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A drug for smallpox has been approved, even though the disease no longer exists (cbc.ca)
201 points by cpncrunch 8 months ago | hide | past | web | favorite | 128 comments

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...

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

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



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.

Nuclear weapons have a shelf life that is surprisingly short for smaller more complicated weapons. Tritium dopants and plutonium cores degrade quickly. The cores can be reprocessed but it is difficult.

Smallpox on the other hand is much more likely to just get your home country nuked into oblivion if they find who deployed it. It's effectiveness as a weapon is going to be limited in first world countries with ring vaccination programs and epidemiologists. On the other hand it would be devastating to the countries that would have a ideological reason to deploy them.

Modern terrorism is a game of chicken. You want to be successful enough to degrade the enemy without triggering a backlash. Smallpox and nuclear weapons are great deterrents, however deploying them would mean the end of the countries and organizations using them.

Dr. Strangelove: "Of course, the whole point of a Doomsday Machine is lost, if you keep it a secret! Why didn't you tell the world, EH?"

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?

> 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".

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.

That "age of 40" number is years out of date. Routine smallpox vaccination for children in the US stopped after 1971, after the disease was declared eradicated in the Americas. The vaccine was given at age 1, so people born in 1971 generally did not get it. So to get to "everyone" you have to look at people aged 47 or above.

Not really. First I'm over 40, and was never vaccinated.

Plus, effective heard immunity requires something north of 85% of the population. Smallpox vaccination rates are not even 50%.

Military personnel are still vaccinated.

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

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

A very optimistic perspective. Seems more likely to me that we are simply lucky than that the intelligence community is competent in their charter.

And supposedly the virus can survive for an extremely long time in a dormant state. Could someone do a little bit of homework who died from smallpox, dig up their corpses, and find live samples that way?

In an all out war those nations holding it tight, might release it. Samson option or just a madman dictator (his military might go ahead with the order too.) So, USA spends next to nothing and has insurance against this unlikely but catastrophic scenario. Makes perfect sense.

Others in comments also made a good point...what if the virus survives decades in cemeteries and is released when they dig or move the cemetery. Within a week hours it would probably be spread all over the world, given globalization.

Winston Churchill held out against using Anthrax against the Nazi’s. I think it’s very surprising actually what countries won’t do in an all-out war.

After all, the goal is usually to get the enemy to surrender / capture available resources / not turn the rest of the world against you. Millions can certainly die, but it could be very possible say for a World War III between US and China where no one winds up using nuclear weapons.

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.

I still get a good feeling going to the Wikipedia page for smallpox and seeing the first two words of the entry:

"Smallpox was"

Don't mean to brag, but making this edit to Wikipedia felt damn good:


I love knowing that I was the person to create the first Wikipedia article on resilience. I didn't have an account at the time, but the IP address is there forever. It's since been disambiguated, which makes it look only 10 years old, but the first edit was me and it was in the material science sense of the word, though now I like to think it says something more generally about me, even if I know that that type of magical thinking is hogwash.


There's a whole "Is vs Was" discussion on the Talk page, for anyone tempted to re-litigate the matter. I'll just point out that other extinct items are often worded like "The dodo is an extinct bird..."

[1] https://en.wikipedia.org/wiki/Talk:Smallpox [2] https://en.wikipedia.org/wiki/Dodo

Check your sentence diagram.

The extinctness of the dodo is present tense. Therefore, it is an extinct bird.

The dodo was a ground nesting bird that inhabited the island of Mauritius. But it's still extinct.

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:


Rinderpest was an infectious disease of cattle, which was eradicated slightly more recently. A cattle disease might seem like a weird priority, but for marginal cattle farmers in poor nations your cows dying basically means very likely you'll starve. So in effect we wiped out one cause of poor people starving to death.

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


May the day when it drops to zero come soon.

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.

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

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

The parasite evolved to attack dogs, unfortunately, so there 500 cases of dracunculiasis in dogs were reported in Chad in 2015. So there's a new reservoir. Still, there is hope.

From what I can tell, wild Polio cases have been in the low double digits the past couple years. Hopefully it will be gone by the end of next decade.

It's a bit more complex than that. The Smallpox vaccine was based on the virus of another species. The Polio virus is based on a weakened human virus - which, unfortunately, sometimes becomes infectious again and that is a problem in its own right. Also, the last pockets of infection are basically in war zones where it's difficult to get the vaccines to. But hopefully you're right - maybe we'll eradicate it in the next few decades.

OPV is a weakened virus, that's why you took it orally, but the modern vaccine isn't, it's a conventional killed virus vaccine and, since it's dead, can't cause polio.

Unfortunately the modern vaccine is also much more expensive (which is a problem in poor countries) and much less effective (which is a problem in countries with endemic polio).

I thought viruses weren't alive as such?

Sure, and neither is a car. But we understand if someone says "My car is dead" they don't mean merely that they switched off the ignition.

If you prefer another word is "inactivated".

Anyhow, I'd like a more precise description of the difference between "weakened" and "dead/inactive" (which is what the parent of my comment was about).


Viruses being alive is a debated topic and doesn’t have an objective distinction from what I understand.

There are two polio vaccines - the conventional live-attenuated polio vaccine works really well in developing settings, because it's cheap, multi-dose, and vaccinated individuals shed virus, which give people who were previously or un-vaccinated some protection via exposure.

But if we ever get down to actually thinking "These are the last 5 cases..." it's entirely possible to use the killed virus formulation used in the U.S. and Europe.

Where those cases are is a bigger pain.

Being cynical, you could say this was before the internet - if we tried something similar today, no doubt the few people in the world with conspiracy theories about the small pox vaccine would find each other on some shadowy crackpot forum, start a facebook group, make a professional looking pseudoscientific website, find an ageing B celebrity to endorse them, make an extreme video that starts appearing in algorithmic feeds, launch a facebook ad campaign targeting both the anti-establishment left and conspiracy laden alt-right, get endorsed on twitter by Trump and other populists, crowdfund some junk science research that gets published in a predatory journal (hopefully not the Lancet again) and sooner or later the chance to eradicate small pox is lost.

We may have hit peak future, and are now heading down the other side...

We were really lucky to get that done before AIDS. The classic smallpox vaccine is a live-virus vaccine and dangerous to people with compromised immune systems. There's a newer non-replicating vaccine, but that didn't come out until 2014.[1]

[1] http://www.bavarian-nordic.com/pipeline/imvamune.aspx

I've just learned that vaccinating people suffering from AIDS makes any sense at all (that their immune system benefits from it); thanks. Do you have any pointers to a more extensive treatment of that topic (it's hard to search for due to popularity of articles about research into vaccinating against HIV)?


The term to use is "immune compromised host"

When I was a boy, I had something-or-other that made me at very high risk for complications if I took the Smallpox vaccine. When we traveled to Africa in the 1960s, my mother had to take special documentation proving that I culd not take the vaccine, and that I had been tested for Smallpox.

My understanding is that it was regulations prohibiting travel between countries by unvaccinated persons that helped eradicate Smallpox, and my paperwork is now a quaint story about a bygone era.

Or it would be, if I didn’t remember the whole thing afresh every time anti-vaxxers demand the “right” to send their unvaccinated children into public schools.

We haven't eradicated it though. I guess it's a bit dated now, but you might enjoy "The Demon in the Freezer," written by the same fellow who wrote "The Hot Zone" (a pop history of Ebola Reston).

Me too. Then I am awed once again when I remember the if the current anti-vaccination trend continues, we might never do it again. As I read in another HN comment yesterday: "we, humans, can do great things, but we are also great at getting in our own way".

I thought some tiny pockets of smallpox came back recently..

No, you are thinking of Polio. Live smallpox only exists in two research centers, one in the US and one in Russia.

We will hopefully eradicate polio soon.

We've eradicated many species.

Some of them were a damn good thing to get rid of!

Rockets landing themselves all backwards is pretty amazing no matter how often I see it.

Rockets don't do that.....

Yep. That was the bit when aliens should have landed and made their selves known saying "alright guys, you've passed." as they then go on to share the wisdom of the rest of the universe. Was disappointed they didn't. I guess we have to show them a few more tricks.

Retrorockets and landing backwards have been around (e.g. the Apollo lunar module). The rockets landing backwards thing is hard for a different reason among many other things, namely the inverted pendulum problem.

I get what you're saying but... the first part is obviously not what I was saying ;)

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.


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

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

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

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?

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.

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

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.

If you’re a company that can develop a new, effective antibiotic, you’d sell it to everybody and make out like a bandit.

There's also phage therapy:


Which is using viruses to kill bacteria.

Also I imagine that gene editing might also become a tool in combating infections in the near future.

Smallpox is a virus so you'd need a virophage or vaccines.

At the cost of killing those infected by antibiotic resistant strains now.

Few people die just due to antibiotic resistant bacteria. Generally someone’s immune system is compromised from something like cancer before they are at risk of death. And at that point it’t a race to find what’s going to finish the job.

Are there actually pathogens that are resistant against all antibiotics?

I assumed that the problem with multi-resistant pathogens was that the patient may not live long enough to try all antibiotics.


But over time it's going to get worse and worse.

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

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.

There is morality in warfare, war slowly civilized in Europe during the Middle Ages and Christianity was a big reason for that. Tactics that would have been effective weren't used simply because it became unconscionable.

The Crusades, and then the Napoleonic invasion of Russia, were both notable departures, and both saw militaries surprised when their adversaries used tactics that had long been banned in Europe. The French were not expecting the Russians to put the torch to their own lands so as to deny the French forage. It made the difference that led to the famous infographic.

It's not unreasonable to think that nation-states refrain from biological warfare for moral reasons. As effective as they might be, the government using them wouldn't survive either due to politics or the hammer of the world coming down on them.

It decivilized during WWII, rather quickly.

Oh the breakdown of the old European style of warfare happened long before that, really people should be calling the Napoleonic wars WWI and the two wars we call WWI and WWII, two and three instead.

But by the time WW2 was over, society was conditioned to think of the technological aspects of the wars rather than the social. But chivalry used to be an actual thing.

I've seen the Seven Years War referred to as the first world war. 1756-63.


Give it another 25 years; I'm sure we'll see genetically engineered plagues used by ethnostates (find some mutation that a large portion of your population has that your opponents do not & make that confer resistance) or as an instrument of genocide (the same thing but in reverse) by then.

Or if you're willing to plan ahead a little more... Develop the plague and the vaccine a decade or more before use, and spend the intervening decade adding it to childhood vaccines and seasonal flu shots. When it comes time for use, have the remainder of your population vaccinated.

I may be a pessimist, but I'd guess that "biological warfare is ineffective in achieving the aims of nation-states" won't be a thing forever.

Hmm, in the past few decades we've seen fewer and smaller wars than ever before. Why do you think that trend is going away?

More likely, warfare biological or not is going to become even more rare and even less accepted.

If we keep up the forces that brought us peace, UN, EU, NATO, international trade, amongst many other forces, we're more likely to a world without war.

The US is threatening withdrawal from NATO, a member state is withdrawing from the EU, and international trade wars are heating up between the largest economies. I’m not sure I would count those trends as a sure thing, though certainly they probably have a good bit of wear left in them.

Brexit and Trump are most likely just temporary set backs.. indeed both are widely recognized as stupid (people saying otherwise usually does so out of political allegiance).

Viewed over the past 70 years, currents trends are merely a tiny bump. And indeed we don't see it catching on in the rest of the EU.

Note. We can't just hope for things to continue, but if we put in some work - odds are pretty firmly in our favor.

I hope it will be the case, but the continued existence of civil wars and failed states may put a damper to that.

It depends on your aims, and willingness to accept the consequences of potential mutations. Eventually the requirements to engineer and produce a plague will become something that can be done in a garage, and without the fundamental limits of something like a nuclear bomb for which plutonium is a required.

At that point, I suspect aggressive deterrence will be the only viable option.

Of course, it's also possible that by the point genetic engineering is sufficiently well understood and accessible to the public that someone could create a doomsday plague in their garage we'll have medical technology sufficient to deal with the threat. We've sort of followed that trajectory with computer viruses, after all.

This still doesn't say good things about the survivability of the 3rd world, though. Even though modern server, desktop and handheld devices (let's call these "people with high-tier healthcare") are rather well hardened, older systems (people without that healthcare) and IoT devices (pets/farm animals/crops/nature) are notoriously vulnerable.

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?

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.

The biggest problem is that we have not managed (as far as I know) to make a virus that can identify friend or foe. Biological warfare is a step above nuclear warfare in the potential to kill all humans on the planet. Unlike chemical or nuclear weapons you can't be assured that it will remain in one area, or that it won't mutate in some fashion to become even more virulent/deadly.

It's a weapon so dangerous to use that only the insane would even develop it in the first place.

A traditional bomb is somewhat predictable. You can bomb places without it infecting your own people, save some accidents and things like that. It sets off in a controlled area, and when the damage is done, it stops.

There is no real way someone could set off a biological bomb and promise it won't make its way back to their own people. If it is infectious enough to wipe out the enemy completely, it is enough to spread to your home country. I think some of this is because a biological bomb would almost need to be something that can be carried through the air. There are probably some that could dust an area requiring direct contact, but if the folks have good hygeine, it'll be less of a threat. Contaminating drinking water is harder still - and again, you have to get through hygiene and all available filtration and sanitation systems that the enemy could be using.

You could infect animals, but animals being what they are they are likely to infect folks that aren't the enemy, including your own ground troops if you have any. Things that need direct contact with bodily fluids are even harder to use directly, and you are just as likely to kill slews of medical personell as you are the folks actually warring. Any accidents kill your own people first.

In any case, the outcome and international response will likely be similar to using nuclear warheads on a people. It might work, but you are going to kill lots of innocent people as well with something that keeps on killing long after the initial sickness due to the infectious nature of the thing.

Additionally, I highly doubt they'd mistake a biological for a traditional bomb: Any smart country with a scientific section would be looking at the components of bomb residue. If a biological agent is included, I think there is a chance of finding it and developing a cure before the kiling happened if it doesn't happen in a short timeframe.

Now, this is just for diseases. Poisons (biological or synthetic) and other sorts of chemical weapons are probably easier to control these things, and international response seems to be unfortunately slow on this depending on where in the world it is happening.

The main difference is that none of the ones you mentioned really spreads.

bioweapons and computer viruses are made to spread in a viral way, without the explicit intervention of humans. So once it's out there, it can't be stopped. In the future, nanobots could potentially be a third one too.

So yes, while biowarfare is banned, the consequences of doing it is far different.

> The main difference is that none of the ones you mentioned really spreads.

They all spread memetically rather then biologically. In a way that is a bigger problem because it means effective eradication is virtually impossible, because even if the practice is eliminated, it has “spores” in human cultural record which are both difficult to eliminate and difficult (arguably impossible) to avoid adverse side effects when eliminating.

If everyone forgot about chemical weapons it would only take until the next chemical plant accident for them to be invented again. In fact, if everyone forgot about them they would probably be immediately used given that it's an obvious idea, not difficult to implement and the reason nobody does it is because in history it turned out to not work so well.

But the point is, it doesn't run the chance of accidentally wiping the human race. No one is going to waterboard themselves, or waterboard 90% of the population. It doesn't outpace us and get out of our control. Every time someone gets killed by that method, it's explicit and intentional.

The same can't be said by bioweapons and AI.

It's hard to imagine a nation choosing to release something like smallpox considering the risk of it coming back at you and infecting your own population is pretty high. It's not like anyone has a fully resistant population where they could be sure it wouldn't spread to their own nation, or allies or generally cause political / military response by other nations.

I mean if two nations were at war, my nation / I didn't care, but fucking small pox showed up spreading around I'd be all for some serious interventionist stuff.... I imagine most nations would be all for it.

Granted, chemical warfare could still be a thing :(

Nation states usually act somewhat rationally because they want to continue their existence. What you have to worry about are the zealots who don’t care about dying as long as they can take their enemies out with them because they think they will have a better life on the other side.

> What you have to worry about are the zealots who don’t care about dying as long as they can take their enemies out with them because they think they will have a better life on the other side.

The zealots are usually foot soldiers for states or quasi-states, or groups aspiring to control/creation of states, and most of those groups are similarly rational to states. A random Hamas footsoldier, especially with assurances that his family will then be cared for, may commit a suicide attack, just as a soldier of a name might engage in kamikaze attacks, of in military missions that involve a practical certainty of personal death. But neither the leadership not the groups as units are prone to deliberate self-destruction to maximize damage to enemies.

Terrorists are still acting for a cause, and usually it involves the (perceived) well-being of their culture.

Which doesn't mean that terrorists actually have the good judgment to recognize potential consequences, but e.g. your typical Islamic extremist would consider wiping out the Middle East to be undesirable.

Yeah fringe groups / terrorist organizations who are all about causing as much chaos and flourishing in that would be the folk's I'd be worried about that.

I was a Nuke, Chem Bio Officer in the US Army in the early to mid 2000s.. Bio weapons are very much a threat. Just because we haven’t seen widespread use doesn’t mean they are a benign threat.

Belligerent states don’t care about what is “banned.” Chemical weapons are also banned but there have been several public and not-so-public uses of those during the past 20 years.

Everything old becomes new again. It just changes appearance.

Nukes, synthetic bio and chemical weapons are high-profile. If you acquire, produce or use them, you end up on the international radar. Everybody's watching you.

But coordinate some useful idiots into convincing enough of their own population that vaccines are bad for them, and you'll pave the way for wiping them out by reintroducing the simple pathogens those vaccines protected against.

The future of biological weapons will be organic, all-natural and non-attributable. We are setting ourselves up for something very bad.

The good thing is that biological weapons kind of suck at being weapons at least. If they are too lethal while horrifying their spread is mercifully limited like ebola - if they are too weak they don't wind up noticed. They stick around and either have no collateral discrimination or are already cured or vaccinated for your own people. Even the classic 'throw plague corpses over the walls' has the twofold problem of having to expose yourself to your weapons to use them and the territory or loot to claim now being tainted.

The end impact wouldn't be good start with - less freedom of movement overall with increased tracking and quarantines, less global trade, more restrictions, and bodily autonomy would be a thing of the past as going untested at borders let alone unvaccinated would be an unacceptable threat. Your body /is/ their business as anything related to the immune system becomes a matter of national security. Said heavyhandenss would breed its own backlash as well to perpetuate conflicts as conspiracies that they are making the disease would spread regardless of truth - which is a bit of a problem now even from the people who insist AIDS was a secret project or Ebola workers being attacked by people who don't have causation and correlation straight. Think 'fake news' is bad now along with fact-immune belief? Imagine how tempting censorship would be in the face of those destabilizers combined with the Streisand effect. Then there is without the sociopathic easy solution 'shoot the sick just in case' which would certainly lead to more travesties.

The ironic kicker is that this dystopian state would have some upsides in making it in even the most vile dictator's interests to overfund public health and ensure adequate food supply as starving people have weakened immune systems and may catch something to spread around. World hunger may be ironically ended by selfishness. Instead of Military Industrial Complex the term may well be Medical-Military Industrial Complex with fringe benefits. Overall it would be horrifying and I personally consider the most horrifying part is that there would be some large actual benefits to that twisted status quo.

That’s not really true though, and you don’t have to kill people to have an effective weapon. You could releas foot and mouth and devastate an economy or starve people. The truth is that biological weapons could be very effective, depending on your aims. You can attack people to weaken, but not slaughter a population, to pave the way for a conventional assault. You can attack livestock, crops, and yes, go for mass slaughter. Ebola is an extreme case, but many other organisms have a more agreeable profile. Anthrax can be used as an area denial weapon because of its persistent nature for example.

You just have to utterly lack a conscience, and that’s an ingredient already present in many cases.

True there are some applications even if they may be inferior to conventional weapons in some ways - the real weakness with the biological weapons is protective equipment. Stopping bullets is hard and explosives are even harder. However like chemical weapons masks and coveralls can offer complete protection in many cases.

The interesting thing is that many of those targets are also conventionally attackable yet don't seem to be even considered. Firebombing farms isn't the norm although it is technically an option to weaken them.

For instance terrorists could cause a lot of disruption and casualties just by sabotaging train tracks or shooting substations yet they they target people directly instead. It seems almost memetic that they avoid the 'boring' options even when they lack other motivations. Al-Qaeda doesn't plan on annexing the US in even their wildest dreams so they would have no reason to care about damage to an asset - it is even cheap and uses highly available tools locally. Yet they never even attempted it. The closest thing was considering bringing a plane into a nuclear powerplant until they did the math and realized that it wouldn't cause a meltdown, radiation leakage, or even loss of power - it would cause cosmetic damage.

I've never understood it either.

You could bring down a power grid in a European nation by a well timed series of strikes on major substations and the parts to replace them just aren't held in stock (not in large numbers) and the lead time is long.

The economic damage from blacking out entire regions would be catastrophic.

The problem, from a terrorist point of view, is that if your lights go out you don't think "terror attack". A terrorist is looking for maximum publicity for minimum effort, not maximum economic damage.

It’s also hard to build bombs without killing yourself, hard to transport them, hard to deploy them for maximum effect. Then you’re likely to face the wrath of whoever you attack, and tracing bombs and bombers is something governments do well. Tracing a pathogen could be very tricky, and it might not be possible at all in some cases. Spreading a virus is something even a toddler can manage. If it becomes cheap and easy to engineer to a contagious pathogen, deploying it will be all too easy, tracing it will be challenging.

Interestingly the lack of tracability brings it's own problems (if you are a terrorist). If some group were to have claimed responsibility for the 2014 ebola epidemic, would you have believed them?

I love that the subtitle gives the answer.

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?

Let's be clear here. There are TWO eradicated diseases. Smallpox and a cattle disease that doesn't affect humans.

Otherwise our track record isn't stellar. The efforts with other diseases that could be eradicated have struggled. Polio is closest with just a few remaining countries. Future eradication attempts may be much harder due to the rise of anti-vaxxers.

> Polio is closest with just a few remaining countries.

Actually Guinea worm disease is closest to eradication: closer than polio. https://en.wikipedia.org/wiki/Eradication_of_dracunculiasis

All vaccines have side effects -- the side effects are quite rare but are sometimes severe. Several thousand people have life-threatening reactions to vaccination each year.

The standard vaccination schedule is comprised of vaccinations with benefits which outweigh the medical risk and cost. If you travel to less developed areas you may receive a wider array of vaccinations.

For an eradicated disease there is no benefit and therefore no reason to assume the risk, or cost.

> Based on past experience, it is estimated that between 1 and 2 people out of every 1 million people vaccinated may die as a result of life-threatening reactions to the vaccine.

-- http://www.who.int/vaccine_safety/committee/topics/smallpox/...

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.

>...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


>...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.


> Weaponized smallpox almost certainly exists.

Yep, when they shipped us off to the Middle East in '03 they gave us the smallpox vaccination even if you had it as a kid because, well, WMDs.

Don't think I had it as a kid since I was born in '71 and that's around the time they were phasing it out -- or at least didn't have the vaccination scar before '03.

The smallpox vaccine used at the time of eradication had two main issues:

1) In some (fairly small) fraction of recipients it lead to severe side-effects, including death.

2) It was a live-virus vaccine, which meant a vaccine recipient could actually infect those around them (with the vaccine, effectively). This was a serious problem if anyone near the recipient was immune-compromised; the risk of deleterious side-effects in immune-compromised individuals, who would not be vaccinated normally) was much higher.

There is a modern (a few years old!) smallpox vaccine that is a dead-virus vaccine and would have a very different cost-benefit tradeoff in medical terms. I don't know what the economic tradeoff looks like (i.e. how expensive it is).

According to Wikipedia, for smallpox the reason was:

> Based on past experience, it is estimated that 1 or 2 people in 1 million (0.000198 percent) who receive the vaccine may die as a result, most often the result of postvaccinial encephalitis or severe necrosis in the area of vaccination (called progressive vaccinia). Given these risks, as smallpox became effectively eradicated and the number of naturally occurring cases fell below the number of vaccine-induced illnesses and deaths, routine childhood vaccination was discontinued in the United States in 1972, and was abandoned in most European countries in the early 1970s.

Let’s say it cost $5 per person to vaccinate against smallpox. That’s well over $1 billion to vaccinate all Americans against a disease that no longer exists. Surely we could do something more useful with that money. Maybe vaccinate against a disease people can still catch.

1 billion isn’t even worthy of a line item in the defense budget. Stick it there as part of national security in the event of biological warfare. QED.

Yes but that 1 billion could go to the defense contractors, lobbyists and “donations” to politicians. Why would any rational politician do that?

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.

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.

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

We already had a vaccine, LYMErix.


No military involvement necessary, only emotional restraint and emphasis on rationality.

Why do you say this?

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

Ah. Went over my head, thanks.


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