FOCUS: The pox may be on you
by K. T. Chelvi
New Straits Times, Malaysia, April 24 2005
http://www.nst.com.my/Current_News/NST/Sunday/Features/20050424094456/Article/indexb_html

A WHO committee wants permission to allow genetic modification of the smallpox virus. Some scientists and physicians are gravely concerned, K.T. CHELVI reports.

Next month, if the World Health Assembly (WHA) says yes - to the recommendations of its scientific committee - the world may see the resurrection of the deadly scourge of the past - smallpox.

WHA's Variola Advisory Committee (VAC) is seeking permission to allow the genetic modification of the smallpox virus. WHA, the decision-making body to the World Health Organisation (WHO), will decide on these recommendations at its 55th meeting in Geneva, starting on May 13. According to the committee, genetic modification would aid and accelerate the development of new vaccines against the Variola virus - the cause of smallpox

Officially, smallpox had been declared eradicated on May 9, 1980, after a successful global vaccination campaign led by WHO. The acute and highly contagious disease which not only kills but also maims, blinds and leaves unsightly scars, had killed an estimated 300 million people in the 20th century alone. Renowned British explorer, translator and orientalist Sir Richard Burton called it the most dangerous epidemic, which sweeps like a storm of death over the land - wiping out towns, villages and towns.

It took the world health body an unprecedented 10 years and a US$300 million (RM1.1 billion) campaign in over 30 nations to eradicate this disease. Presently, the last known strains of smallpox (Variola virus) are kept in two high security laboratories: the Centre for Disease Control and Prevention (CDC) in Atlanta, US, and the Russian State Centre for Research on Virology and Biotechnology in Koltsovo in Russia. Soon after eradication, all remaining Variola virus had been slated for elimination. The world health body had on numerous occasions (1993,1994,1995 and 1996) ordered the remaining virus be destroyed but the labs in US and Russia did not do so.

And now comes the genetic modification proposal. NGOs are crying foul saying that there is no reason for keeping the virus unless it's for the development of biological weapons.

According to Sujatha Byravan, the executive director of the Council For Responsible Genetics (CRG), if these recommendations were allowed, WHO would set an ominous precedent which could trigger the prospect of a biological race. This sentiment is shared by the man who in 1967 headed the WHO smallpox Eradication Team, Professor Donald Henderson.

Henderson, now attached to the Centre for Bio-security at the University of Pittsburg, feared that tinkering with the genetic make-up of the Variola virus might accidently create a more virulent form of the disease. "I'd be happier if we were not doing it and the simple reason is I don't think it serves a purpose I can support," said Henderson who had witnessed the ravages of the disease in the 60s. However, members of WHO's scientific committee insist that the proposed modification is not as risky as many believe it to be.

Professor Geoffrey Smith who chairs the WHO committee for the Variola virus research was reported to have said that American scientists were merely proposing to insert a neon marker from jellyfish into the virus, making it easier to track the virus. "If you have a virus that expresses green fluorescent protein, you can do the drug screening in a much rapid and automated way." Smith, of the Imperial Colleg of London, added that it is clear there is a need to develop drugs against this virus, hence the reason for the recommendations and the readiness of scientific committee to consider them.

Why the urge only now to find a cure for this dreadful disease that had purportedly been vanquished 25 years ago? According to reports, concerns about smallpox as a possible agent for bio-terrorism resurfaced after the 2001 anthrax attacks which killed five people in the US. More so, when it was discovered that a large batch of smallpox virus from the Russian lab went missing after the Soviet Union fell apart. And as a result, there has been increased concern about the availability of vaccine stocks.

Lim Li Ching of Third World Network (TWN), a non-government organisation involved in development, Third World and North-South issues, said: "For WHO, which seemed to have forgotten the smallpox's deadly sweep across the world, allowing GM on the virus would be a devastating step backwards.

"There are numerous evidences showing there had been generic modification on Variola virus way before the proposal by WHA's scientific committee." The US in 2002 had admitted to holding hybrid poxviruses - combinations of smallpox virus and with animal pox virus - created in the late 70s in Britain.

According to a 2004 report in US News, recent inventory of CDC's freezer unearthed unusual "chimera" viruses, created about 40 years ago, by crudely combining smallpox with other pox viruses. The Russians, on the other hand, had in 1991 developed the technology for creating vaccine-resistant smallpox virus, according to a BBC report.

As for genetic modification going dangerously wrong, there is the much quoted example of the Australian scientists who inadvertently created a mousepox strain so powerful that it killed even mice inoculated against the virus. This happened four years ago when the scientists were trying to engineer a sterility treatment to combat the population explosion of mice in Australia by splicing a single foreign gene into a typically mild mousepox virus. VAC is also seeking permission to allow the shipment of relatively large fragments of the virus - up to 20 per cent of its entire genome - from the two secure laboratories to other research institutes around the world as wells as to allow insertion smallpox genes into other pox viruses.

These recommendations will leave the world vulnerable to smallpox as it increases the chances of accidental and deliberate release of the virus, says the Consumer Association of Penang (CAP). CAP urged the Health Ministry's representatives to firmly reject the Advisory Committee's recommendation at the WHA meeting this May. It says despite the sophistication and highly secure environment of the labs, there is always the possibility of accidents, human errors and abuse. The infamous example of Variola leak happened in a research laboratory in Birmingham, England in 1978. The virus which evidently escaped from the labs containment area, killed photographer Jane Parker.
The professor responsible for the unit killed herself and all known stocks of virus were destroyed except for the ones kept in the US and Russia.

In Malaysia, there is no record to show how many died of smallpox before eradication. But an undated Malaysian Medical Association report found on the Net, stated that the last case of endemic smallpox in Malaysia was recorded in the 1950s. And in 1973, there was a small pox scare in Pasir Mas Kelantan, claimed to have spread from Thailand but this turned out to be a false alarm, said a retired senior physician who specialised in infectious diseases.

The science and medical community opposing the recommendation say the scientific benefits claimed by the committee is just not worth the risk to public health. Dr Christoper Lee, Kuala Lumpur General Hospital's senior consultant physician of infectious disease shares this view saying that the potential risk of smallpox is real whereas the benefits claimed remain vague.

"It would be disastrous for Malaysia, in the event of a smallpox outbreak," he said. "Most of us, especially the younger generation, are not vaccinated against the disease and we are exposed from all directions - from the millions who travel, visit and seek employment here."

Dr Lee, who also heads KLGH's Department of Medicine, says WHO must carefully weigh the pros and cons before deciding on the matter. "Public interest and health should be paramount."

Director of Communicable Disease Control Division Datuk Dr Ramli Rahmat agrees, saying that the eradication of smallpox is an achievement everyone should treasure. "We cannot allow a situation where the world population is again exposed to this deadly virus."

Many agree that Variola in its original form is deadly enough to be used as a potent biological weapon and there is no need to tinker with it. If at all, the world is in danger from this former scourge, the VAC and its advisors should come clean. "If they want to genetically modify the smallpox virus for the genuine reason of finding an effective cure, it should be done under the strict scrutiny of the WHO," says the senior infectious disease expert.

But then, if the recommendations are adopted can WHO ensure that the world remains free of smallpox? Can it ensure that these labs would not create a even more lethal mutant of the Variola? Can it ensure that there are no leaks or accidents when samples are sent out in testing kits?