Small Pox Threat Exaggerated, Part II

An epidemic of smallpox hysteria has broken out -- again. Feeding the frenzy is the Bush administration’s recent announcement that the smallpox vaccine will be made available to the public.

The vaccine plan is prompted by fear of a biological attack from Iraq, which "could kill millions," according to an Associated Press report.

First, and as detailed last year in my column "Smallpox Attack Exaggerated," the claim that millions could die in a smallpox attack relies on a gross exaggeration of smallpox’s infectiousness.

Even when the annual global smallpox death toll was 2 million -- as recent as 30 years ago -- the disease was endemic to 31 countries, circumstances quite different from today’s more limited bioterror scenarios.

A threshold issue is whether Iraq even has smallpox.

"I have no doubt in my mind that Iraq does have the smallpox virus," says Dr. Ken Alibek, formerly of the Soviet bioweapons program and now with the George Mason University Center for Biodefense.

But former U.N. biological weapons inspector Jonathan Tucker says there is only inconclusive, circumstantial evidence that Iraq has smallpox, including: a 1994 find by U.N. inspectors of a freeze-dryer labeled "smallpox" in Arabic; an admission by Iraq it worked with camelpox, a relative of smallpox; and an intelligence report that some Iraqi soldiers captured during the Gulf War were vaccinated for smallpox.

This slight evidence may have convinced Dr. Alibek. But as part of the bioterror-defense industry that hardly misses an opportunity to promote the threat, Alibek’s may be convinced more easily.

The Bush administration’s top expert on smallpox, Dr. D.A. Henderson, leader of the successful global smallpox eradication effort 25 years ago, knows a bioterror attack with smallpox is unlikely.

Dr. Henderson was interviewed about smallpox last October by 60 Minutes anchor Mike Wallace: WALLACE: What about a so-called suicide bomber, someone willing to infect themselves and walk down a crowded street or through an airport?

Dr. Henderson: There are those who've suggested that we might have infected terrorists who might fly into the country, infected but looking perfectly well, and then developing the disease and walking all over and spreading it to people in trains or airplanes or what have you… I think it's an improbable scenario. I think people don't realize that first of all, smallpox does not spread until the rash begins. By the time the rash begins, I can assure you that terrorist is feeling absolutely miserable and his ability to even be mobile is very marginal. And it'd be very soon that the rash would be very noticeable and people would say, 'What is that?' And so I don't think it's a very likely scenario.

The Soviet Union weaponized smallpox in the 1980s and had a factory that could produce up to 100 tons of virus in a year. "It was intended for use in intercontinental ballistic missiles… which would…come down… and little melon-sized containers containing the virus would then… open up and spread an aerosol of smallpox over a wide area," Dr. Henderson told Wallace.

This certainly sounds scary. But there’s no evidence Iraq has such a delivery system and it definitely doesn’t have ICBMs.

Another scenario might involve a smaller-scale attack where aerosolized smallpox is released in a small area or a building ventilation system.

Such an attack presupposes Iraq has aerosolized smallpox. But we’re not even sure it has the plain virus.

Weighed against the slim chance of a smallpox attack is the certainty many among the public will develop health problems under a mass vaccination scenario.

"One in a thousand people actually wind up with complications [from] vaccination," said Dr. Henderson. Many could die, especially those with weakened immune systems, those undergoing chemotherapy, organ transplant patients and those with AIDS, he added.

There is no need to take that risk until we see evidence of an outbreak. But we should have the vaccine ready if needed, Dr. Henderson told 60 Minutes.

Fortunately, enough vaccine for a limited outbreak is currently available.

The American Academy of Pediatrics this week advised that unless there’s a high risk of a smallpox attack, it makes sense to vaccinate only if someone is infected, and then start with those closest to the infected patient.

This "search and contain" strategy was developed in 1968 and proved to be effective in helping eliminate smallpox in large nations without vaccinating the whole population.

In any event, mass vaccination for smallpox won’t be possible for at least another year. By that time -- if President Bush has his way -- we should learn whether Iraq ever had the capability of carrying out smallpox bioterror.

Steven Milloy is the publisher of , an adjunct scholar at the Cato Institute and the author of Junk Science Judo: Self-defense Against Health Scares and Scams (Cato Institute, 2001).

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