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Scourge: The Once and Future Threat of Smallpox
Tucker clearly wrote the book believing that the use of smallpox as a biological weapon was a worrisome, but not especially likely, threat, and on September 10th, most of us would not only have concurred, but would probably never have thought that such a thing could happen; after all, smallpox remains the only infectious disease to have been eradicated by humans. After reading Scourge, you will be grateful that the mysterious sender of anthrax-laced mail doesn't have the power of this infinitely worse pestilence in his or her hands.
The smallpox virus, or variola, is a biscuit-shaped bundle of DNA and protein casing, so tiny it can only be viewed with an electron microscope, yet devastating to the human body. The disease kills up to thirty percent of its victims and leaves the rest permanently scarred after battling fever, nausea, and boils so painful that thirsty patients often refused water, unable to swallow without excruciating hurt. Perhaps to be merciful, Tucker has included no photographs of suffering victims covered in the gruesome pustules of the disease, but should you have a morbid curiosity to see one, visit the Polio Eradication Photo Gallery.
Scourge is not a story about a virus, however; it is a story about people. Tucker tells of the history of smallpox and civilizations, how political machinations combined with idealism to bring about the global cooperation that removed smallpox from the earth, and the elaborate subterfuge used by the Soviet Union to hide its research on smallpox as a potential biological weapon. Fans of Laurie Garrett's (The Coming Plague, Betrayal of Trust) journalistic style will appreciate Tucker's treatment; the major figures in the history of smallpox are presented in terms of their personalities and personal struggles, rather than in simple obituary-style listings of what they did.
In describing the early history of the disease, Scourge is fascinating. You may have known that smallpox helped Hernando Cortes conquer the Aztecs in the sixteenth century, but perhaps you didn't know that smallpox may have been the Athenian epidemic Thucydides describes in his account of the Peloponnesian war. The superstitions that existed prior to the germ theory of disease - and, in some areas, long enough to hinder the last stages of the smallpox eradication campaign in the late 1970s - seem truly impossible now, but such was belief prior to the germ theory of disease.
The conquering of smallpox remains one of the great triumphs of mankind - the only infectious disease successfully eradicated by humans. The history of the eradication campaign is one of cooperation between nations and between scientists, but it is also a story of obstacles placed in the way by reluctant governments, the rapid spread of disease due to world travel, and the stubbornness of the superstitious. Here, you will meet such figures as D.A. Henderson, the reluctant leader of the World Health Organization campaign, and Viktor Zhdanov, the man who first proposed a global eradication campaign to the WHO in 1958, then, ironically, became the first chairman of the Soviet council that oversaw the secret biowarfare program beginning in the 1970s.
The clash between the traditional openness of the scientific community, where information is shared relatively freely, and the secretiveness of bureaucracies, where being in the know is a mark of power, is a recurring theme. Often, you'll find yourself rooting for the researchers, who frequently had to reason with government officials who knew nothing about science, but you may be surprised to find yourself agreeing with the government - specifically, the Department of Defense - a time or two.
The story of the Soviet Union's successful cover-up of its research into the use of smallpox as a biological weapon is unsettling, to say the least. Do you find the aftermath of a nuclear bomb impressive? Imagine that bomb followed by an ICBM bearing smallpox - a disease that kills nearly a third of its victims in a normal situation, but would be attacking survivors of a nuclear attack, whose immune systems would be severely compromised by radiation damage. Lest you think that earlier vaccinations might have helped, the smallpox vaccine is effective for only about ten years before revaccination is required, and the United States had stopped mandatory vaccinations long before the last known case of naturally occurring smallpox was diagnosed in 1978. Such a warhead was one of the foci of the Soviet program, even as facilities were carefully disguised so as to give the appearance of compliance with the Biological Weapons Convention treaty. Western governments did not learn of the full scope of the Soviet effort until 1989, and kept the information classified until former Soviet smallpox research scientist Ken Alibek (ne Kanatjan Alibekov) told the story to the American press in 1998.
Although, officially, the last remaining stores of variola virus are kept in Moscow and at the Center for Disease Control in Atlanta, Tucker raises the possibility that other governments - particularly Iraq - may have retained secret stores of smallpox virus, citing enough circumstantial evidence to keep his speculation from being easily discounted. He also brings up the possibility that a government might, to avoid the certain retaliation that would come from launching a smallpox attack, supply the virus to a group like al-Qaeda, then deny responsibility when the terrorists release the disease. Tucker finished documenting these speculations well before the September 11th attacks; now, one hopes they aren't prophetic.
In the case of smallpox, the truth is as morbidly fascinating as any fiction could possibly be, and Tucker tells the story of those who fought to end the scourge and those who would have preserved it as a weapon with equal aplomb, yet from the perspective of a world where smallpox was a piece of history and sophisticated biological attack a back-burner phenomenon. Now that fears of biological warfare are all too real, Scourge is exceptionally relevant - and hopefully not a prediction of what is to come.
You can purchase this book at Fatbrain.
Scientific American, Dec 1996
http://www.sciam.com/1296issue/1296cole.html
Living Terrors
Living Terrors
by Michael T. OsterholmPh.D., former Minnesota State Epidemiologist, and John Schwartz, a science reporter for The Washington Post.
Lays out scenarios for anthrax and smallpox, some history of biowar, why public health system needs to be restored.
The Johns Hopkins University Center for Civilian Biodefense Studies:
home
Smallpox
CDC reports on smallpox attack scenarios:
The scenario
Aftermath of a Hypothetical Smallpox Disaster
Part Two
CDC
Home
S,mallpox
Picture
Modeling Attacks
Public Health Links:
The Coming Plague: Newly Emerging Diseases in a World Out of Balance
by Laurie Garrett
Covers emerging and re-emerging diseases such as HIV, Ebola, Tuberculosis, Smallpox.
Betrayal of Trust : The Collapse of Global Public Health
by Laurie Garrett, Steven M. Wolinsky
How the public health system, in USA and abroad, was allowed to disintegrate.
And the Band Played On: Politics, People, and the AIDS Epidemic
by Randy Shilts
A chronicle of the first 5 years of the aids epidemic.
Richard Preston (Hot Zone author) on smallpox
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The New Yorker's The Demon in the Freezer is mirrored at Cryptome, and is an excellent online read about smallpox; it takes about half an hour. And it is truly disturbing.
If you only read a few parts, read two things:
- the part where Russian scientists warn western observers that "your vaccines won't protect you" against the Soviet's new breed of smallpox.
- the part about insect poxviruses, which turn caterpillars into pure crytstallized virus.
Blech. I hope we have the courage as a nation to go ahead and make the vaccine, in mass quantities, the same way it used to be made. The main objection raised in the article is that "by today's standards" cow puss is an unacceptable vaccine. Hopefully "today's standards" are that life without a vaccine is unacceptable. But that's just my opinion.
If guns kill people, then CmdrTaco's keyboard misspells words.
I guess we didn't bomb Iraq, Afghanistan, and Sudan in the last 15 years. Nor did $300M of Saudi inheritance and an organization devoted to the destruction of the USA (and by proxy, our Western allies) spring up. Right?
The huge difference between an entity like the Soviet Union and a network like Al Qaeda is that, while the USSR was highly prepared and enamored of the will to power, the people holding the reins were not particularly interested in dying as a means of killing others. So while the cynical machinations of the Soviet power elite produced the finest weaponization programs for biowarfare yet seen, they were only intended for use as mop-up agents after a nuclear attack.
The Islamic fundies (not particularly worse than Christian fundies or ultranationalist Israelis, just more prominent) that have taken center stage lately are perfectly willing to die for their cause, as long as they can kill a few unarmed women and children while they're at it. What better for the slaughter of innocents than an epidemic? It worked for Genghis Khan (cf. catapulting plague-ridden corpses into sieged cities). These are not conventional enemies and they are not limiting themselves to conventional warfare. Moreover, a network of semi-autonomous individuals without a distinct nationality, i.e., nothing to lose, is a much more elusive target than a static nation-state like Iraq, Libya, or Afghanistan. So the consequences of being "caught" are also different.
That, in conjunction with the underfunding and collapse of the public health systems around the world, is why I submit that a response to biowarfare is more crucial now than 15 years ago.
And the rebuilding of a worldwide public health infrastructure would be a damn nice side effect of this new urgency, IMHO.
Remember that what's inside of you doesn't matter because nobody can see it.
The government is working on stockpiling enough vaccine for the whole population, but they wouldn't vaccinate unless there were an outbreak. The vaccine can have nasty side-effects in some people, including brain damage, blindness, and death. Not many people, 1 in 250k,IIRC, but that would still be over 1,000 people injured by it if everyone were vaccinated. Those numbers, however, date from the days before AIDS, chemotherapy, and other things that suppress the immune system. It's a 'live virus' vaccine. Because of that it's one of the ones that's used when the danger of the vaccine is substantially less than the danger of the disease.
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Something almost amusing, though... Doctors will always ask if you're allergic to any medications, and I always respond "smallpox vaccine", and we both chuckle, because we know that I'm not likely to need it. Now, though... A story like this can cause genuine fear for me.
GPL made simple: What was my stuff is now our stuff. If you improve our stuff, please keep it our stuff.
I don't know why everyone is so focused on smallbox, even if it's an awful disease.
Ken Alibek (formerly Kantajin Alibekov) who was the deputy director of the immense Soviet Biopreparat biowarfare research and manufacture organizion defected to the US in the early 90's, and has written a book on it as well as testifying to congress and having been thoroughly debriefed on the Soviet program.... They worked on a whole slew of biological weapons including things like marlburg virus (similar to ebola) that would make you wish you only had smallpox!
The Soviets stockpiled weaponized smallpox, plague, marlburg, tularemia etc in quantities of tens of tons each! They aqpparently killed around 100,000 nazis with tularemia in the Battle of Stalingrad.
I haven't read the Smallpox book reviewed here. But if you're interested in the history of disease, I heartily recommend Rats, Lice and History. Not a boring text, it meanders all over the place with a very dry wit and makes a truly horrible subject enjoyable to read about.
We keep the stocks for research into the disease. I think there's an effort underway to sequence the genetic code. Hopefully the research will lead to a safer vaccine than the one we have now. It's based on cow pus.
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Assuming a leak couldn't occur from the CDC stock does seem reasonable. Assuming a leak couldn't occur from the former Soviet lab is not reasonable.
Re: We can deal with it
Not now we can't. There are 20M smallpox vaccine doses in the US now, all of which are of uncertain quality (could easily be as few as 5M still good). It's been estimated by CDC that it might be possible to use diluted vaccine to get 2x-3x but dilution has never been tried. The CDC/HHS estimate that we could have 70M doses in 3-4 months. There are 280M people in the US.
The lethality of smallpox historically is ~30% (which puts an upper bound of 84M US people if everyone is infected) in population with some natural genetic immunity. There are forms of small pox and populations without natural genetic immunity (native American peoples 200-400 years ago) which can have 90+% lethality. Since vaccination ceased in the US prior to 1978, most of the population doesn't artificial immunity so best case the 30% number applied but it could be higher. The main factor controlling the actual number is the nature of the propagation: traditional epidemics are diffusive while terrorist can make them non-diffusive.
Putting the 84M in perspective compare this to US war deaths:
Revolutionary War: 4,435
Civil War (North & South): 498,332
WWI: 116,708
Total (all nations) WWI deaths from combat: ~10M
Total deaths from Spanish Flu in 1918-1919: 21M (600,000 civilian+military US deaths, military US ~200,000 deaths - yes, more US soldiers died in WWI from flu than bullets! And 2x died from bullets in WWI than in Vietnam!)
WWII: 407,316
Vietnam: 58,168
Re: We can only hope...
So maybe we'll have enough vaccine within a year, BUT, the death rate due to lethal vaccine side effects (source: CDC) is about 1:1,000,000, or 280 deaths from vaccination, and 1:10,000 rate of moderate to severe side effects or 28,000 (bad enough to require hospitalization).
Smallpox was a terrible epidemic here in the states when it wqs used as a biological agent against the aboriginal populations in this country.
The Conneticut Indians saw Smallpox decimate 90% of their population. The effect of Smallpox on New England was more drastic than a Nuclear Weapon.
In a nuclear attack, you would lose 70-75% of the populated area, Smallpox killed at least 80% of the Native American population living in New England.
The vistory over smallpox came about because we used it against our old enemies and now our new ones are using it against us.
Jason Maggard
Proud to be Miami
Nothing4sale.org
The US Government stopped all research in chemical and biological warfare (except to produce vaccines and treatments) ~1970 (I think it was '68). The Soviets' work was continued until the early '90s.
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