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Smallpox: Is This Once-Vanquished Killer a Threat Again?

Thirty one years ago, near a small atoll in the South Pacific a thousand miles southwest of Hawaii, American forces were in the midst of highly secret tests of biological warfare weapons. At sunset one quiet July day an armada of ships was positioned in the ocean waters around Johnson Atoll, upwind from a line of barges carrying hundreds of rhesus monkeys. A lone Marine Phantom jet flew in low past the island, then shot off over the horizon. As it passed the island, a pod under one wing released a powder into the air, a long tendril of smoke that soon disappeared. Only a small amount of powder was released in the few minutes the plane shot across the several miles of this "line-source laydown", and the wind soon carried the tiny particles out to sea. A thin, long curtain of powder swept past first one barge loaded with monkeys, then, at increasing intervals, another and another, finally passing the most distant barge nearly fifty miles away. Afterwards, the monkeys were taken back to Johnson Atoll. Over the next few days half of them died. Even the monkeys positioned fifty miles away from the laydown were not protected by distance. Anyone watching that test that day knew beyond any doubt that biological weapons really work, that bioweapons could be used to kill millions of people. The same Phantom jet passing down Route 40 could kill half the people in metro St. Louis.

In 1972 the United States signed the Biological and Toxin Weapons Convention, calling for the destruction of all stocks of offensive bioweapons agents, and termination of all research on bioweapons. Research on bioweapons in this country ground to a halt. Russia also signed the treaty, but defections by senior officials of its bioweapons program reveal that Russia viewed our stopping bioweapons research as an opportunity for them to gain a military advantage. Instead of stopping, they massively expanded their bioweapons program. The cessation of American vaccination for smallpox, a disease thought to have been eradicated, was viewed by the Russians as another opportunity, and they began a program to "weaponize" smallpox virus -- to modify the virus so that particles of it can be efficiently disseminated in tiny aerosol droplets. They then set out to produce the weaponized smallpox virus on a very large scale. Ken Alibekov, former first deputy chief of research and production for the Russian biological weapons program, reports that by 1989 dozens of tons of weaponized smallpox had been produced.

It is not easy to make a bioweapon. Plague and most other disease-causing bacteria and viruses are simply too difficult to grow and dispense. Only two disease agents are easy to produce, easy to dispense, and deadly: smallpox and anthrax. When dispersed as an aerosol, smallpox has a case fatality rate of 30%, anthrax more than 80%. Thus, smallpox and anthrax are effectively alone on the list of practical bioweapon agents. Smallpox has one deadly advantage as a bioweapon over anthrax -- individuals infected with anthrax simply die, while those infected with smallpox first infect many others, then die, in an explosive chain reaction of infection and death. Its case fatality rate may be lower, but a smallpox agent will, for particle applied, eventually kill far more people.

With the economic meltdown of the Soviet Union in the last decade, the Russian bioweapons program ground to a halt, and substantial numbers of the scientists working for it migrated to other countries seeking employment. Iraq, Libya, Iran, and Syria have actively recruited them, and with the lax security of Russian research centers no one knows what bioweapon samples they might have taken with them. That is the nightmare we face, that smallpox is no longer confined to two vials stored in laboratories here and in Russia, a genie in two bottles, but rather has been released from its confinement. Rogue states and religious cults may well have access to it. If so, the future is a nightmare waiting to happen.

There are hints from Russia of a blacker nightmare, of genetic engineering experiments that have linked smallpox with Ebola virus to produce a "black pox," a hemorrhagic form of smallpox with a case fatality rate of 100%. No one knows if these rumors, reported by Alibekov, are true. It doesn't matter, to my way of thinking. Garden variety smallpox is plenty bad enough. The key to keep in mind is that a smallpox pandemic needs only ONE infected individual to get started. When Cortex invaded Mexico, he brought along one slave with smallpox -- and most of the Indians of Central America were dead of smallpox within a few years. Smallpox vaccinations are only good for 10-20 years, and there has been no smallpox vaccination in the United States for the last 20 years. Americans today are as vulnerable as Cortez's Indians. One aerosol can sprayed in a New York subway, or tossed into a ventilation duct at St. Louis's Lambert airport, could change the history of our nation. It is a nightmare scary to contemplate.

But contemplate it we must, if we don't want to live it. The recent decision by President Clinton to defer the scheduled June destruction of the U.S. stock of smallpox virus in case it is needed to prepare new vaccines reflects a growing concern of these dangers. At a major symposium on bioterrorism held four months ago by Johns Hopkins University and the government's Department of Health and Human Services, two recommendations were made that should be taken very seriously.

First, a program should be undertaken to prepare our nation's doctors to deal with a smallpox outbreak. The strain on our medical establishment would be severe, but adequate preparation could make a major difference. The president has budgeted $11.4 billion for antibioterrorism. We should support this funding, and urge that a significant fraction of these funds should be devoted to preparing our doctors to deal with the potential threat.

Second, our only defense against smallpox is a twenty year old stockpile of vaccine. No one knows if it is any good any more. New modern vaccine is needed, badly needed. $51 million has been appropriated in the federal budget for the Center for Disease Control to prepare new vaccine. This seems way too modest a sum, considering the numbers of people in 120 major cities and 50 states, and should be increased substantially.

Finally, it seems high time we had a frank talk with the Russians about the details of their bioweapons research program. A clearer idea of what sort of weaponized smallpox agents might have left the Soviet Union would both help intelligence efforts and guide our defense preparations.

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