STANFORD, Calif.- For the past seven years, the United States has been negotiating a verification protocol to the Biological Weapons Convention of 1972, hoping to put teeth into the convention's ban on biological weapons production. The Bush administration recently rejected the latest draft of the protocol, viewing it as irredeemably flawed. This is a good time to ask what a new American strategy should be for security against biological threats. It is difficult to predict the likelihood or scale of biological attack. The right policy will provide benefits whether or not an attack occurs.

The first step is conceptual: we must stop thinking about biological security in the way we think about nuclear security. Few aspects of the United States strategy for nuclear security carry over cleanly to the biological case. Security against nuclear attack has relied upon nonproliferation and deterrence, with comparatively little role, so far, for defense. Security against biological-weapons threats should lean primarily on defense.

Nonproliferation, for example, is far more difficult in the biological case. Biological agents are microscopic organisms that can be grown with equipment readily available all over the world -- although the resulting weapons have proved difficult for terrorists to master. Many of the organisms can be acquired during naturally occurring outbreaks. Controls remain valuable, but they will never play the central role that they do in nuclear security. And as biotechnology explodes in the coming decades, nonproliferation will face ever greater challenges.

Deterrence may likewise be of limited use in preventing attacks with biological weapons. While the use of battlefield biological weapons may be deterred by threats, biological terrorism could remain largely immune. The incubation times of most diseases -- for example, seven to 17 days for smallpox -- may lead terrorists to hope they can cover their tracks through covert releases of biological agents. Deterrence relies on the threat of punishment. An attacker who cannot be identified cannot be threatened.

When the Aum Shinrikyo cultists sprayed an anthrax organism in Tokyo -- they did so unsuccessfully several times before their deadly 1995 nerve-gas attack -- they made no announcements and the attacks went unnoticed. When followers of the Bhagwan Shree Rajneesh infected 750 Oregonians in 1984 with salmonella, it took over a year for the attack to be distinguished from a natural outbreak.

Rather than nonproliferation and deterrence, biological security must emphasize civil defense. Civil defense in the biological realm means improving the public health system. Most important, it requires improving disease surveillance. Unusual disease outbreaks must be recognized quickly, so that a rapid response is possible. Health care workers in clinics, hospitals and private practice must know how to identify such outbreaks and be ready and able to pass their information rapidly to city, state and national authorities.

This kind of preparedness would also help to prevent unintentional outbreaks of disease. Because infected passengers can travel the world in less time than it takes for a disease to incubate, it is crucial, for the national interest as well as for humanitarian reasons, to improve disease surveillance overseas. The United States welcomes 50 million visitors every year and imports $40 billion worth of food. Disease cannot be stopped at the border. The United States must act internationally as well as nationally.

Because biological security would offer protection against both natural and nefarious transmission of disease, a sound policy would directly benefit society even if no attack ever happened. Effective biological security requires that we fit the cure to the disease.

The break-up of the Soviet Union resulted in conditions that focused attention on the possible risk of "loose nukes."  But the risk from insecure nuclear materials is not limited to the former Soviet Union; there is a need to ensure adequate physical protection on a global basis. 

The Cox Commission of the U.S. Congress was established in June 1998 to investigate concerns over Chinese acquisition of sensitive U.S. missile and space technology in connection with the launching of U.S. civilian satellites using Chinese launchers on Chinese territory. The investigations were broadened in October 1998 to include alleged security problems and possible espionage at the U.S. nuclear weapons laboratories. Some conclusions were released in January 1999 by the White House together with the administration's response. The full declassified (redacted) version of the report of the Cox Commission was released on May 25, 1999.

The decade of the 1990s has seen renewed concerns over nuclear proliferation, both horizontal and vertical. While many in the arms control community focus on numbers, it is control that is the most important factor--the detonation of just one nuclear weapon would be an international catastrophe. Rather than concentrating on numbers, the regime defined herein centers on enhancing the safety and security being provided nuclear weapons and weapons-usable fissile materials. The proposal in the paper is called the Nuclear Weapons Control Treaty (NWCT) and referred to as New Court. The emphasis is on control rather than disarmament, protection from unintended or unauthorized use rather than elimination. New Court, once in place, would provide an environment in which the necessary audits and accountability for undertaking dramatic reductions in the numbers of weapons and the quantities of weapons-usable materials could be made with much greater confidence than exists today. However, it will be decades (if ever) before the number of nuclear weapons goes to zero. In the meantime, it is paramount that comprehensive safety and security be established and maintained.

There are currently more than a thousand metric tons of civilian fuel cycle plutonium, mostly in spent fuel rods, but hundreds of tons are already separated and in storage. Any of this plutonium could be fashioned into a nuclear explosive. There are no practical approaches for disposing of plutonium in periods of time less than decades. Much of the architecture and technology from New Court can be applied to the development of international monitored storage facilities (IMSF) for civil nuclear material. The paper outlines the five key requirements an international depository must satisfy: national security for the depositors and the host nation; safety and security of the material; transparency of operations; technology transfer to provide uniform global protection; and precise accurate accountability of the quantities and forms of material deposited. The synergism and conflict among the factors is briefly described. The paper also contains annexes on the current status of some key monitoring technologies and a description of an international "stored weapons standard" for protecting weapons-usable fissile material.

Background: In the 1980s, many medical organizations identified the prevention of nuclear war as one of the medical profession's most important goals. An assessment of the current danger is warranted given the radically changed context of the post–Cold War era.

Methods: We reviewed the recent literature on the status of nuclear arsenals and the risk of nuclear war. We then estimated the likely medical effects of a scenario identified by leading experts as posing a serious danger: an accidental launch of nuclear weapons. We assessed possible measures to reduce the risk of such an event.

Results: U.S. and Russian nuclear-weapons systems remain on high alert. This fact, combined with the aging of Russian technical systems, has recently increased the risk of an accidental nuclear attack. As a conservative estimate, an accidental intermediate-sized launch of weapons from a single Russian submarine would result in the deaths of 6,838,000 persons from firestorms in eight U.S. cities. Millions of other people would probably be exposed to potentially lethal radiation from fallout. An agreement to remove all nuclear missiles from high-level alert status and eliminate the capability of a rapid launch would put an end to this threat.

Conclusions: The risk of an accidental nuclear attack has increased in recent years, threatening a public health disaster of unprecedented scale. Physicians and medical organizations should work actively to help build support for the policy changes that would prevent such a disaster.

In the 1990s, global concern over illicit trafficking in nuclear material to terrorists and nation-states has intensified. Two major changes are responsible: the evident new intent of terrorists to wound or kill thousands of civilians and the availability of inadequately protected "loose" nuclear materials in Russia and the newly independent former Soviet republics. These changes have made more likely attempts to acquire weapons-usable nuclear materials for terrorist use or for sale to state sponsors of terrorism. As a result, many efforts are being made to strengthen national and international standards for protection of nuclear material from theft and sabotage. One problem with current efforts is that national stnadards now vary widely. Although the Treaty on the Non-Proliferation of Nuclear Weapons (NPT) mandates that non-nuclear weapon parties accept the safeguards requirements of the International Atomic Energy Agency (IAEA) for their nuclear activities, the relevant international standards for physical protection are mostly advisory.

Russia's current strategic nuclear force will become obsolete shortly after the turn of the century. Strategic modernization is therefore essential if Russia is to remain a nuclear power on a par with the US. But modernization will be extremely difficult because of the country's economic and political turmoil. Russia can probably maintain slightly more than 4,000 strategic nuclear warheads under the Strategic Arms Reduction Talks (START) I Treaty - roughly half of what the United States could, in theory, deploy. Under START II, Russia's strategic force will likely contain between 1,800 and 2,500 warheads, compared to 3,500 for the US. Hence, the easiest - perhaps the only - way for Russia to recover rough parity with the United States would be through a START III Treaty that limits both sides to 2,000-2,500 warheads.