Biological disasters of natural origin are largely the result of the entry of a virulent organism into a congregation of susceptible people living in a manner suited to the spread of the infection. Diseases that caused the largest disruption were plague (bubonic and pneumonic), louse-borne typhus, and smallpox, because of their high mortality. Biological disasters also encompass the livestock and crops. The National Disaster Management Authority of India has issued out comprehensive guidelines for managing all types of disasters including Biological disasters. These guidelines are summarized in the succeeding paragraphs.
The anthrax attack in the US through the postal system in 2001 which followed the tragic 9/11 events has belied the general perception that the actual threat of biological threats is minimal. Likewise, in agriculture, the inadvertent introductions of exotic species have had far-reaching consequences. The use of bioweapons became more scientific as technology for the cultivation of pathogens and vaccinology developed. Human pathogens like Bacillus anthracis, Botulinum toxin, Fracisella tularensis, Brucella suis, etc., and crop pathogens like Rice Blast, Rye Stem Rust, etc., were developed into bioweapons. Consciousness is increasing about the fact that apart from human targets, bioweapons could be used to attack agricultural crops and livestock. There were many instances in history where in bioweapons were used as a form of warfare.
Dispersal experiments have been attempted. WHO studies show that 50 kg dispersal on a population of 500,000 would result in up to 95,000 fatalities and over 125,000 people being incapacitated? Other experiments have also shown similar disastrous outcomes. The economic impact of biological threats would be a major burden that could transcend the medical consequences. It has been estimated that the use of a lethal agent like Bacillus anthracis would cause losses of $26.2 billion per 100,000 persons exposed, while a less lethal pathogen, e.g., Brucella suis would cause $477.7 million. A biological threat attack on agriculture can cause as much economic loss as an attack on human beings.
Management of biological disasters will focus on all aspects of Biological Disaster Management, including biological threats, with a focus on prevention, mitigation, preparedness, medical response, and relief. Emphasis will be on a preventive approach such as immunization of first responders and stockpiles of medical countermeasures based upon risk reduction measures by developing a rigorous medical management framework to reduce the number of deaths during biological disasters. Major inputs for successful management of biological disasters is acquiring the capability of rapid epidemiological assessment, identifying assessment tools such as mapping, use of Geographic Information System and Global Positioning System, vulnerability assessment, risk analysis, and use of mathematical models. This would help in strategic decision making for public health interventions.
Environmental assessment and strategic interventions are increasingly becoming a priority issue. Climate change is creating an enabling environment conducive for vector-borne and zoonotic diseases. Areas which require attention are water quality monitoring, food safety and security, vector control, animal health surveillance, sanitation and solid waste management, and safe disposal of hazardous materials, including biomedical waste. Biosafety laboratories are required for the prompt diagnosis of the agents for effective management of biological disasters.
Vaccination if available against a biological agent, can offer good protection to the ‘at-risk’ population.
Use of medication as a public health strategy to prevent disease has been in practice. With a strong pharmaceutical manufacturing base, mobilization of millions of doses of chemoprophylactic agents is possible in the Indian context at short notice. A factor accentuating the spread of disease in India is the poor nutritional standard of the population, especially children. The network of Primary Health Centers is the backbone of the public health system through which public health measures are instituted. Primary health care systems interface with the community and are advantageously placed to detect early warning signs and report public health events.
Indian Integrated Disease Surveillance Program established linkages with all district and state headquarters, and all government medical colleges on a Satellite Network. National Informatics Center has established a ‘disease outbreak monitoring call center’ that would receive primary health care systems interface with the community and are advantageously placed to detect early warning signs and report public health events. The community will be greatly empowered if the risk is communicated and India has vast experience for instituting behavioural change through effective communication. It has been seen that creating awareness in the community not only empowers them to act accordingly, but also alleviates fear and lessens the psychological impact.
Disease outbreaks instill fear, cause anxiety and affect a large population that requires psycho-social interventions. Research and Development areas requiring attention are—operational research in forecasting, using trend analysis, mathematical modelling, GIS based modelling for molecular research on potential genetically engineered BT agents, genomic studies, specific biomarkers, new treatment modalities and advanced robotic tools.The role of the media is very important and be used constructively to educate the community in recognizing symptoms and reporting them early if found. The cooperation of the community may be ensured through judicious handling of the media.