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Bulletin of the History of Medicine 78.1 (2004) 256-257



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David A. Koplow. Smallpox: The Fight to Eradicate a Global Scourge. Berkeley and Los Angeles: University of California Press, 2003. ix + 265 pp. $24.95, £17.95 (0-520-23732-3).

This book's title would suggest that the author's intention is to deal comprehensively with the conquest of smallpox as a human disease—but in fact, its content is specifically focused on the issues surrounding the policy debate as to whether the two known stocks of smallpox virus (in Russia and the United States) should or should not be destroyed. David Koplow is an attorney concerned with national security issues and was himself the Pentagon's senior legal adviser on biological warfare issues (1997-99). On the whole, this is a generally well-written and well-referenced account, although repetitive. A weakness is the fact, not surprisingly, that Koplow views the debate and the issues from the viewpoint of the Department of Defense, which in 1994 first became an ardent proponent of retaining indefinitely the existing smallpox virus stocks.

The book opens with a brief introductory history of smallpox as a human disease and of the global campaign that terminated human-to-human disease transmission. A chapter dealing with smallpox as a potential biological weapon describes the possibilities of its use as a threat agent. The bulk of the book deals, in separate chapters, with the morality of destruction of the smallpox virus, the possible application of environmental principles, and laws dealing with biodiversity and endangered species. One chapter presents the case for and against the destruction of the virus, and a second presents the case for and against its preservation.

The author has endeavored to explain the scientific issues in terms understandable to the nonscientist, and he references a wide range of scientific documents and media reports. Although it would appear that he has presented a reasonably comprehensive history of the evolution of the policy debate, there are important aspects that are all but ignored. The behavior of the World Health Organization (WHO) is variously characterized as being capricious, erratic, and ineffective. The changing decisions regarding, and dates for possible destruction of, the smallpox virus are cited in evidence—but in fact, although scarcely noted by the author, virus destruction was favored by a large majority of the countries, but each provisional date for destruction was postponed as a result of special lobbying led by U.S. delegates. However, the issue is now moot as the result of a November 2001 announcement by the United States that it would not abide by any General Assembly decision recommending destruction of the virus.

Curiously, Koplow does not explain how the issue of virus destruction came to be raised in the first place. This derived from formal requests to the director general of WHO by a number of recently endemic countries that this be formally considered. The countries pointed out that no research was being done on the virus itself, and they expressed their concern about the risk of a laboratory accident such as had happened in the United Kingdom in 1978. The director general, in 1985, asked an international committee of experts to explore the question. The author says little about the committee or the rationale for its [End Page 256] recommendations, despite the fact that this was the central focus for policy development for over a decade. The committee explored the subject thoroughly, including the question as to how or whether the use of smallpox as a biological weapon should influence the decision. To assure that genetic information would be preserved, the committee recommended that cloned fragment libraries and genetic maps be developed. It consulted five major scientific groups, each of which supported virus destruction. Finally, it sponsored an international symposium to solicit divergent views. A 1990 letter from the U.S. Secretary of Health and Human Services urged that early action be taken to develop a recommendation in support of virus destruction.

How policy is developed is an important study area...

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