'Scourge': Killing the Disease - The Once and Future Threat of Smallpox

ALTHOUGH it marked an event of far greater importance to human well-being and happiness than the moon landing, the date May 8, 1980, was largely unheralded at the time and is now mostly forgotten. That was when officers of the World Health Organization certified that smallpox had been eradicated from planet Earth. It was the first, and so far the only, infectious disease to have been eliminated from nature by human effort.

Before its eradication, smallpox had been one of the world's greatest killers: it had ''claimed hundreds of millions of lives,'' Jonathan B. Tucker writes in ''Scourge,'' ''far more than plague -- the dreaded Black Death of the Middle Ages -- and all the wars of the 20th century combined.'' At its worst, the disease had a 30 percent mortality rate, but it produced horrific effects even among those who survived, most of whom were scarred for life with pockmarks and some of whom were rendered permanently blind.

The ailment extended back through recorded history to the ancient Egyptians, and its disfiguring effects are clearly visible today on the mummified face and hands of the Pharaoh Ramses V, who died in 1157 B.C. and whose corpse is in the Cairo Museum. Until 1796, when Edward Jenner developed a smallpox vaccine, successful attempts to combat the illness were limited to quarantine and inoculation, a somewhat risky practice. In inoculation, also called variolation, people were deliberately infected with smallpox pus through skin incisions, in hopes they would be immune thereafter. Variolation was highly effective, causing a milder form of the disease with only a 1 percent mortality rate, but it still killed 1 out of 100 recipients, who also ran the risk of acquiring other diseases carried by the donor, such as syphilis. In vaccination, by contrast, people were infected with cowpox, similar enough to smallpox to confer immunity to it but without any chance of causing smallpox itself.

Tucker, a biological and chemical weapons researcher at the Monterey Institute of International Studies, has produced a concise, suspenseful and scientifically accurate narrative that ranges from the obscure beginnings of smallpox as an affliction of wild rodents in Africa to its eradication to its possible future use as a biological weapon. Public health officials in the grip of ''eradication fever,'' he tells us, were fearsome to behold, not above using force when necessary. Mohan Singh, a religious leader in India, opposed vaccination as an intolerable interference with God's will (as had European prelates a century earlier) and refused to be vaccinated -- to no avail. In the dead of night a government vaccinator burst through the door of Singh's house and pounced on the recalcitrant cleric. ''Singh's wife, Lakshmi, awoke screaming and scrambled to hide herself while Mohan leaped out of bed, grabbed an ax and chased the intruder into the small courtyard. There, a waiting team of doctors and policemen quickly overpowered him, pinning him to the ground while a vaccinator jabbed a bifurcated needle repeatedly into his arm.'' The other family members, biting at their captors, were finally subdued and held down long enough to be given their medicine.

Although the disease has been eradicated for more than two decades, its cause, the variola virus, still exists, raising the possibility that smallpox might eventually reappear in humans (there are no known animal hosts of smallpox). Officially there are only two stocks of the virus, one at the Centers for Disease Control and Prevention in Atlanta, the other at a Russian laboratory in Siberia. Unfortunately, there are several other potential sources. Corpses of smallpox victims preserved in permafrost or dry crypts might hold intact virus particles. Lost, forgotten or intentionally withheld samples left over from the global eradication campaign might be waiting in freezers somewhere in the world, unrecognized but still viable. More speculatively, there is the prospect of constructing the virus afresh from the DNA sequence data that have been available in the open literature since 1993.

Those sources of variola virus pale to insignificance in light of the fact that a number of countries might be sequestering undeclared smallpox stocks from the abandoned Russian biological warfare program, and might even now be developing them for use as weapons. Tucker describes how the Soviet Union -- despite having signed the 1972 Biological Weapons Convention, which banned the development, production and stockpiling of germ weapons -- manufactured 20 metric tons of military-grade smallpox, salting it away at an army facility 45 miles northeast of Moscow. ''In wartime, the smallpox agent would have been loaded into various types of strategic delivery systems, including aerial bombs delivered by long-range bombers and warheads for intercontinental ballistic missiles targeted on U.S. cities,'' Tucker says. Filled with 20 tons of variola, those bombs and warheads would have been able to cover approximately 4,000 square miles, potentially exposing millions of people to the virus, perhaps destroying the United States ''as a functioning society.''

Supposedly, the Soviets destroyed their variola supplies in the late 80's, but it is possible that some Russian bioweapons scientists withheld small samples of those stocks and then sold them to rogue states seeking to develop their own germ weapons. Tucker emphasizes that there is no hard evidence that any such sales occurred, or that there are illicit stocks of variola virus anywhere. He therefore assesses the threat of a bioterrorist attack using smallpox as slight: ''Given the significant technical challenges involved in acquiring and delivering variola virus, the risk of a deliberate reintroduction of smallpox remains quite low, but it is not zero -- particularly if terrorists received assistance from a former Soviet scientist who had done military work on the virus.''

Because smallpox vaccinations offer immunity for only seven to ten years, and because routine vaccinations stopped in 1980, the world is in effect a virgin population, and highly susceptible to a reintroduction of the virus. There are now some 7.5 million doses of smallpox vaccine stored in the United States. In the aftermath of the Sept. 11 terrorist attacks, the federal government announced plans to have 40 million additional doses stockpiled by the summer of 2002, so that this disease, should it ever reappear, can be eradicated a second time.

SCOURGE: The Once and Future Threat of Smallpox.
By Jonathan B. Tucker.
291 pp. New York: Atlantic Monthly Press.

Ed Regis is the author of ''The Biology of Doom: The History of America's Secret Germ Warfare Project.''

It was the first, and so far the only, infectious disease to have been eliminated from nature by human effort.

Let's pray that human depravity doesn't bring it back again.

Thank the Muslims for the fear that this irradicated disease will return.

The west cures and the Islamic world destroys.

Who is the great Satan?

I am not so worried about smallpox. As far as I understand it smallpox cannot spread until it is put into a human host. Then by the time it becomes infectious that person is dreadfully sick and would not be up to walking around the mall coughing on people. He would be at home, on his deathbead writhing in pain. Given this I can't figure out how the enemy could make sure the smallpox spread to enough people at once to kill en masse. It's like they would have to grab people up, inject and them with it. I am not clear on this. We hear too much about who might have stores of it and not enough about how and if it can be deployed and what the probablity is that an enemy has figured out how to deploy it.

As far as I understand it smallpox cannot spread until it is put into a human host. Then by the time it becomes infectious that person is dreadfully sick and would not be up to walking around the mall coughing on people.

A Muhammad Atta or Abu Abbas type would be up to it - for the glory of Allah and his true Prophet, blessings and peace be upon him, of course.

"A Muhammad Atta or Abu Abbas type would be up to it - for the glory of Allah and his true Prophet"

Well the enemy has shown that they are evil enough to do it if they could do it. But the question is...CAN they do it? And I think the answer is no. But someday they may be able to do it so we have to be prepared for the future. But I don't think it is an immediate threat. So I am not going to worry about it at this time.

That was when officers of the World Health Organization certified that smallpox had been eradicated from planet Earth.

It seems to me that smallpox is more of a threat than anthrax. Some friends and I were discussing this yesterday.

That's what we were afraid of.

Well, if you don't understand something, wouldn't it make sense to inform yourself before posting an opinion?

To get started, click here and here

I'm understand the impression that once an individual has been exposed to smallpox, they won't know it. It'll start to grow inside of them for days. During these days they will be contagious. Am I wrong?
By the time they show syptoms they have given it to most people they've seen for maybe a week. An on, and on.

That's what I thought George. I thought it was a cousin to chicken pox and was much the same in contagion time. But I am not an expert on poxes so I leave that up to those who are.

The typical smallpox infected person wouldn't be at the mall -- but most likely he wouldn't be at home either. He'd be at the Emergency Room, a clinic or the hospital (all with lots of people present to be infected). And what about kids -- they'd in the same places or at daycare or at home with the other kids and Mom -- waiting for Dad. And if Dad and/or Mom are 29 or younger (not vaccinated at all) they'll be infected as well and potentially carry the infection.

Small pox is very contagious. And we don't live like we did back in the 1800's.

I am very concerned about smallpox as even a remote possibility.

"The typical smallpox infected person wouldn't be at the mall -- but most likely he wouldn't be at home either. He'd be at the Emergency Room, a clinic or the hospital (all with lots of people present to be infected)." Well the terrorist would have to agree to get smallpox and then go an emergency room. But any attending physician would recognise the small pox pretty quickly and the whole place can be quaranteened and anyone in the ER that day could be notified. Well anyway I do wish I knew more about how small pox could be spread.

. Unfortunately, there are several other potential sources.

This from a Nov 5 NR article about Cuban spies. "Jose de la Fuente, a top Cuban scientist who escaped the island by boat in 1999, said recently that Castro's minions know how to manufacture anthrax bacteria and the smallpox virus."

Well anyway I do wish I knew more about how small pox could be spread.

More about how smallpox can be spread.

Good post!

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Thanks good link it says: "A clandestine aerosol release of smallpox, even if it infected only 50 to 100 persons to produce the first generation of cases, would rapidly spread in a now highly susceptible population, expanding by a "

Well this sounds bad. I wish I could see that expert on TV again. I just know that he really had excellent credentials and after he talked about the small pox threat I felt like the risk was not immediate but we needed to prepare for the future just in case the complications of spreading the virus had been overcome.

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