Chemical weapons have been available and utilized for over a century. The German army used mustard and chlorine gas in World War I. Nerve agents were discovered and weaponized by the Germans during World War II. The Germans built a large facility during the war for the exclusive purpose of producing nerve agent munitions. They were not used during the war for fear that the Allies also possessed such weapons and would retaliate. Nerve agents are organophosphate compounds that are similar to insecticides but in a much more concentrated form. A single drop of a nerve agent is sufficient to kill an adult male. These compounds work by inhibiting cholinesterase, an enzyme that breaks down the neurotransmitter acetylcholine in parasympathetic nerve synapses. By preventing the breakdown of acetylcholine, the nerve remains in a continuous state of excitation (contraction). The effects on the body are many, but the most toxic effect is severe bronchoconstriction and subsequent asphyxiation. Other overt symptoms are blurred vision (from pupillary constriction), salivation, vomiting and loss of bowel & bladder control. If fortunate enough to survive exposure you are likely to suffer neurologic and psychiatric effects for years. Nerve agents fall into two classes, persistent and non-persistent. Either can penetrate the skin or be inhaled if the agent is aerosolized. Antidotes (atropine and pralidoxime chloride) work by blocking the nerve receptors and restoring cholinesterase. The problem is that the antidotes must be administered rapidly and repeatedly, especially if exposed to a persistent agent.
Nerve agents have been used against civilians by the Iraqis on the Kurds and on several occasions by President Assad in Syria. Kim Jong Un is known to possess nerve agents and Kim’s own half brother was murdered with a nerve agent. The most recent use of a nerve agent was against a former Russian spy Sergei Skripal and his daughter who were living in the UK. Both survived the attack but they remain in critical condition. Prime Minister Theresa May believes that Novichok was used in this instance. Novichok was developed by the Soviets as a new and more deadly weapon. Twenty two additional people were treated for exposure including the first responder to the incident. While many politicians and the media focus on NOK’s nuclear capability, I am more concerned with Kim’s stockpile of chemical weapons. A chemical agent atop a missile need not be accurate to produce widespread casualties without destroying infrastructure. If we enter into talks with NOK on nukes, we should include chemical agents as well.