Disease
Declared cases among
Immigrants (number)
Immigrants (percentage)
Greeks (number)
Greeks (percentage)
Malaria
38
84.44
7
15.56
Tuberculosis
229
46.93
259
53.07
Shigellosis
1
3.03
32
96.97
Hepatitis Α
5
8.47
54
91.53
Hepatitis Β
12
35.29
22
64.71
Typhoid fever
6
60.0
4
40.00
Brucellosis
11
11.34
86
88.66
11.3 Bioterrorism as a Potential Threat
Timely information is crucial when it comes to a natural or accidental outbreak of a disease. This information might be beneficial to laboratory or institution workers or the population that needs to be protected. Of course, in most cases, basic hygiene measures (personal or collective, at home or in a wider infrastructure such as schools) can prevent these diseases.
Defence against a deliberate outbreak of a disease requires intelligence. This type of medical intelligence is attributed to national intelligence service both civilian and military. Usually international collaboration is mandatory when weaponized pathogens are the problem.
Risk identification and assessment contribute to national defence as well. It is a continuous process dealing with both the deliberate and non-deliberate forms of disease outbreaks. Internal (sanitary institutions, police reports, etc.) and external (neighboring countries, World Health Organization, EU public health surveillance systems, etc.) hints can assist experts to perform a risk assessment leading to an alert of the public health system.
Current geopolitical instability and turmoil in our own region combined with the existing direct and indirect, overt and covert threats against Western societies make bioterrorism attacks a potential risk.
Production of biological weapons is both easy and cost effective. Of course we must discriminate between the production and weaponization of pathogens that is not as easy and needs specialized equipment. Pathogen production does not require large factories and existing facilities in commercial infrastructure (food industry, drug industry) can be used for this purpose. On a smaller scale, pathogens can be cultivated in small laboratories or mobile caravans similar to those used to produce illegal drugs. Identification of such illegal laboratories is very difficult. Viral pathogens are more difficult to produce as compared to bacteria and also need some extra precautions and equipment.
Large quantities of biological weapons can still be produced in a short period of time (days or weeks) in small laboratories. According to Kathleen C. Bailey, former Assistant Director, Office for Disarmament and Armaments Control, who visited many biotechnology and pharmacology companies, a complete biolab requires no more than a room of 4.5 m × 4.5 m and a budget of USD 15,000 for supplies [1]. In such a room, trillions of bacteria can be quickly produced with low risk and with minimum personal protection equipment such as a gas mask and a plastic suit over clothing.
Difficulties relevant to the production of biological weapons include:
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Difficulties in the protection of workers at all levels of production, transportation, and final dispersal of biological weapons;
-
Low level of training and expertise can lead to accidents and exposure to pathogens;
-
Vaccination of those involved is not always protective/effective;
-
Controlling the quality and quantity of produced material is difficult;
-
Dispersion is not without problems since dispersal device explosives, UV exposure, or weather conditions such as rain or drying may have negative effects on pathogens or spores;
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Storage of pathogens poses additional problems; specific conditions are required to maintain the efficacy, and it is difficult to maintain them in a form ready for dispersion over long periods of time.
11.4 Preparedness and Response to Health Emergencies in Greece
Key stakeholders in public health preparedness and response systems are:
-
General Secretariat of Civil Protection (GSCP) [3] – Organization under the Ministry of Citizen Protection [5] having the overall responsibility for the protection of the population against all disasters [4], either natural (earthquakes, wildfires, floods, landslides, severe weather phenomena etc.), technological, or deliberate (large scale terrorist attacks – CBRN agents release included).
-
Centre for Disease Control and Prevention (CDCP) – Organization aiming to protect and promote public health by employing a national strategy for the prevention of disease spread. CDCP is responsible for the surveillance of epidemics, running infectious disease cells at hospitals throughout the country, management of public health hazards, and provision of public guidelines in case a public hazard emerges. It is under the control and funding of the Ministry of Health and Social Solidarity [6] operating on a 24/7 basis.
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First Aid National Centre (EKAB) – Organization supporting medical transportation of casualties to state medical facilities.
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Hellenic Police, Hellenic Fire Service, and National Defence General Staff – Entities supporting GSCP’s general emergency plan under the name “Xenocrates”.
11.4.1 Epidemiologic Monitoring in Greece
Epidemiologic monitoring is the systematic and continuous collection, analysis and interpretation of sanitary/medical information relevant to public health.
The objectives of epidemiologic monitoring are:
-
Follow-up of tendencies (estimate the impact of a disease or health problem through time; estimate dispersion of a disease, problem or incident; determination of risk factors);
-
Localization of epidemics or cases (detection of epidemics/cases; prognosis of epidemics);
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