But nine years later, on April 22, 1999, President Clinton, acting on the advice of independent scientific investigators (53–55) and a report by the Institute of Medicine of the National Academy of Sciences (56) decided to delay the planned destruction of smallpox stocks in the United States. The decision was based on the importance of obtaining additional scientific knowledge about how smallpox works, how to chemically attack it with antiviral medical therapy, and concern over the possible use of smallpox as a terrorist weapon. The president wished to review the issue of eliminating smallpox with a re-evaluation and a decision to be made in June 1999 and to explore the possibility of joint research on smallpox with the Russians.

D. A. Henderson, who was largely responsible for leading the successful campaign to eradicate smallpox retorted, “I’ll wager over the next five years you’ll see no work whatsoever... except in the Russian laboratory where smallpox was weaponized. You can draw your own conclusion about that.” At this same time, intelligence reports suggested that clandestine supplies of smallpox were elsewhere, most likely in North Korea, Iraq, and perhaps in other areas.

Henderson continued, “I find it very regrettable that within the World Health Organization, 74 of 79 countries want to destroy the virus but four, including the United States and Russia, favor its preservation.” The new American position, to keep smallpox viruses rather than eliminate them, reversed the 1996 U.S. policy to destroy the virus. Arguments then, as now, for keeping smallpox rested on four points. By maintaining stocks of smallpox, first, the opportunity to develop antiviral antidotes remained. Second, a new and safer vaccine could be devised using modern technology. Third, even with the best intentions of all, smallpox could not be eliminated from the world because dead smallpox victims buried and preserved in permafrost were akin to having smallpox in a freezer. Fourth, we live in a wicked world, so who is to guarantee that smallpox would be eliminated from all laboratories, freezers, and countries?

So, the momentum began to swing the pendulum toward keeping smallpox. An editorial appeared in the journal Nature on April 29, 1999, advocating the preservation of smallpox in the two restricted areas. Then, in Geneva, after the World Trade Center attack on September 11, 2001, the WHO Governing Board agreed in January 2002 to delay the destruction of known samples of smallpox and revisit the issue again in 2005–2006.

However, at the time of the Geneva meeting, Soviet defectors now living in the United States and Great Britain who previously worked in the Russian smallpox bioweapons program told of an ongoing program in Russia (52). Iraqi and Iranian scientists were heavily engaged in research on camelpox, a close cousin of smallpox. Although camelpox has not been shown to infect humans, research to change its tropism to man may be a scientific possibility and therefore of great concern.

With that background came the legacy of the September 11, 2001, tragedy at the World Trade Center. The stakes now rose dramatically