Smallpox Threat - Fright Propaganda or Instinct of Self
Birger Schantz and
The threat of an outbreak of smallpox anywhere in the
world is indeed a frightening prospect. It's quite
obvious that even a very small terrorist organisation
could easily spread the disease globally without
technically advanced vectors - provided it had access to
the pathogenic virus. Furthermore, smallpox belongs to
the category of biological weapons of mass destruction.
It is extremely contagious and will easily spread outside
the area of conflict. Thus completely "innocent" or only
peripherally affected people can be stricken with
This is a severe, global threat against one and
As a Swedish citizen one must ask: can we handle an
attack even if we are affected only in the second-hand?
Have those who have been delegated the power created a
realistic preparedness against what may happen?
In 1980 smallpox was officially declared eradicated
following an internationally successful vaccination
campaign. Simultaneously the former - sometimes
compulsory - inoculation against smallpox was terminated
all over the world.
The smallpox virus, variola, was internationally saved
in two qualified high risk laboratories: the Center for
Disease Control and Prevention in Atlanta, Georgia and
the Russian State Centre for Research on Virology and
Biotechnology, Koltsovo, in the Novosibirsk region.
There are rumours that smallpox virus - intentionally
or unintentionally - has been released from one of the
two and that Iraq, for example, has had access to it.
In the present-day situation, it's fairly obvious that
the American preparations for war on Iraq are close to a
point of no return and that the risk of war must be
judged as very great.
The only clearly stated motive to begin a war against
Iraq are to prevent weapons of mass destruction from
getting into the wrong hands and perhaps be used on an
unprotected civilian populations, particularly in the
The American way of acting is characterised by a very
strong resolution to use unreserved force - war.
It's also very clear that the USA is taking the threat
from biological weapons of mass destruction, especially
smallpox, in earnest and, in parallel with the war
preparations, is planning protective measures against
this particular disease. This planning is extensive and
includes plans for the vaccination of key personnel and
military troops all within five days after a smallpox
outbreak. Detailed plans for all regions of the nation
have been submitted and quarantine measures have been
taken. Using old stores of vaccine, new purchases of 400
million doses, and research to minimise the untoward
inoculation side effects, have secured vaccine assets. In
addition, research has been initiated towards a cure of
the actual disease, a cure that is today non-existent
It's obvious that in the USA, many important
decision-makers find the risk of a global smallpox
epidemic impending and one of the main reason for finding
Iraq such a threat. It's possible that striking first and
rendering the weapons harmless will solve the problem.
Naturally, failure isn't part of this plan. Neither does
it seem to have been taken into consideration that an act
of war may provoke a counterattack using terror weapons
against a third party.
Another solution could be to abstain from open acts of
war, at least until a global defence system against the
actual weapon systems is in operation. There should be a
preparedness that will reasonably guarantee the survival
of the world population.
The fact is that if all nations were effectively
protected against smallpox, the motive to use this
particular weapon will be non-existent, as will the
motive to make war to destroy it.
If a despotic leader is convinced that his country
will be attacked in order to kill him, then certainly
there will be a risk that he'll use his weapons of mass
destruction before his opponent is ready to start the
There is also a risk that he'll chose to strike the
first blow against the opponent's sympathisers and
allies, which will probably be easier to hit and more
severely hurt than the main enemy with an effective
defence already in operation.
In plain language: a war in Iraq could involve the
risk of an attack on, for example, European
What weapons could then be used?
Nuclear weapons are difficult to hide and can only be
used with technically complicated weapon carriers to
reach far-away countries. Iraq probably does not have
access to such weapons today.
Likewise chemical weapons must have carriers and
technically complicated dispersing systems. To obtain an
adequately high concentration of e.g. a nerve gas to kill
more than a very limited number of people, it takes well
equipped military units or administration in semi-closed
places like department stores, underground railways etc.
It is difficult but not impossible to unveil preparations
for such operations. The probability, however, for that
type of terror attack is judged to be relatively
The use of biological weapons for the transmission of
infectious diseases remains the biggest risk. From the
terrorist's point of view only smallpox, by being highly
contagious and having a relatively high mortality, is an
effective weapon of mass destruction. Consequently, the
risk is high that not only the main enemy, but loyal
allies as well, will be struck with disease.
Human beings all have experiences with being ill, but
still find it difficult to understand what a smallpox
epidemic would really involve.
The cessation of general vaccination against smallpox
has made all young people vulnerable when exposed to the
The virus - when released - will spread by itself
without any help by sophisticated technical equipment.
The mortality is high - every third patient will die -
and the strain on the medical care organisation will be
enormous. No effective treatment, like antibiotics for
bacterial infections, exists.
Many experts judge the risk of a global spread with
mass cases and casualties to be very high. The
experiences from earlier epidemics make others claim that
the harmful effects can be limited, particularly if
strong quarantine measures and immediate mass
vaccinations are applied.
The smallpox virus can survive only in body fluids and
human secretions. It is transferred between people by
droplets of saliva and mucus from infected airways. That
makes it the perfect weapon for a suicidal agent. The
only thing required is someone prepared to sacrifice
oneself. Loaded with the virus, the agent then begins
globetrotting to come in contact with as many people as
possible. During the final seven days of the incubation
period he or she still has no or only slight symptoms but
is extremely contagious. Such an agent in an aircraft
could, with a high probability, infect the other
passengers by the air-conditioning system. They will then
spread the disease further on. If the agent is able to
withdraw before the disease becomes too severe, the world
won't understand what has happened until the huge
epidemic is a fact.
Within the medical world, tthere is still knowledge
about the disease, but very few doctors have personal
The defence against smallpox has mainly been
vaccination, stimulating the immune system of the body to
produce antibodies. Vaccination was compulsory in many
countries until 1976, but from then on all newborns of
the world were unprotected. It is common knowledge that
having smallpox and recovering or being vaccinated will
render the individual immune for a very long time. It is
now understood that this immunity is not lifelong but
will begin to deteriorate after about 20 years.
In humans it's possible to watch the virus develop by
symptoms that can be chronologically predicted with a
high level of accuracy. Mathematical models have been
constructed that can predict the development of an
outbreak with reasonable precision and also act as a
foundation for planning vaccine requirements and the
isolation and quarantine of cases of smallpox.
The fact that the disease can, and must, be prevented
gives the people the right to demand not only that
realistic and well-planned protective measures are
undertaken in ample time, but also to demand instructions
about individual actions and decisions to be taken in
case of an epidemic.
What can be done to increase instant preparedness?
Global mass vaccination with very short notice will
probably be very difficult or impossible. Firstly,
because time will not allow for more than inoculation of
certain key groups of personnel and secondly, because
there will not be enough vaccine available.
Almost all the vaccine doses available on the world
market have been bought by USA and UK except for small
amounts for national vaccine production programmes.
Extensive scientific research is trying to find an
effective antiviral medicine, but so far no preparations
Without effective treatment, old techniques of medical
care must be used. If the patient and those near to him
can be quickly isolated, the risk of further spread is
Therefore observations from a professional medical
staff will be vital to prevent the spread. High fever,
initial rash progressing to maculae and vesicles that
finally become encrusted are unmistakable signs. To gain
time everyone must know what actions to take.
Unfortunately, that applies not only to the medical staff
but also to borders and customs officers, security
officers, and the airline staff at the check-in desks.
They all must be aware what to do if a passenger who
shows signs of disease wants to get onboard.
The key words in case of an outbreak must be isolation
of the patient and quarantine for those who may have been
infected. It may sound simple, but is in fact very
complicated. It takes knowledge and careful planning of
what decisions to make and which coercive measures to
use. Another problem is the gigantic resources necessary
for medical care and induced quarantine measures.
Central authorities have probably planned all this in
detail. However, it is time to disperse ample parts not
only to the personnel groups in question, but also to the
-What are the quantities of vaccine available?
- If the supply is limited, who are the first to be
- If the supply is adequate, how will a mass
vaccination be carried out?
- How shall quarantine be arranged?
- How long will the incarceration last?
- What preparations have been made?
- If you are placed in quarantine on the suspicion of
being infected, won't incarceration virtually guarantee
that you will contract the disease?
- How will the public be informed of the first case of
- What will happen to the economy when all travel
- How will our grandchildren get the vaccine and be
The authors are of the definite opinion that all this
will be impossible to carry out when the first case is a
fact - in Sweden or elsewhere.
The well-intentioned strategy - to avoid panic by
saying nothing - is perhaps not too well thought-out. In
any case, the authors are not reassured.
Henderson, Donald A., T.V. Inglesby, J.G. Bartlett,
M.S. Ascher, E. Eitzen, P.B. Jahrling, J. Hauer, M.
Layton, J. McDade, M.T. Osterholm, T. O'Toole, G. Parker,
T. Perl, P.K. Russell, and K. Tonat, for the Working
Group on Civilian Biodefense. "Smallpox as a Biological
Weapon: Medical and Public Health Management," Journal of
the American Medical Association 281, No. 22 (June 9,
Smallpox as a biological weapon
Donald A. Henderson, MD, MPH; Thomas V. Inglesby, MD;
John G. Bartlett, MD; Michael S. Ascher, MD; Edward
Eitzen, MD, MPH; Peter B. Jahrling, PhD; Jerome Hauer,
MPH; Marcelle Layton, MD; Joseph McDade, PhD; Michael T.
Osterholm, PhD, MPH; Tara O'Toole, MD, MPH; Gerald
Parker, PhD, DVM; Trish Perl, MD, MSc; Philip K. Russell,
MD; Kevin Tonat, PhD; for the Working Group on Civilian
The Journal JAMA Vol. 281 No. 22 June 9, 1999
Alibek K., Biohazard. New York, NY: Random
House Inc; 1999
Infectious Diseases Journal
Center for Infectious Diseases
Centers for Disease
Control and Prevention
A ProMED-mail post
where you can see:
SMALLPOX VACCINATION STRATEGIES - USA (04)
SMALLPOX VACCINATION STRATEGIES - USA (05)
SMALLPOX VACCINATION STRATEGIES - USA (07)
SMALLPOX VIRUS, RETENTION OF STOCKS (02)
Born 10 June 1932 in Stockholm. 1962 VMD, 1974 Ph.
1979 Full Professor of Surgery at the Faculty of
Veterinary Medicine, Swedish University of Agricultural
Sciences, SLU, Uppsala. 1986 Director and Head of the
Division of Human Sciences, National Defence Research
Establishment, FOA, Stockholm.1993 Elected Member of the
Royal Swedish Academy of War Sciences. "Kungl.
Krigsvetenskapsakademien". 1994 Appointed Member of the
FOA Directorate as Research and Quality Director
particularly responsible for scientific quality. 1997
Retired from FOA on 31 May. Emeritus Professor of
Surgery, SLU. Henceforth engaged by Bo Rybeck Research
TFF & the authors 2002
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