Experts weigh in on smallpox preparedness

For a disease that was eradicated in 1980, smallpox attracts a lot of time, talk and resources. As of May 8, 1980, the only known presence of the virus was in U.S. and Russian government labs. But consistent rumors of renegade stocks or re-engineered viruses have kept defense experts alert.

The fear is of what a terrorist could do with smallpox. History shows each person with smallpox infected as many as 20 others. And the fatality rate was 30%. Released via aerosol in a large urban area, the disease could spread widely and rapidly. In anticipation of an attack, the U.S. has stockpiled 300 million vaccine doses--up from 15 million in 2001--but still wants more protection. Pursuit of another line of defense led to the government agreeing to pay Siga Technologies ($SIGA) $463 million for 2 million courses of Arestvyr, an antiviral. Arestvyr inhibits viral replication and could be given in conjunction with a smallpox vaccine.

However, as Siga ships the first 190,000 courses, some have said the government is buying too many doses at too high a price. The division between those for and against the deal is, in part, a consequence of differing degrees of confidence in the vaccination response. Some believe that, although the government has enough vaccines, panic would hinder the immunization program.

The other complicating factor, supporters of the Siga deal say, is that while the U.S. has enough vaccines to cover its population, there is a global shortfall. In the event of global attacks, some of the 300 million vaccines stockpiled by the U.S. government may go to helping other countries.

Dr. William Foege, a leader of the smallpox eradication effort and adviser to the Bill & Melinda Gates Foundation, is more optimistic. Foege told The New York Times that school teachers, police officers, firefighters and others could all administer vaccines in a mass immunization program. Each would need only 10 minutes of training as delivery of the smallpox vaccine is fairly simple.

No syringe is needed, just a two-pronged fork that pierces the skin after being dipped in vaccine.

"If we had to, we could vaccinate the entire country in three days," Foege said.

- read the NYT article