Dark Smallpox Winter

Dark Smallpox Winter, The Wall Street Journal, February 11, 2003, p. A26:

As a Bush Administrations official privately about the chances of another terror attack on the U.S., and the answer invariably is 100%. That's only one of the reasons it's troubling that health-care unions and many hospitals are resisting precautionary vaccination for small pox.

The Bush small pox vaccination program was supposed to be completed by the end of this month, yet so far only 700 of 500,000 emergency workers have received shots. Two of the nation's largest health-care unions are actually urging members to refuse vaccinations until the feds cough up special "compensation." (They are the Service Employees International Union and the American Federation of State, County and Municipal Employees.) And any number of hospitals have refused to let first-responders take part in the first phase of the smallpox plan, partly because they say it will cost too much.

These outfits should spend a few minutes reading some of the bioterror documents that have influenced Administration decisions. One is particular noted recently by Defense Secretary Donald Rumsfeld is an account of "Dark Winter," a war game hosted by the Johns Hopkins Center for Civilian Biodefense Strategies in 2001. Its name certainly fits the outcome.

Dark Winter posed a realistic scenario in which 3,000 people were initially infected with smallpox - possible with just 30 grams ( a little over an ounce) of weaponized virus. It assumed each person infected 10 others - a conservative estimate given that there has never been an outbreak in such a dense, mobile, unvaccinated population as today's U.S.

In the simulation, 12 members of the National Security Council are informed that smallpox has broken out: 20 cases confirmed in Oklahoma, with reports of more in Georgia and Pennsylvania. (They will later discover it was released in three shopping malls.) They are told the facts: Small pox has a 30% fatality rate, there is no treatment, and it spreads from person to person. The country maintains just 15.4 million doses of vaccine.

The NSC chooses to vaccinate only essential personnel and anyone who has had contact with the infected, a stragegy known as ring vaccination. By six days into the epidemic, 2,000 cases have been reported in 15 states, with 300 deaths. The disease spreads to Britain, as well as Canada and Mexico, which demand U.S. vaccine serum. Only 1.25 million doses remain, and their distribution becomes violent.

International borders are closed, and food shortages follow. In many states the public health system is overwhelmed and care deteriorates. Civil liberties are suspended: Schools close, some public gatherings are forbidden, states limit travel. Drug companies can't make more vaccine for five weeks.

By 13 days in, 16,000 cases are reported in 25 states - 14,000 in the past 24 hours alone. One thousand people have died and 10 countries have outbreaks. The vaccine is gone, the economy is faltering and residents are fleeing infected areas. A panicked public demands forcible quarantine of victims and their contacts, though by this time that has become logistically impossible.

Then comes the blackmail. Newspapers receive a letter demanding the removal of U.S. forces from Saudi Ariabia and the Persian Gulf within a week. The letter threatens a new smallpox attach, combined with anthrax and the plague, if the U.S. doesn't comply. It contains a genetic fingerprint matching the smallpox strain, proving its veracity.

Dark Winter's simulation ends at this point, though by the time the virus runs its course the U.S., in a worst-case scenario, faced three million cases and one million deaths. Much of what the country values - civil liberties, world power, economic security, access to health care, equal treatment under the law - has been damaged along the way.

The point here isn't to scare people - Well, maybe it is; 15 months after the anthrax attacks, bioterror is a real threat. Protecting against smallpox in advance may make it less likely that an enemy would resort to its use. Dark Winter also underscores how vulnerable U.S. society will remain even with precautions, meaning that the best homeland defense continues to be taking the battle to terrorist abroad and to the states that harbor them.

As for union objections, the Bush Adminstration is preparing a compensation fund for anyone injured by the vaccine. But keep in mind that emergency workers already have insurance and worker's comp, and that health-care workers are already exposed to unusual risk of germs and illness as part of their daily lives.

No homeland defense plan will work without the cooperation of all Americans, especially its leading institutions. The unions and public health officials resisting smallpox vaccination will have a lot to answer for if there is an attack and Americans remain unprepared.