Document 17.400
Initiated: September 2001 17.400
Adopted by the WMA General Assembly, Washington 2002
Editorial Changes made during the May 2003 Council Session

1. INTRODUCTION
   
   
   1. The World Medical Association recognizes the growing threat that biological weapons might be used to cause devastating epidemics that could spread internationally. All countries are potentially at risk. The release of organisms causing smallpox, plague, anthrax or other diseases could prove catastrophic in terms of the resulting illnesses and deaths compounded by the panic such outbreaks would generate. At the same time, there is a growing potential for production of new microbial agents, as expertise in biotechnology grows and methods for genetic manipulation of organisms become simpler. These developments are of special concern to medical and public health professionals because it is they who best know the potential human suffering caused by epidemic disease and it is they who will bear primary responsibility for dealing with the victims of biological weapons. Thus, the World Medical Association believes that medical associations and all who are concerned with health care bear a special responsibility to lead in educating the public and policy makers about the implications of biological weapons and to mobilize universal support for condemning research, development, or use of such weapons as morally and ethically unacceptable.
      
      

   2. Unlike the use of nuclear, chemical, and conventional weapons, the consequences of a biological attack are likely to be insidious. Their impact might continue with secondary and tertiary transmission of the agent, weeks or months after the initial epidemic. The consequences of a successful biological attack, especially if the infection were readily communicable, could far exceed those of a chemical or even a nuclear event. Given the ease of travel and increasing globalization, an outbreak anywhere in the world could be a threat to all nations.

   3. A great many severe, acute illnesses occurring over a short span of time would almost certainly overwhelm the capacities of most health systems in both the developing and industrialized world. Health services throughout the world are struggling to meet the demands created by HIV/AIDS and antimicrobial-resistant organisms, the problems created by civil strife, refugees and crowded, unsanitary urban environments as well as the increased health needs of aging populations. Coping over a short period of time with large numbers of desperately ill persons could overwhelm entire health systems.

   4. Actions can be taken to diminish the risk of biological weapons as well as the potentially harmful consequences of serious epidemics whatever their origin. International collaboration is needed to build a universal consensus that condemns the development, production, or use of biological weapons. Programs of surveillance are needed in all countries for the early detection, identification, and response to serious epidemic disease; health education and training is needed for professionals, civic leaders, and the public alike; and collaborative programs of research are needed to improve disease diagnosis, prevention, and treatment.

   5. The proliferation of technology and scientific progress in biochemistry, biotechnology, and the life sciences provides the opportunity to create novel pathogens and diseases and simplified production methods for bioweapons. The technology is relatively inexpensive and, because production is similar to that used in biological facilities such as vaccine manufacturing, it is easy to obtain. Capacity to produce and effectively disperse biological weapons exists globally, allowing extremists (acting collectively or individually) to threaten governments and endanger peoples around the world. Nonproliferation and arms control measures can diminish but cannot completely eliminate the threat of biological weapons. Thus, there is a need for the creation of and adherence to a globally accepted ethos that rejects the development and use of biological weapons.
      

2. STRENGTHENING PUBLIC HEALTH AND DISEASE SURVEILLANCE SYSTEMS
   
   
   6. A critical component in dealing with epidemic disease is a strong public health infrastructure. Investment in public health systems will enhance capacity to detect and to contain expeditiously, rare or unusual disease outbreaks, whether deliberately induced or naturally occurring. Core public health functions (disease surveillance and supporting laboratory services) are needed as a foundation for detection, investigation, and response to all epidemic threats. A more effective global surveillance program will improve response to naturally occurring infectious diseases and will permit earlier detection and characterization of new or emerging diseases.
      
      

   7. It is especially important that physicians be alert to the occurrence of cases or clusters of unusual infectious diseases, to seek help from infectious disease specialists in diagnosis, and to report cases promptly to public health authorities. Because any physician may see only one or a few cases and may not recognize that an outbreak is occurring, cooperation between primary care physicians and public health authorities is especially important.

   8. Public health officials, dealing with an epidemic, will require the cooperation of emergency management agencies, law enforcement officials, healthcare facilities, and a variety of community service organizations. For these different groups to work together effectively, advance planning will be important. In addition to developing surveillance activities for early detection and reporting, public health efforts should be directed toward educating primary caregivers and public health staff about potential agents that might be used, building laboratory capacity for rapid identification of biological agents, providing medical and hospital services as well as vaccines and drugs to control the epidemic.
      

3. ENHANCEMENT OF MEDICAL PREPAREDNESS AND RESPONSE CAPACITY
   
   
   9. The first indication that a biological weapon may have been disseminated is likely to be the appearance of patients in the offices of practicing physicians, especially those in acute care settings. Physicians thus play a critical role in early detection of an outbreak and must be prepared to recognize and deal with diseases resulting from the use of biological weapons as well as other infectious disease agents and to promptly report suspicious illnesses and diseases to public health officials.
      
      

   10. In the course of an epidemic, physicians will be directly involved with mass patient care, with mass immunization and antibiotic prophylaxis, with providing information to the public, and in a variety of hospital and community efforts to control the epidemic. Thus, physicians should participate with local and national health authorities to develop and implement disaster preparedness and response plans for intentional and natural infectious disease outbreaks.
       

4. BIOWEAPONS RESEARCH AND MEDICAL ETHICS
   
   
   11. Rapid advances in microbiology, molecular biology, and genetic engineering have created extraordinary opportunities for biomedical research and hold great promise for improving human health and the quality of life. Better and more rapid diagnostic tools, novel vaccines, and therapeutic drugs can be foreseen. At the same time, there is concern about the possible misuse of research for the development of more potent biological weapons and the spread of new infectious diseases. It may be difficult to distinguish legitimate biomedical research from research by unscrupulous scientists with the malign purpose of producing more effective biological weapons.
       
       

   12. All who participate in biomedical research have a moral and ethical obligation to consider the implications of possible malicious use of their findings. Through deliberate or inadvertent means, genetic modification of microorganisms could create organisms that are more virulent, are antibiotic-resistant, or have greater stability in the environment. Genetic modification of microorganisms could alter their immunogenicity, allowing them to evade natural- and vaccine-induced immunity. Advances in genetic engineering and gene therapy may allow modification of the immune response system of the target population to increase or decrease susceptibility to a pathogen or disrupt the functioning of normal host genes.

   13. Research specifically for the purposes of creating biological weapons is to be condemned. As scientists and humanitarians, physicians have a societal responsibility to decry scientific research for the development and use of biological weapons and to express abhorrence for the use of biotechnology and information technologies for potentially harmful purposes.

   14. Physicians and medical organizations have important societal roles in demanding a global prohibition on biological weapons and stigmatizing their use, guarding against unethical and illicit research, and mitigating civilian harm from use of biological weapons.
       
       
5. RECOMMENDATIONS
   
   

   15. That the World Medical Association and National Medical Associations worldwide take an active role in promoting an international ethos condemning the development, production, or use of toxins and biological agents that have no justification for prophylactic, protective, or other peaceful purposes.

   16. That the World Medical Association, National Medical Associations and healthcare workers worldwide promote, with the World Health Organization, the United Nations, and other appropriate entities, the establishment of an international consortium of medical and public health leaders to monitor the threat of biological weapons, to identify actions likely to prevent bioweapons proliferation, and to develop a coordinated plan for monitoring the worldwide emergence of infectious diseases. This plan should address: (a) international monitoring and reporting systems so as to enhance the surveillance and control of infectious disease outbreaks throughout the world; (b) the development of an effective verification protocol under the UN Biological and Toxin Weapons Convention; (c) education of physicians and public health workers about emerging infectious diseases and potential biological weapons; (d) laboratory capacity to identify biological pathogens; (e) availability of appropriate vaccines and pharmaceuticals; and (f) financial, technical, and research needs to reduce the risk of use of biological weapons and other major infectious disease threats.

   17. That the World Medical Association urge physicians to be alert to the occurrence of unexplained illnesses and deaths in the community and knowledgeable of disease surveillance and control capabilities for responding to unusual clusters of diseases, symptoms, or presentations.

   18. That the World Medical Association encourage physicians, National Medical Associations and other medical societies to participate with local, national, and international health authorities in developing and implementing disaster preparedness and response protocols for acts of bioterrorism and natural infectious disease outbreaks. These protocols should be used as the basis for physician and public education.

   19. That the World Medical Association urge all who participate in biomedical research to consider the implications and possible applications of their work and to weigh carefully in the balance the pursuit of scientific knowledge with their ethical responsibilities to society.

        

       16.5.2003