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COMMENTARY
Before
It's Too Late, Vaccinate Against Bioterror
By LOUIS WARREN
In the waning years of the Cold War, Russian scientists manufactured
tons of the most virulent strain of smallpox in preparation for germ warfare.
According to U.S. intelligence officials, some of this material is now in
terrorist hands.
U.S. authorities began responding to the threat several years ago, ordering
40 million doses of vaccine to complement the estimated 15 million that
remain in warehouses. But new vaccinations won't even be ready until 2004,
and there is no plan to administer them unless there is an outbreak.
How much of a threat is smallpox? The lessons of history are ominous. The
civilizations of this hemisphere, formed over thousands of years, were
destroyed by disease-causing organisms brought here by Europeans. How did
this happen? Indians and Eurasians were separated by oceans for at least 10,000
years. In that time, pathogens evolved in the more populous and more urban
Eurasian world that had no counterparts in the Americas. When Old World
diseases met New World peoples, epidemics were born. Because American Indians
had no immunities to these illnesses, they spread quickly, in what is known
as "virgin soil epidemics." The litany of death from virgin soil
epidemics is devastating. The Inca, Maya, Cherokee, Arikara, Mandan, Chumash
and hundreds of other peoples saw their populations plummet to one-quarter or
less of what they had been. Some peoples disappeared altogether. The
political impact was decisive. The Aztec armies numbered 100,000 in 1492.
They should have demolished the few hundred Spanish conquistadors who invaded
in the early 1500s with their Indian allies, whom the Aztecs had often
defeated before. But Spanish illnesses decimated the Aztecs and crushed the
spirit of the survivors.
The organisms that did this are well-known killers, including mumps, measles,
whooping cough, influenza, diphtheria and bubonic plague. But the greatest of
these was smallpox.
Smallpox is extremely contagious. It is carried on droplets in the victim's
breath and can kill 30% or more of its victims. In its most virulent form,
pustules multiply until the skin rips off the body. Modern science introduced
the smallpox vaccination two centuries ago. A worldwide inoculation campaign
eliminated the disease in the last third of the 20th century, and in the
United States doctors stopped administering the vaccine after 1972.
Today, a smallpox shot cannot be had for the asking. Each adult who was
inoculated as a child has a scar from it, usually on the left shoulder.
Although few of us realize it, that's our only token of this medical miracle.
The immunity conferred by the vaccine wears off after about 20 years, so
virtually the entire U.S. population of more than 280 million would be
susceptible. We must ask if the U.S. plan to respond to this threat--a
limited supply of vaccine to be dispensed in time of unprecedented
emergency--is wise or sufficient.
Smallpox can spread before symptoms, which begin with fever and aches, are
recognized. Even when the afflicted began to get sick, few doctors would be
able to diagnose this now-unfamiliar killer before thousands, perhaps
hundreds of thousands, were infected. Should it be sprayed from an aerosol
container aboard a plane or two, it could rapidly spread across the country.
Fifty-five million vaccines wouldn't go far.
Perhaps American strategists have good reasons for holding back. But a
preventive immunization campaign would be a much better idea. We have no
experience at responding to bioterror. But as the continuing absence of
measles, mumps and diphtheria shows, we are good at preventing epidemics
through immunization. Such campaigns are not nearly as difficult as guarding
skyscrapers from hijacked jetliners. They are easier and cheaper than
patrolling borders, detecting money laundering or finding fugitive
terrorists.
The attacks of Sept. 11 forced us to imagine the unimaginable. And
envisioning the horror that might be in our future, we should take heart in
remembering that to prevent it, we need only do again what we have done so
well in the past. Combating other bioterrors such as anthrax would involve a
mere extension of our capabilities for mass immunization.
Terrorists know that a smallpox epidemic won't stop at our borders. Their
people are at least as vulnerable as ours. It may be that spreading smallpox
hasn't been easy for terrorists to accomplish. We might even have time to
inoculate everybody before they can succeed.
*
Louis Warren is an associate professor of history at UC Davis.
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