US Stockpiles Smallpox Medicine, Fear of Bioterrorism

By Kim Smiley

The last case of smallpox in the United States occurred in 1949, but the government recently made headlines for spending $463 million on enough medicine to treat two million people infected with the disease.  It is feared that the deadly and disfiguring disease could be used by bioterrorists and the government wanted to be prepared in the event of an attack.

The concern that smallpox could be used for bioterrorism can be analyzed by building a Cause Map, a visual root cause analysis.  The first step is to fill in an Outline with the background information for the problem and determine which goals are impacted.  In this example, the safety goal is impacted because there is a chance of many deaths if smallpox is released, the financial goal is impacted because hundreds of millions of dollars were spent on treatment for smallpox and the customer service goal is impacted because people are nervous about the potential for smallpox bioterrorism.  Once the impacts to the goals are determined, the Cause Map is built by asking “why” questions.

Why is there a potential for many deaths?  This is true because there is the potential that a smallpox outbreak could happen, many are unprotected against smallpox, and smallpox is a very deadly, highly contagious disease.  An outbreak could occur if bioterrorists released smallpox because the virus still exists in research labs in the US and Russia.  Advances in the genetic field have also opened the possibility that the smallpox virus could be  re-engineered and essentially created in a lab anywhere in the world.   Many people are unprotected against smallpox because the vaccination program ended in 1980 when it was eradicated.  People vaccinated prior to 1980 likely maintain some level of protection from smallpox, but the effectiveness of the vaccine degrades over time and they are no longer fully protected.  Smallpox is a very dangerous disease because it has fatality rate of about 30% and many survivors are left blind or disfigured.  It’s also very contagious and can be spread without direct contact because it can be transmitted via aerosolized droplets from saliva and other body fluids.

The financial goal is also worth considering.  Hundreds of millions of dollars have been spent to prepare for a potential smallpox attack.  The government has long stockpiled smallpox vaccines in the event they were needed, but the move to buy medicine to treat the disease is fairly recent and substantially more expensive than just buying vaccines.  This option has only recently been a possibility because there was no treatment for smallpox until now.  A private company developed antiviral medicine to treat smallpox in the hope that it would be profitable.

Developing solutions to problems that might occur is always tricky and likely to cause debate.  There are many reasons why a smallpox bioterrorism attack is frightening, but how much money should the US government spend to prepare for an attack?    How much preparation is enough?  There is no simple answer, but it’s important to understand these types of problems to the best of our ability to help make well thought out and reasonable decisions.

To view a high level Cause Map of this problem, click on “Download PDF” above.