International Disease Monitor


September 1997

It was a hot afternoon. The sun was shining brightly on the summer crowds that thronged the pavements but inside, the room was pleasantly cool because of air conditioning and comfortably shaded thanks to half closed blinds. There were twenty four people assembled in the room when the doors were finally closed and the chairman brought the meeting to order.

‘Thank you for coming, ladies and gentlemen, I‘ve convened this special meeting of the Viral Pathogen Group to scotch a rumour I’ve been made aware of and to relay a report that has arrived on my desk from our colleagues at the United Nations Disease Monitor.

The facts of the matter are as follows. Two weeks ago a sick Iraqi soldier was picked up just inside Saudi Arabian territory by a routine desert patrol. His intentions were not clear in crossing the border but it seems he was being pursued from the Iraqi side so we can assume that he was seeking help or even asylum. He was too ill to give any information to the men who picked him up but one of these men who had special training in biological warfare recognised the possible dangers of the situation and sought expert advice by radio. The sick man was subsequently airlifted, along with the patrol to a hospital in Dhahran which had isolation facilities and where they were all put in quarantine. The immediate fear for the authorities was that the Iraqi had been subject to some biological or chemical warfare accident. One of the staff physicians, however, a man in his sixties thought he recognised the disease as being smallpox.’

A slight hubbub broke out in the room.

‘Quite so,’ conceded the chairman. ‘A full scale alert was declared.’

When specialist people arrived from CDC Atlanta along with a Niklasson team from Sweden it was determined that the disease was not in fact smallpox but an adverse reaction to vaccination against the disease. The man was in fact, suffering from disseminated vaccinia. He was one of these few extremely unfortunate people who cannot tolerate vaccinia virus- I can’t remember the exact incidence figure?

‘One in a hundred thousand,’ said a man half way down the right side of the table who spoke with a strong Swedish accent..

‘Thank you, Sven,’ said the chairman. ‘Of course, once it was established that it was not smallpox they were dealing with there was relief all round. The three or four day nightmare was suddenly over. Unfortunately the Iraqi himself died without being able to furnish us with any details of what exactly had happened. The patrol members who naturally had been worried about their own safety were released from quarantine and allowed to return to duty. But it was a very worrying time for all concerned.’

A murmur of agreement surfaced in the room.

‘In view of the rumour about an outbreak of smallpox, circulating in certain professional circles, both here and at the UN building, I thought I would put the record straight. I have also asked Dr Jacques Lang from the joint WHO/UN smallpox advisory group to join us today and give us an up-date on the world situation with regard to that disease.’

A tall man with a distinct stoop and dark unruly hair that he kept having to brush back from his forehead stood up and sorted his notes in front of him on the table. He took a sip of water before beginning.

‘Colleagues, as you know, there has been no case of smallpox occurring naturally on the planet since 1977 when the last case, a man in Somalia died from the disease. The WHO declared the world free from the disease some two years later. True, there was one more death after the Somali patient that but that was a case of the genie getting out of the bottle — or should I say, the test tube, in a laboratory accident in Birmingham, England.

I think we all learned something from that tragedy. It stood out as a tragic demonstration of the ability of the virus to get out of containment. Ever since that time, the storage of live smallpox virus has been strictly controlled. Currently it is only stored at two places on Earth, the Centers for Disease Control in Atlanta, Georgia, USA and the Russian State Research Centre of Virology and Biotechnology at Koltsovo in the Novosibirsk Region of the Russian Federation. Security at both establishments is of the highest order and containment facilities for the virus are as secure as man can make them.’

‘Even in Russia?’ asked a somewhat jaundiced American voice.

‘I appreciate your scepticism. Russian infrastructure leaves a lot to be desired these days but the Koltsovo institute is beyond reproach.’

‘So, if the virus is locked up safely at only two places on Earth and no one can get at it, why was the Iraqi soldier being vaccinated against the disease in the first place?’ asked one of the women present, a German lady in her late forties. The murmur in the room said that she had just asked the question many other people had been thinking.

Lang grimaced and said, ‘Frau Doctor Lehman has of course asked an intriguing question. Frankly, we don’t know. It may have been some routine procedure that no one ever got round to changing. That sort of thing often happens in a military environment where people are not encouraged to question things. Routine becomes tradition. Another puzzling thing is that the Iraqis have not yet acknowledged the defection of their man nor, I understand, the deaths of three more of their soldiers in the border incident that led to his escape.’

‘What exactly happened?’

‘I understand the sick man’s countrymen were intent on killing him when the border patrol intervened. I don’t have any more details,’ interjected the chairman.

‘Why would they want to kill a sick man if he was just suffering an adverse reaction to a routine vaccination?’

‘Maybe they didn’t know that’s what it was. Maybe they saw him go down with some awful disease and were frightened they might get it too so they took matters into their own hands.’

‘That’s possible if it was a local decision among border guards but if the order came from higher up maybe the Iraqis didn’t want anyone to know he’d been vaccinated.’

‘In that case we’d have to consider the possibility they’ve got their hands on the virus and intend using it as a weapon,’ said an American voice.

The German woman, Lehman, nodded vigorously at this.

‘That’s a bit of a leap, Hank,’ said the chairman.

‘I just don’t see how they could have got hold of it,’ said Lang. ‘There has been no breach of security at either of the holding establishments and there is no animal reservoir for the virus in the wild. It’s purely a disease of humans — that’s partly why we were so successful in wiping it out. That and the availability of such an efficient vaccine. I think we are worrying unnecessarily.’

‘Just for interest’s sake, how would smallpox rate as a biological weapon?’ asked an Asian man.

That’s really not my field,’ replied Lang. ‘But personally, I would find it almost too frightening to contemplate. Smallpox virus is one of the greatest killers the world has ever known. It’s been around for over two thousand years. It killed an Egyptian Pharaoh, several European crowned heads and countless millions of ordinary people before vaccination brought about its demise.’

‘Worse than anthrax?’

‘Just as deadly and more practical to use. Anthrax is an extremely effective killing agent but its difficult to protect your own forces against it and once you’ve used it it’s damned nearly impossible to get rid of. It lies around in the soil for decades. With smallpox you can protect your own people with a very efficient vaccine that is virtually free from side effects, kill the enemy and the virus will quickly die out again in the absence of a human host. It was generalised vaccination of the public that prevented them using smallpox as a weapon.’

‘But that was all stopped,’ said the German woman, provoking a long silence in the room.

‘Indeed it was,’ said the American man. ‘Vaccination against smallpox was stopped in the USA as long ago as 1971.’

‘Around the same time in the UK,’ added an English voice.

‘So two generations have grown up without protection against the virus,’ said the chairman.

‘But there is no virus to protect against,’ insisted Lang. ‘To all intents and purposes smallpox is extinct.’

The room fell to silence again. No one argued with Lang but there was no discernible agreement either. People were worried.

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