On 9 December, 1979, health officials declared smallpox as the first and only human disease to be eradicated in what is considered the greatest achievement of modern medicine. Four decades on, the U.S. and Russia still maintain samples of the potentially deadly virus, and the debate on whether they should be kept or destroyed rages on.

We don't know where smallpox came from. But the infectionwhich is caused by two related variola virusesis thought to date back to the Egyptian Empire in the 3rd Century BCE, with its pustules found on the head of the Egyptian Pharaoh Ramses V. Trade and the expansion of civilizations helped the disease, found only in humans, spread. Characterized by symptoms including a fever, a widespread rash of fluid-filled blisters, vomiting and diarrhea, smallpox is estimated to have killed as many as 300 million people in the 20th century alone.

Following a failed attempt to wipe out the disease in 1959, efforts were renewed in 1967. Thanks to a worldwide vaccination program, the last person to ever be naturally infected by smallpox fell ill in Somalia, on October 12, 1977. By 9 December, 1979, the WHO had concluded the virus had been eradicated worldwide. And on May 8, 1980, the 33rd World Health Assemblythrough which the World Health Organization is governed by its member statesdeclared the world free of smallpox. Amid the Cold War, the body decided it would be wise to have two smallpox repositories in the West and one in the Soviet Bloc, in the interests of political neutrality.

To this day, only two remaining stocks of the variola virus are known to exist. They are kept under high-security conditions at a U.S. Centers for Disease Control and Prevention laboratory in Atlanta, and at Russia's State Research Centre of Virology and Biotechnology (Vector) in the Siberian city of Novosibirsk. Everything known about their location is in the public domain except for the exact rooms and freezers where the samples are kept, David Relman, professor of microbiology and immunology at Stanford University, told Newsweek.

Experts agreed on keeping the virus in case the disease reappears, and in order to help to improve vaccines, create treatments, antivirals and improve diagnostics methods. Any work on variola must be pre-approved by the World Health Organization, which takes inventories on samples every year, and inspects the labs biennially.

Until these objectives are met, the World Health Organization agrees the stocks should not be destroyed. Professor Grant McFadden, director of the Biodesign Center for Immunotherapy, Vaccines, and Virotherapy at Arizona State University, told Newsweek: "There remains debate about how close each of these goals is to completion."

So far, the decision to retain the samples has been somewhat fruitful. In 2018, for instance, the FDA approved the first drug that it believes could treat smallpox. Following a meeting in September 2018, members of the WHO's Advisory Committee on Variola Virus Research were divided, but once again concluded the repositories are still needed to develop an antiviral drug different from the one approved by the FDA.

While some argue the aims of the research agenda have been essentially achieved, McFadden said, others point to the fact only one new drug is now available, the animal models to test the new vaccines are currently inadequate, and the new generation of diagnostics remain unproven, he said.

The virus is needed to test the efficacy of new vaccines and drugs, David Relman, professor of microbiology and immunology at Stanford University, told Newsweek. "And chemical synthesis of the virus, in the event of destruction and then unexpected re-emergence and the need for new testing with the virus, would take too long," he said.

But what ifothers arguethe virus was released by accident, or on purpose? As people are no longer vaccinated against smallpox, this could potentially spark a large and deadly epidemic or pandemic, Amesh A. Adalja, a senior scholar at Johns Hopkins Center for Health Security, told Newsweek. Its potential as a tool of bioterrorism adds another layer to the controversial question of smallpox stock retention.

Concerning incidents have reignited the debate over the years. Previously unknown smallpox vials were found in an FDA building at the NIH Bethesda campus back in 2014. Last year, biosecurity experts feared the publication of a study that detailed the replication of the horsepox virus could provide terrorists with a recipe for making a pathogen that causes smallpox. And in September of this year, an explosion occurred at the Vector lab, (during which the smallpox samples were unscathed).

Relman told Newsweek that while he believes it is safe, but "not foolproof," to keep the repositories, he is "much more worried about the re-synthesis of smallpox from chemicals in the library and re-booting the virus with methods that have now been published."

McFadden is also concerned by that prospect, as well as the potential existence of any undeclared stocks.

For Adalja, the time has come to get rid of smallpox once and for all. "The virus should be destroyed," he said. "As time passes, the initial reason for keeping viable virus has less support."

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"In 2019, we now have achieved most of those milestones so it has become increasingly unnecessary to keep viable virus, especially since its genetic sequence is known and the virus could be recreated if needed," he argued.

"Keeping the viable stocks and working with them could lead to laboratory accidents with resultant infection and spread. The stocks could also be misused or fall into the wrong hands and be used nefariously," Adalja said.

Relman countered that in his view, the arguments for retention are stronger than the arguments for destruction. Not until re-synthesis can happen overnight and is reliable "will the balance of the arguments shift, and by then, by definition, we're back to the same or greater danger despite destruction," he said.

McFadden, meanwhile, said remains agnostic on the issue. "A great deal has been achieved on the original research goals, but the argument that more remains to be done is hard to refute," he said.

"I believe that a fully unanimous opinion of the research community and public health experts familiar with variola virus will be hard to achieve in the near future, and so the destruction decision will need to be political," he said. "It is important to have these debates about whether mankind should deliberately eliminate feared pathogens, or study them."

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Smallpox Was Eradicated 40 Years Ago, So Why Are the U.S. and Russia Still Holding Stocks of the Virus? - Newsweek