REQUIEM FOR A SCOURGE?
The world's last known samples of smallpox seemed
destined for destruction. Then came Sept. 11
By Michael Purdy
Art by Tom Curry
The tone of the two-decades-long debate over whether or not to
destroy the last known samples of the smallpox virus shifted dramatically
after Sept. 11 and the fall anthrax attacks.
In mid-November, the Bush administration formally announced that
it intended to indefinitely postpone the planned 2002 destruction
of U.S. smallpox stocks. Then on Jan. 17, the executive board of
the World Health Organization recommended extending the deadline
for destroying the smallpox samples kept in high-security labs in
the United States and Russia. The board cited the potential use
of the stocks in the development of antiviral drugs.
For the moment, the argument seems to have tilted to favor the preservationists;
however, those seeking destruction of the smallpox stocks
Alfred Sommer battle on.
Before it was brought under control through an aggressive, international
vaccination program in the 1960s and 1970s, smallpox cut a centuries-long
path of misery and death across the globe. The highly contagious
disease, for which no successful treatment beyond vaccination has
ever been developed, causes a rash that can disfigure or blind sufferers,
and kills about one in every three people it infects.
Henderson, the scientist who led the worldwide effort to eliminate
smallpox in the wild, had been a formidable advocate for destruction
as the leader of the School's Center for Civilian Biodefense Strategies.
He says the attacks of last fall have not changed his views, but
he has stepped out of the debate since becoming the director of
the federal Office of Public Health Preparedness.
"I'm now a member of the government and it is a government
position that we should retain the smallpox virus," Henderson
says. "What more can I say?"
Once in favor of destroying the smallpox stocks, Frank Calia, MD,
vice dean of the University of Maryland School of Medicine, says
his mind was changed by the events of last fall. Calia, an infectious
disease specialist who's not involved in smallpox research, calls
the elimination of smallpox in the wild "so wonderful it boggles
the mind." But he says he is deeply concerned by reports that
there may be additional stockpiles of smallpox in the hands of terrorist
groups or rogue states like Iraq or North Korea.
"Had there been only two stockpiles of the virus, and they
were both destroyed and we were sure of that, that would've been
the best eventuality for humanity," Calia says. "However,
we don't know that those are the only two repositories of the virus."
Calia also worries that smallpox immunizations have not been given
for decades, leaving most of the population vulnerable to a potential
"I'm sympathetic to the desire to destroy smallpox, but under
the current situation, the current threat, we need to know more
things about it," Calia says. He feels that the more scientists
can learn about smallpox, the better prepared the world will be
to deal with a renewed outbreak if smallpox is unleashed again.
"So much has been learned since smallpox was eliminated as
a problem in the 1970s," says Calia, pointing out the many
advances in viral research and treatment since the emergence of
the HIV epidemic in the 1980s. Calia would like to see some of those
advances, including new antiviral drugs and potential new smallpox
vaccines, tested against smallpox in an in vivo model of the disease,
and he thinks a primate model of smallpox announced by U.S. Army
researchers at Fort Detrick, Maryland, in January may be able to
meet that need.
However, Sommer disagrees. He strongly criticized the monkey model
in a Baltimore Sun op-ed and in news stories. Sommer, who fought
a staggering outbreak of the disease in Bangladesh in 1972, decries
the example that the primate research sets for other countries.
"Playing with this virus, and keeping it alive and showing
other countries that we are experimenting with it in primates -
are they really going to believe that we're doing this only for
defensive purposes?" Sommer asks. "No. Everybody's going
to go out and want to get their virus for ostensibly 'defensive'
purposes as well."
Sommer, MD, MHS '73, emphasizes that the smallpox virus is not needed
for the development of new vaccines. Smallpox is caused by a virus
known as variola, but the smallpox vaccine is actually made from
a related but less virulent virus, vaccinia, that infects humans
To the human immune system, vaccinia looks a great deal like variola.
Immune cells can easily wipe out the milder vaccinia, and in the
process become primed to exterminate its tougher cousin variola.
Sommer adds that the existing smallpox vaccine, "which did,
after all, eradicate the disease," is perhaps one of the biggest
reasons he feels the debate should be swinging toward destruction.
"In the last couple of months, we have taken smallpox seriously,
which means that we will soon have enough doses [of the vaccine]
for everybody in the United States, and we will have a plan that
will allow us to rapidly distribute and administer vaccine in the
U.S. to everyone for whom it is safe to administer," Sommer
Although a weakened virus, vaccinia is a "live" vaccine,
which makes it highly effective at simulating an infection and provoking
an immune system response in healthy persons. People with weakened
immune systems, however, may be unable to prevent it from causing
a potentially life-threatening infection. The Bush administration
wants a vaccine safe for immunocompromised individuals before destroying
Sommer suggests that instead, researchers should be working on ways
to help them survive vaccinia, the disease they might get from the
smallpox vaccine. Or that public health officials develop "reverse-quarantine"
protocols so that those with weakened immune systems would not receive
the vaccine and would limit personal contacts during an outbreak
to those who have already been vaccinated.
In the ability to destroy the last remnants of smallpox, Sommer
sees a chance almost never given to science. "This is one of
the most dreaded diseases that mankind has ever faced. It has killed
hundreds of millions of people. And here we have an opportunity
to make it disappear forever as a cause of disease," Sommer