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Friday, May 14, 1999 Published at 14:11 GMT 15:11 UK


Terminate our deadly foes

By BBC Doctor Colin Thomas

Arnold Schwarzenegger once famously said: "I'll be back." Well, also on the way back - and just as deadly as his Terminator character - are what I call old-fashioned illnesses.

Not a week goes by without me hearing about a new threat to health from an old disease.

Look at syphilis - we all thought it was on the way out - at least in the developed world - but in eastern Europe and third world countries it is becoming quite a problem with the breakdown of public health care structures and sexual health measures.

Tuberculosis, or consumption as your granny might have called it, had largely been eradicated from the UK, but with the increase in antibiotic resistant strains we cannot be so complacent now.

Potential threat

The World Health Organisation makes much of the eradication of smallpox - declared in 1979 - and would like to eradicate polio for the Millennium. But has the world seen the back of smallpox?

The US and Russian governments - and more recently The Lancet medical journal - have all expressed fears the virus could re-emerge in the future.

The last recorded epidemic of smallpox was in 1972 in Yugoslavia, contracted by a pilgrim returning from Mecca.

It took 4 weeks before the diagnosis was made, but with a huge vaccination and quarantine programme covering millions of people the outbreak was contained and only 35 people died. Twenty million vaccine doses were used.

Vaccine was available

This was not a problem in 1972 because there were ample stockpiles of the vaccine, and it was still being manufactured.

However, today it has been estimated that the world has only about 50 million doses of vaccine in store, and the means of producing the vaccine have been dismantled or destroyed.

If there was another outbreak of smallpox the world would be unprepared, and it would take at least three years to start manufacturing the vaccine again.

The virus lives on in labs

But why, I hear you cry, am I talking this way? Surely if smallpox has been eradicated then this can't happen.

Unfortunately, there are still smallpox viruses located in high security laboratories in the United States and Russia - raising the possibility that it could exist elsewhere too.

As you might know, nuclear material has been known to appear on the black market, and therefore you can't rule out the possibility of smallpox appearing in a terrorist group's arsenal.

I suppose that's why the Russians and Americans are reluctant to relinquish their stocks. Neither can be sure they wouldn't be handing someone else a lethal advantage.

Human immunity is fading

In fact, the older conditions I have spoken about might be more dangerous than in previous eras - because humans' natural immunity, and that delivered by vaccination programmes, has lapsed.

When conditions like syphilis and TB were rife, travel between countries was almost unheard of, or would take months or even years.

Now an infection can travel first class from London to Sydney in 24 hours.

The only sure way of consigning a disease to history is to destroy it totally. While the world continues to hang on to smallpox "just in case" we will have to be careful it's not a case of hasta la vista, baby.

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