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20 Reasons Not to Take Smallpox Vaccine
By Ingri Cassel,
1. One man has said of smallpox vaccination: "One of my concerns
if we were to have universal vaccination, some might lose their life."
~The Times (in London), November 09, 2001.
2. For each million people vaccinated with the smallpox vaccine, as many
as 250 could die, according to the American Medical Association. Multiply
250 times 285 (millions of Americans) and the possible deaths from
universal smallpox vaccination could equal 71,250. ~ Journal of the
American Medical Association, June 9, 1999, Vol. 281, No. 22, p. 132.
[this is more than 71,000 people dead]
3. "The American Medical Association said on Tuesday it was not in favor
of an immediate mass U.S. smallpox vaccination program, saying the
potential threat of a bioterror attack did not warrant inoculating every
American against the disease."
~Reuters, December 12, 2001.
4. "Right now the risk of getting the vaccine is higher than the benefit.
You could get a secondary infection, a full-blown systemic infection."
~Marie Rau, Panhandle Health District nurse, quoted by The
Spokesman-Review, November 20, 2001.
5. CDC director Jeffrey Koplan has admitted that universal smallpox
vaccination could unleash a significant number of side-effects. He said
that because many parts of our population do not have a "robust immune
system," a fair number of people could have serious reactions. ~Koplan
speaking on the PBS special "Bioterror Propaganda" aired by WETA, November
6. If the entire nation were to receive a smallpox vaccine, several
thousand people would likely develop encephalitis, an inflammation of the
brain. ~Washington Post, Dec. 26, 2001.
7. Roger J. Pomerantz, chief of the infectious disease department at
Thomas Jefferson University in Philadelphia, said that doctors have no
idea what the smallpox vaccine might do to people at the extremes of
life--less than 2 and older than 65. He said that an even greater concern
would be its effect on people with weakened immune systems from HIV
infection, chemotherapy or transplants. ~Washington Post, Dec. 26,
8. "Researchers have been reluctant to recommend a new vaccination
program which would use the smallpox vaccine for the local population
because the vaccine can cause disease and death in persons with inadequate
~Science, Vol. 277, July 18, 1997, pp. 312-13.
9. Routine smallpox vaccination in the United States ended in 1972.
Officials are hesitant to resume the immunizations because the vaccine is
the most reactive of all and has been linked to serious side effects,
including death. ~ Reuters, November 29, 2001.
10. Eight printed pages of medical studies documenting the many serious
side effects of smallpox vaccination can be obtained at
www.whale.to/vaccines/smallpox.html. See "smallpox vaccine adverse
reactions 66-76." [Note: go to the home page above and put "smallpox
vaccine adverse reaction" in the search engine.] Repercussions include
serious brain and heart diseases, autism, abnormal chromosomal changes,
diabetes, various cancers and leukemias, plus demyelination of nerve
tissue years after vaccination.
11. The U.S. Supreme Court has ruled that vaccination must not be forced
on persons whose physical condition would make such vaccination "cruel and
inhuman." In other words, the state has no right to command that an
individual sacrifice his life in the name of public health. ~Jacobsen V.
Massachusetts, 197 U.S. 11 (1905).
12. By the 1920s, several British medical researchers documented that
smallpox was not only more common among the VACCINATED, but that the DEATH
RATE from smallpox was actually higher among those who had been
vaccinated. This indicates that the vaccine was ineffective and
predisposed vaccinated persons to more lethal disease. ~Vaccination, Dr.
Viera Scheibner, Australia, 1993, pp. 205-220.
13. Getting a vaccination does not guarantee immunity. ~CDC, January 28,
14. By 1987, scientific evidence indicated that the World Health
Organization's 13-year global smallpox vaccination campaign may have
awakened dormant HIV infection in many vaccines. ~Times (in London) May
15. Vaccines made from animal substrate contain animal viruses that are
impossible to filter out. By 1961, scientists discovered that animal
viruses in vaccines, including smallpox, could act as a carcinogen when
given to mice in combination with cancer-causing chemicals, even in
amounts too small to induce tumors alone. They concluded that vaccine
viruses function as a catalyst for tumor production. ~Science, December
16. Some of the new smallpox vaccine doses will be created with animal
substrate. Because the vaccine will incorporate vaccinia, the cowpox
virus, many wonder about possible mad-cow contamination. Fifty-five
million doses of the new vaccine will be created using a cell line dating
back to 1966 and cultured from the lung tissues of an aborted human fetus.
~World Net Daily, December 4, 2001.
17. The new smallpox vaccine will be genetically engineered. Many
scientists believe that genetically engineered vaccines may be responsible
for the global epidemic of auto-immune disease and neurological
dysfunction. ~American College of Rheumatology, annual meeting, Nov.
8-12, 1998. Merck's genetically engineered hepatitis B vaccine,
Recombivax HB, is a classic example. According to Dr. Bonnie Dunbar of
Baylor College of Medicine, many thousands of reported adverse reactions
to the hepatitis B vaccine include: chronic fatigue, neurological
disorders, rheumatoid arthritis, lupus and MS-like disease. ~Testimony of
Dr. Dunbar to Texas Dept. of Health, March 12, 1999.
Over 15,000 French citizens sued the French government to stop mandatory
hepatitis B injections for school children because of resulting
~Science, July 31, 1998.
Dr. John Classen has published voluminous data showing that the hepatitis
B and other vaccines are closely linked to the development of insulin
~Infectious Diseases in Clinical Practice, October 22, 1997.
18. The British vaccine manufacturer Medeva has a horrendous record of
contamination and blunders. In 2000, the FDA found that Medeva was making
vaccines in conditions of filth, resulting in contaminated products.
Medeva had been illegally using bovine medium to culture its polio
vaccines, then lied about it. Medeva also used the blood of a
Creutzfeldt-Jakob victim (mad cow) to manufacture 83,000 doses of polio
vaccine used for (against?) Irish children. Nevertheless, the FDA allowed
the USA to accept Medeva's flu vaccine (Fluvirin) for the year 2000.
~London Observer series: October 20-26, 2000.
19. In 2001, the British socialized health care system was reported to be
in a state of collapse, with many hospitals and labs operating in abysmal
filth. Five thousand people die each year from infections contracted in
British hospitals; 10,000 become deathly ill from such infections.
Sterilization procedures are barely adequate and said to be risking the
spread of mad cow disease. Government ministers are reportedly trying to
hush up the scandal. www.itn.co.uk/Jan 06, 2001; The Sunday Times of
London, November 12, 2001.
20. The U.S. government apparently intends to conduct NO double blind
studies on the safety and efficacy of the new smallpox vaccine. It has
ordered 286 million doses, one for every man, woman and child in America
at a cost of $428 million. At least half of this vaccine will be
delivered by Acambis PLC of great Britain.
Tip of the Week: Keep all vaccine needles away from your body!
The willingness of terrorist groups to employ weapons against the United States was alarmingly demonstrated by the World Trade Center bombing, in which the stated goal of the terrorists was to maximize civilian casualties. But the use of conventional weapons to terrorize a civilian population is not the only cause for concern. Health professionals should be acquainted with diseases that lend themselves to bioterrorism.
The possibility of a biological attack against one or more American cities is a major concern. Should such an attack occur, medical professionals are the nation's first line of defense. The quickness with which they diagnose and respond to a bioterrorist outbreak could decide whether or not the U.S. suffers a calamity.
The two most threatening diseases associated with bioterrorism are smallpox and anthrax. Despite widespread assurances that smallpox is not longer a threat, there is overwhelming evidence that contaband samples of the virus remain stored in several laboratories throughout the world. That so little attention has been devoted to the possible emergence of a deliberately induced smallpox epidemic is evidence of poor planning as well as governmental irresponsibility.
History of Smallpox
The smallpox virus probably existed since the infancy of the human species, but required the population density that can be supported by agriculture to spread quickly. The first historical record of smallpox infection occurred about 3000 years ago in Egypt. Since then massive smallpox epidemics have swept across Asia and Europe killing and disfiguring hundreds of millions. Its contagiousness and explosive infection rate allows the virus to spread rapidly . Smallpox is unique to humans and is believed to have killed more people than any other disease in recorded history.(1)
Egypt. The oldest known case of smallpox was that of Pharaoh Ramses V of Egypt who died in the twelfth century BC. His mummy reveals that the young king's face and torso were covered with blisters characteristic of smallpox.(2)
Rome. In 165 A.D. the Roman empire was devastated by a smallpox epidemic that raged for fifteen years and killed tens of millions. Romans were completely vulnerable to smallpox, the disease having suddenly emerged from the Asian continent. The decline in population reduced the Roman army which replaced its losses with barbarians who had no particular loyalty to Rome. Rome was never able to recover its former military prowess, and was eventually over-run by barbarian armies.(3)
Europe and Asia. The middle-ages saw devastating outbreaks of smallpox that killed untold millions throughout Europe and Asia leaving many of the survivors immune.
It was not uncommon for victims of smallpox or some other plague to be catapulted over the walls of a city under siege in an attempt to start an epidemic within it.
Mexico. Cortez and his conquistadors invaded Mexico in 1518. The Aztecs had no immunity to a host of European diseases, the worst being smallpox. By the time Cortez and a few hundred of his exhausted warriors attacked Mexico City with its huge population, the defenders had been decimated and demoralized by smallpox. The city fell, and Aztec civilization fell with it.(4)
North America. It is estimated that smallpox, along with a number of lesser diseases, killed 56 million native Americans during the Spanish conquest of Mexico. The death toll mounted as smallpox spread to other Indian nations, none of which had any resistance to infection. Infected blankets from smallpox victims were presented to native Americans as gifts during the westward expansion of the United States.
Smallpox eradication campaign. In 1952, after the disease had killed about 300 million people in the twentieth century (5), a campaign to eradicate smallpox was initiated by the World Health Organization. The Smallpox Eradication Unit was led by Dr. Donald A. Henderson, a particularly capable epidemiologist. The disease existed in thirty-three countries and was killing more than two-million people per year. A program of mass inoculation was instituted over a twenty year period. Eighty percent of the population was inoculated in regions harboring the disease, and the number of new smallpox cases approached zero.
Yugoslavia. Yugoslavia had one of the last serious epidemics in 1972. A Muslim pilgrim returned from Mecca to his home in Kosovo carrying the deadly virus. No case had occurred in Yugoslavia since 1930, and the entire population of Yugoslavia had been routinely vaccinated for the past 50 years. The pilgrim himself was inoculated just two months earlier. Yugoslavia had, at the time, eighteen million doses of vaccine available to serve 21 million people. The World Health Organization of the United Nations had millions more. Yugoslavia had an authoritarian government under Tito which was capable of acting swiftly, and if need be, ruthlessly.
The pilgrim felt achy with flu-like symptoms shortly after his return from Mecca. For over a week he had been exposing his family to infection. His first serious symptom was hemorrhaging in the whites of his eyes, which darkened until they were almost black. The development of lesions on his body did not immediately alert anyone to the possibility of smallpox, since no case had occurred in Yugoslavia for over forty
After the onset of severe hemorrhaging, the pilgrim was rushed to a local hospital where he infected a nurse and eight other patients. From the local hospital he was rushed to a hospital in Belgrade where he infected twenty-eight more people including eight doctors and nurses. They in turn in infected 150 more. The disease was moving rapidly throughout Yugoslavia.
The army was mobilized and martial law was declared. The borders were sealed and unauthorized travel was forbidden. Hotels and apartment houses were requisitioned and used to quarantine over ten thousand people. Within two weeks everyone in Yugoslavia had been revaccinated. The number of newly infected individuals dropped with each wave soon reaching zero.(6)
Bangladesh. In early 1975 smallpox broke out in Bangladesh and swept through more than five-hundred villages. Dr. Henderson and his team vaccinated people in rings around each new outbreak, and tracked down everyone who had contact with infected individuals. By the end of the year there were no new cases.(7)
The last known case in the world occurred in Somalia in 1977.(8)
Epidemiology of Smallpox
Smallpox is among the least pleasant diseases known to man.
It is an explosively contagious viral infection that is unique to humans. It is classified as a hot agent in Biosafety Level 4 category, which means that a single case, anywhere in the world, would be considered a global medical emergency.(1) If smallpox infection is suspected, the Centers for Disease Control (CDC) Emergency Response Office should be immediately notified.
The Bioterrorism Emergency Number is (770) 488-7100.
Outbreak. In the event of an outbreak of even a single case of smallpox, emergency powers are immediatelt assumed by local, state, and federal authorities according to a chain of command and division of responsibilities. CDC personnel will rush to the scene with protective gear, vaccine, and whatever equipment is needed to collect samples. Specimen packaging and transporting includes a documented chain of possession coordinated by the FBI. Biosafety Level 4 disease specimens are rushed to CDC or several select Department of Defense (DOD) laboratories.(9) Travel may be restricted and quarantines imposed. Civil liberties and constitutional rights tend to fare badly during national emergencies of this gravity.
Epidemic outbreak. Smallpox epidemics develop in waves, with peaks and troughs separated by two-week intervals that correspond to the average incubation period of the virus. The virulence of the epidemic is a function of non-immune population density. Immunized people stifle the epidemic by lowering the average number of transmissions per infected individual. In an unvaccinated population, one infected person can infect all non-immune people with whom he comes in contact. Immunized people in an epidemic are analogous to control rods in nuclear reactors - they slow down and stifle chain-reactions.
Precautions. The U.S. Navy's Bioterrorism Task force specifies the use of masks, gowns, gloves, with thorough washing after each exposure, and the isolation of smallpox patients, preferably in negative pressure rooms. Face masks must be worn when entering the patient�s room. Airborne precautions should be followed. Smallpox is transmitted by particles of five microns or less. They can remain suspended near the patient, or move considerable distances in air currents.
Contact precautions include use of clean gloves on entry into a patient's room, removing gown before leaving room, washing hands and exposed surfaces with antimicrobial soap, and air exchange every 6 to 12 hours through monitored high-efficiency filters.(10)
For prophylactic and post-exposure immunization, smallpox vaccine should be administered to everyone in contact with infected individuals. If more than three days have elapsed since exposure, smallpox vaccine should be administered in conjunction with vaccinia-immune globulin (VIG) ) (0.6l/kg 1M).(11)
(this, of course, assumes that such supplies exist).
Exposed individuals should be on the alert for flue-like symptoms and rashes for 7 to 17 days after exposure. Isolating smallpox patients, individually when possible or in groups when not possible, is essential.
The Smallpox Virus (Variola)
Variola, the causative agent in smallpox, is a large virus with a complex structure that belongs to a class of pox viruses called Chordopoxviridae. It has a somewhat brick-like shape with rounded corners and a knobby surface looking much like the surface of a hand-grenade. (Figure 1) By dry weight variola contains 90% protein, 5% lipid, and 3.2% DNA. Its double-stranded DNA consists of over 190,000 nucleotide base pairs built from over 100 proteins. Its dimensions are about 250 x 250 x 200 nm, large enough to be seen with an optical microscope.(12)gure I: The variola virus
Variola replicates in the cytoplasm of the host cell independent of the host cell enzymes. The virus rapidly multiplies until the cell bursts, releasing tens of thousands of variolas capable of attacking other host cells. The replication cycle is repeated every few hours and by the time the victim shows symptoms, he is awash in quadrillions of variolas.
Identification. Confirmation of the presence of the variola virus is carried out by examination of fluid from an active lesion. Active skin lesions are characterized by altered epidermal cells containing eosinophilic intracytoplasmic bodies (Guarneri bodies). Further confirmation is carried out using immunofluorescence and microscopy. The distinctive shape and size of variola (it is the largest known virus) should make a diagnosis definitive.
Mechanism of Infection
Droplet infection. To sustain itself, the smallpox virus is passed from person to person in a continuing and expanding chain of infection. It is spread primarily by the inhalation of airborne droplets, and secondarily by physical contact. A single invisible droplet of exhalant travels in still air about ten feet from its human source, and contains far more viruses than is needed to infect a single individual.(13)
Variola major. There are two variants of the smallpox virus: variola major which is the more lethal variant, and variola minor which is a weak mutant. We will only deal wih variola major. There is enough variation in the disease progression that smallpox may not be recognized even by doctors familiar with the disease of whom there are virtually none.
Onset. During a typical incubation period of ten to fifteen days the infected person will feel normal, but is already contagious. The first signs of the onset of the disease are severe flu-like symptoms, headache and fever. In another three or four days, tiny red dots appear over the entire body. The spots develop, in order of progression, from macules to papules to vesicles to pustules. An identifying characteristic of smallpox is its foul and distinctive odor arising from the victim's pustules, which once smelled is never forgotten.
Pustules. If the pustules merge to form a cont inuous surface encasing the entire body, the disease is said to have split the skin, and the person will usually die. The pustules can be so close together that the skin resembles a cobblestone street.
If the person survives, the blisters will turn into highly contagious scabs which fall off the body, leaving the victim permanently scarred and in some cases blind. The mortality rate is usually between twenty-five and fifty percent. An epidemic in Canada in 1924 killed 50% of those stricken.(14)
There are two particularly deadly forms of smallpox - flat black pox and hemorrhagic black pox:
Flat black pox. In flat black pox the skin remains relatively smooth, but blackens in large areas. The victim's immune system, having been paralyzed, produces no pus. The blackened areas merge as hemorrhaging under the skin advances. The skin sometimes detaches from the body and falls off in large sheets.
Hemorrhagic black pox. In the presence of hemorrhagic black pox, highly contagious black, unclotted blood seeps from the victim's orifices. The virus will sometimes break down the internal membranes which line the body's organs. Pieces of membrane can be expelled through the victim's orifices accompanied by a profusion of blood. The victim almost never survives this development.
Chicken pox. The disease most commonly confused with smallpox is chicken pox. During the first two or three days after the rash has appeared, it may be difficult to tell them apart. Chicken pox lesions are more superficial and variated than the smallpox pustules which are dense and almost identical. Smallpox pustules tend to be more numerous than chicken pox on the face and limbs. Chicken pox lesions, unlike smallpox lesions, are very rarely found on the palms and soles.(15)
The Smallpox Vaccine
Because many of the proteins present in other pox viruses are similar to those found in smallpox, it is possible to develop effective vaccines based on non-human pox viruses (cow pox for instance). Other pox viruses that might grant immunity to humans are monkey pox, orf in sheep, and molluscum contagiosum, a relatively mild sexually transmitted disease in humans.
Smallpox vaccine is effective for approximately ten years, after which it begins to lose potency. No one has been vaccinated in the United States for the past twenty-five years. We are almost as virgin a population as were the Aztecs when the conquistadors descended upon them.
The Centers for Disease Control owns a small supply of smallpox vaccine that is stored in four cardboard boxes in the walk-in freezer of a pharmaceutical company in Pennsylvania. The company, Wyet-Ayerst Laboratories, manufactured fifteen million doses of smallpox vaccine over a period of five years some twenty-five to thirty years ago.(16) The CDC owns six to seven million doses of this production, a ridiculously insufficient amount to protect a population the size of the US. But even this may be an inflated figure and it has been reported that the vaccine has seriously deteriorated. Some people on whom it was tested have had serious and even fatal reactions. The antidote to these reactions has also deteriorated.(17) Such is our state of readiness.
When the World Health Organization declared total victory over smallpox in 1979 it had ten-million doses of smallpox vaccine in storage in Geneva, Switzerland. The CDC then proceeded to deliberately destroy nine and one-half million of these doses.(18) The people making this decision had total confidence in the highly unlikely proposition that variola was completely and permanently eradicated from the face of the earth. (Why, in that case, did they not destroy all ten million doses of vaccine?)
This leaves one-half million doses to deal with a global crisis, or one dose for every 12,000 people.
Smallpox vaccine is not difficult to produce. In the late eighteenth century it was noticed by an English country doctor named Edward Jenner that dairy maids who had contracted a mild disease called cowpox were never stricken with smallpox. Using a drop of liquid from a cowpox blister, Dr. Jenner scratched it into the arm of a young boy. Several months later he introduced deadly smallpox pus into the boy's arm. The boy did not come down with the disease.(19)
Smallpox vaccine is almost 100% effective. Only three in one-million doses produce adverse side-effects. The most frequent of these side-effects is a condition called progressive vaccinia which affects immune-compromised people. This condition, in which vaccinia grows at the vaccination cite, can be cured with vaccinia immune globulin.(20)
The United States does not manufacture smallpox vaccine in even limited quantities. This nation, which managed to manufacture and distribute smallpox vaccine during the administration of Thomas Jefferson, seems incapable of doing so today. Compared to other defense and/or health systems, the cost of inoculating our entire population would be trivial. If the U.S. began a crash program to manufacture the vaccine and inoculate every person in the nation, it is estimated that it would take about 36 months to complete the task.(21)
If we compare our readiness with that of Yugoslavia in 1972 we might as well be a stone-age civilization. Official indifference to the threat of smallpox could be rationalized if the virus was known to be extinct. Unfortunately, the opposite is known to be the case. Anti-terrorist experts are certain that the virus, though outlawed by the United Nations, exists in a number of clandestine biowarfare laboratories located in several countries.(22)
These include Russia, China, North Korea, Pakistan, Iraq and Iran. The United States keeps several vials of live virus at the Centers for Disease Control in Atlanta, hopefully under foolproof security. The viruses are used to experiment with drugs that might be effective against smallpox. So far none have been found.(23)
In 1995 the CIA gave a classified briefing to a number of public health officials and biologists during which the list of possible variola sources was extended to include Osama bin Ladden's Islamic terrorist organization, and Japan's Aum Shinrikyo sect that was responsible for attacking subway commuters in Tokyo with nerve gas.(24) Unlike nuclear weapons, the virus could be surreptitiously introduced into a population without revealing that a deliberate attack had occurred, or who had launched the attack.
In 1992 the leading Russian bioweapons expert and the inventor of the world's most powerful anthrax virus, Dr. K. Alibekov, defected to the U.S. He revealed that the Russian military has secretly stored at least twenty tons of the live smallpox virus on various military bases throughout Russia. The intelligence community has corroborated this information.(25)
The leading Russian institute of virology, known as Vector, is situated outside Novosibersk in Siberia. It is also a viral weapons development facility that contains living variolas in a freezer.(26) Vector is underfunded and is considered by the intelligence community to be a viral Chernobyl - an accident waiting to happen. Since the fall of the Soviet Union, unpaid weaponry scientists have been leaving rotting Soviet military facilities in droves, carrying their expertise with them to unknown paymasters. There is no reason to believe that some Vector scientists are not numbered among them. Nor do we have any assurance that living variolas were not stolen amidst post-Soviet chaos.
Our principle biodefence laboratory is the United States Army Medical Institute of Infectious Diseases in Fort Detrick, Maryland. The head of the laboratory, Dr. Peter Jahring, recently said the following: "I don't think there is any higher biological threat to this nation than smallpox... . If we have a bioterror emergency with smallpox, there will be no time to start stroking our beards. We'd better have vaccine pre-positioned on pallets and ready to go." (27)
In 1995 the National Security Council declared defense against smallpox bioterrorism to be a top priority. The Department of Health and Human Services (HHS), headed by Donna Shalala, was given responsibility for building a stockpile of smallpox vaccine large enough to protect the United States. A controversial study estimated the cost of producing 300,00 doses at seventy-five dollars per dose and a delivery date in the year 2006.(28) It was decided that the cost was prohibitive. (For several generations a much poorer U.S. managed to inoculate everyone in the nation). The project was put on a back-burner, from where it has apparently fallen off the stove.
Retired General P. K. Russell MD, who headed the biohazard team that stopped an ebola epidemic in 1989, blames our vulnerability to smallpox on "a lack of effective leadership on the part of the government." D. A. Henderson said "The effort at HHS still isn't organized."(29) The Department of Health and Human Services is highly politicized even by Washington D.C. standards, and has no history of assuming responsibility for any portion of national defense. This makes the failure to build a smallpox vaccine stockpile even more incomprehensible, since it does not entail the risk of handling live variolas.
Our lack of preparedness is not limited to smallpox. We cannot hope to be completely protected from every possible mode of attack. There is always a period of vulnerability between the introduction of a new attack weapon, and a defense against it. However in the case of smallpox, vaccination predated the bioterrorist threat by more than two centuries. There is no reason why we should remain vulnerable to this terrible disease.
In August 1999 the new director of CDC in Atlanta, Jeffrey Koplan, decided to end the bureaucratic stalemate concerning the production of smallpox vaccine. He called a meeting of high officials in the relevant agencies (the Pentagon, the White House, the National Institutes of Health, and the Department of Health and Human Services) and announced that no one was allowed to leave the room untill a feasable plan for manufacturing an adequate supply of vaccine in the shortest possible time was instituted.
Dr. Koplan is one of the few doctors in the world with experience in fighting smallpox. He had served on the medical team that successfully stopped the world's last epidemic in Bangladesh in 1973. The CDC was given the responsibility of creating the stockpile of smallpox vaccine with a target date set for 2002.(30)
Copyright © 2000-2001 Robert Trupin. Reprinted with permission.
Books with links can be bought at Amazon.com
1. Henderson D. Smallpox: Clinical and Epidemiological Features CDC Vol.5, 08/99
2. Garret L.. The Coming Plague Farrar, Straus, & Giroux; 1994.
3. Preston, Richard The New Yorker 7/12/99. Conde Nash Pubications
4. O'Tool T. Smallpox: An Attack J. Hopkins School of Public Health Vol 5, 1999
5. Bardi J. Aftermath of a Hypothetical Smallpox Disaster J. Hopkins University; CDC:7/99.
6. Henderson D. Bioterrorism as a Public Threat. Emerging Infectious Diseases CDC Vol 5 No.4. 1999.
7. McCade J. Addressing the Potential Threat of Bioterrorism Emerging Infectious Diseases; CDC: Vol5 No.4. 1999.
8. English J, et al. Bioterrorism Readiness Plan: A Template for Healthcare Facilities. Department of Navy: 4/13/99.
9. Preston R. The New Yorker. 1/10/00.
Johns Hopkins University, Baltimore, Maryland, USA
The second day of the symposium featured a discussion of a scenario in which a medium-sized American city is attacked with smallpox. Four panels represented various time milestones after the attack, from a few weeks to several months. Panelists discussed what they and their colleagues might be doing at each of these milestones. The goal of the responses was to communicate the complexity of the issues and to explore the diverse problems that might arise beyond the care and treatment of patients.
The scenario itself was a step-by-step account of a smallpox epidemic in the fictional city of Northeast. Tara O'Toole, the scenario's lead author, read the narrative account before each panel.
The panelists responded to the events as if the epidemic were real and they were actually trying to identify, contain, communicate, and otherwise deal with it. Panel members included experts on hospital, city, state, federal, and media responses. Representing the hospitals were John Bartlett and Trish Perl, Johns Hopkins Hospital; Julie Gerberding, Hospital Infections Program, Centers for Disease Control and Prevention; and Gregory Moran, Emergency Medicine, University of California at Los Angeles. Jerome Hauer represented New York City's response. Representing the state were Michael Ascher, California Department of Health Services Laboratory; Arne Carlson, former governor of Minnesota; Terry O'Brien, a Minnesota State Assistant Attorney General; and Michael Osterholm, Minnesota Department of Public Health. The federal representatives on the panels were Robert Blitzer, former counterterrorism chief with the Federal Bureau of Investigation; Robert DeMartino, Substance Abuse and Mental Health Services Administration; Robert Knouss, Office of Emergency Preparedness, Department of Health and Human Services; and Scott Lillibridge, Centers for Disease Control and Prevention. Joanne Rodgers, Johns Hopkins Medical Institutions Public Affairs, spoke to the response of the media. George Strait, the medical news director for ABC News, acted as moderator for each of the panels scheduled on day two. D.A. Henderson also helped to moderate.
At the start of the epidemic, 2 weeks after the bioterrorist attack, confusion reigns. There is uncertainty as to what the infection is and reluctance to diagnose smallpox even when it is suspected. It is unclear who is in charge of investigating and containing the epidemic. Outside, reporters are knocking on the hospital doors. The question of what took so long to identify the agent opens the panel. Smallpox, a nonspecific flulike illness, is hard to diagnose, replies an emergency medicine physician. The disease is not suspected because it was eradicated in the late 1970s. Any laboratory work on the first cases would initially be testing for a battery of other causes, such as other viral infections (e.g., monkeypox) or reactions to recent vaccinations. A window of 2 weeks before positive identification of smallpox may even be optimistic. The diagnosis would probably take much longer because of physicians' lack of familiarity with the disease.
When all the tests for other infections turn up negative and smallpox is strongly suspected, suggests a state laboratory chief, a conclusive result from the laboratories at the Centers for Disease Control and Prevention (CDC) or the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) would still be needed. These are the only two places in the United States equipped to identify smallpox virus in tissue samples. This part of the diagnosis is fairly straightforward but it would take at least 1 day before the definitive results could be obtained.
Hospitals would probably isolate the early cases presumptively, even if smallpox was not suspected, since the symptoms would appear infectious. This is the opinion of a hospital infections expert. In the city, argues a state health department professional, several hospitals would each see one or two of the first few cases. The city health department would quickly become aware of the similarity of the cases in the various hospitals, recognize a potential outbreak (probably measles) and mobilize early to contain it.
Once smallpox is identified, the following organizations within city government would be notified: the police department, the local emergency management office, the city health commissioner's office, and, ultimately, the mayor's office. This process may be difficult since it requires integrating the health department into emergency management plans, an event with little precedent, notes a city emergency official.
Who is in charge, agree panelists, is one of the most important questions yearly in the epidemic, because any large-scale relief effort would require good management. Complicating the answer, however, are various levels of government, each with its own responsibilities and perspective on response, as reflected in panelists' remarks.
Acts of domestic terrorism are under the jurisdiction of the federal government, so several federal agencies become involved, starting with FBI. FBI is involved from the very beginning since any cases of smallpox would indicate a deliberate terrorist attack. A criminal investigation begins immediately. CDC is involved as soon as samples are sent for laboratory diagnosis.
The state government becomes involved at the outset, since major threats to public health are dealt with on the state level. The state health department starts its own investigation, and to reassure the public, the governor may act as a spokesperson for the management of the epidemic.
The city is involved from the outset, explains the city emergency management official, understanding that "bioterrorism is a local issue," which escalates very rapidly to state and federal levels. The local police and emergency management teams, as well as the city health commissioner, the city health department, and the mayor, are involved.
The problems of the city become state problems immediately, counters the former governor, because the news media treat any potential infectious disease outbreak as a regional problem. This forces the governor's hand. The governor has to move in because there is a need for one person to be in charge.
The most difficult situation is how to deal with the hospital patients. One danger in the early days is losing control of the crisis through panic. Once rumors about smallpox start to spread, many workers within the hospital walk off the job. Understaffing also leads to increased stress and confusion for patients and providers alike.
Even before federal and state command structures are in place, suggests a hospital infections control expert, hospital epidemiologists would already be addressing infection control issues. She notes that hospital infection control specialists would be on the phone to colleagues in other city hospitals alerting one another. Hospital epidemiologists, adds a state health official, would have a contact list of state, local, and federal public-health authorities who also would be notified.
Another problem in coordination becomes clear to panelists: the difficulty in sharing classified risk information among agencies and various levels of government. Any early warning, which could have contributed to a more effective response, was missing in the scenario. Even though the FBI had some early intelligence of the attack, the alerting of health care workers was nonexistent. The problem lies in the fact, assesses a state health department official, that health departments have never been seen as intelligence communities, nor has there ever been a precedent for passing such information to them.
On the federal level, CDC addresses the public health issues of the epidemic, and FBI addresses the law enforcement issues. These aims are not necessarily exclusive of one another, and the possibility of linking efforts is raised. Everyone interviewed as a part of the epidemiologic investigation may have to be interviewed as part of the criminal investigation as well. Perhaps the most effective way to accomplish this is to conduct both interviews simultaneously.
Some aspects of the two federal agencies may overlap, perhaps even conflict, in agendas. Specimens that are sent to CDC for positive identification of the smallpox virus may be needed by FBI as evidence for any eventual prosecution. In many ways, it may appear as if FBI is running the investigation. However, dealing with the sick, obtaining vaccine, and mobilizing the epidemiologic investigation at the local, state, and federal levels are outside the scope of FBI. CDC takes the lead on these public health issues, and together with FBI, coordinates the management of federal resources.
However, who is coordinating activities at the hospitals is still unclear, and the question of authority on that level is unresolved. Can outsiders come into a hospital and wield power, and if so, who are they? Federal responders may have ambiguous authority within a hospital and may add to the chaos. An FBI offical notes that his agency's role in the hospitals will simply be to inform the doctors and administrators of what the hospital needs to do to assist in the criminal investigationkeeping evidence and coordinating interviews with patients. However, this may still leave gaps of authority within the hospital.
In the scenario under consideration, the state identifies one hospital as the smallpox hospital, and this also presents a problem of coordination. The hospital itself has to work out the details of local quarantine and the distribution of medicine to the patients, and there is a need to protect the health-care workers and other hospital staff. Vaccine should be immediately available to these workers, and its distribution will have to be coordinated with CDC.
Outside the hospitals, an epidemiologic investigation will be taking place that will need to be coordinated with CDC. A CDC official points out the need for surveillance in the early days of the epidemic. To assist in collecting data necessary to identify the release source and people at risk, he recommends that CDC provide additional staff for much of the epidemiologic work, including mid- and senior-level investigators. Bringing in these outside experts should not represent a problem for local officials, he suggests, since CDC already has strong ties with state epidemiologists.
How to control the message going to the public weighs heavily upon the minds of all panelists. Reporters on the hospital scene will quickly become aware of any rumors and will demand answers of any worker or official who is handy. Official channels will not be the only source of information during the epidemic, argues the public affairs specialist.
First responders, such as the police or fire officials, might show up with full biohazard protection; such an image immediately raises questions. The media will digest information from day one, whether or not there is an official statement from the city, state, or federal level.
Controlling the message that goes out over the airwaves could be extremely difficult, especially since there may not even be any consensus on what the message should be in the first place. Several panelists point out the need to ensure that information presented to the media is consistent and credible. The city emergency manager suggests that the mayor will work with federal and state officials to get consistent and credible information out to the public. One viable alternative to speculation and misinformation, proposes an FBI official, is to have a centralized joint information center, such as the one his agency set up in Oklahoma City after the bombing, with several experts answering all the questions that arise.
Regardless of how information is disseminated, the message must be carefully considered. If the flulike symptoms of smallpox are identified on the evening news, a flood of noninfected persons with stuffy noses or headaches could swell emergency rooms across the state. Other reports, such as upcoming quarantine efforts, may also spread panic and should be handled carefully. The types of stories the media choose to write present a challenge. The press will not only cover the crisis but the managers of the crisis. Plans for responding to questions about crisis management must be in place. Whether or not the message that goes out to the public includes mention of terrorism should be weighed.
The hospital infections expert pursues a different angle to the issue of information exchange. The difficulties in interviewing the public have not been solved, she points out. Who will do the interviews? How they will be coordinated with criminal investigations? Who will receive vaccine? And how will health-care workers be protected? Will the system be overwhelmed by false casespeople who think they have smallpox? Moreover, a basic problem in the early days of the epidemic is the need for an infrastructure to handle the large volume of calls flooding the hospitals.
What will be the plan of action? Hundreds of people will have to be mobilized to interview the public, and hundreds more will be needed to administer vaccine. The distribution of antibiotics and vaccines represents a logistical problem that must be overcome.
As the epidemic grows and spreads to several states, friction between the levels of government grows. Governors are demanding vaccine supplies, fueling a larger debate of how vaccination should be handled. Tens of thousands of people are vaccinated, but many more still need vaccine. Media reports begin to be critical of the government's handling of the crisis.
What still needs to be done? With a growing number of deaths, the rise in the number of patients in quarantine, the loss of critical health-care workers and city emergency workers, within the city things are beginning to get out of focus, notes a city official. Asking how leadership will function inside the hospital, the hospital epidemiologist identifies a need for official responses that are well thought out, strong, and based on hard science.
The vaccine campaign poses significant issues. The limited supply of vaccine must be divided up and distributed according to greatest riskpersons who may have been infected or who care for those infected, argues an official in federal emergency management. Political leaders and essential city workers are other priority groups. A consensus must be reached as to how to proceed with the vaccinations. CDC is best suited to coordinate vaccine efforts, but the public health community must work towards an emergency. The governor, warns the city emergency manager, may step in and call the shots. There is a need for a public health emergency plan. Did the outbreak start from a single source or from multiple sources? This determination would help with vaccine management and allocation, but there is no answer. Moreover, testing facilities at CDC and USAMRIID are overwhelmed at this point in the epidemic.
Hospitals must deal with quarantine. Restrictions are imposed in the first days or weeks of an epidemic. Workers' fear of being sequestered causes them to leave hospitals understaffed. Many people are likely to stay at their posts if they feel they have reliable information and support, argues a mental health provider. Some, however, may leave the front lines to go home to their own families.
According to a 1905 Massachusetts case, cites a state's assistant attorney general, compulsory vaccinations are not a violation of due process and are therefore legal. So the local, state, and federal levels of government have no obstacle to vaccinating those designated at risk.
A more difficult legal question is that of quarantining smallpox patients. Many of the public health codes used to allocate powers to government officials are old and may not be valid or useful. Also, court precedents from HIV cases may have heavily weighted matters in favor of due process. Minnesota, for example, requires a separate court hearing for each case of quarantine. Thus, quarantine may be possible in a hospital but not in the community.
How Boston Beat a Smallpox Epidemic
Boston Globe (www.boston.com/globe) (02/02/01) P. A3; Saltus, Richard.
A National Institutes of Health study, published in the New England Journal of Medicine, suggests that the escalating rate of infectious disease can be combated if communities emulate some of the practices Boston used to defeat a smallpox epidemic in 1901. All Bostonians infected with smallpox were quarantined in designated facilities, while teams of police officers and doctors vaccinated all healthy people. The reason the effort was so successful was because "virus squads" went as far as inoculating homeless people against their will. The researchers recommend that initiatives be made to reach people with the highest probability of being disease carriers without trampling on individual rights.
So, without vaccine, and without the will to quarantine, we are dead as a nation from the second the vials of smallpox are dropped from the top of Empire State Building. Epidemiologically speaking, the USA, and the rest of the world for that matter, is a virgin for smallpox. There are NO people, world wide, under the age of 30, who have smallpox immunity. Smallpox vaccination is effective for about ten years. The last vaccination was given in 1973 in Bangladesh and Ethiopia.
The American people virtually do not remember what the word "quarantine" means. Jerry Brown refused to spray the crops in California for the Med Fly in about 1980 because the idiot didn't want to spray his space cadet voting constituency who were rabid greens. The Med Fly infestation got so bad that it was virtually out of control. Jerry Brown was told to kiss $3 billion of agri-trade goodbye if he waited to spray. Brown then over-reacted and sprayed everything in California. Once they realize America is doomed and collapsing, they will herd millions of people into concentration camp facilities to protect the uninfected.
The day smallpox is found in the USA, mark it down-- Fully one third of the US population will be wiped out. This will mean total collapse of life as we know it today, and the US will go into total economic collapse. The only precautions will be those you took BEFORE the epidemic. What are the chances of an epidemic? Well, tell me, what are the chances of a mail bomber? What are the chances of a kook blowing up the Federal Building in Oklahoma City? What are the chances of a Charles Manson? What are the chances of a Vietnam Vet machine gunning a McDonalds? Now, we move on to Libya, Iraq, Osama Bin Laden, Hamas, Hizb'ullah, North Korea, Fidel Castro. Then, we move on to the potential of aging bio warfare bunkers in Russia simply popping open from old age.
And, lastly, we have to ask, "Do we believe the World Health Organization, which was managed by a former SS officer during the vaccination program, is believable when they claim smallpox is eradicated?" I do not believe they are God, and I do not believe the virus is 100% gone.
Another basic legal question is whether the lines of legal support are clear to all officials, such as hospital guards and police officers. How far can police go to detain quarantined patients? The limits of emergency powers should be clearly delineated in any predisaster planning.
The epidemic is threatening to expand beyond the city into the rest of the country and even beyond. The World Health Organization (WHO) will probably become involved, and travel notifications have to be introduced.
Even without adequate supplies of vaccine, much can be done with the existing stocks. Prevaccinating some health-care workers is a proactive approach. Having a sizable pool of prevaccinated professionals who can mobilize and act as emergency responders takes much of the pressure off local hospitals. One way to reduce secondary transmission (outside of vaccinating the contacts of the infected person), instructs the hospital epidemiologist, is good infection controlwearing filter masks and washing hands well. Another way of controlling the epidemic is through quarantine. While these measures are not a substitute for adequate vaccine supply, they can slow the epidemic.
One problem with the vaccine supply is that many more people want to be vaccinated than limited stores permit. There are not even enough stores of vaccine to prevent the spread of the epidemic. The existing 6 to 7 million doses of smallpox vaccine will not last forever, and the 36 months it takes for additional large-scale preparations is prohibitive, argues a vaccine campaign expert. Health officials will likely not have the time or resources to target precisely those people who have an actual need for vaccine. The need for vaccine will overwhelm the supply.
The cost of vaccine development may inhibit stockpiling, proposes a CDC official. Since an attack with smallpox is of low probability, large-scale production may be difficult to justify. A partnership between private industry and the government would help, however. Also, the cost of getting caught without an adequate supply could be disastrous.
Possible emergency measures to stretch the vaccine supply, proposes a smallpox expert, include arm-to-arm vaccination as pustules form on the arms of vaccinated people; vaccinia could be grown in massive amounts in tissue culture; and 30 million doses of vaccine could be contracted from South Africa.
The smallpox epidemic has become a major public health emergency affecting several cities in many states and at least four other countries. The event is identified as a terrorist attack, because no other source of smallpox outside a deliberate release exists. For those who have already contracted smallpox, antiviral drugs, such as cydolfivir, may be useful but these medicines may be just as scarce as the vaccines.
Secondary transmission got out of hand, vaccine use did not contain the epidemic, and standard planning did not work. Thus a state health official sums up the deficiencies of response. Hospital resources have been overwhelmed, with people flooding emergency rooms in the belief they have smallpox. These cases are added to hospitalized cases before and during the epidemic; yet there are not even enough beds for all the sick. The hospital staff have become physically and emotionally exhausted from the long hours and from seeing about a third of infected patients die.
Failure of containment has turned the outbreak from local to national and international. However, the epidemic would have been much worse, had it gone unchecked, notes a state health official. Containment was significant. The 15,000 smallpox cases could have easily been more than 100,000.
No perpetrators have yet been identified, despite combining the criminal and the epidemiologic investigations. Such methodical work, however, is important because, unless the intelligence community comes up with information or a tip, there is no other way to identify the source of the epidemic, explains an FBI offical.
Many of the problems in the epidemic could have been avoided or controlled if extensive plans had existed, panelists agree. The panelist speaking from a governor's perspective identifies leadership as the most pressing void. Should the city have been placed under immediate quarantine? Should martial law have been implemented? Is the designation of a single smallpox hospital a reasonable thing for any city to do? These are difficult questions to face in the wake of a disaster. Such issues must be addressed long before trouble strikes.
The significant cost of curtailing the epidemic is debated. How will a smallpox hospital be financed, inquires a physician. The money might come from the federal government as emergency management funding, suggests a city emergency manager. The infrastructure and linkages within the public health community could be improved, the capacity for laboratory testing of samples could be increased, surveillance methods could be enhanced, and a health information strategy could be developed.
While the smallpox scenario is certainly frightening, experience with earlier epidemics (smallpox among them), knowledge of the issues, and expertise to deal with them show that in a crisis people from all disciplines pull together.
Mr. Bardi is a freelance writer in Baltimore who holds degrees in biophysics and science writing from Johns Hopkins University.
Johns Hopkins University,
Center for Civilian Biodefense Studies,
111 Market Place, Ste. 850,
Baltimore, MD 21202, USA;
What shall we do?
Try to find work which allows you to earn a living without interacting with people.
Find a home in the country NOW, not later, for millions will be heading for the country.
Arm yourself. Have firearms and sprays, such as ammonia. Guns may be outlawed. Think!
Learn any ploys you can use to get the vaccine unofficially. Can you get it in Mexico?
Be prepared to move to a part of the country where there is no epidemic.
Learn defensive measures now and how you will employment them.
Shop in the middle of the night. Use mail order for everything you can get.
Spray yourself and virtually everything you bring into your home with Lysol.
Use alcohol hand cleaners when outside the home.
Keep a supply of face masks and latex gloves on hand.
If you are shy about using precautions in public, you better go make arrangement at the local mortuary NOW. They will be rather busy later, and you could end up being dumped in a ditch for the coyotes to eat.
Stop shaking hands with people.
Do not attend public functions for any reason.
Do not attend a church which has no quarantine measure in place.
Lay in a supply of food.
Get a supply of water ahead.
Buy a second freezer and keep it full.
Plant a garden.
Do NOT buy vegies imported from anywhere.
Do not allow your pets to roam the neighborhood.
Home school your children (this may actually be forced on you by local officials, so get on with it).
Never eat out.
Don't stay in Motels.
Drive to destinations-- never use the airlines-- they do NOT filter the air in that plane.
As a family, sit down protocols for defending yourself.
Ask yourselves, "What will we do if someone in the family gets smallpox?"
Given all the smallpox now stocked in the world (20 tons in Russia alone), and given the millions of pathological people on this earth, you can count on it-- there WILL be a smallpox epidemic. You cannot hope for a solution by computer geeks, as we were rescued from Y2K peril. There is NO way to stop evil men from unleashing this epidemic, and they need to do so before about 2005, for by then, most of the White Race, who own all the debt on earth, will have restocked vaccines.
Just imagine all the nations today, hopelessly in eternal debt to the World Bank, who would be liberated by the collapse of the USA and Europe! What a motivation for about 90 national leaders to drop the vial.
You were warned.
OCTOBER 15, 2001
..........Dr. Osterholm last year wrote an excellent book entitled "Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe." (Delacorte Press 2000) I strongly recommend this concise but important book.
"Smallpox, the nightmare to end all nightmares that was eliminated as a natural disease in the 1970s, often starts with a simple fever -- the sort of thing anyone might get," Dr. Osterholm writes in the book. After a relatively long incubation period, it gets worse.
When I interviewed him Sunday, he pointed out that smallpox does kill about 30 percent of the people that contract it. In the United States today, he said, mostly everyone would be susceptible to smallpox since few people have received vaccinations since the 1970s. If you did receive a vaccination 30 years ago, it probably is no longer effective. The Centers for Disease Control and Prevention says: "Routine vaccination against smallpox ended in 1972. The level of immunity, if any, among persons who were vaccinated before 1972 is uncertain; therefore, these persons are assumed to be susceptible." The CDC has an informative site on small pox.
Unlike anthrax, smallpox can be transmitted by people who have contracted it. "So instead of having that first event be the end of it, like it is with anthrax where no one who becomes infected transmits this on, smallpox could be transmitted on," Dr. Osterholm told me.
Oklahoma Governor Frank Keating, a former law enforcement official who participated in the "Dark Winter" war game on bio-terrorism, is also an authority on the subject. He told me local and state health officials quickly need lots more training to deal with the threat of smallpox. He says the supply of vaccine needs to be increased right away.
"Don't let an individual in Washington say that doctors and nurses, for example, in Atlanta can't have them, they have to go some place else," Keating says. "We have to have a decision-making mechanism that's prompt."
Let's hope the threat of smallpox remains simply that -- a threat.
HERE YOU CAN READ WHAT CHANCE YOU HAVE OF
BEING VACCINATED DURING AN EPIDEMIC
CLASSIC EXAMPLE OF THE NEW AGE HEALTH NUTS TAKING CREDIT FOR
THE ERADICATING OF SMALLPOX BY THE OTHER BRANCH OF THE NEW AGE.
This shows how well you can trust these people to tell you the truth.
SMALLPOX HAS INDEED BEEN USED IN BIOLOGICAL WARFARE..................
BY THE UNITED STATES OF AMERICA AGAINST AMERICAN INDIANS
HOW SMALLPOX ATTACKS A VIRGIN CULTURE, LIKE OURS TODAY
The viruses that make us: a role for endogenous retrovirus
in the evolution of placental species
by Luis P. Villarreal
The view that viruses are principally major agents of disease is richly deserved. In human history, viral epidemics have accounted for more human deaths than all known wars and famine combined. This especially evident in the new world following the introduction of smallpox, then measles, influenza, and mumps into the then naive native american population from Europe. In Europe, these disease had already established a childhood pattern of infection. Essentially all adult Europeans were literally the survivors of childhood infections with smallpox and measles.
Smallpox was particularly significant in New World demographics. The first epidemic on the mainland was to hit the Aztec population around the time of the infamous �noche triste� on June 20th 1520, killing all the leaders and many warriors of the Aztec revolt that expelled Cortez. This revolt, one that killed many of Cortez�s conquistadors and drove them from Tinochtitlan (the Aztec capital), was to ultimately fail in spite of the seemingly enormous numerical advantage of the Aztecs. This smallpox epidemic and resulting social chaos was to deliver a death blow to this numeric superiority and clear the way for the successful return Cortez and his allies the following year.
This and subsequent epidemics were to continue their inexorable march through the Inca and Mayan civilizations then later into the North and South American continents, including Indians from the Mississippi valley, the Eastern seaboard, then into California and the Columbia river valley resulting in the greatest demographic catastrophe in human history.
SMALLPOX-- NO CURE-- Prelude to Armageddon