'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.''

Aggg! That second article was depressing. Here's a quote that shows that the expert I saw on TV was wrong.

Sorry about that.

Still, informed and depressed probably beats unaware and cheerful...

"Small pox can be spread by people who don't yet know they have it and even by people who are infected but do not come down with the disease."

Absolutely true, tallhappy. Infected sheets and other types of clothing and linens can also infect during a specfic time frame.

In all fairness to Theresa, I think she (?) is attempting to calm people -- even herself. I believe in preparing for the worst case scenario -- then not having it occur. There is much conjecture and speculation at this point. I, for one, am a pragmatist who errs on the side of being overly suspicious and overly prepared. That does not mean I don't go for the "best" in all situations.

Operating from a position of overall knowledge and understanding of potential dangers, conflicts and adversity is definitely operating from a position of strength if used wisely.

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.[My bold added.]

Would PETA raise hell & sue under the Endangered Species Act (ESA) if the officials tried to eradicate a disease today?

I'm not sure if ESA covers viruses (probably not), but the "logic" of the animal rights (AR) wackos is that we should not interfere with nature or at least minimize our interference with nature. Therefore, even if the wackos approve treating a disease, their "logic" would dictate that we NEVER eradicate a disease. By definition the disease has an important function in the ongoing evolutionary or Darwinian processes and the overall ecology.

This may sound far-fetched, but the AR wackos already have farmers loosing their livelihoods over sucker fish and fire fighters dying because water from a stream with endangered species must be treated extra carefully.

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