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Smallpox: Bioterror’s suicide bomb

Researchers rush to head off doomsday scenario

By Alan Boyle MSNBC

Oct. 10 — Even as health authorities ramp up to deal with the potential threat posed by anthrax, an even bigger effort is focusing on what many consider the top bioterror peril: smallpox.

SMALLPOX AND ANTHRAX lead the list of potential biological weapons that could devastate civilian populations, along with plague, botulism and hemorrhagic fever. But there are huge differences in the character of the two threats.

Unlike anthrax — which struck with deadly effect in Florida just this month — the human smallpox virus was virtually eradicated in the late 1970s. But if smallpox were ever to make a comeback, it would be far more difficult to contain.

“It’s a less likely threat than anthrax, but potentially more catastrophic, because it’s contagious,” said Dr. Jonathan Tucker, author of a book on smallpox titled “Scourge” and director of the Chemical and Biological Weapons Nonproliferation Program at the Monterey Institute of International Studies.

Smallpox was once a worldwide scourge that spread through coughing, sneezing or physical contact — even by handling the bed linens of the afflicted. In the course of 15 to 30 days, sufferers developed pus-filled boils, and 30 percent of those infected died from the disease. Today, thanks to a global vaccination effort, the virus’ domain has been contained to tightly controlled laboratories in Russia and the United States.

That should have been the happy ending to a centuries-old tale of woe. But U.S. intelligence officials believe that Russians, Iraqis and North Koreans have held onto undisclosed stores of smallpox for weapons purposes. Defector Ken Alibek has acknowledged that the Soviets built up large stockpiles of smallpox in the 1980s for use in bioweapons, and terrorism experts worry that virus samples could somehow find their way into terrorist hands.


Samuel Watson, co-director of the BioMedical Security Institute at the University of Pittsburgh Graduate School of Public Health, was reluctant to speculate on the potential for a smallpox attack. But he said the Florida anthrax case could have an effect on the debate.

“If this thing in Florida with the anthrax turns out to be a strain that the Soviets had, or if it turns out to be a strain that the Iraqis had, or Iran or North Korea, or if we had it only in a (Centers for Disease Control and Prevention) lab — if that turns out to be the case, then I think we need to be worried about smallpox,” he said.

A smallpox attack wouldn’t require the highly technical dispersal mechanisms that terrorists need to spark a widespread anthrax outbreak, said Dr. Raymond Zilinskas, deputy director of the Chemical and Biological Weapons Nonproliferation Program.

“With smallpox, you don’t need any of that, you just need infected people ... the biological equivalent of a suicide bomber,” he said.

More than two years before the Sept. 11 attacks, a U.S. working group on bioweapons said the deliberate reintroduction of smallpox “would be an international crime of unprecedented proportions.” But the experts had to admit that such a nightmare scenario “is now regarded as a possibility.”


For that reason, the CDC is once again building up the nation’s long-dormant stocks of smallpox vaccine — a store that currently could be used to vaccinate 7.5 million to 15.4 million people.

Last year, the CDC put in a $343 million order with a British company called Acambis for 40 million doses of a new smallpox vaccine, to be produced at a facility in Cambridge, Mass., by 2004. In the wake of last month’s attacks, the timetable was accelerated so that those doses would be available by the end of next year — even though the vaccine would still lack the Food and Drug Administration’s full approval.

“It could only be administered with informed consent,” Tucker explained. The vaccine would have to go through years of testing before it could be administered routinely.

In the meantime, researchers at four medical centers — at Baylor College, the University of Rochester, St. Louis University and the University of Maryland — are investigating whether the existing vaccine would work even if it were diluted fivefold or tenfold. That would stretch out the nation’s supply to serve 75 million people or more.

Tucker said the results so far were encouraging, but even 75 million doses were “still probably not enough for a worst-case attack.”

Other researchers are trying to develop anti-viral drugs to stop a case of smallpox in its tracks, but it will take years to turn that research into safe medications.

Why aren’t more doses of the vaccine available today? For one thing, the current vaccine carries a slight risk of side effects — with a roughly 1-in-a-million chance of death. Also, since the disease was eradicated, health officials didn’t see a need to continue with routine vaccinations. The current stocks were considered sufficient to deal with an isolated outbreak.

“If there’s an outbreak of smallpox in, say, Los Angeles, public health officials would get in there right away and set up a quarantine. ... They would vaccinate the hell out of everybody in that area who had possibly been exposed,” Zilinskas said.

Even in the wake of the suicide attacks on the World Trade Center and Pentagon, Zilinskas found it hard to believe that anyone would want to unleash smallpox on the world again.

“Even though (Iraqi leader) Saddam Hussein is ruthless, I don’t think he is completely reckless,” he said. “You’d have to be reckless, because if you have these things you must know that everyone is vulnerable. ... The pandemic would spread to other parts of the world, including Iraq, and they’re just as vulnerable as anyone else in the world.”

-- PHO (, October 11, 2001


Response to Smallpox: BioterrorÂ’s suicide bomb

Comments, please, Dr. Weltman --

-- PHO (, October 11, 2001.

Response to Smallpox: BioterrorÂ’s suicide bomb

and even after all the bioterrorism activism, scud missiles, its hard to focus os n the hard stuff. but, a lot has been written about you and the tire, and if you would rather discuss that, lets move a littel

-- (, October 12, 2001.

Response to Smallpox: BioterrorÂ’s suicide bomb

Sure, this is a possible mechanism to spread smallpox, low tech indeed. I note that someone with smallpox pretty quickly becomes so seriously ill, and so awful to look at, that they are not likely to remain an effective means of transmission outside the hospital...but that would be enough to cause massive harm, no doubt. Smallpox is really really bad -- the world would eventually mount another "eradication" campaign, but it would again take decades if we are lucky. Anthrax merely scares me, smallpox terrifies me.

The real question is, who does have smallpox AND a desire to use it...and will they?

-- Andre Weltman (, October 14, 2001.

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