No change in smallpox disease

After ravaging humanity for three millennia, the virus behind smallpox is facing its comeuppance. In May, at a meeting of the World Health Organization, nations will decide if it's finally time to sterilize and incinerate into oblivion the known remaining samples of the virus.

Smallpox is sometimes described as the most devastating disease in human history, and the eradication of the disease — there has not been a naturally acquired case since 1977 — ranks as, arguably, the greatest modern public health achievement. But the path toward a destruction date has been tortuous. 

The debate over whether or not to destroy the samples being preserved by the United States and Russia began in the 1980s. It has centered on whether or not we already have enough information to prevent the virus from ever wreaking havoc again.


"If it's destroyed, the statement is made that after this date, any scientists, any lab, any country that has that smallpox virus is guilty of crimes against humanity," said Dr. DA Henderson, former director of the campaign to eradicate the disease and author of the book "Smallpox: Death of a Disease" (Prometheus Books, 2009).

In a few weeks, member states of the World Health Organization will consider the destruction of the last known samples of smallpox virus, currently held in secure labs by the United States and Russia. Some have sought to publicly frame this issue as a contentious disagreement between our two countries and the rest of the world over whether the virus should be destroyed. This is misleading.

We fully agree that these samples should — and eventually will — be destroyed. However, we also recognize that the timing of this destruction will determine whether we continue to live with the risk of the disease re-emerging through deliberate misuse of the virus by others.

Those who advocate immediate destruction would have us believe that another smallpox outbreak is unthinkable. They want us to believe that there is no need to ensure the global community is adequately prepared to deal with an outbreak and that the only risk comes from maintaining the highly secured samples. For these reasons, they argue that the World Health Assembly should set an immediate date for destruction.



It should not. Although keeping the samples may carry a miniscule risk, both the United States and Russia believe the dangers of destroying them now are far greater.

Smallpox was one of the most devastating diseases humanity has ever faced, killing more than 300 million people in the 20th century alone. The victims it didn’t kill were often left scarred and blind. But thanks to the most successful global vaccination campaign in history, the disease was completely eradicated by 1980.

At that time, the WHO called on all nations to destroy their collections of smallpox virus or transfer them to the WHO-sanctioned collections at one of two labs in Russia or the United States. The global public health community assumes that all nations acted in good faith; however, no one has ever attempted to verify or validate compliance with the WHO request.

It is quite possible that undisclosed or forgotten stocks exist. Also, 30 years after the disease was eradicated, the virus’ genomic information is available online and the technology now exists for someone with the right tools and the wrong intentions to create a new smallpox virus in a laboratory. Furthermore, there are additional pox viruses that infect humans, and while they are not likely to produce the same degree of suffering that smallpox historically inflicted, they could still be dangerous.

In other words, we’ve beaten smallpox once, but we must be ready and prepared to beat it again, if necessary.

Today, most of the world’s population has no immunity to the disease. Once it was eradicated, we stopped routine civilian vaccination for smallpox. In fact, people under the age of 30 have little or no immunity to smallpox. Should an outbreak occur, we do have effective vaccines that could be deployed to protect most Americans. But global supplies are limited and some people cannot safely use the current vaccine for medical reasons.

Fortunately, in the three decades since eradication, science has come a long way. The vaccine used until the 1970s was little different from the crude vaccine developed by Edward Jenner more than 200 years ago. Today, new technologies and advances in vaccine development exist that could allow us to produce a vaccine without the rare but dangerous side effects of the original. Globally, work is under way to develop and test these vaccines. We should not stop now.

Even with an improved vaccine, vaccination alone will not save those who have already been infected once an outbreak has begun. That is why we are also working on developing, testing and licensing effective new drugs to treat smallpox for those patients with the disease. Scientists in laboratories in a number of countries are making progress on these new antiviral drugs and alternative therapeutic agents that, in the event of a new smallpox outbreak, could control the disease’s progression and greatly reduce the risk of death.

We have more work to do before these safe and highly effective vaccines and antiviral treatments are fully developed and approved for use. Once they are ready, we intend to share the fruits of this research with the world. Destroying the virus now is merely a symbolic act that would slow our progress and could even stop it completely, leaving the world vulnerable.

Destruction of the last securely stored viruses is an irrevocable action that should occur only when the global community has eliminated the threat of smallpox once and for all. To do any less keeps future generations at risk from the re-emergence of one of the deadliest diseases humanity has ever known. Until this research is complete, we cannot afford to take that risk.

Destruction of the remaining virus also would eliminate the possibility of accidental release. There is precedent for this; in 1978 an accidental release in a British lab resulted in one death.  

Others, however, warn that labeling possession of the virus a crime against humanity will in no way deter terrorists, and that without the live smallpox virus, called variola, we won't be able to prepare for the worst.

"It would be very important to have something on the shelf that would help prevent or treat an epidemic, whether a virus was introduced by a terrorist or Mother Nature," said Dennis Hruby, chief scientific officer of the pharmaceutical company SIGA, which is developing a treatment for smallpox. It is possible for humans to catch other closely related pox viruses, and it's also possible that a smallpox-like virus could re-emerge from the remaining pox viruses, Hruby said. [7 Devastating Infectious Diseases]

The politics

The countries that own the two remaining stockpiles appear to be digging in their heels against setting a date for destroying them.

"The United States fully agrees that these samples should eventually be destroyed. However, we believe the timing of this destruction will determine whether we eliminate the potential threat posed by the virus or continue to live with the risk of re-emergence of the disease through deliberate misuse of the virus," Bill Hall, a spokesman for the U.S. Department of Health and Human Services' Office of Global Health Affairs, wrote in an email to LiveScience. "That is why we strongly believe the WHA [World Health Assembly] should recommend continued retention of the samples until the needed research is complete."

Media reports indicate Russia's chief health official, Gennady G. Onishchenko, has taken a similar position. “It would be premature and even harmful to dispose of these collections," Onishchenko said, according to the Russian news agency Interfax. 

The drive to destroy the samples has been led by African nations — those that would be least able to respond to an outbreak — and supported by Asian and Middle Eastern countries, according to Edward Hammond, a consultant for the Third World Network, a nongovernmental organization that advocates destruction.

"Theoretically everybody still agrees this should be done,” Hammond said. "The debate is over when it should be done. The truth is the U.S. and Russia are stalling."

World Health Organization delegates are scheduled to discuss this and other topics at the member nations’ annual assembly, May 16-24 in Switzerland.

End of a disease

Variola, which causes smallpox, belongs to a family of pox viruses that include camelpox, monkeypox, cowpox, buffalopox and others. The variola virus is faithful to its human host; other animals do not carry or spread it.

An infection causes flu-like symptoms, followed by the appearance of lesions. Roughly a third of those infected die. [How Smallpox Changed the World]

"Smallpox, it is about one of the most horrible things you can imagine," Henderson said. He saw cases for the last time in the spring of 1975 in Bangladesh. "What a horrible sight. These people looked miserable, they were sort of begging, but they couldn't drink the water if you gave it to them, and they had hideous lesions, and of course these hospitals were not screened and flies were all over… There was a distinctive odor that permeated. It's been described as the odor of rotting flesh, this horrible odor. You couldn't do anything for them, and they were reaching out for you."

In 1796, an English country doctor named Edward Jenner obtained pus from a lesion on the hand of a milkmaid infected with cowpox and used it to innoculate a young boy, protecting him from smallpox, a far more deadly disease. This was the first iteration of the smallpox vaccine. The version used to eradicate smallpox worldwide was based on a different, but closely related, pox virus called vaccinia, according to Jonathan Tucker, a biosecurity expert and author of "Scourge: The Once and Future Threat of Smallpox" (Atlantic Monthly Press, 2001).

A decade-long WHO global vaccination campaign to eradicate smallpox was successful; the last natural case occurred in October 1977, in Somalia. Destroying the virus is the natural end to the eradication campaign, according to Hammond.

"There is a moral and historical obligation to see the eradication through the end," he said.
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