The scramble for the smallpox vaccine

Barely 25 years after a public health crusade eradicated the disease, scientists are gearing up to defeat it again. But should everyone get vaccinated?

By Arthur Allen

Nov 12, 2001 | For the first time in 30 years, young Americans are again baring their arms to be pricked with the 3-inch, two-pronged smallpox needle. The needle is dipped in a vial of liquid vaccine and the dose is trapped by capillary action between the tiny prongs, which are then gently pushed, 15 times, into the upper arm.

The new Americans, mostly university students, are taking part in a study this month to determine whether the 15 million existing U.S. vaccine doses can be stretched to make as many as 150 million. It's a gloomy experiment with an outdated vaccine.

"Who would ever have thought in our lifetime we'd be working on this again?" asks Dr. Carol Tacket, who heads the Baltimore wing of the trial at the University of Maryland's Center for Vaccine Development. "The conquest of smallpox was certainly the greatest achievement of public health. And to think that we're revisiting that so soon just gives this undertone of sadness to the whole undertaking."

Dr. Mary Guinan shares that sadness. In 1974, the freshly minted doctor headed off to Uttar Pradesh, India, to fight smallpox. "It was mind-blowing," she recalls. "You'd go to these unbelievable remote places in the mountains near Nepal. It was cold. There were no maps. There were no hotels, just mud huts. Smallpox was where civilization wasn't."

Guinan was part of a historic mission -- the purposeful elimination of a disease, and a truly horrific disease at that. "The amazing thing," says Guinan, now the state medical officer for Nevada, "was that you'd look at the reports every month, and the smallpox cases were going down. Pretty amazing. The idea that by design of man you could eradicate a disease from the world -- my God, was that exciting!"

In 1977 the very last case of smallpox was reported in Somalia, which had been the final wild refuge of the virus. By "design of man," smallpox had been defeated. But now, by design of man, it may return. If it does, it will return to the metropolis, the places young idealists like Guinan, a Brooklyn, N.Y., native, left behind in their crusade. Smallpox will return to where civilization is.

Of course, smallpox isn't back -- not yet, anyway. But we're getting ready for it. An enormous amount of money will be spent to chase this specter. President Bush set aside $509 million three weeks ago. Now, Health and Human Services Secretary Tommy Thompson says it may cost $2 billion to get a new dose of smallpox vaccine for every man, woman and child in America.

But should we vaccinate every American? Clearly, the public is anxious. Sen. Arlen Specter, R-Pa., demanded at a hearing last week to know why all Americans couldn't be "given the opportunity" to vaccinate their children against smallpox. Specter wanted his four grandchildren vaccinated "as soon as possible."

Perhaps the most chilling smallpox news of the last week came from a group of Russian germ-warfare scientists, who at a news conference in Moscow urged a return to worldwide vaccination in order to protect against the virus.

"All you need is a sick fanatic to get to a populated place," said Lev Sandakhchiev, head of Vektor Institute. Of course it was Sandakhchiev and the Vektor Institute who betrayed humanity by turning smallpox into a weapon in the 1980s. Many believe out-of-work scientists have taken that weapon to "rogue" states and possibly terrorists like Osama bin Laden.

Supposedly, only two stocks of smallpox exist -- at Vektor and in Building 15 at the CDC. But "if you only believe that two labs in the world have smallpox virus," says Michael Osterholm, an epidemiologist previously known as the boy who cried wolf of bioterrorism, "you also believe in Santa Claus and the Easter Bunny."

The good news is that the public health activists who battled smallpox are in powerful positions in the U.S. public health system now. They know how horrible smallpox is, but they also know how to whip it -- at least in most conceivable circumstances. D.A. Henderson of Johns Hopkins University, recently named to head Bush's Office of Preparedness, headed the smallpox eradication campaign. (Another scientist, William Foege, was the visionary behind it. Foege later headed the CDC, and most recently he was responsible for the Gates Foundation's $1 billion investment in global vaccine development and distribution.) Another veteran of the subcontinent smallpox campaign, Jeffrey Koplan, is the current CDC director. Another, Walter Orenstein, heads the CDC's immunization program.

And these veterans know that one key lesson from the smallpox era is: Don't vaccinate indiscriminately. Most experts think even a terrorist's smallpox attack could be contained by quarantining the sick and vaccinating those likely to be exposed to the virus. Very few of them are recommending a mass vaccination program -- yet.

Next Page: The last U.S. smallpox epidemic

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