A Poxy Panic

The controversy over who should receive the smallpox vaccine in the event of a terrorist biological attack is as irrational as the UK government’s decision to stockpile vaccine.

When the Labour government announced its decision in April 2002 to purchase 20million smallpox vaccines, it was widely criticised for awarding the contract to PowderJect. The fact that Paul Drayson, the company’s chief executive, had donated £50,000 to the Labour Party was widely cited as evidence of sleaze and corruption.

But the government’s real offence was spending £32million of public money to protect the public against a threat that is probably non-existent. As the recent controversy over whether the vaccine should be offered only to health workers and other ‘key personnel’ – rather than the general public – revealed, the main consequence of the government’s investment in smallpox vaccine has been to promote public anxieties about the imminent danger of biological warfare.

The official promotion of fears about biological warfare – a recurrent theme on both sides of the Atlantic ever since the 11 September attacks in the USA – raises a number of questions.

Why has there been such a preoccupation with the dangers from anthrax and smallpox? There are after all hundreds, if not thousands, of other noxious micro-organisms that are just as likely (or unlikely) to be used in biological warfare.

It is true that somebody did release anthrax spores with malign intent in the aftermath of 11 September in the USA. It is also true that, despite the panic and disruption this caused, only five deaths resulted. The episode confirmed the long-established view that anthrax is not an effective agent of biological warfare. (Though the origin of the attack remains mysterious, what is known about it suggests that it originated, not from some distant terrorist conspiracy, but from within the US military establishment itself.)

The prominence of anthrax and smallpox in the popular imagination seems to owe more to their status in the history of medicine than to any particular suitability of either pathogen for biological warfare. Smallpox, a cause of epidemic death (and lifelong disfigurement) on a terrifying scale in recent history, was the first disease against which vaccination was shown to be effective, in Edward Jenner’s classic work in the 1790s. It was also the first major infectious disease to have been eradicated – in the 1970s.

The discovery of the anthrax bacillus by Robert Koch played a key role in the development of the germ theory of disease, by Koch and Louis Pasteur and others in the 1870s. Anthrax has always been a much more important disease in animals than in humans.

Why is there so much concern about smallpox and anthrax being used in biological warfare? Apart from tales of infected blankets being given to native Americans by European colonists, smallpox has never been systematically used in warfare. The fact that anthrax is rarely transmitted between humans makes it singularly unsuitable as a biological weapon.

Indeed, attempts to develop and use chemical and biological agents in warfare have in general been very unsuccessful. The use of various poison gases by both sides in the First World War caused casualties on both sides and conferred little military advantage. Though experimentation has continued, such agents have played little, if any, role in subsequent conflicts.

Nor is there any real evidence that any nation or terrorist group possesses smallpox or the capacity to deploy it. There are known to be two World Health Organisation (WHO)-approved stores of the variola virus that causes smallpox, in Atlanta, Georgia and Novosibirsk, Russia. Despite much speculation over the danger of such stores being breached, no such breach has been recorded. According to a long-established schedule, these stocks are due to be destroyed by December 2002.

The practical difficulties of turning micro-organisms into effective weapons are formidable. It is known that the Aum Shinrikyo cult in Japan invested millions of dollars in trying to use anthrax and botulism as weapons and failed miserably; hence their turn to using Sarin nerve gas in their subway attacks (killing 12 people).

The prominence of anthrax and smallpox appears to owe more to their metaphorical significance than their military potential. The spectre of the return of these ancient epidemic diseases offers a potent symbol of modern society in jeopardy from invisible but lethal agents of mass destruction. As I wrote in October 2001, ‘the anthrax panic reveals the grip of the culture of fear in Western society’: ‘This culture predates 11 September, but was powerfully reinforced by the apocalyptic events of that day. In a grim dialectic, insecure governments issue public alerts about biological warfare and calls for vigilance to a populace in a heightened state of anxiety over earlier scares about environmental threats to health.’ (1)

Twelve months later, the timing of the current smallpox scare suggests that raising the spectre of a biological attack at home is intended to help to legitimise government plans for conventional military attacks abroad. The uncharacteristically high level of publicity offered to contingency plans for a military emergency suggests the official calculation that the propaganda value of promoting fears about biological attack is greater than any practical preventive value arising from stockpiles of smallpox vaccine.

The result is a surreal controversy. The government proclaims its readiness to respond to a non-existent threat. The British Medical Association welcomes this empty gesture, particularly as doctors are singled out for protection against this non-danger. Critics immediately respond, with impeccable logic – ‘if doctors need protection against a non-existent threat, then what about the rest of us?’. And £32million is spent, not on protecting the public, but on promoting public anxiety.

Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).

Read on:

Anthraxiety, by Dr Michael Fitzpatrick

How anthraxiety infected Europe, by Thomas Deichmann

A pox on scientific debate, by Sandy Starr

(1) Anthraxiety, by Dr Michael Fitzpatrick