A POX ON ALL OUR HOUSES
04 Dec 2002
Source: Wall Street Journal, December 4, 2002.
A Pox on All Our Houses
By NANCY DEWOLF SMITH
It's difficult to say what is more horrifying: that terrorists may soon unleash a plague of smallpox on the world or that today's vaccines won't work against a disease that has historically killed up to a third of its victims and may now be bred into an even more lethal strain. The only difference between the two scenarios is less than comforting: The threat of a bioterror attack is real while the specter of a vaccine-resistant plague is, for the moment, only a nightmarish conjecture.
The virus that causes smallpox , variola, has been on the earth for at least three millennia. More than a century after vaccination began, the disease was still killing millions of people a year; for the 20th century alone estimates range up to 200 million dead.
We can only imagine their agony. In "The Demon in the Freezer," (Random House, 240 pages, $24.95) Richard Preston describes the symptoms of a man discovered to have had smallpox in Germany in 1969. What seemed at first like the flu was followed by red blotches, then blisters and boils, "like ball bearings embedded in the skin." The boils crusted over and the so-called cytokine storm began, the deadliest stage, when proteins released by the virus attack the immune system.
The good news is that the variola virus lives only in humans, so animals cannot shelter it against our assault. A global eradication program ended in 1977 with the last known case of naturally occurring smallpox . The program was successful in part because an army of vaccinators fanned out from each outbreak area to create a ring of immunization. Like a forest fire hitting a trench, the smallpox would hit a wall of vaccinated people in every direction and, denied a human vector, go no further.
Undetected for even a day, though, smallpox can spread like wildfire. The German patient described by Mr. Preston survived, but tiny fragments of the virus escaped through his hospital window. Nineteen people got smallpox; four of them died. Today, when virtually no one on the planet may be protected -- either our childhood immunizations have worn off or we were born after routine immunization stopped -- many millions of us could suffer the same fate.
Will we? Mr. Preston, the author of the bestseller "The Hot Zone," about an Ebola-virus outbreak, gives us reason to fear the worst. Officially there are two repositories of smallpox: freezers at the Centers for Disease Control in Atlanta and at Russia's State Research Center of Virology and Biotechnology near the Siberian city of Novosibirsk. But virtually nobody believes that's all there is out there.
At the heart of Mr. Preston's book is an account of a Soviet bioweapons program that produced tons of smallpox and a missile system to deliver it anywhere. In 1991, a team of British and American officials were permitted to "inspect" the Soviet facilities, but with no great success. "They ran into the same problems that the United Nations inspectors would later run into in Iraq," writes Mr. Preston, including "denials, evasions, time-wasting bureaucracy." But they saw and heard enough to know that the Soviets were making weaponized smallpox in quantities sufficient to infect every person on the planet 1,000 times over.
And where is it all now? "Nobody seems to know," Mr. Preston writes. He quotes an American scientist who spent time at the Siberian facility: "The Russians themselves have told us that they lost control of their smallpox . They aren't sure where it went but they think it migrated to North Korea."
Then there's Iraq. The American microbiologist Richard O. Spertzel, who headed the U.N.'s biological-weapons inspection teams in Iraq in 1994-98, told Mr. Preston that he is sure the Iraqis have "seed stocks" of smallpox . When inspectors came upon evidence of a smallpox weapons program outside Baghdad, Iraq's top virus expert told them that his team was working on weaponized camel pox. Since that disease is harmless to humans, nobody believed him. The inspectors wanted to have the facility blown up, Mr. Preston explains, but the French nixed the idea.
David Koplow, a former Defense Department adviser on biological warfare, is worried, too. In "Smallpox : The Fight to Eradicate a Global Scourge," (University of California Press, 265 pages, $24.95) he chronicles the long campaign to end the disease and the debate over whether to preserve the smallpox samples that remain. He himself argues against making the virus extinct, for future generations may well "conjure uses for even noxious substances that we devalue today." Still, he notes, preservation requires an antibioterror regime, more strict and vigilant than the current one, to keep the virus out of the wrong hands.
Neither book ignores the most pressing question: What if somebody has developed a genetically engineered form of smallpox that can "crash through" all the vaccines, rendering them useless? A team of Australian researchers has shown how it can be done with a monkey pox. If it can be done with the human kind, then the only thing standing between us and disaster is excessive virulence: The weapon would probably kill the people who used it.
We don't know whether improved vaccines or promising antiviral drugs, like cidofovir, can protect us. Animal experiments suggest that we may be protected from even a "heated up" new form of smallpox if we are vaccinated within a few weeks of exposure. That's only a guess. There's no way to test these theories on healthy human subjects.
Ms. Smith is a member of the Journal's editorial board.