Resurrection

TWO

World Health Organisation

International Disease Monitor

Geneva

September 1997

It was a hot afternoon. The sun was shining brightly on the summer crowds that thronged the pavements but inside, the room was pleasantly cool because of air conditioning and comfortably shaded thanks to half closed blinds. There were twenty four people assembled in the room when the doors were finally closed and the chairman brought the meeting to order.

‘Thank you for coming, ladies and gentlemen, I‘ve convened this special meeting of the Viral Pathogen Group to scotch a rumour I’ve been made aware of and to relay a report that has arrived on my desk from our colleagues at the United Nations Disease Monitor.

The facts of the matter are as follows. Two weeks ago a sick Iraqi soldier was picked up just inside Saudi Arabian territory by a routine desert patrol. His intentions were not clear in crossing the border but it seems he was being pursued from the Iraqi side so we can assume that he was seeking help or even asylum. He was too ill to give any information to the men who picked him up but one of these men who had special training in biological warfare recognised the possible dangers of the situation and sought expert advice by radio. The sick man was subsequently airlifted, along with the patrol to a hospital in Dhahran which had isolation facilities and where they were all put in quarantine. The immediate fear for the authorities was that the Iraqi had been subject to some biological or chemical warfare accident. One of the staff physicians, however, a man in his sixties thought he recognised the disease as being smallpox.’

A slight hubbub broke out in the room.

‘Quite so,’ conceded the chairman. ‘A full scale alert was declared.’

When specialist people arrived from CDC Atlanta along with a Niklasson team from Sweden it was determined that the disease was not in fact smallpox but an adverse reaction to vaccination against the disease. The man was in fact, suffering from disseminated vaccinia. He was one of these few extremely unfortunate people who cannot tolerate vaccinia virus- I can’t remember the exact incidence figure?

‘One in a hundred thousand,’ said a man half way down the right side of the table who spoke with a strong Swedish accent..

‘Thank you, Sven,’ said the chairman. ‘Of course, once it was established that it was not smallpox they were dealing with there was relief all round. The three or four day nightmare was suddenly over. Unfortunately the Iraqi himself died without being able to furnish us with any details of what exactly had happened. The patrol members who naturally had been worried about their own safety were released from quarantine and allowed to return to duty. But it was a very worrying time for all concerned.’

A murmur of agreement surfaced in the room.

‘In view of the rumour about an outbreak of smallpox, circulating in certain professional circles, both here and at the UN building, I thought I would put the record straight. I have also asked Dr Jacques Lang from the joint WHO/UN smallpox advisory group to join us today and give us an up-date on the world situation with regard to that disease.’

A tall man with a distinct stoop and dark unruly hair that he kept having to brush back from his forehead stood up and sorted his notes in front of him on the table. He took a sip of water before beginning.

‘Colleagues, as you know, there has been no case of smallpox occurring naturally on the planet since 1977 when the last case, a man in Somalia died from the disease. The WHO declared the world free from the disease some two years later. True, there was one more death after the Somali patient that but that was a case of the genie getting out of the bottle — or should I say, the test tube, in a laboratory accident in Birmingham, England.

I think we all learned something from that tragedy. It stood out as a tragic demonstration of the ability of the virus to get out of containment. Ever since that time, the storage of live smallpox virus has been strictly controlled. Currently it is only stored at two places on Earth, the Centers for Disease Control in Atlanta, Georgia, USA and the Russian State Research Centre of Virology and Biotechnology at Koltsovo in the Novosibirsk Region of the Russian Federation. Security at both establishments is of the highest order and containment facilities for the virus are as secure as man can make them.’

‘Even in Russia?’ asked a somewhat jaundiced American voice.

‘I appreciate your scepticism. Russian infrastructure leaves a lot to be desired these days but the Koltsovo institute is beyond reproach.’

‘So, if the virus is locked up safely at only two places on Earth and no one can get at it, why was the Iraqi soldier being vaccinated against the disease in the first place?’ asked one of the women present, a German lady in her late forties. The murmur in the room said that she had just asked the question many other people had been thinking.

Lang grimaced and said, ‘Frau Doctor Lehman has of course asked an intriguing question. Frankly, we don’t know. It may have been some routine procedure that no one ever got round to changing. That sort of thing often happens in a military environment where people are not encouraged to question things. Routine becomes tradition. Another puzzling thing is that the Iraqis have not yet acknowledged the defection of their man nor, I understand, the deaths of three more of their soldiers in the border incident that led to his escape.’

‘What exactly happened?’

‘I understand the sick man’s countrymen were intent on killing him when the border patrol intervened. I don’t have any more details,’ interjected the chairman.

‘Why would they want to kill a sick man if he was just suffering an adverse reaction to a routine vaccination?’

‘Maybe they didn’t know that’s what it was. Maybe they saw him go down with some awful disease and were frightened they might get it too so they took matters into their own hands.’

‘That’s possible if it was a local decision among border guards but if the order came from higher up maybe the Iraqis didn’t want anyone to know he’d been vaccinated.’

‘In that case we’d have to consider the possibility they’ve got their hands on the virus and intend using it as a weapon,’ said an American voice.

The German woman, Lehman, nodded vigorously at this.

‘That’s a bit of a leap, Hank,’ said the chairman.

‘I just don’t see how they could have got hold of it,’ said Lang. ‘There has been no breach of security at either of the holding establishments and there is no animal reservoir for the virus in the wild. It’s purely a disease of humans — that’s partly why we were so successful in wiping it out. That and the availability of such an efficient vaccine. I think we are worrying unnecessarily.’

‘Just for interest’s sake, how would smallpox rate as a biological weapon?’ asked an Asian man.

That’s really not my field,’ replied Lang. ‘But personally, I would find it almost too frightening to contemplate. Smallpox virus is one of the greatest killers the world has ever known. It’s been around for over two thousand years. It killed an Egyptian Pharaoh, several European crowned heads and countless millions of ordinary people before vaccination brought about its demise.’

‘Worse than anthrax?’

‘Just as deadly and more practical to use. Anthrax is an extremely effective killing agent but its difficult to protect your own forces against it and once you’ve used it it’s damned nearly impossible to get rid of. It lies around in the soil for decades. With smallpox you can protect your own people with a very efficient vaccine that is virtually free from side effects, kill the enemy and the virus will quickly die out again in the absence of a human host. It was generalised vaccination of the public that prevented them using smallpox as a weapon.’

‘But that was all stopped,’ said the German woman, provoking a long silence in the room.

‘Indeed it was,’ said the American man. ‘Vaccination against smallpox was stopped in the USA as long ago as 1971.’

‘Around the same time in the UK,’ added an English voice.

‘So two generations have grown up without protection against the virus,’ said the chairman.

‘But there is no virus to protect against,’ insisted Lang. ‘To all intents and purposes smallpox is extinct.’

The room fell to silence again. No one argued with Lang but there was no discernible agreement either. People were worried.

‘I wish we’d wiped the damned thing out completely when we had the chance back in ‘95,’ said the English voice.

‘Well we lost the vote on that one,’ said the chairman. ‘You’ll have to wait until the next scheduled date for destruction. If there’s no further delay, the only remaining stocks of smallpox virus will be destroyed completely in June, 1999.’

‘So what have all these scientists who objected to the 1995 destruction proposal been doing in the meantime if as you say live virus is only held at two places on earth?’

‘I assure you, very strict controls have been applied to any research involving smallpox. The virus had its DNA sequence determined so we actually know details of the entire blueprint for its existence. Once that was known it was possible to cut the DNA into defined linear fragments. Research labs are allowed to have access to individual fragments of the virus DNA, never the complete organism and never more than twenty percent of the fragmented DNA at any one time.’

What good is a bit of a virus?’

Lang smiled wryly and answered, ‘When we set out to sequence the virus we expected it to be fairly routine. As with all viruses we thought its genes would be concerned with the structure and propagation of itself. Only half of them were. The other half turned out to be human genes.’

There were several instances of raised eyebrows round the table, despite the scientific credentials of many present.

‘They were genes concerned with the human immune system. In short, the smallpox virus knows more about the human immune system than medical science does. That’s really what prompted the delay in destroying it completely. It can teach us a lot.’

‘I’m uncomfortable about having all these bits and pieces of virus floating

around.’

Lang shrugged and said, ‘It’s not as if just anyone could just join up the fragments to recreate a live virus. It would take a first rate molecular biologist, someone who had studied the entire genome and even then he or she would need a lot of luck. Having said that, if there was any evidence that someone was even contemplating trying such a thing we would step in immediately and put an end to it. Criminal charges would almost certainly be brought.’

‘And rightly so,’ said the chairman. ‘In the meantime, doing nothing is not an option for us.’

He paused and the others waited in silence for him to continue.

‘We are clearly not happy about the vaccinated man but I don’t think we could recommend a return to wholesale vaccination. There are risks associated with all vaccination programmes and we would have to justify them to the people who might suffer side effects.’

‘Perhaps a limited reintroduction might be in order?’ suggested one man. ‘Just to be on the safe side.’

‘That would be a possibility but it’s a decision I think we would have to leave up to individual governments.’

‘Israel was uppermost in everyone’s mind.

‘But before we do that or recommend anything else, I suggest that we ask the Iraqis outright why their man had been vaccinated against smallpox and judge them on their reaction.’

The suggestion gained universal approval.

‘Then that’s settled. I will arrange for a joint WHO/UN delegation to draft the question. We will reconvene when I have an answer. In the meantime perhaps Dr Lang and his colleagues could check again with the institutes holding live virus

and also on the state of monitoring of these fragments.’

Lang nodded. ‘Of course, sir.’

EIGHT DAYS LATER

Same Location.

‘We have received a reply from Baghdad, ladies and gentlemen,’ announced the chairman. ‘They say that during a routine vaccination programme for some of their troops an old batch of smallpox vaccine was used in mistake for hepatitis vaccine. Apparently one batch of freeze-dried vaccine looked pretty much like any other to the junior medical staff who were involved in giving the shots. They apologise for the border incident and any alarm caused.’

‘They apologised?’

‘Makes me suspicious.’

The chairman, took off his glasses and waited until the comments subsided before saying, ‘It is just conceivable they are telling the truth. Unlike many vaccines, freeze-dried smallpox vaccine can be stored for a long time. Such a mix-up could have happened.’

‘The question is, did it?’

‘I think we must be very cautious,’ said the German woman.

‘Dr Lang, have you anything to tell us?’ asked the chairman.

‘We approached both the CDC and the Russian institute. Both report no attempted breach of security and stocks of the virus are all accounted for.’

‘Good, how about fragment movement?’

Lang moved a little uneasily in his seat. ‘That was a bit more difficult,’ he confessed. ‘Many labs across the world have requested viral fragments for their research programmes. AIDS research is very intense. There is a lot of competition.

‘ ‘There’s a lot of money at stake!’ came the cynical comment from one of the group members.

‘Is the monitoring system to ensure that no one lab gets more than twenty percent of the complete virus working or not?’ insisted the chairman.

‘Y. es,’ replied Lang but he sounded uncertain.

‘Let me put it another way,’ said the chairman, ‘Is it at all conceivable that an attempt has been made to recreate live smallpox virus from these fragments?’

‘I would really think … not.’

‘But you’re not absolutely certain?’

‘One can never be absolutely certain. If someone is determined enough to do something then, who knows?’

The chairman was reluctant to let Lang off the hook. He said, ‘Supposing a scientist were to request a few fragments of virus at one institution and then move to another, would it be possible for him — or her to order some more fragments without you realising what was going on?’

‘Our records are institute records,’ conceded Lang. ‘Fragments are not referenced against individuals.’

‘So a university department or research institute might be credited with having three fragments when, in practice, an individual scientist working there might have brought three more with him from his last job and have access to six?’

‘I suppose so.’

A great deal of unease had been created by Lang’s answers. The chairman had to hold up his hand for quiet.

‘Ladies … Gentlemen … please. I suggest we keep a sense of proportion about what we’ve learned. I was deliberately trying to paint a worst possible case scenario. Let us pause and consider the facts as they really are.’

The room returned to calm and order.

I think we can be reasonably sure that stocks of live virus remain untouched and there has been no criminal attempt to obtain them.

People nodded their agreement.

The situation pertaining to the fragments however, may or may not be a cause for concern. We need more in the way of reassurance.’

‘I vote we recommend a complete ban on the circulation of these fragments for the moment,’ said the German woman, Lehman. It was a view that attracted considerable support from the others but one that made the chairman discernibly uncomfortable.

‘I see two things against that course of action,’ he said. ‘One is the fact that we would undoubtedly interrupt aspects of AIDS research programmes all over the world. To what extent, we can’t be sure, — perhaps very little in view of the slowness of progress in that particular field, but it would certainly cause inconvenience and even some degree of resentment among the scientific community. Universal goodwill is important to both the World Health Organisation and the United Nations. I am loath to do anything that might damage it.’

‘Chairman, there is also a view that being overly concerned with our image makes us impotent. I would like to draw the meeting’s attention to the last report issued by the UN inspectors in Iraq before their work was interrupted. They uncovered the presence of a factory at Wadi Ras which they suspected was being used for the manufacture of biological weapons. The Iraqis successfully argued that it was actually being used for vaccine production. In the light of what we’ve heard, I don’t think we can take comfort from that … ’

Argument and discussion continued until the chairman said, ‘Colleagues, We’ll put it to a vote.’

Voting slips were passed round the table, marked in silence and returned to the chairman who separated them into two piles in front of him. It was obviously going to be a close run thing. With the last slip assigned, he stood up and announced, ‘We have voted by a majority of two to recommend an immediate halt to the movement of smallpox viral fragments.’

Some people shrugged, others smiled.

‘Dr Lang? You have something to add?’

‘Perhaps I should just say that individual countries have already been asked to carry out an audit on the fragments their research institutions are holding.’

‘Good, that would be helpful,’ said the chairman. ‘But let’s hope than none of this is really necessary at all. Let’s look forward to finding out that our fears are

groundless and our suspicions nothing more than paranoia.’ It was an appropriate note on which to end the meeting.

The Home Office

London.

October 1997

Adam Dewar arrived at the Home Office with only two minutes to spare before his scheduled meeting. He thought he’d given himself plenty of time for the journey up from his flat by the river but he had underestimated the sheer numbers of late season tourists in the capital. He was feeling distinctly ruffled by the time he had circumnavigated the final group.

‘Video cameras! There can’t be one dog turd left unrecorded in London,’ he complained to his boss’s secretary, Jean Roberts as he entered her office a little breathless.

‘Tourism is good for the economy, Dr Dewar,’ she replied with a smile. ‘Nice to see you in good form. You can go straight in.’

Dewar worked for the Sci-Med Inspectorate, a government body set up to provide preliminary investigation into potential wrong-doings in the Hi-Tec areas of science and medicine, areas where the police had little or no expertise. The staff comprised a number of medically or scientifically qualified people whose task it was to carry out discreet, occasionally under-cover enquiries in the often blurred margins that separated incompetence from outright criminality. Highly qualified professional people invariably resented outside interest in what they were doing, regarding it as unwarranted interference, so discretion was of the utmost importance until at least, the facts were established.

Adam Dewar was a doctor specialising in medical investigations. He was well aware that there was no more sensitive or conservative body than the medical profession. Closing ranks was almost a knee-jerk response to outside questioning. The well-guarded mystique of the witch doctor was still extant in late twentieth century medicine. The less the patient knows the better.

Dewar had been on leave for the past four weeks. This was part of the pattern of the job. Investigations were often intensive, requiring long hours of work and high stress levels. Occasionally they could be downright dangerous or even life threatening. When they were completed, leave was generous. Dewar had spent his staying in a small village in the south of France which he had known since childhood, enjoying the wine, the food and sunshine of Provence. He had however spent the final week preparing for his return in fairly hard physical exercise. He had swam three miles daily in the sea off San Raphael and used the cool of the evening to run respectable distances along the vineyard paths between neighbouring villages. He felt reasonably fit again not that his last assignment had taken much out of him in a physical sense.

He had been sent to look into the apparently high death rate among patients of a Lincolnshire surgeon when compared with statistics for similar operations in other parts of the country. There had in fact, been no criminal aspect to this case. The surgeon in question had merely grown old in his job and had been unaware of his failing powers. His strong personality — common in surgeons, had prevented colleagues from doing much about the situation. It was one thing knowing what was wrong, quite another saying it. The man was also very influential in senior medical circles, circles which could make or break careers. The situation had been allowed to develop until the Sci-Med computer had draw attention to the statistical blip.

Dewar had not been subject to the man’s power and influence and he had a strong personality too. Under the terms of the Sci-Med Inspectorate he had the power to resolve the situation and he had. The surgeon had been retired. Happily, the end result had been achieved without scandal or rancour thanks to the application of common sense.

Dewar knocked on the door and responded to the immediate invitation to enter.

A tall silver-haired man stood up behind his desk and held out his hand. He was John Macmillan, Dewar’s boss and the director of the Sci-Med Inspectorate.

‘Good to see you, Dewar. How are you feeling after your break?’

‘Very well, thank you, sir.’

‘Good, What d’you know about smallpox?’

Dewar shrugged his shoulders. ‘Not a lot, I’m afraid. It was a terrible disease in its time but it’s been extinct for many years. A triumph for the World Health Organisation, as I recall. It was cited as an example of the power of vaccination programmes when I was at medical school. Quite poetic really when you think that the very first instance of vaccination was Edward Jenner’s work on that very disease back in the eighteenth century. It took just under two hundred years to wipe out something that had been around as long as mankind.’

‘Wipe out may be a little strong,’ said Macmillan.

‘You mean it’s broken out again?’ asked an incredulous Dewar.

‘Not exactly but this has newly come in from a joint WHO/United Nations body. They’d like our help.’

Macmillan handed the documentation over to Dewar who flicked through it and quickly realised he’d need more time to assimilate it.

‘When you’re ready, I’d like you to handle it,’ said Macmillan.