December 3, 2002 - The C.I.A. is investigating an informant's accusation that Iraq obtained a particularly virulent strain of smallpox from a Russian scientist who worked in a smallpox lab in Moscow during Soviet times.

The officials said several American scientists were told in August that Iraq might have obtained the mysterious strain from Nelja N. Maltseva, a virologist who worked for more than 30 years at the Research Institute for Viral Preparations in Moscow before her death two years ago. The C.I.A. considered the information reliable enough that President Bush was briefed about its implications.

Dr. Maltseva is known to have visited Iraq on several occasions. The institute where she worked housed what Russia said was its entire national collection of 120 strains of smallpox, and some experts fear that she may have provided the Iraqis with a version that could be resistant to vaccines and could be more easily transmitted as a biological weapon.

Iraqi Connection World Health Organization records in Geneva and interviews with scientists who worked with her confirmed that Dr. Maltseva visited Iraq at least twice, in 1972 and 1973, as part of the global campaign to eradicate smallpox.

Formerly secret Soviet records also show that in 1971, she was part of a covert mission to Aralsk, a port city in what was then the Soviet republic of Kazakhstan, north of the Aral Sea, to help stop an epidemic of smallpox. The Soviet Union did not report that outbreak to world health officials, as required by regulations.

Last June, experts from the Monterey Institute of International Studies, drawing on those Kazakh records and interviews with survivors, published a report saying the epidemic was a result of open-air tests of a particularly virulent smallpox strain on Vozrozhdeniye Island in the Aral Sea.

Alan P. Zelicoff, co-author of the Monterey report and a scientist at Sandia National Laboratories, said the Aralsk outbreak was a watershed because it demonstrated that the smallpox virus was more easily spread than previously thought and that there may be a vaccine-resistant strain.

The organism can indeed be made to travel long distances, city-size perhaps, and there may be a vaccine-resistant strain or one that is more communicable than garden-variety smallpox, he said in an interview. The Monterey report led American officials to question whether America's smallpox vaccine would be effective against the Aralsk strain or whether new vaccines or drugs might be needed if the strain was used in an attack.

David Kelly, a former United Nations weapons inspector in Iraq, said there was a "resurgence of interest" in smallpox vaccine in Iraq in 1990, "but we have never known why." Scientists and American officials have speculated that Iraq may have bought the Aralsk strain from Dr. Maltseva, whose institute, like so many other scientific labs in Russia, has fallen on hard times since the Soviet Union's collapse.

Significant Vaccine Risks
The possibility that Iraq possesses this strain is one of several factors that has complicated President Bush's decision, expected this week, about how many Americans should be vaccinated against smallpox, a disease that was officially eradicated in 1980.

The White House is expected to announce that despite the fact that terrorists may possess vaccine resistant strains of smallpox and the significant risk of vaccine-induced illness and death, it will authorize vaccinating those most at risk in the event of a smallpox outbreak - 500,000 members of the military who could be assigned to the Middle East for a war with Iraq and 500,000 civilian medical workers.

Unfortunately, the smallpox vaccine is just not harmless. The vaccine injection causes a red, tender and crusting reaction at the vaccination skin site that lasts up to two weeks. More importantly, one out of 150,000 smallpox vaccination recipients experiences more severe reactions, including overwhelming infection due to the vaccine virus in individuals with abnormal immune systems, encephalitis or brain infection. Another one out of 500,000 individuals will die as a direct result of the vaccine. Vaccination of the entire U.S. population will result in 600 deaths and 2,000 individuals with serious brain infections.

If a terrorist deploys smallpox in the US thousands would surely die from the virus vs hundreds from the vaccine. For this reason the US will vaccinate, but it will only vaccinate after the first confirmed smallpox case is diagnosed. Hopefully, the distribution of the vaccine will be rapid and containment of the spread of infection will be quick. If the vaccine is administered within 2 days of exposure only a few thousand will die.

Bio-Terrorism Scenario
Dr. Donald A. Henderson, a senior adviser to the Department of Health and Human Services and a leader of the smallpox eradication campaign, explained the problem this way: "If there's a bioterror event, and someone releases enough smallpox to create a hundred cases -- let's say in the Baltimore area - it would be a national emergency. The demand for vaccine would be beyond all belief." In Yugoslavia in 1972, the outbreak was started by one man, and eighteen million doses of vaccine were needed - one for almost every person in the country.

"That first wave after the bioterror event could be a hundred people with smallpox," Henderson said. "It takes two weeks after exposure before doctors can diagnose smallpox. Meanwhile, those hundred people will give smallpox to a thousand or two thousand people. That's the second wave. Some of those first hundred people will go to other cities -- to Washington, to New York, all over. So the second wave will include cases in other American cities, and probably in foreign countries. By then, it'll be too late to treat them, and we'll lose the second wave. We'll be well into the third wave -- ten to twenty thousand people with smallpox -- before we can really start vaccinating people. By then, we'll begin to pick up so many cases in the Baltimore area that we won't be able to track cases, and we'll just have to vaccinate everybody around Baltimore. A lot of people in Baltimore work in Washington. And so you're going to have a whole lot of people in Washington with smallpox. You can see the deal. Immediately, you would have to vaccinate Washington." Henderson thinks that a hundred million doses of vaccine would be needed in the United States alone to stop a surging outbreak triggered by a hundred initial cases of smallpox from a bioterror event and the outbreak would kill at least 6000-7000 individuals.

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