September 18th, 2001. New York City. United States of America.

Five letters were mailed through the United States Postal service to five media outlets in New York.

Three weeks later. October 9th, 2001. United States of America.

Two more letters were mailed to two senators from different states

These letters, sent a few weeks after the attack on the World Trade Center, killed only five people and left eleven people critically ill. But it left the American population more scared than ever because it proved that the public was susceptible to a bioterrorism attack.

The culprit in the 2001 US Postal Service attacks was a bacterium called Bacillus anthracis - simply known as Anthrax. 

Bioterrorism has become a commonplace name now. From video games to Hollywood blockbusters, bioterrorism has become a pop culture icon that has become almost fantastic. But the reality is that we don’t quite understand how bioterrorism works. Nor do we understand the massive threat that it poses. 

Imagine that you’re living in the city of Hiroshima in Japan during World War II. Now imagine the day the United States dropped the atom bomb on the city of Nagasaki. Once the bomb was dropped and the damage was done, you knew that it was over and that you only had to deal with the aftermath. It was predictable. There was the radiation and the death toll and then loss of infrastructure that you had to deal with and you had to be prepared for a future attack. Of course the devastation caused by that bomb was inhuman and unforgivable, but at least the people knew that it was over. 

This is how conventional weapons work. More or less, the bigger they are, the more damage they cause. Once they hit, their action is short lived. And you can mount a defence against them. But most importantly, you know when their effect is over. The problem is the aftermath.

Now imagine a biological weapon. Actually, lets take a historical example. 

The year is 1519, and Spanish explorer Hernan Cortes landed on the shores of Mexico. It was a time of exploration and the sailing across the Atlantic in search of the New World was all the rage. So Cortes got money and found himself a fleet and set sail across the Atlantic and wound up in Mexico. 

However, he did not come to Mexico alone. He brought with him slaves and an army of Spanish soldiers. One of the slaves had small pox. From the slave, a Spanish soldier got it but he died in the war. And from the dead solider the Aztecs got it. 

With no immunity against the deadly disease, the natives died in the thousands and the massive Aztec empire fell to a mere handful of Spanish conquerers.

But the problem wasn’t just the deadly pathogen. The disease was so rampant that it took a massive toll on the Aztec public. In fact, the local population was so demoralised and confused that in a fit of anger, the population stoned their own king to death.

"As the Indians did not know the remedy of the disease...they died in heaps, like bedbugs. In many places it happened that everyone in a house died and, as it was impossible to bury the great number of dead, they pulled down the houses over them so that their homes become their tombs." 

This was an observation made by a Spanish monk. 

But this isn’t the only example. Diseases have been used to wipe out nations and populations through out history. 

As early as 600 BC there is evidence of bio warfare. King Solomon used the the herb Hellbore in the siege of Krissa. The water of the city was laced with the herb which rendered the defender so weak with diarrhoea that the city fell. 

In 1346, during the siege of Caffa by the Tartar army, the Tartar army had an outbreak of plague. Ingeniously, the army flung the cadavers of the dead soldiers into the city starting an epidemic. 

In 1495, the Spanish mixed the blood of leprosy patients with wine and served it to the French soldiers they were fighting in Italy. 

In 1797, the British gave blankets riddled with small pox to the native Americans and wiped out almost 90% of their population. 

In 1863, the yellow fever and small pox was used to weaken the army of the North in the American Civil War.

In 1995, a radical group called Aum Shinrikyo used Sarin gas in the Tokyo subway system. 

In 2001, the US faced the anthrax scare. 

In 2017, Sarin was used ruthlessly in Syria leading to mass casualties.

So why is it so important for us to know about it now? 

Our technology is making leaps and bounds and we are now able to “Weaponize” these biologicals. We can now make the spores of Anthrax as small as we want so that they can reach the smallest of the bronchioles in the lungs. We now have the technology to make aerosolised sprays of dangerous chemicals which causes them to be spread out over a larger area. We are capable of genetically engineering micro organisms so that they are resistant to commonly found antibiotics. 

Unfortunately, while it should be a matter of pride and scientific achievement for us as a race, these achievements have left us scared because we don’t know when they will be used against us. And this is the key stone of Bioterrorism. 

Bioterrorism is so effective as a weapon because it breaks a population down from the inside out. It builds fear in the hearts of the populace and destroys their morals. They don’t know what they are fighting, or how it will spread. Many a times, there is no effective mechanism of defence. 

Take small pox, for example. Due to extensive vaccinations, the disease has been eradicated from the world. But the vaccinations have been stopped and as a result essentially the whole world is susceptible to the disease. And even though in 1984, all the viruses were destroyed and only two samples were left in America and Russia, there are still fears that there may be radical groups that have small pox samples and are planning an attack. 

The lesson from Bioterrorism is this. We as doctors must recognise that the world is a terrible place. As a race we have taken creatures of nature and have decided to use them to show our dominance over our own race. Its a pathetic excuse for progress, but it is the truth. 

The second lesson is that the future of our civilisation is headed towards this. So, as medical professionals it is up to us to know what the potential weapons of bioterrorism are and how we can defend and protect those in our care against them. 

Because in this war of unseen pathogens, we are the soldiers of fortune.