Museum of Health Care Blog

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In the last blog post we debunked the story that cowpox was the sole vaccine for smallpox. We looked at the history and evolution about the vaccine through the work of Dr. Josê Esparza. You can catch up on the blog here.

Janet Parker was the last person in the world to die from smallpox in 1978. She was working as a scientific photographer above one of the labs at Birmingham Medical School. The lab was working with smallpox and Parker contracted the disease on August 11th. She would die a month later.

This event shook the world not only because the last smallpox case in the UK was 5 years prior, but because smallpox was on its way to being confined to the history books. The World Health Organisation (WHO) led a global vaccination program to eradicate smallpox beginning in 1967. This involved major surveillance and “ring vaccination” where they vaccinated anyone who was in contact with a confirmed case. WHO declared smallpox to be eradicated in 1980, just two years after the death of Janet Parker.[i]

No one really knows how this accident occurred. There was some speculation that it travelled up through the lab’s vents into Mrs. Parker’s photography studio. However, in the criminal case against the university that argument was disproven.[ii] What we do know is that at the time Smallpox wasn’t considered as big of a threat because most of the population was vaccinated. According to virologist Dr. David Evans they would have been operating at a biosafety level two for (on a four-level scale).

It was only after the death of Mrs. Parker that WHO realised the dangers of studying smallpox and destroyed all samples of the virus expect in two labs. Today, the labs that are allowed to continue their study of smallpox are in Atlanta (GA) and in Siberia (Russia). But the work of Dr. David Evans might be challenging this assumption that smallpox is confined to these labs.

Dr. Evans and his team at the University of Alberta were the first to recreate the formerly extinct horsepox virus using synthetic biology. I spoke with Dr. Evans about his research that sparked controversy in the scientific world.

There are two key ethical concepts to consider with this type of work. The first, is the Dual Use Research of Concern (DUROC). This pertains to experiments that are beneficial for society but could be extremely harmful in the wrong hands. Scientists must weigh both sides and choose accordingly. The second dilemma is Gain of Function research. This is when you genetically manipulate an agent to make it more dangerous. The benefits to this research would be to create drugs on genetically elevated viruses. The risks are clear when you seek to make a more dangerous virus.

Dr. Evan’s work falls into both ethical dilemmas. The benefit to his synthetic horsepox experiment is that it can be used to improve the smallpox vaccine. Moreover, scientists are trying to create a virus that only kills cancer cells. These studies use Orthopox viruses, so having a better understanding of the genus could lead to a cure for cancer.

But it can also lead to dangerous synthetic mutations to make the virus more harmful. It could inspire terrorists to bring smallpox back into the 20^th century (as many governments around the world have cautioned). But to Evans, his research proved nothing the world didn’t already know. We can create viruses in the lab and we’ve been doing it successfully since 2002 with the polio virus.[iii]

But is this essentially a recipe for bioterrorism? Dr. Evans says no. He believes that it is not an exact recipe, and you would have to be an expert in the field to even begin filling in the gaps. Certain details were redacted before they published their research, and the methods are not entirely explained.

Every day, synthetic virology is getting less and less expensive.[iv] But that doesn’t mean the process is foolproof. It is impossible to completely grow viruses that infect humans in bacteria. There will always be parts of the genetic code that can’t grow which leads to instabilities. Of course, now with CRISPR gene editing technology, those instabilities will be easier to fix.

There is also an honour code amongst companies who sell genetic sequences. They are not going to sell the components of smallpox, or any other harmful disease, to anyone. And even if one can get their hands on the genetic codes, it is a laborious process, to say the least.

There is another issue to consider when studying smallpox today. The two labs that are allowed to study the virus are in vastly different locations. The Russian lab is a remote part of Siberia where anyone who handles smallpox must wait 3 weeks before they can leave the area. Whereas the CDC lab in Atlanta, Georgia is in a metropolitan city. Of course, there are procedures in place to prevent the virus from escaping but having the lab in a highly populated area is a risk. Dr. Evans had a rule with his horsepox team that they could not interact with horses. But as we learned from the case of Janet Parker, labs can’t always be perfect.

I’ve spent a long time talking about the vaccine and the future of smallpox research but not the experience itself. Smallpox is a horrible disease where individuals breakout in hundreds of painful poxes all over their bodies. It wiped out Indigenous populations and devastated continents. While smallpox is a disease with the highest human death toll (~300 million) this number can only refer to the direct deaths from the disease.

We can never truly quantify the indirect deaths or suffering that always accompanies a pandemic. Like the death of Janet Parker’s 77-year-old father Frederick who passed from a cardiac arrest during his quarantine, supposedly brought on from the stress of his daughter’s infection. Or the death of the professor Henry Bedson who headed the smallpox lab. Distraught by Parker death he committed suicide and left a note that read, “I am sorry to have misplaced the trust which so many of my friends and colleagues have placed in me and my work.”[v]

It is truly remarkable that we as a human species have managed to eradicate an entire disease. The idea of living in a post-smallpox world would have seemed miraculous to anyone living before the 1700s. But we should be careful not confuse progress for perfection. Science has come a long way but with each new development comes its own set of problems and questions we will continue to solve.