Bioterrorism in Asia

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Bioterrorism in Asia

The dramatically titled World at Risk report released in December 2008 by a US congressional commission predicting that a bioterrorist attack is likely in the next five years may have been aimed primarily at a domestic American audience, but it has also served to remind Asian nations of their vulnerability.

The report warns that the US government ‘has yet to fully adapt’ to the increasing dangers of biological and nuclear terrorism, concluding that the ‘sobering reality [is] that the risks are growing faster than our multilayered defenses’.

The report also made headlines in Asia, where geography, climate and, especially, population patterns – the continent is home to 16 of the world’s 20 most densely populated major cities – put it at particular risk.

‘I think most of the “authorities” would say that the one country that has it together is the United States,’ says Frederick Burkle, director of the Asia-Pacific Center for Biosecurity, Disaster and Conflict Research. ‘So if the US feels [bioterrorism] is a big threat. I’d have to say it’s probably more so in Asia.’

Burkle points to the links between susceptibility to naturally occurring infectious diseases and the threat of bioterrorism, and warns of three key elements that combine to make an ‘imperfect storm’ in Asia: the high population density of people and animals; the prevalence of infectious disease; and the region’s rapidly growing bioscience research industry.

Hong Kong and Beijing

Hong Kong, with 6410 people per square kilometre and a large bird population, fits the danger profile. No stranger to infectious disease, the dependency suffered an outbreak of SARS in 2003 that killed 298 people, and continues to battle avian flu. Consequently, a Hong Kong police official says there is a ‘high degree of vigilance’ regarding bioterrorism, assessing the current threat level as ‘moderate’.

‘Hong Kong maintains multi-agency groups at both strategic planning and incident management levels [and] contingency plans are regularly exercised,’ says the official.

However, in the run up to last year’s Olympics, China’s attention was focused on Beijing. ‘The 2008 Olympic Games provided a strong stimulus for bioterrorism preparedness,’ says Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University in New Jersey. ‘I think they did believe there was a threat, especially given that the East Turkestan Islamic Movement [was] indicating [it was] willing to use biological weapons.’

Although details of the kind of attack the authorities were preparing for remain classified, Huang notes that the Chinese Academy of Inspection and Quarantine established a project for rapid inspection and diagnosis (including deploying biosensors at airports, subway stations and in stadiums), which suggests a focus on anthrax, plague and SARS.

Despite these efforts, Huang believes a number of questions still remain over China’s preparedness for a bioterrorist incident, both in emergency response and political terms, and particularly at a local level: ‘I think when we look at actual capabilities, they still have a lot of challenges. And the recent outbreak of avian flu has suggested that health workers have problems with correctly diagnosing unfamiliar diseases.’

Huang also believes there are coordination problems between civilian health authorities and military health institutions, as well as questions over transparency. ‘We know that the regime has attached a lot of importance [to] social and political stability,’ he says. ‘But because the objective of bioterrorism is to instil fear and cause mass panic, it runs directly against the regime’s objectives. So if an attack happened, decision makers would face a huge dilemma because reporting would have huge implications for social stability.’

Seoul and Tokyo

According to Soon-Joo Wang, Chief of the Emergency Center at Hallym University Hangang Sacred Heart Hospital in Seoul, it was also the perceived threat to a major sporting event that prompted the South Korean government to take bioterrorism countermeasures.

‘The South Korean Syndromic Surveillance System was one of the earliest ones, made in 2001 for the 2002 FIFA World Cup,’ Wang says of the nation’s detection system. The South Korean government also established the Korean Center for Disease Control, stockpiles antibiotics and vaccines, and holds annual conferences and training symposiums.

Soon-Joo Wang believes smallpox poses the most serious threat: ‘The terrorist who is infected can contact citizens in the incubation period – it can be a walking bomb and can destroy a nation [through] one person.’

Across the Sea of Japan sits the Tokyo metropolitan-Yokohama area, which, with more than 33 million people, is by far the most populous urban region in the world.


A scenario submitted to the Ministry of Education, Culture, Sports, Science and Technology in 2007 by the Keio University Global Security Center highlighted the potential dangers the city faces from bioterrorism.

In this scenario, a terrorist releases Bacillus anthracis – the bacterium that causes anthrax – at a Tokyo Christmas Eve concert attended by 50,000 revellers. Within days, thousands are sick, with the first death recorded on 29 December. Three days later, 3000 people have died. Two days after that, the number of fatalities reaches 8000.

Richard Love, professor and senior research fellow at the Center for the Study of Weapons of Mass Destruction at the National Defense University in Washington, DC, believes large Japanese cities are generally well-prepared for a biological incident.

‘Their individual response capabilities are pretty good, though it varies widely depending on where you go,’ says Love, who has been a member of several US State Department and Department of Defense delegations working with the Japanese on consequence management. ‘For the most part, I’d say their large cities are pretty capable.’

However, Katsuhisa Furukawa, fellow at the Research Institute of Science and Technology for Society in Tokyo, thinks there is still room for improvement, including by raising awareness in the scientific community. He believes the bioscience community in Japan has been haunted by the activities of the notorious Unit 731, the Imperial Japanese Army’s secret biological and chemical weapons development unit, and says scientists pledged after World War II not to get involved in research for defence purposes. Furukawa argues that such an approach has made some scientists slow to realise the dual-use potential of their research.

‘The scientific community doesn’t have a good sense about how their results could be misused,’ Furukawa says. ‘On the other hand, when you talk to the diplomatic or defence community, they don’t know much about advanced scientific experiments.’

Aum Shinrikyo attack

In 1995, Tokyo was rocked by a terrorist attack when the chemical sarin was released in its subway system, killing 12 and affecting hundreds. The cult responsible, Aum Shinrikyo, had also attempted to conduct biological terrorism and had experimented with anthrax, botulin toxin and cholera.

But Furukawa says it was 9/11, and the subsequent anthrax attacks in the US, that finally alerted Japanese authorities to the potential of terrorists using weapons of mass destruction, prompting the government to take a series of steps to prevent biological agents falling into the wrong hands.

In October 2001, the Ministry of Health, Labor and Welfare met for the first time to discuss measures to combat bioterrorism, leading to the introduction, in December 2004, of the Action Plan to Prevent Terrorism. This called for ‘strengthening of strict control of material potentially used for terrorist attacks’ and the ‘establishment of [a] system to control pathogenic micro-organisms potentially used for bioterrorism.’

Frederick Burkle believes the problem of improving oversight of facilities is complicated by the rapid growth of bioscience research centres in Asia: ‘You never find out what they are dealing with. They have their own security programmes and human surveillance programmes, and the bio-surveillance programmes we have in the United States and other countries are totally separate from this industry.

‘They are almost like two ships that go by in the dark. And if you talk to them about it, everything is a trade secret – that seems to be an excuse for not really knowing if there is a surveillance system of merit or not going on.’

Burkle says several Asian nations, including China, Indonesia and Malaysia, are pouring large amounts of money into bioscience research, but he singles out Singapore as a leader in preparedness for a bioterrorism incident.

Rodney Hoff, executive director of the Regional Emerging Diseases Intervention Centre in Singapore, agrees. ‘They have probably the most sophisticated bioterrorist defence system in the region,’ he says, noting that the country has systems in place for monitoring food production from its neighbours and a sophisticated intelligence system that monitors groups known to have been working on bioterrorist weapons.


Burkle says a clear indication of a country’s ability to handle a bioterrorist incident is its ability to cope with infectious disease outbreaks – and Singapore’s response to SARS in 2003 is generally seen as having been exemplary.

Once the danger was identified, the country implemented a comprehensive series of risk communication measures that included setting up a dedicated TV channel and a range of information outlets, including a hotline. Singapore has also since introduced cutting-edge detection technology, such as the Infrared Fever Screening System, which can detect whether someone has a fever.

Love believes this sophistication is born of necessity. ‘If you go to Singapore and you drive around, you see that if there is an event in a country of a couple of million, because of the size of it, they’re wiped out,’ he says. ‘The threat is so great because there is no defence in depth. They have got to catch whatever it is early, and they have to catch it at the border, because right at the border is right at their homeland.’

Australia’s Preparedness

According to the Federal Government, ‘Australia has a robust health system with measures in place to provide a comprehensive and effective health response in the event of a disaster or mass casualty event, including a bioterrorist act, natural disaster, bombing or communicable disease outbreak.’ Central to this is the National Incident Room, established in 2002 in response to the Bali bombings in October of that year ‘to ensure a nationally consistent and coordinated response to a national health emergency.’

The government believes smallpox, anthrax, plague, tularaemia, viral haemorrhagic fevers (Ebola, Lassa and Marburg viruses) and botulinum toxin pose the most serious bioterrorism threats within Australia, and has guidelines in place in case of outbreaks. Additionally, the National Emergency Medicines Stockpile was set up in 2002 in the wake of 9/11 to supplement existing medical stocks and maintain specialist medical supplies, including the smallpox vaccine.

At time of writing, the level of pandemic threat was ‘0’ in Australia, compared with ‘3’ overseas.

Black Ice

In September 2006, the picturesque Swiss  town of Montreux, known for its jazz festival and sweeping views of Lake Geneva, played host to a surprising event – an international bioterrorism exercise.

The Bioterrorism International Coordination Exercise, or Black ICE, was co-sponsored by Switzerland and the United States, and brought together leaders from 12 international organisations for a table-top exercise aimed at enhancing communication.

‘Many countries had unrealistic expectations about what international organisations could do,’ says a senior US State Department official, adding that many bioterrorism coordinators in Europe had never even met each other before the exercise.

The scenario began with six terrorists from the fictitious Council of Eight in South Asia deliberately infecting themselves with smallpox and travelling by plane to Central Asia, all the time trying to infect as many people as possible. As the scenario unfolded, individual nations were overwhelmed and asked for help from international bodies such as the United Nations.

By the end of the exercise, 465 people were ‘infected’ and 108 ‘died’ over a six-week period, with the response hampered particularly by a lack of vaccines.

The State Department official says Black ICE prompted a number of organisations to establish links so they could continue the dialogue, although he admits the response by international organisations is only part of the challenge – national entities also have to be involved. He believes this can be complicated by reluctance among many governments to reveal vital but sensitive data, such as about infected agricultural sectors.

But he thinks the two-day exercise was a useful start that has prompted governments and international bodies to pay greater attention to the problem: ‘I see more and more nations thinking both domestically about this, but recognising that diseases do not stop at borders.’