1

Introduction

Of all weapons of mass destruction, biological weapons have the highest risk for

widespread human devastation. Adrienne Mayor, a classics professor at Stanford University,

describes this class of weapons as the Pandora’s Box of horrors that was opened thousands of

years ago.1 Policy, military strength, nor funds are capable of entirely preventing the spread of

biological pathogens once they are released. Yet, in the past century, only several tens of

thousands of the 500 million human deaths from infectious diseases have been the result of

deliberate release.2 Lack of advanced biological technology has contributed to this peculiarity.

However, the recent emergence of widely accessible gene editing technology makes a biological

attack more feasible. The full impact of a carefully planned and well executed biological

weapons attack is no longer only imaginable but possible as well.

The failure of the existing health system’s response to recent biological outbreaks

heightens the concern surrounding an impending biological attack. The slow and one-

dimensional response to the 2014 Ebola epidemic in West Africa allowed over twenty-eight

thousand cases and over eleven thousand deaths to occur. After facing international scrutiny,

leading powers and health NGO’s worked together to revamp the response to a modern epidemic

outbreak. However, the recent onset of plague in Madagascar suggests that these discussions

were cursory. International doctors, led by the World Health Organization, continue to

concentrate more on personal political interests than saving lives in impacted regions. I

recommend a reprioritization by the global health community to adjust for the evolving threat of

biological weapons.

1
“Adrienne Mayor Quotes,” AZ Quotes, accessed October 30, 2017, http://www.azquotes.com/author/58532-
Adrienne_Mayor.
2
Friedrich Frischknecht, “The History of Biological Warfare,” EMBO Reports 4, (June 2003): 47-52,
doi: 10.1038/sj.embor.embor849.
 2

Ebola

The fact that Ebola was an identified disease when it was first reported in Guinea in late

2013 highlights the lapses in the existing healthcare system. Ebola was first discovered in 1976

when an infected host animal passed the disease to humans. From this early outbreak, the

international community learned many of the disease’s characteristics. It spreads quickly through

fluid transmission including sexual intercourse. Healthcare workers and those involved in burial

processes are potential victims if proper precautions are not taken. Between 2 and 21 days after a

victim is infected, they will begin to experience vomiting, diarrhea, rash, impaired organ

functions, and bleeding. These symptoms can be confused with malaria, typhoid fever, and

meningitis but can be confirmed with fairly basic testing. Until an experimental vaccine was

discovered in 2015, the only existing treatments were rehydration and personal care aimed at

improving comfort. As a result, the most effective way to reduce Ebola was to prevent wildlife-

to-human transmission, unintentional human passing, and sexual transmission. There are a

variety of methods to achieve these objectives, but they each require large amounts of

coordination, funding, and government action.3

Sadly, the world was not prepared for anything on the scale of the 2014 Ebola outbreak.

A lack of funding and organization on the local scale allowed the disease to spread rapidly.

Guinea, with a GDP per capita of $561 in 2014, experienced 3804 cases of the disease between

2014 and 2015. Liberia, with a GDP per capita of $458.47 in 2014, dealt with 10,666 cases by

May, 2015. Sierra Leone, with an abnormally high GDP per capita of 708.44$ in 2014, still

experienced 14,122 outbreaks before November, 2015. Each of these nations was forced to rely

3
“Ebola Virus Disease,” World Health Organization, June 2017, accessed October 30, 2017,
http://www.who.int/mediacentre/factsheets/fs103/en/.
 3

heavily on international institutions including Red Cross / Crescent and the World Health

Organization (WHO). Meanwhile, the United States, with a GDP per capita of $54, 599 in 2014,

only experienced 4 cases. 45 In affluent European nations where important individuals were

medically evacuated to, no deaths occurred. Yes, there are many exogenous variables that

contribute to this pattern. Examples include geography, localized dissemination, education, and

time. However, this economic gap does shed light on a common trend that continues to be

evident in world healthcare related to epidemics. The existing system is more effective for

advanced nations than for developing nations.

Despite limiting the power of local health practitioners, international healthcare focused

predominantly on preventing the spread of Ebola to developed nations. Generally, the World

Health Organization (WHO) will only intervene if it believes that an existing domestic health

system is not capable of stopping an epidemic on its own. This approach is flawed, because it is

ambiguous and promotes an aggressive hierarchy over trusted community doctors. One reason

that the WHO initially withheld from reacting is that internal politics prevented preemptive

action. In late 2015, the WHO Ebola Response team criticized itself: “The worst fears of

persistent exponential growth beyond September were not realized.”6 The organization did not

commit to responding to Ebola until the infection was out of control and widely publicized in

media. Once enacted, the described decision-making process created an unproductive dichotomy

between existing and imported healthcare. A 2016 critique on the Ebola response noted the lack

of trust between authorities and mobile populations.7 International doctors, according to the

4
World Health Organization, “Ebola Virus Disease.”
5
“GDP Per Capita (Current US$),” The World Bank, accessed October 30, 2017,
https://data.worldbank.org/indicator/NY.GDP.PCAP.CD.
6
WHO Ebola Response Team, “West African Ebola Epidemic after One Year,” N Engl J Med 372, no. 6 (February 2015):
584-587, doi: 10.1056/NEJMc1414992.
7
Vera Scott, Sarah Crawford-Browne and David Sanders, “Critiquing the response to the Ebola epidemic through a
Primary Health Care Approach,” BMC Public Health 16, no. 410 (2016), https://doi.org/10.1186/s12889-016-3071-4.
 4

report, flew in, treated patients for an allotted amount of time, and then left. These doctors rarely

trained local authorities, spoke the native language, or attempted to connect with patients in any

manner. Some patients chose to die and spread the disease rather than be treated by foreigners

with no respect for customs. Many international doctors were so painstakingly concerned with

not getting sick themselves that they failed to complete their primary job of saving lives. As a

result, in the first 9 months of Ebola, there were over two-thousand deaths and a mortality rate of

over 70 percent.8 These figures are unacceptable.

The World Health Organization also did not adjust its education methods to prevent the

spread of disease among uneducated populations in West Africa. Advanced western education

techniques were successful in developed countries during the period. For example, analyze the

intricate campaign that was launched in the United States during the same period. Public

announcements encouraged people to wash their hands, avoid sexual intercourse with victims,

and not share bodily fluids in other ways. By the end of 2015, every educated adult and child

knew that Ebola was transmitted by liquid. These same techniques failed in West Africa, though.

For the first several months of the outbreak in West Africa, there was little information available.

Despite most rural West Africa areas not having access to internet, the WHO published many of

its resources related to Ebola on its website. Information from imported doctors was not

delivered in relatable and specific ways. Victims continued to have sex, share food, and travel.

The continuation of traditional burial practices involving touching illustrates accentuates this

lapse. Had the World Health Organization initiated a focused response much earlier, the disease

8
WHO Ebola Response Team, “Ebola Virus Disease in West Africa – The First 9 Months of the Epidemic and Forward
Projections,” N Engl J Med, no. 371 (October 2014): 1481-1495, DOI: 10.1056/NEJMoa1411100.
 5

could have been better isolated by local populations themselves. This would have also helped

build trust between local and international doctors.

Finally, international organizations failed to ensure a complete recovery in impacted

communities. The World Health Organization and associated medical companies claim success

in stopping the epidemic, but in reality they only finished part of the process. Ebola is a

reoccurring disease, and its victims are able to spread the infection even after symptoms

disappear. By not completing the entire medical process with victims, doctors allowed treated

victims to spread the infection. Additionally, by leaving intermittently, transferring stations, and

not establishing meaningful connections with patients, doctors and nurses failed to treat the

mental and emotional harm of Ebola. Families were torn apart, entire communities were wiped

out, and religious leaders were killed by the epidemic. The impact of this can be seen in

economic trends within the nations. In Sierra Leone, Guinea, and Liberia the GDP per capita has

fallen since the outbreak of Ebola.9 Doctors were more concerned about preventing the spread of

infection beyond West Africa than ensuring a long-term continuation of preexisting lifestyles for

impacted communities. Incomplete treatments also posed a security dilemma. There are several

reported cases of infected sheets, clothing, and other items disappearing with no trace. It is

suspected that terrorists or rogue nations may have capitalized on the WHO’s chaos to develop

biological weapons out of the existing Ebola virus. Had an international presence worked to

establish a permanent and secure health infrastructure in impacted countries, this risk would have

been alleviated.

9 The World Bank, “GDP Per Capita (Current US$).”

Updates

Following strong international criticism, the World Health Organization attempted to

update its response to future epidemics of a scale similar to Ebola’s. November 2015, a panel of

22 experts from the Harvard Global Health Institute and the London School of Hygiene and

Tropical Medicine publicly called the WHO response to Ebola an egregious failure.10 Some

reports condemned politicians for letting domestic politics get in the way of a proper response

prior to the 2014 election.11 Miguel J. Martinez, from the University of Barcelona, asserted that

the future response to a similar epidemic must involve multi-disciplinary team-based research.12

In his mind, the response to the 2014 outbreak was purely a medical response. Had humanities

researchers been able to advise doctors in the field on historical burial practices, the disease may

have been stopped much sooner and a lasting link could have been made with local authorities.

James G. Hodge Junior, the executive director of the Johns Hopkins Bloomberg school of Public

Health, argued from a law perspective that only interventions known to prevent the spread of

infectious disease without significant collateral public health repercussions may be sustained.13

General media criticism and negative public opinion also pressured the WHO to respond.

As a result, the World Health Organization reformed its structure in an attempt to

alleviate the negative effects of internal politics. One response was a new incident-management

system that helps coordinate work between the WHO’s own departments and regional partners

10
Joanna Plucinska, “Experts Say the WHO’s Response to the Ebola Crisis Has Been a Failure,” Time Health, November
22, 2015, accessed October 30, 2017, http://time.com/4123858/ebola-crisis-who-response-failure/.
11
Alec T. Beal, Marlise K. Hofer and Mark Schaller, “Infections and Elections,” Psychological Science 27, no. 5 (2016):
595-605, https://doi.org/10.1177/0956797616628861.
12
Miguel J. Martinez, Abdulbaset M. Salim, Juan C. Hurtado and Paul E. Kilgore, “Ebola Virus Infection: Overview and
Update on Prevention and Treatment,” Infect Dis Ther 4, no. 4 (December 2015): 365-390, doi: 10.1007/s40121-015-
0079-5.
13
James G. Hodge Jr., “Legal Myths of Ebola Preparedness and Response,” Notre Dame Journal of Law, Ethics & Policy
29, no. 2 (2015), http://scholarship.law.nd.edu/ndjlepp/vol29/iss2/2.
 7

more efficiently.14 Also, following its inability to accurately fund Ebola recovery, the

organization founded a massive Contingency Fund for Emergencies. Financing for the fund is

achieved through flexible and voluntary contributions from individuals and partners.15 Within 24

hours of an emergency, 500,000 dollars are guaranteed before additional funds must pass a

WHO-led action agency.16 This design is intended to assist in isolating initial victims in the

earliest stages of epidemics. The health organization has also publicly devoted itself to opening

communication transparency specifically regarding internal intentions and regional practices.

Through particularly this last change, the World Health Organization believes it is better

prepared now for biological emergencies than it was at the time of the Ebola Outbreak.

Unfortunately, the success of these new policies is yet to be seen.

Plague

The recent outbreak of pneumonic plague in Madagascar serves as an indicator of how

effective these new policies are in their early stages of application. The lethality and public

impact shared by Ebola and Plague make them comparable. Plague has existed for even longer

than Ebola. The Black Death from 1346 – 1353 is one of the best known cases of bubonic

plague. Like Ebola, plague is originally transmitted from an animal to a human. The most

common types of transmitters are fleas and rats. Symptoms of plague include fever, aches,

vomiting, nausea, and blood-tainted sputum. Bubonic plague is not easily transferable between

humans. However, if it spreads to the lungs, it gains the title of pneumonic plague. At this point,

it can be spread through coughing or other equally susceptible means. Pneumonic plague only

14
Akshat Rathi, “The WHO botched Ebola,” Quartz Media, February 24, 2016, accessed October 30, 2017,
https://qz.com/618286/the-world-health-organization-deserves-a-rare-applause-for-its-handling-of-the-terrifying-zika-
epidemic/.
15
“Emergency Fund for Emergencies,” WHO Health Emergencies Programme, April 2017, Accessed October 30, 2017,
http://www.who.int/about/who_reform/emergency-capacities/contingency-fund/CFE_Impact_2017.pdf.
16
WHO Health Emergencies Programme, “Emergency Fund for Emergencies.”
 8

has a 24-hour onset compared to the 2 to 21-day onset of Ebola. This makes it easier to contain

but also quicker to spread. Ebola on the other hand is presently more difficult to treat than

plague, which can be treated using antibiotics if they are delivered early enough. 17 So, although

the two infections are different, they serve as moderately equal indicators of the health system’s

ability to respond.

The most recent outbreak in Madagascar continues to spread rapidly. Plague, particularly

bubonic plague, is in fact fairly common in Madagascar. However, it is typically isolated to the

December rain season when rodents are forced to come out of their burrows. In the past, this

predictability has given Madagascar domestic healthcare time to prepare, isolate, and treat cases.

On September 11, though, a 47-year old man was admitted with symptoms of pneumonic

plague.18 The impact of the plague breaking out 3 months early has been tragic. As of October

16, more than 680 people had been infected and over 57 had died.19 By October 20, the number

of cases had reached 1,153 with over 70 percent of these classified as pneumonic.20 18 out of 20

districts have been impacted, showing the range of the disease.21 This is also the first time that

the disease has taken place in a densely populated area.22 All signs suggest that this outbreak has

the potential to devastate Madagascar, its neighbors, and potentially much of the world.

Although the outbreak has not gained popularity in American news yet, it is still beginning to

17
“Plague,” World Health Organization, accessed October 30, 2017, http://www.who.int/csr/disease/plague/en/.
18
“Plague – Madagascar,” World Health Organization, September 29, 2017, accessed October 30, 2017,
http://www.who.int/csr/don/29-september-2017-plague-madagascar/en/.
19
Meera Senthilingham, “Plague Outbreak Leaves 57 dead, more than 680 infected in Madagascar,” CNN, October 16,
2017, accessed October 30, 2017, http://www.cnn.com/2017/10/16/health/madagascar-pneumonic-bubonic-plague-
outbreak-continues/index.html.
20
The Associated Press, “94 Deaths from Plague in Madagascar, UN Health Agency Says,” The New York Times, October
20, 2017, Accessed October 30, 2017, https://www.nytimes.com/aponline/2017/10/20/world/europe/ap-eu-united-nations-
madagascar-plague.html.
21
World Health Organization, “Plague Outbreak Madagascar,” WHO External Situation Report 4, October 17, 2017,
http://apps.who.int/iris/bitstream/10665/259271/1/Ex-PlagueMadagascar18102017.pdf.
22
Zosia Kmietowicz, “Pneumonic Plague Outbreak Hits Cities in Madagascar,” BMJ, (2017): 359,
doi: https://doi.org/10.1136/bmj.j4595.
 9

draw international attention. The question is, has anything truly changed since the response to

Ebola?

The initial response by the Madagascar Administration of Health was, at least on paper,

fairly effective. Methods included investigations of new cases, epidemiological surveillance of

affected circles, disinfection, awareness campaigns, and implementation of safe burial practices.

This was at least a partial outcome of Madagascar’s past experience with bubonic plague,

developing urban population, and geographic isolation though. Now though, Madagascar’s low

GDP per capita of $401.32 is limiting the effectiveness of these implemented programs. 23 Most

citizens are far more concerned with finding work or food than following preventative measures.

Additionally, the government simply does not have the funds to continue its programs if the

plague continues to spread rapidly.

Thus, the international community is beginning to come together in support of

Madagascar. Experts such as Dr. Ostroholm have visited Madagascar; there is clearly awareness

of the situation in the upper tiers of leadership. It seems, though, that the World Health

Organization is still slow in its response. October 1, the World Health Organization published a

news release claiming that it had “scaled up” its response by offering $300,000 in emergency

funds and appealing for an additional $1.5 million.24 This is a meager amount in a nation with 25

million people.25 In this same news release, the organization defended its moderate response by

arguing that, as mentioned above, plague is endemic to Madagascar.26 This is concerning,

because despite its commitment to responding better to epidemics, the organization failed to

23
The World Bank, “GDP per Capita.”
24
World Health Organization, “WHO scales up response to plague in Madagascar,” World Health Organization Media
Centre, October 1, 2017, accessed October 30, 2017, http://www.who.int/mediacentre/news/releases/2017/response-
plague-madagascar/en/.
25
“Population, total,” The World Bank, accessed October 30, 2017, https://data.worldbank.org/indicator/SP.POP.TOTL.
26
World Health Organization, “WHO scales up response to plague in Madagascar.”
 10

recognize the anomalies of this specific outbreak and its potential for massive casualties nearly a

month after it first occurred. As of October 10, with over 1000 cases reported, only 2.9 million of

the 9.5 million dollars desired by the Madagascar government had been raised.27 The European

Centre For Disease Prevention and control released an assessment October 13 regarding the

plague in Madagascar and, now, Seychelles. It’s list of 7 suggested measures each focus entirely

on preventing the spread of disease to the European Union.28 The first physical action taken by

the World Health Organization was to recently apply movement restriction measures.29 Only

within the past two weeks has UNICEF Madagascar started collaborating with the World Health

Organization and its partners.30 It seems that once again there is more focus on preventing the

spread of the disease than solving the epidemic in Madagascar. On October 18, the IFRC

claimed that it was in the process of mobilizing 2,660 Red Cross volunteers and releasing 1

million Swiss Francs.31 This is an encouraging gesture, but it comes around a month too late.

Today, nearly two months after the first reported case of Pneumonic plague, the disease

continues to spread swiftly and has no clear end in sight.

Like Ebola, there is concern that the existing plague will be weaponized. The lack of

rapid response in Madagascar is concerning for two reasons. Potential perpetrators have had

plenty of time to travel to Madagascar to gain samples of plague for research purposes. The

National Terror Alert Response Center includes Pneumonic Plague on its list of dangerous

27
UN Office for the Coordination of Humanitarian Affairs, Government of Madagascar, UN Country Team in
Madagascar, “Madagascar: Plague Epidemic,” Reliefweb, October 10, 2017, accessed October 30, 2017,
https://reliefweb.int/report/madagascar/madagascar-plague-epidemic-joint-situation-report-no-1-10-october-2017.
28
European Centre for Disease Prevention and Control, “Outbreak of pneumonic plague in Madagascar: recent
introduction in the Seychelles,” Rapid Risk Assessment, October 13, 2017,
https://ecdc.europa.eu/sites/portal/files/documents/plague-madagascar-seychelles-rapid-risk-assessment-october-2017.pdf.
29
UN Office for the Coordination of Humanitarian Affairs, “Madagascar: Plague Epidemic.”
30
Ibid.
31
Laura Ngo-Fontaine and Matthew Cochrane, “IFRC Secretary General Visits Madagascar as Red Cross Scales up
Plague Response,” IFRC Press Release, October 18, 2017, accessed October 30, 2017, https://media.ifrc.org/ifrc/press-
release/ifrc-secretary-general-visits-madagascar-red-cross-scales-plague-response/.
 11

chemicals.32 Both Ebola and Plague are category A organisms, meaning they can be easily

disseminated / transmitted, result in high mortality rates, cause public panic, and require special

action.33 Ebola must be stored at a high temperature, but plague is much more persistent and can

be aerosolized.34 Additionally, the delayed reaction suggests that if an attack does happen, the

world is still not prepared to responds to it efficiently. It is believed that weaponized plague

pathogens developed specifically for the purpose of killing humans may be capable of evolving

within 2 to 4 days of release to make most antibiotics futile.35 If a response were not conducted

within this timeframe to at least isolate cases, the consequences would be catastrophic.

Future

So far, the modern world has been fairly lucky with regard to biological epidemics.

However, if there continues to be a slow response to outbreaks by the international community,

this luck may run out. It seems that powerful nations, including the United States, are moderately

prepared for biological attacks. During the Clinton administration, the United States developed a

substantial civilian biodefence program.36 These programs focused on regulating biological agent

transfers, particularly of Category A agents, and training emergency responders in 120 major

national cities.37 Additionally, beginning in 1999, the CDC began setting aside 121 million

dollars specifically for emergency biological response funding.38 Prior to the 2001 anthrax

attacks, a survey showed that state and local authorities did not have plans in place to sufficiently

32
“Facts About Pneumonic Plague,” National Terror Alert Response Center, accessed October 30, 2017,
http://www.nationalterroralert.com/pneumonicplague/.
33
“Emerging Infectious Diseases / Pathogens,” National Institute of Allergy and Infectious Diseases, accessed October 30,
2017, https://www.niaid.nih.gov/research/emerging-infectious-diseases-pathogens.
34
Thomas V. Inglesby, David T. Dennis, Donald A. Henderson and et al, “Plague as a Biological Weapon,” JAMA 283,
no. 17 (2000): 2281-2290, doi:10.1001/jama.283.17.2281
35
Ibid.
36
Ali S. Khan, Stephen Morse and Scott Lillibridge, “Public-health preparedness for biological terrorism in the USA,” The
Lancet 356, no. 9236 (September 2000): 1179 – 1182, DOI: http://dx.doi.org/10.1016/S0140-6736(00)02769-0.
37
Khan, Morse and Lillibridge, “Public-health preparedness for biological terrorism in the USA.”
38
Ibid.
 12

address a moderately sized biological attack.39 This attack served as a wakeup call though, for

the United States now has a Bioterrorism Preparedness and Response Office focused specifically

on planning, surveillance, epidemiology, rapid laboratory diagnostics, communications, and

stockpiling. The United States has taken the lead on response structure, vaccine development,

and population control. There is certainly no guarantee that the United States is safe from a

widespread biological attack, but its resources make the potential for isolation, treatment, and

recovery high.

However, particularly in regions with limited resources, the framework for responding to

epidemics still needs updates. To start, the response to naturally occurring epidemics must be

refined. If the world, led by the World Health Organization, is not even capable of responding

efficiently to epidemics stemming from individual outbreaks, then it will certainly not be able to

respond effectively to an attack with assisted dissemination. First, the WHO should expand its

role to preemptively prepare developing nations for epidemics. This would help eliminate the

slow response by the WHO, because it would already be integrated at the time of an outbreak.

Additionally, this would help reduce the distrust between local doctors and international

advisors. Second, future education campaigns must target each region specifically. It is likely

that the World Health Organization will adopt this change on its own, but it has not been visible

in Madagascar beyond small training sessions. A multi-faceted approach to epidemic education

development involving leaders from various fields would ensure more rounded implementation

in the future. Finally, the World Health Organization should take a leadership position in

ensuring complete recovery and treatment by impacted regions. Limits on available funds and

resources make this step difficult. Therefore, WHO should focus on directing existing

39
Donald D. Fricker, Jerry O. Jacobson and Lois M. Davis, “Measuring and Evaluating Local Preparedness for a Chemical
or Biological Terrorist Attack,” Rand Corporation, 2002, https://www.rand.org/pubs/issue_papers/IP217.html.
 13

organizations with purpose rather than absorbing the responsibilities of existing organizations.

Through these policies and a general commitment to minimize the role of politics in the World

Health Organization, the world should be better equipped to respond to a predictable epidemic

outbreak.

The response to a widespread accidental biological release or malicious biological attack

requires additional adjustments. One of the key factors in limiting the spread of epidemics has

been the ability to isolate initial cases. In a biological attack, whether by a terrorist or state actor

such as North Korea, this will be extremely difficult. The most effective forms of dissemination

involve aerosolized bacteria. North Korea has been linked to reports regarding the use of sleeper

agents releasing bacteria through modified backpacks in schools.40 It is likely that an attempted

attack would be initiated in multiple cities simultaneously. This would make it difficult to isolate

individual case pockets, especially for a disease such as Ebola that has a long onset. I suggest

that the World Health Organization create a legal framework for how it will choose to prioritize

its response around the globe. Potential deciding characteristics should include size of city,

population, or potential for treatment. This would avoid bias regarding economic prestige, which

is a debatable human rights violation.

Additionally, geographic isolation has played a key role in limiting the spread of an

epidemic globally. Most naturally occurring diseases are passed from animals to humans. A

common place for this to occur is rural settings where food supplies are scarce. The spacing

between households or communities in rural settings prevents the spread of disease to a certain

extent. This was the case in West Africa during the Ebola outbreak. Even despite a failure by the

40
Caroline Mortimer, “North Korea could be mass producing biological weapons to unleash smallpox and plague, report
warns,” Independent, October 23, 2017, accessed October 30, 2017, http://www.independent.co.uk/news/world/asia/north-
korea-biological-weapons-belfer-centre-pyongyang-nuclear-kim-jong-un-smallpox-plague-nerve-gas-a8015931.html.
 14

WHO, the epidemic was contained primarily to West Africa. Madagascar on the other hand is an

island, so it is fairly easy to contain the disease. If bioweapons targeted multiple major urban

centers when utilized, infections would spread far more rapidly. There are more citizens in the

304 square miles of New York City than in the entire nation of Sierra Leone. In order to save

lives, isolation techniques will need to be concentrated from the regional or national level to the

neighborhood level. Cities should work with the World Health Organization to develop

stockpiles of supplies specifically for biological attacks in each neighborhood. This would allow

infected areas to be cordoned off while still maintaining isolation of the city until a more

effective solution or vaccine is discovered.

There is also concern over how an unidentified infection, whether it is formed naturally

or genetically modified, would affect the world order. This conundrum is highlighted by the poor

conditions of refugee camps. A paper from 1998 argues that there is great potential for

something more virulent than cholera and Ebola emerging in camps and taking a large toll before

being identified and controlled.41 Refugee camps host massive amounts of people in close

quarters with poor sanitation. For example, the Dadaab complex in Kenya houses nearly 140,000

refugees. War continues to strike much of the world, particularly Africa and the Middle East, so

camps continue to grow. Within these camps, healthcare is limited. Water is sparse and generally

unsafe for drinking. Food and shelter is limited. Rape is common. Malnourishment, fear, and

exhaustion lower the effectiveness of immune systems. Violent conditions prevent those

admitted to camps from receiving even the most basic vaccines. Fundamentally, these locations

are the perfect breeding grounds for disease. In order to prevent the evolution of catastrophic

41
Ezekiel Kalipenia and Joseph Oppongb, “The refugee crisis in Arica and implications for health and disease: a political
ecology approach,” Social Science and Medicine 46, no. 12 (June 1998): 1637 – 1653, https://doi.org/10.1016/S0277-
9536(97)10129-0.
 15

infection, the World Health Organization must preemptively work with national leaders to

establish more hospitable conditions in refugee camps. This is unlikely because, as the trends

above point out, many leaders do not find the risk of spreading disease home worth the

opportunity of saving refugees. There are also not infinite resources available to provide more

hospitable conditions. Recognizing this, world organizations should work together to pursue

efficient sanitation construction techniques, apply city-planning policies to refugee camps, and

use an epidemic-rooted sense of urgency to lobby international governments to accept more

refugees.

Conclusion

In conclusion, the existing healthcare system is not equipped for a widespread biological

outbreak or attack. It took the World Health Organization 9 months to respond to the outbreak of

Ebola in West Africa in 2014. Then, the biased motivations of imported doctors prevented

effective treatment and recovery from occurring. After facing severe criticism, the organization

attempted to revise its policies by creating a specific board for emergency response, increasing

funding, and making communication transparent. Unfortunately, the response to Plague in

Madagascar is still flawed. In the coming years, the world must develop new frameworks for an

organized response to naturally occurring pathogens, create a method for prioritizing a fair

response to a widespread biological incident, implement a system for cordoning neighborhoods

of urban centers, and work to limit dangerous conditions where new diseases can evolve in.

Hopefully, with these fixes, the world will be able to overcome the impending impact of a

biological attack more effectively.

Bibliography
 16

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