Issue 3, September 2002
Smallpox: Historical Review of a Potential Bioterrorist Tool
Biology and Comparative Literature, University of Southern California
In the wake of the October anthrax mailings,
America has become attuned to the possibility of terrorists unleashing
smallpox on the United States. Unlike anthrax, smallpox is highly
contagious and difficult to contain. Although smallpox was eradicated
from the United States in 1949 and officially eradicated worldwide
in 1980, Americans are currently very vulnerable to the disease, which
might spread rapidly throughout the United States - and to other countries
- upon release.
Mandatory vaccination of school children against smallpox ended in
1972 in the United States. Because the last outbreak of smallpox in
the United States was in February 1949, by 1972 the risk of vaccine
complications far outweighed the risk of smallpox infection. An estimated
120 million Americans - about half the population - have never been
vaccinated and have no immunity to the disease. Those who have been
vaccinated have not had a booster shot in decades; their immunity
has waned, although no one knows by what factor and how susceptible
to smallpox they may be.
Because of its extreme virulence, smallpox has impacted not only the
lives of its victims but even the outcomes of wars and conquests.
Smallpox scourged the entire world before Dr. Edward Jenner invented
vaccinations in the 18th century and the official eradication of the
disease by the World Health Organization (WHO) occurred in 1980. If
smallpox were reintroduced to the United States, many fear present-day
Americans would fare no better than the Native Americans, whose numbers
were devastated when Europeans introduced the disease to this continent
in the 16th century. "Today, we're all Indians," says Elizabeth Fenn,
historian and author of Pox Americana.
The government currently has more than 100 million doses of
smallpox vaccine and has signed a contract to purchase enough
to vaccinate all Americans in case of an outbreak
Though the situation is grave, Fenn's warning is probably overstated.
Millions of Americans have been vaccinated; their immunity -- even
if it has waned over time -- would slow the spread of the disease
upon an outbreak. The government currently has more than 100 million
doses of smallpox vaccine and has signed a contract to purchase enough
to vaccinate all Americans in case of an outbreak. These new stocks
should be ready by the end of the year, but the current supply would
be enough to contain isolated outbreaks. Large-scale outbreaks of
genetically altered smallpox would pose more of a problem for the
Since its eradication, debate has continued about whether U.S. and
Russian smallpox stocks -- which were generated for bio-weapons research
during the cold war -- should be destroyed, since their existence
leaves open the possibility of smallpox falling into the hands of
bioterrorists. North Korea, Iraq, and possibly other nations, have
undeclared smallpox stockpiles. No matter what protective measures
the government takes, a smallpox outbreak is possible as long as such
Smallpox Pathogenesis and Symptoms
Smallpox is contracted by inhalation of variola virus particles.
Lesions in the throat and mouth release large amounts of virus into
the saliva, which are spread into the air by coughing. Smallpox
is spread via saliva during face-to-face contact or by inhalation
of virus particles from pus and scabs encountered on bed sheets
and other places.
Upon inhalation, variola implants itself in the lining of the throat
and nasal cavity, and then migrates to the lymph nodes and the blood.
By the eighth day after contraction, the virus has undergone intense
multiplication. Variolae localize in blood vessels in the skin and
inside the mouth and throat. After about 12-14 days of incubation,
high fever, headache, backache, and other flu-like symptoms appear.
A rash appears in the mouth and throat and on the face, arms, trunk,
and legs. After one or two days, the rash turns into deeply imbedded
pustules, or pox, which become scabby after about a week.
At this point, the pox do not itch, but they cause excruciating,
fiery pain. Sometimes the pox are so numerous and close together
that they cannot be distinguished from one another. In 1634, William
Bradford, governor of the Plymouth colony in Massachusetts, wrote
of the horrific effect of smallpox on the skin of infected Native
Americans: "Their skin... cleaves... to the matts they lye on; when
they turn them, a whole side will flea off at once... they die like
rotten sheep." Viral toxins and human immune complexes circulating
in the blood cause death in the second week of infection. The most
virulent form of smallpox, caused by variola major, is fatal in
30-50% of unvaccinated patients. A milder form of smallpox, called
alastrim, is caused by the variola minor strain and has only
a 1% death rate among unvaccinated people. If the smallpox patient
recovers, the scabs separate and fall off after three to four weeks,
accompanied by extreme itching. The pox leave behind terrible scars,
especially on the face.
According to the American Medical Association (AMA), smallpox occasionally
causes encephalitis and blindness, but in its most common form it
rarely affects organs other than the skin.
Viral particles from saliva and sores remain viable outside
the body for a long time - for instance, on sheets and clothing
-- and may infect others months later.
Variola is extremely virulent: The AMA says natural infection may
occur after inhalation of fewer than 10 viral particles. Although
the patient is most contagious during the first week, viral particles
from saliva and sores remain viable outside the body for a long time
- for instance, on sheets and clothing -- and may infect others months
Smallpox in Human History
of the variola virus jumped species from rodents to African hunters
thousands of years ago. Over millennia, the rodent virus specialized
to infect humans, then spread across Africa and beyond, menacing the
entire globe. In the seventh and eighth centuries A.D., Arab armies
carried smallpox out of Africa to Southwestern Europe; in the 11th
and 13th centuries the crusades and trade along the Silk Road to China
also contributed to the widespread dissemination of the disease across
Eurasia and beyond.
According to Greek
historian Thucydides's, variola is thought to be the cause of the
430 B.C. plague that weakened Athens and contributed to its defeat
by Sparta. Smallpox facilitated the European conquest of North and
South America. Native populations had never been exposed to variola
virus and had no immunity to it. The Spaniards' victory over the Aztecs
is a well-known example. In 1519, Spanish forces led by conquistador
Hernando Cortes arrived in the Aztec capital of Tenochtitlan. The
Aztecs were decimated two years after Cortes' arrival -- but not by
the Spaniard's horses, guns, or military skill. It was smallpox that
almost completely annihilated the Aztecs, causing the population to
fall from 25 million in 1519 to three million 50 years later.
smallpox inoculation, practiced in India
of Athens described by Thucydides in his History
of the Peloponnesian War, thought to be caused
armies carry smallpox out of Africa to Southwestern
Urban II gives the speech which spurs the first
of the Crusades
trade with China via the Silk Road begins
Cortes and his troops arrive in the Aztec capital,
England, Lady Mary Wortley Montagu spurs experimental
variolation on prisoners
suffers 5 major smallpox epidemics
performs the first vaccination
kills 400,000 Europeans a year and is endemic
in Eurasia Australia, South Africa, and North
and South America; variolation slowly spreads
across Europe and to America
Parliament passes the Vaccination Act
advances the germ theory of disease
of the Soviet bioweapons program
discovers that the virus used in vaccinations
is no longer cowpox but a new virus, vaccinia
army begins germ warfare research
War II, smallpox infection swells across the globe
of countries in which smallpox is endemic rises
from 69% to 87%
outbreak of smallpox in the US
intelligence discovers the existence of the Soviet
Union bioweapons program
with mock smallpox germs are tested in Washington
launches the Intensified Smallpox Eradication
Program; KGB agents obtain samples of a virulent
strain of variola major in India
ends the US biological warfare program
begins phasing out mandatory vaccination in schools;
Biological and Toxic Weapons Convention treaty
reported case of smallpox in Somalia
declares global eradication of smallpox
scientist Pasechnik defects to Great Britain
year previously set for destruction of US and
Russian smallpox stockpiles
11 terrorist attacks
for destruction of smallpox stocks extended indefinitely;
NIH bioterror defense budget increased to $1.5
drastically affected everyday life. In 1800, English historian Thomas
Macaulay wrote that the disease "was always present, filling the churchyard
with corpses, tormenting with constant fears all whom it had not yet
stricken ... making the eyes and cheeks of a betrothed maiden objects
of horror to the lover." Between 1719 and 1746, London suffered five
major smallpox outbreaks. As the 18th century drew to a close, smallpox
was killing 400,000 Europeans each year and had spread from Eurasia
to Australia, South Africa, and North and South America.
smallpox was first performed in India in 1000 B.C. Pus or scabs
from variola pox were rubbed into a skin lesion in a process called
variolation. Although variolation sometimes led to smallpox infection,
it reduced the death rate among infected people from 30% to 1%.
Lady Mary Wortley Montagu, the wife of a member of the English Parliament,
observed variolation in the Ottoman court during a trip to Constantinople
in 1717. She persuaded the Princess of Wales and her husband to
sponsor a public experiment on the efficacy of variolation on prisoners.
Due to the success of the experiment, the princess had her own children
variolated. From then on, variolation became more widespread; however,
because of medical and religious concerns it was not completely
embraced by the public. The pus used for variolation was often contaminated
with the bacteria that caused tuberculosis or syphilis. To cure
people by infecting them seemed unnatural and immoral. However,
due to variolation's dramatic reduction in smallpox death rates,
the procedure spread across Europe and to America throughout the
late 18th century.
In 1770, Dr. Edward Jenner, of Glouchestershire, England noticed
that milkmaids who had been infected by cowpox (a much milder virus
in the same genus as smallpox) had smooth complexions free of pox
scars and didn't contract smallpox. To test his theory that cowpox
immunity lessened the severity of smallpox, he variolated 13 milkmaids
with smallpox who had had cowpox. Generally, a few pox would develop
around the site of variolation, but the milkmaids he variolated
in his study did not develop the characteristic lesions. In 1796,
now confident in his theory that previous cowpox infection protected
people from smallpox infection, Jenner performed a daring and highly
unethical experiment: He injected a boy with cowpox, and then variolated
him. Like the milkmaids in his previous experiments, the boy did
not develop any smallpox lesions. Jenner coined the word vaccination
(from Latin vacca, cow) to describe his cowpox inoculation.
Jenner performed his experiments over 100 years before Pasteur advanced
his germ theory of disease in 1880. Jenner did not know about immunity
or viruses -- he only knew his vaccination worked.
Jenner's vaccination method was not widely accepted for several
years. In 1797, the British Royal Society rejected a paper in which
Jenner described his vaccination experiments. The members felt that
his ideas were "too revolutionary" and his experimental evidence
"too limited." Jenner published his paper privately in 1798; within
the year it was translated into Latin, German, and French, and about
1000 people were vaccinated.
method of cowpox inoculation, called vaccination, became more and
more popular in Europe and America over the next 50 years, largely
because it had much milder side effects than variolation and could
never result in smallpox infection. Variolation involves exposing
patients to variola virus; vaccination only exposes patients to
cowpox. By 1800, more than 100,000 citizens of Great Britain had
been vaccinated and in 1840 the British Parliament passed the Vaccination
Act, mandating free vaccination of infants and outlawing variolation.
Most Western governments adopted similar laws by 1900. In 1939,
Allan Downie of the University of Liverpool determined that the
virus used for smallpox vaccinations was no longer genetically identical
to cowpox but had diverged into a new virus. Downie called the virus
vaccinia. To this day no one knows why the change occurred.
In the United States, rates of smallpox infection decreased as mandatory
vaccination of schoolchildren was put in place throughout the first
half of the 20th century and the invention of the ice box made vaccine
storage efficient. While the United States and European countries
were getting smallpox under control, the developing world still
suffered from it. Infection rates were high in Africa, South America,
and Asia, where vaccination was not as widespread as in the West.
During World War II, smallpox infection swelled. Previously unexposed
regions were overtaken by variola carried by foreigners, or by soldiers
who brought the virus home from foreign lands. From 1941 to 1946,
the percentage of countries in which smallpox was endemic rose from
69% to 87%. During that period, smallpox killed three to four million
1, 1967, the WHO began the Intensified Smallpox Eradication Program,
one of the greatest triumphs in the history of medicine. The WHO employed
a strategy of mass vaccination coupled with subsequent surveillance
and containment. After mass vaccination of a population, WHO agents
monitored it for isolated cases of smallpox, containing them via quarantine
and small-scale vaccination. Key to the program's success was its
sensitivity to local needs. Operations were specialized to each country
and agents worked carefully within the framework of local cultures.
Freeze-dried vaccine (which does not require refrigeration) and a
hydraulically powered jet injector capable of performing 1000 vaccines
per hour made eradication possible in developing countries where electricity
was scarce and generators unreliable. The last reported case of smallpox
occurred in Somalia in 1977; the disease was declared eradicated and
large-scale vaccination ended worldwide in 1980.
and Soviet Germ Warfare Programs
The U.S. Army began germ warfare research in 1942 in response to
intelligence about Tokyo and Berlin's germ warfare programs. George
Merck (of Merck pharmaceuticals) was put in charge of bioweapons
research at the U.S. Army base at Fort Detrick, Maryland. The program
started out with an emphasis on bacterial rather than viral agents.
For example, in the 1950s, according to Germs: Biological Weapons
and America's Secret War, Fort Detrick scientists worked to
determine how much anthrax was necessary to annihilate Moscow, Kiev,
In 1956, the U.S. government learned of the existence (but not the
extent) of the Soviet bioweapons program and expanded its program
in response, shifting its emphasis from bacterial to viral disease.
U.S. scientists began freeze-drying smallpox and testing aerosol
generators for dissemination. The generators were designed for hiding
in everyday objects. Atomizers hidden in briefcases were tested
with mock smallpox germs in the then-named Washington International
Airport in May 1965. Scientists determined that if the virus had
been real, one in 12 travelers would have been infected. In the
1960s, the Army secretly considered using smallpox as a weapon against
the North Vietnamese but decided against it because of the risk
of Soviet retaliation in kind.
On November 25, 1969, then-President Nixon ended America's biological
warfare program because he felt the human race already carried "too
many of the seeds of its own destruction." His administration led
the world in advocating the 1972 Biological and Toxic Weapons Convention
treaty, which banned possession of such agents except for research
into vaccines and treatments. The United States and the Soviet Union
were among the approximately 100 countries to sign.
The American government did not know the tremendous scale on which
the Soviet government pursued its bioweapons operations until October
1989, when Soviet scientist Vladimir Pasechnik defected to Great
Britain and detailed what he knew. The Soviet operation had been
underway since 1928 but began in earnest in 1967 when the government
sent agents to India during a smallpox outbreak. Soviet doctors
inoculated and treated patients while the KGB obtained samples of
the virus, an especially virulent strain of variola major. When
the WHO certified the global eradication of smallpox in 1980, Soviet
officials knew it would be an excellent biological weapon.
The Soviet Union researched efficient means of growing and delivering
variola. They intended to use smallpox to achieve total annihilation
in case of nuclear warfare with the United States and worked on
a device to attach to nuclear warheads that would disseminate variola
virus. Scientists searched for chemicals to stabilize the virus
in a radioactive environment so that it might infect and kill any
American survivors of nuclear holocaust.
U.S. germ warfare projects began more than 10 years after the Soviet
Union's and on a much smaller scale. However, the U.S. Army's program
was atrocious in its own right. At its peak production level, the
Soviet Union produced 100 metric tons of variola virus annually
with a combined peak yearly production of biowarfare agents (including
bubonic plague and anthrax) of 10,000 metric tons. The U.S. Army
never mass-produced variola or bubonic plague for germ warfare.
Its combined peak production of other biowarfare agents like anthrax
was 6.5 metric tons per year. The Army tested its germ weapons on
prisoners in Ohio State Penitentiary and on nearly a thousand soldiers
in the Utah desert, also spraying civilians with "mild germs" in
order to investigate delivery techniques.
The Fate of Smallpox Stockpiles
Many fear that
the retention of variola stocks by the United States and Russia
puts us in danger of smallpox attack. In addition to Russia and
the United States, North Korea and Iraq are suspected to have stockpiles
of variola major. Rogue nations or terrorists may have a virulent
strain of smallpox, obtained from an American or Soviet lab working
on biological warfare. Financial support for Russian laboratories
has declined in the past few years, leaving their stocks particularly
vulnerable, according to the AMA. While the stocks exist, it is
possible for terrorists to steal and use them. One of the primary
arguments against retaining the American and Russian stocks of virus
is the possibility that terrorists will use the retention as an
excuse to develop weapons of biological warfare. Virologist Jeffrey
Almond of the University of Reading (UK) would "argue for the preservation
of smallpox" for research if we lived in "an ideal world," but as
things stand, we should destroy our stocks to make it clear that
"it's a crime against humanity to develop such weaponry."
Jeffrey Almond of the University of Reading (UK) would "argue
for the preservation of smallpox" for research if we lived in
"an ideal world," but as things stand, we should destroy our
stocks to make it clear that "it's a crime against humanity
to develop such weaponry."
Some feel that to destroy Soviet and American stocks of the virus
and declare it eradicated from Earth would be perpetrating a fraud.
Iraq and North Korea have undeclared variola stocks and reports of
uncertain reliability suggest that China, Cuba, India, Iran, Israel,
Pakistan, and Yugoslavia may also have stocks. Any country might have
obtained and saved samples of the virus from infected patients before
smallpox was eradicated.
Due to the risks of retaining the virus, in 1996 the WHO set mid-1999
as the date for destruction of all variola stocks. Decades of presidential
administrations have supported the destruction of U.S. variola stockpiles.
The Clinton administration "privately assured" other nations it would
support destruction in 2002 after further research, and together with
Russia pushed the WHO to extend the deadline.
However, the political climate has changed since September 11 -- the
possibility of a bioterror attack has become more palpable, even if
the probability of such an attack has not actually increased. Kenneth
Bernard, former U.S. assistant surgeon general, believes research
on variola stocks is critical. In an Associated Press story from January
17, 2002, he said, "We regard the potential release of smallpox as
a critical national and international security issue."
That same day, the WHO reversed its order, recommending the retention
of variola for research into new vaccines and treatments. No new date
was set for the destruction of the viral stockpiles, although research
progress reports are to be drawn up in two to three years. China was
the only nation to protest the indefinite extension of the destruction
deadline. China's ambassador to the WHO, Sha Zukang, said in the same
Associated Press article that China believes "early eradication of
the virus stocks is the only fundamental guarantee of the eradication
The Bush administration recently announced that U.S. variola stocks
will not be destroyed until scientists develop two antiviral drugs
and a vaccine all Americans can safely take (including those with
suppressed immune systems). Bush proposed a $3.7 billion increase
in the National Institutes of Health (NIH) budget for the next fiscal
year, which begins October 1. The NIH bioterror defense research budget
will increase five-fold to $1.5 billion. In a January 25, 2002 Los
Angeles Times story, Dr. Anthony Fauci, infectious disease chief
at NIH, was recorded as saying research priorities will include developing
a better smallpox vaccine and quicker methods of diagnosing smallpox.
The increase worries many analysts, government officials, and scientists,
who wonder whether the money will be spent wisely and whether it will
unnecessarily detract from more immediate problems such as the flu,
which kills more than 15,000 Americans in a typical season. Proposed
NIH bioterror research will focus on anthrax and smallpox, but this
may leave the United States vulnerable to many other deadly agents.
Many feel that more of the money should go toward public health efforts,
including better training for doctors and more hospital beds. Such
measures would benefit more people no matter what kind of bioterrorist
attack may occur.
American Preparedness Against the Threat of Terrorism
It is difficult
to predict the likelihood of a terrorist smallpox attack on the
United States. As long as stockpiles exist, an attack is possible.
The worst-case scenario is bleak: Officials might not be able to
contain a wide-spread outbreak of a genetically-engineered virus
without large numbers of casualties, although a major epidemic would
probably not ensue. If non-genetically-engineered smallpox were
unleashed in the United States on a small scale - which is much
more likely - casualties would be relatively low: Existing immunity
in the populace and vaccine supply would probably protect a majority
of the population.
New studies imply that immunity may last longer than previous estimates,
which guaranteed immunity for only a decade after vaccination. An
article by Joe Cohen in a recent issue of Science magazine
describes three such studies. A study by Israeli researcher Baruch
El-Ad showed a decline in antibody levels for three years after
vaccination but a constant level of antibodies for the next 30 years.
Francis Ennis of the University of Massachusetts medical school
found that virus-specific T-cell memory can persist for up to 50
years "in presumed absence of antigen." T-cell memory allows the
body to "remember" an antigen like a viral protein so that, if exposed
to it in the future, the immune system can react quickly to stifle
infection. A study published in 1913 by William Hanna examined the
severity and fatality of smallpox in people of various ages who
were immunized only once in infancy. These data show that 93% of
people ages 50 years and older who were immunized in infancy escaped
severe infection and death while 50% of unimmunized people in the
same age group suffered severe illness and died.
As the response of New York officials to the last American smallpox
outbreak in 1947 illustrates, mass vaccination is wasteful and dangerous.
Reacting to public hysteria, officials vaccinated 6 million people
in one month according to a November 6, 2001 Los Angeles Times
story, exhausting the vaccine supply in the area.
Containment of the last smallpox case in America in 1962 was more
successful and achieved by much more moderate means. James Orr had
flown from Brazil to New York, and then took a train to Toronto,
before coming down with smallpox. Rather than sealing the U.S.-Canadian
border and vaccinating millions of people, officials vaccinated
only 3,000 people who had been in the same area as the infected
man and fumigated the planes and trains. When the public health
system reacts quickly to a smallpox outbreak affecting a relatively
small number of people, fewer need to be vaccinated.
On November 28, 2001, the Department of Health and Human Services
signed a contract with biotech firm Acambis Inc. to buy 155 million
doses of smallpox vaccine within a year, bringing the U.S. stockpile
of the vaccine to 286 million doses. However, because of the risk
of complications , the vaccine will not be used unless an outbreak
occurs: If all Americans were vaccinated, 400 people would most
likely die from complications, 250 people would contract a potentially
fatal rash, and three out of every one million would contract encephalitis.
Scientists at four American research universities are also studying
the effects of diluting vaccines to one-fifth and one-tenth strength.
If these doses are strong enough to generate immunity, a smallpox
outbreak could be contained with a limited amount of vaccine.
Vaccination efforts are important but would fail to contain the
disease unless coupled with an effective quarantine, which could
be difficult to achieve: The incubation period of smallpox is about
12 days (giving infected individuals time to scatter far from the
infection site) and the disease is difficult to diagnose for the
first two to three days, because the symptoms are flu-like. One
can imagine a worst-case scenario in which terrorists discharge
variola virus into a crowded public area; exposed people would scatter,
perhaps across the country and around the world if the attack occurred
at an airport. Infection rates would vary, depending on the age
group of exposed people (i.e., whether they have been vaccinated
and how long ago), but people would not show symptoms until 12 days
after the exposure. Once they began to manifest symptoms of infection,
people might be misdiagnosed for 2-3 days, further delaying initiation
of quarantine efforts.
Senior officials in the Clinton administration all but failed
a role-playing exercise designed to assess their ability to
deal with a sophisticated smallpox attack in March 1998.
Senior officials in the Clinton administration all but failed a role-playing
exercise designed to assess their ability to deal with a sophisticated
smallpox attack in March 1998. The scenario involved an outbreak in
California and the Southwest of a genetically-engineered strain of
variola similar to one the Soviets had been developing. Officials
were unable to contain the smallpox outbreak without large numbers
of casualties and could not contain secondary outbreak due to the
genetic changes in the virus. Critics of the exercise point out that
the virus used in the model was "science fiction," although it pointed
to weaknesses in the system. Officials realized "they lacked the knowledge,
resources, and stamina to contain or treat a secondary outbreak" of
A sophisticated smallpox attack might involve the release of genetically-altered
variola. A government which has retained smallpox stocks might hire
scientists to genetically engineer a more deadly version of variola
or a chimera - a genetic hybrid of variola and another virus - neither
of which anyone would have immunity to, whether vaccinated or not.
Such a virus could cause a secondary outbreak of another disease after
a smallpox outbreak.
The government is likely prepared to deal with a small-scale attack
perpetrated with variola that has not been genetically altered. Such
isolated attacks are more likely than large-scale, sophisticated attacks
with genetically engineered viruses: The risks to the public caused
by mass-vaccination are far greater than the risk of such a sophisticated
attack. While it is unlikely that smallpox will reemerge as a national
epidemic in the United States, the acquisition of enough vaccine for
all Americans and efforts to change the public health system will
help ensure protection in the long run.
American Medical Association Working Group for Civilian Biodefense.
"Consensus Statement: Smallpox as a Biological Weapon: Medical and
Public Health Management." Journal of the American Medical Association
281 (1999): 2127-2137. http://jama.ama-assn.org/issues/v281n22/ffull/jst90000.html
[Link current as of August 17, 2002.]
Bradsher, Keith. "Smallpox Vaccine Costlier Than Expected." New
York Times 7 November 2001. New York Times On The Web. 29 March
Cohen, Jon. "Smallpox Vaccinations: How Much Protection Remains?"
Science 294 (2001): 985.
Donn, Jeff. "Qualms Grow with Bioterror Research." Los Angeles
Times Online. 27 January 2002. http://www.latimes.com/news/nationworld/wire/sns-ap-bioterrorism-research0127jan27.story
[Link current as of August 17, 2002.]
Fenn, Elizabeth. Pox Americana: The Great Smallpox Epidemic of
1775-82. New York: Hill and Wang, 2001.
Meckler, Laura. "US to Stockpile Smallpox Vaccine." Los Angeles
Times Online. 29 November 2001. http://www.latimes.com/news/nationworld/wire/sns-worldtrade-smallpox.story
[Link current as of August 17, 2002.]
Miller, Judith, Steve Engelberg, and William Broad. Germs: Biological
Weapons and America's Secret War. New York: Simon and Schuster,
Miller, Judith. "U.S. Set to Retain Smallpox Stocks." New York
Times Online. 16 November 2001. http://www.nytimes.com/2001/11/16/international/16GERM.html?searchpv=past7days
[Link current as of August 17, 2002.]
Neergaard, Lauren. "Bush Proposes Major Raise for NIH." Los Angeles
Times Online. 25 January 2002. http://www.insulinfree.org/society/bush.htm
[Link current as of August 17, 2002.]
Nullis, Claire. "Smallpox May Be Kept for Research." Los Angeles
Times Online. 17 January 2002. Note: AP archives are available
on Lexus/Nexus at your local library.
Ornstein, Charles. "Survivors of the War on Smallpox Fear Their Old
Foe." Los Angeles Times online. 6 November 2001. http://www.latimes.com/news/nationworld/wire/sns-worldtrade-smallpox-lat.story
[Link current as of August 17, 2002.]
Tucker, Jonathan. Scourge: The Once and Future Threat of Smallpox.
New York: Atlantic Monthly Press, 2000.
main page on smallpox
Clinical and Epidemiologic Features": a special issue of the CDC's
magazine Emerging Infectious Diseases
Slideset on the Diagnosis of Smallpox (available for download
in HTML and as powerpoint presentation)
American Medical Association Working Group for Civilian Biodefense's
Statement: Smallpox as a Biological Weapon: Medical and Public Health
Information for the General Public"
Journal of Young
Investigators. 2002. Volume Six.
Copyright © 2002 by Katherine Bourzac and JYI. All rights reserved.