The U.S. is stockpiling smallpox drugs in case of a biological attack

While smallpox has been eradicated in the wild, samples of the deadly virus still exist in the United States and Russia. Some biodefense experts fear that the continued existence of smallpox leaves the world open to a bioterrorist smallpox attack. To contain a possible smallpox outbreak, the U.S. government has authorized a controversial purchase of a drug to treat smallpox, to the tune of $463 million. But does the U.S. really need what it's buying?

The New York Times reports that the government has ordered enough doses of the drug Arestvyr, formerly known as ST-246, to treat 200 million people in the event of a smallpox attack. However, bioterrorism experts disagree as to whether so much of the drug is necessary, and whether it warrants such a high price tag.

Since the September 11th attacks, the U.S. has increased its stockpile of smallpox vaccine from 15 million doses to 300 million doses. Arestvyr, on the other hand, is a drug meant to treat viral infections. The drug hasn't been tested on humans suffering from smallpox infections (for lack of subjects), but it has successfully treated smallpox and monkeypox in monkeys and smallpox-related viruses in humans. The FDA has approved the drug for emergency use only.

Siga, the manufacturer of Arestvyr, and its advisors, claim that as a smallpox treatment, the drug would be key invaluable in the event of an attack, but many experts believe that the huge order isn't close to necessary. The NYT suggests that Siga might be trading on an exaggerated fear of smallpox and the difficulty in containing it:

Left untreated, smallpox kills a third of victims. But prominent experts say the danger is overblown. Because it can take up to two weeks before an infected person becomes seriously ill, and up to five more days before he or she begins to infect others, there is time to respond, they said.

Also, they said, by the time smallpox victims reach the infectious stage, when their pox are erupting, they are too sick to wander around. That is why outbreaks in schools or factories were nearly unheard of.

Smallpox was eradicated by “ring vaccination” — finding each case and vaccinating just the 50 to 200 people closest to it.
Head over to the New York Times to read more about the politics of Arestvyr, as well as quotes from several biodefense experts.