Bioscope '02

by Dr. Barbara Price

           If there is anything new in understanding biological warfare, it is that we still do not understand it. Whether it is the mechanisms of virus interactions with the host organism or how a vaccine works, this is an art, a science with many missing pieces in our understanding.
           Does the recently released report of an epidemic in the Aral region of the Soviet Union in 1971 really describe a more virulent form of small pox or is it just a report of an accidental epidemic started from an open-air test of small pox? (http://cns.miis.edu/pubs/week/pdf/020619.pdf) Even the experts are not sure. Virulence can vary with immune system, environment, vaccination history, just to name a few factors.
           But what is apparent is that the strategy we in 2002 would rely on, in open societies with freely moving populations, is that the time and conditions for arresting the epidemic would probably not be successful. It took 47 days to discover and two days to confirm smallpox in Aralysk: only a few days from when one patient was admitted to the hospital for an unrelated concussion and later broke out in a rash. Aralysk was quarantined and over a 16-day period, Sep 25 to Oct 10, the medical and police evacuated and evaluated 270 people who might have been exposed and isolated 104 people in a special field hospital.
           Over a 14-day period, 42,020 people in the city were vaccinated and 20 medical personnel were examining 20,000 people per day. Using these procedures, the public health officials in the Soviet Union were able to contain the epidemic and in fact only 9 people were confirmed to have smallpox. The officials were lucky to have had a patient treated for a concussion in a hospital, break out in a rash. That was 47 days after the first person had symptoms.
           Could we, in the US or other countries, repeat this success? Probably not. Civil liberties aside, a recent estimate notes that at least 25% of the population would be excluded from a mandatory vaccination because of the high risk of serious adverse effects. This includes people with AIDS, with eczema, with other immune compromised conditions and those that are likely to be in close contact with these people.
           Even though we are still looking for the people responsible for making and distributing anthrax contaminated mail and we are unsure of how we could vaccinate successfully so that we contain a smallpox outbreak, the interest of doctors in learning more seems to be flagging. A recent AMA report notes that fewer physicians are taking CME courses for training in public health and bioterrorism. Unfortunately, neither public health nor bioterrorism are short-term interests. Both take long-term commitments. But can our societies, used to the 6 second sound bite and in which more than 20% of the people do not know what a molecule is, make these commitments?