- Dr. Jonathan B. Tucker is the Director of the
Chemical
and Biological Weapons Nonproliferation Program at the Center for
Nonproliferation
Studies of the Monterey Institute of International
Studies
-
-
- Smallpox, the only infectious disease to have been
eradicated,
was one of the most terrifying of human scourges. It covered the skin with
hideous, painful boils, killed a third of its victims, and left survivors
disfigured for life. In this riveting, often terrifying look at the history
of smallpox, Jonathan B. Tucker tells the story of this deadly disease,
the heroic efforts to eradicate it worldwide, and the looming dangers it
still poses today.
-
- Over the centuries, the smallpox virus afflicted rich
and poor, royalty and commoners, and repeatedly altered the course of human
history. In the sixteenth century, the Spanish conquistadors brought
smallpox
to the New World where it spread like wildfire among the indigenous
populations,
enabling the Spanish to conquer the Aztecs and Incas. In the eighteenth
century, smallpox was so widespread in Europe that most people either
became
immune or died from the infection in childhood. Acquired immunity allowed
the British army to employ smallpox as a biological weapon against North
American Indian tribes in the aftermath of the French and Indian
War.
-
- No safe way of preventing smallpox existed until 1796,
when an English country doctor named Edward Jenner developed a vaccine
against it. During the ensuing 170 years, vaccination banished smallpox
from the industrialized countries, but it remained a major cause of
suffering
and death in the developing world, killing almost two million people a
year. Finally, in 1967, the World Health Organization launched an
intensified
global campaign to eradicate smallpox. By early 1978, the disease had been
eliminated worldwide, a triumph ranking among the greatest achievements
in medical history.
-
- Even after smallpox eradication and the decision to halt
the routine vaccination of civilians, laboratory stocks of the smallpox
virus remained. During the 1980s, Soviet leaders cynically exploited the
world's new vulnerability to smallpox by mass-producing the virus as a
strategic weapon. After a Soviet defector exposed this top-secret program
in 1992, the potential military threat triggered a series of urgent debates
over how to respond. In recent years, the possible return of smallpox has
taken an even greater urgency with the realization that clandestine stocks
of the virus may still exist. In Scourge, Tucker tells the fascinating
history of smallpox and draws some important lessons for the future.
___
-
- Smallpox Does Not Discriminate
-
- From:
http://www.pgw.com/catalog/Fall2001/groveatlantic/0871138301titleframe.html
-
- One of the most terrifying of human diseases, smallpox
covered the skin with hideous, painful boils, killed a third of its
victims,
and left the survivors disfigured for life. Over the centuries, the disease
afflicted rich and poor, royalty and commoners, and repeatedly altered
the course of human history. In Scourge, Jonathan B. Tucker tells the
dramatic
true story of smallpox and draws some important lessons for the future.
No safe way of preventing smallpox existed until 1796, when an English
country doctor named Edward Jenner developed a vaccine against it. Over
the next 170 years, vaccination banished smallpox from industrialized
countries,
but it remained a major cause of suffering and death in the developing
world. In 1967, the World Health Organization launched a global campaign
to eradicate smallpox. After a heroic effort, the last natural outbreak
was snuffed out a decade later. During the 1980s, Soviet leaders cynically
exploited the world's new vulnerability to smallpox by mass-producing the
virus as a strategic weapon. In wartime, the deadly agent would have been
loaded into missile warheads targeted on American cities. After a Soviet
defector exposed this top-secret program in 1992, the recognition of
smallpox
as a potential military and terrorist threat triggered a series of urgent
debates over how to respond. Scourge tells the riveting history of
smallpox,
the heroic efforts to eradicate it worldwide, and the looming dangers it
poses to the world today. ___
-
- Scared Of Smallpox
-
- The government wants to build up supplies of the vaccine.
Is this a real threat?
-
- By Jennifer Barrett NewsWeek Web Exclusive 10-18-1
-
- Smallpox vaccinations in the United States were
discontinued
nearly 30 years ago, and the last known case anywhere in the world was
in 1977. So why are federal health officials suddenly asking for $500
million
to buy 300 million doses of the smallpox vaccine?
-
- As early as January 1999, a World Health Organization
committee warned that smallpox now poses ìthe most serious
bioterrorist
threat to the civilian population.î But the recent cases of anthrax
exposure, including one death, have made the chances of an attack more
worrisome. While the United States has antibiotics to treat anthrax, a
potentially lethal bacteria, the smallpox virus is much harder to treat
- its fatality rate is nearly 1 in 3 cases. That makes vaccination the
most effective weapon against the disease. Secretary of Health and Human
Services Tommy Thompson has promised that enough doses will be ready to
vaccinate every American by ìsometime next year.î Will that
be soon enough?
-
- Jonathan Tucker, director of the Chemical &
Biological
Weapons Nonproliferation Program at Californiaís Monterey Institute
for International Studies, and author of the book 'Scourge: The Once and
Future Threat of Smallpox,' spoke with NEWSWEEK's Jennifer Barrett about
the threat of smallpox and the possibility of reinstating nationwide
vaccinations
against the virus. Tucker recently fractured his jaw, but was able to
conduct
the interview with NEWSWEEK via e-mail.
-
- NEWSWEEK: On Wednesday, Secretary of Health and Human
Services Tommy Thompson announced that he had asked lawmakers for $509
million to contract four pharmaceutical companies to produce as much as
300 million doses by the end of 2002, enough to protect every American
from smallpox. Is that a realistic monetary figure and timeline? What's
involved in building up the vaccine supply?
-
- Jonathan B. Tucker: Secretary Thompson's proposal to
acquire 300 million doses of smallpox vaccine by the end of next year is
an enormously ambitious proposal. The old smallpox vaccine was produced
by inoculating the vaccine virus (vaccinia) into the scarified skin of
living calves and harvesting the virus-rich pus. This method resulted in
a vaccine that, while effective, was often contaminated with bacteria and
other viruses. As a result, the old production method no longer meets the
quality-control standards of the Food and Drug Administration (FDA).
Instead,
the vaccine virus will be grown in living animal cells suspended in a
nutrient
medium in a stainless-steel tank known as a bioreactor. Developing the
new production process, scaling it up, and ensuring that the new vaccine
is safe and effective, will all take time. Even if all 300 million doses
can be produced by the end of 2002, a task that will pose major technical
challenges, the new vaccine will not have been approved by the FDA. Thus,
it could only be administered in an emergency situation as an
Investigational
New Drug, requiring informed consent. Finally, whether or not Congress
is prepared to appropriate more than $500 million to acquire smallpox
vaccine
remains to be seen.
-
- What prompted you to write 'Scourge'?
-
- As a specialist on biological weapons, I found the story
of smallpox particularly dramatic and compelling, reflecting both the
positive
and negative sides of human nature. For thousands of years, smallpox killed
hundreds of millions of people and repeatedly changed the course of world
history. It was also the first - and thus far, only - infectious disease
to be eradicated by means of a global vaccination campaign that was
coordinated
by the World Health Organization during the late 1960s and early 1970s.
Yet at the same time Soviet epidemiologists were participating in this
noble effort, the Soviet military was secretly turning the smallpox virus
into a strategic weapon. The fact that the smallpox eradication campaign
- one of the greatest achievements of 20th-century medicine - had been
betrayed did not become known to Western governments until the defection
in 1992 of a senior Soviet bioweapons scientist. His revelations led to
growing concern in the West that other countries with bioweapons programs,
such as Iraq and North Korea, might have followed the Sovietsí lead
and turned smallpox into a weapon.
-
- How much of a threat is smallpox as a biological warfare
agent?
-
- "Smallpox virus (scientific name variola major)
would be a 'good' biological warfare agent because it is unusually robust,
can be disseminated through the air as an inhalable aerosol to infect
people
over a large area, and - unlike anthrax - is contagious from one person
to another."
-
- -- JONATHAN TUCKER director
Chemical & Biological Weapons Nonproliferation Program
-
- Smallpox virus (scientific name variola major) would
be a 'good' biological warfare agent because it is unusually robust, can
be disseminated through the air as an inhalable aerosol to infect people
over a large area, and - unlike anthrax - is contagious from one person
to another. Even if a relatively small group of people were infected in
an initial attack, they could spread the disease widely. As a result,
release
of the virus could trigger an expanding epidemic unless transmission was
halted by means of an aggressive vaccination campaign. The drawback of
smallpox as a biological weapon is that it could not be
ìtargetedî
- unless contained, the disease would continue to spread and might
eventually
boomerang against the attacking country.
-
- You say the deliberate use of smallpox as a
military/terrorist
weapon is the most likely source of recurrence. Why?
-
- Because the smallpox virus only infected people and did
not have a wild-animal host, it was possible to eradicate the disease by
using vaccination to interrupt the chains of human-to-human transmission.
A number of scenarios have been suggested for a possible resurgence of
smallpox.
-
- First, there is a finite risk that the smallpox virus
could escape from the two maximum-containment laboratories in the United
States and Russia where internationally sanctioned research with the virus
is taking place. Second, it is possible that global warming could cause
the frozen corpses of smallpox victims in the Arctic who were buried in
the permafrost to rise to the surface and infect someone who came into
contact with them. Third, a related virus called monkeypox, which causes
sporadic outbreaks of human disease in jungle regions of central and
western
Africa, might mutate to become more virulent and contagious in humans.
Most experts downplay these risks, however, and contend that the most
likely
source of a recurrence of smallpox would be the deliberate release of the
virus as a military or terrorist weapon.
-
- How hard would it be for someone to obtain and to release
the smallpox virus?
-
- Acquiring, producing, and delivering the smallpox virus
would pose a series of challenging technical hurdles for terrorists, making
an attack with the virus unlikely - although potentially catastrophic were
it to occur. First, because the smallpox virus no longer exists in nature,
terrorists would have to acquire it from a state with undeclared laboratory
stocks of the virus, or perhaps from former Soviet bioweapons scientists
who had smuggled out samples of the virus. Second, the terrorists would
have to grow the virus in eggs or animal cells, which is technically
challenging.
Third, they would have to find some means of disseminating the virus as
a fine, inhalable mist of microscopic particles or droplets (called an
aerosol), which would require specialized technology and know-how. For
a low-tech attack, suicide terrorists might consider infecting themselves
and spreading the disease, but they would have only a few days to do so
before the facial rash became obvious. Moreover, even terrorists prepared
for instant martyrdom in an explosion might hesitate before willingly
suffering
a slow, painful, and hideous death from a disease like smallpox.
-
- Where might one find smallpox virus stocks?
-
- Only two laboratories in the world have been authorized
by the World Health Organization (WHO) to retain samples of the smallpox
virus. The first is at the U.S. Centers for Disease Control and Prevention
(CDC) in Atlanta, and the second at a Russian laboratory known as
ìVector,î
in the town of Koltsovo near Novosibirsk. These two repositories are
currently
conducting research with live smallpox virus under close oversight by the
WHO, with the aim of characterizing multiple strains of the virus,
screening
a wide variety of antiviral drugs for possible efficacy in treating
smallpox,
and developing an animal model of the disease. It is rumored, however,
that undeclared stocks of smallpox virus may exist in a number of
countries,
including Russia, North Korea, and Iraq. The evidence in the public domain
is circumstantial, such as the fact that Iraq and North Korea continue
to vaccinate troops against smallpox. Iraqi officials also admitted to
U.N. weapons inspectors that they had conducted military research on a
closely related virus called camelpox, which could have been used as a
ìsurrogateî to develop production and dissemination techniques
for smallpox virus.
-
- If someone gained access to the stocks, how much would
he or she need to create a major outbreak?
-
- Because smallpox is contagious, even a relatively small
release that infected a few dozen individuals could spread considerably
by the time the first cases were diagnosed. Since smallpox has a two-week
incubation period before the first symptoms appear, the exposed individuals
might disperse widely. The worst-case scenario would involve a release
of smallpox in an airport, so that infected people would travel to cities
around the country and trigger multiple outbreaks.
-
- What makes smallpox so dangerous? How does it compare
to anthrax and other forms of bioterrorism?
-
- Smallpox, which has a mortality rate of about 30 percent,
is less lethal than inhalational anthrax, which kills roughly 90 percent
of its victims [if untreated]. But whereas anthrax is not contagious and
is treatable with antibiotics at an early stage, smallpox spreads readily
from person to person, and no drug treatment is available. Thus, anthrax
would only affect those individuals who were directly exposed to the
bacteria,
but a release of smallpox could trigger a major epidemic that, if not
aggressively
contained by vaccination, could spread uncontrollably.
-
- How can we protect ourselves from a smallpox
outbreak?
-
- Given the lack of a drug therapy for smallpox, the best
approach for reducing our vulnerability to smallpox is to expand the
available
supply of the vaccine. Most Americans alive today are susceptible to
smallpox
infection, either because they were never vaccinated or because their
immunity
has worn off. Since a single vaccination provided protection for only about
10 years, people who were vaccinated once in childhood have little residual
immunity. Those who received at least one ìbooster,î or
revaccination,
probably have a greater level of immunity today, but not necessarily enough
to protect them fully.
-
- Thus, in the event of a smallpox outbreak, it would be
necessary to vaccinate all those at immediate risk of exposure. At present,
the United States retains somewhere between 7.5 million and 15 million
doses of smallpox vaccine, far from enough to manage even a medium-size
epidemic. Responding to this situation, the U.S. government is moving to
expand the national supply of the smallpox vaccine by taking a two-pronged
approach. First, as a stop-gap measure, the National Institutes of Health
have commissioned studies of the feasibility of diluting the existing
vaccine
5- or even 10-fold, which could expand the available supply to some 75
million doses. Second, the government is accelerating the acquisition of
a large additional supply of vaccine.
-
- In your opinion, why hasnít our government taken
the threat more seriously before now?
-
- Before the recent anthrax attacks, bioterrorism was
largely
seen as a theoretical threat. Only one major incident in the United States
had been previously reported: a scheme by the Oregon-based Rajneeshee cult
in 1984 to affect the outcome of a local election by contaminating local
restaurant salad bars with salmonella (food-poisoning) bacteria. That
incident
made more than 750 people sick, but did not result in any deaths. Although
the Clinton administration began to take concrete measures to address the
threat of bioterrorism, these programs were poorly coordinated, and
Congress
declined to fund a number of proposed initiatives. Since Sept. 11, the
once hypothetical threat has become a reality, resulting in a dramatic
change of attitude on the part of policymakers, the Congress and the
public.
-
- Why did we not reinstate nationwide (or worldwide)
vaccinations
earlier, particularly if the government was aware of the danger of an
intentional
smallpox outbreak?
-
- Vaccination of American children against smallpox was
mandatory before school entry until 1972, when the U.S. government
determined
that the risk that cases of the disease would be imported into the country
- the last U.S. case was in 1949 - was lower than the risk of serious
complications
associated with the vaccine. (The smallpox vaccine is based on a live virus
called vaccinia, which is closely related to the smallpox virus and
protects
against it, but normally does not cause disease itself.)
-
- In people with eczema or an impaired immune system,
however,
the vaccine virus can proliferate out of control, causing serious
complications
such as encephalitis or even death. Rare complications were also reported
in otherwise healthy people, and it was impossible to predict in advance
who would be stricken. When Americans were routinely vaccinated against
smallpox, roughly one in every million recipients suffered death or
permanent
brain damage. The risk of complications would probably be significantly
higher today because of the greater incidence of immunosuppression
associated
with HIV/AIDS infection, cancer chemotherapy, and organ
transplantation.
-
- Given this situation, it would make sense to begin
vaccinating
the general population against smallpox only if the risk of terrorist use
of the disease was assessed to be higher than the risk of complications
from the vaccine. That is not currently the case. One advantage of the
smallpox vaccine is that it works extremely rapidly and can either prevent
or reduce the severity of the disease even if administered up to five days
after infection. Thus, in the event one or more cases of smallpox were
diagnosed, the vaccine could be administered in a targeted manner to all
those who had come in contact with the first wave of cases, thereby
containing
the outbreak and preventing further spread.
-
- What measures should the government take to protect us
from other bioterrorist threats? What would that require in terms of money,
manpower and time?
-
- In addition to stockpiling antibiotics and vaccines,
the best approach to reducing the nationís vulnerability to
bioterrorism
is to fill a number of serious gaps in our public-health system. These
gaps include: (1) training primary-care providers to recognize unusual
infections such as anthrax and smallpox, which they would normally never
encounter in their medical practice, and telling them where to report
suspicious
cases of infectious disease; (2) increasing the staffing and resources
of city, county and state public-health departments, so that they can
respond
to doctorsí reports on a 24/7 basis; (3) increasing the number of
diagnostic laboratories with the ability to diagnose bioterrorist threat
agents, and (4) helping hospitals to develop contingency plans for handling
the massive influx of patients that might result from a bioterrorist
attack,
particularly with a contagious agent.
-
- Local, state and federal public-health agencies will
also need to be networked together with computers and Internet links so
that the system functions as an integrated whole, and resources (such as
vaccines, drugs, manpower and expertise) can be brought to bear promptly
where they are needed. The advantage of strengthening the U.S.
public-health
system is that such measures are ìdual-use.î Even if a major
bioterrorist attack never materializes, we will be better prepared to
respond
to a serious outbreak of a natural-emerging infection, such as the recent
outbreak of West Nile virus in New York City. In the worst-case scenario,
we might have to deal with a serious natural epidemic akin to Spanish
influenza,
which killed more than 20 million people worldwide in 1918-19.
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