Global Policy Essay, May 2013

The Bioterrorist Threat of Ebola in East

Africa and Implications for Global
Health and Security
Amanda M. Teckman
Abstract
Last years natural outbreaks of Ebola hemorrhagic fever in Africa alarmed global health experts because of
the diseases increasing appearance in Central and East Africa. The greater frequency with which Ebola is
appearing raises questions about human accessibility to the virus and human usages of the virus for
harmful purposes. The increase in natural outbreaks in the region, coupled with a possibility of a terrorist
group recruiting experts to acquire the virus and to prepare it to use as a bioweapon, should lead
policymakers to consider the risk of a deliberate outbreak. This prospect is worthy of consideration,
particularly in East Africa due to the history of terrorist attacks by different groups in the area; the potential
for these groups to obtain Ebola in the field; the lack of political capacity in the region and global will to
develop a vaccine; and the pathogens natural occurrence in the region. The possibility of a deliberate
outbreak in East Africa is a global health and security issue because of Ebolas contagiousness in a
globalized world; the increasing rate at which Ebola is appearing; the fear that could potentially arise from
misinformation during an outbreak; and the lack of a vaccine. Based on an analysis of the conditions that
make an Ebola bioterrorist attack in East Africa a potential threat, there are several recommendations for
changing or enhancing global policy with regard to infectious diseases in general and Ebola specifically.
These measures will better prevent and mitigate the spread of a deliberate outbreak and lessen the effects
of a natural outbreak.

Policy Implications

1
2

Policymakers need to recognize the benefits of strengthening global political will and regional capacity
to develop an Ebola vaccine so that terrorists or other groups are deterred from considering obtaining
the virus to use in a deliberate outbreak.
Public health organizations should intensify surveillance and prediction of natural Ebola outbreaks in
East Africa; knowledge of natural outbreaks can help mitigate a deliberate outbreak.

Global increased sharing of information and resources is key to preventing the spread of infectious
diseases, and collaboration should be encouraged; immediately after a potential Ebola case has been
identified, it should be shared with the World Health Organization (WHO) so that more resources can be
dedicated to an investigation into whether the outbreak is natural or deliberate and in order for
misinformation to be limited. Additionally, biosecurity infrastructure should be enhanced to increase state
capacity to fight infectious diseases and biological events.

Members of governmental and nongovernmental organizations working in East Africa should be trained

in infectious disease outbreaks and in how to prevent and mitigate the spread of such pathogens; in a
globalized world, increased knowledge and awareness are paramount to limiting infections and
fatalities.

Global Policy Essay, May 2013

Introduction
The Ministry of Health of the East African county of Uganda reported
an outbreak of Ebola hemorrhagic fever to the WHO on 24 July 2012
(WHO, 2012a).

Five days later, 14 died of the disease (WHO, 2012a) and by the
beginning of October, when the outbreak was declared over,
there had been a total of 24 confirmed and probable cases, 17 of
which resulted in death (CDC, Outbreak postings). On the heels
of this outbreak came another occurrence in Uganda on 17
November, killing three (WHO, 2012b). A total of seven
confirmed and probable cases and four fatalities were reported
as of 02 December 2012 (WHO, 2012b). Prior to the two most
recent occurrences last year in East Africa, there had been five
natural outbreaks of Ebola hemorrhagic fever in the east African
region since 1976 when the virus was first discovered in
neighboring Democratic Republic of Congo (Allaranga et al.,
2010, p.32). While these recent outbreaks have not resulted in a
large number of deaths, this paper focuses on the increasing rate
at which these outbreaks have occurred and how this could
affect terrorist access to the virus and the subsequent possibility
of bioterrorism.

Terrorism
refers, on the
one hand, to a
doctrine about
the presumed
effectiveness of
a special form
or tactic of feargenerating,
coercive
political
violence and,
on the other
hand, to a
conspiratorial
practice of
calculated,
demonstrative,
direct violent
action without
legal or moral
restraints,
targeting mainly
civilians and
noncombatants,
performed for
its
propagandistic
and
psychological
effects on
various
audiences and
conflict parties
(Schmid, 2012,
p.158).

The natural recurrence in East Africa of Ebola hemorrhagic fever

(Pourrut et al., 2005, p.1005), which kills 25 to 90 per cent of
those who contract it (WHO, 2012c), is cause for concern from a
global health and security perspective. Not only can Ebola be a
highly contagious infectious disease, the virus which causes it
has the potential to be used as a bioweapon (Lederberg, 1999,
p.67). The threat of an Ebola bioweapon being used in East
Africa is possible because Ebola already occurs naturally in the
region and terrorists already present in the area might want to
access the virus. Because it is an infectious disease, Ebola could
spread in the globes interconnected environment. The fact that
there is low political will to develop a vaccine maximizes this
threat because there is little to deter desire to obtain and
deliberately use the virus. This paper will examine the threat of
an Ebola bioterrorist attack in East Africa. It will also analyze the Schmid (2012, p.158)
includes in the definition
implications of a deliberate outbreak for global health and
security and will present policy recommendations for minimizing that a terrorist can be a
state actor or a nonthe threat of an attack.
state actor, indicating
that terrorism as a
Terrorism in East Africa
tactic is employed in
Before turning to the threat of bioterrorism in East Africa, I will
discuss terrorism in the region in order to establish its history. In three main contexts: (i)
illegal state repression,
this paper, I use Schmids academic consensus definition of
(ii) propagandistic
terrorism, which includes the following:
agitation by non- state
actors in times of peace
or outside zones of
conflict and (iii) as an
illicit tactic of irregular
warfare employed by
state- and non-state
actors.

Crenshaw (2008, pp.

513- 517) notes that
individuals or groups
may resort to terrorism if

other methods for

extremist change do not
work; if they are weak
and unable to recruit
enough members to
effectively change policy
using nonviolent means;
if the outlook of the
organization has recently
changed to reflect
urgency and optimism; if
new resources such as
money are acquired; or if
there have been
innovations in
technology, strategy or
weapons. While these
characteristics can be
conditions for terrorist
activity, there is no one
determinant of whether
or not individuals or
groups will engage in
terrorism.
Groups that have
engaged in terrorist
activity exist in East
Africa and have pursued
targets in East Africa. In
this paper, East Africa
refers to a region
broadly consisting of
countries in the East
African Community:
Burundi, Kenya,
Rwanda, United
Republic of Tanzania
and Republic of Uganda
(East African
Community, n.d.) and
the Horn of Africa:
Djibouti, Eritrea,
Ethiopia, Somalia,
Sudan and South Sudan
(Social Science
Research Council, n.d.).
Since 1998, there have
been several terrorist
attacks in the region,
most notably the 1998
U.S. embassy bombings
in Kenya and Tanzania
by Al Qaeda; the 2002
attacks in Mombasa,
Kenya; the 2008 suicide
attacks in Somalia by Al
Qaeda; and the 2010
bombings in Uganda by
Al Shabaab (Ploch,
2010, p.1).

The existence of terrorist groups in East Africa highlights an

opportunity for them to locally engage in terrorist acts across the
region. According to Crenshaw (2009), Al Qaeda is not a popular

movement. Instead it is a
web of overlapping
conspiracies, often piggy-

backing on local conflicts

Global Policy Essay, May 2013

The state and non-state

actors that have
previously engaged in
terrorism in East Africa
and that have ties and
access to resources in
East Africa demonstrate
the possibility of another
attack in the region. The
The Somali-based Islamist group, Al Shabaab, also exhibits
conditions that are
characteristics of a terrorist group, including an ideological
present in East Africa
commitment to jihadism and Islamic law and support from Al
Qaeda (Gartenstein-Ross, 2009). The group emerged after the (as described above by
Islamic Courts Union unsuccessfully led an insurgency against Ploch) facilitate the
the transitional and Western-backed government of Somalia. Al mobilization of terror
Shabaab grew out of a failure of other methods to implement a groups (Rabasa, 2009,
strict version of Islam in Somalia (Gartenstein-Ross, 2009). This p.xi) . While it is
important to note that
explanation of the origins of Al Shabaab corresponds with
Crenshaws characteristic of a terrorist group: the inability to
these conditions exist in
effect change through nonviolent means.
other regions of the
world, the focus of this
Terrorist groups have existed in East Africa for some time
paper is East Africa.
because many of the states in the region are weak:
One method of terrorism
Al Qaeda and affiliated groups have had a presence in involves using biological
East Africa for almost 20 years. The regions porous
weapons, or
borders, proximity to the Arabian Peninsula, weak law bioterrorism.
enforcement and judicial institutions, pervasive
Bioterrorism using
corruption, and, in some cases, state complicity in
human beings as the
terrorist activities, combined with the almost 20-year
vector from which the
absence of central authority in Somalia, have provided biological bomb would
an enabling environment for Al Qaeda and other violent ensue is a subset of
extremist groups (Ploch, 2010, p.4).
suicide terrorism
(Valenty Shepherd,
It should be emphasized here that besides the commonly known non 2006, p. 424). Ebola is a
-state actors such as Al Qaeda, individuals as well as state actors
potential bioterrorist
are clearly capable of engaging in or sponsoring terrorism and
agent (Lederberg, 1999,
should not be overlooked as potential perpetrators. Mickler (2010,
p. 67) and East Africa is
p.5) notes that the military actions of the government of Sudan in
among the areas in
Darfur beginning in 2003 could be considered state terrorism
which Ebola occurs
because there is compelling evidence that civilians were the
naturally (Pourrut et al.,
deliberate and primary targets of violence; the strategy involved
2005, p.1005). This
instilling fear into the wider regional population; and the violence
creates a threat nexus:
against civilians and communication of fear to the wider population the region, terrorism and
was intended to punish and deter support for the insurgency against Ebola. In the following
the state. Micklers characterization of the government of Sudan
section, I will discuss the
engaging in terrorism coincides with Schmids definition of terrorism. epidemiology of Ebola
and its potential to be
used as a bioterrorist
agent.
and grievances.Clandestine cells are the norm, not rallies and
demonstrations pulling in large numbers of supporters. It cannot
mobilize the vast majority of Muslims. Its options are limited
(Crenshaw, 2009) . This description of Al Qaeda highlights
several characteristics that can determine terrorist activity, such
as being weak and unable to recruit enough members.

Epidemiology of Ebola
Ebola virus, having five
known subtypes, is part
of the family of
filoviruses and causes
the infectious disease
Ebola hemorrhagic fever
(CDC, 2009, p.1). The
virus occurs naturally in
animal populations and

can be transmitted to
and among human
populations through
direct contact with the
body, bodily fluids, or
contaminated clothes or
linens of an infected
person (MacNeil and
Rollin, 2012, p.1).
Commonly, human
infection has been
associated with entering
caves or mines or
handling bushmeat (p.2)
. Telltale symptoms
include fever and
bleeding from orifices,
with an incubation
period of two to 21 days
(WHO, 2012c). Other
symptoms include
vomiting, diarrhea,
fatigue, headache, and
myalgia, which are
symptoms of other
tropical diseases
(MacNeil and Rollin,
2012, p.1). The
presence of symptoms
that are commonly
associated with other
diseases is problematic
because it makes the
disease difficult to
diagnose (MacNeil and
Rollin, 2012, p.1). A
person with Ebola
hemorrhagic fever
exhibiting symptoms
typical of common
tropical diseases can be
misdiagnosed and
mistreated, and
quarantine measures
may not be taken. This
poses a public health
threat.
Ebola virus is capable of
causing the disease
Ebola hemorrhagic fever.
The fever is infectious
and has a high mortality
rate among those who
contract it. Case fatality
rates are between 25 and
90 per cent (WHO,
2012c). As of 02
December 2012, the most
recent outbreak of Ebola
in Uganda had a case

fatality rate of 57 per cent, with four deaths

Global Policy Essay, May 2013

occurring among seven reported cases (WHO, 2012b). There is

no vaccine available for the fever and those who contract the
disease are infectious as long as their blood and secretions
contain the virus (WHO, 2012c). Scientists are working toward
finding preventive and post-exposure treatments due to the
significant threat the virus presents: Ebola virus constitutes an
important local public health threat in Africa, with a worldwide
effect through imported infections and through the fear of misuse
for biological terrorism (Feldmann et al., 2007, p.849).

Some researchers
indicate that the threat of
terrorists or other groups
obtaining and preparing
viruses for use as
bioweapons is low, but
this view should not
prevent policymakers
from recognizing the
potential threat. In order
for a would-be
bioterrorist to use a
biological agent such as
Ebola, Ebola would have
to be obtained in its
natural environment, in a
lab or be produced
synthetically. Once
obtained, it would have
to be weaponized or
prepared in such a way
that it can be used to
infect and kill.

While scientists have been conducting research for years to find

a vaccine for Ebola virus, no approved vaccine for humans has
yet been developed. On 13 June 2012, Nature reported the
publication of research in Science Translational Medicine finding
that if given a cocktail of antibodies within 24 hours of exposure
to the Ebola virus, monkeys survived and were cured of the virus
(Ndhlovu, 2012). Additionally, on 29 January 2013, research was
published in Proceedings of the National Academy of Sciences
journal showing that a vaccine protect[ed] macaques from Ebola
virus and Marburg virus infections, both prophylactically [pre exposure] and post-exposure by eliciting the body to produce
certain antibodies (Marzi et al., 2013). These are major
advancements in the search for an Ebola cure. However, an
effective, approved vaccine against viral hemorrhagic fevers for As of 2001, Carus (2001,
humans will take time to develop. Due to the threat Ebola poses p.14) counts 8 instances
in which terrorists
not only in East Africa but to humanity in general, the scientific
and political communities must place more emphasis on finding a acquired biological
cure for humans.
agents: one was from a

legitimate supplier, one

was stolen, one was selfmanufactured, two were
Ebola virus is classified by the CDC as a high-priority agent
obtained from natural
that pose[s] a risk to national security because [it] can be easily sources and three had
disseminated or transmitted from person to person; result in high unknown sources.

Threat of an Ebola bioterrorist attack

mortality rates and have the potential for major public health
Isolating an agent in its
impact; might cause public panic and social disruption; and
natural environment
require[s] special action for public health preparedness (CDC,
Bioterrorism agents). The virus ability to be used as a bioweapon
Barletta, Sands and
is a potential global security threat. However, it is important to
Tucker (2002, p. 57)
remember that the virus itself is not a biological weapon and
although not known to have occurred, only an expert would have indicate that it takes
expertise in
the ability and skill to transform the virus into a bioweapon.
Requirements for producing biological agents include obtaining microbiology to collect
the correct strain of the agent and having the skill in handling the naturally occurring
agent, growing the agent with the desired characteristics, storing biological agents and
the agent and effectively dispersing the agent (Leitenberg, 2001, that it is very difficult to
weaponize an agent
p.309).
such as anthrax. In fact,
the authors note that it
would be much easier to
buy or steal cultures of
dangerous pathogens
from academic, industrial
or commercial labs
(Barletta, Sands and
Tucker, 2002, p. 58).
While technically difficult,
obtaining a biological
agent from nature is

possible. For example,

Leitenberg notes that
the Soviets researched
and developed natural
strains of Ebola for the
purposes of biowarfare
(Leitenberg, 2001,
p.279). Additionally,
Carus (2001, p.14)
describes six cases in
which a biological agent
was acquired from
nature.
Synthesizing
Ebola or exploiting
unsecure lab
facilities
Tucker (2011, p.70)
notes that a would-be
bioterrorist needs tacit
knowledge, or skills,
know-how, and sensory
cues that are vital to the
successful use of a
technology but that
cannot be reduced to
writing and must be
acquired through
hands-on practice and
experience, in order to
synthesize a virus.
Tucker (2011, p.69)
also concludes that deskilling, or a gradual
decline in the amount of
tacit knowledge
required to master the
technology that will
eventually make it
accessible to nonexperts, including those
with malicious intent
will not occur in the
near future. Specifically,
synthesizing an Ebola
virus requires
synthesizing proteins
that make it infectious,
a process which
necessitates tacit
knowledge (Tucker,
2011, p.73).
However, Tucker (2011,
p.77) explains that the
requirement for tacit
knowledge in
synthesizing a virus
may lessen if a group
with malicious intent

Global Policy Essay, May 2013

are not easy to prepare,

keep and use. However,
could recruit a team of expert scientists. Although difficult and
an aerosol attack is
unlikely, recruiting scientists to synthesize a virus or stealing a
possible and could be
sample from a lab is still possible. For example, Rappert (2003,
p.456) notes that it is difficult to ensure ethical behavior of scientists, devastating, they note. A
as the long history of the contribution of scientists and medics to the demonstration [by
Johnson, Jaax, White and
production of biological weapons would suggest something of the
Jahrling] of fatal aerosol
difficulty of ensuring scientists refrain from contributing to such
capabilities. Despite international efforts, for reasons of patriotism, transmission of the Ebola
professionalism and profit, bioscientists have been willing to go alongvirus in monkeys
reinforces the importance
with substantial covert state-sponsored programmes. Leitenberg
(2001, p.286) indicates that Iran has succeeded in recruiting some of taking appropriate
scientists who worked in the former Soviet [bioweapons] program. precautions to prevent its
potential aerosol
transmission to humans.
Koblentz (2010, p.115) reiterates that the insider threat is a
This reveals that the
global concern because those with legitimate access to
possibility of aerogenic
pathogens may exploit that access. The growth of biodefense
infection using the Ebola
programs in the United States and around the world has
increased the risk of the insider threat: a scientist who uses his virus is an important
threat (Ustun and
or her knowledge and access to pathogens or toxins for
Ozgurler, 2005, p.3).
malicious purposes.
Zubay (2005, p.73) notes
Alternatively, research published on Ebola and Ebola manipulations that Ebola can be stable
can make it easier for a non-expert to learn about the processes
in small aerosol particles,
required to handle and prepare the virus to be used as a weapon.
and has been an effective
Although there is U.S. policy regulating dual- use research (research mode of transmission of
that can be used for both beneficial and detrimental purposes),
Ebola between animals. In
foreign research is not officially regulated (Holtcamp, 2012, pp.239- humans, the transmission
242), making it possible for an author or publisher to accidentally
of Ebola in aerosol form is
publish research that could enable the preparation, storage and
not a major mode of
usage of biological weapons. The would-be bioterrorist using this
transmission because
research would need to have tacit knowledge of the processes,
there have been few
though, as mentioned above.
human cases without
prior direct contact with
Weaponization
blood or fluid secretions
(Zubay, 2005, p.73).
Besides obtaining the virus and knowing how to handle the
However, with advancing
agent, another condition for a would-be bioterrorist to effectively knowledge about how to
use Ebola as a bioweapon would be to weaponize the virus, or manipulate viruses, the
prepare it for use as a bioweapon. This includes growing, storing traits that make these
and dispersing the agent.
[hemorrhagic fever virus
agents] difficult to
Tucker (2011, p.73) quotes virologist Jens Kuhn on the likelihood weaponize might be a
of a terrorist weaponizing Ebola: The methods to stabilize, coat, diminishing barrier
store, and disperse a biological agent are highly complicated,
(Kellman, 2007, p. 31).

known only to a few people, and rarely published. They will in all
likelihood get stuck during the weaponization process.
An article by Ustun and Ozgurler (2005, p.3) supports Kuhns
analysis, claiming that the risk of a bioterrorist attack is minimal
because bioweapons

Another form of the

weaponization of Ebola is
Ebolapox, or a hybrid of
Ebola and smallpox.
Ebolapox would cause
blackpox, causing
external bleeding, black
skin and internal bleeding
(Zubay, 2005, p. 74). A
weapon composed of
Ebolapox would possess
the violent hemorrhaging
and high fatality rate
characteristic of the Ebola
virus and the

contagiousness of the
smallpox virus.

According to Zubay
(2005, p.75), a reverse
genetics system
provides a way to
produce highly virulent
mutated viruses for the
purpose of biological
warfare or biological
terrorism. This system
involves the replication
and transcribing of the
filoviral RNA genome,
causing the formation of
functional virions from a
DNA copy of the filoviral
genome. Volchkov and
colleagues at the Institut
fr Virologie in Marburg,
Germany, used the
reverse genetics system
for Ebola to create a
mutated virus. The
mutant virus was more
toxic to cells than the
naturally occurring virus.
While Tucker (2003, p.3)
details the unlikelihood
of a terrorist obtaining
and weaponizing a virus,
he also points out the
need for global
standards to prevent
pathogens from getting
into the hands of
terrorists. [I]t is critical to
impede biological
attacks by making it
more difficult for
terrorists to obtain [in
labs] deadly pathogens
and toxins (Tucker,
2003, p. 3). Global
biosecurity, or policies
and procedures
designed to prevent the
deliberate theft diversion
of malicious use of highconsequence pathogens
and toxins (Tucker,
2003, p. 3) needs to be
enhanced.
Likelihood of a
bioterrorist
attack, Ebola,
and political
implications

Global Policy Essay, May 2013

While some authors highlight the unlikelihood of a bioterrorist

attack, others state that this should not prevent policymakers
from preparing for the potential global health and security risk
posed by a bioterrorist attack.
Badey and Cappellanti (2009, p.6) indicate that based on the
analysis of the constraints on the potential use of biological
agents by terrorists, a biological attack by terrorists remains
highly unlikely. Some researchers believe the threat of
bioterrorism is low because a terrorist would have to become
infected by the virus in order to communicate the disease to
targets (Cuhna, 2002, p.491), a suicide-infector. But according to
Bhardwaj, Srivastava and Karan (2009), besides terrorists using
cars and robotic devices to spread a disease, another concern is
suicide coughers, who have been self -infected and infiltrate
large gatherings with the intention of infecting and killing. While
groups such as Al Qaeda and Al Shabaab are known for using
suicide methods to draw attention to their causes, Tucker (2010,
p. 4) notes specifically that Al Qaeda would probably not launch
a biological attack unless it was confident it could inflict mass
casualties. Although the groups operatives may be willing to
undertake suicide missions, they do not wish to die in vain, and
a failed attack would be seen as a major setback for the
organization.

least likely to occur.

However, they also note
that states should be
prepared for a
bioterrorist attack
anyway. Because of the
potential consequences
for the targeted society
of a terrorist attack with
bioweapons,
governments must be
prepared for such an
attack. The authors
suggest a balance of
policies that prepare a
state for a bioterrorist
attack while not
overemphasizing the
threat, which could lead
to chaos.

There are political

implications associated
with the notion that a
bioterrorist attack is
unlikely, particularly with
Besides terrorists obtaining biological agents on their own, there an Ebola bioagent: the
is a possibility that states with biological agents can provide them political will to develop a
or sell them to terrorists; however, this is also unlikely. Leitenberg vaccine is low if a
(2001) cites a 1996 U.S. Defense Intelligence Agency statement bioterrorist attack is
assessed as not
that confirms this: Most of the state sponsors have chemical,
biological or radioactive material in their stockpiles and therefore probable. For example, if
have the ability to provide such weapons to terrorists if they wish. it were recognized that
an Ebola bioterrorist
However, we have no conclusive information that any sponsor
has the intention to provide these weapons to terrorists (p.290). attack were probable,
political leaders would
A state that has biological weapons capability and wants to
create urgency in finding
develop these agents for use would most likely use its own
resources of scientists to weaponize and disseminate the agent a vaccine. In addition,
Kellman (2007, p.150)
(Leitenberg, 2001, p.290). Nevertheless, the New York Times
notes that there are
recently reported the leader of Hezbollah, a militant group in
political implications for
Lebanon, announcing that Syria would be providing it with
being underprepared for
unique weapons that it never had before that would change
an attack that utilizes a
the balance of power (Barnard, 2013). The article reports
lesser-known weapon. If
speculation that these unique weapons could be chemical
Ebola were used as a
weapons.
bioweapon, authorities
Gould and Zanders (2005, p. 7) indicate that the most
would be held less
catastrophic scenarios [of biological terrorism] involving mass
accountable for being
underprepared, as
casualties, though possible, are the
opposed to an outbreak
of anthrax, which is a
biological agent that has
been used, studied and
is understood (Kellman,
2007, p.150). If political
will to create a vaccine is
low, there is little
urgency and few
resources devoted to
develop one. This lack of
political will, urgency and

resources devoted to
finding a vaccine may
tempt terrorists to try to
obtain the virus and
acquire the resources
necessary to prepare it
and use in an attack.
Another danger comes
from the fact that there is
no approved vaccine and
that the benefits of
devoting resources to
developing one was
uncertain because of the
diseases rarity, little
interest by industry, and
the potential cost
(Feldmann and Geisbert,
2011, p.857). However,
frequent outbreaks in the
past decade, several
imported cases of viral
haemorrhagic fever and
laboratory exposures, and
the potential misuse of
Ebola virus as a biothreat
agent has changed that
view. Now, states are
making efforts to develop
vaccines for diseasecausing agents that are
biothreats such as Ebola.
According to National
Institute of Allergy and
Infectious Diseases
(NIAID) director, Anthony
Fauci, an effective Ebola
vaccine not only would
provide a life-saving
advance in countries
where the disease occurs
naturally, it also would
provide a medical tool to
discourage the use of
Ebola virus as an agent of
bioterrorism (National,
2003).

Carus (2001, p.11)

notes the increase in
terrorist groups using
biological
weapons:
between 1990 and
1999,
there
were
nineteen cases of
terrorists
using
biological
agents;
between 1980 and
1989, there were only
three. The author also

identifies

Global Policy Essay, May 2013

research is tailored to
fighting health issues of
the developed world.
Additionally, the
pharmaceutical industry
First, an increasing number of terrorist groupsare
has focused on
adopting the tactic of inflicting mass casualties to
developed world health
achieve ideological, revenge, or religious goals;
second, the technological sophistication of the terrorist issues because
developed countries
groups is growing. We now know that some terrorists
have the resources to
have tried to master the intricacies of aerosol
dissemination of biological agents. Some terrorists might buy these
pharmaceuticals. [A]s
gain access to the expertise generated by a statepoor people cannot
directed biological warfare program. Finally, Aum
Shinrikyo demonstrated that terrorist groups now exist afford such expensive
products, investigating
with resources comparable to some governments.
Therefore, it is seems increasingly likely that some group their diseases is not
will become capable of using biological agents to cause very interesting from a
business perspective
massive casualties. (Carus, 2001, p.11).
(De Winter, 2012, p.76).
Global political will to develop a vaccine
Some authors suggest
that the reason for low
It was previously mentioned that global political will to develop an
political will in finding
Ebola vaccine is low. This section attempts to explain why. Post,
Raile and Raile (2010, p.671) define political will as a sufficient set vaccines for some
infectious diseases is
of decision makers with a common understanding of a particular
problem on the formal agenda [who are] committed to supporting a lack of political capacity.
commonly perceived, potentially effective policy solution. A group of Filauri, Ferraro and
government or industry leaders who understand the serious threat Ragon (2011, p.15) note
and implications of a natural or deliberate Ebola outbreak and who that many neglected
tropical and vector-borne
are committed to finding a vaccine to mitigate the effects of an
diseases continue to
outbreak constitutes political will for developing an Ebola vaccine.
emerge and reemerge in
These leaders would be dedicated to providing resources to
scientists in an effort to assist their discovery of a vaccine. Bausch Africa where a significant
number of governments
et al. (2008, p.159) note that if the political will existed, field
have limited state
experiments with filoviruses could be used more effectively in
research programs for realistic therapeutic and preventive options capacity. Gizelis (2009,
p.124) argues that
[i.e., vaccines] for filoviruses.
countries whose
One explanation for the low political will in finding an Ebola vaccine governments have
is that Ebola, for now, has occurred most frequently in the
strong state capacity are
developing world. De Winter (2012, p.75) explains that the research more effective in
agenda in the health sciences is distorted against poor countries.
hampering the spread of
While there is extensive research for health issues in the developed infectious diseases: high
world, there is little research being devoted to health issues in the
state capacity, that is the
developing world. According to De Winter (2012, p.76), this is called ability of states to
the problem of neglected diseases. Because most funding for
penetrate and shape
research is provided by developed countries, most of this
society, will increase the
effectiveness of state
institutions in dealing
with communicable
diseases or building
preventive measures
that slow down the
spreading of the
disease. The author
found that states whose
political systems are in
transition are more likely
to have a difficult time
managing a
communicable disease;
reasons why bioterrorist attacks in the future may cause more
deaths.

the state will have low

capacity to respond to
an outbreak or prevent
one (Gizelis, 2009,
p.128). For example,
Sidahmed (2010, p.20)
characterized Sudans
political disposition in
2010 as a regime
transitioning from
authoritarianism to
democracy following a
transition from
democracy to
dictatorship. According
to Gizelis analysis,
politically transitioning
Sudan is a state that
would be more likely to
have low capacity. If a
government has low
state capacity, it is less
likely to devote
resources to developing
a vaccine.
Developing a vaccine
takes time and
resources, both
monetary and human.
According to Barrett and
Beasley (2009, p.D2), it
takes 18 to 20 years
from the time a vaccine
is discovered to the time
it is licensed, and the
entire process could cost
more than $500 million.
While preliminary
research on a vaccine
for filovirus hemorrhagic
fever (FHF) can be
carried out in a
laboratory, clinical
research should be
carried out during an
outbreak, which is
unpredictable and may
occur in an area not
conducive to human
clinical trials. If clinical
research on FHF is to be
carried out it must occur
in endemic areas in subSaharan Africa, most
likely under outbreak
conditions in areas with
rudimentary medical
infrastructures. Any plan
to conduct prospective
clinical research on FHF

must deal with a staggering array of scientific, logistical, political, social, financial, legal,

and ethical

Global Policy Essay, May 2013

frequently in East Africa.

While bioterrorism in
East Africa is a concern,
resources devoted to
one health threat should
not be diverted to
While I have pointed out the international contagion threat the Ebola another health issue.
challenges (Bausch et al., 2008, pp.151-152). Bausch et al.
(2008, p.159) note that if political will exists, a clinical research
program can be carried out due to the advances in field
experience in FHFs.

virus poses, to date no outbreak has been classified as a pandemic.

Policymakers must be careful not to assume the disease never will
be. The importance of strengthening global political will to develop a
vaccine for Ebola has increased recently due to frequent outbreaks
in the past decade, several imported cases of viral hemorrhagic
fever and laboratory exposures, and the potential misuse of Ebola
virus as a biothreat agent (Feldmann and Geisbert, 2011, p.857).

The potential for a

deliberate biological
attack in Africa is a
security concern and
methods to reduce the
risk should be put in
place. Borrie and Loye
(2005, p.102) note that
Is bioterrorism in East Africa a concern?
it is in the political
Terrorists, as defined above, have not used bioweapons in East interest of African
countries to take
Africa to date, and while it may be unlikely, there is still a
possibility because of a threat nexus: the region, terrorist activity cognizance of the
increasing potential of
and the presence of naturally occurring pathogens.
the life sciences being
For example, Al Qaeda, a terrorist organization with a history of misused for hostile
executing attacks in East Africa, has demonstrated the desire to purposes. Preventive
cause mass casualties and an interest in using disease as a
action will reduce the
weapon (Koblentz, 2010, p.114) . While the group has not been vulnerability of the
able to develop a biological weapon with the capability to cause a countries to endemic
large number of deaths, it may do so in the future, if it is able to diseases as well as to
biological attacks. With
recruit experts and obtain an agent such as Ebola.
this statement, the
Due to the presence of naturally occurring pathogens in East
author is careful to point
Africa and the increasing appearance of Ebola, there is
out that this does not
concern that someone with malicious intentions could access
mean fewer resources
these pathogens. Disease-causing micro-organisms occur
be devoted to issues
naturally in the region [of East Africa] and are therefore
also facing Africa. While
accessible to those with sufficient knowledge to use to
a bioterrorist attack in
deliberately cause disease. This is an adequate reason to
East Africa is unlikely, it
presume that eastern Africa, like other regions with similar
is still possible due to
conditions, faces a potential threat from [bioweapons]
terrorist activity in the
(Njuguna, 2005, p.14).
region and the presence
of the more frequently
Leroy et al. (2011, p.964) find that despite the fact that filoviruses
appearing Ebola, and
are a major public health issue for Africa and a category A
steps should be taken to
biothreat due to the explosive disease course; high case fatality
prevent and mitigate this
rate; and lack of specific treatments or vaccines, these viruses are major public health
a minor public health threat due to the low disease burden
issue.
compared to other diseases in Africa. As a major public health
issue for Africa, the naturally occurring Ebola virus needs more
attention, especially since it is appearing more

Natural occurrence
of Ebola in Africa
and the state of
health systems
Ebola virus occurs
naturally in Central and
East Africa and the
disease caused by the
virus is appearing with
more frequency. This
has implications for
global health and
security because it

makes the virus

potentially accessible to
groups who may want to
recruit an expert to find
the virus and prepare the
virus for use as a
bioweapon.
Human interaction with
the environment can
cause the emergence and
reemergence of infectious
diseases. Increasing
human numbers have
been a principal factor
leading to uncontrolled
urbanization, changes in
agriculture, land use and
animal husbandry
practices, and accelerated
globalization, all of which
have been major and
inter-related drivers of the
re- emergence of
epidemic infectious
disease (Wilcox et al.,
2008, pp.113-114).

An article in the
Lancet notes that an
increase in human
consumption of
wildlife products has
led pathogens to find
new hosts: the
transmission of Ebola
to humans is an
example of
organisms or
pathogens exploiting
new host
opportunities
resulting from human
behaviour (Karesh et
al ., 2012). Because
of the consumption of
wildlife products in
Africa and the link to
the incidence of
infectious diseases,
the region is ripe for
anyone with specific
expertise to harvest a
naturally occurring
virus.
Attempts at obtaining
pathogens from
nature that can be
weaponized have
been successful. For

example, the Japanese cult Aum Shinrikyo

Global Policy Essay, May 2013

obtained a natural strain of anthrax; however, it turned out to be

a non-virulent strain (Barletta, Sands and Tucker, 2002, pp.5758). And, as stated before, Carus (2001, p.14) notes six
instances in which a biological agent was acquired from a
natural source.
In addition to the natural occurrence of Ebola in East Africa, the
region and Africa in general is more susceptible to a lethal
infectious disease outbreak because of the lack of health
infrastructure. Due to lack of proper equipment and hygienic
practices, large-scale epidemics occur mostly in poor, isolated
areas without modern hospitals or well-educated medical staff
(Tyagi, Kumar and Singla, 2010, p.3). Mackey and Liang (2012,
p.67) report a shortage of 1.5 million health workers in Africa due
in part to brain drain, or a migration of health care workers from
developing countries to developed countries. One result of this
shortage of health care professionals is a weak formal health
system. Another result is that patients instead use traditional
healers, some of whom treat the sick in their own homes, which
may not be sterile environments (Allaranga et al., p.34). These
practices promote transmission of infectious diseases.
From a global health and security perspective

the diffusion of
information about the life
sciences are making the
ingredients necessary to
develop biological
weaponsknowledge,
expertise, equipment,
and materialsmore
widely available
(Koblentz, 2010, p.102).
While globalization has
made it easier for an
infectious disease to
travel and for nonexperts to access
biotechnological
advancements, it has
also provided
improvements in more
effectively responding to
Ebola outbreaks.
However, the fact
remains that there is no
cure, and once someone
is infected with Ebola,
there is a chance it will
spread and infect others.

Koblentz (2010, p.100) notes that the international health and

security risk posed by a biological agent is increasing because of
advances in science and technology, the emergence of new
diseases, globalization, and the changing nature of conflict. It is Additionally, an Ebola
bioterrorist attack in
the convergence of these trends that has propelled biological
East Africa is a danger
threats onto the international agenda.
to global health
An Ebola bio-attack in East Africa is a potential threat for global because it presents a
global political security
public health for several reasons. First, because we are now
living in a globalized world where people and objects can travel risk. The virus can infect
anyone that it comes in
quickly from one part of the globe to another, a disease as
potentially contagious as Ebola could also travel as rapidly. The contact with; it does not
east African region is a destination for foreign investors, tourists, discriminate. The virus
is contagious and,
health workers, diplomats, students and non- governmental
coupled with the fact
organization representatives. For example, the growing
popularity of China as a destination for both short- and long-term that humans come in
closer contact with a
training for Kenyanscannot be separated from the wider
wide range of people
involvement of China in Kenya's infrastructure development
now more than ever, it
and Chinese migration to East Africa (King, 2010, p.488). The
is possible for anyone to
steady flow of people and goods to and from East Africa
demonstrates the ease with which a pathogen can travel.
become infected, even
Additionally, the globalization of the pharmaceutical and
world leaders.
biotechnology industries and
Second, natural Ebola
outbreaks are occurring
more frequently in SubSaharan Africa, and
this indicates a greater
potential for
transmission to a
greater number of
people and a greater
potential for a terrorist
to obtain the virus.
Authors of an article in
Trends in Microbiology

point out that Ebola has

become a global health
concern because of the
recent increase in
cases as well as the
possibility for it to be
used as a bioweapon:
There has been
an increasing
frequency of
filovirus [i.e.
Marburg virus
and Ebola virus]
outbreaks
reported from
endemic
regions of Africa
in recent years
which, together
with its potential
for introduction
into nonendemic
countries
through
international
travel and its
potential for use
as a
bioweapon, has
made [the
Ebola virus] a
worldwide
public health
concern
(Groseth,
Feldmann and
Strong, 2007,
p.408).
Between 1976 and 1997,
there were two outbreaks
in East Africa; between
2000 to present, there
were five outbreaks (CDC,
Known cases). Table 1
shows the frequency of
occurrence and number of
deaths associated with
Ebola outbreaks in East
Africa.
Third, the outbreak
narrative of a bioterrorist
attack in East Africa can
create fear and can
further the spread of the
disease. The outbreak
narrative, or the journey
of an infection from

identification through containment chronicled by science, media and how they handle it:
dramatizations, affects the way people perceive the disease and

Global Policy Essay, May 2013

Second, public health

As [outbreak narratives] disseminate information, they organizations should
affect survival rates and contagion routes. They promote increase surveillance
and their ability to
or mitigate the stigmatizing of individuals, groups,
detect and identify an
populations, locales, behaviors and lifestyles and they infectious disease. For
change economies. They also influence how both
example, USAIDs
scientists and the lay public understand the nature and Predict project mapping
consequences of infection, how they imagine the threat tool can be used as a
and why they react so fearfully to some disease
model1. According to an
outbreaks and not others at least as dangerous (Wald, article in the East
2008, p.2-3).
African Journal of
Public Health,
Therefore, the outbreak narrative may include misinformation
collabor
that may cause fear and alter the path of the disease.
ation
with
Finally, the lack of an Ebola vaccine or effective treatment
those in
protocol potentially threatens global health and security because
charge
in the event of an outbreak, only strict quarantine measures
of the
would prevent the spread of a disease which is already difficult to
conserv
diagnose, as previously mentioned.
ation of
wildlife
is
essenti
al for
the
early
detectio
n of
viral
hemorr
hagic
fever
epidemi
cs.
Policy recommendations
Hemorr
hagic
The potential dangers that an Ebola bio-attack in East Africa
fever
presents to global health and security cannot be overlooked. In
epidemi
fact, one of the reasons there is no vaccine is too little attention
cs
has been paid to the virus. Due to its potential to cause
caused
morbidity and mortality across the globe, the threat of an Ebola
by
bio-attack should not be ignored. Therefore, the WHO, individual
Ebola
states and other organizations must formulate a response to this
and
global health concern. A strong response will be comprised of
Marbur
the following.
g
viruses
First, states should strengthen political will and capacity to
are
develop a vaccine for use in an outbreak and to deter
occurri
bioterrorists. While a cure may be decades away, if scientists are
ng
actively supported in looking for a cure, it is more likely that one
more
will be discovered sooner, discouraging a deliberate Ebola
and
outbreak, rather than highlight any weakness in global defense
more
against Ebola.
frequen
tly in
SubSahara
n Africa
and
only an
adapte
d
epidemi

ological
surveill
ance
system
will
allow
for
early
detectio
n and
effectiv
e
respons
e
(Allaran
ga et
al.,
2010,
p.32).
Early detection of
Ebola can help mitigate
its spread, in either a
natural outbreak or a
deliberate attack.
Third, states and public
health organizations
should support African
disease control centers
and sharing of resources
(human resources,
financial and
material/testing,
prevention and
treatment equipment).
An article on the 1995
Ebola outbreak in Kikwit,
Democratic Republic of
Congo, reveals that
shortly after the disease
was suspected,
nine
internat
ional
medica
l
teams,
includi
ng the
WHO,
Doctor
s
Withou
t
Border
s and
the
CDC,
arrived,
bringin

g supplies and knowledge. The arriving teams

helped to augment the understaffed hospital,
provided barrier supplies and disinfectant,
improved the quality of the isolation unit's
effectiveness, assisted in developing safer
burial procedures and improved the triage
system for sick patients (Hall, Hall and
Chapman, 2008, p.447).
According to Njuguna (2005, p.17), if a terrorist attack with a
biological agent were to occur, medical microbiology

laboratories would
be instrumental in
helping to detect and
identify the agent
and in alerting the
authorities. Referral
centres should have
all necessary
resources to support
the field

laboratories.

http://healthmap.org/pr
edict/

Global Policy Essay, May 2013

bioterrorist agent, killing

25 to 90 per cent of
Additionally, the benefits of biosecurity measures should be
shared with practitioners and policymakers in East Africa. During those infected; and
seminars held in developing countries, Rappert and Gould (2009, there is no vaccine for
p.90) found a pattern: a low prior recognition of dual -use issues Ebola. Ebolas
by practicing scientists, students and policymakers. Specifically, epidemiological makeup
in Africa, the authors found that there was a positive response to creates circumstances
in which it could spread
investment in science but at the same time a suspicion of new
technologies (Rappert and Gould, 2009, p.81). The international quickly to all parts of the
globe. Global health and
community and developed states should share ways in which
security are currently
biosecurity can protect people. Advanced knowledge of lab
security measures and investment in biosecurity infrastructure is compromised because
a vaccine has not been
a positive step toward limiting biological outbreaks, whether
discovered to prevent
natural or deliberate.
and treat the virus and
Fourth, states, non-governmental organizations and public health to deter bioviolence.
The political will in both
organizations should closely collaborate and effectively
the developed and
communicate. The more aware expert organizations are of
developing world does
infectious disease outbreaks, the more high level institutions
such as the WHO and the CDC will be able to become involved, not exist to cultivate
such a vaccine. Several
prevent the spread of misinformation, and devote resources to
steps need to be taken
handling not only the outbreak but also the investigation.
to change the threat a
deliberate Ebola attack
Finally, public health organizations should encourage and
facilitate training in infectious disease outbreaks and prevention in East Africa poses to
practices for members of organizations who are serving in East global health and
security, including
Africa (i.e., diplomats, members of the armed forces). These
stronger political will to
members should be trained in infectious disease outbreaks to
develop a vaccine;
help prevent their own infection and mitigate an outbreak by
increased surveillance
taking necessary precautions. For example, in 2009, the U.S.
and prediction
Armed Forces Health Surveillance Center, Division of Global
capabilities; sharing of
Emerging Infections Surveillance and Response System
(AFHSC- GEIS) supportedtraining initiatives in 40 countries for information and
U.S. military, civilian and host- country personnel (Otto et al, resources with partners
in East Africa; and
2005, p.1). Increased public knowledge and awareness is an
training individuals
important step in preventing and containing an infectious
working in East Africa in
disease.
prevention. These
Conclusion
measures will help deter
an offensive Ebola
The threat of an Ebola bioterrorist attack in East Africa is a global
outbreak in East Africa
health and security concern, and should not be ignored. While the
and will mitigate the
threat is unlikely due to difficulties in obtaining the virus and
effects of another
recruiting experts to handle and weaponize the virus, the threat still natural outbreak in the
exists and is increasing due to the more frequent outbreaks and
region.
subsequent accessibility to the virus in East Africa. A threat nexus
Amanda M. Teckman
occurs in East Africa: there is a history of terrorism in the region;
Ebola naturally occurs there; the virus has the ability to be used as a is a graduate of the
John C. Whitehead
lethal

School of Diplomacy
and International
Relations at Seton Hall
University, where she
specialized in global
health and human
security.
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