The Demon in the Freezer by Richard Preston
The Demon in the Freezer: A True Story
by Richard Preston
Random House. 240 pp. $24.95
Take to you handfuls of soot of the furnace, and let Moses throw it heavenward in the sight of Pharaoh; and it shall become fine dust over all the land of Egypt, and shall be a boil breaking forth with blains upon man and upon beast, throughout the land of Egypt. [Exodus 9:8-9]
Whatever one’s views on the historicity of the biblical plagues, it is remarkable how closely this passage resembles a description of modern biological warfare. A handful of smallpox virions, each about the size of a particle of soot, contains enough pestilent material to infect millions of people. Released at a high enough altitude, a cloud of such viral dust might spread invisibly for 50 miles or more. Anyone who breathes in as few as a half-dozen grains could become symptomatic in a fortnight, breaking out with blisters and sores or with bleeding skin. Within another week, depending on the form of the disease, such a person would stand about a one-in-three chance of dying. In the meantime, the same person would transmit the contagion to three, five, or twenty others. In a month, absent effective controls, a plague of smallpox could easily spread “throughout the land.”
Probably one of the chief reasons this horrific scenario has not yet come to pass is that smallpox virions, unlike furnace soot, have been hard to come by since the disease was eradicated from nature in 1979. Officially, there is not enough smallpox left in the world to do any large-scale harm. The only internationally recognized samples reside today in two freezers: one at the Centers for Disease Control (CDC) in Atlanta, Georgia, the other at a Russian research center in Siberia called Vector. World Health Organization (WHO) rules forbid any other laboratory from possessing more than a tenth of the virus’s DNA. In theory, then, the probability of another human case of smallpox—let alone a plague—is virtually nil.
Nevertheless, as Richard Preston demonstrates in The Demon in the Freezer, the reality is somewhat more chilling. In the 1990’s, United Nations inspectors in Iraq uncovered evidence of a robust biological-weapons program—evidence including, among other things, laboratory equipment labeled “smallpox.” According to high-level defectors from the Soviet Union, that now-defunct dictatorship also manufactured smallpox by the ton, and many of the mobile containment units in which this smallpox was stored remain unaccounted for. The demon, in other words, is out of the freezer, and it may be only a matter of time before it is loosed again.
Much of this book’s narrative is told from the viewpoint of an insider at the U.S. Army Medical Research Institute of Infectious Disease (USAMRIID) at Fort Derrick, Maryland. The staff of that government agency had to cope with the anthrax threat of 2001; for several years, however, it has also been preparing for the potentially even more frightening threat of smallpox. But USAMRIID is only part of Preston’s story. The Demon in the Freezer is peopled by a lively cast of characters, ranging from dyspeptic Soviet virologists to single-minded Hindu mystics, many of whom were involved either in the triumphant eradication of smallpox or in its terrifying rebirth as a weapon of mass destruction. Some of the characters, like Peter Jahrling of USAMRIID, come across as Hollywood heroes. Others, like the British-educated Iraqi biologist Hazem Ali, bear a distinctly villainous taint. (Evidently lying through his teeth, Ali protested to UN inspectors that he had been working on the innocuous camelpox virus.)
The Demon in the Freezer also describes, in fascinating and horrifying detail, exactly what smallpox is and what it does. Among its gruesome manifestations, Preston delineates garden-variety smallpox, in which the patient breaks out into blisters; confluent-type ordinary smallpox, in which the blisters merge into sheets of pus; and hemorrhagic smallpox, or “black pox,” which is almost always fatal and in which the skin bleeds and darkens and the whites of the eyes turn red.
As for the danger still posed by the disease, that is palpable in Preston’s sickeningly vivid description of the rapidity with which a single infection can blossom into an outbreak. In December 1969, a traveler returned to Meschede, Germany, from Bangladesh with an incubating case of smallpox. At the first sign of fever, he was placed in a private room in an isolation ward; as soon as the cause was determined to be smallpox, the WHO stepped in, shipping thousands of doses of vaccine and organizing a mass vaccination campaign virtually overnight. Nevertheless, nineteen more people were infected, four of whom died, and the toll would undoubtedly have run much higher but for the quick action of local medical authorities and the WHO.
That happened over three decades ago. If such an outbreak were to occur in an urban area today, it is not certain that enough vaccine could be produced quickly enough to contain it. Much of the world’s vaccine stock was destroyed in 1990 to save on refrigeration costs. More ominously still, research with animal-pox viruses suggests that it is potentially very simple to produce a strain of smallpox that is both extremely virulent and resistant to standard vaccines.
Our hope, Preston concludes, lies in the ongoing effort to produce biological counter-agents by working with the live virus. But such research is controversial. The WHO voted in January 1999 to destroy the last remaining (legal) stocks of the smallpox virus—the samples at the CDC and in Siberia—by July of that year; although the deadline has since been extended, the agency is anxious to finish the job, even if that means an end to vaccine research. D.A. Henderson, the physician who spearheaded the WHO’s smallpox-elimination program, believes (according to Preston) that an effective vaccine will never be developed using an animal model. Although he may turn out to be right, Preston’s account of the breathless effort by CDC and USAMRIID scientists to develop a model of smallpox in monkeys is a powerful suggestion of the progress that could be made by pressing forward.
For better or for worse, Preston studiously avoids the harder questions: what steps could be taken to minimize the impact of a biological attack? If stocks of vaccine were not a problem, what would be the pros and cons of widespread vaccination? How might we counter the potential use of genetically engineered, vaccine-resistant strains? Is it wise for the United States to continue its 30-year-old moratorium on biological-weapons research, in light of the fact that other nations are evidently pursuing such weapons at full tilt?
To say the least, these issues are controversial, and Preston—who, after all, is neither a virologist nor an epidemiologist nor a politician but a professional writer with a doctorate in English—can hardly be faulted for leaving policy debates to the experts. But it is clear that they urgently demand answers.
It is no less clear that we cannot afford to hesitate in acting against rogue states known to possess biological weapons. Although much has been made of the suspicion that Iraq may be trying to acquire nuclear weapons, comparatively little attention has focused on its acknowledged biological and chemical programs—even though, compared with nuclear weapons, virus-weapons development is relatively cheap and easy to disguise or conceal.
On a similar note, The Demon in the Freezer should give pause to those who believe that any threat can be defeated by international good will. The 1972 Biological Weapons and Toxin Convention is a case in point. Signed by 144 nations, the treaty forbids the development, possession, or use of offensive biological weapons. Yet there is good reason to believe that numerous signatories have flouted the convention by pursuing research into agents like smallpox. These include not only manifestly untrustworthy states like Iraq and North Korea but also Russia, India, China, Taiwan, and supposedly enlightened France. (France denies the charge; but then, so does Iraq.) What is needed, clearly, is not more good will but a more effective international regime for policing and punishing bioweapons development, along the lines proposed by the Bush administration in November 2001.
I do not mean to overstate Preston’s accomplishment, especially in literary terms. His prose, while crisp and eminently readable, can be too terse and formulaic; his attempts at injecting “human interest” into the narrative sometimes fall flat, and his occasional efforts at profundity are embarrassing (“the hand is a symbol of humanity, part of what makes us human”). But such faults should not be allowed to distract from his book’s central message, which is that biological warfare is not only a real danger but one that we are not adequately prepared to handle.
A single case of smallpox infection, arising by accident or act of terrorism, would engender an instant public-health crisis. Even if a rapid vaccination program could be coordinated, it could be rendered effectively useless by a genetically engineered virus. If a terrorist got hold of such a virus, the potential damage is almost unimaginable. Preston’s book is a kind of wake-up call to a world that has largely forgotten how much havoc the smallpox demon can wreak.