Confronting smallpox

What is smallpox?

It’s a highly contagious virus that ravaged the world for generations, killing more than 300 million people in the 20th century alone. It kills about 30 percent of those it infects, and blinds or scars most survivors. As recently as the 1960s, more than 10 million people were stricken with smallpox every year, and several million of them died.

Wasn’t it eradicated?

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It was. The World Health Organization in 1967 spearheaded a global effort to wipe out smallpox through a massive and aggressive vaccination program. The WHO declared the program a success, and smallpox eradicated, in 1980. Every country in the world was supposed to destroy stocks of the virus or to turn them over to two repositories, one at the Centers for Disease Control (CDC) in Atlanta and the other at a Russian lab in Siberia. But intelligence agencies report that as many as 10 countries, including China, India, Pakistan, Iran, Iraq, Cuba, North Korea, Israel, and Yugoslavia, either possess or have tried to acquire the virus.

Can’t we just vaccinate everybody?

In theory, yes. The Bush administration wants drug companies to produce 300 million doses of vaccine—enough for every American—by next year. Doctors caution, however, that such a massive program would cost more than $500 million for the pills alone—and would have a human cost as well. About two people out of every 1 million who receive the vaccine die from side effects, meaning that national immunization would probably kill hundreds. That’s why most federal health officials oppose immunizing the entire population. For now, the point is moot: There isn’t enough vaccine to go around. The U.S. stockpile contains just 15.4 million doses. The CDC has said that in the event of an outbreak, anyone who might have been exposed would have to be vaccinated, whether or not they had a smallpox shot as a child. About 60 percent of the current population did get a smallpox shot prior to 1972, but the CDC says immunization wears off after about five years. Other doctors say the record of outbreaks a century ago indicates otherwise. Even after 50 years, they say, vaccination rendered most people immune.

Can the government

fight an outbreak?

It’s been done. In 1947, a man suffering from smallpox arrived in New York City from Mexico. Doctors did not recognize the disease at first. Then two other people in the hospital began showing the same symptoms, and the race to stop a smallpox outbreak was on. The patients were placed in isolation. Doctors then launched a program to immunize not just everyone who had come in contact with the patients but everyone in the city who had not been vaccinated recently. In little more than a month, more than 6 million people had gotten fresh shots. The quick response helped the city limit the damage to 12 cases, with two deaths.

Is smallpox worse

than anthrax?

In many ways it is. As a virus, smallpox is not treatable with antibiotics. And unlike anthrax victims, people infected with smallpox can transmit the disease to others. Smallpox usually spreads through face-to-face contact, traveling from one person to another via infected droplets of saliva. Scientists estimate that one person might pass on the disease to 10 others, and patients staying on separate hospital floors from an infected patient have been known to catch the virus. Even the clothes or bed linens of an infected person can carry the disease. British soldiers used smallpox as a biological weapon in the French and Indian Wars (1754–67) by giving American Indians blankets that had been used by people suffering from smallpox.

What are the symptoms?

The most striking one is the rash that gives the affliction its name. But other signs emerge first. For the first week or two after infection, the patient feels fine and is not contagious. Then the virus begins to overwhelm the immune defenses, and its host falls ill with fever, vomiting, headache, and stiffness. A rash appears a few days later in the form of spots, which typically break out first on the face, before spreading across the body. The spots develop into painful blisters. These turn into scabs. The patient remains contagious for days or even weeks, until the scabs fall off, typically leaving scars.

Can it be treated?

Yes, but only if it is caught right away. A dose of the vaccine can dramatically increase the chance of survival, but only if it comes within four days of infection. Once the outward symptoms show themselves, it is too late.

The man who saved the world