
A drug for smallpox has been approved, even though the disease no longer exists - cpncrunch
https://www.cbc.ca/news/health/second-opinion-smallpox-drug-tpoxx-1.4756087
======
preinheimer
The article makes it sound like the only remaining samples are tightly
controlled. Remember just a few years back the NIH found some samples lying
around in a closet: [https://www.cnn.com/2014/07/11/health/smallpox-found-nih-
ali...](https://www.cnn.com/2014/07/11/health/smallpox-found-nih-
alive/index.html)

I doubt that it was the only sample in the world to escape eradication.

~~~
dfsegoat
It was pretty well documented that Russian stockpiles of their India strain
went missing by the metric ton, post-USSR.

[https://www.wsj.com/articles/SB1039129770495563833](https://www.wsj.com/articles/SB1039129770495563833)

[https://www.nytimes.com/1999/06/13/world/government-
report-s...](https://www.nytimes.com/1999/06/13/world/government-report-
says-3-nations-hide-stocks-of-smallpox.html)

~~~
andy_ppp
How is it that we haven’t seen more disasters caused by missing suitcase nukes
or smallpox? My guess is the security services are better at keeping things
stable than we think but it also probably means you’re under perpetual
surveillance.

~~~
flingo
If potential disasters were actively getting stopped, they'd be documented.

I think it's just that nobody has both the ability and desire to destroy the
world at the same time. Do we even know if smallpox would kill a modern human?

~~~
hn_throwaway_99
> Do we even know if smallpox would kill a modern human?

The last person to die of smallpox died in my lifetime. I hope I'm not so old
that I'm no longer considered a "modern human".

~~~
lkrubner
At least in countries like the USA there is still some herd immunity. Everyone
over the age of 40 was vaccinated and also some people younger than 40.

~~~
andy_ppp
Do we know if the vaccine works against modern “weaponised” strains of
smallpox?

~~~
felix_nagaand
Vaccination would presumably be adjusted for by anyone weaponizing small pox,
or any other biological wmd for that matter.

------
DenisM
I am awed every time I think that we have _eradicated a disease_.

It’s just such a “the future is now” thing. I mean, it was 1980, but still.

~~~
ddebernardy
It's still the only one we've eradicated insofar as I can recollect... (Polio
will, hopefully, follow in the coming decades.)

Aside - Good video series by Yale for anyone interested in the history of
diseases in western society:

[https://www.youtube.com/watch?v=UoWxdlGBVTI&list=PL7C32775F0...](https://www.youtube.com/watch?v=UoWxdlGBVTI&list=PL7C32775F0529BFEF)

~~~
Turing_Machine
We're getting damned close with guinea worms -- down from 3.5 _million_ cases
in 1986 to 22 in 2015.

[https://en.wikipedia.org/wiki/Eradication_of_dracunculiasis](https://en.wikipedia.org/wiki/Eradication_of_dracunculiasis)

May the day when it drops to zero come soon.

~~~
Baeocystin
I do hope we get a full genomic sequence of it before it's gone, though.
Anything that has co-evolved dealing with the human immune system for so long
likely has useful tricks up its sleeve if they were applied for medical use.

And considering how much suffering this parasite has caused, it is a nice
thought to think that humanity might get some benefit out of it beyond simply
stopping the cycle of pain.

~~~
greglindahl
They're currently sequencing the hell out of it to figure out why it's
attacking dogs and what they can do about that.

~~~
Baeocystin
Glad to hear it, and I hope they come up with a canine solution with speed.

------
occamrazor
How do they know that the treatment is effective? I would assume it has been
tested only in vitro, unless they infected and cured volunteers.

~~~
projektfu
[https://www.ncbi.nlm.nih.gov/pubmed/29972742](https://www.ncbi.nlm.nih.gov/pubmed/29972742)

They received special dispensation to declare it effective if it treated
monkeypox in monkeys and rabbitpox in rabbits.

~~~
jessriedel
Are the in vivo animal tests considered significantly more convincing than in
vitro tests on human cell cultures?

~~~
civilitty
They had to have used both in their premarketing application. There are a lot
of basic tests that can be done in vitro that can flag early indications of
toxicity in humans but in the end you need some sort of in vivo testing.
Infecting someone with what is essentially a bioweapon for a clinical trial is
a an ethical nonstarter but together, the in vitro and in vivo tests are
enough to tacitly approve this drug.

I think this is essentially unprecedented and I doubt any pharmacies would be
allowed to stock it let alone dispense it without calling the FDA/manufacturer
directly and getting case by case approval to apply it under clinical
supervision. The approval does clear the bureaucratic hurdles to transporting
across state lines and getting it into the hands of a doctor quickly in the
emergency event that smallpox returns.

Edit: Their Phase 3 trial [1] appears to be the equivalent to a regular Phase
1 trial where the dosage of the drug is increased under clinical supervision
until side effects become intolerable for 50% of the patients to find a safe
maximum dose. This means that they tested safety in vivo on humans already and
instead of showing efficacy (whether it actually does what it is supposed to
do vs a placebo) on humans, they were allowed to do it with animals. They used
449 18 to 80 year old patients which is quite a bit more than usual for a
safety phase so they can be reasonably certain it won't make the situation
worse in the event of smallpox.

[1]
[https://clinicaltrials.gov/ct2/show/NCT02474589](https://clinicaltrials.gov/ct2/show/NCT02474589)

~~~
jessriedel
Hey, thanks, super helpful. Incidentally, how do they ethically test safety
for a drug that has no plausible health benefit to the patient? Are they
allowed to just pay the patient?

~~~
civilitty
Except in rare cases like chemotherapy drugs, only healthy patients are
selected for a phase 1 study and the entire phase is carried out at hospitals
under doctor supervision.

They do get paid and there really is no ethical alternative. By definition,
zero drugs would have a "plausible health benefit" at this stage because
you're trying to figure the negative effects and a maximum safe dose without
having confounding effects from the disease you are trying to treat.

~~~
jessriedel
Oh interesting, I was only familiar with the chemo-type testing. Thanks again.

------
hamilyon2
Can we fund development and stockpile reserves of new, effective antibiotic,
all while not selling it to anyone else? As an insurance against bioterrorism,
if nothing else.

~~~
ju-st
They exist:
[https://en.wikipedia.org/wiki/Drug_of_last_resort](https://en.wikipedia.org/wiki/Drug_of_last_resort)

~~~
Dylan16807
well... [https://www.independent.co.uk/environment/farmers-
chickens-a...](https://www.independent.co.uk/environment/farmers-chickens-
antibiotic-boost-weight-colistin-farm-animals-infections-a8191521.html)

------
lanius
I shudder to think what modern warfare would be like without biological
weapons being banned.

~~~
dmurray
Plenty of war practices are banned but still carried out. Torture of
prisoners, chemical warfare, targeting civilians, killing enemies who have
surrendered or who can't fight back. All of these get committed by major
modern states - most of them even by the US in the last ten years.

Governments refrain from biological warfare because it's not effective in
achieving their aims, not because it's banned.

~~~
nojvek
Why aren’t biological weapons effective? I mean if US wanted to wipe out Its
enemies or vice versa, if someone really hated the US army, biological bomb
that would go off after a large part of army is already infected would be the
most deadliest right?

~~~
fucking_tragedy
I'd imagine it's for the same reason we don't drop nuclear warheads on
everyone we come into conflict with even thought it's a pretty efficient way
to wipe enemies out. Infectious diseases don't discriminate, they can mutate
and spreading them means your enemy can get a sample to weaponize.

------
jccalhoun
I love that the subtitle gives the answer.

------
goda90
Why do we discontinue vaccines for "eradicated" diseases? Is it just to save
money? Did the vaccine have side effects that stop being worth it? On the
other hand, besides protection from bioterrorism, can a vaccine provide some
benefit in protecting against related diseases?

~~~
Spooky23
Because they are not gone.

Weaponized smallpox almost certainly exists. It escaped a Soviet lab in the
70s and other countries including the US worked on it.

Smallpox is uniquely deadly... it wiped out something like 75% of the
indigenous population of the americas.

~~~
opo
>...Smallpox is uniquely deadly...

The indigenous people were exposed to many diseases, not just smallpox:

>...Numerous diseases were brought to North America, including bubonic plague,
chickenpox, cholera, the common cold, diphtheria, influenza, malaria, measles,
scarlet fever, sexually transmitted diseases, typhoid, typhus, tuberculosis,
and pertussis (whooping cough).[2][3][4] Each of these brought destruction
through sweeping epidemics, involving disability, illness, and extensive
deaths

[https://en.wikipedia.org/wiki/Native_American_disease_and_ep...](https://en.wikipedia.org/wiki/Native_American_disease_and_epidemics)

>...it wiped out something like 75% of the indigenous population of the
americas.

It's hard to give a precise estimate of how many deaths occurred. Some say it
was much higher than 75%. For example:

>...Between 1492 and 1650 the Native American population may have declined by
as much as 90% as the result of virgin-soil epidemics (outbreaks among
populations that have not previously encountered the disease), compound
epidemics, crop failures and food shortages.

[https://www.encyclopedia.com/science/encyclopedias-
almanacs-...](https://www.encyclopedia.com/science/encyclopedias-almanacs-
transcripts-and-maps/impact-european-diseases-native-americans)

------
Puer
It would be unfortunate if otherwise eradicated diseases make a reoccurrence
because of the ill-informed anti-vaccination movement. I hope this drug and
others never has to see use in the future.

~~~
rhino369
People aren't generally vacinated against small pox becuase it has been
eradicated. If it comes back, it's because of biowarefare or research mistake.

~~~
trentmb
Or climate change.

[https://www.scientificamerican.com/article/as-earth-warms-
th...](https://www.scientificamerican.com/article/as-earth-warms-the-diseases-
that-may-lie-within-permafrost-become-a-bigger-worry/)

------
fallingfrog
Somebody needs to come up with a military application of Lyme disease so we
can get a vaccine for it finally.

~~~
strictfp
Why do you say this?

~~~
fallingfrog
Because in the current political climate you can only get money for something
if it can be weaponized somehow.

~~~
strictfp
Ah. Went over my head, thanks.

