Before It’s Too Late, Vaccinate Against Bioterror
In the waning years of the Cold War, Russian scientists manufactured tons of the most virulent strain of smallpox in preparation for germ warfare. According to U.S. intelligence officials, some of this material is now in terrorist hands.
U.S. authorities began responding to the threat several years ago, ordering 40 million doses of vaccine to complement the estimated 15 million that remain in warehouses. But new vaccinations won’t even be ready until 2004, and there is no plan to administer them unless there is an outbreak.
How much of a threat is smallpox? The lessons of history are ominous. The civilizations of this hemisphere, formed over thousands of years, were destroyed by disease-causing organisms brought here by Europeans. How did this happen? Indians and Eurasians were separated by oceans for at least 10,000 years. In that time, pathogens evolved in the more populous and more urban Eurasian world that had no counterparts in the Americas. When Old World diseases met New World peoples, epidemics were born. Because American Indians had no immunities to these illnesses, they spread quickly, in what is known as “virgin soil epidemics.”
The litany of death from virgin soil epidemics is devastating. The Inca, Maya, Cherokee, Arikara, Mandan, Chumash and hundreds of other peoples saw their populations plummet to one-quarter or less of what they had been. Some peoples disappeared altogether. The political impact was decisive. The Aztec armies numbered 100,000 in 1492. They should have demolished the few hundred Spanish conquistadors who invaded in the early 1500s with their Indian allies, whom the Aztecs had often defeated before. But Spanish illnesses decimated the Aztecs and crushed the spirit of the survivors.
The organisms that did this are well-known killers, including mumps, measles, whooping cough, influenza, diphtheria and bubonic plague. But the greatest of these was smallpox.
Smallpox is extremely contagious. It is carried on droplets in the victim’s breath and can kill 30% or more of its victims. In its most virulent form, pustules multiply until the skin rips off the body. Modern science introduced the smallpox vaccination two centuries ago. A worldwide inoculation campaign eliminated the disease in the last third of the 20th century, and in the United States doctors stopped administering the vaccine after 1972.
Today, a smallpox shot cannot be had for the asking. Each adult who was inoculated as a child has a scar from it, usually on the left shoulder. Although few of us realize it, that’s our only token of this medical miracle. The immunity conferred by the vaccine wears off after about 20 years, so virtually the entire U.S. population of more than 280 million would be susceptible. We must ask if the U.S. plan to respond to this threat--a limited supply of vaccine to be dispensed in time of unprecedented emergency--is wise or sufficient.
Smallpox can spread before symptoms, which begin with fever and aches, are recognized. Even when the afflicted began to get sick, few doctors would be able to diagnose this now-unfamiliar killer before thousands, perhaps hundreds of thousands, were infected. Should it be sprayed from an aerosol container aboard a plane or two, it could rapidly spread across the country. Fifty-five million vaccines wouldn’t go far.
Perhaps American strategists have good reasons for holding back. But a preventive immunization campaign would be a much better idea. We have no experience at responding to bioterror. But as the continuing absence of measles, mumps and diphtheria shows, we are good at preventing epidemics through immunization. Such campaigns are not nearly as difficult as guarding skyscrapers from hijacked jetliners. They are easier and cheaper than patrolling borders, detecting money laundering or finding fugitive terrorists.
The attacks of Sept. 11 forced us to imagine the unimaginable. And envisioning the horror that might be in our future, we should take heart in remembering that to prevent it, we need only do again what we have done so well in the past. Combating other bioterrors such as anthrax would involve a mere extension of our capabilities for mass immunization.
Terrorists know that a smallpox epidemic won’t stop at our borders. Their people are at least as vulnerable as ours. It may be that spreading smallpox hasn’t been easy for terrorists to accomplish. We might even have time to inoculate everybody before they can succeed.
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Louis Warren is an associate professor of history at UC Davis.
