Should last remaining known smallpox virus die?
Tuesday, March 8, 2011; 9:41 PM
More than three decades after smallpox was eradicated, an international struggle has reemerged with new intensity about whether to destroy the only known specimens of the virus that causes one of humanity's worst scourges.
Some public health authorities, infectious-disease specialists and national security experts say the time has come to autoclave hundreds of vials of the pathogen held in two high-security government labs in the United States and Russia.
"We feel the world would be safer without having these stocks in existence. Why risk it escaping and resurging again?" said Lim Li Ching, a researcher at Third World Network, an international research and advocacy group based in Malaysia.
But the U.S. and Russian governments, which have repeatedly delayed incinerating the samples, are fighting for another stay of execution. Scientists need the living virus, they say, to make a better vaccine and finish developing the first treatments in case the deadly microbe is unleashed again - by accident, by a bioterrorist or by re-creating it from the computerized records of its DNA sequences.
"We still have work to do to protect the public," said Ali Khan of the Centers for Disease Control and Prevention in Atlanta, which guards one of the collections containing about 450 strains.
The debate will culminate in May, when the World Health Assembly, which governs the United Nations World Health Organization (WHO), will vote whether to condemn the virus to extinction.
Smallpox is caused by the variola virus. Victims suffer high fevers, wracking headaches and body pain, pus-filled skin ulcers, vomiting and bleeding. About one-third die. There is no approved treatment.
A WHO-sponsored campaign pushed the virus back to a single last natural case, which occurred in Somalia in 1977. The World Health Assembly officially declared smallpox eradicated in 1980.
Every laboratory except one in the United States and one in Russia subsequently agreed to destroy any samples they had, and the WHO set a deadline in 1990 for getting rid of the last two by 1993. But the United States balked in 1994 after revelations emerged that the former Soviet Union had worked to develop smallpox as a biological weapon. Since then, the United States and Russia have repeatedly postponed, citing concerns that others might be hiding the virus and the imperative to conduct more research.
Because of the successful eradication program, vaccination initiatives stopped worldwide, leaving most defenseless against the disease. In the United States, anyone born after 1967 is vulnerable.
After Sept. 11, 2001, the United States stockpiled enough vaccine to inoculate every American against smallpox. But AIDS patients, transplant recipients and others with weak immune systems cannot use it safely. Two new drugs appear to be effective but have not undergone sufficient testing to win Food and Drug Administration approval.
"We better have the countermeasures available to deter any attacks so the bad guys, whoever they might be, know we could defend well against a very deadly attack," said Kenneth W. Bernard, a national security and homeland security adviser to Presidents Bill Clinton and George W. Bush.
In a recent statement reported by the Russian news agency Interfax, Gennady G. Onishchenko, Russia's chief health official, echoed the U.S. position: "It would be premature and even harmful to dispose of these collections." The State Research Center of Virology and Biotechnology in Siberia, also known as the VECTOR Institute, has the other repository of about 120 strains.
But others argue that the existing vaccine is sufficient, two promising antiviral agents are in hand and the genetics of 49 strains of the virus have been catalogued, giving scientists whatever they need. The collections only leave open the possibility that the virus could escape accidentally or be smuggled out.
"There is no other disease that has come close to this through history in terms of killing people," said D.A. Henderson of the University of Pittsburgh Center for Biosecurity in Baltimore, who led the WHO eradication program and has been pushing for decades to destroy the stocks. "We have to worry about the threat that it still poses."
By holding on to the virus, "some countries might suspect that the U.S. and Russia have a hidden agenda, such as developing the virus for offensive purposes," said Jonathan B. Tucker, a biosecurity expert. "While I definitely do not believe that the U.S. is engaged in offensively oriented research with the smallpox virus, the resulting suspicions could prove politically corrosive."
A new vaccine and drugs can be evaluated without the virus, Henderson and others argue. In the meantime, the existing vaccine could snuff out any outbreaks, and the FDA could grant emergency authorization to use the two experimental drugs, Henderson said.
"If the stocks were to be destroyed and something is passed through the Security Council of the United Nations or the World Health Assembly that says anyone with smallpox virus would be charged with crimes against humanity, it would be a deterrent to anyone using it," Henderson said.
But others scoff at that suggestion.
"Do you think really that if al-Qaeda had smallpox, they wouldn't use it because it would be deemed by Western lawyers as a crime against humanity?" Bernard said.