Beyond the Dirty Dozen: A Proposed Methodology for Assessing Future Bioweapon Threats
Beyond the Dirty Dozen: A Proposed Methodology for Assessing Future Bioweapon Threats
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DOI：
10.1093/milmed/usx004
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发表时间：
2018-01-01
影响因子：
1.2
通讯作者：
Smith, James O.
中科院分区：
文献类型：
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作者：
Cieslak, Theodore J.;Kortepeter, Mark G.;Smith, James O.
背景：国防政策规划者和对策开发人员经常面临棘手的问题，涉及到资源和努力的优先顺序。在生物防御领域尤其如此，每一次新出现的传染病暴发都会带来关于病原体是否有可能断奶的问题。最近与西尼罗河病毒、严重急性呼吸系统综合症、猴痘和H1N1流感的经验突出了这一问题。适当地，在每一种情况下，都提出了生物恐怖主义的可能性，尽管每一次暴发最终都被证明是有自然根源的。事实上，确定暴发是否有非自然来源可能是相当困难的。因此，问题仍然存在：这些和其他新出现的传染病爆发的病原体是否会对未来的武器化构成威胁？这种威胁有多大？是否应该将宝贵的资源从其他防御努力中转移出来，以便为交战各方可能敌意使用新疾病做好准备？回答这些关键问题需要某种形式的系统威胁评估。方法：通过在北约生物医学咨询委员会内进行的广泛合作，我们开发了一个评分矩阵，用于评估此类疾病的致病因素的武器化潜力，并试图通过检查使用已知威胁因素的数据的重复性来验证我们的矩阵。我们的矩阵包括潜在武器的12个属性，并与详细的评分说明一起提供给6个北约国家的12个生物防御专家小组。研究参与者被要求在0-3的范围内对这12个属性中的每一个进行评分：传染性、感染与疾病比率(可靠性)、可预测性(和潜伏期)、发病率和死亡率(毒力)、大规模生产和储存的简易性、气溶胶稳定性、大气稳定性、传播的简易性、可传播性、预防对策的可用性、治疗对策的可用性和检测的易用性。通过检验平均分的标准差(SD)来评估评分数据的可重复性。结果：我们的结果是出乎意料的。我们的专家认为，几种常见的生物治疗疾病，如炭疽病和图拉热症，由于易于发现、缺乏传播性和现成的对策，比许多其他疾病的威胁性要小。相反，专家认为几种毒素具有很高的潜在威胁性，部分原因是它们的可靠性、毒性和缺乏可用的对策。对于更常见的威胁，专家之间的一致意见(由较低的SD确定的平均得分)更高。讨论：我们的研究旨在提供一套简明和适用的标准，北约国家可以使用这些标准来评估新出现的传染病威胁的武器化潜力。我们的结果是出乎意料的。我们认为，缺乏适当的加权因素可以解释这些结果，并建议今后的研究根据评估数据的预期用途和其他情况因素对12项拟议标准中的每一项进行权衡。我们认为，我们研究的最大价值在于编纂生物武器的属性。
Background: Defense policy planners and countermeasure developers are often faced with vexing problems involving the prioritization of resources and efforts. This is especially true in the area of Biodefense, where each new emerging infectious disease outbreak brings with it questions regarding the causative agent's potential for wea-ponization. Recent experience with West Nile Virus, Severe Acute Respiratory Syndrome, Monkeypox, and H1N1 Influenza highlights this problem. Appropriately, in each of these cases, the possibility of bioterrorism was raised, although each outbreak ultimately proved to have a natural origin. In fact, determining whether an outbreak has an unnatural origin can be quite difficult. Thus, the questions remain: could the causative agents of these and other emerging infectious disease outbreaks pose a future weaponization threat? And how great is that threat? Should precious resources be diverted from other defense efforts in order to prepare for possible hostile employment of novel diseases by belligerents? Answering such critical questions requires some form of systematic threat assessment. Methods: Through extensive collaborative work conducted within NATO's Biomedical Advisory Council, we developed a scoring matrix for evaluating the weaponization potential of the causative agents of such diseases and attempted to validate our matrix by examining the reproducibility of data using known threat agents. Our matrix included 12 attributes of a potential weapon and was provided, along with detailed scoring instructions, to 12 groups of biodefense experts in 6 NATO nations. Study participants were asked to score each of these 12 attributes on a scale of 0-3: Infectivity, Infection-to-Disease Ratio (Reliability), Predictability (& Incubation Period), Morbidity & Mortality (Virulence), Ease of Large-Scale Production & Storage, Aerosol Stability, Atmospheric Stability, Ease of Dispersal, Communicability, Prophylactic Countermeasure Availability, Therapeutic Countermeasure Availability, and Ease of Detection. Reproducibility of scoring data was assessed by examining the standard deviations (SD) of mean scores. Results: Our results were unexpected. Several familiar biothreat diseases such as anthrax and tularemia were judged, by our experts, to be less threatening than many others owing to a number of factors including ease of detection, lack of communicability, and the ready availability of countermeasures. Conversely, several toxins were judged by experts to have very high potential as threat agents owing, in part, to their reliability, virulence, and a lack of available countermeasures. Agreement among experts, as determined by lower SD about a mean score, was greater for more familiar threats. Discussion: Our study was designed to provide a concise and east-to-apply set of criteria that could be used by NATO nations to evaluate emerging infectious disease threats with respect to their weaponization potential. Our results were unexpected. We believe that a lack of appropriate weighting factors may explain these results and suggest that future studies weigh each of the 12 proposed criteria based on the intended use of the assessment data and other situational factors. We believe that the greatest value of our study lies in a codification of the attributes of a biological weapon.