Smallpox is still a threat to America, 40 years after its eradication

If you’ve watched the HBO miniseries on founding father John Adams, you probably recall the scene in which his wife Abigail inoculates her young children against smallpox by inserting pus from an infected person into their skin. It was excruciating to watch, and was incredibly risky at the time, reminding us just how far vaccine development and delivery have come. The prick of a needle surely beats a slice from a scalpel.

But Abigail Adams believed it was the right decision for her family — and with good reason. Smallpox had already killed tens of thousands across the colonies around the time of the American Revolution. While smallpox inoculation was controversial then, she knew it was the best option for saving herself and her children. And it worked.

Fast forward a little over 200 years, to 1980 — the year the World Health Assembly declared smallpox fully eliminated as a result of a successful global vaccination program. No naturally occurring smallpox outbreaks have happened since. This is one of the greatest achievements in the history of public health.

So why then is there mounting concern about the reemergence of smallpox today? We need no longer worry about smallpox circulating naturally, but it remains a dangerous threat as a biological weapon — particularly now that the global population is no longer routinely immunized. As a result of this threat, vaccines, antivirals and diagnostic tests for smallpox continue to be developed and stockpiled in the U.S. and around the world. But we believe our country can, and must, do better.

As members of the independent Bipartisan Commission on Biodefense, we have spent the last 10 years listening to experts and making recommendations to Congress and the White House on ways to improve our country’s biodefense. Our findings to date will be included in this spring’s updated version of the National Blueprint for Biodefense.

Last week, we released a new report focused specifically on smallpox. In this report, we outline nine actionable recommendations that the administration and Congress can adopt to significantly mitigate the risk to our nation and the world.

The experts we have spoken to worry that the current contents of the U.S. Strategic National Stockpile to combat smallpox are depleted, with not nearly enough vaccine and other medical countermeasures to deal with the consequences of the disease being weaponized. In the event of an outbreak, we would be dangerously unprepared: should a smallpox attack occur, vaccines would need to be administered within seven days. There would not be time to procure sufficient smallpox vaccines, antivirals and diagnostic tests to protect our nation. Given smallpox’s 30 percent mortality rate, the consequences would be devastating. As a result, we urge the federal government to reassess the contents of the national stockpile and ensure that they are commensurate with the threat.

Additionally, the intelligence community must reinvigorate its efforts to produce biological intelligence. Over the years since the U.S. ceased its own biological weapons program, the intelligence community has reduced its emphasis on the biological weapons threat. Today, however, the threat has never been greater: The growth of synthetic biology means that even nonstate actors could have the capacity to weaponize smallpox.

As a result, we recommend that the CIA take a number of steps to address this threat, including identifying activities occurring in foreign laboratories involved in biological weapons research and determining the physical disposition of previously weaponized smallpox produced by the former Soviet Union.

The traditional global strategy of reacting to biological events as they occur is not viable for a disease like smallpox. The impact of a third of the U.S. or global population perishing within weeks would be catastrophic, with equally dire implications for our national security and economy.

There is no benefit in waiting and every reason to act now. By implementing the nine recommendations in our new report, we can ensure the continued elimination of smallpox and preemptively address the threat of other diseases before they emerge.

Abigail Adams knew the risks and acted to protect her family. Our federal leaders must do no less to protect the nation.

Former Democratic Senate Majority Leader Tom Daschle and former Michigan Republican Congressman Fred Upton serve on the Bipartisan Commission on Biodefense.