Ghost of a flea

Smallpox worries

SMALLPOX WORRIES made me talk to my doctor about smallpox before the holiday. The recent barrage of smallpox media in connection to the February/March war to oust the fascist regime governing Iraq made me wonder what the likelihood of a smallpox event might be either as an act or war or as an instrument of terror. Furthermore, should smallpox be re-introduced, what risk would it pose to the general public or to my family, friends or me? This post by Glenn Reynold's was particularly troubling. I have been concerned about smallpox or genetically engineered "chimera" for some time. My doctor's first reaction was to ask why I was asking about smallpox. "Maybe I've read too much Tom Clancy." I first encountered the notion of a chimera virus combining the deadliness of a hemorrhagic disease such as ebola and the airborne communicability of the flu in Clancy's novel Rainbow Six (1998). Executive Orders (1996) was based on a terrrorist act which found a brutal echo in 9/11, an act so brutal it would have been dismissed as pure fantasy until it had been demonstrated. In fact, Clancy was the only public commentator on the day of 9/11 who had an immediate grasp of what had transpired and what the consequences of the day might be. There is no reason Clancy's imagination should be less prescient in the case of biological weapons. There is no reason a state entity run by a lunatic or a nongovernmental organization composed of lunatics could not re-introduce smallpox provided the minimum condition of access to the virus is met.

This is worth repeating: there is no reason an organization with access to smallpox could not release it. Dismissing the possibility as alarmist fantasy seems ludicrous after 9/11.

My reflection on the matter is a moot point. Despite the mass innoculation of the United States military - starting with the Commander in Chief - and the opportunity for American citizens to access the vaccine on a voluntary basis there is no comparable program anticipated for Canada. Five hundred health care workers are to be inoculated on a trial basis - for what purpose? - but there is no plan to safeguard the Canadian military from the threat let alone to allow Canadian citizens the choice of access to the vaccine. Five hundred Canadian health care workers is two orders of magnitude fewer than the 500,000 of their American health care counterparts to be inoculated.

There are a number of factors which complicate choices about smallpox either for governments or for individuals. Does smallpox exist outside the two official final repositories for the virus (yes... obviously)? If so, how difficult would it be to use smallpox as a weapon? Would a vaccine against naturally occurring smallpox be effective against a "weaponized" version? What resistance might old inoculations provide to people born before 1974 (in Canada) or 1972 (in the United States) before mass vaccination was halted? What risk is posed by the smallpox vaccine itself? How is this risk different for healthy adults in contrast with children, the elderly or those with compromised immune systems? Could people still be vaccinated effectively once an outbreak began? Finally, how worried should I be about smallpox as a disease?

My reaction to these questions is further complicated by some of my recent work. I taught the course "Collapse of Civilizations" at the University of Toronto last fall. I found it diffuicult to imagine the devastation brought about by the introduction of alien infectious diseases to the New World at the time of the Conquest. Some controversy surrounds the precise consequence of these diseases but it is clear that the effects of a disease such as smallpox on a non-resistant population can be horrific.

Calculations of risk inevitably involve personal experiences - such as teaching a course - which alter an individual's choice in contrast with their friends or neighbours let alone at the level of policy with effects on millions of people. I have been struck by the universal reaction among my friends against participating in the universal flu vaccination campaign undertaken by the government of Ontario. As a teacher, it struck me as sensible to do something simple to avoid getting one of the likely strains of flu or passing it on to my students. My friends, however, were suspicious of the government's intentions claiming the campaign was sinister and motivated more by a desire to save money (and this is bad because?) than by a concern for public health. I hope my friends do not find hospital emergency rooms crowded by anxious flu patients should they need emergency services for something more pressing and I hope their decision does not mean elderly flu victims die when they could have been saved. That said, I hope all my unvaccinated friends get the flu this winter.

Annoying conspiratorial logic regarding flu vaccinations is potentially catastrophic thinking in the face of a smallpox epidemic. Given the apocalyptic consequences of a deliberate release of smallpox as a weapon - and the likelihood the Iraqi state entity is in possession of weaponized smallpox - the actions of the United States government to make the the vaccine widely available appear to be sensible. "Once the Americans are immunized," my doctor said, "smallpox is no longer a problem." He meant that once the primary target for this potential biological weapon are rendered less vulnerable the likelihood of its being used is diminished greatly. I hope he is right. There is nothing the Canadian government is likely to do beyond crossing its fingers.

Posted by Ghost of a flea at January 2, 2003 06:00 PM

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