Beginning January 2003, the administration of U.S. President George W. Bush plans to inoculate as many as 500,000 military personnel against smallpox. Pentagon officials want those soldiers who might eventually be deployed in the Middle East protected against the deadly virus.
Although some biological weapons experts say the chances that Iraq has obtained stocks of smallpox are low, the virus is so easy to produce and maintain that officials are rightfully concerned. And some experts even claim that rogue nations like Iraq may also possess new "super" strains of smallpox that could be immune to today's vaccine.
Decades ago the United States and the Soviet Union began efforts to weaponize smallpox. The United States produced a powdered substance capable of floating through the air and infecting thousands of people. The Soviets created a liquid form of smallpox equally dangerous. In 1972, the United States and the Soviet Union signed a global treaty along with more than 100 other nations, including Iraq, banning all biological weapons. Nevertheless, clandestine development of germ warfare continued.
Smallpox was declared eradicated worldwide in 1980. The only official remaining stocks of the virus are kept at the U.S. Centers for Disease Control and Prevention, in Atlanta, and in Russia, at the Vector laboratory in Novosibirsk, Siberia.
It is feared, however, that Russia lacks the security to prevent samples of the virus, or the expertise on how to develop it, from being sold on the world market. In fact, according to a 1994 report from the Defense Intelligence Agency, both Iraq and North Korea sought and received smallpox technology from the Russians in the early 1990s.
Yet even if Iraq does indeed possess smallpox, Russia is not necessarily at fault. A natural outbreak of smallpox occurred in Iraq in 1971, and again in 1972. It is possible the Iraqis isolated the virus then and kept a sample.
According to biologists, growing and maintaining the smallpox virus would not be difficult for Iraq, a country that admitted in 1995 to pursuing a clandestine biological weapons program. A year earlier, UN inspectors examining Iraqi medical facilities uncovered an industrial-sized freeze dryer, the type used by microbiologists to extend the life of germ samples. It was labeled in Arabic "smallpox machine." Iraqi officials claimed the freeze dryer was meant for the smallpox vaccine, not the virus.
Nevertheless, many former UN biological weapons inspectors in Iraq continue to warn that Iraq could still be hiding stocks of smallpox, possibly in weaponized form.
Domestic Preparations
At home, federal authorities released detailed guidelines Sept. 24, 2002 for state-led mass inoculations in the event of a smallpox outbreak in the United States. Members of the Bush administration assert that the existence of a single case of smallpox within the entire Western Hemisphere would signify a terrorist attack.
Smallpox is one of the most feared biological weapons because it is highly contagious (the virus can be spread through the air), it's sometimes difficult to treat, and it kills as many as one-third of those infected.
The guidelines, which were produced at the Federal Centers for Disease Control and Prevention, ask all 50 states and the District of Columbia to devise plans to vaccinate the nation's 288 million residents within seven to 10 days of an outbreak. Written with the input of local health officers and drawn from previous experiences of mass inoculations, they provide advice on a wide range of logistical dilemmas ranging from choosing vaccination sites, dealing with security and transportation issues, to data collection and staffing. If given within four days of direct contact with the virus, the vaccine can prevent it altogether.
Because of security precautions, the vaccines will be kept in federal hands until the time of an outbreak. The CDC in Atlanta says it can ship the vaccine to anywhere in the country in just 12 hours. It would take between five to seven days to ship enough doses for all Americans.
Each state would then be tasked to organize as many as 20 vaccination centers to run 16 hours a day for every 1 million people. An estimated 4,680 health care workers would be needed to inoculate each group of 1 million people to meet the goal of total national vaccination within seven to 10 days.
The sheer enormity of such a mass inoculation has already drawn criticism. Yet so far, no one has suggested inoculations would be unnecessary. Instead, critics say, vaccinations should begin earlier and include the tens of thousands of health care workers needed to carry out the operation. Indeed, federal authorities have also issued a plan to immunize the so-called first responders who would be key in any mass vaccination effort.
For critics, however, this is not enough. They say the vaccine should be made available now to the public on a voluntary basis. The argument goes that if enough people are inoculated before such an attack it may actually deter terrorists from trying to cripple the United States using smallpox. In addition, these vaccinations could be carried out in a more systematic and controlled environment rather than the chaos brought on by a bioterror assault.
But the problem federal authorities face is that the vaccine itself can be deadly. People with skin disorders like eczema and topical dermatitis, or who have reduced immune systems such as AIDS and cancer patients or organ transplant survivors, are at risk of serious side effects. For people with skin problems the death rate is a relatively low 1 percent to 6 percent, but for people with weakened immune systems that rate rises as high as 36 percent. Children younger than one year and pregnant women are also discouraged from using the vaccine.
There is a medicine that can counter these reactions, but currently the United States has only 600 to 700 doses. An estimated 5 million people will suffer serious complications. Health officials are also looking into a diluted form of the vaccine.
Worse, people likely to react poorly to the vaccine can also become infected by close contact with someone who has recently been vaccinated. This is because the virus used to treat smallpox is shed from the sore at the vaccination site for two to three weeks - a fact that would significantly hamper the logistics of any form of early voluntary vaccination program.
The guidelines do not give details on how a nation-wide inoculation campaign would be paid for. States have received $918 million from the federal government to build bioterror defenses, but some experts worry that may not be enough. According to the CDC, it would cost somewhere between $1.4 billion and $2.8 billion for patient screening and injections alone.
Further, even mass vaccinations may not be enough. According to some experts, the United States would only be protecting itself against the natural form of the smallpox virus. These experts warn there may be new strains of the virus biologically engineered to be immune to the existing vaccine. They cite recent work by a team of Australian researchers who were able to create a strain of mousepox (similar to smallpox but only affecting mice) that could kill naturally immune mice and some vaccinated mice. Pox viruses are apparently quite easy to engineer because they readily accept foreign genes. Experts say it is possible Iraqi microbiologists have tried their hand at creating "super" strains of the smallpox virus.
American scientists are currently trying to develop a new vaccine that would be effective against versions of a "super" smallpox, but results are not expected anytime soon. Meanwhile, the United States must provide some measure of protection for its Middle East-bound troops and the first-responders at home against a virus that can kill as many as one third of its victims. And it makes sense to get these inoculations underway now, before any future smallpox attack. Waiting until the end of the one- to two-week incubation period when smallpox symptoms would begin to show on the battlefield or in our major cities before taking any preventative action just isn't feasible.
Sources:
Ceci Connolly, "Smallpox Vaccine Guidelines Readied," The Washington Post, Sept. 23, 2002.
Ceci Connolly, "Volunteers Key to Smallpox Vaccine Plan," The Washington Post, Sept. 24, 2002.
Sheryl Gay Stolberg with Lawrence K. Altman, "New Plan for Smallpox Attack," The New York Times, Sept. 24, 2002.
William J. Broad, "Guide for Mass Smallpox Vaccinations: Recipe With Missing Ingredients," The New York Times, Sept. 24, 2002.
Denise Grady, "Medical Conditions Create Vulnerability to Vaccine," The New York Times, Sept. 24, 2002.
"If Smallpox Breaks Out: Questions and Answers on the U.S. Vaccination Plan," The New York Times, Sept. 24, 2002.
"The Daunting Smallpox Plans," Opinion, The New York Times, Sept. 25, 2002.
Judith Miller and Eric Schmitt, "Pentagon Plans Smallpox Shots for Up to 500,000," The New York Times, Oct. 12, 2002.
William J. Broad, "White House Debate on Smallpox Slows Plan for Wide Vaccination," The New York Times, Oct. 13, 2002.
Richard Preston, "The Specter Of A New And Deadlier Smallpox," The New York Times, Oct. 14, 2002.
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