By David Ruppe
Global Security Newswire
WASHINGTON — Although a handful of states are suspected by U.S. authorities of illicitly possessing stores of smallpox virus, the probability of a smallpox attack against the United States is low, a senior U.S. official said yesterday (see GSN, Nov. 5).
“I think we’re looking at it at this point as a low risk of it being used as a weapon,” D.A. Henderson, the Health and Human Services Department’s top science adviser for public health preparedness, said.
He also said the information the United States has on suspected smallpox stores in other countries is “simply not terribly good.”
That view is relevant to the Bush administration’s pending decision on whether to vaccinate the entire U.S. population, about 290 million people, which Henderson said could cause an estimated 300 to 400 deaths and possibly 1,400 serious illnesses from the side effects of the vaccine.
An alternative under consideration would be to vaccinate up to 500,000 medical and emergency response personnel (see GSN, Oct. 17).
Henderson’s view provides a counterpoint to a CIA assessment, reported by the Washington Post Tuesday, which concluded that Russia, France, North Korea and Iraq maintain undisclosed stocks of the virus. The story also said al-Qaeda terrorists had sought the virus but had not successfully acquired it.
Concerns about the perceived threat, the Post said, have strengthened the position of some in the administration pushing for vaccinating the U.S. population. There are others, however, who support the more limited vaccination strategy, leaving President George W. Bush to make the decision, the story said.
Differing Degrees of Certainty
Following a successful campaign to eradicate smallpox amid a global outbreak in the 1960s and 1970s, the World Health Organization requested that all stores of the virus around the world be destroyed or turned over to the organization for storage at only two sites, one each in Russia and the United States. By late 1983, all but those two countries had reported no longer possessing the virus.
Henderson has previously said he believes Iran and Iraq may have obtained samples when that outbreak passed through their respective countries.
In a briefing sponsored by the Chemical and Biological Arms Control Institute Tuesday, Henderson described as “probable” the possibility Russia was working on smallpox at one undeclared site.
“The Ministry of Defense production center, the principle center, at Sergiyev Posad, is still intact, it is a secret facility. What all may be going on in there is very difficult to find out and frankly very little is known about that, except it is still wholly intact,” he said.
He listed as “possible” illicit stores at a number of other sites.
“We’ve had rumors from Russia of several other sites where smallpox virus might be present,” he said.
He said there were “varying degrees of certainty or uncertainty” regarding suspected stocks in North Korea, Iraq and Iran.
“The information we have as to where smallpox might be present, is simply not terribly good, and it is very hard to ascertain this,” he said
The CIA report also rated the levels of confidence in the intelligence on suspected stocks from high with respect to Russia, to not as high for Iraq and France, to medium for North Korea, according to the Post.
A French Foreign Ministry spokesman yesterday said the country does not have any smallpox stocks (see GSN, Nov. 6).
With respect to France, Henderson said, “I can’t verify or endorse what was said in the Washington Post.”
He suggested French stocks of smallpox vaccine might have served as a source of confusion, just as Swiss vaccine stocks recently were misinterpreted as the smallpox virus.
“Certainly, this allegation with regard to France. I had no idea where that came from,” he said.
Henderson said the United Kingdom and the United States once also had trouble keeping track of their own stocks. After making their declarations to the WHO, he said, “one of our military laboratories, one of our state health department laboratories, several places in Britain, discovered after they’d thought they’d destroyed it that they hadn’t destroyed it.”
“So they went ahead and autoclaved it and told us afterwards, ‘Oops, we didn’t realize that we had it,’” he said.
By David McGlinchey
Global Security Newswire
All U.S. residents should probably be vaccinated if a terrorist attack spreads smallpox in the United States, the White House biological terrorism chief said yesterday, even though the vaccine might cause adverse affects in up to one-third of those immunized (see GSN, Oct. 18).
“There’s nothing else that one can really do at that point, other than make the vaccine available,” D.A. Henderson told Global Security Newswire.
Contracting the smallpox virus is much more dangerous and lethal than complications that arise from the vaccine, Henderson said. Nevertheless, no U.S. officials are supporting mandatory immunization because the vaccine carries serious implications as well, he said.
“If we were vaccinating a hundred million people, [there would be] a fair number of deaths and a fair number of people with serious enough complications to wind up in the hospital,” Henderson said during a seminar hosted by the Chemical and Biological Arms Control Institute. “There is no other vaccine which comes close to this in terms of severity of impact, and this is something that has to be recognized. This is not influenza vaccine or polio vaccine,” he added.
Significant Medical Risks
In the midst of a debate on how to protect the United States from smallpox terrorism, health officials have noted that people with a variety of medical conditions are at high risk of adverse side effects. Eczema, atopic dermatitis, pregnancy, and depressed immune systems are the primary ailments that increase the risk of adverse affects. Officials do not agree on how many people fall into this category — estimates range as high as 30 percent of the U.S. population — but most say that the number is far higher than it was 30 years ago, when the United States last immunized against smallpox.
“There are significantly more people at risk for adverse reactions to the smallpox vaccine than there were three decades ago when the program ended,” said analyst David Evans, of the Washington-area ANSER research firm, in a written reply to questions. “There is an increased number of people who are immune-suppressed. This includes people with AIDS, hepatitis B and C [and an] increased number of individuals who have had organ transplants and may be taking immune suppressing drugs.”
Eczema is also a much more common ailment for people who live in the United States, and medical experts are not sure why, Henderson said.
Those with suppressed immune systems — particularly those infected with HIV — might be in the most danger. Officials do not completely understand the effect of the vaccine on an HIV-positive person because HIV itself was not understood during the last wave of immunizations. If the vaccine was found to result in certain death for those with HIV, health officials would need to find another solution to protect that population, Furmanski said.
Some analysts noted that the smallpox virus might also wreak havoc in other parts of the world. There is no guarantee that a smallpox attack in the United States would respect international borders. The factors that the United States faces in dealing with an immune-suppressed population become “significantly worse” if the virus surfaces in Africa, Evans said.
“An outbreak of wild smallpox would devastate an unprotected HIV-positive population. One is appalled to think of what would happen in sub-Saharan Africa,” said independent researcher Martin Furmanski.
Weighing Consequences
Experts have generally agreed that in the face of a direct threat in the United States, the at-risk population would be better off taking their chances with the smallpox vaccine than with the virus. Many of the vaccine’s side effects do not require hospitalization, Evans said.
“In the event of a confirmed smallpox outbreak … everyone who was actually exposed to smallpox should be vaccinated, without any exclusions because the extreme threat of wild smallpox presents a much greater danger than that of the vaccinia virus,” said Furmanski.
It is unclear, however, when it would become imperative to immunize everyone.
“Suppose we got an outbreak in Washington, D.C.? What are you going to do in Minneapolis? Are you going to recommend that everybody be vaccinated?” Henderson asked.
“At this stage, we probably would say no, unless we felt that there was some greater risk,” he said.
Planning for Contingencies
The U.S. Centers for Disease Control in Atlanta is trying to ensure that warnings to those at risk would spread quickly and effectively if the need were to arise, but several experts noted that it is difficult to form a single plan when there are many reasons a person might be at risk from the vaccine.
“It is a fairly random group in some sense,” Evans said.
The primary focus of the strategy is informing people who have not been immunized of what steps to take, according to Lisa Rotz, a medical epidemiologist in the CDC’s bioterrorism preparedness and response program.
“Right now we don’t have any other proven alternatives [to the vaccine],” Rotz said.
In the case of an outbreak or a heightened threat, health officials would probably try to reach at-risk people through local public health officials and media outlets, Rotz said.
“There are certain things you might not want to do, getting on public transportation and sitting next to someone you don’t know,” she said. If a smallpox outbreak occurred, the disease would be spread by people who are unaware, she added, “someone who is coming down with symptoms but has had tickets to a sporting event for a while, and is going to go, no matter what.”
Scientists at the National Institute of Health are also developing a safer vaccine, continuing work that began years ago and was discontinued.
“Work was underway towards the end of the last inoculation. It just so happened that they got rid of smallpox,” Rotz said.
The chairman of the Fifth Review Conference of the Biological Weapons Convention — scheduled to begin next week in Geneva — plans to end the conference quickly without attempting to discuss a protocol to strengthen the treaty, a U.N. source said today (see GSN, Sept. 6).
Hungarian Ambassador Tibor Toth plans to introduce his proposal to end the conference quickly after it begins Monday, the U.N. source said. Toth’s proposal also calls for a new review conference timetable, with shorter meetings to be held every year instead of every five years (Agence France-Presse, Nov.7).
The BWC Fifth Review Conference was originally scheduled to run from Nov. 11 to Nov. 22 (Xinhua.net, Nov. 11).
For further information, see:
BWC Text and Associated Documents (U.S. Defense Department)
BWC States Parties (U.S. State Department)
Fifth Review Conference of BWC
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