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|Weapons of mass destruction|
Biological warfare (BW)—also known as germ warfare—is the use of biological toxins or infectious agents such as bacteria, viruses, and fungi with the intent to kill or incapacitate humans, animals or plants as an act of war. Biological weapons (often termed "bio-weapons", "biological threat agents", or "bio-agents") are living organisms or replicating entities (viruses, which are not universally considered "alive") that reproduce or replicate within their host victims. Entomological (insect) warfare is also considered a type of biological weapon. This type of warfare is distinct from nuclear warfare and chemical warfare, which together with biological warfare make up NBC, the military initialism for nuclear, biological, and chemical warfare using weapons of mass destruction (WMDs). None of these are considered conventional weapons, which are deployed primarily for their explosive, kinetic, or incendiary potential.
Biological weapons may be employed in various ways to gain a strategic or tactical advantage over the enemy, either by threats or by actual deployments. Like some chemical weapons, biological weapons may also be useful as area denial weapons. These agents may be lethal or non-lethal, and may be targeted against a single individual, a group of people, or even an entire population. They may be developed, acquired, stockpiled or deployed by nation states or by non-national groups. In the latter case, or if a nation-state uses it clandestinely, it may also be considered bioterrorism.
Biological warfare and chemical warfare overlap to an extent, as the use of toxins produced by some living organisms is considered under the provisions of both the Biological Weapons Convention and the Chemical Weapons Convention. Toxins and psychochemical weapons are often referred to as midspectrum agents. Unlike bioweapons, these midspectrum agents do not reproduce in their host and are typically characterized by shorter incubation periods.
The use of biological weapons is prohibited under customary international humanitarian law, as well as a variety of international treaties. The use of biological agents in armed conflict is a war crime.
- 1 Overview
- 2 History
- 3 As a means of terrorism
- 4 Modern BW Operations
- 4.1 Offensive
- 4.2 Defensive
- 4.3 Genetic warfare
- 5 List of BW institutions, programs, projects and sites by country
- 6 List of people associated with BW
- 7 In popular culture
- 8 See also
- 9 References
- 10 Further reading
- 11 External links
Offensive biological warfare, including mass production, stockpiling, and use of biological weapons, was outlawed by the 1972 Biological Weapons Convention (BWC). The rationale behind this treaty, which has been ratified or acceded to by 170 countries as of April 2013, is to prevent a biological attack which could conceivably result in large numbers of civilian casualties and cause severe disruption to economic and societal infrastructure. Many countries, including signatories of the BWC, currently pursue research into the defense or protection against BW, which is not prohibited by the BWC.
A nation or group that can pose a credible threat omass casualty has the ability to alter the terms on which other nations or groups interact with it. Biological weapons allow for the potential to create a level of destruction and loss of life far in excess of nuclear, chemical or conventional weapons, relative to their mass and cost of development and storage. Therefore, biological agents may be useful as strategic deterrents in addition to their utility as offensive weapons on the battlefield.
As a tactical weapon for military use, a significant problem with a BW attack is that it would take days to be effective, and therefore might not immediately stop an opposing force. Some biological agents (smallpox, (pneumonic plague) (JOEL)have the capability of person-to-person transmission via aerosolized respiratory droplets. This feature can be undesirable, as the agent(s) may be transmitted by this mechanism to unintended populations, including neutral or even friendly forces. While containment of BW is less of a concern for certain criminal or terrorist organizations, it remains a significant concern for the military and civilian populations of virtually all nations.
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Rudimentary forms of biological warfare have been practiced since antiquity. During the 6th century BC, the Assyrians poisoned enemy wells with a fungus that would render the enemy delirious. In 1346, the bodies of Mongol warriors of the Golden Horde who had died of plague were thrown over the walls of the besieged Crimean city of Kaffa. Specialists disagree over whether this operation may have been responsible for the spread of the Black Death into Europe, Near East and North Africa, resulting in the killing of approximately 25 million Europeans.
The British Army commanders approved the use of smallpox as a biological weapon in the French and Indian War to target Native Americans during the Siege of Fort Pitt in 1763. Correspondence between General (Baron) Jeffrey Amherst and Colonel Henry Bouquet provides further evidence that the English army freely planned for the use of biological weapons to kill Native Americans, as detailed in Native American disease and epidemics. A smallpox outbreak was reported in the Ohio Valley and Great Lakes area through 1763 and 1764.
The spread of smallpox weakened the French and Native American resistance to the British troops led by Bouquet. The smallpox outbreak was considered a direct result of two blankets and a scarf taken from a Small Pox Hospital, then gifted by William Trent and others English army representatives to leader Maumaultee and warrior Turtle Heart of the Delaware people during their visit to Ft Pitt. Amherst and Bouquet discussed other biological weapon deployments as a result. Apologists pose questions as to whether the outbreak was the result of the Fort Pitt incident or the virus was already present among the Delaware people. It is likely that the British Marines used smallpox in New South Wales in 1789. Dr Seth Carus (2015) states: "Ultimately, we have a strong circumstantial case supporting the theory that someone deliberately introduced smallpox in the Aboriginal population."
By 1900 the germ theory and advances in bacteriology brought a new level of sophistication to the techniques for possible use of bio-agents in war. Biological sabotage—in the form of anthrax and glanders—was undertaken on behalf of the Imperial German government during World War I (1914–1918), with indifferent results. The Geneva Protocol of 1925 prohibited the use of chemical weapons and biological weapons.
With the onset of World War II, the Ministry of Supply in the United Kingdom established a BW program at Porton Down, headed by the microbiologist Paul Fildes. The research was championed by Winston Churchill and soon tularemia, anthrax, brucellosis, and botulism toxins had been effectively weaponized. In particular, Gruinard Island in Scotland, was contaminated with anthrax during a series of extensive tests for the next 56 years. Although the UK never offensively used the biological weapons it developed on its own, its program was the first to successfully weaponize a variety of deadly pathogens and bring them into industrial production. Other nations, notably France and Japan, had begun their own biological weapons programs.
When the United States entered the war, Allied resources were pooled at the request of the British and the U.S. established a large research program and industrial complex at Fort Detrick, Maryland in 1942 under the direction of George W. Merck. The biological and chemical weapons developed during that period were tested at the Dugway Proving Grounds in Utah. Soon there were facilities for the mass production of anthrax spores, brucellosis, and botulism toxins, although the war was over before these weapons could be of much operational use.
The most notorious program of the period was run by the secret Imperial Japanese Army Unit 731 during the war, based at Pingfan in Manchuria and commanded by Lieutenant General Shirō Ishii. This unit did research on BW, conducted often fatal human experiments on prisoners, and produced biological weapons for combat use. Although the Japanese effort lacked the technological sophistication of the American or British programs, it far outstripped them in its widespread application and indiscriminate brutality. Biological weapons were used against both Chinese soldiers and civilians in several military campaigns. In 1940, the Japanese Army Air Force bombed Ningbo with ceramic bombs full of fleas carrying the bubonic plague. Many of these operations were ineffective due to inefficient delivery systems, although up to 400,000 people may have died. During the Zhejiang-Jiangxi Campaign in 1942, around 1,700 Japanese troops died out of a total 10,000 Japanese soldiers who fell ill with disease when their own biological weapons attack rebounded on their own forces.
During the final months of World War II, Japan planned to use plague as a biological weapon against U.S. civilians in San Diego, California, during Operation Cherry Blossoms at Night. The plan was set to launch on 22 September 1945, but it was not executed because of Japan's surrender on 15 August 1945.
In Britain, the 1950s saw the weaponization of plague, brucellosis, tularemia and later equine encephalomyelitis and vaccinia viruses, but the programme was unilaterally cancelled in 1956. The United States Army Biological Warfare Laboratories weaponized anthrax, tularemia, brucellosis, Q-fever and others.
In 1969, the UK and the Warsaw Pact, separately, introduced proposals to the UN to ban biological weapons, and US President Richard Nixon terminated production of biological weapons, allowing only scientific research for defensive measures. The Biological and Toxin Weapons Convention was signed by the US, UK, USSR and other nations, as a ban on "development, production and stockpiling of microbes or their poisonous products except in amounts necessary for protective and peaceful research" in 1972. However, the Soviet Union continued research and production of massive offensive biological weapons in a program called Biopreparat, despite having signed the convention. as of September 2018, 182 countries have ratified the treaty and none are proven—though nine are still suspected—to possess offensive BW programs.
As a means of terrorism
Biological weapons are difficult to detect, economical and easy to use, making them appeal to terrorists. The cost of a biological weapon is estimated to be about 0.05 percent the cost of a conventional weapon in order to produce similar numbers of mass casualties per kilometer square. Moreover, their production is very easy as common technology can be used to produce biological warfare, like that used in production of vaccines, foods, spray devices, beverages and antibiotics. A major factor about biological warfare that attracts terrorists is that they can easily escape, before the government agencies or secret agencies have even started their investigation. This is because the potential organism has incubation period of 3 to 7 days, after which the results begin to appear, thereby giving terrorists a lead.
A technique called Clustered, Regularly Interspaced, Short Palindromic Repeat (CRISPR) is now so cheap and widely available that scientists fear that the amateurs will start experimenting with them. In this technique, a DNA sequence is cut off and replaced with a new sequence or code that codes for a particular protein or characteristic, which could potentially show up in the required organism. Though this technique is a breakthrough and is commendable, it can cause serious issues and potential danger if used by people with wrong intentions. Concerns have emerged regarding Do-it-yourself biology research organizations due to their associated risk that a rogue amateur DIY researcher could attempt to develop dangerous bioweapons using genome editing technology.
In 2002, when CNN went through Al-Qaeda's (AQ's) experiments with crude poisons, they found out that the AQ associated had begun planning ricin and cyanide attacks with the help of a loose association of cells. The associates had infiltrated many countries like Turkey, Italy, Spain, France and others. In 2015, to combat the threat of bioterrorism, a National Blueprint for Biodefense was issued by the Blue-Ribbon Study Panel on Biodefense. Also, 233 potential exposures of select biological agents outside of the primary barriers of the biocontainment in the US were described by the annual report of the Federal Select Agent Program.
Though a verification system can reduce bioterrorism, an employee or a lone terrorist having adequate knowledge of the company plants, can cause potential danger by injecting a deadly or harmful substance into the plant. Moreover, it has been found that about 95% of accidents that have occurred due to low security have been done by employees or those who had security clearance.
Modern BW Operations
It has been argued that rational state actors would never use biological weapons offensively. The argument is that biological weapons cannot be controlled: the weapon could backfire and harm the army on the offensive, perhaps having even worse effects than on the target. An agent like smallpox or other airborne viruses would almost certainly spread worldwide and ultimately infect the user's home country. However, this argument does not necessarily apply to bacteria. For example, anthrax can easily be controlled and even created in a garden shed; the FBI suspects it can be done for as little as $2,500 using readily available laboratory equipment. Also, using microbial methods, bacteria can be suitably modified to be effective in only a narrow environmental range, the range of the target that distinctly differs from the army on the offensive. Thus only the target might be affected adversely. The weapon may be further used to bog down an advancing army making them more vulnerable to counterattack by the defending force.
Ideal characteristics of a biological agent to be used as a weapon against humans are high infectivity, high virulence, non-availability of vaccines, and availability of an effective and efficient delivery system. Stability of the weaponized agent (ability of the agent to retain its infectivity and virulence after a prolonged period of storage) may also be desirable, particularly for military applications, and the ease of creating one is often considered. Control of the spread of the agent may be another desired characteristic.
The primary difficulty is not the production of the biological agent, as many biological agents used in weapons can often be manufactured relatively quickly, cheaply and easily. Rather, it is the weaponization, storage and delivery in an effective vehicle to a vulnerable target that pose significant problems.
For example, Bacillus anthracis is considered an effective agent for several reasons. First, it forms hardy spores, perfect for dispersal aerosols. Second, this organism is not considered transmissible from person to person, and thus rarely if ever causes secondary infections. A pulmonary anthrax infection starts with ordinary influenza-like symptoms and progresses to a lethal hemorrhagic mediastinitis within 3–7 days, with a fatality rate that is 90% or higher in untreated patients. Finally, friendly personnel and civilians can be protected with suitable antibiotics.
Agents considered for weaponization, or known to be weaponized, include bacteria such as Bacillus anthracis, Brucella spp., Burkholderia mallei, Burkholderia pseudomallei, Chlamydophila psittaci, Coxiella burnetii, Francisella tularensis, some of the Rickettsiaceae (especially Rickettsia prowazekii and Rickettsia rickettsii), Shigella spp., Vibrio cholerae, and Yersinia pestis. Many viral agents have been studied and/or weaponized, including some of the Bunyaviridae (especially Rift Valley fever virus), Ebolavirus, many of the Flaviviridae (especially Japanese encephalitis virus), Machupo virus, Marburg virus, Variola virus, and Yellow fever virus. Fungal agents that have been studied include Coccidioides spp..
Toxins that can be used as weapons include ricin, staphylococcal enterotoxin B, botulinum toxin, saxitoxin, and many mycotoxins. These toxins and the organisms that produce them are sometimes referred to as select agents. In the United States, their possession, use, and transfer are regulated by the Centers for Disease Control and Prevention's Select Agent Program.
The former US biological warfare program categorized its weaponized anti-personnel bio-agents as either Lethal Agents (Bacillus anthracis, Francisella tularensis, Botulinum toxin) or Incapacitating Agents (Brucella suis, Coxiella burnetii, Venezuelan equine encephalitis virus, Staphylococcal enterotoxin B).
The United States developed an anti-crop capability during the Cold War that used plant diseases (bioherbicides, or mycoherbicides) for destroying enemy agriculture. Biological weapons also target fisheries as well as water-based vegetation. It was believed that destruction of enemy agriculture on a strategic scale could thwart Sino-Soviet aggression in a general war. Diseases such as wheat blast and rice blast were weaponized in aerial spray tanks and cluster bombs for delivery to enemy watersheds in agricultural regions to initiate epiphytotics (epidemics among plants). When the United States renounced its offensive biological warfare program in 1969 and 1970, the vast majority of its biological arsenal was composed of these plant diseases. Enterotoxins and Mycotoxins were not affected by Nixon's order.
Though herbicides are chemicals, they are often grouped with biological warfare and chemical warfare because they may work in a similar manner as biotoxins or bioregulators. The Army Biological Laboratory tested each agent and the Army's Technical Escort Unit was responsible for transport of all chemical, biological, radiological (nuclear) materials. Scorched earth tactics or destroying livestock and farmland were carried out in the Vietnam war (cf. Agent Orange) and Eelam War in Sri Lanka.
Biological warfare can also specifically target plants to destroy crops or defoliate vegetation. The United States and Britain discovered plant growth regulators (i.e., herbicides) during the Second World War, and initiated a herbicidal warfare program that was eventually used in Malaya and Vietnam in counterinsurgency operations.
In 1980s Soviet Ministry of Agriculture had successfully developed variants of foot-and-mouth disease, and rinderpest against cows, African swine fever for pigs, and psittacosis to kill chicken. These agents were prepared to spray them down from tanks attached to airplanes over hundreds of miles. The secret program was code-named "Ecology".
Entomological warfare (EW) is a type of biological warfare that uses insects to attack the enemy. The concept has existed for centuries and research and development have continued into the modern era. EW has been used in battle by Japan and several other nations have developed and been accused of using an entomological warfare program. EW may employ insects in a direct attack or as vectors to deliver a biological agent, such as plague. Essentially, EW exists in three varieties. One type of EW involves infecting insects with a pathogen and then dispersing the insects over target areas. The insects then act as a vector, infecting any person or animal they might bite. Another type of EW is a direct insect attack against crops; the insect may not be infected with any pathogen but instead represents a threat to agriculture. The final method uses uninfected insects, such as bees, wasps, etc., to directly attack the enemy.
Research and development into medical counter-measures
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In 2010 at The Meeting of the States Parties to the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and Their Destruction in Geneva the sanitary epidemiological reconnaissance was suggested as well-tested means for enhancing the monitoring of infections and parasitic agents, for practical implementation of the International Health Regulations (2005). The aim was to prevent and minimize the consequences of natural outbreaks of dangerous infectious diseases as well as the threat of alleged use of biological weapons against BTWC States Parties.
Role of public health and disease surveillance
It is important to note that most classical and modern biological weapons' pathogens can be obtained from a plant or an animal which is naturally infected.
Indeed, in the largest biological weapons accident known—the anthrax outbreak in Sverdlovsk (now Yekaterinburg) in the Soviet Union in 1979—sheep became ill with anthrax as far as 200 kilometers from the release point of the organism from a military facility in the southeastern portion of the city and still off limits to visitors today, (see Sverdlovsk Anthrax leak).
Thus, a robust surveillance system involving human clinicians and veterinarians may identify a bioweapons attack early in the course of an epidemic, permitting the prophylaxis of disease in the vast majority of people (and/or animals) exposed but not yet ill.
For example, in the case of anthrax, it is likely that by 24–36 hours after an attack, some small percentage of individuals (those with compromised immune system or who had received a large dose of the organism due to proximity to the release point) will become ill with classical symptoms and signs (including a virtually unique chest X-ray finding, often recognized by public health officials if they receive timely reports). The incubation period for humans is estimated to be about 11.8 days to 12.1 days. This suggested period is the first model that is independently consistent with data from the largest known human outbreak. These projections refines previous estimates of the distribution of early onset cases after a release and supports a recommended 60-day course of prophylactic antibiotic treatment for individuals exposed to low doses of anthrax. By making these data available to local public health officials in real time, most models of anthrax epidemics indicate that more than 80% of an exposed population can receive antibiotic treatment before becoming symptomatic, and thus avoid the moderately high mortality of the disease.
Common epidemiological clues that may signal biological attack
From most specific to least specific:
- Single cause of a certain disease caused by an uncommon agent, with lack of an epidemiological explanation.
- Unusual, rare, genetically engineered strain of an agent.
- High morbidity and mortality rates in regards to patients with the same or similar symptoms.
- Unusual presentation of the disease.
- Unusual geographic or seasonal distribution.
- Stable endemic disease, but with an unexplained increase in relevance.
- Rare transmission (aerosols, food, water).
- No illness presented in people who were/are not exposed to "common ventilation systems (have separate closed ventilation systems) when illness is seen in persons in close proximity who have a common ventilation system."
- Different and unexplained diseases coexisting in the same patient without any other explanation.
- Rare illness that affects a large, disparate population (respiratory disease might suggest the pathogen or agent was inhaled).
- Illness is unusual for a certain population or age-group in which it takes presence.
- Unusual trends of death and/or illness in animal populations, previous to or accompanying illness in humans.
- Many affected reaching out for treatment at the same time.
- Similar genetic makeup of agents in effected individuals.
- Simultaneous collections of similar illness in non-contiguous areas, domestic, or foreign.
- An abundance of cases of unexplained diseases and deaths.
Identification of bioweapons
The goal of biodefense is to integrate the sustained efforts of the national and homeland security, medical, public health, intelligence, diplomatic, and law enforcement communities. Health care providers and public health officers are among the first lines of defense. In some countries private, local, and provincial (state) capabilities are being augmented by and coordinated with federal assets, to provide layered defenses against biological weapon attacks. During the first Gulf War the United Nations activated a biological and chemical response team, Task Force Scorpio, to respond to any potential use of weapons of mass destruction on civilians.
The traditional approach toward protecting agriculture, food, and water: focusing on the natural or unintentional introduction of a disease is being strengthened by focused efforts to address current and anticipated future biological weapons threats that may be deliberate, multiple, and repetitive.
The growing threat of biowarfare agents and bioterrorism has led to the development of specific field tools that perform on-the-spot analysis and identification of encountered suspect materials. One such technology, being developed by researchers from the Lawrence Livermore National Laboratory (LLNL), employs a "sandwich immunoassay", in which fluorescent dye-labeled antibodies aimed at specific pathogens are attached to silver and gold nanowires.
In the Netherlands, the company TNO has designed Bioaerosol Single Particle Recognition eQuipment (BiosparQ). This system would be implemented into the national response plan for bioweapon attacks in the Netherlands.
Researchers at Ben Gurion University in Israel are developing a different device called the BioPen, essentially a "Lab-in-a-Pen", which can detect known biological agents in under 20 minutes using an adaptation of the ELISA, a similar widely employed immunological technique, that in this case incorporates fiber optics.
- Would demonstrate how to render a vaccine ineffective;
- Would confer resistance to therapeutically useful antibiotics or antiviral agents;
- Would enhance the virulence of a pathogen or render a nonpathogen virulent;
- Would increase transmissibility of a pathogen;
- Would alter the host range of a pathogen;
- Would enable the evasion of diagnostic/detection tools;
- Would enable the weaponization of a biological agent or toxin
Most of the biosecurity concerns in synthetic biology, however, are focused on the role of DNA synthesis and the risk of producing genetic material of lethal viruses (e.g. 1918 Spanish flu, polio) in the lab. Recently, the CRISPR/Cas system has emerged as a promising technique for gene editing. It was hailed by The Washington Post as "the most important innovation in the synthetic biology space in nearly 30 years." While other methods take months or years to edit gene sequences, CRISPR speeds that time up to weeks. However, due to its ease of use and accessibility, it has raised a number of ethical concerns, especially surrounding its use in the biohacking space.
List of BW institutions, programs, projects and sites by country
- Fort Detrick, Maryland
- Project Bacchus
- Project Clear Vision
- Project SHAD
- Project 112
- Horn Island Testing Station
- Fort Terry
- Granite Peak Installation
- Vigo Ordnance Plant
- Porton Down
- Gruinard Island
- Operation Vegetarian (1942–1944)
- Open-air field tests:
Soviet Union and Russia
- Biopreparat (18 labs and production centers)
- Stepnagorsk Scientific and Technical Institute for Microbiology, Stepnogorsk, northern Kazakhstan
- Institute of Ultra Pure Biochemical Preparations, Leningrad, a weaponized plague center
- Vector State Research Center of Virology and Biotechnology (VECTOR), a weaponized smallpox center
- Institute of Applied Biochemistry, Omutninsk
- Kirov bioweapons production facility, Kirov, Kirov Oblast
- Zagorsk smallpox production facility, Zagorsk
- Berdsk bioweapons production facility, Berdsk
- Bioweapons research facility, Obolensk
- Sverdlovsk bioweapons production facility (Military Compound 19), Sverdlovsk, a weaponized anthrax center
- Institute of Virus Preparations
- Poison laboratory of the Soviet secret services
- Project Bonfire
- Project Factor
- Unit 731
- Zhongma Fortress
- Kaimingjie germ weapon attack
- Khabarovsk War Crime Trials
- Epidemic Prevention and Water Purification Department
- Grosse Isle, Quebec, site (1939–45) of research into anthrax and other BW agents
- Experimental Station Suffield, Suffield, Alberta
List of people associated with BW
- Includes scientists and administrators
- Shyh-Ching Lo
- Kanatjan Alibekov, known as Ken Alibek
- Ira Baldwin
- Wouter Basson
- Kurt Blome
- Eugen von Haagen
- Anton Dilger
- Paul Fildes
- Arthur Galston (unwittingly)
- Kurt Gutzeit
- Riley D. Housewright
- Shiro Ishii
- Elvin A. Kabat
- George W. Merck
- Frank Olson
- Vladimir Pasechnik
- William C. Patrick III
- Sergei Popov
- Theodor Rosebury
- Rihab Rashid Taha
- Prince Tsuneyoshi Takeda
- Huda Salih Mahdi Ammash
- Nassir al-Hindawi
- Erich Traub
- Auguste Trillat
- Baron Otto von Rosen
- Yujiro Wakamatsu
- Yazid Sufaat
Writers and activists:
In popular culture
- Animal-borne bomb attacks
- Antibiotic resistance
- Asymmetric warfare
- Baker Island
- Biological contamination
- Chemical weapon
- Discredited AIDS origins theories
- Entomological warfare
- Ethnic bioweapon
- Exotic pollution
- Herbicidal warfare
- Human experimentation in the United States
- John W. Powell
- Johnston Atoll Chemical Agent Disposal System
- Plum Island Animal Disease Center
- Project 112
- Project AGILE
- Project SHAD
- McNeill's law
- Military Animal
- Rhodesia and weapons of mass destruction
- Ten Threats
- Yellow rain
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However, in the light of contemporary knowledge, it remains doubtful whether his hopes were fulfilled, given the fact that the transmission of smallpox through this kind of vector is much less efficient than respiratory transmission, and that Native Americans had been in contact with smallpox >200 years before Ecuyer’s trickery, notably during Pizarro’s conquest of South America in the 16th century. As a whole, the analysis of the various ‘pre-micro- biological” attempts at BW illustrate the difficulty of differentiating attempted biological attack from naturally occurring epidemics.
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In retrospect, it is difficult to evaluate the tactical success of Captain Ecuyer's biological attack because smallpox may have been transmitted after other contacts with colonists, as had previously happened in New England and the South. Although scabs from smallpox patients are thought to be of low infectivity as a result of binding of the virus in fibrin metric, and transmission by fomites has been considered inefficient compared with respiratory droplet transmission.
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