There is no longer any good reason to preserve lab samples of smallpox virus, an organism responsible for mass death and destruction

(Image: Andrzej Krauze)

DELEGATES from across the world will meet next week at the World Health Organization in Geneva, Switzerland, to consider an irrevocable act: the deliberate and final extinction of a species.

Everyone agrees that the world is a better place without this particular species roaming free. There was universal celebration when it was all but wiped out more than three decades ago. Even so, the WHO debate stands a fair chance of stalling because the group is well practised in not quite making things happen where this species is concerned. It will be the sixth attempt to resolve this issue. So what’s going on?

The species is the Variola virus, which causes smallpox, and the group deciding its fate will be the 67th World Health Assembly, the WHO’s decision-making body.


At its height, smallpox killed 1 person in 12 and mutilated hundreds of millions more. During the 20th century, vaccination steadily edged it towards extinction. Like most doctors of my generation, I never saw a case after qualifying in 1977 and hopefully never will, because the global eradication of smallpox was confirmed in 1980.

The disease may have disappeared globally but the virus is not extinct. After eradication, the WHO closed smallpox research labs across the world and destroyed all stocks of the virus except for two duplicate sets of representative strains, which were kept for research in two high-security establishments. This was in 1983, when US president Ronald Reagan’s Star Wars initiative dominated the headlines. In true cold war symmetry, the WHO handed one batch to the US Centers for Disease Control (CDC) in Atlanta, Georgia, and the other to the State Research Centre for Virology and Biotechnology in Koltsovo, Novosibirsk, then part of Soviet Russia. At both sites, the virus samples were locked away in liquid nitrogen. The WHO has repeatedly postponed the date of destruction because of US and Russian opposition.

Not much has changed since the last time the stockpiles were spared in 2011. Experimental smallpox drugs are in the pipeline. The intact virus is pretty redundant as a research tool: the genomes of many strains have been thoroughly sequenced and key proteins required by the functioning virus can be made in the lab. Over the last 30 years, the stocks of virus have contributed little to scientific understanding, other than confirming that new drugs aimed at other viruses still plaguing us are not much use against smallpox.

The Advisory Group of Independent Experts, convened by the WHO, recently argued that keeping the virus will never serve any useful purpose. It has been overruled by another expert committee, also convened by the WHO; the Advisory Committee on Variola Virus Research says the stockpile can help the work on antiviral treatments.

Talk of the need for new treatments is undoubtedly influenced by past misuse of the virus for military ends and contemporary fears that terrorists or a rogue state might commandeer smallpox as a bioweapon.

During the 1760s, the English hatched a plot to exterminate Native Americans by deliberately infecting them via blankets that had been exposed to smallpox. They didn’t wipe them out, but many died. This theme was picked up and refined 200 years later by the Russians. It is an unfortunate coincidence that their highly virulent strains of weapons-grade smallpox were developed at the VECTOR germ warfare laboratory in Koltsovo, on the same site that now houses the virus stock that was entrusted to the Soviet Union.

The Variola virus is a genie which must not be allowed to escape from its bottle into the world again. The chances of smallpox being released, inadvertently or deliberately, from either the CDC site or Koltsovo are vanishingly small, given the elaborate security.

The Variola virus is a genie which must not be allowed to escape from its bottle into the world again

However, that risk will never be zero while stocks remain. Destruction removes that risk and might allow the WHO to focus on what we will really need if smallpox ever comes back, either because a related virus evolves to replace it, or a human villain releases some unknown cache.

There is no proven treatment for smallpox and our vaccines, while effective, are in short supply. The vaccine issue is where we should focus our efforts. A handful of countries have enough to immunise just 20 per cent of their populations; the WHO used to hold hundreds of millions of doses but destroyed most when freezer space was in short supply during the 1990s. In an emergency, it would take months for vaccine production to get up to speed, and even then this would be on a pathetically small scale.

Today’s transport networks are capable of spreading the virus quickly through the biggest susceptible population in the history of our species. Immunity was lost as vaccination, which carries health risks, stopped soon after eradication. So a smallpox outbreak could easily become a global catastrophe, which the WHO’s stocks of Variola would do nothing to mitigate.

So what should happen in Geneva next week? Above all, the World Health Assembly should vote to destroy the stocks of Variola virus without further delay. This would prevent yet another unedifying and expensive cycle of indecision. If the threat of smallpox staging a comeback is at all credible then our capacity to deal with it must also be credible.

Also, we must not forget the wider significance of smallpox. It is not just one of the nastier exhibits in the museum of medical horrors. It is the only human infection that we have successfully exterminated. It is time for the WHO to move on.

This article appeared in print under the headline “Smallpox must die”