After decades of denial, U.S. officials are apparently taking the threat of chemical or biological attack, especially with smallpox, seriously.
Physicians trained by the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) are giving educational seminars. Physicians in Jamestown, NY, were told of the critical importance of crowd control-by military personnel ordered to shoot to kill persons trying to evade decontamination procedures before entering an emergency facility.
The U.S. government is planning to stockpile 300 million doses of smallpox vaccine. After four hastily organized public forums, the 15-member Advisory Committee on Immunization Practices recommended on June 20 that 10,000 to 20,000 persons on special response teams be vaccinated, if they chose to be, but that vaccine not be made generally available. All smallpox vaccine is now the property of the federal government and is considered investigational.
Assuming that the risk of a bioterrorist attack is small, the risk of adverse vaccine reactions outweighs the benefit. Some estimate that 50% of vaccinees might suffer some adverse reaction. Severe reactions such as progressive vaccinia, eczema vaccinatum, and encephalitis occurred in about 1.2 per 1,000 vaccine recipients prior to 1977, most in children under the age of two. Experts believe such reactions would be more common today because more people have compromised immune systems due to infection with HIV or use of immunosuppressive drugs.
A ``primer'' vaccination called modified vaccinia Ankara (MVA) was tested in 150,000 persons in Germany in 1970 to ``help the body adjust before the real vaccine was administered.'' No serious adverse reactions occurred, but since the combination was not tested in an endemic area, efficacy has not been demonstrated (Science 2002;296:1594). Thus, many consider it to be unusable.
Events of concern include the revelation that Russia tested its own weaponized smallpox in 1971 in Aralsk, killing three (unvaccinated) patients and hospitalizing seven others. Homes were disinfected, hundreds were quarantined, and 50,000 doses of vaccine were given. There is some evidence that an especially virulent strain was involved. Of greatest portent, according to Al Zelicoff, M.D., Senior Scientist, Center for National Security and Arms Control, Sandia National Laboratories, is the first demonstration of aerosol dissemination of smallpox virus over distances greater than tens of meters. The apparent ``travel distance'' (15 km) exceeded any other airborne propagation of the virus by three orders of magnitude or more. The potential for thousands of index cases dramatically changes strategy, as noted by every modeler at the recent National Academy of Sciences meeting.
Dr. Zelicoff thinks we can do better than trust 200-year-old vaccine technology that has only short-term effectiveness (measured in years, at best), causes side effects in a substantial percentage of recipients, requires immobilizing large segments of the population in an outbreak with the attendant economic consequences, and might not work with a very large inhaled inoculum. There are several promising antiviral drugs, a possible animal model, and the prospect of a much improved vaccine (www.promedmail.org).
In his recently published book, Scourge: the Once and Future Threat of Smallpox, Jonathan Tucker discloses that Iraq had manufactured smallpox vaccine as late as 1989 and immunized troops with it. Moreover, Saddam Hussein instructed his germ warfare specialists to study camelpox, which rarely infects humans, possibly to refine production techniques and dissemination methods (Soldier of Fortune, March 2002).
Information sources: DDP member Jim Vanne of Aurora, IL, has a 92-page Word document with numerous internet links to news stories, sources of practical information, and suppliers of equipment. If you're on-line while reading it, you can instantly link to the references. Mr. Vanne will send you a copy on request (jvanne@cleanweb.net).
The Biothreat Analyzer is available from thinkworks-llc.com. Included are descriptions of protective equipment and suppliers; checklists of questions to ask in evaluating incidents or patients; concise information on various chemical agents, potential biowarfare agents, and drugs; and contact information, including telephone numbers and web sites, for additional help. If you enter a patient's symptoms, a list of potential diagnoses will be generated.
An index to bioterrorism resources is found on the AMA web site at www.ama-assn.org. Search on ``bioterrorism resources.''
The Dark Winter exercise-a fictional portrayal of a smallpox attack-is described and analyzed at www.hopkins-biodefense.org.
``Toxic and Biological Terrorism,'' based on a major textbook chapter by toxicologist John Sullivan, M.D., of the University of Arizona College of Medicine, a 62-page document with many useful tables, is available at the Pima County Medical Society web site, www.pimamedicalsociety.org.
The National Civil Defense Monument, years in the making, was recently dedicated in a ceremony at the National Emergency Training Center in Emmitsburg, MD. This project was completed mostly through the tireless efforts of John Bex. DDP is commemorated on a flag that is prominently displayed. We thank Mr. Bex and the many DDP members who contributed to this project to recognize the efforts of workers in this field.
A columnist for the San Francisco Chronicle called my attention to a different kind of memorial, a virtual museum, at www.civildefensemuseum.com, created by Eric Green. You can actually listen to the few remaining sirens and take a tour of various shelters. Our nation is much less equipped for survival now. The site refers the visitor to www.radmeters4u.com, a source of radiation meters that were salvaged and calibrated by Shane Connor when FEMA discarded them-without replacing them. Arizona (and possibly some other States) has retained the deteriorating calibration sources; Physicians for Civil Defense has supplied equipment to various fire departments and emergency response teams.
A guided tour of the U.S. Air Force Academy and Garden of the Gods has been scheduled for Friday morning, July 26, so as not to conflict with the meeting of The American Civil Defense Association (TACDA), which is also at the Sheraton Colorado Springs, on Friday afternoon. TACDA Speakers include General Oleg Kalugin, former head of KGB Counterintelligence; John Darrah, retired chief scientist with the Air Force Command; and war correspondent Charles Wiley, now with Accuracy in Media. Frank Williams will also speak on the history of TACDA.
A CD-ROM including audio and supplemental material from the 2000 and 2001 meetings will be available, thanks to the efforts of Jeremy Snavely and Steve Harris.
Featured viewgraphs include strategic defense by Lowell Wood; the sun-climate connection by Willie Soon; radiation hormesis by Myron Pollycove and T.D. Luckey; and energy follies by S.S. Penner. The text of a number of talks, including two by J. Gordon Edwards on insects and human health, is also included.
While audio and videotapes of past meetings are still available also, there is no substitute for hearing the prominent scientists who contribute to our program in person. Fly there, drive there, bus there, bike there, but be there!
DDP, 1601 N. Tucson Blvd. Suite 9, Tucson, AZ 85716, (520)325-2680, www.oism.org/ddp.