Armed Conflicts and Terrorism

Public health emergency preparedness and response to bioterrorist Attack

Seretidis Christos


We have seen a series of terrorist acts by immigrants and illegal immigrants in the years we have been through (2020-21), as well as in the past (first, second or even third generation). Wherever it arises from, violence for political or religious purposes is common. We see states, international organizations, citizen groups, ethnic groups, and others defend it as self-defence, as a good objective that can only be achieved through revenge violent ways. (Seretidis, 2020)

At times, violence is justified against tyrannical, oppressive, corrupt leaders and warlords in the name of humanitarian action to save a people from genocide, as the phrase is frequently used. Some causes and purposes justify violent methods more persuasively than others in the public eye (e.g., resistance to a foreign invasion than of violence against a clinical abortion), just as some forms of violence are thought to be more justified than others (e.g. explosion to military vehicle more than blowing up a school bus with children).

Instead of accepting a fertile scepticism that asserts “a terrorist for one person is a freedom fighter for another,” we must investigate all beliefs that ethically justify violence by both guerrillas and terrorists, as well as how regular citizens and third parties accept them. (Seretidis, 2020)

Because terrorism has had obvious consequences over the last hundred years, one must be sceptical of explanations that emphasize innovation, such as globalization and the clash of cultures, and whether these influences must also be analysed in addition to others. These new forms of terrorism that have surfaced around the world have altered everything about national security concerns as well as how such crises are managed at the national level. (Seretidis, 2020)

Governments are concerned about preparing for and responding to new forms of terrorism with the fewest possible casualties. We have made so many references to terrorism and its new forms in the introduction to this essay because we find many important elements, findings, and detect interrelated concerns arising from the causes of these new forms of asymmetry and hybrid threats, such as the immigration crisis, which will concern us in Greece and throughout Europe. Because of all of the abovementioned, Greece is a critical entry point for many potential terrorists. Unfortunately, many extremists linked to terrorist incidents on European soil in recent years have unlawfully entered the Greek border as refugees or immigrants, whether children of refugees or second or third generation immigrants.

Is it reasonable to ask whether European freedoms are at danger?

Are states and National Public Health Emergency (PHE) systems prepared to deal with new types of terrorism, such as bio-terrorism, which we ’ve mentioned? (Seretidis, 2021)

The new types of “internal and international terrorism,” such as cybersecurity and bioterrorism, as well as new forms of “asymmetric and hybrid threat” warfare, are raising concern and uncertainty around the world.

Chronology of Βiological Warfare (BW) and Bioterrorism

The contemporary definition of terrorism emphasizes the objectivity of threatening and terrorizing large groups of people, governments, armies, or societies. Terrorism’s major goal, according to the current definition, is to threaten and intimidate mass groups of people, governments, militaries, or society as a whole. Thus, one can assume that, in the context of a historical assessment of bioterrorism, it entails the use of various biological agents by a number of actors or organizations, including political or military actors and official nations, for a range of purposes (political, religious, or other ideological objectives). As one prominent expert on the subject put it, “the transcendence of biological warfare (BW) over medical and public health, private criminal acts, terrorism, interstate warfare, and international law directed at the elimination of biological warfare” makes this one of the most complicated issues of discourse, poses very difficult problems, and opens some novel ethical challenges. (Lederberg, 1999, pp. 3–5)

The claim of the transcendence of biological warfare and bioterrorism, in addition to being perfectly true in terms of contemporary political and scientific concerns, has historical pertinence, as the act of endangering fellow human beings health through the use of biological technologies appears to be as old as humanity itself. However, due to a number of interconnected variables, such as a scarcity of credible scientific data on purported bioterrorist acts, particularly prior to the development of modern microbiology. Second, because of the polarized nature of any alleged biological attack, historical studies of biological warfare (BW) and bioterrorism are extremely difficult, and any conclusions drawn in this regard must be approached with caution, as the existing materials are vulnerable to various political manipulations. (Christopher et al., 1997, pp. 17–35)

Given these considerations, it’s simple to see how researchers might difficulty to distinguish natural epidemics from purported biological assault.

Biccherna a wood cover

Biccherna a wood cover
Source: (Pinterest, no date)

The Role of Public Health in Emergency Preparedness and Response

Public health professionals are at the frontline of emergency preparedness and response, and public health systems are critical to homeland security and defence. (Levy and Sidel, 2007)

PH personnel (Nurses), who serve in public health at the local and state levels agencies around the world (Gebbie, 2002) and cover a wide selection of programs, make up the largest category of healthcare providers. New infectious diseases such as West Nile virus, severe acute respiratory syndrome (SARS), and avian influenza have emerged.as well as bioterrorism threats (Anthrax) and the scares for other unknown threats, have increased the emphasis on the fundamental operations of the country’s public health infrastructure. These new public health (PH) concerns arise at a time when resources to support such programs are inadequate.

It is no secret that many countries’ national public health system has already been undermined by the years of economic and a lack of administrative oversight. It lacked the requisite financial resources to meet the time’s material and technological challenges. We see no such decisive political will to provide the population with strategies in handling these emerging forms of crisis as well as disease prevention at a time when public health is in desperate need of reform. This essay identifies issues concerning bioterrorism preparedness in public health (PH).

View of the Unit 731 complex at Pingfan

View of the Unit 731 complex at Pingfan China Source: (Wikipedia, 2021)

Lack of experience in Preparing for Bioterrorism

When big, vulnerable populaces are purposefully strongly exposed to highly pathogenic bacteria-organisms that cause extensive sickness, bioterrorism poses a threat to national security. Terrorists demonstrated their potential to disrupt health-care systems when unsuspecting civilians were purposefully exposed to anthrax in the United States in the fall of 2001,. Anthrax had previously been thought to be an exotic wool-sorters sickness (Benenson and American Public Health Association, 1995). Several persons have been recognised were victims, and many authorities were responded. The authorities-agencies were incompetent to define their professional responsibilities and duties. There was a lack of clarity about the line of command, how to disseminate specialist knowledge, and how to interact with the general public through the media. Officials in the field of public health tried to define the boundaries of their own knowledge, authority, and duty. Public health nurses were tasked with conducting communicable disease investigations, clinical duties, mass medicine clinics, and communicating with the confused public in the midst of the chaos.

Develop strategies to prevent terrorism

Public health authorities are in task of safeguarding the public’s safety through preventing infectious diseases. Doctors and nurses examine vulnerable populations and implement anti-infective medications and immunizations on a regular basis. Because the general population is virtually unvaccinated and so unprotected, smallpox would represent a severe threat to public health in the United States. (United States, 2004).

Smallpox has sparked widespread concern in the United States, prompting the beginning of a massive health-care campaign in late 2002 to vaccinate a core group of health-care workers and emergency responders. The goal of immunizing this population is to create a workforce capable of responding to suspected cases. The smallpox vaccine, its administration, and adverse responses are all unfamiliar territory for most nurses and doctors. Additional doctors and nurses will need to be immunized as public health authorities establish smallpox preparedness strategies so that they can give the vaccine in large vaccination clinics. As part of a statewide smallpox preparation campaign, all doctors and nurses are being challenged to learn about the disease, the vaccination, and the strategy of administration. Vaccines are also available for other potentially fatal diseases. Anthrax can be prevented if a vaccine is administered prior to exposure. Unfortunately, the vaccine’s safety was called into doubt once it was made mandatory for members of the US military, and study on the substance is still ongoing (Henderson, Inglesby and O’Toole, 2002).

The influenza vaccination is rarely regarded as part of bioterrorism and emergency preparedness activities, although preventing the disease has additional advantages. Bioterrorism-related illnesses might have symptoms and signs that are similar to influenza. Immunizations should be promoted to limit the spread of influenza, which could obscure the diagnosis and early detection of a more serious bioterrorist activity. Currently, healthcare professionals conduct large-scale community influenza immunization clinics, which aid in the development of herd immunity in a vulnerable population. Reduced access to potential bioterrorist agents is a long-term goal for all health-care practitioners in order to prevent bioterrorism (Levy and Sidel, 2007).

Security in public health and research laboratories has improved since the anthrax incidents, and all healthcare professionals should be aware of and follow the severe national government guidelines and requirements for laboratory security (Centers for Disease Control and Preventio, 2002)

Advocating for the control, reduction, and elimination of weapons of mass destruction (WMD) is another long-term endeavour. Biological weapons have been conceived, developed, and tested by a number of countries, including the United States. The history of their use is a sad reminder of how science and technology may work against nursing and public health goals (Berkowitz, 2002; Levy and Sidel, 2007).


Even since the emergence of state-sponsored Biological Warfare programs, satisfactory conclusions about the effective employment of biological warfare across the history of humanity remain difficult to draw, despite improvements in scientific research on bacteriology and, more extensively, in biology and medicine. For the historical researcher, the paucity of microbiological and epidemiological evidence, the weight of political propaganda, and difficulties of military secrecy make the topic extremely difficult to answer. However, a remarkable feature of that history is the periodic deployment of biological weapons (whether for-profit or genuine), which began long before the scientific revolution of microbiology at the end of the 19th century. Biological Warfare is a “common element of the human behavioural repertoire,” according to BW (72 Rózsa, 2009, pp. 217–219).

This hazard is not a risk-threat of the past, and it continues to be a critical concern, both locally and globally, particularly in light of the current surge in the use (or potential use) of non-state-sponsored Biological Warfare. The question of whether we have become more humanistic in our time than our forefathers in terms of biological warfare, and what are the best strategies to prevent similar risks and threats in the future, remains unanswered. In the end, the history of biological warfare and bioterrorism reveals that the most successful preventive measure is the cultivation and retention of strong cultural norms prohibiting the production and deployment of such weapons at the individual, society, and governmental levels. In general, while biological warfare is an essential issue, it should not cause us to overreact and obscure the reality of actual and serious preventable infections.

Recent terrorist acts in the United States have underlined the importance of public health emergency (PHE) personnel, nurses, doctors as first responders in bioterrorism incidents. Diseases caused by a bioterrorist agent are unlikely to be recognized promptly and will evolve slowly, placing local public health personnel under pressure. Because their position is skills-based, public health nurses aid in disease prevention measures such as immunizations, detecting new cases based on signs and symptoms, and contributing to disease investigations. If a bioterrorism event is detected, the first responders professionals nurses and doctors, act within the agency, and the Public Health (PH) authorities organize and develop chains of command to staff outreach sites, execute mass clinics, encourage responsible communications, and provide training and psychosocial support. First responders, doctors and nurses also participate in exercises and drills to assess their performance and position, and they carry this preparation into their personal life.


Benenson, A. S. and American Public Health Association (eds) (1995) Control of communicable diseases manual: an official report of the American Public Health Association. 16th ed. Washington, DC: American Public Health Association.

Berkowitz, B. (2002) ‘Public health nursing practice: aftermath of September 11, 2001’, Online Journal of Issues in Nursing, 7(3), p. 5.

Centers for Disease Control and Preventio (2002) Laboratory Security and Emergency Response Guidance for Laboratories Working with Select Agents, MMWR. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5119a1.htm (Accessed: 15 June 2021).

Christopher, G. W. et al. (1997) ‘Biological warfare. A historical perspective’, JAMA, 278(5), pp. 412–417.

Gebbie, K. M. (2002) ‘Holding Society, and Nursing, Together’:, AJN, American Journal of Nursing, 102(9), p. 73. doi: 10.1097/00000446-200209000-00045.

Henderson, D. A., Inglesby, T. V. and O’Toole, T. (2002) Bioterrorism: guidelines for medical and public health management. Chicago, Ill: American Medical Association.

Lederberg, J. (1999) Biological Weapons: Limiting the Threat. Edited by Joshua Lederberg. Cambridge. MA: MIT Press. Available at: https://www.belfercenter.org/publication/biological-weapons-limiting-threat (Accessed: 10 June 2021).

Levy, B. S. and Sidel, V. W. (2007) ‘Challenges that terrorism poses to public health’, in Terrorism and Public Health. Oxford University Press. doi: 10.1093/acprof:oso/9780195325256.001.0001.

Pinterest (no date) Vicente Matte no Instagram: “Allegory of the Plague (Tavoletta di Biccherna), 14th century. Giovanni di Paolo”, Pinterest. Available at: https://www.pinterest.se/pin/431501208052946892/ (Accessed: 10 June 2021).

Rózsa, L. (2009) ‘The motivation for biological aggression is an inherent and common aspect of the human behavioural repertoire’, Medical Hypotheses, 72(2), pp. 217–219. doi: 10.1016/j.mehy.2008.06.047.

Seretidis, C. (2020) Ερμηνεύοντας τη σύγχρονη τρομοκρατία – Η Συμβολή της θεωρίας συλλογικής δράσης, SECURITY MANAGER: Περιοδικό για την ασφάλεια. Available at: https://www.securitymanager.gr/ermineyontas-tin-sygchroni-tromokratia-i-symvoli-tis-theorias-syllogikis-drasis/ (Accessed: 10 June 2021).

Seretidis, C. (2021) Νέες Παγκόσμιες Προκλήσεις Εκτάκτων Αναγκών στην Δημόσια Υγεία, SECURITY MANAGER: Περιοδικό για την ασφάλεια. Available at: https://www.securitymanager.gr/nees-pagkosmies-prokliseis-ektakton-anagkon-stin-dimosia-ygeia/ (Accessed: 10 June 2021).

United States (ed.) (2004) Addressing the smallpox threat: issues, strategies, and tools. Rockville, Md.: Agency for Healthcare Research and Quality (Bioterrorism and health system preparedness, Issue brief no. 1).

Wikipedia (2021) ‘Unit 731’, Wikipedia. Available at: https://en.wikipedia.org/w/index.php?title=Unit_731&oldid=1027639573 (Accessed: 10 June 2021).

[1] Biccherna, a wood cover, is an allegory of the plague (used to protect official documents of the civic government of Siena), an unidentified artist painted it about 1437. (Possibly Giovanni di Paolo). This allegory is thought to be a portrayal of the plague and its high contagiousness, and it implies that, in addition to catapulting corpses into besieged cities, plague might also be spread via contaminated arrows. Copyright: ©bpk/Kunstgewerbe museum, SMB/Saturia Linke.

[2] View of the Unit 731 complex at Pingfan, China. Copyright: Despite all our efforts, we have not succeeded in identifying the authors and rights holders for this widely disseminated image. If you believe that you may be a rights holder, we invite you to contact Wiley, the publisher of this Journal.


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