An Unwelcome “Newcomer” to the United Kingdom

Today, British Prime Minister Theresa May announced that a “Novichok” agent was used in the poisoning of Sergei Skripal and his daughter in Salisbury, England. This announcement is highly significant because the use of one of these agents points to a very sophisticated operation using next-generation chemical weapons.

That the word “Novichok” was used publicly could also be highly consequential, as it has a very specific meaning and history. The word “Novichok” roughly translates to “newcomer” and reflects the special nature of this class of nerve agents developed and manufactured in the former Soviet Union. Very little information on them is available generally or in the medical literature.  

In general, nerve agents work by interfering with neurotransmission through the inhibition of acetylcholinesterase, the enzyme that breaks down the neurotransmitter acetylcholine. The continued presence of acetylcholine in the neuromuscular junction leads to perpetual muscle contractions. The result is a recognizable clinical syndrome characterized by salivation, lacrimation, urination, diarrhea, pinpoint pupils, and seizure-like activity. Death arises from paralysis of respiratory muscles. As nerve agents, the “Novichok” agents would be expected to operate in this manner. There are antidotes for standard nerve agents that can be beneficial if given in time.

Familiar nerve agents include VX, sarin, soman, and tabun. “Novichok” agents appear to differ in a few key ways. First, they are deadlier - reportedly up to 10 times more lethal than VX.  Second, the production of "Novichok" agents can be more readily concealed from weapons inspectors, according to a Soviet chemist who worked with them. Other properties, such as improved ease of handling and the ability to evade standard chemical detection equipment, penetrate personal protective equipment, and resist treatment efforts have also been suggested in the fragmentary literature. 

As more information emanates from these cases in England, attention to clinical details of the resulting illnesses and their treatment will be essential to understanding the nature of these deadly agents and how to best counteract their effects. Additionally, because this appears to be the first confirmed deployment of a “Novichok” agent with more than a dozen people potentially exposed, there is a pressing medical and public health need to have all clinically relevant information about these agents that may be possessed by government entities disseminated to healthcare professionals immediately.

This latest use of a chemical warfare agent follows the 2017 assassination of Kim Jong-nam - the half-brother of North Korean dictator Kim Jong-un - in a Malaysian airport. In that case, a binary preparation of VX nerve agent was directly applied to the victim’s face. The US recently imposed additional sanctions on the DPRK in response. 

The use of chemical weapons is internationally prohibited by the Chemical Weapons Convention (CWC), to which 98% of the nations of the world are signatory. Though there is speculation that “Novichok” agents were designed to circumvent the CWC, any chemical used to cause harm is treated as a weapon, and their use is banned under the treaty. The UK government, the Organization on the Prohibition of Chemical Weapons (OPCW), and other national security agencies will need to investigate this particularly serious violation of the CWC.

[Note: This post has been updated from its original version]