WMA Declaration of Washington on Biological Weapons

Adopted by the 53^rd WMA General Assembly, Washington, DC, USA, October 2002,
editorially revised by the 164^th WMA Council Session, Divonne-les-Bains, France, May 2003,
reaffirmed by the 191^st WMA Council Session, Prague, Czech Republic, April 2012, and
revised by the 74^th WMA General Assembly, Kigali, Rwanda, October 2023

PREAMBLE

Rapid advances in microbiology, molecular biology, and genetic engineering have created extraordinary opportunities for biomedical research and hold great promise for improving human health and the quality of life. However, the proliferation of these technologies provides the opportunity to create novel pathogens and diseases and simplified production methods for biological weapons. The technologies are relatively inexpensive and, because production is similar to that used in biological facilities such as vaccine manufacturing, they are easy to obtain. Capacity to produce and effectively disperse biological weapons exists globally, threatening governments and endangering people around the world.

The consequences of a biological attack would be insidious and devastating. Their impact might continue with secondary and tertiary transmission of the agent, weeks, months or years after the initial epidemic. Given the ease of travel and increasing globalization, an outbreak anywhere in the world could be a threat to all nations. A great many severe, acute illnesses occurring over a short span of time could overwhelm the capacities of health systems worldwide.

Physicians and other health personnel are on the frontline in alleviating human suffering caused by epidemic disease and will bear primary responsibility for dealing with the victims of biological weapons.

Participants in biomedical research have a moral and ethical obligation to consider the implications of possible malicious use of their findings. Through deliberate or inadvertent means, genetic modification of microorganisms could create organisms that are more virulent, are antibiotic-resistant, or have greater stability in the environment. Genetic modification of microorganisms could alter their immunogenicity, allowing them to evade natural and vaccine-induced immunity. Advances in genetic engineering and gene therapy may allow modification of the immune response system of the target population to increase or decrease susceptibility to a pathogen or disrupt the functioning of normal host genes.

Nonproliferation and arms control measures can diminish but cannot completely eliminate the threat of biological weapons. Thus, there is a need for the creation of and adherence to a globally accepted ethos that rejects the development, production, possession and use of biological weapons. International collaboration is critical to build such a universal consensus.

The United Nations Biological Weapons Convention (BWC) prohibits the development, production, acquisition, transfer, stockpiling and use of biological and toxin weapons. Having reached almost universal membership, the BWC constitutes a key element in the international community’s efforts to address the proliferation of weapons of mass destruction and has established a strong norm against biological weapons.

Medical associations and physicians have a responsibility in educating the public and policy makers about the implications of biological weapons and to mobilize universal support for condemning research, development, or use of such weapons as morally and ethically unacceptable. They have important societal and ethical roles in demanding the full respect of the BWC, stigmatizing the use of biological weapons, guarding against unethical and illicit research, and mitigating harm from use of biological weapons.

RECOMMENDATIONS

Recognizing the growing threat of biological weapons, the WMA and its constituent members condemn the development, production, or use of toxins and biological agents that have no justification for prophylactic, protective, therapeutic or other peaceful purposes, and makes the following recommendations:

Strengthening global preparedness and response to health emergencies

Governments and national health authorities:

1. To develop a strategy for the effective coordinated and timely access to vital protective measures for new pathogens, whatever their origin, for all populations at risk. The strategy should assure surge capacity to address mass casualty care.
2. In line with the WMA Statement on Epidemics and Pandemics, to meet the critical needs for:

• Adequate investment in public health systems, including resources and supplies, to enhance capacity to effectively detect, investigate and contain rare or unusual disease outbreaks.
• An operative global surveillance program to improve response to naturally occurring infectious diseases and to permit earlier detection and characterization of new or emerging diseases.

3. To provide to WHO adequate means to fulfill its leadership role in ensuring appropriate international cooperation and coordination for surveillance and action on emerging infectious diseases.
4. To support the development of a WHO legally binding instrument on pandemic prevention, preparedness and response, integrating principles of equity and human rights.
5. To develop adequate and targeted health education and training for health professionals, civic leaders, and the public alike, as well as collaborative programs of research to improve disease diagnosis, prevention, and treatment.
6. To develop communications strategies to inform health care professionals and the public about acts of bioterrorism and infectious disease outbreaks, including local information on available medical services.
7. To fund research and development to counteract biological weapons, including:

• to improve understanding of the epidemiology, pathogenesis, and treatment of diseases caused by potential bioweapon agents and the immune response to such agents;
• for new and more effective vaccines, pharmaceuticals, and antidotes against biological weapons; and
• for improving biological agent detection and defense capabilities.

Physicians, Medical Associations and other health entities:

8. To participate with local, national, and international health authorities in developing and implementing disaster preparedness and response protocols for acts of bioterrorism and natural infectious disease outbreaks. These protocols should be used as the basis for physician and public education.
9. To support and fulfill the critical role of physicians in early detection of unusual clusters of diseases or symptoms, potentially resulting from the use of biological weapons, so that they can promptly report it to the appropriate institutions.
10. Physicians in relevant specialties should:

• be alert to the occurrence of unexplained illness and death in the community;
• be knowledgeable of disease surveillance and control capabilities for responding to unusual clusters of diseases, symptoms, or presentations;
• be familiar with the clinical manifestations, diagnostic techniques, isolation precautions, decontamination protocols, and therapy/prophylaxis of biological agents likely to be used in an attack;
• utilize appropriate procedures to prevent exposure to themselves and others; and
• understand the essentials of risk communication so that they can communicate clearly and nonthreateningly about issues such as exposure risks and potential preventive measures.

Counteracting biological weapons research

Governments and national health authorities:

11. To develop and implement national and global raising awareness strategies on the potential development of biological weapons among researchers and practitioners, with comprehensive information on the reporting system to be used if needed.
12. To reinforce accountable and transparent supervision mechanisms and regulation of biological and toxin laboratory work with the potential for weaponized applications.

Physicians:

13. Recognizing the societal responsibility of physicians as scientists and humanitarians, to decry scientific research for the development and use of biological weapons and to advocate against the use of biotechnology and information technologies for potentially harmful purposes.

Researchers:

14. To consider the implications and possible applications of their work and carefully balance the pursuit of scientific knowledge with their ethical responsibilities to society.

Fostering global mechanisms monitoring the threat of biological weapons

Governments:

15. To take necessary measures to guarantee the respect and implementation of the BWC and to reinforce its implementation with appropriate means, ensuring transparency and adequate accountability mechanisms for Member State Parties.

Physicians, Medical Associations and other health entities:

16. To advocate, in cooperation with the United Nations, including the WHO, and other appropriate entities, for strengthening of the Implementation Support Unit under the BWC, including medical and public health leaders in order to monitor the threat of biological weapons, to identify actions likely to prevent biological weapons proliferation, and to develop a coordinated plan for scrutinizing the worldwide emergence of infectious diseases. This plan should address:

• international monitoring and reporting systems so as to enhance the surveillance and control of infectious disease outbreaks throughout the world;
• the development of an effective verification protocol under the BWC;
• education of physicians and public health personnel about emerging infectious diseases and potential biological weapons;
• laboratory capacity to identify biological pathogens;
• availability of appropriate vaccines and pharmaceuticals; and
• financial, technical, and research needs to reduce the risk of use of biological weapons and other major infectious disease threats.