG’s Weapons and Tactics team, the Behavior and Leadership (B/L) team is in the process of conducting comparative research into behavioral and psychological effects, as it relates to former bioterrorism events. Collaborated efforts and thorough analyses will allow CTG teams to provide proper assessments and reasonable preventative methods to counteract a premeditated biohazard event.


[1] "Biological Threats and Terrorism: Assessing The Science and Response Capabilities: Workshop Summary", Institute of Medicine (US) Forum on Emerging Infections, 2002,

[2] "Acute psychological effects of suspected bioterrorism", J Epidemiol Community Health, 2003,

[3] Ibid.

[4] Ibid.

[5] "Emotional and Behavioral Consequences of Bioterrorism: Planning a Public Health Response", The Milbank Quarterly, September 2004,

[6] “What's spreading faster than coronavirus in the US? Racist assaults and ignorant attacks against Asians”, CNN, February 2020,

[7] "Coronavirus: The psychology of panic buying", BBC, March 2020,

[8] Ibid.

[9] "How Prepared Are We for Possible Bioterrorist Attacks: An Approach from Emergency Medicine Perspective", Scientific World Journal, 2018,

[10] "The glaring loophole in U.S. virus response: Human error", Politico, March 2020,

[11] Ibid.

[12] Ibid.

[13] Ibid.

[14] "How Prepared Are We for Possible Bioterrorist Attacks: An Approach from Emergency Medicine Perspective", Scientific World Journal, 2018,

[15] "Surveillance And Detection: A Public Health Response to Bioterrorism", US Air Force Counterproliferation Center, February 2002,

[16] Ibid.

[17] “Homeland Security replacing troubled biodefense system with another flawed approach”, Los Angeles Times, February 2019,

[18] Ibid.

[19] Ibid.

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