Amy Stewart

The smallpox eradication program in the mid-20th century is one of the few undeniable, complete successes that the World Health Organization can put under its belt. The last natural case of smallpox was a Somalian woman in 1977, and the WHO was able to declare smallpox officially eradicated in December 1979.

However, nothing is ever 100 percent certain. Two stockpiles of smallpox virus remain – one at Centers for Disease Control and Prevention in Atlanta and one stock at the State Research Center of Virology and Biotechnology (VECTOR) in Novosibirsk, Russian.

The WHO will by meeting Monay at the 67th World Health Assembly. One of the many health issues they will be discussing includes whether the risk of keeping these two stockpiles is outweighed by the benefits of being able to continue research on live smallpox viruses.

Every two years the WHO evaluates the two sites where live smallpox virus are still stored and researched to ensure that every possible precaution – from transporting research animals to cleaning researchers and equipment – is taken. These two facilities are the only places research on the live smallpox virus, including new vaccines, antiviral treatments and studying the mechanics of the pox diseases can happen.

The reason these two Cold War rivals still keep small amounts of the virus is because of “national security,” and continuing certain scientific research with the live virus in case some unknown entity ever decides to set loose this disease.

Despite how terrifying smallpox has been over the millennia, the variola virus that causes it does have some characteristics that made it easier to eradicate than other infectious diseases. First, by the time the virus is contagious, the person is most likely staying home anyway due to the high fever and later characteristic rash, making it easy to know exactly who should be vaccinated. Second, the virus has shown little of the genetic variability that can be problematic in developing a long-term vaccination program, which is one of the reasons the WHO concluded there was little reason for keeping live samples.

Finally, the WHO was able to organize a painstaking but ultimately successful bid to vaccinate every person who could ever possibly be at risk; as the number of cases decreased, so did the number of vaccinations necessary to control its spread.

The first generation of smallpox vaccines worked well, but had some very adverse side effects. A person is only considered healthy enough to safely take this vaccine if he or she has a good immune system, is not pregnant, has no heart conditions, no skin conditions (not even eczema or atopic dermatitis), and preferably older than 18 years of age. New vaccines now exist that are only necessary if a researcher works with smallpox or for some military personnel.

Even with the potential for new and better vaccinations and treatments, the WHO seems to be leaning towards destroying all live samples. The Advisory Group of Independent Experts who reviews all of the research done by the WHO’s advisory committee on variola virus, as well as what has been done by independent scientists, concluded in their report that there is no need to retain live variola virus stocks for new diagnostics, vaccines or antivirals.

Not everyone agrees with the WHO’s agreed-upon assessment, including researchers at the WHO and the CDC.

Two advisors to the WHO’s advisory committee, G. McFadden and C. R. Damaso, along with I. K. Damon, the Chief of Poxvirus and Rabies Branch of the CDC and Director of the WHO Collaborating Center for Smallpox and other Poxvirus Infections at the CDC, wrote an article in the open journal PLoS Pathogens that stated that “Despite significant advances, there is more work to be done before the international community can be confident that it possesses sufficient protection against any future smallpox threats.”

Their concern is that technological advancements have been made to improve the speed and accuracy of smallpox-like disease recognition and that the two antivirals moving toward FDA approval, tecovirimat and brincidofovir, should be further tested against cells infected with live virus so that they can be approved faster for emergency use.

Damon, Damaso, and McFadden also argued in their piece that better vaccines, safe for anyone in almost any health, may need live virus to be developed.

Despite the continuing national security and research arguments, the WHO has been moving toward decreasing the world’s live smallpox samples for a long time. If an unknown entity were to find smallpox and release it, the only realistic place would be from one of these high-level containment laboratories.

Our lack of 100 percent certainty of what our nation’s enemies possess in terms of bioweapons may keep us stubbornly holding on to a virus that should be firmly kept in the past.