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Last Updated

13 Dec 2002

Source: Wall Street Journal, December 13, 2002.


Smallpox and Beyond

President Bush gives a shot in the arm to individual choice today, unveiling a smallpox plan that will give all Americans access to the vaccine. What the Administration can do now is turn this very good decision into an intense federal campaign to develop and stockpile medical defenses against bioterror.

The smallpox plan looks like a good balance of national security, personal choice and safety. Military personnel and health-care workers will receive the vaccine first, readying the nation in case of an outbreak. The government will engage in a public-education campaign so citizens understand the risks. The vaccine will then be made available to the general public on a voluntary basis by 2004, which is when enough of the new, safer vaccine will finally be available.

Credit Mr. Bush for siding with average Americans over hand-wringing public health officials. About two-thirds of the country has said in surveys that they want access to a vaccine. Credit also goes to several Bush health advisers -- including HHS Secretary Tommy Thompson and new Centers for Disease Control head Julie Gerberding -- for throwing over the usual we-know-best attitude.

The next step, and a far harder one, is to create a truly comprehensive strategy for combating bioterror. To do this, the Bush Administration will have to look beyond vaccines and encourage new antidotes and treatments for biowarfare. In most cases vaccines are effective and a deterrent to terror. But recent intelligence suggests it is possible to genetically modify smallpox, or other viruses, into super-hot strains that could thwart vaccines. That's why defense scientists and many in the medical world have been calling for a concerted effort to develop antiviral drugs that would effectively treat smallpox after it broke out.

Not only would antivirals help the millions of Americans who are vulnerable to the vaccine's side effects, but they would provide an extra layer of defense against hot strains. "It would be hard to engineer a strain of smallpox that could outwit both a vaccine and an antiviral at the same time," says Dr. Scott Gottlieb of the American Enterprise Institute.

Scientists are up to the challenge of creating these sorts of antidotes, but few do. And few ever will until the government views antiviral drugs and vaccines as equally as vital to national defense as tanks, aircraft carriers and Predators.

Shipyards don't build aircraft carriers on the chance someone will buy them; governments contract for them. As there is now no significant private market for bioterror drugs, the government has a role in stimulating R&D for anti-terror defenses too. That means government telling the pharmaceutical industry exactly what it needs and then contracting to buy a specific amount for a worthwhile price.

Take the San Diego start-up Chimerix. The small biotech is working on an oral version of a drug called cidofovir, which might be active against the smallpox virus. This is obviously something worth exploring, but no private investor is going to invest in Chimerix for serious research until there's a commitment from the one real buyer -- the U.S. government.

And smallpox antivirals are only the start. The terrorist goal is to kill, using whatever is available -- anthrax , the plague, botulinum toxin, tularemia, ebola, Lassa fever, Yellow fever, Rift Valley fever, brucela. The U.S. lacks effective vaccines and therapies for many of these. The smallpox decision is only the first line of what has to be a much more aggressive national defense against bioterror.