Extension of Smallpox Vaccine License - Not a Big Deal Unless we Refocus our Attention

Wyeth, the makers of the Dryvax® vaccine, received extension for their eight lots of remaining vaccine.

Dryvax® is a smallpox vaccine. For all practical purposes, if you are old enough to have a small scar on your upper arm (or maybe your parents did), then you've received this vaccine. Problem is that we stopped vaccinating people in the United States in 1972 and then the last known case of (natural) smallpox was in Africa in 1977.

Smallpox vaccination resumed, shortly after 9/11, due to fears of biological attacks and the necessity to vaccinate military personnel and first responders. This resumption of vaccination was marked by significant adverse events, which have previously been known from the old days of vaccination and there was a recent report of secondary inoculation of a close contact. Of note, a new complication has been recognized with cases of pericarditis/myocarditis (inflammation of the heart).

Considering the fact that there is absolutely no naturally occuring smallpox in the world and there has been no "known" (at least known to the public) dissemination of smallpox to terrorist groups or rogue nations; then it is reasonable to avoid mass vaccination at this point in time.

However, I believe that the threat is still present and we do need to maintain preparation. And, thankfully, there are options. I will simply refer to Imvamune®, which is produced by Bavarian Nordic. This is an attenuated vaccinia virus (due to multiple serial passages) which does not replicate in humans. There is sufficient research to suggest that this vaccine is nearly as effective as the older smallpox vaccines and has even been tested in immunosuppressed patients and in HIV.

So, we have eight lots of Dryvax? Big deal, in my opinion. I haven't looked up yet to see how many doses are in 8 lots (and keep in mind that we would be diluting this further to give 1/2 or 1/4 doses to make this supply stretch). But, even with ring vaccination techniques, how are we supposed to control a mass release of Smallpox with this small amount of vaccine?

I think that people invision one dude out in the New York City trying to release smallpox to unwary passers by. And, if that were the case, then the proposed plans to do contact tracting (and see my prior post to see how well we are at doing that currently) and then ring vaccinate in order to contain a biological event. But that's absolute nonsense!!!

Check out Dark Winter. And then some peer-reviewed responses to this exercise: CID Paper (freely available) and Med Anthro paper (not free). This table top exercise looked at mass dissemination at three separate shopping malls in Oklahoma City. But these guys STILL don't get it.

OK, I'm not a psycho, but I just like to think about this stuff... a lot... it's kinda weird. So, if I was some evil terrorist, How whould I do this? Very simple, you do what nature has already done in massive pandemics in the past: You don't do something stupid like infecting one single area, thus making it easy for your enemy to at least try to contain your attack; NO. You release this stuff in 16 cities, simultaneously. You probably say, "that's crazy". Well, duhhh... it is crazy, but let's look at from the perspective of a military strategist:

What resources does our enemy have (assuming, in my opinion, a worst case scenario that we are dealing with an Al-Quaida type of enemy)

• Psycho, religious fanatics who believe that they will go to heaven and have a harem of virgins if they die fighting the United States, Israel, or their allies, thus the suicide bomber or suicide terrorist phenomenon
• Plenty of these zealots
• Plenty of money
• Plenty of time
• Plenty of determination
• Not a whole lot else

So, with just this limited resource, what has Al-Quaida already done?

1. With just 16 people (15 actually), destroyed an entire section of New York City thus taking down two of the largest buildings in the world and killing a few thousand innocent civilians as well as destroying a good portion of the headquarters for the most sophisticated military in all of human history. Oh, and one plane (so a 75% success rate) didn't make it's target to the capital and all of this happened in a just a couple hours.
2. There are many other "coordinated attack" such as bombings in Africa.
3. Multiple, too many to stomach actually the number, of suicide bombings in Israel and Iraq.

So, then, how do you estimate how this enemy might use a new weapon (Smallpox)?

1. Convince your followers that your God will protect you from any attack that you unleash on your enemy - I'm pretty sure this has already been done.
2. You recruit as many zealots as you can who are willing to die for their cause, in essence suicide bombers - I gaurantee that this is already done.
3. Brain wash these guys in the usual way that they do this sort of thing - really, that's about all the training that you would have to do for this plan... and, again, this is already done.
4. Set up cells in 16 major cities. (in the U.S.) I'm going to estimate 3 or 4 of these zealots per cell. Has already been done in the past, and is theorized that there are active cells around the world already.
5. OK, now for the ONLY hard part: Get some smallpox virus, probably just costs some money to pay off an unemployed Russian scientist, or convince Kim Jong Ill to give you some from the Korean stockpile.
6. Now, where the plan gets specific: Get one person with some knowledge of microbiology who is able to smuggle samples of of this to the cells - all he has to do then is inoculate these people. Very easy to do. And smuggling this would be easy as well since a sample of smallpox virus looks like "nothing", just some powder and there is NO TEST to detect this at any security station anywhere in the world (i.e. airports).
7. Give your suicide terrorists a few hundred dollars - easy for Al Quaida to come across.
8. Now, just let your infected suicide terrorists travel around to as many public places as they possibly can; ride as many mass-transit systems as possible. Instruct them to avoid going to a hospital for as long as they can. Instruct them to cough in peoples faces, spit on tables, anything to disseminate the virus as soon as they start getting sick.
9. Now, my friends, nature takes it's course...
10. I'm not sophisticated enough to model out how this sort of scenario would take place, but it scares me to death. Imagine the number of contacts that could be made after good 10 to 14 days of people spreading this intentionally before getting too sick to go any further, and then some good semaritan might be likely to find this person sick and physically take them to a hospital where there is a chance that an admitting physician is not bright enough to recognize smallpox and then let this spread into a hospital of (relatively) immunocomprised patients.
11. How do we trace contact all people who could have been exposed? how well did we just do with ONE guy who chose to do some international travel?
12. There are varying estimates to the number of other people that one contact can infect, but the estimates are ALL greater than one, which means that this naturally spreads into a population.
13. Natural Smallpox kills 33% of all people infected.

Just my 2 cents.