Smallpox and the Bioterrorism Threat

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Smallpox and the Bioterrorism Threat
by James Hall, Associate Editor

April 4, 2002

"Leaning Left"

James Hall The complexities of the War Against Bioterrorism are amply illustrated by the current public policy debate over Smallpox vaccination. Should we vaccinate our population with a not-completely-safe Smallpox vaccine against a threat that may not exist? Or do we wait, but then accept potentially huge losses when an attack occurs? These decisions are the stuff of nightmare in Washington of late.

In 1979, the World Health Organization announced that Smallpox, a once-dreaded, highly communicative disease, killing two million people each year, had been completely eliminated in nature through effective vaccination. The only remaining viruses were supposedly frozen in labs in Russia and the United States. Scientists then spent the next decade arguing whether or not to destroy the virus completely to stop any comeback, or continuing to study it to understand Smallpox's genetic secrets.

The WHO finally voted to destroy the remaining stocks by 1999, but this never happened. By then there were concerns that security leaks in the labs had led to the distribution of Smallpox to nations and terrorists wanting to develop weapons of mass destruction. There were additional concerns that live virus may have survived in the bodies of victims buried in permafrost environments and might be released as that environment continues to warm.

To stop a deadly attack of Smallpox in the post-September 11 environment, the US raced to expand its stocks of vaccine. More vaccine was found in the freezers of a pharmaceutical company, Aventis Pasteur. The administration is now much closer to its goal of 300 million doses to protect the American population.

So what do we do with it? Should we begin to vaccinate Americans or wait for a credible Smallpox threat to emerge? Unfortunately, the vaccine isn't completely safe, and it's estimated that if 300 million Americans were inoculated, approximately 200 of them would die from complications created by the vaccine. Others undergoing treatment for AIDS and cancer, might be exposed to disease by being vaccinated or even by just being exposed to the vaccinated.

This might seem like a small price to pay for security, but for those affected and their families it would be a high price, particularly if we found out later that there were no programs out there to use Smallpox as a weapon.

On the other hand, if America were to be attacked by doses of Smallpox, the disease can travel quickly and invisibly and be widespread before it is even detected. Its relatively long incubation time--twelve days--makes it difficult to track down and isolate the source. Millions of Americans could suddenly find themselves seriously ill, with a mortality rate as high as one in three.

The decision to vaccinate is further complicated by other unanswered questions. Most people over 32, for example, received a Smallpox vaccination when they were young. Is that vaccination still good? Scientists aren't sure.

Among the options under consideration:

1) Vaccinate only essential government and military personnel in exposed areas.

2) Make vaccinations voluntary, so citizens can choose to participate or not.

3) Use a strategy similar to that used for the anthrax outbreak--wait for infection, and then vaccinate all those exposed. Smallpox's characteristics make this strategy less likely to be successful than it was for the anthrax outbreak.

4) Make vaccination mandatory. Probably the least popular decision, but the safest one for the nation as a whole.

5) Wait for a clear sign that our enemies have the smallpox virus and then inoculate. A risky proposition, considering that the US would likely be the first target.

So how do we balance the statistical certainty of 200 dead from vaccination with the prospects of millions dead or maimed in an effective Smallpox attack? When we're not sure that terrorists even have access to the deadly Smallpox virus? Those are questions that will keep more than a few politicians up at night--and maybe some of us average citizens as well.

For a Smallpox attack scenario see this. ***

Photo of the author courtesy of staff files