Bio-warfare
Intentional use of disease causing organisms or products of organisms to harm populations to attain a military objective (war against an enemy)
Bioterrorism
Intentional use of disease causing organisms or products of organisms to harm humans, other animals or plants in order to cause civil unrest and panic or to commit a crime (trying to terrorize people)
Attributes of Biological Weapons
-Readily available, "easy to grow"
-Inexpensive
-Highly transportable
-Not easily detected
-Tasteless, odorless, invisible
-Suicide "infectors" (like suicide bombers)
-Cause large scale panic
-No damage to infrastructure (warfare- unlike bombs- only infec
Disadvantages of Biological Weapons
-Morally and socially unethical
-Delivery can be tricky
-Difficult to control spread
-Hazard to self
-"Pandora's Box" - open and let things come out-can't take it back
History of bio warfare
-Ancient Romans threw carrion into wells to poison their enemies
-Hannibal (Carthage) in 184 BC, hurled pots of venomous snakes onto Pergaman ships
-Bodies catapulted into Caffa by Mongolian army
*Purposely trying to infect people, to your advantage
French and Indian War bio warfare
1754-1764
The English used small pox-laden blankets in 1763 at Fort Pitt to subdue Indians loyal to the French (Even before Germ Theory of Disease)
World War I bio warfare
1914-1918
German Secret service covertly used the bacteria that causes glanders and anthrax to infect animals used by the Allies during WWI (infected horses to impede transport-damage enemy's ability to travel)
Geneva Protocol 1925
International agreement
-Put into effect 1928; 29 nations signed including US
-Treaty: "A protocol for the Prohibition of the Use in War of Asphyxiating Gas, and of Biological Methods of Warfare."
-Banned all use during war
-Treaty was not ratified by US
Post-Geneva Protocol
-Bacillus anthracis (anthrax) and other agents were developed for weaponization by: US, Germany, Great Britain, Japan, Russia after the Geneva Protocol was in place!
-Protocol didn't mention production, storage or transfer of biological agents
USSR biological warfare program
Program started in 1928
-Developed Scientific Research Institute of Microbiology (SRIM)
-Bioweapon (BW) developing and testing
USSR ceased to exist after December 26, 1991
-12 republics formed
Works War II: Stalingrad 1942
-Soviets MAY have infected German Panzer troops with tularemia-causing bacteria in Battle of Stalingrad
-Outbreak spread through Stalingrad, resulting in >100,000 cases tularemia (also naturally)
-Germany was defeated, turning point!
US biowarfare program
- Camp Detrick
-British wanted a biological weapons program (suspected Germany had one) but Britain was constantly being bombed
-US started one April 1943 (our soil, injunction with them)
-Since 1969 used for biological defense program
-Site of several US
Japan Biological warfare program
-Japan invaded Manchuria in 1931
-Developed Unit 731 as a BW research, development and production facility
-Thousands of Chinese, Koreans, Russians, criminals and P.O.W.'s experimented on
Ping Fan, Manchuria
Agents most developed: plague, *anthrax, choler
Pine Bluff Arsenal 1950 (US)
-BW production facility on 14,000 acres
-Manufactured organisms that cause: Brucellosis, Tularemia, *Anthrax, Q-fever, VEE, Botulinum toxin
-Many different kinds
-High security- don't want to be bomb site
Biological and Toxin Weapons Convention (BWTC)
1972
-Banned the research, development and use of biological agents for warfare
-Mandated destruction of all stocks
-USSR, assuming the US would not stop work, continued there program
-Lacked any formal inspection system to ensure compliance (no way to kn
Biopreparat
-Soviet bio-research laboratories and production plants under a supposedly non-military umbrella
-Weaponized agents, made better BWs and designed effective delivery systems
-Kanatjan Alibekov decided to defect to US (sneak out of country of origin and nev
Vector Laboratory Complex
Built in Siberia, 1975
-Largest, most sophisticated BW facility ever built
-10,000 of the most dangerous/exotic viruses known including:
--140 varieties of small pox
--Hemorrhagic fever viruses (bleed out): Ebola, Lasssa fever, Machupo
Soviet Union and Small Pox
-1958 the USSR proposed the eradication of small pox, knowing what a good BW it would be
-Weaponized a highly virulent strain
-Perfected mass production and stockpile of hundreds of tons
-Delivery system included aerial bombs and ballistic warheads
1970-8
South Africa: 1980s-early 1990s BW program
-World's largest CW/BW program
-Covert drops in Namibia and Mozambique (Botulinum toxin, Vibrio cholera, Hepatitis A) for political gain
-May have attempted assassinations of members of African National Congress
-Sound attack?
Iraq: 1980s-1990s BW program
-Extensive BW program (Bacillus anthracis, Botulinum toxin, Vibrio cholera, Yersinia pestis, Ricin and afla toxin)
-Sadom Usain had these (weapons to deliver and agents)
-Range of delivery devices (Scud missiles, bombs, rockets, spray and drop tanks
-Got
Anthrax Attacks 2001
Came in two ways through the mail
-Media targets: September 18 (news rooms)
-Government office targets: October 9
-People affected in Conn, NJ, NY, Wash DC, FL
-Letters passed through sorting machine contaminating postal workers
-> People all over very af
Who was responsible for anthrax attacks
-Senior biodefense researcher at USAMRID was key suspect- Bruce Ivens
-Committed suicide July, 2008 upon news of FBI's intent to charge him
-No charges were filed, no direct evidence uncovered
-FBI closed the case, questions remain
Meeting the treat of Bioterrorism
Preparedness
-build drugs and vaccines
-research and supply
Detection and Surveillance
-infrastructure (special labs for most dangerous pathogens)
-trained personnel (how to identify)
Response to events
*Build better infectious disease network in US
*Bene
Category Agents
A: highest priority, high mortality, easily disseminated and/or person-to-person transmission
ex) smallpox, anthrax, plague
B: moderately easy to disseminate, moderate morbidity and low mortality
ex) Typhus, Q fever
C: include emerging pathogens that coul
Emerging Infections
Infectious diseases whose incidence in humans has increased recently
Re-emerging Diseases
Infectious diseases that were under control and are now on the rise
Factors in Infectious Disease Emergence
-Human demographics
-Societal behavior changes
-Human susceptibility to infection
-Breakdown in Public Health
-Technology and industry
-International travel and commerce
-Economic development and land use
-Poverty and social inequality
+ Microbial adaptio
1.) Global Air Travel
Microbes travel from continent to continent- hard to stop
ex) Zika
Zika Emergence (Short history)
-First seen in Uganda in a monkey (1947)
-14 human cases in Africa and South Asia (1951-2006)
-Outbreak on Yap, 73% of pop infected (2007)
-French Polynesia outbreak (2013)
-Brazil- first new world case (2014)
-WHO declared International Health Emergency
Zika Virus
-Transmitted by mosquito bite
-No treatment or vaccine available
-Symptoms: fever, rash, joint pain, conjunctivitis (red eyes)
-Symptoms normally last 2-7 days
-Illness is usually mild and death is rare
-Other ways to contract: mother to fetus, sex, blood
Challenges facing Malaria
-Surveillance
-Mosquito control
-Public Health systems overwhelmed
-Population of children with microcephaly (following up with them)
Zoonoses
Diseases of animals (reservoir hosts) that may be transmitted to humans under natural conditions (live in animal reservoir -> spill over into humans if opportunity arises)
-Most zoonoses have a vector (insects, ticks or mites)
-Examples of zoonotic infect
Lyme Disease
Increased deer populations and deer mouse populations in proximity to human habitation
-Lyme disease correlates directly with deer population density
-Transmitted to humans via deer tick(blood meal mice/deer -> blood meal us)
-Most common vector borne ill
Monkey Pox
-Discovered in 1958 in monkey colony
-First human case 1970 in DRC
-Human to human transmission well documented
-Direct contact, respiratory tract or mucous membranes (eye, nose, mouth)
Similar to Small Pox but MILDER (but still very sick)
-Fever, headach
Requirements for Emerging Human Pandemic
-Emergence of a novel pathogen (brand new or longtime since)
-Immunologically naive population
-Replication in humans -> disease (spill over into humans)
-Efficient human to human transmission
The National Strategy for Pandemic Influenza
-Stop, slow or limit the spread of a pandemic TO the US
-Limit the domestic spread of a pandemic, and mitigate disease, suffering and death
-Sustain infrastructure and mitigate impact tot he economy and the functioning of society (minimum impact to econom
Ebola first outbreak
First documented outbreak 1976 (Yambuku Mission Hospital, N. Zaire) treated by catholic flemish nuns- did not have right diagnostic tools. Most died, disease spread quickly to families and patients at hospital.
Hospital full of very sick patients
-Doctor
Ebola virus identified by _____ ____, Belgian scientist
-Peter Piot
Ebola Tranmission
-Incidental infection in humans, no carrier state? (Don't think there's a carrier state- people who have ebola get sick)
-Spread via direct contact with blood/secretions/vomit
-Nosocomial risk is high (not spread through air, not vector born)= get sick in
Ebola Treatment
-No "standard" treatment
-Supportive care
Experimental treatment
-Transfusions from survivors
-New anti-viral drugs
-Trial on people- early experimental stages
-Ethical to withhold a possible treatment? Do we try it? -> If don't have anything else
Ebola in the US: Kent Brantly
First case brought to the US for treatment
-Contracted ebola by working with infected patients
People anxious- fear of disease- fearing victim/blaming victim
Ebola transmission in the US
Thomas Duncan- first case of ebola diagnosed in the US (Liberia -> Dallas, TX
-Came in through normal flight- no symptomology
-Screening- temp, symptomology
-2 nurses contracted ebola from him
-He died October 8, the nurses survived
*Huge miss of hospital
End of the Outbreak
-March 2016 Sierra Leone
-April 2016 Guinea
-June 2016 Liberia
-28,652 confirmed, probably and suspected cases
-11,325 deaths
- >10,000 survivors
Current Ebola Outbreak
Democratic Republic of the Congo
-Began Aug 1, 2018 in North Kivu Province
-10th outbreak in DRC
As of April 21, 2019
-1290 cases
-833 deaths
-Healthcare workers (becoming infected and dying): 89 cases (32 deaths)
*Need better control on this. It is neces
Actions taken to prevent ebola
1.) Surveillance and contact tracing
2.) Case Management
3.) Points of Entry control
4.) Safe and Dignified Burials
5.) Ring Vaccination (hopeful)
Origin of HIV
-1900-1940 HIV enters humans multiple times from chimps in W. Central Africa
-Viral, host and environmental factors contributed to the virus spreading
-Colonial medicine societal change aided virus spread
HIV/AIDS History
5 strange pneumonia diseases in young (gay) men in the US (1981 Los Angeles)
-Suggest the possibility of a cellular-immune dysfunction related to a common expose
-> No clue what's causing this, happening to all gay men (grouping)
Time course of HIV infection
Acute infection and lot of HIV RNA in blood
-Long HIV+ asymptomatic phase
-Development of AIDS when immune system looses control of virus (peak again). T cells so low that can no longer control virus. Start to catch other weird disease because of weak imm
Wasting Syndrome
-10% loss of body weight in 30 days
-Chronic diarrhea, fever, weakness
-Affects most patients
-"Slim" disease in Africa
Cancer Risk of HIV
1.) Kaposi's Sarcoma: skin cancer that can become systemic
-Originally "Gay Cancer"
2.) Non-Hodgkin's Lymphoma (blood cell cancer)
-70% higher in AIDS patients
3.) Cervical Cancer
*Take away cells that can defend against these
1990's
-Perceptions began to change
-Ryan White CARE Act (money to fight disease)
-New HIV drugs (HAART)
-UNAIDS begins operation
-NEPs declared effective (needle exchange programs)
1999
-AIDS 4th killer worldwide, 1st killer Africa
-33 million HIV+, 14 million
Hemophilia Treatment 1978
-1 batch of Factor VIII that was HIV+ injected into between 2300 men and boys
-They require frequent injections
-Typical hemophiliac exposed to blood of 1,250,000 - 3,250,000 people
-Therefore: a rare microbe that occurs in 1 out of 3 million people is ac
Needle Exchanges
-Provide sterile needles in exchange for dirty needles
-Estimate 15-20% IDUs are HIV+
-1/5 of newHIV infections are IDUs
Cons:
-increase drug use
-"safe use" possible
-decrease getting clean
-1 clean use
Pros:
-Not harassed - only way it's legal
-decrease
Why it's such a huge problem in Africa: Africa's President
Thabo Mbeki
HIV denialist
-Believed people in poverty caused AIDS
-Refused to fund diagnostics and treatment (even in pregnant women)
HIV: some behavior control the spread
HIV is easily the most complex infectious diseaase of our time both _____ and ______
Biologically and socially
Negative attitudes/responses towards HIV/AIDS
-Blame victims (homosexuals, hemophiliacs, heroine users, Haitians (brought back after teaching abroad))
-Ease fear of infection
-Relieve responsibility for taking action (ignored for a while: President Reagan)
Jessie Helms, North Carolina: against all so
Positive responses to HIV/AIDS
-Charitable organizations focused on HIV/AIDS
-Increasingly string international relief response
-Individuals given a voice
- patient care became bett
-Elizabeth Taylor: American Foundation for AIDS research- first time foundation out together to research
Patient Rights Movement
First large, vocal, angry group
-Increased funding
-Fast-track drug approval (only approved drug at the time was AZT, which was very expensive and toxic to body)
-Paved the way for others to advocate for their cause
AIDS Quilt: made of panels crafted by t
What impediments exist to controlling HIV/AIDS?
1.) Stigma- getting tested and getting the news is a traumatic event and then have to tell spouse
2.) Cost
3.) Getting into the high risk populations and to the people who don't want help
Major AIDS Relief Organizations
1.) Global Fund
-HIV, TB and Malaria
2.) PEPFAR
-Global Fund + US government agencies + indigenous organizations
3.) UNAIDS
-Leadership, advocacy, tech assistance, monitoring, relief, Millennium Goals
4.) WHO
-Evidence based tech support
Looking into the future
-New infections decreasing, life expectancies increasing in many countries
-HIV $$ are building sustainable primary health care systems (to serve all needs- malaria, broken leg, etc.)
-Need more effective prevention measures
What are keys to success?
Science-based HIV prevention is effective when:
-Backed by high-level political leadership (unlike Africa)
-A national AIDS program (reaches everyone)
-Adequate funding
-Strong community involvement
Components of successful prevention efforts include:
-Cl
Haiti
-Occupies western 1/3 of Hispaniola
-Habited by the Taino people (>500 million)
Columbus lands in Haiti 1492 and finds what?
Found a mostly forested island:
-50% was lush tropical rain forest
-20% dry forest
-15% pine forest
-15% savannah/grassland
Lush, diverse and healthy
Also found the Taino wearing GOLD
Spanish colonize the area
-Columbus leaves 39 men from the Santa Maria at La Navidad
-Returns in 1493-4 with 17 ships and 1200 men
-Finds La Navidad in ruins (39 sailors killed)
-Spanish establish Santo Domingo on South coast
Death by Disease and Slavery
-First Smallpox outbreak recorded in 1507
-Natives dying of Old World diseases (no immunity)
-Spanish demanded gold, food and labor (enslaved)
-First African slaves as replacement labor in 1503 because many Taino people lost their lives
-Taino population
France joins Spain as colonel power
Spain ruled islands in 1500's
-Shipping base for mining
-Lost interest when gold gone
Early to Mid-1600's
-French buccaneers establish bases on west coast
-French colonists sent to "settle" area (domesticate pirates)
Spain ceded control of West 1/3 to Fra
The Jewel of the Antilles (Haiti)
-1697- mid 1700s the richest French colony
-May have had 50% of GDP of France
-Grew sugar cane, indigo, coffee, cotton
-By 1750 chief port slavers (ship dock, sell humans to slave owners)
-By 1789 importing 40,000 slaves/year (high death rate)
-Population
Trade Triangle
Slaves to Americas -> sugar, tobacco, cotton to Europe -> textiles, manufactured goods to Africa
Haitian Revolution
1791-1804
Start of the French Revolution 1791 spurs disorder in colony
-Slaves revolt
-Spain and Britain go to war with France, Britain sends troops to Spanish side of colony
-France abolishes slavery to get slave support (to get them to fight for them)
Toussaint Louverture
-A former slave, helps defeat the Spanish and English (1796-1801)
-Attacks Spanish in Santo Domingo, frees slaves and unifies island
-1801- Constitution written for unified island. No provision for French governance!
Napoleon regain control
-1801-02 sends >40,000 troops
-Plans to use island as stepping stone for an empire in the Mississippi Valley
-Louverture imprisoned in France where he dies 1803
Disease takes its toll
-By March 1802, 1200 French soldiers in hospital, 30-50 deaths/day from Yellow Fever and Malaria (destroyed infrastructure while fighting)
-Jean-Jacque Dessalines takes up revolt
-Weakened troops are defeated, 3000 return to France
Napoleon sells Louisiana Territory to the US
-Realizes defending colonies is too costly
-US can now expand westward
Haiti's Independence **
1804
**
Jan 1, 1804
-Second independent nation in Western Hemisphere (US=first)
-First and only successful slave revolt
-First in West to abolish slavery
Jean-Jacques Dessalines
Proclaims himself governor for life
-Whites forbidden to own land/property
-Maintains plantation style labor system (good economy but slave based)
-Assassinated in 1806
1843 to 1915, 16 of 20 rulers either overthrown or assassinated (never been leaders, d
Why does Haiti not get foreign recognition for over 60 years?
-All other countries practicing slavery
-It would be recognizing a successful slave revolt
This kept Haiti impoverished right from the start- no trading
Haiti makes a deal with France
-1825 Haiti agrees to pay France for lost property- salves and land (Haitians paid fine for themselves being free)
-The desmans is for 150 million francs (10x whole GDP)
-1938 France agrees to reduce debt to 90 million francs over 30 years
-$21 billion eq
US occupation of Haiti
-1915 to 1934 US military in control
-Marines disbanded their Army and started the modern Haitian Army who carried out their orders
-Brutal occupation
-Monroe Doctrine: foreign policy- US didn't want Europeans colonizing these lands because it would affec
The Duvalier Dictatorship
-Francois (Papa Doc) ruled from 1957-1971
-Jean Claude (Baby Doc) ruled from 1971-1986
*Long time considering history of coups
Coup: military wants to take out leader, storms building, leader leaves office
Papa Doc
-President 1957-1971 (until death)- declared himself president for life (wrote in the Constitution that his son would take over after him)
-Doctor promising to champion the cause of the poor black majority
-Had support of military, but tried to oust him 1
Baby Doc
-Became president at age 19 in1971 until overthrown in 1986
-Continued the lavish lifestyle, murder and repression
-US relations continued to warm, mainly by anti-Cold War sentiment (communism vs democracy)
-Opened doors to NGOs and manufacturing
-Haiti's
Destabilization in Haiti
-African Swine Fever Virus- eradication of pig population (US decision, tried to replace with US pigs but they couldn't survive in Haiti)
--> They were robbed- pigs were their capital (exchange for goods and services)- never reimbursed
-HIV: 1982 CDC coin
Jean Bertrand Aristide
-1983: ordained a catholic priest and assigned to a poor parish, St. Jean-Bosco
-Preached Liberation Theology
-Created a following among the poor
Aristide Elected President
-December 16, 1990 with 67% of vote
-*First democratically elected president
-Army and many wealthy Haitians opposed his "dangerous ideas" (O for the P, options for the poor)
-Violent military coup ousted him in September 1991 (9 months later removed from
Aristide returns to Haiti
1994 President Clinton intervened to restore constitutional democracy
-Aristide reinstated as president
Examples of reform initiated
-Military demobilization (was only used against own leaders)
-Human rights investigations (secret police)
-Tonton trials
1
2000 Aristide re-elected
-91.7% of popular vote
-Fanmi Lavalas political party
-Still powerful opposition in Haiti, France and the US
-US and others slow assistance to Haiti
-Development at a stand still, government running out of money (others countries are doing this to try to
2004: Resignation/Coup
-Flown (with wife) on a US plane to Central African Republic and then on to South Africa
-US backed administration put in place, UN peacekeeping force
-Fanmi Lavalas party members and leaders purged (thousands killed), prevented from participating in elec
A very tough time to come
-2006 Rene Preval elected again
-2008 international economic crash and increase in food/fuel prices cause riots
-Hard hit during hurricane season (2 in a row in 1 year during worldwide economic meltdown)
-GDP decrease 10-15%
-60% harvest destroyed, infras
Michel Martelly
-Elected president November 2010
-Fanmi Lavalas candidate not allowed to run
-Allegations of widespread fraud- 12/18 candidates said the elections should be declared invalid
-*First peaceful transfer of power to opposition
-Plan announced to reinstates mi
Next President? 2015
-President primary in Oct, elections Dec 27, 2015 failed to elect a winner
-Martelly resigned Feb 10, 2016
Interim President Jocelerme Privert
-Feb 17, 2016-?
-ROLE: set up valid elections with 120 days (was late in doing so)
Next President? 2016
-Jovenel Moise won the election held on November 20, 2016 with 56% of the vote
-Voter turnout was 21%
-27 candidates, 6 who campaigned
-Took office Feb 7, 2017
Haiti Today
-Population: >10 million
-Low income ($846/cap)
-40% urban population is unemployed
-59% live on <$2.41 US/day
-61% adults are literate
-40% lack access to healthcare
-1% elite controls >50% wealth (large income gap)
Brief History of the Dominican Republic
Back and forth control
-After the Haitian Revolution, the Eastern part of the island remained in French hands
-Spanish living there revolted and France returned the Eastern part to Spain - 1808
-Haiti conquers entire island - 1822
-Eastern part revolts/be
Rafael Trujillo
President/dictator from 1930-1961
-Did try to modernize his country, mainly for his own benefit
-But he used loan money for development (did not embezzle all of it)
Joaquin Balaguer
Followed Trujillo after Civil War (1966-1996)
-During this time there was repressive rule, but more stability and developing democracy
-Dictator, infrastructure development
Interrupting Balaguer's Rule:
-Dominican Revolutionary Party (DRP) candidates Antonio Fernandez (1978) and Salvador Blano (1982)
-Balaguer back in power 1986, 1990, 1994
Since then, either DPR or Dominican Liberation Party in power
-Largest economy in Caribbean and C.Am
-Diversified s
Dominican Republic Today
2/3 of island
-Population: 11 million
-Economy: Upper middle income ($14,770/cap)
-16% unemployment
-40% live in poverty (still high)
-2.8% below $1.25 US/day (not as extreme)
-92% adults are literate (education for 6-14 y'olds)
-10% of population control
What accounts for the dramatic differences between the two countries? Why is Haiti so poor compared to the Dominican Republic?
-Population density
-Deforestation in Haiti- hurricanes-> mudslides
-Poverty trap- started with embezzlement
-> Lack of government responsibility (corrupt)
-> Decrease employment (individual level poverty trap)
-Prone to natural disasters- can't recover
-
Health in Haiti
-Life Expectancy 64 years (78 in DR)
-IMR 47 deaths/1000 live births (18 in DR)
-Major cause of death:
--Kids: diarrheal disease, LRI (respiratory), malnutrition --> preventable, can and should be addressed
--Adults: HIV, TB
-Improved sanitation access: 2
Health care services in Haiti
-Shortage of health care workers
-50% of services provided by NGOs
-75% of births have no qualified health care provider
Jacmel Public Hospital
-Served 500,000
-No surgeon, anesthetist, ob/gyn
-Docs often don't get paid
-Serious lack of equipment
-Intermi
Cholera in Haiti
-Outbreak began October 21, 2010
->665,000 cases, ~8,200 deaths
-UN publicly apologized for bringing Cholera to Haiti (Nov 2016) and pledges solutions
-Hurricane Matthew 2016- people living in tent cities, easily spread widely through water and poor sanit
Food Security in Haiti
-"Alarming" rank on the Global Hunger Index
Lack of self sufficiency
-Brought about by Globalization (the tariff on rice reduced from 35% to 3% in the 90s)
-Lack of governmental support of agriculture (as a condition for loans) and land degradation
-Food
USAID - United Sates Agency for International Development
The traditional US route for non-military foreign aid: focus is addressing poverty as a root cause of violence
-For advancing national security
-Foreign policy
-War on Terrorism
Led by a presidential appointee, guided by the Department of State
Soft Money
Where doe out money need to go?
-Infrastructure (clean water, sanitation, roads/markets, housing stock, schools, hospitals)
-Healthcare
-Business development
-Education
-Agriculture
*Everything is interconnected
*Putting money in one thing has outcomes of effecting others
(Poverty trap