Last Updated

13 Dec 2002

Source: Los Angeles Times, July 28, 2002.

SMALLPOX

A Deadly Recipe

By WENDY ORENT, Wendy Orent writes frequently on infectious disease and is currently writing a book about plague.

ATLANTA -- Those American scientists who know Gen. Pyotr Burgasov don't expect much candor from him. Alexis Shelokov, a member of a U.S. scientific team that, in 1992, investigated a mysterious 1979 outbreak of anthrax in the then-Soviet Union city of Sverdlovsk, says the tall, silver-haired former deputy minister of health was "easy, pleasant, smiling, good to eat and drink with, a man who loved people and loved life. He was very comfortable with lying." Burgasov denied -- and still denies -- that the 68 people who died of inhalational anthrax in that outbreak were victims of a bioweapons accident. He insists they ate infected meat. But in a November 2001 interview in the Moscow News, the affable Burgasov offered candid advice to terrorists. Anthrax isn't worth much, he noted--it doesn't spread. "But smallpox -- that's a real biological weapon," he said.

Burgasov then dropped a bomb of his own, one that is still reverberating in the American corridors of power. "On Vozrazhdenie Island in the Aral Sea, the strongest recipes of smallpox were tested," he said. "Four hundred grams of smallpox formulation was exploded on the island." At that same time in 1971, he continued, a research vessel sailing on the Aral Sea passed within 15 kilometers of the testing site. A young technician was on board taking samples of plankton. The airborne smallpox "got her," in Burgasov's words, and she fell ill after returning home to the town of Aralsk, where she passed the infection on to her brother and other people. "I called [Yuri] Andropov, who at that time was chief of KGB, and informed him of the exclusive recipe of smallpox obtained on Vozrazhdenie Island," Burgasov said.

Burgasov's bomb took a long time to detonate. Dr. Ken Alibek, former deputy director of Biopreparat, the Soviet biological-weapons apparatus, reported on Burgasov's interview before the U.S. House Committee on International Relations in December, but no one paid attention. In April, however, the Center for Nonproliferation Studies of the Monterey Institute of International Studies received the original Soviet-era reports on the outbreak from Dr. Bakyt B. Atshabar, director of the Kazakh Scientific Center of Almaty, Kazakhstan. The report was sent to biodefense expert Alan P. Zelicoff of Sandia National Laboratories in New Mexico, who also interviewed two of the original patients in Kazakhstan by telephone and subjected the data to rigorous statistical analysis. Zelicoff, a medical doctor, presented his findings June 15 at a National Academy of Sciences Institute of Medicine forum on smallpox vaccination, and Burgasov's bomb exploded.

The "exclusive recipe" of smallpox tested on Vozrazhdenie Island produced no ordinary disease. The young technician who first fell ill had been vaccinated. So had her brother, whom she infected when she returned to Aralsk. Both suffered, as Zelicoff determined, severe illness. And both were contagious. Although they survived, a young woman who visited them did not. She died of hemorrhagic smallpox, the most terrible form of the disease, which causes uncontrollable bleeding and rapid death. Two infants also died of hemorrhagic smallpox. None of the three had been vaccinated. The vaccinated patients did not die, but they came down with moderately severe disease.

Before naturally occurring smallpox disappeared in 1978, hemorrhagic smallpox was exceedingly rare -- not more than 2.5% of all smallpox cases took this form, which was most common in countries such as India and Bangladesh, where crowded conditions allowed severe disease to spread more easily. Yet in Kazakhstan, all three nonvaccinated cases were hemorrhagic. The numbers are small but the percentage is unnerving.

Zelicoff's presentation provoked an instant uproar.

Dr. Donald A. Henderson, who directed the smallpox-eradication campaign and who has long advocated destruction of the remaining legitimate stores of the smallpox virus, immediately protested that, since smallpox still occurred in nearby Afghanistan, the technician may have caught the disease naturally at one of the several Central Asian ports the ship visited. But the woman, though she made many stops in the region, never visited Afghanistan, and no one who did fell ill. Furthermore, Burgasov himself states that this was a bioweapons incident. And former Soviet bioweapons scientist Sergei Popov, who now works for Advanced Biosystems Inc., a biodefense firm in Manassas, Va., says he had heard rumors of the Aralsk bioweapons outbreak for years. Evidence suggests that we should take Burgasov at his word.

Zelicoff's analysis goes further: He suggests that the particular so-called Aralsk strain must have been epidemiologically selected to be as hot as possible, "the strongest recipe of smallpox," in Burgasov's inimitable phrasing. A commentary on Zelicoff's analysis, written by smallpox expert Dr. Peter B. Jahrling of the U.S. Medical Research Institute of Infectious Diseases, puts it this way: "We know that the Soviet bioweapons development program attempted to select natural strains of increased virulence and that one of the selection criteria was hemorrhagic diathesis in mice and embryonated eggs." In other words, Soviet bioweaponeers deliberately tested strains of smallpox to select those most likely to "go hemorrhagic."

What does all this mean? Thirty years ago, Soviet scientists had weaponized a smallpox strain probably far more lethal than most forms of natural smallpox. We often hear that smallpox has a death rate of 30%, nothing like the 99% fatality rate of, say, untreated pneumonic plague. But in fact this is only an average. Smallpox strains from Africa killed about 10% of those infected, while the much hotter strains of India and Bangladesh killed many more, close to 50%.

Alibek, the former Soviet biological weapons official, has stated that the Soviets deliberately selected an especially lethal strain from India, the so-called India 1, as the basis for their smallpox bioweapon. Was the "exclusive recipe" from Aralsk the same as India 1? Possibly -- but if not, then India 1 might be worse. And we do not know which strains may be in the hands of rogue nations.

A number of American scientists, including Zelicoff, have asked the Russian scientists at the Vector Laboratories of Novosibirsk, keepers of the Russian-held World Health Organization smallpox repository, to locate and turn over the Aralsk strain for joint collaborative study. Vector scientists deny knowledge of the strain or even the incident. This strikes some observers as implausible, though Vector did not exist in 1971, and its director and chief smallpox expert, Lev Sandakhchiev, was working on acetabularia, a form of giant algae, at the time. If Vector has the strain, however, it's unlikely the lab would be able to hand it over on its own. "Such a decision would have to be made at the highest levels of the Russian government," Alibek says. Meanwhile, a formal request for India 1 and other smallpox strains from the Vector repository has yet to be made by the Centers for Disease Control and Prevention in Atlanta. Without that formal request, says a knowledgeable official, the Russian scientists cannot issue an export license.

It isn't likely, therefore, that we'll soon understand the precise properties of the Aralsk strain, or India 1 for that matter. But we should be better prepared to face the smallpox threat than we are. The government should permit the American people to choose to be vaccinated now. A freshly vaccinated population -- excluding the very young, those with major skin disorders and people with seriously compromised immune systems -- could well deter a smallpox strike in the first place. Why waste effort trying to infect a vaccinated population?

Even if an attack occurred, widespread vaccination would minimize death and social disruption. Furthermore, the ongoing research by Jahrling and his team into less dangerous vaccines and better antiviral drugs to treat smallpox after infection should become a top priority of the CDC and the federal government.

Now we know, thanks to Zelicoff's efforts and Burgasov's candor, what weaponized smallpox strains can do. But if the event at Aralsk was the devil's fingertip, what would the whole hand be like?

We should take steps to ensure we never find out.