Preventing Smallpox

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• SUSAN DENTZER:

  Until it was eradicated in 1980, smallpox had long been one of humanity's most terrible scourges. The successful campaign in the 1960s and '70s to wipe the disease off the face of the earth was led by Dr. D.A. Henderson. He now heads the new Office of Public Health Preparedness at the U.S. Department of Health and Human Services.

  DR. D.A. HENDERSON, Director, Public Health Preparedness, Health & Human Services: Smallpox throughout history has been one of the worst of all of our pestilential diseases; more greatly feared over the centuries than plague or yellow fever or cholera. And actually, it killed many, many times more people than any of those organisms.

• SUSAN DENTZER:

  The disease was spread from person to person, usually as droplets expelled from an infected person's nose or mouth. Ten to fourteen days after infection, victims developed severe aching pains, headache, and fever, followed by a rash that eventually produced the characteristic pockmarks of the disease.

• DR. D.A. HENDERSON:

  About 30 percent of the people die of the disease, and this occurred in Europe, let's say, under fairly good conditions of medical care, and it occurred at that rate in India and Pakistan, Bangladesh, places where they have less adequate standards of care. There is no therapy, and so once the individual gets the disease, he survives or dies.

• SUSAN DENTZER:

  In the wake of the success of the global eradication campaign, there are now only two official repositories of the smallpox virus, whose scientific name is variola. One is at the Centers for Disease Control in Atlanta, another is in Russia at the inauspicious-looking Institute of Virus Preparations in Moscow. But in the early 1990s, the United States learned of an extensive effort that had been under way for years in the former Soviet Union to develop special stocks of the virus for use as a weapon of mass destruction.

• KEN ALIBEK, Former Deputy Director, Soviet Bioweapons Program:

  It could easily manufacture up to 200 tons of smallpox biological weapon a year. Believe me, it was a tremendous amount.

• SUSAN DENTZER:

  Ken Alibek was formerly second in command of that Soviet, and later, Russian, bioweapons effort. He defected in 1992 and now runs a Virginia-based government contracting firm. He says the deadliness of Russia's stores of smallpox virus almost defies imagination.

• KEN ALIBEK:

  You know, it's difficult to just to tell something without scaring people, but you know, 200 tons… You can imagine 200 tons could destroy the entire world population several times over.

• SUSAN DENTZER:

  In a book he wrote on the subject, Alibek says the Soviets also perfected ways to manufacture and spread the virus: For example, loading it onto nuclear warheads and ensuring that it could disperse readily through the air. And Alibek is one of many who suspects the Russians have continued the program, opening up the possibility that poorly- paid Russian scientists could deliver the virus into dangerous hands.

• KEN ALIBEK:

  If a scientist working with smallpox is making somewhere between $50 or $100 a month, isn't it enough? Of course, it's not enough. There are many dealers, arms dealers in the former Soviet Union. They sell and buy everything, from conventional weapons to nuclear materials, and now it's obvious, of course, that there is a market, believe me. There was and there is and there will be a market of biological… biological agents.

• SUSAN DENTZER:

  And in fact, that market for smallpox virus and other biological agents could be huge. Recently the U.S. Government accused Iraq and at least five other countries of violating a 1972 global convention prohibiting the production and use of bioweapons. The government called Iraq's program in particular "a serious threat to international security." Even if Iraq and other rogue states are producing smallpox virus as a bioweapon, there's considerable debate over how likely it is that a bioterrorist group could mount a successful smallpox attack. Henderson of HHS is a skeptic, albeit a cautious one.

• DR. D.A. HENDERSON:

  My personal feeling is that smallpox is much more difficult to get a hold of than anthrax. It's more difficult to handle. It would be more difficult to distribute. So that the risk of smallpox being released in the population is less than anthrax, but it is not zero. And that's what worries us.

• SUSAN DENTZER:

  So given the risks, Henderson says the nation has no choice but to prepare to respond to a smallpox attack, first by stockpiling ample supplies of vaccine.

• DR. D.A. HENDERSON:

  With smallpox, you can vaccinate after the individual has been exposed to the virus. Let's say you are exposed today. We can vaccinate you two to three days later and protect you against smallpox.

• SUSAN DENTZER:

  And indeed, this week, the Centers for Disease control unveiled a smallpox response plan that envisions just such an approach. Consider what would happen if a handful of smallpox cases showed up in several hospital emergency rooms in a major city like Boston. Federal, state, and local responders would quickly draw a ring around those cases, focusing first on all the people those victims had come in contact with over the previous two weeks. All of those people and their family members would be inoculated with anti-smallpox vaccine, and possibly quarantined at home or in specially designated hospitals while they were still infectious. If that didn't stem the outbreak, officials would proceed to vaccinate and quarantine wider circles of people until the epidemic was halted. Today there are at least 115 million Americans who have never been vaccinated for smallpox. Most of the rest were vaccinated so long ago that their immunity has waned or worn off completely. And although no preventive mass vaccinations are currently planned in the absence of a smallpox attack, government officials have concluded that protecting the population mandates accumulating enough doses for every American. So yesterday the government announced plans to build a massive stockpile of anti- smallpox vaccine. A total of 209 million doses of will be purchased from a joint venture between a British company, Acambis, and a U.S. firm, Baxter International. In addition, researchers are now testing to see whether a stock of roughly 15 million doses that the government has on hand could be stretched to 77 million doses or more. If so, that could create a total stockpile of 287 million doses of vaccine. Dr. Carol Tacket is Professor of Medicine at the University of Maryland.

  DR. CAROL TACKET, University of Maryland School of Medicine: What we're doing here is taking the existing vaccine and diluting it one to five and one to ten and giving it to volunteers and see if those volunteers have what we call a take. The take is the local reaction that occurs at the site of vaccination. After about four days, there is a little red bump that turns into a little vesicle or blister and that eventually makes a crust and a scab which separates and then the vaccine is left with a little scar at the site of vaccination. And at the end of that process almost everybody who has a take is then immune to smallpox.

• SUSAN DENTZER:

  Dr. Anthony Fauci of the National Institutes of Health told members of Congress today that results so far have been encouraging.

  DR. ANTHONY FAUCI, National Institutes of Health: And our experiments over the years tell us that take rates coincide very well with the production of antibodies that you'd like to induce. So it isn't final yet, but things are looking quite good. We will have those results in their final form by the end of January, the very beginning of February.

• SUSAN DENTZER:

  The huge store of newly produced smallpox vaccine is expected to be in place by the end of next year.