Rebirth of the scourge Is smallpox the next weapon in the terrorists' arsenal?
By MICHELE MANDEL-- The Toronto Sun
It has been called the eleventh plague. Smallpox was supposed to be the ancient scourge relegated to the past, an eradicated disease found only in medical history books and the freezers of two guarded laboratories. Now, in the wake of Sept. 11 and anthrax terror, fears are growing that the silent killer may be the next weapon in the terrorists' arsenal.
As early as January 1999, a World Health Organization (WHO) committee warned that smallpox poses "the most serious bio-terrorist threat to the civilian population."
And we are still completely unprepared.
Scientific experts caution that there is only circumstantial evidence that terrorists may have the smallpox virus. Many believe it is far more likely that they have some of the other more easily obtainable biological weapons, such as plague, botulism, tularemia or hemorrhagic fevers.
But we're not ready for any of them, warns Dr. Mark Miller, president of the Canadian Infectious Disease Society.
"I'm worried that we still don't have the rudimentary basic preparedness for any of the diseases on the (bio-terror) list," Miller says. "We do not have a network of capable first-line physicians able to diagnose these diseases who are aware of them. I'm concerned that most of our laboratories are not set up for rapid diagnosis, they're using old, outdated technology which is really outmoded today. We need rapid response in the event of a catastrophe and we don't have the capability."
Miller believes smallpox is the least likely of the agents to be used, but it would certainly be the deadliest.
"It would be the disease with the most impact because you're talking about models that have shown anywhere from hundreds of thousands to millions of deaths should a smallpox exposure take place."
Unlike anthrax, which has killed only a handful of Americans, smallpox is highly contagious and the release of even the smallest amount of the virus would be catastrophic.
Smallpox travels invisibly through the air, has no known treatment and kills 30% of its victims. Very few doctors have seen smallpox and most wouldn't recognize it if they did.
NONE OF US ARE IMMUNE
And none of us are immune anymore. More than half the population was born after the disease was declared eradicated and mass vaccinations ended in the 1970s. And for those of us who do bear the telltale scar of the inoculation, our immunity only lasts from 10 to 20 years.
"We're all Indians," smallpox historian Dr. Elizabeth Fenn told The New York Times two years ago, referring to native populations destroyed when the Europeans brought smallpox to the new world. "We're approaching 100% susceptibility."
Meanwhile, our vaccine stockpile is piteously small. In the U.S., they are gearing up production to have enough to vaccinate every American if necessary by "sometime next year."
Federal Health Minister Allan Rock has vowed to stockpile 30 million doses in preparation to vaccinate every Canadian against a smallpox attack. Right now, the Canadian defence department is said to have enough vaccine for about 380,000.
How vulnerable are we? In June, a two-day simulation exercise called Dark Winter was held at Andrews Air Force Base in Washington, D.C. It began with a fictional scenario depicting a covert smallpox attack by Iraq that left 24 infected in Oklahoma. After an imaginary two weeks, decisions by the assembled politicians coupled with the quick exhaustion of the stockpiled vaccine would have resulted in 16,000 people infected in 25 states and 1,000 dead, 10 other countries reporting cases and the grim prediction that within three weeks there would be 300,000 victims, a third of whom would die.
And it would only multiply from there.
It was just a test, just an exercise, but it terrified its participants. "This would cripple the United States if it were to occur," John Hamre of the Centre for Strategic and International Studies testified before the House Committee on Government Reform last summer. "No city, no state is capable of dealing with an incident like this."
In many ways, the history of smallpox represents both the best and worst of human nature, says Jonathan Tucker, author of Scourge: The Once and Future Threat of Smallpox. The disease has killed hundreds of millions of people over the course of history, yet it is also the first and only infectious disease to be completely eradicated through a global vaccination campaign undertaken by WHO -- one of the highlights of 20th-century medicine.
Meanwhile, Soviet scientists were betraying that achievement by secretly developing smallpox as a weapon.
Before vaccination was invented in 1796, smallpox epidemics would cripple civilizations. It was also completely democratic, claiming rich and poor alike and counting Egyptian Pharaoh Ramses V, Queen Mary II of England and Tsar Peter II of Russia as victims. The Aztecs were defeated not so much by Hernando Cortes's army as by the smallpox the Spanish conquistadors had unknowingly brought with them. North American natives were decimated by the disease. In the 20th century alone, smallpox killed 300 million people -- three times the number who died in wars.
It is an insidious killer that is explosively contagious. Virus particles become airborne from the infected person and can travel up to 1.5 metres with every word or cough. Even contaminated clothing or bed linen can spread the virus. If you inhale a single particle of smallpox, you can develop the disease. For the first 10 to 14 days, you would feel fine. The first symptoms would be deceivingly similar to the flu: Fever, headache, and weakness. At this point, you are already contagious, infecting anyone you talk to. Two to three days later, body temperature falls and you would feel somewhat better just as the skin rash appears, first on the face, hands and forearms and then after a few days progressing to the trunk. The spots turn into blisters, eventually becoming painful, pus-filled and the size of peas. You have a one in three chance of dying a horribly excruciating death.
For every one case, another 20 will begin exhibiting symptoms two weeks later.
With weapon-grade smallpox, the future is even more terrifying. With advances in biotechnology, the virus could be dispersed through the air in a mist form invisible to the naked eye. Bio-terrorism expert Michael Osterholm has proposed a devastating scenario if smallpox were released into a major international airport. Dispensed from a device the size of a heat thermostat velcroed to the wall, three tablespoons of the virus could be turned into aerosol particles that would fill an entire airport concourse with millions of infectious doses. And no one would know when it was there. Long before anyone suspected, those infected would have travelled to their destinations, quickly spreading the disease throughout the world.
"Sept. 11 has made the possibility of mass casualty bio-terrorism much more of a real concern," says Jonathan Tucker, author of Scourge and director of the Chemical and Biological Weapons Nonproliferation Program at Monterey's Institute for International Studies. "As far as I know, there is no intelligence that bin Laden has acquired smallpox and that it's an imminent threat. So I think it remains more of a hypothetical threat, but one that is sufficiently compelling that we need to reduce our vulnerability and acquire more vaccine."
The smallpox vaccine, if given up to four days after exposure to the virus and before the rash appears, will provide protective immunity. But there's very little vaccine available. Americans have 15.4 million doses in storage, but researchers are considering stretching that number by diluting each dose.
Health Minister Rock says Canada's 380,000 doses may be diluted to vaccinate 10 times as many people. But there are serious concerns about the quality of the old vaccine and the new production will take time.
With panicked calls for a return of mass vaccinations, the WHO issued a statement last week warning against it. The risks of vaccination are too high, killing one in one million recipients, they said, especially for the very young, old, and those with suppressed immune systems.
Bio-terror is the poor man's atomic bomb.
The past is riddled with instances in which disease was used as a weapon of war. In 1346, when the plague infected the Tartar army during its siege of Kaffa (now Feodossia, Ukraine) they threw the bodies of their plague-ridden comrades over the city walls of their enemy, infecting thousands and forcing the Kaffa army to surrender.
Bio-terrorism was also used in North America during the French-Indian War in 1763. The English gave blankets to the Indians guarding Fort Carillon for the French during the long, cold winter. The blankets, given as a "token of good fortune," were actually infected with smallpox. The disease killed hundreds and the Indians lost control of the fort.
WORLD WAR II PROGRAMS
In more modern times, the Japanese are believed to have been the first to experiment with biological weapons during World War II. Not to be left behind, the Americans and British began their own programs soon after.
In 1969, though, U.S. president Richard Nixon unilaterally renounced their use. Three years later, countries throughout the world signed a treaty at the Biological Weapons Convention forbidding research and use of biological weapons. But it was still going on in the Soviet Union.
Within one year of signing the treaty, the Kremlin secretly established a massive biological-warfare research program called Biopreparat.
In 1992, its deputy director, Kanatjan Alibekov, defected to the U.S. with his shocking story: He and thousands of other Soviet scientists had been working to mount deadly germs like anthrax, smallpox and plague on intercontinental ballistic missile warheads. Their formulas for weapons-grade, antibiotic-resistant anthrax, smallpox and Black Death were turned over to military facilities for mass production and stockpiling by the tonne. There was never less than 20 tonnes of weapons-grade dry smallpox stockpiled in bunkers.
After the collapse of the Soviet Union, the bio-warfare program fell on hard times and unemployed Russian scientists were desperate to support their families. Alibekov, now known as Ken Alibek, warned Congress that it was very possible that smallpox left Russia in the pockets of mercenary biologists bound for Iran, Iraq, Libya, Syria and North Korea.
How did they get hold of the virus in the first place? The disease had been declared eradicated in 1980, but WHO decided to keep some of the live virus in case there would be some future need to develop drugs against it. It was officially stored in only two secure repositories on the planet, one at the Centers for Disease Control and Prevention in Atlanta and the other at the Soviet Union's sophisticated facility, Vector, in Siberia.
During the 1990s, Vector was a 4,000-person, 30-building complex protected by an elite guard, but a visit by American scientists in the autumn of 1997 found a half-empty facility protected by a handful of guards who had not been paid for months. No one could say where the scientists have gone nor could they guarantee that they hadn't taken some of the smallpox virus with them.
It gets worse. There is the very real possibility that agents such as smallpox have been genetically altered by these rogue scientists. In that case, the vaccine we currently have would be no protection at all. Alibek, the Soviet defector, has said that his fellow Russians had been experimenting with plague bacteria resistant to 16 different antibiotics and were splicing together the viruses that cause smallpox and Ebola.
"Just by reading scientific literature published in Russia in the last few years, a biological weapons developer could learn techniques to genetically engineer vaccinia virus and then transfer the results to smallpox; to create antibiotic-resistant strains of anthrax, plague, and glanders; and to mass-produce the Marburg and Machupa viruses," Alibek said in chilling testimony to the American armed services committee last year. "Billions of dollars that the Soviet Union and Russia put into biotechnology research are available to anyone for the cost of a translator."
For Scourge author Tucker, it is a sad irony that the first disease eradicated by man may now be used against it as a weapon of mass destruction.
That was driven home the other day when he received an e-mail message from David Heymann, head of the communicable disease section at the WHO, informing him about their new Web site on smallpox. "He said, 'Never would I have thought 30 years ago that we would need to digitalize the training materials and set up a Web site for a disease we worked so hard to eradicate ... '
"And that's very poignant," Tucker says. "People devoted their lives to eradicate this disease for 11 years. I think it's very troubling that it's come back, potentially, to haunt us."
Dr. Miller is more worried that as our panic shifts from anthrax to smallpox, we are ignoring the other diseases far more readily available to terrorists.
Physicians and labs are only now gearing up to identify anthrax, but none of them would be able to diagnose symptoms of plague or tularemia. "We're one step behind. We shouldn't be -- we should be anticipating," says the president of the Canadian Infectious Disease Society.
"The same public health people sending out notices about anthrax should be sending out a letter stating these are the six diseases that are likely to be used as biological agents of terrorism. These are the clinical signs and symptoms."
CENTRAL REPORTING SYSTEM
Incredibly, Canada also lacks an immediate, centralized reporting system. "If we had multiple cases of plague at the same time in this country, there's no way anybody in B.C. would know about a case in Nova Scotia and there would certainly be no one in the federal government who would know about both cases."
Still, he hopes these new fears about smallpox will awaken a public demand for an improved system.
"On any given day, we should be able as Canadians to say that we have adequate preparedness for any biological agent that could be used for terrorism," Miller says. "Today we cannot say that."
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