With war looming, biological attacks on the United States have been predicted. The smallpox vaccinations many of us had as children were effective for perhaps as little as five years. President Bush has ordered the inoculation of 500,000 military personnel; in January, he issued a call for ten million healthcare workers to be vaccinated voluntarily. But many of these professionals, fearful of the vaccine's side effects, are not participating, effectively stalling the immunization plan.
Readers of Richard Preston's latest book, The Demon in the Freezer, may find this alarming.
Preston's book is the third in his "Dark Biology" trilogy. It follows The Hot Zone, a non-fiction account of an Ebola virus outbreak, and The Cobra Event, a thriller about biological weapons and terrorism. In The Demon in the Freezer, Preston returns to non-fiction with an inside look at the history, devastation, and eradication of the smallpox virus. We also learn how smallpox has once again become a serious danger, the biggest bioterrorist threat we face.
The deadliest natural smallpox virus is known as Variola major. It is lethal and highly contagious in the air. One infection can cause twenty new cases, each of which can cause twenty more. Indeed, smallpox can start the biological equivalent of a runaway chain reaction.
"It has taken the world nearly 20 years to reach roughly 50 million cases of AIDS—variola could reach that point in 10 to 20 weeks," Preston notes.
‘The genie is out of the lamp.’
He illustrates the problem with the story of a German man who became infected during a trip to Pakistan in 1970. When the man, infected with smallpox, appeared in an emergency room in Germany, seventeen cases of smallpox occurred in the hospital on the floors above—and only a handful of the victims had any direct contact with him. The German government ultimately vaccinated a hundred thousand people to stop the outbreak.
Smallpox kills about a third of the people it infects. The virus is thought to have killed more people than any other infectious disease, including the Black Death. Preston writes, "Roughly one billion people were killed in the last 100 years of the virus's activity on earth" (which ended in 1979).
The disease causes skin to puff up with blisters the size of hazelnuts, especially over the face. The book's physical descriptions of smallpox victims can be gruesome and are not for the faint of heart. In a tame passage from an early chapter entitled "Stripper", Preston relates, "the virus had stripped the skin off his body, both inside and out, and the pain would have seemed almost beyond the capacity of human nature to endure."
The book's most inspiring section recounts the World Health Organization's successful effort to wipe out variola from the planet. The eradication campaign ran in full force from 1965 to 1975. A scientist named D.A. Henderson and seven staffers supervised thousands of healthcare workers who labored tirelessly to contain outbreaks around the world. For example, in India, at the peak of the campaign, workers visited 120 million homes over the course of just a year and a half.
The eradication of smallpox is considered one of mankind's greatest achievements, and Preston tells this story well, using the same engaging, clear prose throughout the book.
The story of smallpox does not end with its eradication from nature in 1979. Officially, the virus now exists in only two places—a storage facility in Russia and the Centers for Disease Control in Atlanta. Preston presents convincing evidence, however, that several nations, including Iraq and Russia, have developed biological weapons using the smallpox virus.
Preston introduces us to Peter Jahrling, the top scientist at USAMRIID, the United States Army Medical Research Institute for Infectious Diseases, whose primary mission is to protect the public against a biological terrorist attack.
"If you believe smallpox is sitting only in two freezers," Jahrling tells Preston, "I have a bridge for you to buy. The genie is out of the lamp."
The book pits Jahrling and D.A. Henderson, who is now the chief bioterrorism advisor to the Secretary of Health and Human Services, against each other in a complex bioethical conflict. Henderson and his supporters want to destroy the last two "official" strains of the smallpox virus. Jahrling fights to keep the smallpox virus alive. He and his USAMRIID team reawaken the smallpox virus at the CDC, and conduct a series of controversial experiments by infecting monkeys with live Variola for new vaccine research.
Preston presents chilling evidence that scientists in Russia and perhaps other countries are working to genetically engineer a new smallpox virus that would be resistant to the existing vaccine. "A vaccine-resistant smallpox would be everyone's worst nightmare come true," the author writes. "We would be left trying to fight a genetically engineered virus with a vaccine invented in 1796."
Preston jumps around and follows a number of narrative strands throughout the book; at times the story feels disjointed and the large cast of scientific characters can be overwhelming. He begins and ends the book with interesting, detailed coverage of the investigation of the anthrax attacks of 2001. But he does not make strong connections between the current smallpox threat and those anthrax deaths, and ultimately these chapters feel like they belong in a different book altogether.
Nevertheless, Demon in the Freezer is gripping, painstakingly researched, timely, and, above all, frightening beyond words.
Toward the end, Preston recounts a secret meeting of experts on infectious diseases held in April 2002. Asked to create a model of the spread of smallpox, one expert made this prediction: "…if you don't catch the first guy with smallpox before he kisses his wife, it goes out of control. We could be dealing with hundreds of thousands of deaths. It will absolutely shut down international trade, and it will make 9/11 look like a cakewalk. Smallpox can bring the world to its knees.""