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February 2004 - Updated December 2013

Contact: Stephen M. Apatow
Founder, Director of Research & Development
Humanitarian Resource Institute (UN:NGO:DESA)
Humanitarian University Consortium Graduate Studies
Center for Medicine, Veterinary Medicine & Law
Phone: 203-668-0282
Email: s.m.apatow@humanitarian.net
Internet: www.humanitarian.net

Url: www.H-II.org

In our hunt for weapons of mass destruction, it would be constructive to remember that one vial of a bioagent can result in the continental/intercontinental spread of cantagion. The impact of a bioterrorist incident presents the challenge of mass casualties, the closure of roads, airports and waterways causing interstate and international commerce to potentially grind to a halt as containment and control becomes the priority.


The agent is smallpox.  Prior to its eradication, smallpox afflicted up to 15 million people annually, of whom some two million died with millions more left disfigured and sometimes blind. Had smallpox not been eradicated, the past twenty years would have witnessed some 350 million new victims -- roughly the combined population of the USA and Mexico -- and an estimated 40 million deaths -- a figure equal to the entire population of Spain or South Africa. [1]

Eradication via vaccination led to a resolution by the Thirty-third World Health Assembly on the 8 May 1980 declaring that smallpox had been eradicated globally. [2]

Today, the threat of smallpox as a weapon of mass destruction [3] threatens a significant percentage of the global population. In the United States, approximately 25 percent (70 million) of the population would be excluded from smallpox vaccination due to risk factors that include eczema, immunodeficiency, or pregnancy, in themselves or in their close contacts. Extended to the global population base, approximately 1.5 billion would be at serious risk if smallpox spread worldwide due to a bioterrorist incident, in a scenario exponentially complicated since vaccination is the key variable for containment and control.

Kemper et al. did a "Back of the Envelope" presentation of possible risks associated with smallpox vaccination for the Effective Clinical Practice,  March/April 2002 issue for the American College of Physicians (ACP) journal [4]. They concluded:

The prevalence of eczema and the number of immunocompromised individuals have increased over the past 3 decades. High-risk populations would be excluded from vaccination, as would their potential contacts,  since recent vaccine recipients are "infectious" and can transmit the virus (vaccinia).

Individuals with eczema are at high risk for developing eczema vaccinatum. The prevalence of eczema is at least 10 percent, or more than 28 million people in the United States. Immunocompromised persons are at high risk for progressive vaccinia. We know of no overall estimate for the number of immunocompromised individuals in the United States. This number would include recipients of organ transplants (184 000 solid-organ transplants in the 1990s), individuals with diagnosed and undiagnosed HIV infection or AIDS (850 000), and patients with cancer (approximately 8.5 million).  We estimate, therefore, that in the entire U.S. population as many as 10 million individuals (3.6 percent) may be at increased risk for developing progressive vaccinia.

Therefore, approximately 15 percent of the population may have increased risk for a direct adverse event after smallpox vaccination. In addition to exclusion of these individuals from vaccination, persons in close contact with them should not be vaccinated to avoid inadvertent transmission and subsequent indirect adverse events. Close contacts would include, at minimum, household members. Insufficient data are available to estimate precisely the number of close contacts who would be excluded from a vaccination campaign. We estimate that another 10 percent of the population would be excluded. On the basis of the foregoing, we further estimate that 25 percent of the population would be excluded from vaccination because of high risk or the possibility of coming in contact with a high-risk individual."

Current threats involving the deliberate reintroduction of smallpox as an epidemic disease would be an international crime of unprecedented proportions, but it is now regarded as a possibility. [5]

Without intervention, each person infected with smallpox could infect between 10 and 20 others in a society that had not been immunized. Epidemiologists refer to this number as the "transmission rate" of an epidemic.

A transmission rate of 20 means the first 50 victims could infect 1,000 others, and these "second generation" cases could infect 20,000 more, who would infect 400,000, and so on. The sixth generation of such a mathematical progression would be 160 million and if such a hypothetical epidemic were to occur with smallpox, that number of cases would be reached in approximately 10 weeks after the first case appeared.

[See also: Smallpox Vaccination and the Patient with an Organ Transplant [6],  Smallpox Vaccination and the Patient with Congenital Or Acquired Immunodeficiency [7],  Smallpox Vaccination and the Patient with HIV/AIDS [8].


The rapid spread of West Nile Virus from New York City throughout the North American Continent [9] during a
period of three years demonstrates the threat of bioterrorism and actions needed to ensure international security (http://www.humanitarian.net/law/biodefense).

The article "Iraq and West Nile Virus: A Possible Connection," opens the following discussion [10]:

"According to newly publicized documents, the U.S. shipped a variety of dangerous viruses and pathogens to Iraq during the 1980s, including anthrax, the West Nile virus, botulinum toxin and the plague, among others. These announcements raise the possibility that the West Nile virus was artificially introduced into the United States by Iraq in 1999 in order to test Iraq's bioweapon capabilities and U.S. defenses. 

A Centers for Disease Control source told CDI the CDC is investigating the possibility that the appearance of West Nile was part of a coordinated plan to introduce biological weapons into the United States by Iraq. "We've been investigating that possibility pretty much since nine-eleven," he said. The source refused to provide his name, citing security concerns, as did other health communication experts contacted through the CDC public inquiry hotline, and added that he cannot speculate on any probabilities until further investigation is complete. A CDC media spokesperson denied these statements in a later interview, adding that the CIA briefly investigated this possibility in 1999."

According to the press release "West Nile Virus May Be New Deadly Strain, USGS Tells Congress" [11]:

"Recent crow die-offs suggest the West Nile virus which emerged in New York in late August could be more deadly to North American bird species than to species in Africa, the Middle East and Europe, where the virus is normally found, a USGS scientist reported today at a congressional field hearing held in Connecticut by the Senate Committee on Environment and Public Work."


A number of factors associated with the genomic sequence of the SARS coronavirus that would be of significance to co-circulation/recombination with strains of H3N2, H9N2.

These discussions are crucial of effective surveillance, containment and control of outbreaks associated with outbreak of highly pathogenic avian influenza in migratory birds.  Migratory bird patterns in the East Asian-Australasian Flyway [12] stretch from within the Arctic Circle in Siberia and western Alaska, through North and South East Asia to Australia and Aotearoa/New Zealand. It covers twenty countries including Russia, Japan, China, Taiwan, Korea, Malaysia, Thailand, Vietnam, Philippines, Indonesia, Mongolia, Alaska, Cambodia, Myanmar, Bangladesh, East Timor, Brunei, Singapore and Papua New Guinea, as well as Australia and Aotearoa/New Zealand. 

In December 2003, an appeal wa made to scientists on the WHO/OIE/FAO level to provide feedback on questions associated with the genomic analysis of the SARS Coronavirus and speculation that the strain could have been a product of genetic engineering [13]. 

The genes of SARS-CoV were compared with the corresponding genes of known coronaviruses of humans, pigs, cattle, dogs, cats, mice, rats, chickens, and turkeys. Each gene of SARS-CoV has only 70% or less identity with the corresponding gene of the known coronaviruses. Thus, SARS-CoV is only dis-tantly related to the known coronaviruses of humans and animals. Phylogenetic analysis suggests that SARS-CoV does not fit within any of the three groups that contain all other known
coronaviruses [14].

Could genetic engineering have contributed inadvertently to creating the SARS virus?  If the answer is yes, then accidental introduction or deliberate use of biological agents in food and agriculture [15] is an important viable association with appropriate action and containment of an existent threat.

If a rogue country is in possession of weapons of mass destruction, and the intelligence community has sufficient information that an imminent threat exists for a terrorist attack, can the United Nations and Security Council prevent an international incident via preemptive action? Jayantha Dhanapala, Under-Secretary-General for Disarmament Affairs, United Nations, in a speech given at American Bar Association, Spring Meeting 2002 [16] articulates:

"Perhaps the weakest area of the rule of law now concerns the issue of enforcement. It is a truism that international law lacks the police functions that are found in domestic legal systems -- it is instead a system that still relies largely upon self-help when it comes to enforcement. The ability of the UN Security Council to perform its enforcement responsibilities under the Charter is limited by its need to operate in consensus and by its practical inability to order enforcement actions -- especially involving the use of military force -- against one of its permanent members."


1. WHO, Smallpox Eradication -- A Global First: http://www.who.int/archives/who50/en/smallpox.htm
2. Forward, Smallpox and its eradication. F. Fenner, D.A. Henderson, I. Arita, Z. Jezek, I.D. Ladnyi - http://www.who.int/emc/diseases/smallpox/Smallpoxeradication.html
3. Stephen M. Apatow, Biological and Toxic Weapons Convention:  A Crucial Legal Instrument in the Global War Against Terrorism. http://www.humanitarian.net/law/nonproliferation1082002.html
4. Kemper et al. did a "Back of the Envelope" presentation of possible risks associated with smallpox vaccination for the Effective Clinical Practice,  March/April 2002 issue for the American College of Physicians (ACP) journal. http://www.acponline.org/journals/ecp/marapr02/kemper.htm
5. Centers for Disease Control, Smallpox Reference Materials. JAMA, Smallpox as a Biological Weapon: Medical and Public Health Management, Vol. 281 No. 22, June 9, 1999.
6. Smallpox Vaccination and the Patient with an Organ Transplant, Lesia K. Dropulic, MD and John G. Bartlett, MD.
7. Smallpox Vaccination and the Patient with Congenital Or Acquired Immunodeficiency, Jerry Winkelstein, MD, Howard Lederman, MD, PhD, and John G. Bartlett, MD. http://www.hopkins-biodefense.org/pages/resources/bartlett3.html
8. Smallpox Vaccination and the Patient with HIV/AIDS, John G. Bartlett, MD. http://www.hopkins-biodefense.org/pages/resources/bartlett.html
9. Iraq and West Nile Virus: A Possible Connection,  Center for Defense Information. http://www.cdi.org/terrorism/west-nile.cfm
10. West Nile Virus - Biodefense and Epidemiological Tracking. Humanitarian Resource Institute Emerging Infectious Disease Network. http://www.humanitarian.net/eidnet/wnv/wnv_biodefense.html
11. West Nile Virus May Be New Deadly Strain, USGS Tells Congress,  U.S. Department of the Interior, U.S. Geological Survey, December 14, 1999. http://www.usgs.gov/public/press/public_affairs/press_releases/pr1128m.html
12. East Asian-Australasian Flyway. http://www.abc.net.au/wing/community/learningflyinfo.htm
13. Bioinformatics: Pathobiological Diagnostics, Humanitarian Resource Institute. http://humanitarian.net/biodefense/bioinformatics
14. SARS coronavirus: a new challenge for prevention and therapy: Holmes, J. Clin. Invest. 111:1605–1609 (2003). 
doi:10.1172/JCI200318819. http://humanitarian.net/biodefense/bioinformatics/ref/sars_kvh.pdf
15. 2003 International Conference on Agricultural Science and Technology (ICAST).  http://www.humanitarian.net/biodefense/biosecurity/intlforum.html
16.  Jayantha Dhanapala, Under-Secretary-General for Disarmament Affairs, United Nations, in a speech given at American Bar Association, Spring Meeting 2002. http://www.lcnp.org/disarmament/Speeches/dhanapalasabaspeech.htm

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