Illustration by John Hersey
Smallpox is eradicated. Sort of. There are secret, highly guarded stockpiles—and Soviet defector Ken Alibek claimed his government had not only weaponized smallpox, but also engineered an even more virulent strain. But we’ve stopped vaccinating against smallpox, and that makes us more vulnerable to other orthopoxes, like monkeypox, which normally affects squirrels but can make its way to monkeys and humans. Could monkeypox be used in biological warfare? Quite possibly, as could other exotic viruses—Ebola, dengue fever, Venezuelan equine encephalitis… The U.S. Defense Threat Reduction Agency has contracted with Inhibikase Therapeutics to study two cancer drugs that could help protect troops—and the rest of us—from these viruses. Dr. Mark Buller, professor of molecular microbiology and immunology at Saint Louis University, has been subcontracted to focus on the drugs’ effect on monkeypox.
You’re looking for broad-spectrum antivirals, not just a magic monkeypox drug. When they started biodefense research, they planned to spend about $5 billion purchasing vaccines to protect against different biothreats. But they quickly realized they wouldn’t have enough money to take care of all potential threats—especially since a new virus emerges every few years. Now “one drug, one bug” is out, and the approach is to develop broad-spectrum drugs that target more than one pathogen.
Orthopoxes can be fatal—how? We’re not absolutely certain of the mechanism, but—are you a fan of Downton Abbey? In the 1918 influenza pandemic, patients would seem to improve, only to take a turn for the worst and die. Well, that’s the same with smallpox. The skin lesions would be healing, but 22 or 23 days after infection, the person would die. In the case of smallpox, a severe reaction from the immune system, such as a cytokine storm, could be part of this turn for the worse.
Why use cancer drugs? These two drugs, Gleevec and Tasigna, target a cellular enzyme that is necessary for certain cancers and viruses to cause disease. The drug blocks the release of monkeypox virus from infected cells and prevents its spread in the body. This gives the immune system a chance to rally.
What sort of mechanism could be used to infect soldiers—or civilians? Once somebody has acquired monkeypox, it could be aerosolized into a very fine mist and released into the HVAC system of a building.
And just how does a government or a terrorist group get hold of these viruses? Most of them are available in the field. Take anthrax: It’s common in Africa, Pakistan, and Iraq. Some in the intelligence community are mystified that acquiring anthrax seems to be such a hurdle, because it shouldn’t be. That’s true of a lot of these other agents—they get outbreaks of monkeypox and ebola all the time in the Democratic Republic of the Congo.
Some people want all stockpiles of smallpox destroyed, while many scientists want them preserved. I’m not for destroying anything. A reasonably competent scientist could generate the smallpox virus just from the [genetic] sequence, anyway.
