. . . And the Things That Keep Us Awake at Night
Smallpox is deadly and highly contagious. The government thinks that Iraq has it. Should we be scared?
by Jonathan V. Last
10/23/2001
Jonathan V. Last, online editor
NOW THAT TWO D.C. postal workers appear to have died of anthrax, perhaps the TV networks will retire those inappropriate "anthrax scare" and "anthrax anxiety" titles and replace them with a more apt headline-maybe "anthrax attacks" or "anthrax assault" or "anthrax murders." After all, "anxiety" suggests a hypothetical risk, something that only the neurotic should be alarmed about. And "scare" should probably be reserved for something truly fearsome. Something like smallpox.
The variola virus--smallpox--is lethal, like anthrax, but far more dangerous in that it's highly communicable (through coughing and sneezing and via infected clothing and linen). It first presents with flu-like symptoms, two weeks after the subject is infected. A couple of days later a rash appears. In fatal cases (30 percent), death follows five or six days after the onset of the rash. Once a person is infected, the only remedy is an early administration of the vaccine. The good news, such as it is, is that people become infectious only once the rash appears.
There is reason to hope that anti-American terrorists don't have any smallpox in their arsenals. Still, officials are worried enough that they are planning for worst-case scenarios. Last week secretary of Health and Human Services Tommy Thompson announced that the government was going to acquire 300 million doses of variola vaccine.
Smallpox has already been used as a biological weapon in North America. During the French and Indian Wars (1754-1767), the British distributed smallpox-laced blankets to some hostile tribes, against whom it was a frighteningly effective killer, according to Donald Hopkins's "Princes and Peasants." A crude form of inoculation was developed by Edward Jenner in 1796, but the disease remained formidable.
With a relatively safe and inexpensive vaccine in hand in 1967, the World Health Organization launched a prolonged campaign to eliminate smallpox. They succeeded in just ten years. As result of a WHO recommendation in 1980, the world's supply of laboratory-kept smallpox was consolidated at two sites: The Centers for Disease Control in Atlanta and the Institute of Virus Preparations in Moscow. Such was the logic of the Cold War.
Treaty-fetishists were convinced that Americans were out of harm's way because the Soviet Union had signed the 1972 biological weapons convention prohibiting the development of germ weapons. Unfortunately reality trumped wishful thinking. Ken Alibek, who served as deputy director of the Soviet biological weapons program, claims that as soon as the smallpox supplies were consolidated, the Russians went to work weaponizing it. They engineered the virus to be deliverable by artillery shells and ICBMs and were capable of producing tons of it annually. After the fall of the Soviet Union, their supply of smallpox was relocated to a government facility in western Siberia still monitored by the WHO.
So if the only two supplies of smallpox are at the CDC and a bunker in Siberia, why did Tommy Thompson move last week to spend $509 million on 300 million doses of variola vaccine?
First, because of the financial decay in Russia, it's hard to be confident that the supply there is secure, and that the scientists and equipment used to create it are no threat. According to the New York Times, a 1998 government report concluded Iraq and North Korea possess rogue stores of smallpox.
Second, the United States possesses only between 7 and 15 million doses of the smallpox vaccine, which causes some experts to fear mass panic in the event of a smallpox breakout. Before September 11, the government had already been planning to increase the U.S. supply to 40 million doses by 2005. On October 3, Thompson ramped up production so that those 40 million doses will be available by next summer, and 300 million doses, enough for every American to be vaccinated, will be ready late next year.
Third, Congress and the Defense Department are worried about Dark Winter, a war game staged last June at Andrews Air Force Base. In the scenario that was played out, terrorists infected 25 people with smallpox in Oklahoma City in December 2002. Within two months the disease had spread to 25 states, 3 million people were infected, 1 million people had died, and interstate commerce was a thing of the past. When the exercise ended, the government had still not contained the epidemic.
There is debate in the medical community over the realism of the Dark Winter assumptions. Each infected person in the game passed the bug on to 10 others. This infection rate was based largely on two cases: a 1970 outbreak in Germany where each carrier infected 17 others, and a 1972 outbreak in Yugoslavia where each carrier infected 38 others.
But a recently issued CDC report suggests that most outbreaks feature infection rates closer to two people per infected person. The CDC concludes that 30 million doses of vaccine administered mostly to health-care workers and government agents, combined with an aggressive quarantine policy, would be sufficient to control a smallpox attack. At the same time, a Journal of the American Medical Association article paints a less rosy picture, arguing that. "The discovery of a single suspected case of smallpox must be treated as an international health emergency."
Americans ceased vaccinating their children for smallpox in 1972. Does this mean everyone over 30 can relax? Hardly. Protective antibody levels in vaccinated persons decline substantially over a ten year period. Thus, the population is essentially completely susceptible. The key to how damaging a smallpox attack would be lies in the infection rate. A Dark Winter rate of 10 could mean disaster while a 1.7 could be readily manageable. And the truth is that no one knows what an infection rate would look like in modern America. Increased mobility from air travel could make matters worse than in the past. Lower population density thanks to suburbanization, could make the spread much less rapid than in the past. And a health-care system that is on alert for the disease could catch the initial infections quickly, making the infection rate considerably lower than it would have been on September 10.
Perhaps, we needn't be scared yet, but anxiety is understandable.
Jonathan V. Last is online editor at The Weekly Standard
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