Bugs Without Borders

1.

The Reagan administration’s decisions to build the Trident submarine and the MX missile and to launch the Strategic Defense Initiative were based on considerations of “domestic politics, history and mythology” as much as they were on “reality—or the best intelligence estimates about it,” writes Frances FitzGerald in Way Out There in the Blue, her account of Reagan’s defense program.¹ Today, Washington is deeply preoccupied with biological and chemical weapons, and the Bush administration is preparing to spend heavily on biological defense research. America’s leaders fear that the rogue states and terrorist groups that are now our adversaries would be more likely to use such weapons, because they are cheaper and easier to procure and deploy than nuclear warheads. In The Demon in the Freezer, Richard Preston describes how US biodefense research can be seen as preparation for a new arms race, but he neglects to address the moral implications of this for the laboratories, the people who work in them, or for the American public in general. Nor is Preston as enlightening as Frances FitzGerald might be about whose interests this buildup actually serves.

In past centuries, epidemics of smallpox, plague, cholera, and other diseases killed millions of people in medieval market towns, colonial cities, and Victorian slums. It is unlikely that the germs that caused these diseases would kill as many people in industrialized nations such as the US, with modern health care, good nutrition, and adequate water and sanitation, but this is not an experiment we would want to carry out. Few twenty-first-century Americans know what an epidemic of smallpox or plague is like, but these diseases so ravaged our ancestors that we may carry the fear of them somewhere in our genes.

The Demon in the Freezer opens with a description of the early stages of the investigation into the anthrax attacks that killed five people in the fall of 2001. In October and November of that year, five envelopes containing highly purified, “weapons grade” anthrax arrived by mail at the headquarters of various newspapers and television news broadcasters as well as at the Washington offices of two liberal Democratic senators, Tom Daschle of South Dakota and Patrick Leahy of Vermont. The envelopes contained letters that said “DEATH TO AMERICA/DEATH TO ISRAEL/ALLAH IS GREAT” and then, curiously, most warned the recipients to take antibiotics right away.

Preston describes the urgency and confusion with which government scientists first responded to the anthrax crisis. He also describes the horror that overcame some of the researchers when they imagined what would have happened if those letters had contained smallpox, which, unlike anthrax, can spread from person to person. To show how infectious smallpox can be, the scene in Demon shifts to a small hospital in the Sauerland region of Germany in 1970, where a young tourist, just returned from Pakistan, lies in quarantine, suffering from smallpox. One day his symptoms temporarily abate and, against the orders of the nurses, he opens the window of his room a few centimeters and smokes a cigarette. Within days, seventeen other people, including several nurses who had never even been in the same room with the young man, contract the disease from him. Scientists later discover that the smallpox virus emerging from a patient’s breath can creep out of a window and up the walls of a building, then back in another window, and infect people two floors above.

The Demon in the Freezer begins with the anthrax attacks, but most of the book deals with smallpox, which since the mid-1970s has existed only in freezers. The smallpox virus is the most terrifying of all the infectious substances that could be used as a weapon. Unlike anthrax or ebola, smallpox spreads easily. Unlike plague, there is no cure for it, and some strains kill 60 percent of their victims, and leave many others blind or disfigured. There is an effective vaccine against smallpox, but its side effects can be deadly for people with weak immune systems. In the 1970s an extensive global vaccination campaign coordinated by the World Health Organization (WHO) eliminated the smallpox virus from nature. But for years, scientists had been collecting samples of smallpox virus from the tissues of sick patients. Scientists used these smallpox stocks for research, for assigning types to virus strains, and for other benign purposes. When the smallpox eradication program came to an end in 1979, the WHO urged every country except the US and the Soviet Union to destroy its stocks of smallpox virus.

Today, only two declared stocks of smallpox remain on earth, one in a freezer in the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and the other in a freezer at the Russian State Research Center of Virology and Biotechnology⁷ near Novosibirsk. However, there are rumors that other countries may not have destroyed their stored smallpox stocks when the WHO told them to do so, and the CIA has recently asserted that Iraq, North Korea, and France probably retained frozen vials of smallpox which could be turned into weapons, and that Russia has secretly continued to “weaponize” its own smallpox stocks.^[2]

Throughout the 1990s, scientists, ethicists, lawyers, philosophers, and even conservationists debated whether or not the United States and Russia should destroy their stocks of smallpox. Some experts, including Donald Henderson, the former head of the WHO Smallpox Eradication Campaign, argued that the stocks should be destroyed, since they had no scientific purpose that couldn’t be fulfilled by safer alternatives and their existence posed a threat to world security. In principle, a terrorist could steal the virus from the extremely secure freezers they are stored in, or a clumsy researcher could infect himself, and then spread the disease to others. Destroying the stocks would also reassure the world that the US and Russia honor the 1972 Biological and Toxin Weapons Convention banning the development, production, and stockpiling of biological and chemical weapons. Countries that have ratified the convention are permitted to conduct research on drugs and vaccines against potential biological weapons, but they are not allowed to design or create germ weapons or build the delivery systems for such weapons.³

Henderson also argued that destroying the stocks would create moral clarity about one of the most dangerous substances the world has ever known. It would make the possession of smallpox absolutely illegal, and as the arms control expert David Koplow has written, it would make “the possessors… rogues, enemies of all people.”⁴ However, other scientists, including Peter Jahrling of the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), believe that the smallpox stocks are useful for defensive research on drugs and vaccines, and in this dangerous, unstable world, there is no guarantee that we might not need them someday.⁵

2.

The Demon in the Freezer takes us to Frederick, Maryland, in 2001, where Peter Jahrling and his colleagues at USAMRIID are preparing to travel to Atlanta where they will try to infect a group of lab monkeys with the smallpox stored at the CDC. Under normal circumstances, monkeys do not contract smallpox, only human beings do. But when Jahrling et al. give the Atlanta monkeys an enormous dose of the germ, enough to kill literally millions of people five times the monkeys’ size, the monkeys do develop a disease very similar to human smallpox. Jahrling’s discovery that monkeys can contract smallpox and suffer and die from it just as human beings do is important because previously it was difficult to test new drugs and vaccines for the disease. The infected monkeys make such research easier, but they also make the decision to destroy the smallpox stocks more difficult, for Jahrling has shown that the smallpox stocks could be genuinely useful for research, even though he is still a long way from developing a cure or improved vaccine for the disease.

Alfred Sommer, dean of the Johns Hopkins School of Public Health, called Jahrling an “idiot” in print, because his smallpox experiment could alarm the leaders of other nations who might wonder why the US is trying to make new cures and vaccines for smallpox. This could set off a biological arms race with other countries, just as anti-ballistic missile research could have exacerbated the nuclear arms race. Preston dispassionately records Jahrling’s grim satisfaction over the successful monkey experiment, and Sommer’s and Henderson’s concerns about it, but we never learn what Preston’s own opinion is.

Other worrying questions have been raised about US biodefense research, but Preston barely mentions them. While some scientists had misgivings about Jahrling’s monkey experiments, other activities underway in America’s biodefense labs come even closer to, if they do not exceed, the limits set by the 1972 Biological and Toxin Weapons Convention. On September 4, 2001, The New York Times reported that an Army lab was creating germ “bomblets” that could, in principle, be filled with smallpox and dropped over a city.⁶ Army researchers were also trying to erect makeshift germ warfare labs in the desert and they were developing plans to engineer more aggressive strains of anthrax that Russian scientists claimed to have developed already. Government officials told reporters that the purpose of all these apparently offensive research projects was to try to understand what our adversaries—Saddam Hussein, for example, or the Russians—might be capable of. However, some critics felt that the line between trying to recreate what a terrorist would do and actually doing what he would do was a very thin one indeed.

Three months after the Times article, The Baltimore Sun reported that for several years the US Army laboratory at Dugway Proving Ground in Utah had been working with the same strain of anthrax that went into those infamous letters in 2001, and had also been making powdered anthrax that was easily dispersible, like the anthrax in those letters.⁷ On page 204 of Demon, Preston claims, in parentheses, that the Dugway program did not produce anthrax “that was anywhere near as pure as the Daschle anthrax,” but he does not say how he knows this, and he does not quote a source. In fact, FBI and army spokesmen have refused to comment publicly on whether Dugway ever made anthrax similar to that in the letters.⁸

The Dugway anthrax program is important because the FBI has long suspected that the anthrax used in the 2001 attacks came from a US biodefense lab, and that a scientist, or more likely a group of scientists, who worked there may have sent it in the mail. If, as Preston asserts, Dugway never made anthrax similar to that in the letters, this would be extremely important for the American public to know. Since Preston only mentions it parenthetically, and since no other source will confirm it, we can only conclude that anthrax similar to that used in the attacks may well have been made at Dugway. Who did it and why is still a mystery, but many simple questions have not been answered, and some haven’t even been asked. In Demon, Preston discusses the FBI investigation of the anthrax attacks, but never draws the obvious conclusion that the nature of biodefense research is both morally ambiguous and potentially extremely dangerous.

In July 2001, President Bush firmly rejected proposals to strengthen the 1972 Biological and Toxin Weapons Convention, which is currently voluntary, and contains no provisions for enforcement or verification. The new provisions, which were accepted by many other nations that have signed the convention, would have permitted scientists from signatory countries to inspect one another’s labs to ensure that defensive biological weapons research really is, in fact, defensive, and that it is focused on vaccines and drugs, and not on the creation of weapons. The Bush administration also postponed until 2006 any further discussion about strengthening the convention.

Preston hardly mentions the debate over the convention, nor does he have much to say about the possible motives behind the anthrax attacks. If the letters came from abroad, one can only wonder why a foreign attacker would target two liberal US senators and a couple of tabloid newspapers. The biologist Barbara Hatch Rosenberg, a professor at the State University of New York, Purchase, believes that the anthrax letters came from an American lab, and were sent to persuade the press, and by extension public opinion and Congress, of the dangers of germ weapons. Perhaps the attacker(s) wanted to convince people of the need for more government funding for biological defense, or perhaps he (they) bore a grudge against some US government agency.

If their intention was to increase biodefense spending, they certainly succeeded. A huge amount of government money is now flowing into biodefense research, both to government institutions such as USAMRIID and to private government contractors such as Scientific Applications International Corporation and Battelle Memorial Institute. In 2000, Bill Clinton asked Congress for $2.8 billion to thwart and prepare for attacks with exotic weapons, including germs, but Congress refused. After the anthrax letters, Bush asked Congress for $11 billion more, roughly the amount approved in the November 2002 Homeland Security Bill.⁹

The lesson of the anthrax attacks is that, wherever the anthrax came from, the rapidly expanding international biodefense industry needs supervision, either under the terms of an expanded version of the 1972 convention or some other independent mechanism.¹⁰ This is necessary because scientists often fail to appreciate the moral dimensions of their work. This was most dramatically explored by the German biologist Benno Müller-Hill in his 1984 book Murderous Science, which describes some of the most gruesome experiments of the Nazi era, including research on the eyes of murdered Gypsies, the brains of murdered mental patients, and the miscellaneous organs of murdered Jews. When Müller-Hill interviewed some of the assistants who worked in the institutions where this research was carried out, he found that

most of them had declared that they had not known anything of the events which linked their academic institutions with the murderers; that there were no traces of anti-Semitism in their field of work;…that their best friends were Jewish or half-Jewish;…and that [as pure scientists] they had given little or no thought to the general context of these events.¹¹

Biodefense research is hardly comparable to the horrors of Nazi science, but this doesn’t mean that we don’t need to keep an eye on it. Preston’s detachment from such important questions as the motive behind the 2001 anthrax attacks and the need to monitor biodefense research deprives Demon of moral and narrative force. Just when the reader expects Preston to pull back from the details of the personality of a particular scientist, or of a particular experiment, and take these issues on, perhaps even giving us his point of view, the scene changes to another experiment, another lab, another portrait of another scientist. As a result, Demon seems fragmented, disorganized, and is actually quite difficult to read.

How do we monitor what is going on in those labs, and at the same time prevent the spread of information that could be used by terrorists elsewhere?¹² This is not an easy balance to strike. But since the 1972 convention went into effect in 1975, the use of germ weapons has generally been clandestine, small-scale, and directed against those close to where the weapons were developed, not against distant enemies. In 1979, an accident at a secret germ weapons factory in Sverdlovsk, Russia, that was working on anthrax killed at least sixty-six people who happened to be downwind from the plant at the time. In 1984, a bizarre Indian cult known as the Rajneeshis, based in The Dalles, Oregon, poisoned local salad bars with salmonella bacteria in order to influence an election the following day. In the 1980s, Saddam Hussein used chemical weapons on the Iraqi Kurds and neighboring Iranians. In 1995, the Japanese Aum Shinrikyo cult used poison gas to kill other Japanese in the Tokyo subway. Some of these incidents were accidents, but most were deliberate. If a US scientist or group did carry out the 2001 anthrax attacks, he (or they) would fit right in to this pattern. If that is the case, perhaps the best way to protect Americans from a biological attack with smallpox would be to eliminate every vial containing the smallpox virus that we can get our hands on, whether it is in North Korea or in our own freezers.¹³

3.

Unlike Richard Preston, Robert Desowitz aims not to frighten us with his new book on infectious diseases, but to infuriate us, and for this reader, he succeeded. Desowitz is an epidemiologist and writer who has spent a lifetime trying to find better ways to control such deadly tropical diseases as malaria and sleeping sickness. In his charmingly wry new book, Federal Bodysnatchers and the New Guinea Virus, he laments the ongoing health crises in developing countries and shows us that in the struggle against infectious diseases, the real battle is often not between public health experts and germs, but between public health experts and accountants. Although Desowitz does not deal with the issue of germ warfare, he does show how naturally occurring epidemics can be severely exacerbated by excessive emphasis on financial considerations—an impulse far more common, and ultimately far more deadly, than the willful urge to commit bioterrorism.

Federal Bodysnatchers opens in New York in the summer of 1999, when a small number of elderly people began turning up with symptoms of brain inflammation at hospitals in Queens. No fewer than twelve different government agencies commenced urgent investigations to find out what these patients were suffering from. But it took these agencies almost six weeks from the time the first patient arrived at a Flushing hospital to figure out that the outbreak was caused by the West Nile virus, which was also responsible for the deaths of thousands of birds in the same region. While the various agencies were busy with their investigations, seven people died. It is unlikely that knowing the identity of the virus could have saved any lives, but it is still worth asking why the US Centers for Disease Control, the New York State and City Health Departments, and a great many other institutions were so slow to learn what virus they were dealing with. Desowitz and others have criticized these institutions for ignoring the biggest clue of all: West Nile was also killing thousands of birds in the New York area, and there are few viruses that cause brain inflammation in both birds and people. However, for weeks the scientists continued to treat the human and avian epidemics separately.

It turns out that until September 1999, few scientists knew that West Nile could cause brain inflammation in birds. In most regions where West Nile epidemics have occurred in the past, such as East and Central Africa or the southern Mediterranean, local birds are immune to West Nile. American birds are not immune to West Nile, but since the virus had never been seen in the Western Hemisphere until 1999, US researchers did not know this. Had they known, their investigations would have gone much more smoothly. The only scientists who seemed to know, prior to 1999, that West Nile could kill certain bird species were associated with the Israeli goose industry, but they were keeping quiet.

In Federal Bodysnatchers we learn that in this globalizing world, the livers of Israeli geese are made into pâté de foie gras, much of which is exported to France, presumably because it is cheaper to rear geese in Israel than in France. In 1997, Israeli geese began dying from West Nile virus infections, but the epidemic was barely reported in the scientific literature and Israeli hospitals did not conduct surveillance for West Nile infections in people, even though an outbreak of West Nile virus had caused several severe cases of brain inflammation in the 1970s and 1980s. In fact, retrospective research carried out in 1999 showed that more than a quarter of the general population became infected with West Nile in the 1997–1999 outbreak that was centered around the goose farms. While very few of these people had symptoms, at least two Israelis died from the West Nile virus in 1999. According to Israeli researchers, “It seems likely that other such cases occurred in 1997 to 1999 but were unrecognized, not reported, or both.”¹⁴

When the virus from a sick Israeli goose was analyzed, its DNA was found to be identical to the virus that would later kill people and birds in New York, and it is very likely that the virus spread to the US from Israel. Wherever it came from, greater openness on the part of the Israeli goose liver industry might have helped the Americans in their search for the cause of the deaths of those elderly patients in Queens.

According to Desowitz, the Israelis didn’t suppress information about the deaths of geese from West Nile, but they didn’t publicize it either. Desowitz suggests that one reason for this reticence might have been fear that the French would ban Israeli goose livers, as they had banned British beef in 1996 after the first human cases of mad cow disease were reported in the United Kingdom. So when the West Nile virus arrived in America two years later, it took our public health institutions by surprise. Israeli hospitals are now carrying out surveillance on their own, and they have found that, indeed, West Nile virus is killing people in Israel too.¹⁵

Federal Bodysnatchers contains other examples of how misplaced emphasis on financial considerations has had disastrous consequences for human health. In the 1950s and 1960s, Desowitz worked for the World Health Organization’s ill-fated Global Eradication of Malaria Campaign. The achievements of the campaign were uneven, mainly because malaria is very difficult to control. The campaign also relied heavily on the much-maligned insecticide DDT. However, Desowitz shows that for all its flaws, the Malaria Eradication Campaign, which ended in the early 1970s, looks pretty good today. For example, in India the number of annual deaths from malaria went from 800,000 at independence in 1948 down to zero eight years later, when the eradication campaign was underway. After the eradication campaign ended, malaria started killing Indians again, and in 1994, 20,000 died from the disease.

Today, malaria kills more than one million people every year. Current WHO strategy, based on finding sick people, treating them with antimalarial drugs, and advising people in malarious areas to use insecticide-treated bed nets, has made little headway so far. This is so partly because malaria is most widespread and severe in places where health services can’t reach people in time to give them the drugs that could save their lives. In addition, most people who live in malarious places cannot afford bed nets or the insecticide they need to be dowsed in.

It turns out that DDT was really the fallen hero of the old Malaria Eradication Campaign. DDT is cheap, and spraying it on the walls of a house twice a year can effectively kill or repel mosquitoes. DDT will not solve the global malaria crisis, but it can make a difference and it is appropriate for use in developing countries. There is also no evidence that it is more toxic to the environment or to human health than many other insecticides when it is used in the small amounts required for house-spraying to control malaria. However, in 1972 the US, once the major manufacturer of DDT, banned it. Today very few countries continue to make it, and WHO and the World Bank discourage the use of DDT in malaria control programs.

The DDT ban turns out to have been a triumph, not for the environmentalists, because many other pesticides are just as toxic as DDT, if not more so, but for the chemical industry. In the 1960s, these companies realized that DDT was unprofitable because it was so cheap. They wanted to clear the lucrative agricultural market to make way for newer, more expensive insecticides, so that when environmentalists, inspired by Rachel Carson’s passionate 1962 book Silent Spring, began to campaign for a DDT ban, the companies readily obliged. However, the ban on the manufacture of DDT was a disaster for developing countries, because it really does save lives, and there is currently no affordable alternative.¹⁶

That global markets do not respond to the needs of people who don’t have any money is hardly news. But when those needs are a matter of life and death, markets sometimes respond to the invisible hand of shame. In 1995, the pharmaceutical company Aventis stopped making the drug DFMO (also known as eflornithine), the most effective and safest drug for sleeping sickness, a parasitic disease that kills more than 60,000 people every year in developing countries. The victims are all poor and could not afford to buy the drug, even if the company charged them only the cost of manufacture. In 2001, another pharmaceutical company, Bristol-Myers Squibb, began marketing cream containing DFMO as a remedy for facial hair growth in women. This cream, known as Vaniqa, is now sold for considerably more than the cost of manufacture. As Desowitz points out, “Marketing DFMO as a prescription vanity cosmetic while denying it to those dying of sleeping sickness did not exactly project a favorable corporate image.”

The medical charity Médecins sans Frontières (MSF), which has criticized the pharmaceutical industry for neglecting the diseases of the poor, didn’t think so either. MSF began a cam-paign to encourage the companies to make the drug available. This led to a corporate-sponsored DFMO donation program for sleeping sickness patients in developing countries. Until 2006, MSF will receive free DFMO for use in its African clinics. However, in general, there is no market in the West for better medicines for other tropical diseases such as Kala-Azar, malaria, and lymphatic filariasis. Donation programs can help, but eventually more sustainable ways must be found to reconcile the health needs of the poor and the financial priorities of the pharmaceutical industry. Some form of government intervention will almost certainly be necessary.

In the heat of the New York West Nile outbreak, the immediate reaction of numerous investigators and journalists, including Richard Preston,¹⁷ was to suspect not the Israeli goose industry but the agents of Saddam Hussein. Desowitz shows that to protect human health, we need to keep an eye on pharmaceutical, chemical, and other corporations, just as we need to keep an eye on foreign terrorists. We also need to keep an eye on our government. Members of the Bush administration have often reiterated their commitment to confront AIDS, malaria, diarrheal diseases, and other health crises in developing countries, but the money they have allocated for these purposes does not come close to matching their rhetoric. The Global Fund for AIDS, Tuberculosis, and Malaria, for example, now faces a serious shortage of funds that threatens its very survival. One hundredth of the money the administration plans to give back to the richest Americans in the tax cut could save many people in developing countries from diseases that are easily prevented or cured. Indeed, after reading these two books, it was Federal Bodysnatchers that worried me, not The Demon in the Freezer.