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The War Against Smallpox David W. Tschanz, MSPH, PhD

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Loose Ends

The eradication of smallpox was an unprecedented, perhaps unrepeatable accomplishment. But as in all successful wars unforeseen questions confronted the victors.

The battle against smallpox was won, but like prisoners of war, remnants of the once formidable viral armies remained, held in various laboratories throughout the world. The Birmingham episode galvanized opinion among world public health officials -- the real danger from smallpox no longer lays in nature, but in these stocks of variola virus still remaining in laboratories. Throughout the late 70s and early 80s WHO encouraged labs still harboring the virus to destroy their stocks of virus or ship them to either the CDC in Atlanta or the Research Institute of Viral Preparation in Moscow. Japan shipped its stock in 1978. In 1981 the last variola virus in the Netherlands was whisked, complete with motorcycle escort, to a plane for shipment to Atlanta. England followed suit in 1982. In 1983, South Africa, the last holdout, destroyed its virus amid a flurry of publicity.

The Birmingham episode still weighed heavy on the minds of many. Despite its confinement, smallpox is still lethal. A small error could introduce it into an unvaccinated population with unforeseeable results. While vaccine could be produced in mass quantities in short order, deaths in the dozens, hundreds or thousands would be the inevitable result of an escape.

What kept smallpox confined, rather than eliminated, all these years was an understandable reluctance to destroy what are the last remnants of a life form. Then in the late 1980's it became possible to map the entire virus' genome and to sequence the order of its 175,000 base pairs -- in effect creating a genetic blue print. With this advance the last remaining objection to eliminating variola vanished. The specter of the possibility of these remaining stocks escaping into the increasingly unvaccinated population of the world led WHO, the US and the former USSR, in December 1990, to decide that all remaining variola viruses would be destroyed.

WHO also suggested some further precautions. All laboratories that have ever experimented with the virus are being asked to search the contents of their freezers to make sure no overlooked vials remained tucked away in out of the way corners.

In Fall 1993 another meeting was held. Opinion in the world scientific community was bitterly divided between those in favor of destroying the remants and those for whom this is too final an act.

Opponents of elimination question the wisdom of destroying another life form. Their arguments are based on philosophical and ethical considerations and a deep concern that the irrevocability of the act has not been thought through. Possible dangers are dismissed as hysterical -- smallpox virus has been safely confined for nearly a generation without an accident. There is no rush.

On the opposite side are those who point to other facts. The smallpox virus, they argue, has no function beyond mere existence. No vaccine is derived from it. Variola's genetic structure has been mapped and sequenced. If necessary it could, with current technology, be recreated by any one in possession of the full blueprint. What smallpox is, they argue, is a proven killer. This is one genie that has been put back in the bottle and its time to toss the bottle away.

On June 30, 1999, after two earlier stays of execution, the remaining stocks of smallpox virus will be destroyed. This event, which will be simultaneously conducted at both the Centers for Disease Control & Prevention in Atlanta and at the Moscow Institute for Viral Preparation, is epochal.

The 500 remaining samples will be placed in a simple laboratory autoclave and subjected to 266 F for 45 minutes. When the cycle is completed, it will signal the execution of the greatest serial killer in the history of mankind. Smallpox will be gone. Forever.

Since it’s planned destruction in 1996, smallpox has received several stays of execution, the most recent in January 2002, when the World Health Organization (WHO) postponed the planned destruction of the world's last remaining stocks of smallpox virus to allow more research into vaccines against its possible use as a bioweapon.

In 2000, the UN body set 2002 as the deadline for getting rid of remaining stocks. But the deaths of five people from anthrax in the United States following the September 11 suicide plane attacks raised the specter of extremist political groups getting access to virulent biological agents such as the smallpox virus.

The World Health Assembly, the WHO's top decision-taking body, accepted a recommendation by the organization’s executive board, itself based on the findings of a special expert committee, that the remaining stocks be retained and that the issue be reviewed not later than 2005.

The only official stocks of variola virus, the smallpox agent, are held in the United States and Russia. The U.S. stocks are kept at the Centers for Disease Control (CDC) in Atlanta, Georgia, while the Russian stocks are at the Center for Research on Virology and Biotechnology, located in the Urals town of Koltsovo. WHO carries out biosafety inspections on the strict containment of the stocks.

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