Scourge: The Once and Future Threat of Smallpox

Smallpox is the only infectious disease to have been eradicated, but the virus still exists in laboratories. Following a 1992 revelation that the Soviet Union had secretly developed smallpox into a military weapon, officials around the globe expressed concern that samples of the virus could fall into the hands of "rogue" states and terrorist organizations. Since vaccination stopped in 1980, most of the world is now susceptible to infection. Tucker (Monterey Institute of International Studies) provides a history of the horrific disease and analyzes urgent efforts by the US and other countries to strengthen their medical defenses against it. Annotation c. Book News, Inc., Portland, OR (booknews.com)

Without the smallpox virus, the world today would be exceedingly different. Although issues surrounding smallpox have been the subject of speculative fiction, Scourge is a superb and engaging factual treatise -- both historical and scientific -- dealing with the impact of this highly contagious and often lethal infection from ancient times to the present. Beginning with the opening sentence, in which smallpox is denoted as "the world's most dangerous prisoner," the author relates a fascinating tale in which it is not armies and conquest that repeatedly change the course of civilization, but the variola poxvirus, manifested as two forms of disease: variola major and variola minor. Although the historical vignettes are interesting, no attempt is made to provide an in-depth analysis of many events that are themselves the subject of entire books. Instead, some of the initial purported forays into the field of biologic weapons involving smallpox are highlighted. However, it is clear that these anecdotes are a prologue to an unexpected series of much more serious recent events. Thus, the author sets the stage for the real story -- that of three centuries of valiant attempts by the global medical community to eradicate this terrible scourge, albeit without complete success. The heroes of the story are physicians who work tirelessly to rid the human population of this disease, often against strong political countercurrents and under dangerous circumstances. From the discovery of vaccine prophylaxis by Edward Jenner to Donald A. Hendrickson's tireless efforts to see the disease abolished, a massive assault on this pathogen was launched. This humanistic work, often conducted under extreme conditions in the field by a global health care team involving as many as 150,000 persons, culminated in the World Health Organization's announcement in 1980 that smallpox disease had been wiped out -- a singular, historic event. Just a little over a decade previously, it had been estimated that 10 to 15 million people in 43 countries had smallpox, a statistic of which even recent medical school graduates may be unaware. Furthermore, eradication of smallpox transpired in the midst of the Cold War, so it is perhaps even more surprising that Soviet and U.S. teams found common ground in developing strategies to contain outbreaks of disease and jointly supply vaccine. Intriguingly, the real villain, the virus itself, had not been eradicated, since it was stockpiled at that time in any number of secure and not-so-secure facilities. The descriptions of the biologic-warfare programs conducted by one major world power -- and perhaps more than one -- are both terrifying and appalling. In the latter portion of the book, the author reconstructs the way in which biologic-warfare agents based on the variola virus were developed behind the Iron Curtain, apparently on the mistaken assumption that the United States was doing the same as part of a biologic-arms race occurring in parallel with the proliferation of nuclear weapons. The scientific and political debate over whether the remaining stocks of virus should be destroyed makes interesting reading, particularly in relation to the disparate views of basic-science researchers, World Health Organization physicians, politicians, and military personnel. The work of judging the actions of the principals in what seem to be morally ambiguous events is left in large part to the reader. Written before the tragic events of September 11, 2001, and the sporadic cases of anthrax infection that were subsequently identified, the cautionary note in the final chapters of the book concerning the potential use of smallpox as a biologic weapon looms even larger on today's world stage. In summary, Scourge is a well-written, informative history of the eradication of smallpox disease. The author's authoritative command of the intrigue surrounding the "stay of execution" of the virus itself and its potential use as an agent for biologic warfare makes the latter portion of the book read much like a modern spy thriller, one that is difficult to put aside as recent events continue to unfold. David L. Dunn, M.D., Ph.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Tucker, an expert in biological weapons, has a sense of both the detail and the broad sweep of history that helps him make the story of smallpox as disease and as weapon fascinating and frightening. He reveals that the deadly infection was used as a weapon in American colonial and revolutionary times as well as in the Civil War, and he devotes much of the book to the WHO smallpox eradication program, which freed the world of it in 1978. D. A. Henderson, a major participant in that program, demonstrated the toughness and persistence needed to face down powerful politicians and bring religious leaders to heel. Nationalism and economics have often played negative roles in the fight against smallpox; for instance, the shah of Iran kept an epidemic secret so that celebration of the two-thousand-five-hundredth anniversary of the Persian Empire wouldn't be overshadowed. Tucker describes in detail the long struggle over maintaining research stocks of the virus--an effort that rather leaves smallpox as a terrorist weapon looming threateningly over this well-written, thoroughly documented book. William Beatty
Copyright © American Library Association. All rights reserved

A political scientist and an expert on bio-weapons analysis, Tucker provides an engrossing look at the continuing debate over the destruction of smallpox. The author uses numerous interviews with key players to look at the political and social aspects of the disease. Although a brief history of smallpox is included, the strength of the book lies in the author's description of the process used to eradicate naturally occurring smallpox. Equally valuable is the last section that considers the pros and cons of destroying the laboratory stockpiles of the virus. Postponed several times, the elimination of the remaining virus is now set for 2002. Concern remains among experts that if smallpox were somehow reintroduced into society, the public health system would not be able to contain the disease. The potential viability of smallpox as a biological weapon is covered in reasonable depth. Light on technical language, this accessible book is highly recommended for all libraries. Tina Neville, Univ. of South Florida at St. Petersburg Lib.
Copyright 2001 Reed Business Information, Inc.