News & Politics > Special Report
Manufacturing Fear: The US Smallpox Plan
by Jeanne Lenzer & Tobiah Cole; Photos by Reuters

The American public has to be surprised at the resistance of some
hospitals and medical personnel to the smallpox vaccine
program recommended by President Bush. At Saint Cloud Hospital in Minnesota, only one-tenth of eligible workers agreed to take the vaccine. Over 80 hospitals have already refused to institute the vaccine program outright, including such large teaching hospitals as Children’s Hospital of Philadelphia and Grady Memorial Hospital in Atlanta.

us officials have painted a grim picture of a catastrophe if a widespread vaccine campaign isn’t instituted. They warn that Iraq and North Korea have smallpox. Smallpox has been presented as one the most dangerous biological agents. The war game “Dark Winter,” starring former-Senator Nunn as president, postulated that as many as one million people could die. Senator Max Cleland called bioterrorism “the most immediate threat to our country today.” Senator Joseph Biden said that bioterrorism dwarfs the threat posed by third world missiles. Former cia Director James Woolsey said that biological attacks are the most serious threat we face from weapons of mass destruction. The mass media has featured all these warnings and many more, without delving into conflicts of interest and biases of the sources.

President Bush said in December that there is no evidence of any increased or “imminent” threat from smallpox. Instead, he said, his administration was simply “evaluating old threats in a new light.” D.A. Henderson, principle advisor to the secretary for Health and Human Services for Public Health Preparedness, echoed Bush’s statement saying in a phone interview, “I receive almost daily intelligence briefings, and this is not a threat that we consider a high probability event.”

But Ken Alibek, a prominent source of us intelligence regarding the dangers of biowarfare, scoffs at Henderson’s assessment saying, “I do consider smallpox to be the biggest threat to the nation. When we say low or high probability, that means nothing. If somebody is doing work on smallpox, it is so secret, so classified…to say the probability is low is to say our knowledge is low.” Alibek adds that hospitals and health care workers who refuse the vaccine are making “a big mistake.”

Alibek is a man with extensive experience of his own. He began working in 1975 for Biopreparat—a state-owned pharmaceutical facility that served as a front for the ussr’s secret biowarfare program. He was able to move quickly through the ranks. By 1983 he was director of a biowarfare research and production facility in Stepnogorsk. Alibek became deputy director of Biopreparat in 1987, reportedly overseeing 30,000 people. In addition to what must have been considerable administrative work, Alibek was also the top scientist for the weapons program. In particular, he claims to have directed the research that produced a weaponized form of anthrax four times more efficient than the standard product. He received a Doctor of Sciences for this work in 1988.

After the Soviet breakup Alibek left Biopreparat and defected to the us. He has since risen to prominence in the us—especially after publication of his best-selling book Biohazard. Despite his constant warnings of the dangers of biological warfare, he has not abandoned the field. In fact, Alibek has moved up in the United States biodefense program quickly and easily; much as he did in the Soviet program. His past as a top Soviet producer of mass destruction weapons has not unduly hampered his American career.

Alibek is now a distinguished professor at George Mason University. He achieved this distinction by partnering his firm with the school to create a center for biodefense, at virtually no cost for the school.
Alibek is not a disinterested intellectual. He has aggressively sought to profit from the fears of biological warfare that he has helped to produce. His activities range from hawking nutriment supplements on numerous Web sites to obtaining multimillion-dollar contracts for a defense consulting company. He even has an audiotape that is sold by the right-wing magazine and Web site Newsmax.com. He is the head of Advanced Biosystems—a subsidiary of Hadron (now renamed Analex), a company with interesting political, military, and intelligence connections.

Alibek’s firm has received millions of dollars of government funds to research respiratory immune boosting. These would presumably protect against multiple biological agents. Although immune boosting could have general medical benefits, it is notable that Alibek’s research uses a nonlethal strain of anthrax and a virus related to smallpox.
Alibek has his critics, even within the biodefense establishment. Virologist Peter Jahrling of the us Army Medical Research Institute of Infectious Diseases calls Alibek’s promotion of immune boosting nutriment supplements “snake oil.” Jahrling is equally critical of Alibek’s funded research on immune boosting inhalers, calling it a great idea like cold fusion.

But internal controversies aside, business is booming in the biodefense field. Appropriations are now about five billion dollars per year; about four times the amount spent before 9/11. Grants are plentiful and people are hiring.

However, medical experts on contagious disease, who are not connected to biodefense, are a potential threat to the fear and doom atmosphere that has been so successfully engineered. These experts have their own interests that can be quite different from those of the biodefense business.

Why doctors and nurses aren’t rolling up their sleeves
Smallpox vaccination, in particular, is a real threat of its own to medical personnel and the people they treat. There are rare but severe complications caused by smallpox vaccine. Henderson says that between one and four people per million vaccinated will die as a result of the vaccination and another 40 people per million will suffer a life-threatening illness.

Smallpox vaccine, because it is a live virus, can sicken unvaccinated people who are in close contact with a vaccinated person. Those with impaired immune systems are at much greater risk. To avoid sickening and killing their patients, vaccinated medical personnel will have to be either quarantined for some time or wear patches over the injection site, a measure not proven to stop transmission. Even so, mass smallpox vaccination will have drastic complications on the immune depleted.
And it’s not just the flu-like syndrome that worries doctors and nurses. They are worried about such serious illnesses as encephalitis (inflammation of the brain), which leaves about one-quarter of its victims with permanent brain damage, bacterial infection in the blood which can cause kidney failure, and other serious side effects of the vaccine that require prolonged hospitalization.

Some experts warn that the numbers affected may be higher than in previous eras since so many more patients with immune problems are alive now. Patients at high risk from vaccine-related illness include asthma patients taking steroids, patients taking chemotherapy, diabetics, heavy drinkers and alcoholics, the very young, the very old, pregnant women, those with eczema and other skin conditions, and patients with hiv-aids.

Weighing the threat
Attempts to use smallpox as a weapon go back, at least, to infested blankets used as germ warfare against Native Americans. The development of an effective vaccine by Edward Jenner largely ended its consideration as a weapon until the Soviet Union reportedly made large quantities of smallpox for use in missiles and bombs. Their effectiveness as weapons is hypothetical. For that matter, nobody really knows whether such smallpox weapons exist even now.

Some medical experts have expressed considerable skepticism about the true danger of smallpox as a biological weapon even if it is used by terrorists. One of the more prominent experts is Thomas Mack, md, mph, professor of preventive medicine, Keck School of Medicine, University of Southern California, Los Angeles. “He [Alibek] isn’t saying anything new. We know smallpox is out there. But you have to distinguish between smallpox and weaponized smallpox. There’s really very little evidence, questionable evidence at that, that anyone has been able to weaponize smallpox.”

Smallpox is much more difficult to use as a weapon than is commonly acknowledged by the biodefense lobby. The virus dies readily unless the proper conditions are maintained. If smallpox was successfully grown, purified, and loaded into a bomb or missile, its storage life would be short and the dispersal of the product could easily kill it. Even if it survived dispersal, smallpox is stable only in cool, dry conditions and in the absence of sunlight.

Mack led teams that studied and controlled over 120 smallpox outbreaks, giving him perhaps more experience than any other researcher. He says the danger of smallpox as a weapon of mass destruction is exaggerated. “If you aerosolize smallpox, the half-life is one-half hour. Any high heat or humidification causes it to die faster.” Mack adds, “If you put it in a crop duster and you flew it over the Super Bowl maybe some people would get sick…but there still wouldn’t be many cases.”

Other scenarios are equally unlikely to succeed. Since 98 percent of patients have obvious and alarming signs of the disease, usually covering their face and body, they wouldn’t be able to get on a plane—one of the most common scenarios offered by alarmists.

If the worst happens—managing smallpox
Even if an outbreak is caused by a terrorist attack, the “first-generation”—the first people infected—can be tracked and their close contacts can be immunized, giving complete or partial protection even after exposure. This reduces the number of second-generation infections among contacts. Since it usually takes about three weeks to become ill, investigators have time to track and find contacts, even in an era of high mobility.

Generally, close contact or prolonged face-to-face exposure is required for transmission, making contact-tracking easier than many people realize. The transmission rate of smallpox is lower than measles or influenza. In addition, transmission almost always occurs during the period that the patient has the characteristic rash. It is for these reasons that smallpox containment works. Contacts of carriers can be located, vaccinated post-exposure, and isolated if needed. These same reasons mean that the postulated suicide transmission by terrorists would be very unlikely to inflict much damage. The bioterrorist would have a very short period of time to move around and infect people before becoming too sick and too obviously ill to continue. Close contact, after all, is required, not merely crossing paths.

While the risks of a possible attack are hypothetical, the risks of vaccination are definite. An unnecessary mass vaccination will kill many people: “If we tried to protect everyone against an initial generation of smallpox, then 800 to 900 people would be killed by the vaccine,” says Mack. “All we can do is make sure we are ready to do control.”

What it adds up to
The United States has sought to exert its political, economic, and military power on a global scale. Generally, military interventions have been justified to the public on the basis of the threat of conventional weapons held by proxies of the Soviet Union. For instance, while it was obvious that Grenada and Nicaragua posed no military threat, it was assumed the Soviets were the “real enemy.” With the collapse of the Soviet Union there is no country that poses a military threat to the United States using conventional weapons.

The threat of biological weapons has increasingly expanded to fill this ideological need for an enemy. The hypothetical and essentially unprovable nature of this threat well suits the purpose of justifying military intervention. Many medical people have chosen to exercise their own judgment about the threats they face rather than relying on biased experts. The rest of us should also think critically.