Global health officials are expected to decide this week whether to grant a stay of execution to the last known stocks of smallpox, a move the U.S. argues is critical for the development of medicines to counter a potential bioterrorist attack.
The decision, to be made at an annual meeting of the World Health Organization opening Monday in Geneva, will conclude a debate launched in January over the fate of the remaining stocks of one of the most lethal viruses in human history.
Smallpox was eradicated more than 30 years ago, but samples of the virus have been kept at the U.S. Centers for Disease Control and Prevention in Atlanta and a Russian government laboratory near Novosibirsk.
A WHO panel recommended destruction of the remaining virus in the early 1990s. But that act has been put off multiple times, as concerns rose about the need for countermeasures against a potential intentional or accidental release from unsanctioned stocks.
It's not clear how close the World Health Assembly, the WHO's decision-making body, will come to a consensus. Most attendees at the smaller January meeting backed continued research, but some stressed the need to set an eventual date for destruction, according to a transcript of the meeting.
The U.S. has been making its case to health officials in meetings in many countries over the past several weeks, arguing that scientists need more time to finish developing antiviral drugs and vaccines to protect the public from a potential outbreak.
In particular, the U.S. believes the live virus is needed to finish developing a vaccine without the serious side effects that older-generation vaccines can have in people with immune deficiency disorders, along with two other antiviral medications.
The research would be shared with other countries, not just kept for U.S. defense purposes, said Nils Daulaire, director of the Office of Global Health Affairs at the Department of Health and Human Services, and the U.S. representative on the WHO's executive board.
"We're talking about getting the science right," Dr. Daulaire said. "We do favor the eventual destruction of the stocks once the primary goals of the research have been achieved. We don't think it's a never ending process."
But, he added, "Research has this nasty tendency not to be predictable. We don't know what the time horizon is."
The U.S. must win over skeptical governments—particularly in developing countries—that fear they would be on the front lines of an accidental release and say the best defense is to destroy the stocks. "You just can't provide 100% security," argued D.A. Henderson, head of the WHO's eradication campaign and a distinguished scholar at the Center for Biosecurity at the University of Pittsburgh.
A scientific review completed late last year by a WHO advisory committee agreed the stocks are still needed to develop vaccines and antiviral drugs. But another review by independent experts argued that the only "compelling" reason to keep the live virus is to meet regulatory requirements for testing vaccines and drugs, and new methods for meeting regulatory approval should be developed that don't require the live virus.
The main challenge smallpox researchers face is finding a way to test treatments on animals, because smallpox infects only humans. Researchers have yet to infect monkeys with smallpox in the same way that it infects humans, for example.
"At the end of the day, it comes down to a regulatory issue," said Lim Li Ching, a researcher for the Third World Network, a nongovernmental organization based in Malaysia that advocates for destruction of the virus. "From a public health perspective, all the goals the World Health Assembly authorized research for have been achieved."
U.S. government scientists say they believe they will find an animal model that works. At a meeting late last year with virologists from other fields, they identified some potential new methods, such as alternative ways of administering doses of virus.(source:online.wsj.com)