Smallpox reversal could be dangerous

May 06, 1999|By D. A. Henderson

IN A startling and puzzling reversal of policy, the Clinton administration has taken the position that the two known remaining stocks of smallpox virus -- one here, one in Russia -- should be kept indefinitely for possible research purposes.

The U.N. World Health Assembly had recommended destroying stocks of the virus by June 30. However, it is to meet in Geneva, Switzerland, later this month to vote again.

The assembly's position had been firmly supported by the United States since 1990 when then-Secretary of Health and Human Services Louis Sullivan first proposed destruction of the stocks to the assembly. Virtually all the member nations supported that move.

The case for destroying the virus rests on minimizing -- hopefully, eliminating -- the risk that the smallpox virus would ever again plague mankind. Smallpox kills about 30 percent of those afflicted; there is no treatment.

Terrorist threat

An accidental release of the virus from a laboratory or the use of smallpox as a weapon by a terrorist could readily set off a catastrophic epidemic. Relatively few people are now immune to the disease. Vaccinations were discontinued in this country in 1972 and throughout the world by 1980. Many people who were vaccinated are susceptible to the disease because of waning immunity.

Only through vaccination and isolation of patients can such an epidemic be controlled and eventually stopped. Unfortunately, the stocks of vaccine throughout the world are small and no manufacturers are equipped to produce more.

The disease is ugly and frightening. Victims experience high fever, severe aching pains and a pustular rash over the entire body. Imagine being covered in thousands of boils, with all the accompanying pain and discomfort.

Those who survive are left with severely pock-marked faces, and some are blinded. It is no wonder that before its eradication in 1979, smallpox was the most feared of all the pestilential diseases.

It is difficult to find anyone who personally knows the horrors of smallpox who favors preserving the virus. Some virologists, however, have insisted that it be preserved for further research.

Little study

They argue that the study of such an unusual virus may provide unique insights into the cause of disease virulence or immunity. Whether that's true or not, it should be noted that little smallpox-related research has been conducted for years. Only one laboratory in the world is conducting such research; it's a former bio-weapons facility in Siberia. It began its work with the virus in May 1996.

The most often-cited reasons for retaining the smallpox virus is that a new vaccine or a therapeutic drug might be developed. Neither is likely nor practical.

It would cost several million dollars to develop a drug or a vaccine. A new anti-viral drug is highly unlikely, partly because of the difficulties in developing a successful drug against any such disease. In afflicted individuals, the smallpox virus is mainly found in the pustules, which are all but impenetrable by drugs.

Lack of subjects

Developing a new smallpox vaccine poses other problems. It would be impossible to determine if it protected people from infection. Scientist can't experiment with it on animals because they don't get the disease, and there are no human cases. By the time scientists could determine if the vaccine were effective, it might well be too late.

Although the United States asks that the virus be preserved, an overwhelming majority of nations polled by the World Health Organization (WHO) last year favored destroying it. Who should decide the virus' fate?

Surely the United States would not propose to act unilaterally. The decision to embark on a program to eradicate the virus was a collective one. Developing countries incurred two-thirds of the cost, with the United States contributing less than 10 percent, the then-Soviet Union 3 percent.

Moreover, the virus strains in the two laboratories are primarily from specimens provided by the infected countries. Are they owned by the United States and Russia, or are they held in trust on behalf of WHO?

The practical implications of the United States and Russia retaining the virus for prospective research studies should not be overlooked. Wouldn't scientists in other countries want to do such research in their own labs?

Such reasoning would provide the argument for various countries to obtain the smallpox virus for their own studies. Possibly, the smallpox virus could be disseminated to many laboratories, including ones in Iraq and North Korea.

The steadfast U.S. position advocating destruction of the virus was not a capricious decision. Reversing that position now could be the ultimate folly.

D. A. Henderson directed the World Health Organization's global small pox eradication program from 1966 to 1977. He is a professor of epidemiology and director of the Center for Civilian Biodefense Studies at Johns Hopkins University.

Pub Date: 5/06/99

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