The Smallpox Threat: How Serious?

Mike Wallace Talks To The Expert

This past week Secretary of Health and Human Services Tommy Thompson began to make arrangements to have on hand enough smallpox vaccine for every man, woman and child in the United States. Although this highly contagious disease was eradicated from the face of the earth back in the 1970s, it now turns out that it could be making a reappearance in the hands of terrorists. The implications could be monstrous.

What can we do about it? How worried should we be? No one knows smallpox better than Dr. D.A. Henderson, who led the team that eradicated it 25 years ago. He is now the top advisor on bioterrorism for the Department of Health and Human Services. Mike Wallace reports.

Smallpox differs from anthrax in several ways, Henderson says. "I think it's less likely that we would have a smallpox release than we would an anthrax release. Anthrax is more available, it's easier to handle. But if we had a smallpox release, it could be really catastrophic."

Why? The smallpox vaccinations that older Americans received as children have worn off. In the 1960s and '70s, Dr. Henderson traveled the world, searching for every last case of the disease. He vaccinated anyone who could still contract it. By 1980, the world was declared free of smallpox, and the U.S. stopped vaccinating.

Henderson says that smallpox is "one of the worst diseases known to man. You feel perfectly well for about 10 days to 12 days after you are infected with the virus." Victims don’t know they have it.

"Then you develop a very high fever, aching pains, probably the worst influenza you can imagine. Most of the patients go to bed, they just feel so miserable. And then a rash begins. It's very painful." One in three victims dies, and the rest are scarred for life.

The disease is spread by coughing. The mist can remain suspended in the air for as much as 24 hours and then drift. According to Henderson, in 1970, a patient in Germany infected patients on three floors. "If it gets into this aerosol form, it can spread very widely and infect a lot of people."

That is why Russian scientists, during the 1980s, turned the smallpox virus into a biological weapon.

"They had a factory that could produce as much as 80 to 100 tons of smallpox virus in a year. And it was intended for use in intercontinental ballistic missiles which would be shot over, would come down, break up, and little melon sized containers containing the virus would then spin and open up and spread an aerosol of smallpox over a wide area."

The Soviet Union has collapsed, and many of those Russian scientists are out of work. There's concern that the smallpox sample, and the knowledge of how to use it as a weapon, may have spread beyond Russia's borders.

"What we don't know is, have the Russians or Russian scientists carried it to other countries. It would be easy to do," says Henderson.

Henderson says that he would not be “too surprised” if Iraq, for example, had turned smallpox nto a weapon. What about al Qaeda? “You have to be concerned about it,” he says.

Henderson says that even if Saddam Hussein didn't get the virus from the Russians, he could have gotten it from his own country during a smallpox outbreak in the region in the early 1970s.

"They isolated the virus," says Henderson. "We know that. They have indicated that they destroyed all their virus. Did they? I don't know. There's no way to confirm that."

How might an agent of bin Laden, or of Saddam Hussein, manage to spread smallpox in the United States?

“One would not spread smallpox through the mail,” says Henderson. “It does not spread that way. The way it would spread would be, probably like an aerosol, like a perfume atomizer. It'd be a puff of a spray and then it sort of vanishes into the air, you don't know it's there.”

What about someone willing to infect himself and walk down a crowded street, or through an airport?

"I think it's an improbable scenario," Henderson says. "I think people don't realize that first of all, smallpox does not spread until a rash begins. By the time the rash begins, I can assure you that terrorist is feeling absolutely miserable and his ability to even be mobile is very marginal. And it'd be very soon that the rash would be very noticeable and people would say, ‘What is that?’ And so I don't think it's a very likely scenario."

If an outbreak did occur, Henderson says that the first step would be to isolate those with the disease.

"We would then want to vaccinate the contacts of the patients and it may be that there are so many cases in a city that we may have to say, 'Alright, we'll vaccinate the entire city' and make it available to everyone."

Since smallpox is a virus, antibiotics like Cipro don't work. The only cure is to give the vaccine within a few days of exposure. That's what happened the last time smallpox was seen in New York City, in 1947. A man caught the disease in Mexico, came to New York, and infected 12 people. In response, though, New York vaccinated 6.5 million people.

Today, there are only between 7 and 15 million doses for the entire country.

That's why the Secretary of Health and Human Services, Tommy Thompson, this past week, made a startling request, reversing the government's long-standing insistence that the current vaccine plan was adequate. He said the government was considering buying 300 million doses of vaccine, at a cost of $500 million.

What led to that decision? “Realizing that we're now dealing with a group of terrorists, who are a fairly sophisticated group, led to the thought that we could have smallpox,” says Henderson. "I mean, this could be a reality."

Henderson says that if the U.S. does get 300 million doses of vaccine, it should not vaccinate. According to him, one in a thousand people actually wind up with complications of vaccination. He says vaccinations could cause deaths, especiallyin peopl with weakened immune systems: those undergoing chemotherapy and organ transplant patients, and those with AIDS. There is no need to take that risk, he says, until there is evidence of an outbreak. But the U.S. should have the vaccine ready if needed. Henderson calls it an "insurance policy."

Some high level officials, including Tom Ridge, who is now the chief of homeland security, have suggested that everyone should be vaccinated.

"I think there are some who have felt that it was a good idea to vaccinate everybody who maybe don't have a full appreciation of the complications and the trade-off of this," Henderson says. He says that he and Ridge are planning to get together to talk about the issue, "so he'd have a better understanding of it."

That's precisely the kind of scientific expertise, he says, that was lacking at highest levels of the previous administration.

"There (was) the feeling that, 'Well, bioweapons really haven't been used. It's very difficult to use. There must be some moral line that people would not cross.’ All of these have been arguments that people have advanced to say, 'We don't need to worry about bio-terrorism.'"

Henderson says that Secretary of Health Tommy Thompson, whom he is advising, is working hard to understand the scientific issues involved in fighting bioterrorism.

A few weeks ago, Thompson told Wallace that “We are safe. You're safe and my kids and my grandchild are safe.” He was criticized for this.

"I think there's a lot of panic," says Henderson. "There's a lot of anxiety, and I think his concern was of trying to calm a population, and this was not very successful because obviously the people sitting out in the states and the cities knew that they just were not prepared as they should be. It didn't resonate."

Is the U.S. prepared for a smallpox outbreak? "I would say at this point, we're in preparation of being prepared... of being fully prepared."

"When you look at what happened on the 11th of September, you realize you're dealing with some quite sophisticated people who have some really specific things in mind, and have a capability to do a lot of things that we wouldn't have thought they did. And the question we ask is, what's next?"

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