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A Pox on Both Your Houses: Should the United States Destroy Its Stockpile of Smallpox Virus?

 The situation: A potential standoff between Russia and the U.S., both of whom have stashed smallpox virus to develop emergency countermeasures in the event of biological warfare.

courtesy of flickr user hukuzatuna

In advance of the World Health Assembly this May, a commentary in a journal called Biosecurity and Bioterrorism (published online ahead of print on January 10, 2011) calls on the United States to get rid of most or all of its stock of smallpox virus.

The author, Jonathan B. Tucker, Ph.D., is a “professor of science and technology for peace and security” at Darmstadt University of Technology in Germany. That’s a title you don’t hear very often.

But Dr. Tucker writes that many public health experts and scientists, especially those in developing countries, would like to destroy any virus stashes, citing the overexaggerated risk of biological warfare and the existence of antiviral drugs that are in development but could be used in a public health emergency under an Emergency Use Authorization (EUA).

Failing an agreement between the U.S. and Russia to clean house and get rid of their smallpox viruses, Dr. Tucker offers some suggestions for compromise, including an agreement by the U.S. and Russia to share their smallpox research with World Health Organization (WHO) member countries and develop a stash of antiviral drugs to be controlled by the WHO for distribution to victims of a smallpox outbreak anywhere in the world. Both countries would then increase their contribution of smallpox vaccines to this WHO reserve.

What do you think? Should we keep some smallpox virus in reserve, or get rid of it?

–Heidi Splete (on twitter @hsplete)

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Filed under Drug And Device Safety, Health Policy, IMNG, Infectious Diseases, Internal Medicine, Polls, Primary care, Uncategorized

Celebrity Viruses

Thin-section transmission electron micrograph of HIV. courtesy of CDC's Dr. A. Harrison; Dr. P. Feorino

Transmission electron micrograph of HIV, courtesy of CDC.

Today the Institute of Medicine released its report on improving recognition of and care for chronic hepatitis B and C infections.  In the report the IOM highlighted the lack of knowledge about hepatitis B and C among the general public but also among physicians, other healthcare providers, and social service providers. (see story)

In particular, the IOM recommended mounting a public awareness campaign similar to the successful HIV/AIDS campaign.  That begs the question of why HIV/AIDS has engendered such attention while hepatitis B and C have not.  Why has HIV been a sort of celebrity virus?  It’s estimated that 3-5 times as many people live with chronic hepatitis B and C than with HIV/AIDS. Yet in general, even physicians are poorly educated about these diseases.

Why?  Is it because HIV/AIDS posed an imminent threat to the health of an individual (i.e. death) when it was initially identified and before effective treatment regimens were available, ?  Is it because those with hepatitis B and C are often asymptomatic?  Is it because there are no celebrities with hepatitis B and C?  Is it because HIV/AIDS organizations are better organized and less fragmented?

The pervasive lack of knowledge about hepatitis B is particularly troubling, given that there is a very effective vaccine to prevent infection.  However, you can’t really get the vaccine if your physician doesn’t know about it.

Let us know what you think.  What’s behind the disparity?

—Kerri Wachter ( @knwachter on Twitter)

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Filed under Infectious Diseases, Primary care