The (Life) Science of War

Here's a nightmare scenario. Four Islamic extremists decide to give their lives to the jihad against America. Instead of blowing up the Brooklyn Bridge or flying a fuel-laden airplane into an ExxonMobil refinery outside of Houston, they allow themselves to contract smallpox. This will kill them in about 12 to 14 days. But for roughly 10 of those days, they will not look or feel sick. No one will know that they are smallpox carriers.

One of them goes to the Mall of America. Two others wander about O'Hare and Midway airports. The fourth visits the Chicago train station. Over the course of one week, they each come into contact with maybe 1,000 to 1,500 people each day. Each of those people comes into contact with 100 more each day, who in turn come into contact with, say, 75 more, and on it goes. Unbeknownst to any of them (except the terrorists), many of those people coming into contact with one another are smallpox contagious. None of them will feel it or show it. But in two weeks, they will be either very sick or dead.

By the time the first cases become known to public-health officials, hundreds of thousands of people will have already been exposed. And by then, it will be too late. An epidemic will be loose across the land. The ring containment strategy, which calls for the immediate inoculation of anyone who might come into contact with a smallpox carrier (thus containing an outbreak), will be overwhelmed by the sheer number of cases. In military terms, smallpox is a "force multiplier" that changes the rules of warfare.

If you're the president of the United States, you have exactly two options: You can either hope that it never happens or preemptively inoculate everyone in the country. That doesn't seem like a terribly difficult decision until you realize that if you choose the second option, there will be serious side effects, such as vesicular rash and postvaccinial encephalitis, for 0.09% of all Americans. That's roughly 253,000 people -- just about the entire population of Louisville, Kentucky. And for a small number of Americans (up to six per one million), the vaccine will be fatal.

That's the decision that sits on President Bush's desk right now. Production of the smallpox vaccine is being ramped up to meet existing demand and to prepare for the distinct possibility of a presidential directive. By this time next year, there should be more than enough to go around. By this summer, there will be enough smallpox-vaccine doses available for people to get "scratched" voluntarily by their general practitioners. (Administration of the smallpox vaccine is an unusual procedure: The dosage is scratched into the skin, rather than injected.) Until there is a better vaccine -- or an antiviral medicine that works -- the side-effects math won't change at all.

Chemical and biological warfare has been the nightmare scenario of American military planners, and military planners around the world, ever since the late 1980s and early 1990s, when it became known that the Soviet Union had developed especially virulent strains of both anthrax and smallpox at a secret facility known as the Biopreparat. As word of the Biopreparat's work spread across intelligence agencies worldwide, the specter of genetically modified anthrax or smallpox loomed. Behind it lurked the possibility of genetically targeted smallpox, anthrax, or serin gas: biological and chemical agents that could, in theory at least, kill Jews but not Arabs, blacks but not whites, Asians but not Caucasians.