Version 2012

Handbook of WMA Policies
World Medical Association ⏐ D-2002-01-2012
WMA DECLARATION OF WASHINGTON
ON
BIOLOGICAL WEAPONS
Adopted by the 53rd
WMA General Assembly, Washington, DC, USA, October 2002
and editorialiy revised by the 164th
WMA Council Session, Divonne-les-Bains, France,
May 2003
and reaffirmed by the 191st
WMA Council Session, Prague, Czech Republic, April 2012
A. INTRODUCTION
1. The World Medical Association recognizes the growing threat that biological wea-
pons 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 uni-
versal 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.
R
E
S
C
I
N
D
E
D

Handbook of WMA Policies
World Medical Association ⏐ D-2002-01-2012
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. Inter-
national 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, biotech-
nology, 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.
B. STRENGTHENING PUBLIC HEALTH AND DISEASE SURVEILLANCE SYSTEMS
2.
1. 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 deli-
berately induced or naturally occurring. Core public health functions (disease sur-
veillance and supporting laboratory services) are needed as a foundation for detec-
tion, investigation, and response to all epidemic threats. A more effective global
surveillance program will improve response to naturally occurring infectious dis-
eases and will permit earlier detection and characterization of new or emerging
diseases.
2. 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.
3. 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 identifi-
cation of biological agents, providing medical and hospital services as well as
vaccines and drugs to control the epidemic.
R
E
S
C
I
N
D
E
D

D-2002-01-2012 ⏐ Prague
Biological Weapons (Washington)
4. C. ENHANCEMENT OF MEDICAL PREPAREDNESS AND RESPONSE CAPACITY
a.
1. 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.
2. In the course of an epidemic, physicians will be directly involved with mass patient
care, with mass immunization and antibiotic prophylaxis, with providing informa-
tion 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.
5. D. BIOWEAPONS RESEARCH AND MEDICAL ETHICS
a.
1. 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 diag-
nostic 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 un-
scrupulous scientists with the malign purpose of producing more effective biologi-
cal weapons.
2. 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 im-
munity. 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.
3. Research specifically for the purposes of creating biological weapons is to be
condemned. As scientists and humanitarians, physicians have a societal respon-
sibility to decry scientific research for the development and use of biological wea-
pons and to express abhorrence for the use of biotechnology and information
technologies for potentially harmful purposes.
4. 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.
R
E
S
C
I
N
D
E
D

Handbook of WMA Policies
World Medical Association ⏐ D-2002-01-2012
6. E. RECOMMENDATIONS
a.
1. That the World Medical Association and National Medical Associations world-
wide take an active role in promoting an international ethos condemning the
development, production, or use of toxins and biological agents that have no justi-
fication for prophylactic, protective, or other peaceful purposes.
2. That the World Medical Association, National Medical Associations and health-
care workers worldwide promote, with the World Health Organization, the United
Nations, and other appropriate entities, the establishment of an international con-
sortium 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 sys-
tems 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 physi-
cians 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, tech-
nical, and research needs to reduce the risk of use of biological weapons and other
major infectious disease threats.
3. 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.
4. 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 prepared-
ness 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.
5. 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.
R
E
S
C
I
N
D
E
D