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Post Magazine
This Week:
Clear and Present Danger
Hosted by Shannon Brownlee
Special to The Washington Post
Monday, Oct. 29, 2001; 1 p.m. EST
The medical community thought it had wiped out smallpox years ago, but could this ancient scourge, in enemy hands, come back to haunt the United States? "The probability of a smallpox attack is extremely low," says one expert. "But it is not zero."
Shannon Brownlee, whose article "What's Next?" appeared in Sunday's Washington Post Magazine, was online Monday, Oct. 29 at 1 p.m. EST, to field questions and comments about the article and about smallpox.
Brownlee is senior Markle fellow at the New America Foundation. She writes about healthcare, medicine and biotechnology.
A transcript follows.
Editor's Note: Washingtonpost.com moderators retain editorial control
over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Maynard, Mass.:
How likely is it that a terrorist would use smallpox in the coming months, given there will be enough of the vaccine within a year to start mass vaccinations?
Also, how long does the virus stay alive if used in a powder or aerosol? In the past, the virus was scattered on bedrolls and given to Native Americans -- could it be spread in a similar means today (on imported goods, for example)?
Shannon Brownlee: Nobody really knows how likely an attack with smallpox is, but given the fact that it would likely become a pandemic, or worldwide epidemic, experts have to assume the chances are very small.
The virus can live in the air on its own for several hours. It can also live for months when it is encapsulated in scabs from the pustules -- embedded in blankets, for instance. I don't know if that would be a way to spread it now.
Shrewsbury, N.J.:
A bioterrorist might first immunize his own people against smallpox, before launching an epidemic on another nation. How do we know that someone such as Saddam Hussein hasn't already immunized his country against smallpox? The argument that the disease could come back to infect the ones who spread it is a specious one.
Shannon Brownlee: We don’t know for sure that a rogue nation is not immunizing its citizens, but there are several ways to get hints. For example, if citizens from that country are found with fresh immunization scars, or if we find evidence they have been manufacturing the vaccine. Vaccinating an entire nation, however, is not an easy task. And you are going to get side effects, including deaths, including deaths, from large-scale vaccination. It is hard to imagine that all of Afghanistan could be vaccinated for smallpox without anybody knowing it. It’s perhaps less difficult to believe a totalitarian regime like Hussein’s might accomplish it. But the real answer is, we just don’t know.
Bethesda, Md.:
As a reporter myself, your article, while informative on one level, struck me as irresponsible and tabloid-ish. At the very least, far less than I would have expected of The Post.
Smallpox is an extraordinarily small threat. To plaster it across the front of a magazine plays on people's already jangled nerves and gets them to read to allay or feed their fears.
While I appreciate the effort you obviously put into the piece, it struck me as inappropriate. The only way smallpox is news right now is when the sales-hungry media makes it into news. It occurs to me that there is enough to report on right now without making up headlines on what MIGHT be.
Shannon Brownlee: Everybody is entitled to an opinion about what makes news, and I disagree strongly with yours. I started this story months ago, when smallpox was a very very small threat. It seemed worth doing then because the way this country was responding to that threat was an object lesson in how not to prepare for bioterrorism. That still holds, even after September 11.
My job isn’t to calm the public, or excite it. I’m supposed to inform people. Smallpox may be a small threat, but as Jonathan Tucker put it, the threat is not zero, and the consequences are devastating. Americans should know what is going on, and should have an opportunity to have a voice in how to respond.
Bethesda, Md.:
How soon will we be able to get a smallpox vaccine? Can domestic pets contract smallpox?
Shannon Brownlee: That’s going to be up to the Secretary of Health and Human Services, but my guess is you will probably not be able to get a smallpox vaccine even when the civilian stockpile has been built up. Nor would you necessarily want to get it. There is a small but very real risk of very serious side-effects from the vaccine – including death. Back when the disease was still out there, that risk was worth taking. Now, it may not be worth it unless we have clear evidence that someone intends to use it as a weapon. I have no idea if pets can get smallpox. I would guess not, unless your pet is a primate.
Rockville, Md.:
Dear Ms. Brownlee:
Thank you for your informative article. It was frightening, but necessary. You briefly address this, but I wanted to ask in any case. Isn't the ultimate deterrent to the use of smallpox as a weapon the fact that in a globalized world smallpox in any country could well mean smallpox in EVERY country (or nearly so)? It is hard to imagine any country or even group using this weapon knowing that the infection could and probably would ripple across the globe -- the U.S. might even be among the least hard hit because it has good medical care and some chance for vaccinations.
Thanks for your reply.
Shannon Brownlee: Thanks for your kind words about the story. I found it frightening to report and write. You are quite right, the possibility of a pandemic would seem to be a very strong deterrent to any nation using smallpox. I worry about it getting in the hands of a group that might welcome viral Armageddon. The only reassuring note in that scenario is that a small group would almost certainly be unable to produce it in large quantities, so any release would be small of more containable. The places that would be hardest hit, should smallpox be scattered around the globe, are those with the highest rates of HIV infection. But we would not get off scot-free if an epidemic were to escape control.
Damascus, Md.:
Eradicating a deadly disease like smallpox was a noble goal. The WHO has proposed efforts to eradicate other diseases. Given the ease with which bio-terrorists can then threat worldwide populations, doesn't this make the WHO efforts futile? Should we stop vacination for other diseases? Who figures the risk-benefit tradeoffs in this new world?
Shannon Brownlee: Well, you have just asked the $60 million question. The WHO is now pursuing eradication of polio. Some public health specialists have wondered whether that is still such a noble goal, given the potential for bioterrorism. I don’t think we stop, vaccinating; rather, the solution may be to continue vaccinating. But that is expensive and carries its own risk. A certain number of children contract polio each year from the vaccine itself.
Charlottesville, Va.:
In Slate magazine, one article reported on a smallpox outbreak in Ireland(?) which showed that the population had acquired immunity for 50 years since their immunization. I know that it would be difficult to comment on an article in another media but is it possible that those of us who were lucky enough to have the smallpox immunization before 1972 have some immunity?
Shannon Brownlee: I don't think anybody knows. Certainly, all the people I talked to said it was impossible to really know how long the vaccine might last. YOu get lifelong immunity from a couple of exposures, whether via vaccine or actual infection. But I can't answer your question beyond that.
Washington, D.C.:
Thanks for taking questions today.
The scenarios you've described in your article are simply terrifying to imagine. I've read that what is needed now is a research project along the lines of the Manhattan Project (I believe it was former Senator Sam Nunn who made that suggestion in the Wall Street Journal). It seems that the federal agencies are not coordinating very well, and the answer could be a large scale coordinated effort that would attract the very best scientists in the world. What are the chances of this occuring and do you think it could work?
Shannon Brownlee: I think three things are needed now: vaccine, a cure, and a better public health infrastructure. A Manhattan project could accomplish the first two, but not the last, and without a better public health system, we will be hard pressed to contain the disease if it were released.
Reston, Va.:
As a geographer with an emerging interest in mapping biological threats, I would be interested in knowing more about Dr Henderson's ideas about the "topography of infection as a road map to disaster." At them present time our maps of diseases are crude and not very current.
Shannon Brownlee: Gosh, that was a little poetic license, that bit about a roadmap to disaster. But I believe the WHO eradication effort did keep maps of outbreaks. I was trying to create a visual way of getting across the idea that the number of cases increases by an order of magnitude every two weeks -- and that kind pattern is very scary to epidemiologists. Flu is even worse. A single kid with measles can infect an entire room of unvaccinated people.
Arlington, Va.:
We always hear about great figures from history having had (and survived) smallpox. For instance, didn't several members of royal families get it? I thought Queen Elizabeth I had it. I've read several history books that talk about aristocrats who had faces disfigured by small pox. How did they survive?
Shannon Brownlee: Smallpox has, on average, a mortality rate of 30 percent. Turn that around, and it means 70 percent of people infected survive. Why does one person survive and another succumb? Nobody really knows for sure, but Dr. John Huggins, at the US Army Research Institute for Infectious Disease, believes that it depends upon how many virus particles the victim breathes in, how good his or her immune system is, and whether or not he or she is infected with any other diseases.
Annapolis, Md.:
Since smallpox is so highly contagious, if an individual is diagnosed with smallpox, would that individual have to be admitted into a hospital and placed in quarantine? Would the treatment course be measured in days? Weeks? Months? If an entire community is affected, would the government's reaction be one of sealing off the community?
Shannon Brownlee: Goodness, those are the tough questions. In the past, smallpox patients have been quarantined, either in their homes or in the hospital. There is an incubation period of about two weeks, when you have no symptoms -- and are not contagious. Then the disease lasts another two weeks after the onset of fever, nausea, chills, aching. I'm not exactly sure when the pustules heal, but I don't recall it being longer than a month after the onset of symptoms.
Falls Church, Va.:
I have heard from multiple sources who work in
various fire departments and hospitals that they
will be receiving small pox vaccines ASAP.
These are front line emergency folks who have
responded to the Anthrax threat. They have
been told to keep quiet and don't say anything for
fear of widespread panic. If they talk they
lose their jobs. Let's just say they work for
Northen Virginia's largest fire and police departments. Can you say
credible threat?
Shannon Brownlee: No, you cannot say credible threat. You can only say prudent precaution, and even then, I would not be too quick to believe that they really are about to be vaccinated. That said, a number of people in the bioterrorism community think that frontline personnel -- doctors and nurses, foremost, then emergency personnel -- should be vaccinated now, just to be prepared.
Washington, D.C.:
Your article (as well as other sources) indicates that recently vaccinated people can accidentally infect others with the vaccinia virus. Why not take advantage of this ability to infect others by INTENTIONALLY harvesting the virus from recently vaccinated people and using it to vaccinate others? (The people from whom the virus was harvested could be screened for other diseases the same way blood donors are screened to ensure they didn't also pass on other diseases.) If each volunteer passed the vaccinia virus on to 20 others, we'd have plenty of vaccine for everyone in the U.S.
Shannon Brownlee: Eww. interesting idea, but I imagine the yuck factor is pretty high. I don't think I want vaccinia virus from another person. In the past, as in before the invention of vaccination, many societies practiced "variolation," passing smallpox from the scab of one person to a scratch in the skin of another. A lot of people died, but fewer than if they had breathed the virus. For some reason, getting the virus via the skin allows the body to mount a defense against it. I'm not sure that "vaccinia-ation" would result in resistance to smallpox, but maybe it would. I think I'd rather wait for the cell-culture vaccine.
Washington, D.C.:
I think the "sensible" terrorist would avoid using smallpox for a number of reasons, some of which you mentioned in your article, but most importantly because they are already seeing enormously disproportionate "bang for their buck" from the current anthrax situation.
There are other diseases that are much easier to obtain, cultivate and disseminate than smallpox. I personally have just waged a fictional bioterrorist attack on Washington D.C. using a drug-resistant strain of p.falcipirum malaria. The disease is easy enough to obtain from a tissue sample of an infected person in Thailand. It can be cultivtaed with high-school biology lab equipment. The anopholes mosquito is still fairly common and easily bred. I learned enough doing research for the novel that I could pull it off with relative ease. Our leaders need to think a little more creatively if we hope to thwart bioterrorism.
Shannon Brownlee: No kidding, they are getting a very big bang for their buck with some pretty low-tech dissemination of anthrax. A better public health infrastructure and better intelligence are desperatelh needed no matter what organism bioterrorists might use. So, what's the title of your novel?
Bethesda, Md.:
In your opinion, were the top experts on smallpox sufficiently aggressive, during the past 5-10 years, in pressing government officials to create, quickly, a large stockpile of smallpox vaccine?
Shannon Brownlee: If you are asking did they try hard enough, I think they beat their heads against the wall of bureaucracy in Washington. You have to realize that ten years ago, people from public health had no standing when the discussion turned to defense. Only recently have defense experts been able to make the conceptual shift from nuclear and chemical to biological, and to understand how completely different the response to a biological threat must be. It's not that people in Washington are stupid. It's that biological is unfamiliar territory for most defense and intelligence experts. And we have lived with the nuclear threat for half a century, and it is difficult to dislodge ways of thinking and doing that are so deeply engrained in the cultures of the various bureacracies.
Falls Church, Va.:
Thanks for the informative piece yesterday. I read some of the "Dark Winter" material on the Hopkins Web site and found that even though this was an EXERCISE, using smallpox as a worst case scenario, we are seeing many of the shortcomings indentified then playing out now. I particularly note the difficulty getting all the players on the same page with information to present a cohesive picture of the "event" to the public. I am also concerned that we have politicians wading into medical issues without the proper traing and background info to digest information. Any comment? Thanks, Tina
Shannon Brownlee: Thanks for your kind words. I think we are indeed seeing the confusion and lack of coordination being played out with anthrax. Here's an observation, appropos of your comment: The President's science advisor was just confirmed by the Senate. He is a physicist. Every single science advisor for the last half century has been in the so-called "hard sciences," physics, engineering, chemistry. A disproportionate number have been nuclear physicists. I would argue that it's time for a biologist to take this post. One could also argue that having a Secretary of HHS who knows something about public health would be a boon right now. Secretary Thompson is in an unenviable position.
Somewhere, USA:
I just have to say that, as an emergency medicine physician in the Northern Virginia area, there is really no "underground movement" to vaccinate frontline public health workers -- contrary to the Falls Church post. Part of the reason this step would have to be taken very carefully is that anyone vaccinated would then be a great threat to children, those who are immune-suppressed (such as those with HIV), and those with excema. Giving a live-virus to anyone is a risk, giving it to frontline health workers is a step that needs to be taken with extreme caution.
I don't know if this step will be considered in the future, but I do believe that the everyone needs to step back, take a deep breath, and think about the consequences of such an action. I don't think anyone wants to do more harm than good.
Shannon Brownlee: Thank you for your post. Smallpox vaccine is not to be taken lightly. My son had eczema as a toddler. I would be very leery of getting the vaccine myself, or having him vaccinated. That goes double for anyone who is immune compromised, by HIV or chemotherapy, or anti-rejection drugs after organ transplant.
Rockville, Md.:
First, I so appreciated your article and disagree with earlier question from the other reporter. This has been concerning me since Sept. 11 and knowing that this is beginning to be addressed is more a comfort to me than anything. I have two questions, first what can we the public do, I suspect writing our congressmen requesting vaccine, anything else? Second, I've heard there will be research done at NIH to see if the existing stockpile of vaccine can be diluted and still effective (forgive my lack of understanding), if that is anywhere near correct, what is the likelihood of that working and how soon could this be available? As soon as I know we have a significant amount of vaccine, I can rest easy, but I do feel we need to get that hurdle crossed as well as have a plan of action ready as there is no time for learning curve as there has been with anthrax.
Shannon Brownlee: You are quite right. With smallpox there is no time for a learning curve. In a way, anthrax is giving us a dress rehearsal. I don't know any more than you do about efforts to dilute the current stockpile to make it go further. I think the public can write Congress and ask that money be appropriated for not only a vaccine stockpile, which is of course underway, but also for a better emergency plan.
Washington, D.C.:
Your article claims that "Modern vaccines must be manufactured in cell culture, or cells that live in petri dishes." My question for you is, when did we change from using live animals to cell cultures exclusively? My high school biology teacher said vaccines were produced by infecting horses with the relevant pathogen. (I'm still in my twenties, so high school wasn't very long ago.) Also, various Web sites claim that chick embryos and other intact animals are still used for vaccine production. Are they wrong?
Shannon Brownlee: It's my understanding that new vaccines must be produced in cell culture. In this case new means a vaccine that has to undergo review by the FDA. The new smallpox vaccine was going to be treated as if it were a totally new entity that had to undergo FDA review. Now that the civilian stockpile effort is being speeded up, the FDA review process may well be truncated.
Washington, D.C.:
You mentioned that what we need to handle this problem is a vaccine, a cure, and a better public health system. Your article is not optimistic about our seeing any of these three in the near future. In the meantime, how do the American public prepare for the possibility of an attack and its possible consequences, such as massive quarrantines? For example, should we be prepared to stay in our homes without going to the store (or work, etc.) for weeks at a time?
Shannon Brownlee: I am by no means a disaster expert, but as a citizen I've been thinking a lot about what to do. Speaking as a private citizen, not as an expert, and not even as a reporter who has researched the topic, I think having enough food an water in your house to stay indoors for a couple of months would not be a bad idea. I don't want to sound alarmist, and I still think smallpox is an incredibly small threat, but it wouldn't hurt to be ready. Of course, when I lived on the San Andreas fault in California I never put together the earthquake kit we were all instructed to keep. So who knows if I will actually go to the store and buy enough canned food for a couple of months.
Alexandria, Va.:
According to your article, HIV-positive (and otherwise immune-compromised) individuals would be at special risk during a smallpox attack. They would be more likely to contract and spread smallpox and they would not be able to receive the vaccine. What can be done to prepare such people for a smallpox attack?
Shannon Brownlee: I don't know. At this point, it is pure conjecture -- based on some good scientific reasoning -- that people with HIV might be more vulnerable. After all, HIV did not appear until after smallpox was gone. But if they are more vulnerable, public health authorities may need to treat immune compromised people differently. (That's not just those infected with HIV, but also people on chemotherapy, and who have had organ transplants. That's a lot of citizens.) Special quarantines in the event of an outbreak might be one answer, but it's not anybody's first choice, I'm sure.
Reston, Va.:
By now, we're all clearly aware that Anthrax is distributed in a white powder.
How would Smallpox be distributed? What can we be "prepared" to see/experience?
Shannon Brownlee: Smallpox will have to be detected by doctors and nurses who see patients, or by alert citizens who realize that what they or family members have is no ordinary case of the flu. Having said that, I hope readers don't all rush to the emergency room this winter at the slightest sniffle.
Chicago, Ill.:
Fascinating article. You mention how smallpox inspired the invention of the vaccination in, I believe it was, the late eighteenth century. My question is, when did smallpox vaccination become common in the West? Throughout the nineteenth century, how many people were vaccinated? How effective was it? I ask because of my most vivid literary memories is the gruesome smallpox death of the protagonist of Emile Zola's novel Nana, which was set at the advent of the Franco-Prussian war in 1870. (Of course, the reader was supposed to recognize that in Nana's case, smallpox, or verole in French, was a stand-in for syphilis, la petite verole.)
Shannon Brownlee: Thank you. Gosh, you know more than I do, certainly, about the literary history of smallpox. Vaccination was not routine until the 20th century, though it was practiced widely during the 19th. We think arguments about childhood vaccination are a modern phenomenon, but doctors were arguing about the merits of Edward Jenner's vaccination well into the 19th century. Also, even Western countries that routinely vaccinated in the 20th century did not do a perfect job. In 1972, a Yugoslavian returned from Mecca with a case of smallpox and triggered an outbreak there, even though the country had a pretty good vaccination program.
washingtonpost.com:
Shannon, thanks so much for joining us today. This has been an incredible discussion.
Shannon Brownlee: My pleasure. I will try to answer a few more right now.
Arlington, Va.:
Of the 70 percent that survive, are they all disfigured?
Shannon Brownlee: To some degree, yes. The scars are pretty nasty.
Houston, Tex.:
We are assuming that smallpox might not be used because the whole world would be affected. This is similiar to the assumption
that we should not try to stop takeovers of
airlines, because the hijackers would not intentionally take their own lives. That turned out to be a very bad assumption. Even
if smallpox is not used, what about the Ebola
virus? Suppose that a terrorist were able to infect themselves and then fly to New York?
Shannon Brownlee: I think you're right that we can't assume that smallpox won't be used because of the threat of pandemic -- although that is a pretty serious disincentive. As for Ebola, that's not a worry. Ebola is harder to catch, and it burns itself out as an epidemic. Ebola has to live in other animals and it reinfects humans only sporadically. I don't stay up nights worrying about Ebola.
Coffeyville, Kan.:
Is the world really free of wild small-pox? As an epidemiology student in 1979, I met a professor who related seeing two sailors badly affected with a disease that was thought to be small pox in Ethiopia. He related that they were not allowed to certify the cases as small pox but were forced to certify them as "monkey pox."
Shannon Brownlee: If those cases really were smallpox, we would probably have seen more cases since then. Monkeypox is bad enough, however, especially in people who are immune compromised. It does not look as if monkeypox is easily passed from person to person.
Williamsburg, Va.:
Although I have read that the chances of a smallpox attack are very slim, why is there so much attention being given to the possibility?
Shannon Brownlee: Because the consequences are so devastating. As the experts put it, smallpox is a low-probability, high-impact event.
Harrisburg, Pa.:
No real question. Your article was great. I may not be able to attend your online conference, but perhaps you could comment on whether iodine tablets should be stocked in areas near nuclear power plants. I bought my own, but I know that it is still a debatable issue in the NRC and federal government. Thanks.
Shannon Brownlee: Thanks for your nice comment. Gosh, I’m stumped about the iodine. I have no idea.
San Diego, Calif.:
A terrifying and terrific story. What a writer!
Shannon Brownlee: thanks very much. It is really gratifying to hear such comments from a reader.
Richmond, Va.:
I am the father of two little girls and am very concerned about smallpox. I feel that our government is not accelerating the production of the smallpox vaccine quick enough. Their goal is enough vaccine to treat 300 million people by the end of 2002. Can't we devote more resources to it and have it available in six months?
Shannon Brownlee: As the mother of a six year old, I understand your worries. The problem is, producing that much vaccine is hard to do. You have to build a production facility, or take over an existing one that is probably making other valuable medicines. I think it would be amazing if they get it out the door in a year.
Greensboro, N.C.:
In an initial smallpox infection of "Dark Winter" proportions -- i.e., by Day 6 2000 are infected in 15 states -- how much vaccine would need to be immediately available to control the epidemic?
Given vaccine initiatives currently underway -- i.e., successful dilution of existing vaccine stores and ramped up production of 300 million doses -- when can we expect our vaccine stores to reach that level?
It seems to me that this is the "dirty little secret" that no one is talking about. Until our vaccine stores are up to these levels, the U.S. is unbelievably vulnerable to a catastrophic event.
Given the fact that the terror value of smallpox decreases in proportion to the rate that U.S. vaccine stockpiles increase -- I would have to assume that that if anything is going to happen, it would most like happen within this window of maximum U.S. vulnerability.
Starting on Nov. 1, 2001 and based on the rate of current vaccine production, how long is our window of maximum vulnerability?
It is also interesting that this "window" -- whether it be one, three or six months -- corresponds perfectly with the optimum season for smallpox infection (December through March).
I hope you will give me a straight answer on this -- as no one else I have heard has been willing to broach the subject.
Shannon Brownlee: Greensboro, N.C.: In an initial smallpox infection of "Dark Winter" proportions -- i.e., by Day 6 2000 are infected in 15 states -- how much vaccine would need to be immediately available to control the epidemic? INITIAL ESTIMATES WERE ON THE ORDER OF 40 MILLION. THAT NUMBER CREPT UP TO 100 MILLION. 300 MILLION WILL BLANKET THE NATION IN VACCINE.
Given vaccine initiatives currently underway -- i.e., successful dilution of existing vaccine stores and ramped up production of 300 million doses -- when can we expect our vaccine stores to reach that level?
I THINK WE WILL BE DOING INCREDIBLY WELL IF WE GET IT OUT THE DOOR BY 2002. BUT I AM NOT BY ANY MEANS AN EXPERT ON VACCINE PRODUCTION TIME-FRAMES (OR ANYTHING ELSE, FOR THAT MATTER).
It seems to me that this is the "dirty little secret" that no one is talking about. Until our vaccine stores are up to these levels, the U.S. is unbelievably vulnerable to a catastrophic event. Given the fact that the terror value of smallpox decreases in proportion to the rate that U.S. vaccine stockpiles increase -- I would have to assume that that if anything is going to happen, it would most like happen within this window of maximum U.S. vulnerability.
WE ARE AGREED THERE. BEFORE HHS DECIDED TO RAMP UP PRODUCTION, SOME OF THE EXPERTS I TALKED TO AGREED THAT WE WERE AT OUR MOST VULNERABLE IN THE NEXT FIVE YEARS. NOW THAT THE VACCINE WILL BE READY SOONER, THAT WINDOW OF VULNERABILITY HAS BEEN NARROWED.
Starting on Nov. 1, 2001 and based on the rate of current vaccine production, how long is our window of maximum vulnerability? UNTIL THE VACCINE IS BEING CHURNED OUT. I FOUND IT REASSURING THAT DYNPORT SAID THEY COULD PRODUCE UP TO 700,000 DOSES A MONTH. It is also interesting that this "window" -- whether it be one, three or six months -- corresponds perfectly with the optimum season for smallpox infection (December through March). YES, IT DOES.
I hope you will give me a straight answer on this -- as no one else I have heard has been willing to broach the subject. PUBLIC OFFICIALS ARE WALKING A VERY NARROW TIGHTROPE BETWEEN SCARING THE PUBLIC UNDULY AND NOT INFORMING PEOPLE ENOUGH. I HOPE I'VE WALKED THE LINE.
Fairfax, Va.:
Whereas anthrax is not contagious, smallpox apparently is. How would we deal with this problem? Maybe we have seen to many movies, but something like that could spread like wildfire and hurt millions. It seems that the “wait-and-see” approach has proven fatal for those dealing with anthrax. Should we seek out our doctors for a vaccination now?
Shannon Brownlee: No, do not go to your doctor -- except for a flu shot. that would be a good idea. But you can't get a smallpox vaccination because it is only available to people at high risk, those who work in laboratories with the virus, for instance. But you don't want to be getting a smallpox vaccine in any case. It carries it's own risk.
New York, N.Y.:
How might one be able to tell if someone may have smallpox if she (yes, she) is completely covered by her clothing?
I was travelling on a New York City subway (The IRT 7 line) when a Muslim woman entered while wearing what I would guess be traditional clothing that covered every part of her body except for her eyes.
Having becoming accustomed to such sights on this subway line, I didn't give THAT much thought about her at the time. It didn't occur to me until much later that this might be an ideal way to hide that one may have smallpox if you were infected and intent on infecting everyone around you in a suicidal terrorist act.
She was, however, quiet and not coughing nor showing any other behaviorial signs of illness.
Shannon Brownlee: You wouldn't be able to tell, in that case. But anybody would be a pretty sick puppy if they were at the contagious stage of smallpox. Your comment brings up one the most troubling aspects of a bioterrorism attack, as opposed to a more conventional weapon like a bomb. We start looking at our fellow citizens with distrust.
Jefferson, Maine:
Why has the media focused on smallpox? The number of possible threats by terrorists is infinite. Why are we burdening the public with this one?
Shannon Brownlee: Well, I wrote this story long before September 11. Other journalists have been reporting on smallpox because the federal government is.
Glastonbury, Conn.:
The underdeveloped nations of the Middle East have poor access and distribution networks for smallpox vaccine. If the virus was disseminated in the United States wouldn't it be likely that we would be largely protected through vaccination while the unprotected populations of the middle east would be susceptible to a smallpox epidemic?
Shannon Brownlee: Yes and no. A totalitarian regime is a great way to vaccinate a country quickly -- as was the case in Yugoslavi in 1972, when huge numbers of people were vaccinated in about three weeks.
Salvador, Bahia, Brazil:
Do people who were vaccinated for smallpox as children (decades ago, before the disease was "eradicated") need to get booster shots to be protected against a new threat?
Shannon Brownlee: Yes, but that booster is probably unavailable.
Reston, Va.:
Before the anthrax attack, would you have said that a smallpox attack would be less likely than an anthrax attack? Why?
Shannon Brownlee: Yes, and a smallpox attck is still less likely than anthrax by a long shot, largely because it would spread around the world.
Kannapolis, N.C.:
Knowing the very real possibility of this viruluent disease being used as a bio-terror agent, are prepararions being made to begin poduction of vaccine? Also, those of who are old enough had vaccines when we were children but how effective is it now?
Shannon Brownlee: Yes, the federal government is on a crash program to produce vaccine for civilian use. And no, your childhood vaccination is probalby not much use.
Manchester, England:
Dear Miss Brownlee,
I have been following your articles and comments on the net for some time now and they have interested as well as intrigued me. You are an articulate and intelligent writer and this allures me to the employment of journalism. I am currently a student at the University of Salford, England and am in the midst of studying this subject at degree level.
The reason for my writing to you, is to ask if it would at all be possible to gather more information about yourself. A few weeks ago, we were set an assignment to find a journalist that we admired and to ask them how the current U.S./Taliban crisis was affecting them. How you felt about it and what your opinions on the subject were?
If it would at all be possible to have a reply, I would be most grateful, although I realize that you must be an extremely busy person.
Thank you for reading this and I wait in anticipation for your reply,
Yours faithfully,
Poonam Kansal.
Shannon Brownlee: yes. please write me at brownlee@newamerica.net
North Bethesda, Md.:
Should the U.S. government PROACTIVELY procure the 300 million vaccines necessary to protect our country? It seems that we are in the react mode with anthrax and addressing the small pox situation proactively seems the right way to go.
Shannon Brownlee: The government is doing just that.
Santa Cruz, Calif.:
Why do you say a smallpox outbreak is unlikely if D.A. Henderson stated that smallpox was produced in the Soviet Union and many of the 40,000 scientists have scattered around the world? Dr. Osterholme said he feared the possibility of a person being infected and sent to infect others. Henderson and Osterholme are top authorities in the field.
Shannon Brownlee: D.A. Henderson and Mike Osterholm will both tell you they are frightened of smallpox, but they still think the chances that somebody will use it are small – for reasons I discussed in the story: it’s hard to grow and disseminate; very few nations have it; and it’s release could lead to worldwide catastrophe.
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