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India’s preparedness against bioterrorism:

biodefence strategies and policy measures
Kewal Krishan1, Baljinder Kaur2,* and Anshula Sharma2
1
Department of Defence and Strategic Studies, and
2
Department of Biotechnology, Punjabi University, Patiala 147 002, India

easily spread through air, water, food, foamites or

Bioterrorism is a realistic threat to the security and
well-being of all countries. Significant legal and biode- through infected hosts such as insects, animals, humans
fence measures must be taken to prevent the produc- and other reservoirs3. Biological terrorism resulting in
tion and use of deadly biological weapons. Previous mass destruction or causalities further ensues distur-
bioterror incidences, dense population and congenial bances or panic among population 4. Detection of such
climatic conditions of India, make it vulnerable to biological agents may require several hours to weeks.
bioterrorism threats. This review provides a compre- Hence, the rate of mortality by utilizing bioweapons can
hensive picture of the potential biothreats to the coun- be excessive, compared to the traditional ways of destruc-
try, the existing laws and policies to counteract such tion5 . Because of these facts, such agents are gaining
incidences with a strong need for their implementa- importance around the world, than nuclear or chemical
tion, and biodefence strategies for preparedness and weapons6.
protection, to make India a bioterror free nation.
Origin and history of biowarfare
Keywords: Bioterrorism, biodefence strategies, policy
measures. The origin of bioterrorism dates back to pre-historic era
when Hittites and Scythians sent infected rams to their
IN the world of advanced weaponry and strategies, the enemies7. Assyrians poisoned enemy wells with rye ergot
threat of bioterrorism is of great concern not only to the fungus in 600 BC (ref. 8). In 1346, during the siege of
safety of every country, but also to the health and well- Feodosia (Ukraine), Tartar forces used plague victims as
being of its citizens1. Due to rapid increase in the techni- biological weapons to spread plague pandemic in the city,
cal skills of terrorists and fast growing research in the interpreted as black death which still remains controver-
field of molecular biology and biotechnology, the risk of sial 9.
bioterrorism is increasing day by day. Another major fac- This outburst later spread through many countries like
tor which adds to the intricacy of situation is the rapid Europe, the Near East and North Africa during 14th
expansion of networks of transnational terrorist groups, century and is believed to be the most destructive and
accessibility to resources, technologies, and expertise re- distressing public health disaster in recorded history10.
quired for developing a biological weapon. Thus, the The intended and planned use of smallpox-loaded cloth-
ability to detect and respond to a bioterrorism attack is ing resulted in disease outburst among the South Ameri-
necessary to minimize adverse health effects and prevent can natives and Indian tribes settled in the Ohio River
fatalities2. Valley11,12. There were similar strategies of polluting water
resources with infectious substances, use of diseased
Bioterrorism cadavers or animal carcasses in many wars among several
European countries, American Civil War and other con-
Bioterrorism is defined as a planned or destructive use of flicts, in the 20th century8. Germans used diseased ani-
biological agents such as viruses, bacteria, fungi or toxins mals as delivery vectors during World War I to spread
produced from living organisms. The main aim of bioter- biological agents like Bacillus anthracis (anthrax), Clos-
rorism is to harm people, animals and plants by causing tridium botulinum (cholera), Pseudomonas pseudomallei
death, so as to achieve political or social destruction. The (glanders) and Yersinia pestis (plague) in US, France,
virulence and ability of an agent to cause a disease can be Italy and Russia8. In 1925, Geneva protocol was signed
increased through creating mutations in that agent. Also, by many countries like France, Canada, Great Britain,
the agents can be designed in such a way that the current US, Belgium, Italy, Poland, Japan, the Netherlands and
medical treatments are unable to cure and they can be the former Soviet Union to minimize use of bioterrorism
agents. Despite this, these countries continued to use bio-
logical agents against each other 13. During 1932–1945,
*For correspondence. (e-mail: [email protected]) Unit 731 biological warfare programme of Japan, known

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to be the most dangerous bioterrorism operation caused Potential biological weapons and characteristics
mass casualties of more than 10,000 prisoners due to of biowarfare agents
anthrax, plague, cholera and gas gangrene. Japanese mili-
tary also spread plague-infected laboratory fleas into Biological weapons are those which contain replicating
major Chinese cities, leading to its outbreak in China14. microorganisms such as bacteria, viruses, fungi, protozoa,
The United States was also blamed for using biological prions or poisonous chemical toxins produced by living
weapons during Korean War 15. At the same time, other organisms. These are of many types based on the type
countries too were conducting biological warfare research of pathogen and are used against humans, animals, or
programmes either officially or un-officially. Thus, to crops5,19. These agents are easy to obtain and cultivate
curb such incidences, a first multilateral treaty, known as and hence countries manufacture and maintain them in
Biological Weapons Convention (BWC) was proposed in bulk. Serious respiratory and contact precautions are rec-
1972 (ref. 8). Even then the member countries continued ommended in case of infections caused by biological
their harmful biological research programmes16. During agents like Bacillus anthracis (anthrax), Burkholderia
Persian Gulf War, the Iraqi regime planned and spon- mallei (glanders), Burkholderia pseudomallei (ulcers, ab-
sored a total biological and chemical warfare programme scess), Clostridium botulinum (botulism), Ebola virus
utilizing B. anthracis, butulinum toxin and C. perfrin- (ebola), Rickettsia (typhus and rickettsialpox), Variola virus
gens, to deliberately harm USA and allied countries who (smallpox), Yersinia pestis (plague), etc. These organisms
were running ‘Operation desert shield’ at that time17. can be easily dispersed and cause very high morbidity
Apart from these rare but well documented state- and mortality in the infected population. Persons, who
sponsored and military-related biowarfare incidences, have not contracted these infections earlier, do not pos-
several private and civilian groups were also involved in sess any natural immunity against these pathogens. Com-
the development and spread of highly infectious biologi- pared to other common diseases, diseases caused by these
cal agents and chemical weapons. Religious groups like agents are difficult to diagnose and cure20. According to
that of Rajneesh were charged for deliberately spreading previous studies, different terrorist groups have relied on
Salmonella typhimurium in Oregon City (USA) in 1984 different disease transmission methods such as aerosols,
and in 1995 Aum Shinrikyo attempted sarin gas attack contaminated food, water, explosives, pharmaceuticals or
against Tokyo (Japan). Several incidences on the use of any other non-living object or direct contact with dis-
infected letters (with anthrax and plague) for harmful pur- eased individuals or cadavers. The factors which affect
poses by individuals were reported in the US between the effectiveness of an attack are weather conditions and
1996 and 2001. In 2002, ricin, a chemical weapon was stability of the agent21. Programmed robots and suicide
recovered from six terrorists in England. A year later, ter- coughers are also emerging as potential delivery tools of
rorists attacked the Russian embassy with ricin. In 2004, biological agents for mass destruction22.
ricin was also found in the mail room of the US senate
office. In 2013, a person was charged for mailing ricin
Methods of detection of biowarfare agent
contaminated letters to the US President, a senator and a
local judge5,18.
Biowarfare agents are detected using combined molecular
In India, prevalence of such bio-terror attacks is com-
and microbiological sensing technologies. Presently, an-
paratively less. There are some rare incidences of spread
tibody-based immuno-assays, biochemical testing, mass
of epidemics in India, but it is often difficult to monitor
spectrometry, microbiological culturing and genomic
the origin of such diseases. A few such cases, though of-
analysis using PCR (used in Biowatch program of USA)
ficially not confirmed include spread of pneumonic
are recommended for primary identification of biological
plague in Surat in 1994, dengue hemorrhagic fever in
agents and their specific genes23–25. These techniques are
Delhi in 1996, anthrax in Midnapur in 1999 and encepha-
highly reliable, sensitive and selective. However, some of
litis in Siliguri in 2001. It is in fact tough to differentiate
the detection methods have drawbacks like difficulty in
natural epidemics from alleged biological attacks, be-
isolation, extraction and purification of samples for test-
cause of several reasons, such as lack of evidences or
ing, poor detection capability in identifying differences in
confusion related to natural spread of the disease. Some-
pathology and etiology, differences in physiochemical or
times, political manipulation on the use of infectious
structural properties of pathogens and the presence of
agents as weapons, may distort the truth, as the facts be-
different materials and matrices5,23 .
come evident later. Nevertheless, in this article, we pro-
vide a concise overview of some likely biological warfare
events that occurred in history. Regarding international Social, emotional and behavioural impacts of
bioterrorism, Barras and Greub provide an exclusive bioterrorism
review where they summarize the main events that
occurred during the modern microbiology era, from Bioterrorism causes damage, fear, and anxiety among
World War I to the US World Trade Center attack7. people and affects the society and government of a
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country26. It restricts scientific investigations on con- agement of the outbreak. Thus to combat bioterrorism,
cerned pathogens as well as exchange of scientific infor- synchronized and determined efforts of different agencies
mation27,28. It is responsible for the change observed in like intelligence agency, Indian army, Border Security
the current scenario of emergency medical awareness and Force, law enforcement machinery, all health depart-
responses29. ments and civil administration are needed36.
Defensive and serious actions are required against
bioterrorism so as to protect the society and its people.
India’s preparedness against bioterrorism
Legally there is a provision for reviewing criminal
charges and fine against bioterrorist activities30 . For
Preparedness will focus on risk analysis of biological
example, in USA, one graduate researcher was charged
weapons, medical and public health consequences, medi-
under the new anti-terrorism law for mishandling
cal countermeasures and long-term strategies to combat
anthrax-tainted cow tissue during 1960s (ref. 31). Similarly,
and prevent future threats. The National Disaster Man-
in another case, a well-known US researcher was charged
agement Authority (NDMA), Govt. of India (GoI) has
for concealing information, mishandling and illegally
proposed a model instrument where participation of both
importing plague-infected laboratory samples32. In UK, a
government and private sectors is a pre-requisite to man-
top research institute was charged nearly $65,000 as fine
age the menace of biological disaster. According to
for improper handling of biological agents and negligence
NDMA, a sound infrastructure is necessary for both
towards the security of laboratory workers and public33.
medical countermeasures and for research and develop-
Besides being lethal, the psychological impact of bio-
ment to evolve novel instruments and methods of testing.
weapons is equally damaging and long lasting. The
Biological disasters cause socio-economic upheavals
impact includes horror, panic, fear of invisible agents,
and decline of population. Depending upon the vulner-
anger towards terrorists, government or both, acknowl-
ability of populations to specific biological agents, these
edgement of awakening symptoms to infection, suspicion,
may cause mass destruction similar to chemical and nu-
social isolation, demoralization and loss of faith in social
clear weapons. Epidemics can result in heavy losses due
institutions34. Sometimes, biowarfare agents have direct
to depletion of crops, domestic animals and natural re-
impact on the central nervous system and produce a wide
sources like air, water and productive soil. So, a multi-
range of psychological implications such as restlessness,
sector approach has to be adopted, for which judicial in-
depression, irritability, headaches, fatigue, mood swings
volvement of the government is a prerequisite. In India,
or even long-term cognitive impairment35.
there are several nodal ministries for dealing with epi-
demics caused by bioterrorism. Similarly, several acts re-
Bioterrorism: Indian scenario lated to management of environment, human, animal
health, crops, etc. have been enforced to punish miscre-
Dense population, poor hygiene and deprived sanitation ants of such unlawful activities (Figure 1).
facilities along with congenial climatic conditions make The Ministry of Health and Family Welfare (MoH and
India vulnerable for the spread of infectious diseases FW) is one of the main ministries dealing with epidemics.
caused by biological agents. Highly infectious and viru- The national health sector guidelines are designed and
lent agents occur naturally in India because of easy avail- regulated by this ministry. It also provides directions and
ability of extended water-locked agricultural fields and technical support for capacity building in surveillance
animal farms. In addition, India does not have adequate and in the early detection of any outburst. This ministry
medical facilities, i.e. on an average a single government also helps in employment of Rapid Response Teams’
doctor serves nearly 12,000 people. Hence, most of the manpower and logistic support. The Ministry of Home
people remain untreated and when they move across the Affairs (MHA) is another nodal ministry for prevention
country, the release and spread of disease becomes quite of bioterrorism and works in conjunction with MoH and
easy leading to the outbreak of bioterrorism36. Research FW. MHA is responsible for assessment of threat sensi-
authorities also need time to differentiate between the na- tivity by providing intelligence inputs and then establish
ture and type of biological agents, i.e. whether they are and implement preventive mechanisms. The Ministry of
natural or man-made and how to deal with them36. Defence (MOD) manages the matters and consequences
A number of challenges arise during fight against of biowarfare. Clinical case management is supported by
bioterrorism. The very first challenge is the proper collec- the Indian armed forces, as they have a number of hospi-
tion of specimens at the site and their identification. It is tals around the country. They use ambulances, aircrafts
usually hard to find the site where the original outbreak and ships to handle casualties. The Defence Research and
occurred or from where it was initiated. If samples are Development Organization (DRDO) is actively engaged
not accurately identified, it becomes difficult to control in developing protective systems and equipment for
the bioterrorism crisis. Secondly, it is also a challenge to troops to fight against nuclear, biological and chemical
recognize the occurrence of the attack and quick man- warfare22.

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Figure 1. List of supporting nodal ministries and their activities for protection against bioterrorism.

The Ministry of Environment, Forests and Climate and preparing guidelines to be followed by the authorities
Change is responsible for evaluation of short- and long- of different states to prevent any disaster. It also works
term consequences. The Ministry of Agriculture deals for the further improvement of development plans and
with biological disasters related to plants, animals, live- projects and accomplishment of disaster management.
stock and fisheries, which works in conjunction with the The National Crisis Management Committee (NCMC)
Department of Animal Husbandry, Dairying and Fisher- co-ordinates and monitor responses in crisis situations
ies. The Department of Agriculture and Co-operation in especially in disasters. It provides strong co-ordination
the Ministry of Agriculture, deals with crop diseases. The and implementation of relief measures during disasters.
Directorate of Plant Protection, Quarantine and Storage, The National Disaster Response Force (NDRF) provides
deals with pests. For research on agriculture and allied specialized response in a threatening disaster situation.
sciences, the Indian Council of Agricultural Research This force is well trained for multitasking in different
works under the supervision of the Department of Agri- disciplines. NDRF also provides training to the State Dis-
cultural Research and Education. aster Response Forces personnel, police and civil defence
Urban or Rural Development Ministry and Department home guards in the field of disaster response.
of Drinking Water Supply are key supporting ministries
for maintaining proper sanitation facilities, drinking wa- Existing laws and policies
ter and hygiene. Indian Railways also plays a key role in
providing medical facilities with the help of trained per- Any biological disaster response policy can only be
sonnel, as it has many tertiary care hospitals across the raised using a well-defined national biosecurity and bio-
nation. It also conducts mass evacuation of the affected safety protocol. The implementation of such a policy
community. MoH and FW chalks out strict standards for should follow a judicial framework within which the
water, food, shelter, sanitation, hygiene, etc. It helps in main grassroot level implementers such as health offi-
the development of human resources through various cials, private as well as government hospital doctors,
capacity development programmes, establishment of paramedics, general public and most importantly the
attentive and supportive socio-political environment. gram panchayats, district, state and national level health
NDMA is responsible for laying down policies on authorities work. They need to be carefully revised and
management, approving plans of different ministries or monitored from time to time. The laws or policies should
departments of GoI in accordance with the national plan have sufficient safeguards to prevent their misuse. Some

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of the existing laws or policies for protection against and Stockpiling of Bacteriological (Biological) and Toxin
bioterrorism are described below. Weapons and their Destruction’. This is the first multilat-
A Plant Quarantine Regulatory Act was passed to eral disarmament treaty which prohibits the development,
provide protection against any harmful insect, fungus or production and stockpiling of an entire category of bio-
other pests, that cause destruction of the crops. This act logical warfare agents of mass destruction. This conven-
was operational through the ‘Destructive Insects and tion opened for signature on 10 April 1972; came into
Pests Act’, 1914, in India. The significance of Plant force on 26 March 1975 with the deposit of ratification
Quarantine Act has increased due to present globalization by 22 states. By January 2015, 173 states (countries) gave
and liberalization in international trade of plants and their acceptance for the prohibition of development and
plant materials. The National Security Act, 1980 was stockpiling of toxic biological weapons. Use of biological
passed to strengthen the national security by allowing the agents is permitted for prophylactic, protective and
government to arrest a person, if his actions are suspected other peaceful purposes. The successful operations of
to cause harm to the defence of the country or affect its BWC was officially reviewed by state parties in 1980,
foreign relations. Such preventive arrests can also be 1986, 1991, 1996, 2001/02, 2006 and 2011. The scope of
made to protect the security of a state or public or any these review conferences was to highlight new techno-
community. The other act which plays an important role logical and scientific developments, enhance trans-
in preventing terrorist activities is ‘The Terrorist and Dis- parency and strengthen BWC by adopting additional
ruptive Activities (Prevention) Act, 1985’. This act was agreements37.
passed in May 1985, due to increase in terrorist activities
in some parts of the country. With further growth in ter-
International Health Regulations
rorist incidences, especially in states like Punjab, this act
was continued and improved. To further strengthen its
Due to the rapid increase in international travel and trade,
power in order to cope up with the threat of terrorism, the
and occurrence and re-emergence of international disease
Terrorist and Disruptive Activities (Prevention) Act 1987
threats and other health risks, 196 countries including all
was enacted. The Prevention of Terrorism Act (POTA)
the Member States of World Health Organization (India
2002, was passed by the Parliament of India to strengthen
also), have agreed to implement the International Health
the anti-terrorism operations. This act was established
Regulations (IHR) (2005). These regulations encourage
especially after the attack on the Parliament.
countries to work together to save lives and livelihoods
The Epidemic Diseases Act, EDA (Act 111 of 1897)
which are affected by the outbreak of infectious diseases
was established to prevent the spread of dangerous epi-
and other health problems. They also help countries to
demic diseases by allowing the states to take strict actions
stay away from unnecessary interference with interna-
and preventive measures for the control of epidemics.
tional trade and travel37. At the national level, the existing
The Water (Prevention and Control of Pollution) Act,
contingency plan of MoH and FW is about 10 years old
1974 and The Air (Prevention and Control of Pollution)
and needs to be revised. To implement IHR (2005) guide-
Act, 1981 have been established for prevention, control
lines, there should be strict and strong surveillance at
and abatement of water and air pollution respectively. To
borders, airports and ports. A well co-ordinated action
enhance the level of environmental protection and im-
plan of intelligence agencies, MoH and FW and MoD is
prove safety of human races, other living creatures, plants
needed for development and establishment of strong de-
and property, Environment Protection Act was passed in
fence and deterrence strategies. Preparedness against any
1986. The entry of livestock and livestock products was
biological disaster will be possible with the implementa-
regulated by ‘The Livestock Importation Act, 2001’. This
tion of these guidelines.
act also provides modalities of International Animal
Health Certification. For better management of disasters,
the Disaster Management Act (DM Act), 2005, was Strategies for defence against bioterrorism
enacted and with the establishment of operational frame-
work, this act provides prevention, improvement, prepar- Awareness against biothreats, biosurveillance, biomoni-
edness and recovery against any disaster37. toring, disease diagnosis and recovery (hospital and
community preparedness) are indispensable tools of de-
fence against any bioterrorism36. A biodefence strategic
Biological Weapons Convention plan consists of several important components as shown
in Figure 2. The preparation to deal with bioterrorism
A long term debate on Geneva Protocol has led to the must be widespread and versatile. The main focus should
development of Biological Weapons Convention (BWC) be on the development of trained biological disaster quick
as a new preventive measure that would serve as a sup- response teams (BDQRT) and their knowledge enhance-
plement to the 1925 Geneva Protocol. This convention is ment through regularly updated learning modules. Emer-
known as ‘Prohibition of the Development, Production gency operations can be executed by combined efforts of
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Figure 2. Important stages of a biological disaster management plan.

NDRF, BDQRT, public health departments and commu- Hospital preparedness is the primary and essential pre-
nity workers. ventive measure required to combat bioterrorism36,42.
Key regulatory parameters of biodefence strategic plan Hospitals should be upgraded for managing chemical,
include efforts like development of full international co- biological, radiological and nuclear attacks. There should
operation to deal with bioterrorism, educating the popula- be a strong communication and networking system be-
tions at risk, proper monitoring of potential producers and tween NDMA and district and state level health depart-
users of biological weapons, improvement of biowarfare ments, ambulance/transport services, state police
monitoring techniques and apparatus to stockpile biologi- departments, etc.42. The government should stock suffi-
cal weapons fighting supplies38. Collaborative efforts are cient drugs to be used against harmful agents. Computer
needed to improve and develop new drugs, vaccines, new simulation models can be used to estimate the require-
methods of diagnostics, detection and decontamination. ment of staff, antibiotics or medicines on the basis of
Forensic techniques should be strengthened to detect the number of patients43. Every doctor, specialist or clinical
origin or presence of biological weapons39. India should practitioner should remain up-to-date regarding current
utilize its advanced biotechnology techniques to keep a infectious diseases and should use web-based alerting
continuous vigil on the shifting terrorist strategies that systems to make use of relevant epidemiological informa-
disrupts its social and economic prosperity and control tion into their daily practice. In case face to face training
the possibility of such bio-terrorist attacks40. Highly programmes are not available, then people should make
sophisticated, rapid and ultra-sensitive methods like mass the best use of internet and web resources for the self-
spectroscopy, Raman spectroscopy, biosensors, poly- learning. Protective equipments like service gloves,
merase chain reaction (PCR) and other molecular tech- gown, masks, respirators, etc., can be used in our daily
niques are currently available for detection of biowarfare practices to control infections caused by such biological
agents in air, soil, water and food articles (Figure 2). agents. Health departments should own responsibility for
Faster and standard disinfection methods need to be short- and long-term medical follow-ups, casualty rate,
developed for decontamination of highly infectious bio- risk site characterization and environmental decontamina-
logical agents41. tion and protection.
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Community preparedness programmes, an important  Mass level immunization can offer protection to popu-
aspect of human resource development, should be imple- lations at risk;
mented free of cost at high school, college and university  Prophylactic measures should be lawfully enforced;
levels so that the Indian young population can learn first otherwise it would cause massive destruction due to
aid methods and strategies to curb the menace of biologi- rapid spread of infectious agents which usually have
cal disaster. Establishment of more specialized health very less cell doubling time.
care and laboratory facilities and up-gradation of existing
biosafety laboratories are important indicators of India‘s Conflict of interest: Authors report no conflicts of inter-
medical preparedness. In addition, proper hygiene of ests.
washrooms, cleanliness of environment and surroundings
should be maintained.
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