Since there is no accepted treatment for the disease once it has been acquired, the possibility that it might return to the world in a more virulent, weaponized form has prompted a new though limited vaccination program, with its own risks. The United States ended routine vaccinations against it in 1972. Smallpox, for example, was eradicated from the world in 1980, and there has not been a case within the United States since 1949.

As the possibility materializes that chemical and biological weapons could be used as instruments of terror in a domestic context, similar questions are being raised for civilian populations as well. The consent waiver was granted, but the vaccine was made available only on a voluntary basis. military personnel without their consent. (2) The controversy surrounded a waiver that the Department of Defense sought from the Food and Drug Administration that would allow it to administer pyridostigmine and botulinum toxoid vaccine to U.S. Questions about the limits of what can be justified in the name of defense were raised during the first Gulf War.

In a very real sense, the bulwark of last defense against such agents must be mounted, not atop a wall or in a distant trench, but within the very bodies of military and civilian personnel. Responding to the threat of chemical and biological weapons raises complex but important ethical questions.

All this makes chemical and biological weapons uniquely potent tools for insurgency and destabilization. The 1995 release of sarin gas into the Tokyo subway by the Aum Shinri Kyo group suggested that effective delivery devices may be harder to procure than the chemical agents themselves, but the 2001 anthrax attack in the United States, which used the postal service as a delivery device, showed there could also be surprisingly low-tech solutions to delivery and dispersal.

Moreover, chemical and biological weapons are especially attractive alternatives for groups that lack the ability to construct nuclear weapons. A biological attack may not even be discovered until long after a disease has spread through a population. Their effects can be both devastating and indiscriminate, taking the harshest toll on the most vulnerable classes of noncombatants. Chemical and biological weapons are rightly regarded with a special sense of horror.

For the Common Good by Alex John London