Jeremy Laurance: Health Check

The terrorist shadow hanging over our hospitals

There is one image I cannot get out of my mind following the carnage in America. It was not shown on any news bulletin or in any newspaper and it exists only in my imagination. A psychologist would probably declare that it is a sign of my catastrophising mentality.

The image is of a man in a sludge-grey raincoat and brown scuffed shoes, walking onto a ferry at Calais. He is carrying a suitcase, and has just got off a train from somewhere in Europe.

At Dover he catches a train or bus to London, and makes his way to Oxford Street. He finds the perfume hall of one of the big stores, and spends some time testing the scents. Perhaps he buys some. Then he leaves.

What the shoppers do not know is that among the perfume testers on the display counters, he has left a rogue atomiser, disguised to look just like the real thing. It is filled with anthrax spores.

Anthrax does not kill immediately. It attacks the respiratory system, and in its early stages the symptoms are indistinguishable from flu. But over the following week, increasing numbers of patients would develop septicaemia (blood poisoning), and deaths would start to occur.

The terrorist by this time might have distributed other atomisers in stores in Bristol, Norwich, Leeds and Glasgow. By the time the diagnosis of anthrax was made, the initial exposure of perhaps several hundred individuals would have spread to tens of thousands through contact with family members, work colleagues and medical staff.

The only treatment is high doses of antibiotics. There is a vaccine, but it is kept in very limited quantities. In the nightmare scenario, the population would be gripped by panic, and hospitals would be besieged by mobs demanding drugs and vaccination.

Three years ago, the then US Secretary of State for Defence, William Cohen, raised a 5lb bag of sugar on television to demonstrate the quantity of anthrax spores required to kill half of Washington's 600,000 population.

Last Monday Joe Biden, chairman of the American Senate's Foreign Relations Committee, reiterated the warning, six days after the attack on New York. The real threats to the country were not from missiles or nuclear weapons, he said, but came "in the hold of a ship or the belly of a plane or smuggled into a city in the middle of the night in a vial in a backpack".

In the last week, both Tony Blair and Jack Straw have highlighted the threat from chemical and biological weapons – easy to construct, simple to transport and as lethal as a nuclear warhead.

All NHS hospitals and health authorities were warned to prepare for a terrorist attack using chemical or biological weapons in guidance issued last year. Some ran exercises. Police teams trained by scientists from Porton Down, the government research centre on biological and chemical warfare, have been formed to take the lead role in the event of an attack.

The heightened state of readiness can be traced back to the use of Sarin nerve gas in an attack by a Japanese religious cult six years ago, which focused world attention on the threat. Twelve people were killed and 5,000 injured in that attack. Last week's events in New York, and the coming reprisals by the US, can only have raised the threat by several orders of magnitude.

In America, it emerged only last month that the Pentagon had built a biological weapons factory in the Nevada desert. The aim was to see how easy it was to get hold of the components necessary to make a weapon, mimicking the steps a terrorist might take. At Camp 12 of the Nellis Air Force Range, scientists constructed a 50-litre cylinder capable of cultivating germs out of materials bought commercially from hardware stores.

At the same time, the Pentagon confirmed that it had drawn up plans to genetically engineer a more potent version of the anthrax bacterium. The stated aim was to test whether the anthrax vaccine given to US servicemen would provide effective protection against such a superbug. But the bug itself could also be used offensively. The plans still await approval.

A sign of America's readiness for a biological war came with the disclosure last year that the US Government had ordered 40 million doses of smallpox vaccine at a cost of $343m (£200m). That is a vaccine against a disease that no longer exists. It was eradicated from the planet in 1980 and only two research institutions, one in the US and one in Russia, still retain stocks of the virus – unless, that is, a terrorist group or state organisation holds a supply.

Sir William Stewart, the former UK government chief scientist, warned in his presidential address to the British Association for the Advancement of Science earlier this month that Britain could be caught unawares by biological terrorism. The foot-and-mouth outbreak has already starkly illustrated what could go wrong if we were unprepared. "What if it were a human disease?" he said. "Biological warfare and bio-terrorism are issues we do not like to consider."

We are going to have to consider them now.