This is my first "Tomgram" as I'm labeling the original material I'm hoping to generate every now and then from various friends and writers with whom I work. In this case, David Rosner, director of the Center for the History and Ethics of Public Health at Columbia University, offers his thoughts about the present smallpox scare and some of the questions that are not being asked in the media about it.
It's rare, as a start, to find anyone saying the obvious: that smallpox, like so much else that now might endanger us, dropped into our world through the superpower confrontation of the Cold War. Few people are asking a simple question: What are we to make of a far-fetched, fear-drenched scenario of mass death that drives us to acts of policy guaranteed to result in actual deaths? The strangeness of this is so close at hand that it can hardly be seen. Smallpox was a symbolic policy choice among many more pressing but perhaps more mundane dangers on this earth. But it is symbolic no longer.
If fear is consciously being used to drive more general policy decisions and agendas, it might also be worth asking whether those using this fear, including the President, are themselves in part driven by nameless fears (as Bush certainly was on September 11). In any case, Rosner raises many necessary issues below. He is most recently co-author of the book Deceit and Denial, the Deadly Politics of Industrial Pollution, which has the goods on a fifty year corporate cover-up of the dangers of lead poisoning.
I've included as well a brief but vivid tale Naomi Schalit, a producer at Maine Public Radio, wrote me from the frontlines of media coverage of the smallpox story, and some suggestions for further reading. Tom
The Problem with Smallpox
By David Rosner
The eradication of smallpox has been hailed as among the greatest triumphs in public health history. Once a disease that swept through cities and towns, leaving in its wake untold number of casualties and disfigured peoples, it has disappeared from the natural environment through massive inoculation and public health campaigns worldwide. And since the last case of smallpox appeared in the 1970s, it can be truly said that it is the only diseases to have been "eradicated" through human intervention.
Yet the Cold War allowed us to grab defeat from the jaws of victory by seeing in smallpox a chance to create a new and "better" weapon of mass destruction. The United States and the Soviet Union managed to agree to make sure that the virus that causes smallpox would remain in storage awaiting a new opportunity to terrorize the world. For decades, both countries stored it, distributed it to various research labs and otherwise ensured that this public health victory would be turned into a potential human tragedy. Not only did the two countries refuse to destroy the remaining vials of smallpox virus, but they worked hard to figure out means of making it all the more deadly and immune to the very public health measures that had "eradicated" it in the first place. They both envisioned a new biological weapon against which the enemy would be completely unprotected! By genetically altering the virus and selecting out strains that will not be intimidated by the smallpox vaccines used in the earlier vaccination campaigns, the two countries have effectively created a world in which we can all worry.
This is the irony at the heart of the current Bush administration call to vaccinate hundreds of thousands of emergency workers and achieve "voluntary" compliance by the rest of us in the United States: the vaccines developed in American labs may be effective against older strains of the virus, and perhaps even against the newer, more powerful strains we have developed, but it is unclear whether they would protect us against strains purposely modified or developed in the old Soviet Union. We may be willing to believe that our own strains were safe-guarded, and that vaccines can protect us from ourselves, but what about the other guy's viruses? Where are the vials of virus that were kept by a nation-state in the process of dissolving?
But an even bigger problem is: What about many other biological weapons that we and the Soviets spent decades refining? What about cholera, typhoid and of course anthrax? Smallpox is but one of many possible terrorist tools and we have no understanding of what might or might not have been stored, or what new and "better" strains of cholera, anthrax and a host of other deadly infectious agents might have been developed through the wisdom of the Soviet weapons labs and ours?
This all begs the question of whether there is a real threat in the first place. Smallpox, and any other biological agent for that matter, can't just be let loose but needs elaborate preparation for dispersal. Further, it is not clear that mass vaccination campaigns won't kill more people than exposure to the virus itself. In 1947, the last time a mass campaign to inoculate against smallpox was carried out in New York City, three people died of smallpox, while a dozen died from the after-effects of the vaccination itself.
If -- and it is a big if -- smallpox can be used as a weapon of terror, that is only one of the issues brought to the fore by the smallpox scare, for the smallpox hoopla is being used to fundamentally transform public health agencies throughout the nation. There is serious concern among some public health workers that the mundane activities of the public health community --- making sure our water is safe to drink, babies are immunized, the air isn't too polluted to breathe, sanitation in restaurants is maintained, and our food isn't spoiled when we eat it -- are all being sacrificed on the altar of bioterrorism. We really aren't sure what to do about unknown peoples driven by rational and irrational motivations, but it is useful to employ the smallpox issue as a method for integrating public health into an emerging anti-terror state. We may not know what to do about biological warfare, but we certainly know how to use our fears and anxieties about danger for political purposes.
For the past year the public health community has been under enormous pressure to transform itself into an anti-terrorist enterprise. Following September 11, and particularly following the anthrax scare, Tommy Thompson (as well as the heads of the federal Department of Health and Human Services and of the Office of Homeland Security) has pressed public health departments throughout the country to focus efforts on disease surveillance projects, laboratory improvements and civil defense preparation. Money for "anti-terrorist" activities threatens to divert the attention of public health workers from a host of other activities like anti-smoking and environmental issues as federal terrorism money is dangled in front of cash-strapped departments of health and university researchers throughout the nation. Fear of smallpox has played nicely into the overall strategy of the Bush administration to militarize public health.
copyright David Rosner
Naomi Schalit, producer for Maine Public Radio, comments on:
"the poor reporting on the smallpox plan promulgated by Bush, and forced on the states. Deep in paragraph twelve of a story in yesterday's Times, Lawrence K. Altman writes: 'Dr. John F. Modlin, the chairman of the immunization advisory panel, said that the Bush administration clearly had gone far beyond his group's recommendations in planning to vaccinate the 10 million workers and some members of the public....Dr. Modlin said he could not recall any other time that the government had not followed the recommendations of the panel.'
"Why was this not the lead story? Why was the fact that the Bush
administration is clearly risking public health in the service of their political objective -- to keep the hysteria up -- not the real story, now that Bush is going to get a needle prick on his upper arm, the closest that man will ever come to active duty in defense of his country?
"I covered the state's press conference on Friday, and felt, as I sat there with my mostly young, colleagues, that there was an eight hundred pound elephant in the room, as Maine's two top public health officials stood in front of us, in clear distress, telling us that they were going to ask for three
thousand volunteers to get vaccinated. Finally, as they moved to leave, I raised my hand. "Tell me," I asked, "how do you two women feel, as physicians, about what you're being asked to do by the feds?"
"The Bureau of Public Health director grimaced; the state's epidemiologist practically jumped back on the podium. In the end, they distinguished themselves by their candor. And by the way, at the end of the day, the epidemiologist
called me at my office and thanked me for asking the question that clearly put them on the spot. She said, "This is the time now for us to begin asking these questions out loud. I can't keep quiet any longer."
"How many others are actually speaking up? And how many reporters are listening, for God's sake?"
[Here is the response of Kathleen Gensheimer, who stressed she was speaking as a physician, not as the state epidemiologist, as reported in Schalit's radio story:]
"We clearly cannot stand back and ignore what the Federal government's saying at this time period, because there may be information that the National Security Council has, the CIA has, that we are just not privy to. I would only hope that the Federal government has clear information that suggests that this sort of a smallpox campaign is indeed necessary if we are to subject our public health and medical workforce to this sort of a vaccination program which clearly has threats associated with it."
Below are a few pieces of interest on the subject from the last week of reportage, if you want further reading:
A report, "Smallpox Strike Called Unlikely," by Charles Piller of the Los Angeles Times, December 13 2002, indicates how hard it would actually be, even with expert help and state backing for terrorists to create a smallpox epidemic.
To read more click here
A December 13 LA Times op-ed, "What We Need Is a Fear Vaccine," by Michael Shermer, editor of Skeptic magazine, a monthly columnist for Scientific American, and author of "Why People Believe Weird Things" (Henry Holt, 2002) is worth reading. It begins:
"President Bush plans to announce today the government's program to implement a smallpox vaccination program within weeks, starting with half a million military personnel and another half a million health-care and emergency workers, then expanding the program in early 2004 to offer immunization to the entire American public.
"Officials estimate that at least 10 million doses will need to be created just to handle all public and private health, medical, police, fire and other emergency personnel. Millions more doses would have to be created if a majority of the public volunteered for the program.
"Hold on just a moment. When was all of this decided? Did I miss the public debate after being abducted by aliens? Smallpox was eradicated by 1980. What's going on here?"
To read more click here
And finally, from Tech Central Station via the Globalsecurity.org website, "Hi-Tech vs. Low-Tech Threats" by Noah Shachtman, that sensibly begins:
"The Bush Administration has repeatedly raised the specter of evildoers armed with exotic weapons - from Al-Qaeda's "dirty bombs" to Saddam's biotoxin-spraying unmanned planes. But the recent attacks in Kenya underscore a simple truth, defense experts say: terrorists hardly ever use high-tech gadgetry. Instead, they rely on low- or no-tech methods to help pull off their missions.
"'These are not James Bond movie villains, imagining the most complex means to an end,' said John Pike, director of Globalsecurity.org. 'They look for the simplest plan.'
To read more click here
