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FDA approves drug to treat smallpox

fda.gov

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Re: FDA approves drug to treat smallpox

#31
post #13

Earlier quoted context omitted.

There are a lot more people who will soon have access to genome fabrication technology (there are already companies that do this as a service) than can break into a BSL4+ laboratory and steal one of the few remaining smallpox samples.

Would smallpox survive in a microscope slide? I remember my late grandpa had a microscope slide labeled smallpox in his basement. He was an old time doctor and had all sorts of neat things down there after he died. I don’t remember what happened but think the slide is still sitting in a storage shed or something. Always been curious about the risk of having such a slide.

Somewhat related: From https://en.wikipedia.org/wiki/Variolation#Decline

> Although variolation eventually declined or was banned in some countries, it was still practiced in others. "Buying the smallpox" was still practiced in Sudan until the late nineteenth century. However, variolation survived longer elsewhere. During the World Health Organization's Smallpox Eradication Campaign, vaccination teams came across variolators in remote areas of Pakistan and Afghanistan and their samples were confiscated. In the early stages of the campaign, live virus was detected in some, but as the campaign progressed variolators could not replenish their stocks, and although virus particles were detected in some samples, very few contained live virus. Our knowledge about the survival of smallpox virus suggests that passage of time makes it extremely unlikely that any infectious samples have survived.

Re: FDA approves drug to treat smallpox

#32

If smallpox-as-a-bioweapon is even a slight possibility why don’t we start vaccinating for it again? It seems like it would be much easier to prevent the problem at all rather than to try to respond to it.

> If smallpox-as-a-bioweapon is even a slight possibility why don’t we start vaccinating for it again?

Well this would not treat the problem, because smallpox is not the problem here. The fact that we're squishy fragile hosts/food, and bioweapons are getting easier and easier to make, is the problem.

If there was a smallpox vaccination campaign, unless completely secret, the bad actors would simply move on to a different virus/variant/fungus/bacteria.

The only real protection against any of this is to make sure the world has a similar vaccination regime, to ensure mutual destruction.

Re: FDA approves drug to treat smallpox

#33
post #13

Earlier quoted context omitted.

There are a lot more people who will soon have access to genome fabrication technology (there are already companies that do this as a service) than can break into a BSL4+ laboratory and steal one of the few remaining smallpox samples.

Would smallpox survive in a microscope slide? I remember my late grandpa had a microscope slide labeled smallpox in his basement. He was an old time doctor and had all sorts of neat things down there after he died. I don’t remember what happened but think the slide is still sitting in a storage shed or something. Always been curious about the risk of having such a slide.

> Would smallpox survive in a microscope slide? I remember my late grandpa had a microscope slide labeled smallpox in his basement. He was an old time doctor and had all sorts of neat things down there after he died. I don’t remember what happened but think the slide is still sitting in a storage shed or something. Always been curious about the risk of having such a slide.

Not sure, but I'd hazard that someone driven enough to break into one of the few remaining facilities holding live stock of smallpox would also probably be willing to infect themselves with it so as not to worry about preserving it.

Re: FDA approves drug to treat smallpox

#34
post #13

Earlier quoted context omitted.

Would smallpox survive in a microscope slide? I remember my late grandpa had a microscope slide labeled smallpox in his basement. He was an old time doctor and had all sorts of neat things down there after he died. I don’t remember what happened but think the slide is still sitting in a storage shed or something. Always been curious about the risk of having such a slide.

Take this comment with a grain of salt, but there was an episode of House where his patient dug up some old treasure chest and it had a bottle with smallpox sores and they got infected. I remember him saying the virus can lay dormant for a long time. I’d make a phone call or two and get that safely dealt with.

The Lancet had a series of articles in the early 1980s about smallpox in Egyptian mummies, and the risk to Egyptologists. As far as I remember, at least some mummy bodies were preserved in cool, non-dry surroundings which are the best conditions for maintaining viability of the virus. There were also letters about people finding envelopes in old desks containing saved smallpox scabs, and there was concern about the viability of organisms in those. Bottom line: no one really knows. (Always a good answer in medicine.)

Re: FDA approves drug to treat smallpox

#35

> Complications of smallpox included encephalitis (inflammation of the brain), corneal ulcerations (an open sore on the clear, front surface of the eye), and blindness. A tragic reminder of the horror inflicted on indigenous people by the colonies that would become the United States[1]. A bioweapon used to craft the narrative of the empty, pristine continent, bestowed by God for the fulfillment of Manifest Destiny[2]…

One doesn't have terribly much to do with the other. Smallpox was introduced to the Americas in 1520. The only recorded attempt to deliberately infect Native Americans with it was in 1763 by a British officer. By 1803 the US government was already running smallpox vaccination programs for the Native American tribes with which they had contact. Not that the later Manifest Destiny actions weren't horrific and devastati…

The Brits of that era were equal-opportunity smallpox infectors. They captured some of George Washington's slaves, infected them with smallpox, and then released them on the battlefield at Yorktown, hoping to spread disease back to GW. They also brought smallpox into the American camp before the battle of Quebec, and there was an epidemic.

Re: FDA approves drug to treat smallpox

#36
post #28

If smallpox-as-a-bioweapon is even a slight possibility why don’t we start vaccinating for it again? It seems like it would be much easier to prevent the problem at all rather than to try to respond to it.

The current smallpox vaccines stockpiled in the US use a live virus¹ and have a fairly high rate of serious side effects (1–2%) for a disease that doesn't currently exist. The vaccines are also still effective a few days after exposure to smallpox. ¹ https://en.wikipedia.org/wiki/Vaccinia

Also, the way the smallpox vaccine is administered is mildly gruesome:

> A droplet of ACAM2000 is administered by the percutaneous route (scarification) using 15 jabs of a bifurcated needle. ACAM2000 should not be injected by the intradermal, subcutaneous, intramuscular, or intravenous route.

(emphasis mine)

https://en.wikipedia.org/wiki/Smallpox_vaccine

https://en.wikipedia.org/wiki/Bifurcated_needle

Re: FDA approves drug to treat smallpox

#37

If smallpox-as-a-bioweapon is even a slight possibility why don’t we start vaccinating for it again? It seems like it would be much easier to prevent the problem at all rather than to try to respond to it.

In this case, probably multiple reasons: A weaponized version might be designed to work around current vaccines. Though we do stockpile them, just in case. Also they're live vaccines with not so great risk profiles. Assuming the vaccines were still effective against a weaponized version, with an off-the-shelf (literally) vaccine ready to go we could aggressively vaccinate every sick and symptomatic person and everyone those people even looked at, and pretty effectively stop mini outbreaks as they occur. It's actually the method that was used in some developing countries during the eradication campaign. So we have a (likely) effective alternative to mass vaccination.

Also the vaccination leaves a small scar, so there's that too. Then again, if you don't get vaccinated, get smallpox, and survive? You may be full of lots of little scars.

There's also probably some societal/political/social problems (or some other better word to fit this) to starting up vaccinations: it would seem strange to do it if we didn't have specific knowledge of a threat. Look at COVID: we know it's a threat and people don't get vaccinated. So with smallpox vaccinations you'll get some people who panic thinking there must be a threat, others saying if there's no threat then it's pointless and won't do it.

Also as we see from COVID (and if you look at the history of the polio vaccine along with the massive industrial complex around annual flu vaccines) it's clear that such efforts are truly & enormously massive and expensive and difficult. We can't really go around doing that for every potential threat.

Notably, what was approved by the FDA does not appear to be a vaccine, and is instead an anti viral medication effective against smallpox. Also notably, we don't truly know it's safety profile: it would be tough (and unethical) to infect humans with smallpox to try out the drug, so it was tested on animals and approved on the basis of those results. I guess if you want to develop medications against potential-but-not-yet-realized threats, that's the best you can do.

Re: FDA approves drug to treat smallpox

#39
post #22
post #12

This risk has been acknowledged for a long time. Shortly after 9/11 and the anthrax attacks in 2001, the US began stockpiling enough smallpox vaccine for the whole country[1]. They claim to have kept that stockpile going[2] but they also said the same of the PPE stockpile... [1] - https://www.cidrap.umn.edu/news-perspective/2001/11/acambis-... [2] - https://www.cdc.gov/smallpox/bioterrorism-response-planning/...

Gotta rotate the supplies. This is why even though I've _reduced_ my use of bottled water, I keep an active supply of bottles on hand at a level sufficient for an emergency and consume through the stock to keep it fresh.

What for use?

Re: FDA approves drug to treat smallpox

#40
post #32

If smallpox-as-a-bioweapon is even a slight possibility why don’t we start vaccinating for it again? It seems like it would be much easier to prevent the problem at all rather than to try to respond to it.

> If smallpox-as-a-bioweapon is even a slight possibility why don’t we start vaccinating for it again? Well this would not treat the problem, because smallpox is not the problem here. The fact that we're squishy fragile hosts/food, and bioweapons are getting easier and easier to make, is the problem. If there was a smallpox vaccination campaign, unless completely secret, the bad actors would simply move on to a diffe…

The fact that we're squishy fragile hosts

If that describes you then you really need to be putting out some serious DPS, glass-cannon style. Otherwise you need bulk up on CON and figure out your dump stats so you can tank effectively for the damage dealers/buffers/de-buffers.

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