On October 13, 1977, a government health worker in Somalia found a nomad family desperately ill. Among the victims were two children. The worker, not knowing what else to do with the family, put them in his Land Rover and took them to a hospital in Merka, south of Mogadishu. No one at the hospital knew what to do either, but a hospital cook, 23-year-old Ali Maow Maalin, did. He jumped in the Land Rover and drove the children off to an isolation center. Nine days later, Maalin came down with smallpox.
He survived, history's last naturally infected smallpox patient. Note the word "naturally."
In 1980, the World Health Organization, which had battled smallpox all over the world for decades, declared the disease eradicated, the first and only human disease to be totally eliminated. The virus, with the deceptively innocent name of variola, is extinct in nature. The only remaining virus stocks exist deeply frozen in two high-security laboratories, one at the Centers for Disease Control (CDC) in Atlanta, Georgia, the other at Vector, the Russian facility in Novosibirsk. We think.
If you think anthrax is a terrible threat as a biological warfare agent, you ain't seen nothing yet.
It is impossible to exaggerate the awfulness of smallpox or its place in history. It was one of the deadliest and most disfiguring of all human ailments. In some places, smallpox was 90 percent fatal. Death by smallpox was particularly horrible. Survivors could spend the rest of their lives with vision clouded or lost forever, with deep ugly scars across their bodies reminding them the time they spent in the shadow of death. Smallpox broke the siege of Mecca in 568 C.E.
Smallpox is the reason Queen Elizabeth I wore heavy white makeup and wigs. India has a goddess of smallpox, Sitala, so significant was the disease there. It was smallpox, not Cortes' army, that destroyed the Aztec Empire at Tenochitl‡n. He actually lost the battle, only to have the virus win the war for him. American settlers, though not completely clear on the science, took blankets that had covered smallpox patients and deliberately sent them to the Indians as gifts, hoping to infect them. It often worked, literally decimating entire tribes including the Mandan, Assiniboin, and Blackfeet.
No cure. A smallpox victim now would suffer almost the same fate as a victim in the 13th century, although antibiotics would treat some secondary infections, and modern medicine could make the patient more comfortable. The mortality rate would be about the same--30 percent for smallpox overall, but there are two forms that are 100 percent fatal. It will either kill you or it won't.
But smallpox itself was vulnerable. In 1796, the English physician Edward Jenner infected an eight-year-old boy, James Phipps, with material taken from cowpox sores on the hand of Sarah Nelmes, a milkmaid. Jenner had noted that milkmaids, who frequently caught an annoying but nonfatal disease from their cows, rarely caught smallpox. After Phipps recovered from the cowpox, Jenner deliberately infected him with smallpox. He was immune and lived to a ripe old age. Jenner had produced the world's first vaccine. The cowpox virus, called vaccinia, is a cousin to variola, and produces almost complete immunity from smallpox. Vaccinia mutated some time in the past, probably contaminated by variola. The vaccinia in smallpox vaccine is an unnatural hybrid. The disease also was vulnerable because it has no animal host. It infects only humans. Unlike polio, for instance, it can't hide in animals and return later to strike people.
Putting it bluntly, if anyone does use smallpox as a weapon, there is very little that can be done about it. The United States currently has enough vaccine stored away for 6-7 million doses and it would take as long as three years to build up stocks sufficiently to block an epidemic, which would be much too late. Only one company, Wyeth, currently makes vaccine for the military. Most Americans under the age of 30 have never been vaccinated, and those who have been vaccinated may no longer have total immunity. The effects of smallpox loose on an unvaccinated population are the stuff of nightmares.
The Invisible Fire is the only complete history of the eradication of this killer--and a strong hint of what would happen if it ever got loose again.
Joel N. Shurkin
HopkinsHealth
Johns Hopkins School of Medicine
Baltimore, Maryland