Stockpiling smallpox vaccine may be best use of resources

More time and energy should be spent on developing smallpox vaccine stockpiles rather than pursuing new vaccines or antiviral agents, according to an editorial published on Tuesday in Biosecurity and Bioterrorism.

D.A. Henderson, a distinguished scholar with the UPMC Center for Health Security in Baltimore, and Isao Arita, the director emeritus of the Kumamoto Medical Center in Kumamoto, Japan, discussed the contemporary status of preparedness and response in coping with the unlikely return of smallpox. Henderson and Arita said there are few countries that possess an emergency vaccine stockpile in an increasingly susceptible world.

"Countries and committees have substantially ignored the far more important initiatives that the global community and individual nations should take in order to be prepared to deal with smallpox outbreaks should they occur," Henderson and Arita said. "Few have stockpiles of vaccine; not more than eight to 10 countries have sufficient vaccine to cope with an outbreak."

Henderson and Arita said it makes little sense to keep investing in new vaccines or antiviral agents when there is little interest in buying well-tested, available vaccines to provide minimal attention. They said it would be much more rational to invest in the development of smallpox vaccine stockpiles.

"There are now available two excellent replicating strains of freeze-dried vaccine virus that are highly protective, whose shelf life is 10 years or more, and whose cost is about $3 per dose," Henderson and Arita said. "We suggest, as a reasonable goal, to have aggregate stockpiles of vaccine amounting to perhaps 10 percent of the global population, with another 300 million doses in a WHO stockpile. One licensed vaccine production facility is in operation, and a second is due to come online by the end of the year."

Henderson and Arita also commented on whether or not the current stocks of live smallpox virus should be destroyed. They proposed either an internationally witnessed destruction of the virus in the two collaborating laboratories or the creation of an international lockbox for the virus strains to retain the genetic diversity of the smallpox isolates if they are ever needed for unforeseen uses.

Henderson and Arita both served as directors of the World Health Organization's Global Smallpox Eradication Program.