Smallpox’s State of Affairs

While it may seem odd to write about and take note of popular culture references to infectious diseases, I believe it is an important activity because these references serve as bellwethers for the general public’s view of these issues. During the recent Ebola outbreak, for example, it seemed clear that the public was reacting not just to the facts, but was also influenced by the frightening plots of the movies Outbreak and World War Z. Understanding how the public views certain infectious diseases pre-event is key to crafting effective risk communication strategies as well as anticipating issues that may arise

The latest episode of NBC’s CIA drama State of Affairs portrayed a smallpox outbreak in Panama sparked when vials of the virus at an old US research facility are broken during an earthquake. This is detected when a Department of Defense sniffer plane detects the virus during a fly over and sparks a robust US response. Many individuals are exposed and a vaccination plan is implemented.

Notwithstanding the reality of the sniffer plane component of the story, any case of smallpox anywhere in the world represents a grave public health emergency, as this is a disease that no longer circulates naturally. Therefore any case would have to be the result of an accident or a deliberate act of biowarfare.

Smallpox was eradicated from the planet—thanks, in part, to the bifurcated needle—decades ago and shortly thereafter samples of the virus were to be destroyed or consolidated at one of two laboratories: the CDC in Atlanta and Vector in Russia. However, given the discoveries at the NIH earlier this year, we know that samples existed outside of those two laboratories. Incidents such as occurred at the NIH and are fictionally depicted in State of Affairs reinforce the importance of threat reduction via ensuring that the appropriate biosafety measures are meticulously followed when storing and working with deadly pathogens such as smallpox.

Another aspect of smallpox, which made it eradicable, is that the vaccine can be effective as post-exposure prophylaxis if administered while the virus is incubating. Such vaccination, while not as effective as pre-event vaccination, can help staunch a burgeoning outbreak.

Overall, State of Affairs got the major issues of smallpox right during the episode—hopefully reflecting more than a modicum of understanding by the public of this naturally extinct virus.