Smallpox casts menacing shadow over US

23 Oct, 2001 07:58 PM6 mins to read

The US is preparing for the possibility of a smallpox attack, reports DAVID USBORNE.

NEW YORK - The United States is rushing to buy sufficient doses of the smallpox vaccine to inoculate every American, amid fears that the deadly disease officially eradicated from the planet 25 years ago might make a comeback as a terrorist weapon.

The effort is being led by the US Health Secretary, Tommy Thompson. He is talking to pharmaceutical companies about delivering 300 million doses of the vaccine within nine months. That would imply having a vaccine ready for every citizen.

There is still intense debate over whether so comprehensive an approach is necessary. The last naturally occurring case of smallpox was recorded in Somalia in 1977.

The World Health Organisation declared the disease officially defeated three years later. And smallpox, a highly infectious illness that is fatal for three in 10 people who catch it, has not been seen in the US since 1949.

The White House is anxious not to spread panic about smallpox, which for centuries was one of the most serious diseases to afflict the human species. Americans are already edgy about the anthrax scare.

Officials have said nothing about receiving concrete intelligence to suggest a terrorist smallpox attack may be imminent.

Politically, however, no one wants to be unprepared in case someone does acquire the virus and unleashes it in a big city.

"I think the American people will feel much more comfortable knowing they have their name on a vaccine shot in our inventory," Thompson told the New York Times yesterday. "It's the security of knowing you have enough for every American".

The US has about 15 million doses for civilian use. Plans to expand the supply were on the table long before September 11.

Last year, the US Government awarded a contract to British firm Acambis to manufacture a further 40 million doses at a cost of $US343 million for delivery in 2002.

After September 11, attitudes changed quickly. Vice-President Dick Cheney accepted the need to acquire doses for every US citizen after watching a research video made at Johns Hopkins University. Called Dark Winter, it spelled out how devastating a smallpox outbreak would be. President George W. Bush signed up to the idea on October 4, the day a man in Florida was diagnosed with anthrax.

One adviser to Thompson is Dr Donald Henderson. Attached to Johns Hopkins and one of those who brought Dark Winter to the attention of the White House, he is one of only a few American doctors with first-hand knowledge of smallpox.

"After Dark Winter there was a spate of briefings, so that a whole lot of people suddenly began to realise just how serious an epidemic of this sort could be," he said.

But Henderson stressed that it was not easy to disperse smallpox. It could not, for example, be sent in powder form in envelopes as has been happening with anthrax. It would have to be puffed into the air like an aerosol.

Henderson does not take very seriously the idea of an infected terrorist wandering the streets of New York, because they would be too debilitated to go anywhere.

On the other hand, smallpox poses a more frightening threat than anthrax. It is relatively easy to isolate cases of anthrax, and victims can usually be helped with antibiotics. Smallpox is a virus and can quickly be spread.

People who catch it first notice severe flu-like symptoms, including a high temperature, severe headache and aching back. Later a flat rash develops, particularly on the face, arms and legs, and quickly erupts into scores of round pustules. Those who survive often live with horrible scarring.

"It is the lion king of infectious diseases," said Michael Osterholm of the Centre for Infectious Disease Research at the University of Minnesota. "Once it were to get into that population, it would not only take hold, but its ability to be transmitted on to additional generations with large increases in numbers of each of those generations is a very real possibility."

In theory, there should be no cause for worry. After the World Health Organisation declared smallpox was no longer a threat, it was agreed that remaining research stocks would be sent to two repositories, one at the Centres for Disease Control in Atlanta and another in Russia.

There have always been suspicions, however, that smallpox might have since fallen into the wrong hands.

These fears were first confirmed in 1989 when a top Russian biologist, Vladimir Pasechnik, defected to Britain and described the extent to which Moscow had been secretly diverting smallpox for military use.

The aim was to put the smallpox virus into warheads of cruise missiles. It is now thought disaffected scientists who were involved in those secret Russian programmes may have sold their knowledge and expertise to rogue Governments, such as Iraq or North Korea. They might also have sold themselves to terrorist groups.

Like most industrialised countries, the US stopped giving routine smallpox vaccinations to young children in the early 1970s.

Meanwhile, there is no scientific certainty as to whether the doses given to older generations of Americans will still be effective. Most experts fear that the vaccines, which contain a virus similar to smallpox, will have worn off by now. So everyone would have to be vaccinated.

The US is not alone in feeling unsettled by the possibility of a smallpox outbreak. The WHO has suggested that other countries should be examining their state of readiness for a possible attack involving the virus.

"Our advice to Governments is that they should check their level of preparedness for disease, and that includes for smallpox," a spokesman said on Monday.

So far, there is no sign that the US Government is preparing to vaccinate the whole country preventatively. Instead, vaccines would be made available from the stockpile - which would be held at secret locations - if the disease was detected.

This is partly because the vaccine itself is not risk-free. About one in a thousand people can have adverse reactions. Emphysema is one recorded side-effect.

The rates of bad reactions may be much higher than in previous generations because of the existence of Aids, as the vaccine can be particularly risky for anyone with a weakened immune system.

That has created another problem: the medicine needed as an antidote in the event of anyone responding badly to the smallpox vaccine is also in extremely scarce supply.

So the US is also asking drug companies about providing that drug, vaccinia immune globulin, in large quantities.

- INDEPENDENT

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