Smallpox: From eradication to weaponization

Courtney Byers

Sponsor: Wayne Hynes

04 December 2017
Smallpox: from eradication to weaponization Byers 2

I. Abstract

Smallpox is one of the most lethal diseases in the world today. This is because of its

fatality, and severity of its impacts. Smallpox was quite prevalent until early 1972s when it was

eradicated (Whitley, 2003). However, even after eradication, there are still some stored amounts

of the smallpox-causing virus. Bioterrorism has also been on the rise in modern terrorism,

making it more of a global threat. With the severity and fatality of smallpox, it could be a

potential biological agent to be used in bioterrorism. Therefore, it is essential to eradicate it as

soon as possible to avoid future attacks. Also, there are no active vaccines and medicine for this

disease. Therefore, it is necessary for scientists and biological and chemical experts to come

together and develop a drug that can heal smallpox, as well as a vaccine that can be used to

prevent it.

II. Introduction

Smallpox is a lethal disease. There have been no cases of smallpox outbreak recently.

This epidemic is much feared by people all over the world (Berche, 2001). This is because of its

fatality. It has a high mortality rate, and it also disfigures the infected people. It is also known to

cause blindness. Bioterrorism targets the use of such agents as the small-pox causing virus to

cause harm to people. This makes Variola virus a potential agent for bioterrorism. As such, this

paper will be looking at how possible this virus can be used for terrorism, and how the

responsible authorities can prevent this. The paper will show how smallpox developed and how

previous cases have been. The paper will also discuss smallpox as a bioterrorism tool. Also, it

will explain the methods that have previously been used to eradicate smallpox and how this

technique can be improved to make them more efficient.

Bioterrorism is the use of biological agents to cause harm to others (Berche, 2001).

Usually, terrorists can intentionally release biological substances to the atmosphere, with the
Smallpox: from eradication to weaponization Byers 3

intention of creating damage to others. Biological agents are dangerous once they are released

out into the environment. They cause illnesses which can sometimes lead to instant death or

prolonged and permanent health problems. An example of a biological agent is the virus that

causes smallpox.

Smallpox is a contagious disease that is caused by a virus referred to as Variola virus.

Smallpox is very deadly. Berche (2001) argued that it is important to eradicate smallpox because

of its high case-fatality rate. He further explained that unless somebody had been vaccinated four

days before the exposure, there is no antivirus for the Variola virus. This makes smallpox quite

dangerous for the society because of the lack of antivirus. Further, smallpox can be easily

transmitted from one person to another. Therefore, it is really important to keep smallpox

eradicated.

A biological agent causes smallpox; a virus called Variola virus. Smallpox has very

fatal and has a very high rate of transmitting ability. Because of this, smallpox poses a significant

threat to national security. Terrorists can release the smallpox virus with the intention of posing a

threat to public health, and to cause fear amongst people. According to Berche (2001), even

though smallpox was eradicated in 1980, there are still several cans of it stored in some

laboratory, under high security. Further, he stated that there is

probably more of it stored in North Korea, Iraq, and Russia,

for use by the military. The fact that it is there, and the fact

that it is very lethal, makes it a potential biological to be used

in a biological attack by terrorists.

III. Background

Figure 1: Ramses, an Egyptian ruler who has

noteable bumps on face and body.
Smallpox: from eradication to weaponization Byers 4

Smallpox is said to have originated from Egypt. The first condition was diagnosed around

10000-12000 years ago (Graeden et al. 2014). Research shows that some people from that era

had lesions and bumps on their skin. A good example was Ramses, shown in figure 1, who was a

ruler in Egypt around this time. His monuments and pictures show that he had bumps on his face

and his body, after which smallpox was named. In 1754 to around 1767, the Variola virus was

used as a biological weapon in the war between the French and Indians and the United States.

The virus was British soldiers gave the Indians some blankets which had been used by people

who had been infected with smallpox. Hence, it was transmitted to them.

During this era, the worst smallpox condition that was recorded is said to have killed

about thirty percent of the people exposed to the virus and left many disfigured. However, it is

said that the effects were more excellent in America. America did not have exposure to the

Variola virus until the arrival of Spanish and Portuguese conquistadors stated that smallpox and

other European diseases led to a

reduction of the Indigenous

American population by about

ninety percent.

Statistics show that in the

twentieth century, smallpox was

responsible for around three

hundred to five hundred million

deaths in America. Figure 2 shows

the dramatic number of global

smallpox cases from the 1920s to Figure 2: This graph represents the total reported cases between 1920
and 2010.
Smallpox: from eradication to weaponization Byers 5

eradication in the 1980s. In the 1950s, it was reported that more than 50 million of the annual

deaths were caused by smallpox. In the early 1960s, there was a smallpox outbreak in the Soviet

Union, followed by another outbreak in early 1970s in the same region. Currently, the virus is

being stored in two different laboratories under very high security. In the 1980s, the World

Health Organization ordered that the stock of these viruses b destroyed. However, researchers

advised otherwise arguing that the stock could be used for further research, towards coming up

with the best cure and vaccine for smallpox.

Smallpox is a lethal disease that is spread through various methods. Controlling the spread

of the disease is a vital element in minimizing casualty and promoting better health. There is no

defined treatment for smallpox. Hence, victims that contract the disease are more likely not to

survive the ideal. However, vaccination of the victims within 4-7 days of exposure has proven to

reduce the severity of the disease. In this regard, quarantine of victims has been used over time

as a control measure to minimize rate of the spread. Therefore, vaccination against smallpox is

the best action towards eradication of the disease.

In 1971, there was a smallpox outbreak in Aralsk. This was entirely unexpected because

the smallpox endemic had been eradicated from the Soviet Union in the 1930s. Another outbreak

had occurred a decade earlier, in 1961 in the same town. The Soviet Union health authorities

agreed to keep the attack a secret against the International agreement, which requires such

attacks to be reported to the World Health Organization. This mystery remained undiscovered

until the 1990s. It was reported that the attack was probably caused by the Soviet military

biological weapons testing of the Variola major virus which causes smallpox. It is also said that

Smallpox is caused by a virus known as Variola major, which is a DNA virus. It is

classified into Variola major and Variola minor viruses based on the severity of the infection that
Smallpox: from eradication to weaponization Byers 6

it can cause (Whitley, 2003). The virus is said to have an inversely proportional relationship with

the environment. Before its eradication period, it was more likely to survive in winter and spring,

where there are low temperature and humidity.

Smallpox infection starts after

someone is exposed to the virus. The

virus enters the body through the

respiratory system, through the skin, and

sometimes through the conjunctiva or

the placenta (Whitley, 2003). On

entering the body, it moves rapidly to

lymph nodes located in different regions

of the body. On the third day of the Figure 3: A patient that is infected with smallpox and has
developed the infectious rash.
fourth day after infection, asymptomatic

viremia occurs in the spleen, bone marrow, and other lymph nodes, with further dissemination of

the virus. On the eighth day of the twelfth day after infection, secondary viremia occurs, and at

this point, an onset fever and toxemia will occur. The virus then settles on the small blood cells

of the dermis, the mouth, and the throat. Hence a rash will appear in the mouth, the throat, and

the skin. At this stage, shown in figure 3, the victim becomes infectious. Other body parts which

are affected are the spleen, lymph nodes, kidneys, liver, and bone marrow.

Rashes appear in the mouth, throat and on the skin. Lesions also develop in the

epidermis, as the cells become swollen and vacuolated (Whitley, 2003). This could lead to the

bursting of the cell membranes. At this stage, characteristic B-type inclusion bodies can be found

in the cytoplasm. Fever is also a significant symptom of smallpox. Body aches, headache, chills,
Smallpox: from eradication to weaponization Byers 7

malaise, muscle aches, and particularly backache, may also be experienced. Can be difficult to

diagnosis sometimes and can easily misdiagnose due to other diseases have similar signs and

symptoms.

Smallpox cases in the United States were reported lastly in 1947. There were twelve

victims as a result of an outbreak in the New York City. There used to be vaccination operations

in the United States that ended in the year 1972. The vaccinations that were being carried out in

the military came to an end in 1990 (Whitley, 2003). Even though some evidence shows the

existence of residual immunity, it is worth noting that over the last thirty years, the immune

status of those vaccinated had not been satisfactorily established.

There are

several vaccines that

have been invented

since the first diagnosis

of smallpox till now.

Figure 4 shows

common smallpox

vaccines that have been

Figure 4: Common smallpox vaccines used during the process of eradication.
(Kennedy et al. 2009) used. More research on

the best vaccines for smallpox is going on, and we expect that more vaccines will be introduced

in future. First was the first generation vaccines, which were manufactured using the same

Variola virus which causes smallpox (Baciu, & Ebrary, 2005). Therefore, the vaccines were not

as effective. Second, came the second-generation vaccines which were manufactured using a

clonal virus that was purified from the first generation vaccine stock. Third was the third
 Smallpox: from eradication to weaponization Byers 8

generation vaccine, which is safer for use by human beings. Before being used on people, they

have tested on several cell culture animals. Also, they are manufactured in line with the general

manufacturing practices and using modern technology and techniques (Baciu, & ebrary 2005).

The safety of a vaccine is a critical aspect of administering vaccines and is a key

component in the immunization programs (Baciu, & ebrary, 2005). Vaccines are rigorously

tested and monitored under a strict safety research. The efficacy is analyzed and observed during

the process of vaccination testing, and the results from the test form the basis of the testing

process. The testing process lasts a lifetime of every vaccine that is tested.

Vaccines enable the body

to boost immunity to smallpox.

Figure 5 shows the process of

immunity when given a vaccine.

A vaccine is the only way that

human beings can protect

themselves from contracting the

disease. Smallpox vaccines are

Figure 5: The process of long-term immunity when given a vaccine. effective for a period of 3 to 5

years (Baciu, & Ebrary, 2005). After the vaccine is administered, the victim is commonly

expected to experience fever. However, minimal occurrences of death after vaccination have

been reported.

With the increase in the risk of terror, biological weapons have taken center stage.

Historical use and deployment of biological warfare have been the new common weapon among

terror group (Zelicoff, & Bellomo, 2006)s. In the 15th Century, Pizarro was reported to have
Smallpox: from eradication to weaponization Byers 9

issued South Americans with clothes that were contaminated with smallpox. The increased use

of smallpox as a biological weapon was evident in 1754 to 1767.

Smallpox vaccination in the United States was made possible by administration of the

vaccinia virus vaccines. The Advisory Committee on Immunization Matters only allows this

virus to be handled by lab technicians who are exposed to the virus that can infect them with

smallpox (Fong & Alibek, 2005). In this regard, regulations and policies were defined to monitor

the usage of the vaccines across the United States. As such, there are fewer cases of new

smallpox victims, Fong recommended that the vaccine is preserved. Lab personnel working with

orthodox viruses are prone to infection with smallpox; hence are supposed to be administered

with the vaccine.

The use of biological weapons in the war zone is an aspect that has been evident since the

1900s (Barras, & Greub, 2014). Biological weapons refer to the use of viruses, bacteria, and fungi

that when released to people cause fatal deaths and injuries. Bioterrorism is an act that is aimed

at causing massive harm to human beings by use of biological weapons.

Smallpox contaminated blankets were issued to the Indians as an act of terror. This

resulted in more than 50% mortality rate. In the 1970s, there were evident outbreaks, which

occurred in Germany (1970) and Yugoslavia (1972). Low doses of smallpox were released in

Germany, and this led to a widespread outbreak.

Biological agents are the substances used to cause harm to the human body. The use of

these agents has been common in modern terrorism and warfare. Examples of these agents are

viruses, bacteria, toxins, and Rickettsia (Barras, & Greub, 2014). Examples of bacteria are those

that cause anthrax, cholera, and malaria. Examples of viruses are those that cause hemorrhagic
Smallpox: from eradication to weaponization Byers 10

fever, viral hepatitis, and smallpox. Examples of toxins are Mycotoxins, Neurotoxin, and

Phytotoxin. Example of rickettsia is those that cause typhus, spotted fever, and query fever.

Quarantine is where people who have been exposed to a biological agent are separated

from other people, and their movement is restricted to a particular area so that they can be

observed on whether they will get sick (Khardori, 2006). On the other hand, isolation is where

the sick people are separated from those who are not sick so that they cannot infect those who are

not yet infected. Prevention is better than cure. Therefore, quarantine method is better than

isolation. This is because if people who have been exposed to a biological agent are confined

within a certain area, this prevents the spread of the virus to other people even before the

infection has occurred. On the other hand, isolation waits until the infection has been confirmed.

Therefore, before it has been diagnosed, there is a possibility that the infected people will have

spread the infection to other people.

PPE (Personal Protective Equipment) refers to the kind of protective clothing or kit that

people are required to wear while at work or when handling specific equipment (Khardori,

2006). This protective kit is meant to shield these people from risks to their health and safety.

For example, there are respiratory protective equipment and dermal protective equipment.

Respiratory protective equipment is used to prevent a person from inhaling hazardous

materials that may affect their breathing or respiratory system (Khardori, 2006). There are two

types of respiratory protective equipment. One is the respirators, which use filters to remove any

contaminants in the air within a given workstation. Two is the breathing apparatus which is used

to supply clean breathing air from an independent source. For people working is risky areas, it is

a requirement for them to wear these clothes at all times.

Smallpox: from eradication to weaponization Byers 11

Dermal protective equipment is used to protect a person from substances or equipment

that may be harmful to their skin (Khardori, 2006). That is, this equipment protects the wearer

from skin damage. Examples of this equipment are gloves, jackets, overalls, and boots. They

completely shield the skin from any exposure to hazardous material, and from injuries that may

be caused by machines.

Public health is an integral component of health care and promotion of health. In this

regard, the management and execution of health actions that promote better health are considered

as vital aspects of public health care and management (Parker et al., 2014). Policy formulation

and governance are of the essence as far as health is considered. Policies define the environment

and the realm of public health. Governance and policymakers are vital pillars that define laws

and regulations which affect the existence and efficacy of health programs (Parker et al., 2014).

In the existence of the law and policies governing legal implications, the issue of liability is

inevitable. Liability protection is paramount when addressing health. Hence, humanity needs to

be shielded from effects that might emanate from any vaccination vice. Otherwise, compensation

should be upheld for the victims (Khardori, 2006)

Biological weapons are lethal and destructive to the humanity. Smallpox has a severe

effect on the human body. The media shows that there is a possibility that some of the terror

groups could be contemplating using Smallpox as a bioweapon. From media reports, threats

from terrorists have been evident. In 2002, Tony Blair spent resources in promoting smallpox

vaccine as a countermove against a terror threat (Epstein, Cummings, & Chakravarty, 2004).

There is no medicine for smallpox. The vaccine is the only prevention available for the

disease. The virus is spread by air, touch, and sharing of tools such as razors and toothbrushes

(Epstein, Cummings, & Chakravarty, 2004). In this regard, prevention requires someone to stay
Smallpox: from eradication to weaponization Byers 12

away from contact with someone with smallpox. More so, smallpox victims are quarantined to

prevent the spread of the disease as it is highly contagious. Vaccination of smallpox within 4-7

days after exposure has proven to lessen the severity of the disease (Baciu, & Ebrary, 2005).

However, it is worth noting that this does not entirely prevent or cure the disease.

Biowatch is a program that was initiated by the United States federal government to

detect the release of hazardous biological and chemical agents in their cities and towns (Parker et

al. 2014). The centers for disease control and prevention offer a vital platform for the control and

testing of vaccinations. Monitoring vaccines during the development period are paramount to

any testing period (Parker et al., 2014).

Smallpox is a disease that cannot be treated (Baciu, & Ebrary, 2005). Or yet, the cure has

not yet been found. Hence, prevention is the only remedy against the disease. Hence, vaccination

has been used as the only preventive measure against smallpox.

There are no alternative treatments for smallpox. The vaccine is meant to prevent

contracting the disease. Hence, the condition has no cure after the victim contracts the disease.

Vaccination is the process of using the vaccinia virus to boost the humans body against

smallpox virus. In this regard, some people are prone to react to the vaccine. Vaccination against

smallpox is a remedy for the disease (Molina & Earn, 2015). It has no treatment; it is paramount

that the vaccination is administered to prevent any possible threat and spread of smallpox.

IV. Discussion/Conclusion

There is need to develop alternative treatments for smallpox. This is because, as lethal

as it is, it can pose a great threat to humanity. The ease of transmission and its ability to take so

many lives in a short while makes it necessary for the government to come up with disaster

management measures, such as a special first aid, that can be given to those who are exposed to

the virus, to prevent them from getting the disease. Also, it is imperative for the government to
Smallpox: from eradication to weaponization Byers 13

invest more in protective equipment, especially for those who are more likely to come into

contact with the virus, such as the military. Therefore, this paper shows that there are high

chances of the Variola virus to be used as a biological agent by terrorists. Therefore, the

government should seek to enhance its security by eradicating the virus by all means possible.

This way national security, as well as global security, is enhanced.

Smallpox: from eradication to weaponization Byers 14

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