oberlin alumni magazine  
dancing with death (continued)

As improbable as it seemed at the beginning, these low-tech efforts obliterated the deadly disease. Records of the horror of smallpox epidemics exist in Hindu manuscripts 3,000 to 4,000 years old, and the disease has been etched into the history of every country and culture. In the 20th century alone, smallpox killed at least 300 million people and left tens of millions of survivors horribly scarred, disfigured, and grossly impaired.

New World Indians, with smallpox contracted from European settlers, ministered to by a medicine man: illustration, 16th century.

The eradication of smallpox was arguably the greatest triumph in medical history. Never before had the efforts of health workers led to the disappearance of any infectious disease, let alone a viral disease. Although viruses are relatively uncomplicated in structure, almost nothing else about them is simple. Most are little more than a string of genes surrounded by a protein overcoat. Some are also bounded by a fatty envelope. They are not cellular in structure and lack the ability to carry out an independent metabolism. Strictly speaking, viruses are not alive, although they share important attributes with living things. Viruses can infect living cells and reproduce before destroying the very cells they briefly called home. As they have genes, they can mutate and, in time, viral populations evolve.

Despite the simplicity of its structure, researchers know relatively few details about how the virus causes such gross pathology. Although there are vaccines to protect uninfected people from acquiring some viral infections, there are no medications capable of curing patients already infected. No viral disease--not hepatitis, polio, influenza, nor AIDS--has ever been cured by medicine. Smallpox, an illness with no known cure and caused by a deadly virus whose lethal mechanism is not well understood, was the first infectious disease to be wiped out.

Henderson directed the WHO Smallpox Eradication Unit from the beginning to the end of this incredible effort, hoping that he and his colleagues would live out their lives with the assurance that their accomplishment had been an unambiguous boon to humankind. Unfortunately, that was not to be.

After the pronouncement that smallpox was gone, WHO tackled the thorny issue of what to do with remaining smallpox virus stocks stored in laboratory freezers at sites around the world. WHO recommended the destruction of all stocks except for those in two places: the United States Center for Disease Control in Atlanta, and the Institute for Viral Preparations in Moscow. Research would continue at these two sites with the goals of finding the DNA chromosome in isolates of the virus and replicating the chromosome in a virus-free environment--in fact, genetic cloning. This would determine the exact sequence of DNA subunits in the chromosome, allowing scientists to study safely the genes of this killer without using an intact virus.

In 1972, even before smallpox had disappeared, the U.S. halted almost all smallpox vaccinations except for medical staff working with the virus and some military personnel. Today almost no Americans younger than 28 (more than 100 million people) have protection. For the rest of us, the question of vulnerability is not at all clear. The duration of smallpox vaccine protection has never been satisfactorily determined. It is likely that most people from around the world are vulnerable to its ravages if the disease ever reappears.

The final WHO recommendation was that on June 30, 1999, all remaining virus stocks be destroyed. The rationale made sense: it seems pointless to immunize people against a non-existent disease. Almost half the world population is unprotected, and a single case of smallpox anywhere would create a medical emergency of unparalleled urgency. According to WHO, the only possible sources of a new outbreak are the vials of virus stocks stored in freezers in Atlanta and Moscow. Destroying them would forever eliminate the risk of a laboratory accident that could trigger a tragedy.

Thus the uncomplicated recommendation of WHO was proposed as the next logical step, which would presumably be the last. Sadly, this is where the story turns ugly and where the interconnectedness of all things becomes manifest.

Unless we are truly a world gone mad, the assumptions underlying the WHO recommendations began with the idea that the eradication of smallpox was a magnificent boon for the common good of all people, regardless of nationality or allegiance. Another assumption was that scientists and governments and all specialists with relevant expertise would cooperate in ensuring that the disease would never again inflict its horror. It was unthinkable that any individual or group or government would abuse that tacit trust to further their own political or economic or ideological goals.