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SMALLPOX
A Deadly Recipe
By WENDY ORENT
Wendy Orent writes frequently on infectious disease and is currently
writing a book about plague.

July 28 2002

ATLANTA -- Those American scientists who know Gen. Pyotr Burgasov don't
expect much candor from him. Alexis Shelokov, a member of a U.S.
scientific team that, in 1992, investigated a mysterious 1979 outbreak
of anthrax in the then-Soviet Union city of Sverdlovsk, says the tall,
silver-haired former deputy minister of health was "easy, pleasant,
smiling, good to eat and drink with, a man who loved people and loved
life. He was very comfortable with lying." Burgasov denied--and still
denies--that the 68 people who died of inhalational anthrax in that
outbreak were victims of a bioweapons accident. He insists they ate
infected meat. But in a November 2001 interview in the Moscow News, the
affable Burgasov offered candid advice to terrorists. Anthrax isn't
worth much, he noted--it doesn't spread. "But smallpox--that's a real
biological weapon," he said.

Burgasov then dropped a bomb of his own, one that is still reverberating
in the American corridors of power. "On Vozrazhdenie Island in the Aral
Sea, the strongest recipes of smallpox were tested," he said. "Four
hundred grams of smallpox formulation was exploded on the island." At
that same time in 1971, he continued, a research vessel sailing on the
Aral Sea passed within 15 kilometers of the testing site. A young
technician was on board taking samples of plankton. The airborne
smallpox "got her," in Burgasov's words, and she fell ill after
returning home to the town of Aralsk, where she passed the infection on
to her brother and other people. "I called [Yuri] Andropov, who at that
time was chief of KGB, and informed him of the exclusive recipe of
smallpox obtained on Vozrazhdenie Island," Burgasov said.

Burgasov's bomb took a long time to detonate. Dr. Ken Alibek, former
deputy director of Biopreparat, the Soviet biological-weapons apparatus,
reported on Burgasov's interview before the U.S. House Committee on
International Relations in December, but no one paid attention. In
April, however, the Center for Nonproliferation Studies of the Monterey
Institute of International Studies received the original Soviet-era
reports on the outbreak from Dr. Bakyt B. Atshabar, director of the
Kazakh Scientific Center of Almaty, Kazakhstan. The report was sent to
biodefense expert Alan P. Zelicoff of Sandia National Laboratories in
New Mexico, who also interviewed two of the original patients in
Kazakhstan by telephone and subjected the data to rigorous statistical
analysis. Zelicoff, a medical doctor, presented his findings June 15 at
a National Academy of Sciences Institute of Medicine forum on smallpox
vaccination, and Burgasov's bomb exploded.

The "exclusive recipe" of smallpox tested on Vozrazhdenie Island
produced no ordinary disease. The young technician who first fell ill
had been vaccinated. So had her brother, whom she infected when she
returned to Aralsk. Both suffered, as Zelicoff determined, severe
illness. And both were contagious. Although they survived, a young woman
who visited them did not. She died of hemorrhagic smallpox, the most
terrible form of the disease, which causes uncontrollable bleeding and
rapid death. Two infants also died of hemorrhagic smallpox. None of the
three had been vaccinated. The vaccinated patients did not die, but they
came down with moderately severe disease.

Before naturally occurring smallpox disappeared in 1978, hemorrhagic
smallpox was exceedingly rare--not more than 2.5% of all smallpox cases
took this form, which was most common in countries such as India and
Bangladesh, where crowded conditions allowed severe disease to spread
more easily. Yet in Kazakhstan, all three nonvaccinated cases were
hemorrhagic. The numbers are small but the percentage is unnerving.

Zelicoff's presentation provoked an instant uproar.

Dr. Donald A. Henderson, who directed the smallpox-eradication campaign
and who has long advocated destruction of the remaining legitimate
stores of the smallpox virus, immediately protested that, since smallpox
still occurred in nearby Afghanistan, the technician may have caught the
disease naturally at one of the several Central Asian ports the ship
visited. But the woman, though she made many stops in the region, never
visited Afghanistan, and no one who did fell ill. Furthermore, Burgasov
himself states that this was a bioweapons incident. And former Soviet
bioweapons scientist Sergei Popov, who now works for Advanced Biosystems
Inc., a biodefense firm in Manassas, Va., says he had heard rumors of
the Aralsk bioweapons outbreak for years. Evidence suggests that we
should take Burgasov at his word.

Zelicoff's analysis goes further: He suggests that the particular
so-called Aralsk strain must have been epidemiologically selected to be
as hot as possible, "the strongest recipe of smallpox," in Burgasov's
inimitable phrasing. A commentary on Zelicoff's analysis, written by
smallpox expert Dr. Peter B. Jahrling of the U.S. Medical Research
Institute of Infectious Diseases, puts it this way: "We know that the
Soviet bioweapons development program attempted to select natural
strains of increased virulence and that one of the selection criteria
was hemorrhagic diathesis in mice and embryonated eggs." In other words,
Soviet bioweaponeers deliberately tested strains of smallpox to select
those most likely to "go hemorrhagic."

What does all this mean? Thirty years ago, Soviet scientists had
weaponized a smallpox strain probably far more lethal than most forms of
natural smallpox. We often hear that smallpox has a death rate of 30%,
nothing like the 99% fatality rate of, say, untreated pneumonic plague.
But in fact this is only an average. Smallpox strains from Africa killed
about 10% of those infected, while the much hotter strains of India and
Bangladesh killed many more, close to 50%.

Alibek, the former Soviet biological weapons official, has stated that
the Soviets deliberately selected an especially lethal strain from
India, the so-called India 1, as the basis for their smallpox bioweapon.
Was the "exclusive recipe" from Aralsk the same as India 1?
Possibly--but if not, then India 1 might be worse. And we do not know
which strains may be in the hands of rogue nations.

A number of American scientists, including Zelicoff, have asked the
Russian scientists at the Vector Laboratories of Novosibirsk, keepers of
the Russian-held World Health Organization smallpox repository, to
locate and turn over the Aralsk strain for joint collaborative study.
Vector scientists deny knowledge of the strain or even the incident.
This strikes some observers as implausible, though Vector did not exist
in 1971, and its director and chief smallpox expert, Lev Sandakhchiev,
was working on acetabularia, a form of giant algae, at the time. If
Vector has the strain, however, it's unlikely the lab would be able to
hand it over on its own. "Such a decision would have to be made at the
highest levels of the Russian government," Alibek says. Meanwhile, a
formal request for India 1 and other smallpox strains from the Vector
repository has yet to be made by the Centers for Disease Control and
Prevention in Atlanta. Without that formal request, says a knowledgeable
official, the Russian scientists cannot issue an export license.

It isn't likely, therefore, that we'll soon understand the precise
properties of the Aralsk strain, or India 1 for that matter. But we
should be better prepared to face the smallpox threat than we are. The
government should permit the American people to choose to be vaccinated
now. A freshly vaccinated population--excluding the very young, those
with major skin disorders and people with seriously compromised immune
systems--could well deter a smallpox strike in the first place. Why
waste effort trying to infect a vaccinated population?

Even if an attack occurred, widespread vaccination would minimize death
and social disruption. Furthermore, the ongoing research by Jahrling and
his team into less dangerous vaccines and better antiviral drugs to
treat smallpox after infection should become a top priority of the CDC
and the federal government.

Now we know, thanks to Zelicoff's efforts and Burgasov's candor, what
weaponized smallpox strains can do. But if the event at Aralsk was the
devil's fingertip, what would the whole hand be like?

We should take steps to ensure we never find out.