On smallpox

In 1977, smallpox was eradicated as the result of a massive global effort. Rather than completely eliminate the virus, it was decided that the United States and Russia would each keep a sample. Part of the reasoning for this is that pox viruses are common in the animal world, and could potentially jump between species. Having samples of human smallpox could be useful, in the event that such a thing occurred.

Unfortunately – and rather threateningly – the Russian smallpox sample didn’t sit idly in a freezer. Smallpox is a highly contagious, highly lethal disease and yet Biopreparat, the Soviet Union’s biological weapons agency, made some twenty tonnes of the stuff, tested it on animals, and developed mechanisms to use it as a weapon, including delivery via warheads on intercontinental missiles. This was done at the State Research Institute of Virology and Biotechnology (also called Vector), outside the city of Novosibirsk, in Siberia, as well as at a more secret facility in Sergiyev Posad. It was also tested on Vozrozhdeniya Island. The Soviets made so much that it couldn’t all be accounted for. Quite possibly, some found its way into biological weapons programs in other states, such as China, India, Pakistan, Israel, North Korea, Iraq, Iran, Cuba, and Serbia.

Whereas human beings once had two major forms of protection from smallpox – immunity resulting from exposure to the virus, and vaccination campaigns – the former is now absent and the latter defunct and potentially difficult to restore. A single case, perhaps arising from some accident, could directly infect hundreds of people and kick off an escalating series of waves of infection, spaced fourteen days apart, as people go through the incubation period and become infectious. Such a global outbreak could kill a massive number of people.

The idea of an accidental release is not fanciful. In 1978, medical photographer Janet Parker became one of the two last people to contract smallpox, working in the anatomy department of the University of Birmingham Medical School. It seems entirely plausible that accidental exposure could occur at some shady biological weapon lab in Cuba, Pakstan, or North Korea.

If anything like that ever happens, people may end up looking on the decision not to stick to just one frozen sample of smallpox as the worst thing the Soviet Union ever did. Hopefully, all the concern and money expended on security since 2001 has at least left the world in a better position to launch a mass vaccination campaign, should the need ever arise.

Author: Milan

In the spring of 2005, I graduated from the University of British Columbia with a degree in International Relations and a general focus in the area of environmental politics. In the fall of 2005, I began reading for an M.Phil in IR at Wadham College, Oxford. Outside school, I am very interested in photography, writing, and the outdoors. I am writing this blog to keep in touch with friends and family around the world, provide a more personal view of graduate student life in Oxford, and pass on some lessons I've learned here.

8 thoughts on “On smallpox”

  1. Active global monitoring of emerging outbreaks is also a sensible practice. Whether they arise naturally or as the result of some accidental release, it seems likely that the sooner outbreaks are detected, the more effectively they can be dealt with.

  2. I was just thinking about this the other day after a conversation about what technologies an individual could introduce into a sixteenth century society if one were transported through time with no equipment. In a worst case scenario of a big smallpox outbreak and low stores of official vaccines we could go back to the old-fashionned approaches to innoculation by infecting people with cowpox and/or using variolation by infecting people with milder strains of smallpox through scratches on their skin. Variolation carries a significant mortality risk, so on balance infecting people with cowpox would be safer, but you’d need a lot of infected animals.

  3. Lest anyone think the possibility of an accidental or intentional smallpox outbreak in the future would be no big deal, as far as human suffering goes, Richard Preston’s description of the disease is illuminating:

    Smallpox is explosively contagious, and it travels through the air. Virus particles in the mouth become airborne when the host talks. If you inhale a single particle of smallpox, you can come down with the disease. After you’ve been infected, there is a typical incubation period of ten days. During that time, you feel normal. Then the illness hits with a spike of fever, a backache, and vomiting, and a bit later tiny red spots appear all over the body. The spots turn into blisters, called pustules, and the pustules enlarge, filling with pressurized opalescent pus. The eruption of pustules is sometimes called the splitting of the dermis. The skin doesn’t break, but splits horizontally, tearing away from its underlayers. The pustules become hard, bloated sacs the size of peas, encasing the body with pus, and the skin resembles a cobbled stone street.

    The pain of the splitting is extraordinary. People lose the ability to speak, and their eyes can squeeze shut with pustules, but they remain alert. Death comes with a breathing arrest or a heart attack or shock or an immune-system storm, though exactly how smallpox kills a person is not known. There are many mysteries about the smallpox virus. Since the seventeenth century, doctors have understood that if the pustules merge into sheets across the body the victim will usually die: the virus has split the whole skin. If the victim survives, the pustules turn into scabs and fall off, leaving scars. This is known as ordinary smallpox.

    Some people develop extreme smallpox, which is loosely called black pox. Doctors separate black pox into two forms — flat smallpox and hemorrhagic smallpox. In a case of flat smallpox, the skin remains smooth and doesn’t pustulate, but it darkens until it looks charred, and it can slip off the body in sheets. In hemorrhagic smallpox, black, unclotted blood oozes or runs from the mouth and other body orifices. Black pox is close to a hundred per cent fatal. If any sign of it appears in the body, the victim will almost certainly die. In the bloody cases, the virus destroys the linings of the throat, the stomach, the intestines, the rectum, and the vagina, and these membranes disintegrate. Fatal smallpox can destroy the body’s entire skin — both the exterior skin and the interior skin that lines the passages of the body.

    I think it really speaks ill of humanity that anybody ever weaponized this. Of course, it wasn’t just the Russians. The United States experimented with smallpox, EEE and WEE, AHF, Hantavirus, BHF, Lassa fever, glanders, melioidosis, plague, yellow fever, psittacosis, typhus, dengue fever, Rift Valley fever (RVF), CHIKV, late blight of potato, rinderpest, Newcastle disease, bird flu, and the toxin ricin.

    They even designed a cluster bomb for distributing biological agents, and several different types of bomblets. They also exposed conscientious objectors who had volunteered to the plague and other diseases.

  4. Pingback: Biohazard
  5. Emerging infections
    No good deed goes unpunished
    Smallpox has gone, but monkeypox is now rearing its ugly head

    Sep 2nd 2010 | New york

    ONE of the greatest public-health victories of the last century was the eradication of smallpox. After the disease was pronounced extinct, in 1980, people stopped using the smallpox vaccine. That seemed the ultimate symbol of technology’s triumph over a medieval scourge.

    Alas, it turns out that the end of vaccination has unleashed new demons. Researchers have long suspected that smallpox vaccine also provides protection against diseases such as monkeypox and cowpox, and three decades ago a committee of experts weighed up whether ending vaccination for smallpox might allow one of those diseases to spread in humans. They decided this was unlikely. Now, a study published in the Proceedings of the National Academy of Sciences suggests they may have been wrong. A team led by Anne Rimoin of the University of California, Los Angeles, conducted surveys of people living in the centre of the Democratic Republic of Congo. They found a dramatic surge in monkeypox—a disease which, though not as bad as smallpox, kills up to 10% of those it infects.

    The researchers selected central Congo partly because the last comprehensive study of monkeypox, carried out between 1981 and 1986, covered the area well. In addition, reports had been surfacing from that part of Congo about people with the disease. Their investigation found a 20-fold increase, up from 0.7 cases per 10,000 people during the earlier survey to 14.4 cases per 10,000 between November 2005 and November 2007.

    Scrutiny of the data reveals two curious trends. First, men were more likely to be infected than women, and people living in rural and forested areas more likely than town dwellers. That suggests those groups are in regular contact with a natural reservoir of monkeypox. Despite its name, monkeypox virus is believed to reside mainly in rodents such as squirrels and giant pouched rats. As war and poverty have forced those living in this area to rely more and more on meat from wild animals (with men doing the hunting), opportunities for the virus to pass from rodents to people have increased.

  6. Smallpox is caused by the variola virus, an ancient pathogen that naturally infects humans and no other species. Victims suffer high fevers, wracking headaches and body pain, pus-filled skin ulcers, vomiting and bleeding. About one-third die. Many survivors are left blind and scarred. There is no approved treatment.

    “For centuries, repeated epidemics swept across continents, decimating populations and changing the course of history,” according to a WHO history.

    By rapidly vaccinating everyone around each victim beginning in 1966, a WHOsponsored campaign led by D.A. Henderson of Johns Hopkins finally pushed the virus back to a single last natural case, which occurred in Somalia in 1977. The WHO officially declared smallpox eradicated in 1980.

    Every laboratory except one in the United States and one in Russia subsequently agreed to destroy any samples they had, and the WHO in 1990 set a deadline for getting rid of the last two by 1993.

    But the United States balked in 1994 after revelations emerged that the former Soviet Union had worked to develop smallpox as a biological weapon. Since then, both the United States and Russia have repeatedly postponed, citing concerns that Iraq, Iran, North Korea and others might be hiding the virus and the imperative to conduct more research.

    Because of the successful eradication program, vaccination programs stopped worldwide, leaving most defenceless against the disease. The United States discontinued immunizations in 1972, so anyone born after 1967 is vulnerable.

    Following the Sept. 11, 2001, al-Qaeda attacks, the United States stockpiled enough vaccine to inoculate every American against smallpox. But the vaccine is imperfect. AIDS patients, transplant recipients and others with weak immune systems cannot safely use it.

    Two new drugs appear to be effective but have not yet undergone sufficient testing to win Food and Drug Administration approval. Scientists need the live virus to develop good animal models to test them, some say.

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