October 12, 1986
Joshua Lederberg

A subcommittee of the NAS/CISAC Committee devoted to BW met in Moscow
October 8-10, 1986.  A list of the Soviet and U.S.  participants is
appended.

This is a preliminary transcript of my impressions of the meeting.

There will be a detailed transcript of the notes taken by Lynn Rusten
and others of our delegation.  This is a preliminary account of first
impressions.  I stress here matter that pertains particularly to
problems of verification.  In fact with the exception of Ustinov the
Soviet scientists present at the meeting had very little experience or
background in BW problems.  I asked Ustinov about that and he said that
he and Antonov had given that same group a briefing approximately a week
earlier.  It does happen then that this meeting has become a way of
introducing a significant group of Soviet scientists from the civilian
sector into some thought about BW arms control problems.

It is important to note that Dr M. Meselson of Harvard had been invited
by the Ministry of Public Health to visit Moscow at the end of August,
and was briefed for 3 days about the 1979 anthrax epidemic at
Sverdlovsk.  His respondents were Burgasov (Deputy Minister of Health),
Bezdenezhnykh, (an epidemiologist from the RFSR health ministry),
Nikiforov and Yampolskaya (both physicians from Moscow.  Meselson
talked to our group for about two hours in New York on September 22.
The 5-year BWC review conference was held in Moscow at the end of
September, and I was briefed about that by Robert Mikulak at ACDA.

Bochkov did not attend: "away on business." Sagdeev attended briefly at
the end of the second day and at one of the luncheons.  In addition I
had an extended conversation with him at his home for dinner on Friday
evening.

The meeting was held at the Institute for Bioorganic Chemistry, still
under construction.  Its director, Yuri Ovchinnikov, was away on
business, in Europe.  He has been rumored to be in poor health, but is
evidently asymptomatic according to Dr. Rich, who saw him recently.

Although Ivanov is the deputy director of the Institute Sverdlov acted
as co-chairman on the Soviet side.  In a brief discussion of the agenda
he was quite agreeable to devoting the first day to questions about BW
arms control and the second day to cooperative research programs.  It
was evident from the outset that the latter was of the greatest
interest and incentive to the group.  I asked him whether it would be
possible to invite Nikiforov to the meetings and he said that that had
already been arranged and he would be available for the Thursday
morning.  Burgasov it turns out has retired only very recently (to the
great delight of one of the Russians who said that he had been
extremely restrictive, for example forbidding the publication of any
information about AIDS in the Soviet Union).  Bezdenezhnykh has died of
a heart condition during the last few weeks.  Nikiforov said that he
was already in very bad health at the time that they had talked to
Meselson.

My opening statement is attached.  There was little concrete response
about my remarks on means of verification.  By common agreement the
conference of experts to be held at Geneva in early April would be the
place to negotiate detailed proposals.  There was, however, general
agreement about the need for confidence building and a very strong
affirmation that medical scientists did have an important
responsibility to be sure that BW was indeed controlled and that the
Treaty be strengthened in a way to assure mutual confidence.  There was
a repeated echoing of the thought that extensive scientific cooperation
between the U.S. and the USSR in fields related to BW would contribute
greatly to providing that mutual reassurance.  There were really no
dissonant notes of any kind: the only approximation to it was from
Schvedkov a political scientist from the Institute for the US and
Canada.  He said the Soviet public has reason to worry about what the
US military is doing.  He quoted press reports about happenings in the
Pentagon.  He also quoted a story in Graham Allison's book on formation
of foreign policy "that Nixon's proposals for BW disarmament had been
resisted by the US Army. Also, Gorbachev had made the furthest
proposals on verification in his speech on September 9th that would
allow for an international network for verification of the nuclear test
ban.  Indeed a supra national network that might be viewed as a
prototype for what could be done in the BW area.  The Third country
problems have to be looked at in a broad international context.
Terrorism is generated by international conflicts and is the recourse
of the weak against the strong.  As to the BWC, suspicions are not
supported by the fact and the convention is working.  "

Nevertheless everyone else including Ustinov seemed to resonate with
the conclusions of the BWC review conference in Geneva that called for
strenthening of the BWC and even Schvedkov's remarks were made in a
much milder tone than what usually comes forth from his institute.  I
had the impression that he had a perfunctory message that he was
obliged to deliver and that nobody was paying very much attention to
it.

My own remarks about the importance of affirmative cooperative
verification, that each side had in his own interest the promulgation
of openness and reassurance were responded to positively by every other
member of the group to whom I talked.  (Lisov from the Ministry of
Defense did not utter one word during the entire meeting.  He had a
rather dour expression throughout, which may or may not have any
significance.) The entire proceedings were videotaped.  Lynn Rusten's
request to get a copy was at first rebuffed bureaucratically "that it
had not been arranged beforehand.  Videotapes are stringently
controlled." Sagdeev reassured her however that it would be done.

During the discussion I brought forward the Wall Street Journal article
on BW defense budgets of the Pentagon.  This was not new information
but I think that some of our colleagues were a little startled to see
the depth and candor with which this kind of discussion was published
in the United States.  At the very end of the meeting I also deposited
the DoD Report to Congress on the same subject as an illustration of
the openness that prevailed on our side.  The scientists were hardly in
a position to make promises about future Soviet behavior in this
direction but I'm sure this was useful and appropriate information for
them to have.

Nikiforov arrived at the very start of the Thursday session but he had
left the slides back at his institute (!).  We agreed that it was
important that they be included as part of his presentation and so he
agreed to wait and to sit in in our discussion for the hour or so that
it took for them to arrive.  Nikiforov heads the department of
infectious diseases at the Central Institute for Postgraduate Medicine
in Moscow.  This has a hospital of 360 beds; there are 110 departments
which give courses ranging from a few weeks to many months to a total
of 28,000 physicians every year (There are 1.2 million physicians in
the Soviet Union).  His department provides teaching for about 280
postgraduate physicians in the field of infectious diseases.
Yampolskaya is an assistant in that department, one or two layers
removed from Nikiforov.  It is not unusual at all for them to be
consulted on medical problems that arise throughout the Soviet Union.
In this case they were called by Professor Kortev from the Medical
Institute in Sverdlovsk about the two cases of disease with very
strange onset.  (In this precis, I will omit most detail that
duplicates what was recorded by Meselson.  As stated before, a full
report will be provided later.)

Acute and severe abdominal pain and high fever suggested to them some
form of intoxication.  It was only after the post-mortem that they were
able to confirm a diagnosis of intestinal anthrax.  Throughout his
career Nikiforov has seen many sporadic cases: perhaps 100 to 120
altogether, which had much the same picture.  He said that previously
they were all fatal so that he felt gratified that they were able to
save even the small proportion that did survive in this case.  There
was no precedent for an outbreak of intestinal anthrax of this
dimension in history.  He did not think the clinical course of the
disease was unusual for that particular diagnosis.  They are not
particularly research oriented and he does not believe the strains were
saved.  When tested contemporaneously they were sensitive to all the
usual antibiotics including penicillin.  The bacilli did have a very
thick capsule which is closely associated with very high virulence in
anthrax.

We had not as yet received Meselson's notes of his August trip.  We
therefore had only a few limited points of testimony to use as the
basis of more detailed questioning.

At my request, Nikiforov met with us again on Friday, and asked Olga
Yampolskaya to join us, together with Dr. Sverdlov. Her English is
reasonably fluent, and this facilitated the discussion.  When we asked
them questions about epidemiology they stressed that they had no first
hand information of those studies since their task was the clinical
care of the individual patients in the hospital.  Besides Yampolskaya
there were five other assistants who came up at various times from
Moscow and they had 22 local M.D.'s also helping in the management of
the outbreak.  Yampolskaya in fact had no detailed knowledge at all
about the epidemiology until she heard Professor Bezdenezhnykh at the
meeting with Matt Meselson.  That was the first time that she had any
inkling that there were political overtones to the epidemic.  Neither
of them had the detailed case records at their own disposal.
Yampolskaya thinks she was selected to help in the briefing because she
had kept certain personal notes on a few of the individual cases.  We
did not think it fruitful to pursue very strongly the epidemiological
side in Bezdenezhnykh's absence.  We strongly urged, and Sverdlov
echoed this, that it would be of great scientific (not to mention
political) importance for a detailed account of the epidemic to be
published.  Nikiforov said that he had come to that conclusion
himself.  It was urged on him that he get a young epidemiologist to
assist him in the compilation of the detailed records.

On the clinical course, Nikiforov gave very dramatic account of the
development of the syndrome.  When it reaches a stage of toxic shock it
does include cyanosis and dyspnea but this is only fairly late in the
development of the disease.  As to the family distribution Nikiforov
thought he remembered one family with as many as three victims.
Perhaps ten of the families of the total had more than one case.  He
has no explanation for why a rather small proportion of those who
presumably ate the infected meat actually came down with the disease.
As the cases began to accumulate they became very concerned about
trying to collect them at the earliest possible point so besides the
public health measures with which he was not directly connected (the
circulation of notices warning about meat contamination; destruction of
sources of infection) he encouraged the hospitalization of essentially
every case who presented with fever or other promonitory symptoms.  He
said that in total perhaps as many as 500 individuals with even mild
fever were hospitalized for a time in order to enhance the opportunity
of catching any new cases as early as possible.  He concluded that
penicillin was as effective as any of the other antibiotics but they
had tried a variety of broad spectrum antibiotics not to leave out any
possibilities.  They used steroids in massive doses to attempt to
mitigate the shock syndrome.  (There is a mistranslation in our copy of
the 1980 paper: prophylactic antibiotics were given to not by family
members of the cases.)

Some of the gross pathology that he desccribed was quite impressive.
One set of pictures showed multiple lesions on the tongue and stomach
which he believed were primary sites of infection by anthrax
organisms.

At one point near the end of the discussion on Friday morning Nikiforov
left an opening with a remark about the political colorations so we
pressed him a bit more closely.  He was unaware of any military
involvement of any kind.  There were no military or police in the
hospital.  He thought that conceivably they might have played some role
in the public health management for example in arranging for the
burning of some sheds in which infected animals had been kept.  He said
that most of these would have been in the suburbs in the south probably
about two weeks after he arrived in the city.  We showed him The New
York Times article (dated       '80) giving the emigres' report of the
outbreak.  He only seen it the day before, namely the copy I had given
to Sverdlov.  He never heard of Kashino, reported there as a suburb of
Sverdlovsk which was in the path of the airborne plume.  As to the
rumors, he was not aware of any at the time. He said he had had some
hint of some fuss later on but had paid no particular attention to it.
He put what he read in The New York Times article as the "Mark Twain
Syndrome", recalling that he had once been involved in a cholera
epidemic. He heard over the radio that the entire medical team
including himself had been killed by the disease.  "Reports of his own
death were grossly exaggerated".  After Chernobyl, families had all
kinds of rumors about what was happening to them based on their fear of
radiation.

Yampolskaya said that there were lectures from time to time in
Sverdlosk at the Medical Institute and in Moscow, where the outbreak
was used as teaching material and there must be dozens if not hundreds
of medical residents who have heard about it.

I was left in very little doubt that they had been describing their
personal experience in the management of an epidemic of intestinal
anthrax.  For sources of corroboration it will be necessary to go into
the epidemiological aspects of the disease and this information is now
in the hands of the Ministry of Public Health.  It is certainly an
obstacle that Bezdenezhnykh has died and whether Burgasov's successor
will be more or less amenable to the distribution of those records
remains to be seen.  Without yet having seen the internal report I did
not have any grounds to proceed very much further in my own questions
and I made no effort to get in touch with the Ministry.  I'm sure that
Ustinov would be very cooperative in responding to any requests to try
to reach that channel.  Official diplomatic sources should request
documentary material from the Ministry of Public Health.

My own private thoughts are that the whole question of the anthrax
epidemic is a secondary issue.  The story told so far appears to be
internally consistent and not in sharp violence with the other
available data, although these can be interpreted in different ways.
It would be very easy for other observers to panic about the nature of
the epidemic particularly if they had reason to believe that there is
indeed a military BW facility near Sverdlovsk.  That question is after
all not touched by any of the medical questions that we have addressed
here so far.  If there were also military personnel who had succumbed
to the infection, whatever the source, they probably would not have
been treated at the civilian hospital; so there is not a necessary
contradiction with Nikiforov's statements.

The primary question, verification of the nature and functions of the
military facility will have to be addressed at other levels.  But it
would be an interesting test of just how far the Russians are willing
to go in "openness" to ask whether there is any form of inspection of
the suspected facility to which they would be agreeable.

Meanwhile, again as a personal view, I believe that it would extremely
imprudent on the part of USG to continue to refer to the epidemic as
evidence of violation of the BWC.  Separate questions are a) the
channels through which the Soviet Union is responding to its
obligations for consultation under the BWC and b) the primary
allegation, which may have nothing to do with the epidemic, of
continued BW production activities at Sverdlovsk in violation of the
BWC.   It must cause them much embarassment that a) anthrax remains
endemic in Russia, and b) that public health safeguards had broken
down, especially in the management of the bonemeal plant!

If we continue to refer to the epidemic per se in the face of the
evidence they have presented, we face a) discredit from third parties,
and b) [if it was indeed foodborne] the consolidation of Soviet views
that we are not serious about our concerns for verification, but
propaganda-motivated.  It may be difficult to reach a standard of
evidence that finally settles the matter and would require an
affirmative retraction on the U.S.  part; but there may be no need to
reach that if we simply withhold further adverse comment about the
epidemic.  There remains every reason to demand satisfaction about
facilities suspected of being BW-oriented; and the current Soviet mood
may bend them to some accomodation by way of some form of inspection
....

If the epidemic itself is to be pursued, diplomatic channels might
explore other kinds of corroboration: a visit to Sverdlovsk, if done at
all, could focus on further conversations with the medical personnel
resident there who were involved in treating patients.  One might also
be able to interview some of the few survivors and perhaps some family
members of fatal victims to try to get some more detail about the
clinical course of the disease.

Emigre sources might be interrogated more closely on the factual
evidence of pulmonary vs abdominal involvement; also how they knew that
the first casualties were military.

I did ask Nikiforov if he had seen inhalation anthrax himself.  He said
yes some years ago in Albania he had encountered a few cases of it.
The distinctive pathological feature is involvement of the lung
parenchyma which he said he did not see in the autopsies at
Sverdlovsk.  Fibrinolysis and plural hemorrhage as well as hemorrhage
in every other organ system including the brain are characteristic of
the systemic form of the disease whether of intestinal or other
origin.  He had graphic autopsy pictures of these features.

Dr. Woodward and Dr. Bennett could add with the benefit of their
personal experience in pathology their impressions of what was being
said.

Nikiforov and Yampolskaya have, I think, said all that they know and
remember and they do not have more by way of their own records.
Further investigation would have to stress the epidemiological aspects
which would involve separate negotiations with the Ministry of Public
Health, through governmental channels.  We should not be too optimistic
that they have the more detailed records that would conform to our
expectations.

-----

Our further discussions with the Russian academicians concerned areas
that would be promising for scientific research cooperation.  Dr.
Sverdlov's resume is a fair account.   It would further both medical
science and cooperative verification of the BWC if some of these
proposals could be implemented.


.bp
	I am checking:  Meselson had evidently phoned the Soviet
Ministry of Health about our impending visit and this was undoubtedly
how it came about that Nikiforov was primed to talk to us.

M.M. also recalled that the Russians had mentioned radio broadcasts
warning of contaminated meat.

Date NYT, WSJ articles