Smallpox and the Fragile State of Bioterrorism Preparedness
While the world focuses on cyber threats and conventional warfare, an older and deadlier threat lies dormant—waiting for the right moment. Smallpox, once eradicated, could resurface not by natural means, but through bioterrorism. With limited public immunity and vaccine supplies that fall far short of nationwide coverage, the U.S. may not be as prepared as it believes. The question isn’t just if we’re ready—but what happens if we’re not?
Bioterrorism: A Silent Threat in National Security
Though it doesn’t dominate the news cycle, bioterrorism remains a serious, if often underestimated, danger. Between 1970 and 2019, only 21 bioterrorism-related incidents were reported in the United States (Tin, Sabeti & Ciottone, 2022). Still, rarity should not be mistaken for insignificance. When it comes to weapons of mass disruption, biological agents can be among the most devastating—and current efforts to guard against them fall short.
Why Smallpox Still Haunts Us
The CDC and NIAID identify nine Category A agents that pose the greatest threat to public health and national safety (Minnesota Department of Health, 2022; Baylor College of Medicine, n.d.). Of these, smallpox remains one of the most dangerous. Known for its severe symptoms, rapid spread, and terrifying 30% fatality rate, a modern outbreak could claim around 102 million lives in a country of roughly 340.1 million.
A Vaccine Discontinued, A Population Left Vulnerable
Vaccination against smallpox was common in the U.S. until 1972. After the disease was declared eradicated in 1980, routine inoculation ceased. Today, only a limited number—mainly military personnel and lab workers—are still vaccinated. This means that the vast majority of Americans would have no immunity if smallpox were to reemerge, especially through bioterrorism.
America’s Vaccine Stockpile: Enough for Everyone?
In preparation for emergencies, the U.S. maintains a national supply of smallpox vaccines. Although official numbers are rarely disclosed, in 2022 it was reported that over 100 million doses were on hand—an effort partly spurred by the Monkeypox outbreak, since the smallpox vaccine is effective against both (U.S. Department of Health & Human Services, 2022). However, with a population of over 340 million, this reserve would only cover about 29% of the country.
What History Can Teach Us: The 1947 NYC Outbreak
The importance of preparation becomes strikingly clear when looking at past outbreaks. In 1947, a man returning from Mexico fell ill while traveling home to Maine. He stopped in New York City and moved freely for four days, unknowingly carrying smallpox. Eventually hospitalized, he died two weeks later without a diagnosis (Weinstein, 1947).
Shortly after his death, two more individuals treated on the same hospital floor returned with fever and rashes. Tests confirmed smallpox. Authorities moved quickly—vaccinating all known contacts and launching a massive public campaign. In just three weeks, over 6.3 million New Yorkers received the vaccine. In the end, only 12 people were infected, and two died—including the original patient.
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