Bioterrorism: a very 21st Century threat

EPM sat down with Ted Fjällman, CEO of Prokarium, a company tasked with developing vaccines against bioterrorist threats, to find out more about this growing danger.

Q: What is the true threat of bioterrorism today?

A: In 2001 there were attacks in the US using the dry spores of Bacillus anthracis commonly known as anthrax, where 30,000 people had to be treated, 22 became ill and five people died. Three buildings had to be decontaminated also, with a total direct cost in excess of $1 billion. In August 2014, a laptop owned by a Tunisian physics and chemistry graduate fighting with ISIS/Da'esh was found to contain a 19-page document on how to develop bubonic plague from infected animals and turn it into a weapon. And ISIS/Da’esh and other terrorist organisations now have access to advanced laboratories taken over in Syria and Iraq, in some cases specifically designed by the fallen regimes for production of weapons of mass destruction.

While the anthrax attacks were posted in letters, Yersinia pestis, the bacterium responsible for bubonic plague, can be made into an aerosol and could be spread with a crop-dusting airplane. If released over a densely populated area or during a major event, it is estimated that 1.9-3.4M people could need treatment, 450,000 could become ill and 380,000 could die, with city-wide decontamination costing $1.8 trillion. Quarantine of cities is harder today, due to greater international travel, so if treatment is not available swiftly, biological diseases will continue to spread.

The increase in DIY-bio videos online and the access to community biolabs where the skills to grow micro-organisms can be learnt, increases the risk that a small number of people and possibly even individuals could plan and carry out a biological attack.

However, access to the disease organism is one of the most difficult hurdles for the terrorists. Sadly many diseases do exist in wild animal populations and given the skills the disease organisms could be cultivated. Suicidal terrorists can travel to outbreak zones, get infected and use themselves as weapons, but that is less likely to cause a large-scale epidemic. However, these suicidal terrorists could be a source for cultivating the disease organism (from e.g. sores), which is then weaponised by non-infected terrorist collaborators.

Q: What approach should societies be taking to help in the counter attempt?

A: While it is important to strengthen detection and control measures of materials coming into a country, it is not possible to police everywhere. Similarly, education of DIY bio community laboratories to detect and report any suspicious behaviour amongst users can also reduce chances of ‘home-grown’ bioterrorists emerging. But DIY bio enthusiasts do not have the resources or the inclination to police their fellow ‘biohackers’.

Thus it is very prudent to prepare for dealing with the possibility of a successful biological attack by terrorists. For this, we need to develop vaccines and treatments that can be manufactured simply and quickly and administered rapidly to an infected population. Stockpiling of the vaccines and therapeutic medicines (i.e. develop strategies for long-term storage/longer shelf-life) will be important. Finally, the military, police and public health workers should run small-scale demonstration exercises to test the rapid deployment and countermeasures in a representative population.

Q: And what is Prokarium specifically doing?

A: Prokarium is developing an oral, thermostable and easily manufactured vaccine platform called Vaxonella. Being oral means that Vaxonella-based vaccines are easy to distribute and even self-administrable without needing skilled health workers for e.g. injections. Vaxonella is thermostable at 40°C for 12 weeks and has a shelf life of over three years when stored at 4°C. This long-shelf life means the vaccines can be stockpiled by governments and the thermostability means you could send the vaccine out to the general population without needing refrigeration. In addition, the manufacture can be scaled up quickly without the need for very highly skilled technicians, because Vaxonella does not require the costly and length purification steps that injectable vaccines do.

Using Vaxonella, Prokarium is now developing a specific vaccine against Yersinia pestis, the organism that causes plague. This will be tested in the clinic next year.

Q: Recently we reported that you were granted funding – what will this mean for your work?

A: Prokarium received a £1 million government innovation procurement contract from the UK Department of Health and the UK Vaccine Network, under a programme called Small Business Research and Innovation (SBRI), administered by Innovate UK. The contract allows Prokarium to conduct a clinical trial that not only will determine the potential of a plague vaccine, but also the potential of the platform to orally deliver other vaccines in the future. This clinical proof of concept for the Vaxonella platform sets the stage for strengthening the UK’s and the world’s capability to respond to epidemics and bioterrorist attacks based on many different diseases.