Ken Tucker reviews 'It's all Relative: Tillis Sings Tillis'

DATE October 7, 2002 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Richard Preston discusses the dangers of smallpox
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

The eradication of smallpox was one of the greatest world health victories in
history, but now we are faced with the possibility that smallpox will be used
as a terrorist weapon. Health policy experts have been debating if, when and
how to begin a new program of vaccinations. On Friday, the nation's top
public health officials, including the directors of the Centers for Disease
Control and Prevention and the National Institute of Allergy & Infectious
Diseases, recommended a vaccination program that would first immunize up to
10 million health-care workers and then make the vaccine available to the
general population. The final decision is up to the president. It is
unlikely the vaccine will be licensed for general use until 2004.

My guest, Richard Preston, is the author of the new book "The Demon in the
Freezer," about smallpox and anthrax, their history and current scientific
efforts to thwart them if they are used as bioterrorist weapons. Preston is
also the author of the best-seller "The Hot Zone," about the Ebola virus. He
has won the American Institute of Physics Award and the Centers for Disease
Control's Champion of Prevention award. Preston has written for The New
Yorker since 1985.

I had a slightly different attitude reading this book than reading your first
book, "The Hot Zone." In "The Hot Zone" I thought, `God, this is so
fascinating,' and I was so--the descriptions of the Ebola virus and what it
did to the human body. I remember when I interviewed you, you described it
and I thought, `Wow, this is really interesting.' Reading similar kinds of
descriptions in your new book, but this time about smallpox and anthrax, I'm
scared in a way that I wasn't scared reading the Ebola book, because I figured
my odds of getting Ebola are pretty small, but my fears of biological warfare
are greater. So I'm wondering, like, when you were writing this book, was it
more difficult for you to immerse yourself in this material?

Mr. RICHARD PRESTON (Author, "The Demon in the Freezer"): Well, I have to
admit to you that I'm more scared of smallpox than I am of Ebola virus. That
was the case always for me. When I was researching "The Hot Zone," I went to
Africa and I went inside Kitum Cave, which is in East Africa, which is thought
to harbor one of the strains, types of Ebola virus called the Marburg virus.
And, as you can imagine, my wife was not terribly pleased that I was going to
this cave, but I felt that with the right kind of biohazard gear, I would be
all right, and I was.

The problem with smallpox is that, unlike the Ebola virus, it is finely tuned
to attack the human body. In fact, this virus cannot live successfully in any
other organism except homo sapiens. And it is considered by doctors to be the
worst disease in history. And it is very much--I feel it's a kind of a
personal threat. It's a life form that knows us and loves us in a way and
longs, in a biological sense, to return to its natural host. It is sitting
supposedly in two freezers illegally, one in Russia and one in the United
States. There may be more than one freezer in Russia. It appears that there
may be military labs in the Russian Federation that are secretly working on
smallpox today. But in any case, one feels that the virus is very much more
personal and I feel, in a way, that--I don't feel so much fear for myself
personally, but for my loved ones.

GROSS: When you talk to experts, how worried are they about the possibility
of anthrax or smallpox being used as weapons?

Mr. PRESTON: The people who know smallpox are very concerned about it. I
should say that professional medical doctors who have seen human smallpox
cases and have worked with them have a very doctorly attitude toward it. And
they are not always the ones who are the most concerned about it because, in
their experience in history, they were able to eradicate the virus with
liberal use of the vaccine. Today, while we have a national stockpile of the
vaccine, it's rather unclear whether it could be gotten into people quickly
enough. The virus spreads very rapidly through the air. And there also is a
great deal of concern that maybe with very simple genetic engineering tricks,
it might be possible to make the virus evade the vaccine.

GROSS: Well, let's talk a little bit about some of the research that you've
done for the book. Some of the book is built around the researchers at
USAMRIID, which is the US Army Medical Research Institute of Infectious
Diseases. Just describe what this institute does.

Mr. PRESTON: Well, it's the premier biodefense lab in the United States, and
it's a very interesting place. They have different levels of biosecurity.
They have these places called hot suites or Level 4 hot areas where they work
with the really dangerous stuff. The scientists work inside bioprotective
space suits and those people there, they don't work with smallpox. The
smallpox virus can only be worked with legitimately at one place, which is the
Centers for Disease Control in Atlanta. But in the Army labs, they work with
other viruses and they work with viruses closely related to smallpox, such as
monkey pox. Those people--the ones who think professionally about biodefense,
those people have a different attitude toward smallpox than the traditional
doctors who worked with it. I think they feel and see very clearly that there
are a number of countries around the world that are looking very carefully at
smallpox and recognize that it could well prove to be the mother of biological
weapons and that, therefore, it's dangerous.

GROSS: Why is smallpox so lethal?

Mr. PRESTON: No one knows. The actual cause of death in a human being from
smallpox is not known to science. It's amazing how little is actually known
about the smallpox virus. That's because very little research has been done
on it in modern years.

GROSS: I almost hate to ask you to describe this, but since we have been
lucky enough, or most of us have been lucky enough to never see a case of
smallpox, why don't you describe what smallpox does to the human body.

Mr. PRESTON: Well, one of the interesting things about smallpox is that it's
a shape-shifter of a disease. It doesn't assume any particular classical form
in the human body. It has a number of forms, and different doctors have
different classification schemes. It interacts in a very complex way with the
human immune system, and that's why it shows its face in different ways in the
human body. There is what is called classical ordinary smallpox, and I'll
describe that and then I'm gonna describe an extreme form of the virus.

In classical ordinary smallpox, you get an illness that's rather like the flu.
You get a backache and you get a sore throat and you feel ill, vaguely ill for
four or five days. And you often develop a worried face, which is known as
the worried face of smallpox, and it's a diagnostic sign to experts. But most
doctors would be totally unable to recognize a person with smallpox when
they're in this phase. However, they are contagious and the back of your
mouth will be--may have small pustules or little tiny blisters in it and you
may be leaking the virus directly into the air when you speak. The virus can
spread during this phase. Then on about day five or so, you erupt--the skin
erupts and you develop pustules that are concentrated in the extremities of
the body--in the face, the arms and legs and somewhat less so on the trunk,
but really the pustules can go everywhere. They are large, extremely painful
bulbs of pus. If they merge into solid sheets across the body, that means the
patient will probably die. That's known as confluent ordinary smallpox.

Smallpox also assumes the hemorrhagic form, which is rather like the Ebola
virus. The skin can remain smooth but it darkens. It can slip off in sheets,
and the patient can bleed from all the orifices of the body, as with Ebola
virus. The eyes turn red with hemorrhage and in some cases the eyes actually
turn--the whites of the eyes turn coal black. This is from deterioration in
the eye. If there's any sign of blood in the skin or anywhere in the body of
a smallpox patient, that means the outcome is almost certain to be fatal.
These bloody cases are almost always fatal.

There is another form of smallpox, which is known as variola synaeruptiona,
which is a very mild, non-fatal type of smallpox. It is highly transmissible.
I mean, people can be--if you have it, you may not know you're very sick, but
you can give full-blown smallpox to people all around you, which is one reason
why the virus is so dangerous.

GROSS: Why is the virus so contagious? I think you estimate in the book that
each person who gets smallpox gives it to around 10 others, or it keeps
multiplying by 10.

Mr. PRESTON: The fact is that no one knows what the multiplier of smallpox
is, and it's one of the great and important questions about this virus. And
there is a big debate going on in the scientific community. The multiplier of
a virus is the average number of people who catch it from one person. And if
the multiplier is four, five, 10, 15 or 20, then the virus can multiply itself
very explosively through human populations. It can be very difficult to
control, even with vigorous vaccination going on. We don't know what the
multiplier of smallpox is in modern industrial societies. We haven't seen it
much in hospitals. We haven't seen what it would do in shopping malls and
urban areas, in closed air spaces and with air travel. We just don't know.

GROSS: Now smallpox had been eradicated. It has been eradicated, although
we're worried that some terrorists will start it up again, but it has been
eradicated. You've studied how that was done. Can you give us, like, a
capsule version of the technique that was used to disseminate enough vaccine
so that the virus was eradicated?

Mr. PRESTON: In my book I capitalize the word `eradication' and I use it as a
proper noun because the eradication is one of the great achievements. And it
was led by a handful of doctors in Geneva, led by Dr. D.A. Henderson, who's
now, you know, a bioterrorism guru working for the federal government. And
they used a technique known as ring vaccination around outbreaks. Whenever
they identified the virus moving through a human population, they would swoop
in. They would vaccinate everybody around the village where the virus had
been seen and, in that way, they would create a kind of fire wall of immune
people all around the virus and the virus would find that it had no further
hosts that it could infect and it would die out in that spot. Through about
10 years of intensive ring vaccination, they were able to eradicate the virus
as a natural disease.

GROSS: Why was some virus saved after the eradication and what was the
rationale for that?

Mr. PRESTON: I don't think there was a clear rationale of why the virus was
saved. And Henderson and others have said to me, `Gosh, you know, we had an
opportunity. We really could have gotten rid of those stocks around 1980. We
could have done it.' But they didn't. It was kept for research. People
weren't really thinking about what could be done with a virus as a weapon.
And meanwhile, we now know that, quite secretly, the Soviet Union and probably
other countries as well had already seen the potential for smallpox as a
biological weapon and, in the Soviet biowarfare program, they were beginning
the effort of developing these enormous secret stocks of frozen smallpox
virus, which could be used in ICBM warheads that were allegedly aimed at the
United States. Where those warheads are today, the smallpox warheads, whether
they've been drained, whether they've been sterilized, what's happened to them
or what's happened to the designs for those warheads is simply unknown, as far
as I can tell.

GROSS: So that's a real wild card. That's something to worry about.

Mr. PRESTON: Well, you know, there are a lot of things to worry about, and I
would remind people that smallpox virus has been around forever. It was only
eradicated recently, and our ancestors lived with smallpox in their families.
And this country was built by families that had experienced smallpox and
everybody knew it, knew what it was, and it didn't stop us from becoming what
we are today. And it won't in the future, either. During the course of
researching this book, I ended up at the Army lab where they have the arm of
a child, an American child, which is--the child died of severe
smallpox--confluent smallpox, probably in the 1940s. It's a Caucasian child,
about three years old. We don't know whether male or female, just the arm.
And I went into the lab and I handled the arm. It's safe now. It's
completely sterilized. And I had a sense of what this virus looks like in a
human being and it was absolutely impressive. But at the same time, I
recognized that this was a sight that we have forgotten, yet all of our
ancestors knew it only too well.

GROSS: My guest is Richard Preston. His new book, "The Demon in the
Freezer," is about smallpox and anthrax. We'll talk more after a break. This
is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Richard Preston. He's the
author of the book "The Hot Zone," about the Ebola virus. His new book is
called "The Demon in the Freezer." It's about anthrax and smallpox, their
history, their treatment and the possibility of them being used as weapons.

Now there are fears of what the Soviets might have done with their smallpox
and the new strains they might have been developing. You say it's also
conceivable that Iraq could have gotten a strain of smallpox from one of the
last epidemics in Iran and Iraq in the '70s and they could have stored that
and used that for the basis of weapons. Where did you first come across that
possibility?

Mr. PRESTON: Well, this was pointed out to me by Dr. Richard Sperzel, who
was one of the head biological weapons inspectors for the UN in Iraq. And he
pointed out that the Iraqi government now has officially declared that it had
a weapons of mass destruction program and a biological warfare program as
early as 1973. And in 1972, the year earlier, there was a massive outbreak of
smallpox in Iraq. And it left many hospitals and hospital labs in Iraq with
frozen stocks of real live smallpox virus. The virus, I should point out, can
be frozen indefinitely for up to 50 years without any apparent decrease in its
potency. And Dr. Sperzel pointed out that it seems almost inconceivable that
a nation that is embarking on a biological weapons program--and in 1973 Iraq
was building biosafety Level 3 containment labs--these are serious labs--that
they would go around and ransack their country to get rid of all the stocks of
smallpox that were in the hospitals all over the country. It's just
inconceivable that they would have done that. So logically, one assumes that
there are seed stocks of smallpox in Iraq today. Where they are and what is
being done with them is not in my knowledge. I don't know.

GROSS: Now you write that in 1994 the World Health Assembly voted to destroy
all the stocks of smallpox. And they set a deadline for that destruction of
June 30th, 1995. And then in 1999 the UN voted to keep smallpox alive for
another three years, until June 30th of 2002. Can you explain all those
deadlines to us?

Mr. PRESTON: Well, there was a profound desire on the part of the eradicators
of smallpox, D.A. Henderson and others, to have a public execution of the
virus, to take all the public stocks and cook them in an oven. And this, they
felt, would be a way to demonstrate to the entire world--for the United States
and Russia to take the high ground and to say to the rest of the world, `We
can get along fine without smallpox, and you can, too.' I think by then they
had no illusions that there are no other places where smallpox is kept, but
they felt that it would be a very important public, ethical and moral
statement to make and that there was no good, justifiable reason for keeping
the smallpox virus around for scientific research when it is so dangerous to
people.

GROSS: So that final deadline of June 30th, 2002, passed a few months ago.
What happened regarding that deadline? Did it mean anything finally?

Mr. PRESTON: Well, in the end, what happened was that there was a
reconsideration for the reasons why a smallpox virus, the real McCoy, should
be kept around in labs in the US and in Russia. And the justification is that
the vaccine is the traditional vaccine that was invented in 1796; it's
18th-century biotechnology. And genetic engineering is moving very fast, and
it's quite conceivable that a strain of smallpox could suddenly appear in a
terrorist attack or even in a laboratory accident with a weapons lab that
would not be stoppable with the traditional vaccine. Therefore, there would
need to be alternatives for stopping smallpox, namely anti-viral drugs--we
know now that anti-viral drugs can work pretty well on the HIV virus, so why
not smallpox--and a better modern vaccine. But in order to have these things,
the Food and Drug Administration requires testing of the real thing. You have
to take the real virus and you have to test, somehow or other, a drug on that
virus to prove that the drug works. You can't take the drug and test it on
some relative of smallpox. That's not acceptable to the FDA.

GROSS: So what kind of tests are being done now on monkeys for improving the
vaccine?

Mr. PRESTON: Well, there have been a series of protocols on real live monkeys
at the CDC run by a team of researchers from the Army led by Dr. Peter
Jahrling. And they have managed, against, I think, most expectations, to
actually infect monkeys with real live smallpox and make those monkeys look
like they have smallpox.

GROSS: Now this is unusual because smallpox is supposed to only live in
humans, not in other species?

Mr. PRESTON: Smallpox, yes, doesn't live naturally in any other species and
it's interesting because, perhaps 10,000 years ago, the smallpox virus was an
emerging virus like HIV or Ebola, coming out of some unknown animal host
somewhere in nature. And it made a transspecies jump into humans. This is
what viruses do. It's one of the main strategies for survival of a virus. It
can change hosts dramatically sometimes. In this case, the original host of
smallpox is unknown and the virus apparently is no longer able to infect even
its original host. In fact, the original host may be extinct. So the Army
people went ahead and they found that by really loading the monkeys with
smallpox, giving a monkey the equivalent of about 100 million human lethal
doses of smallpox, they could simulate the disease. The disease comes on
full-blown in the monkey if you do that and the monkey pustulates. The monkey
can die. The monkey even can develop hemorrhagic type smallpoxes, gruesome
work. And then the idea eventually, I think, is going to be to test drugs and
vaccines on these monkeys and to prove that you can save the monkey's life
that way.

GROSS: How much progress are these researchers making in developing a better
smallpox vaccine?

Mr. PRESTON: I think the progress is looking very good. We certainly are not
there yet. But I also would like to give people a sense of reassurance here
that, you know, the problems that we have, the threat that we have from
smallpox is a threat that's coming out of biology labs in other places. And
probably one very good way to deal with that threat is through biology itself.
And the research is promising. I think it's very likely that we will have at
some point a drug that really does work on smallpox. That will be a very good
thing and the sooner the better. And I think it also is quite possible now to
have an extremely good vaccine on smallpox that's milder and that may work
just as well.

GROSS: Richard Preston's new book about smallpox and anthrax is called "The
Demon in the Freezer." He'll be back in the second half of the show. I'm
Terry Gross and this is FRESH AIR.

(Soundbite of music)

(Announcements)

GROSS: Coming up, we continue our conversation with Richard Preston about
smallpox, and Ken Tucker reviews a new CD featuring Pam Tillis performing
songs written by her father, Mel Tillis.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross, back with Richard Preston, author
of the new book "The Demon in the Freezer," about smallpox and anthrax and
what scientists are currently doing to protect us against their use as
terrorist weapons.

On Friday, the nation's top health official suggested a smallpox vaccine
strategy that would begin by immunizing health-care workers, then make the
vaccine available to the general public. The vaccine is unlikely to be
licensed for general use until 2004. When we left off, Richard Preston was
talking about how scientists are working on improving the smallpox vaccine.

I know one of the fears now is that terrorists could be using a genetically
altered form of smallpox that might be resistant to the vaccine. The vaccine
might not prevent somebody from catching a genetically engineered strain of
smallpox. Can scientists work in advance of knowledge of what the genetically
altered strain would look like and come up with a vaccine that could vanquish
a strain that they don't even know what it is yet?

Mr. PRESTON: This is a great question. Probably, but we don't know. Genetic
engineering is the wild card and genetic engineering has gotten to be really
easy. And I spent time in labs with people doing actual engineering of
viruses to see how it's done. Today, you can engineer a virus, a new virus,
for peaceful research for probably less than $1,000 in lab materials, and you
do it through the help of something called a virus engineering kit, which can
be ordered through the Internet for about $200. That's the way scientists get
the stuff.

And virus engineering now is considered to be so routine that many senior
scientists find it rather tedious and boring, and so they turn the work over
to graduate students or even summer interns. We're not talking about rocket
science here. And it's quite clear to me that Iraqi scientists, or many
scientists in other countries, can do this kind of work just as easily as
anybody else.

Recently, within the last couple of years, there's been some surprising and I
think maybe scary research that was developed originally in Australia, where a
group inadvertently put a certain gene into the mousepox virus and found that
they'd created a kind of killer virus that could overwhelm the mouse's
immunity. Now mousepox is not infective in humans, but it's very closely
related to smallpox. So the concern was that if you took this single gene and
you put it into smallpox, you might have a vaccine-proof virus which
scientists themselves refer to as a super variola. Variola is the scientific
name of smallpox--so a superpox or super variola that could get around the
vaccine. And this type of work might be done in a relatively simple lab for
the cost of materials of about the price of a used car.

GROSS: What are the odds that we could do something before we knew what that
strain was?

Mr. PRESTON: Well, I spent some time with scientists in a lab in St. Louis,
and one of the was a virologist named Dr. Nonhy Chin(ph) and I watched him
while he engineered strains of this type of virus and tested them in mice to
see what would happen to try to develop a vaccine strategy that would work.
And he remarked to me--he said to me at one point, `You know, I think you
could learn how to do this yourself in about two months.' But what they found
out was that there probably are ways to vaccinate people against this type of
genetically engineered smallpox. And furthermore, a good smallpox drug would
probably attack the virus in ways that you couldn't engineer around by adding
genes to the virus. So there are ways to deal with it. But it is necessary
for scientists to go forward and do this.

GROSS: You know, in thinking about the possible weaponization of smallpox, I
just keep asking myself, `How stupid can you be?' because if you're in one
part of the world and you're sending your smallpox weapon to another part of
the world, it's going to come back to your part of the world eventually. It's
a disease that spreads. Once the cat's let out of that bag, it's not going to
just stay in one place. So any terrorist who uses that is hurting his or her
own people in the long run. So I keep asking myself, `Who could possibly
unleash this no matter how evil or perverse they are?'

Mr. PRESTON: Indeed. And that goes right to the question of human nature,
but we should not forget that in the Soviet Union, Soviet biologists developed
genetically engineered strains of plague or black death, which is highly
contagious in the air, and they made the kind that can't be treated with
antibiotics. And then they allegedly put it in missiles aimed at various
targets, perhaps in the United States. And there was no consideration there
that it might get back to Russia. That's the way the thinking goes. And the
fact of the matter is that a weapon doesn't have to be used in order to be
extremely powerful. The hydrogen bomb is a very effective weapon.

GROSS: That's the whole deterrent strategy?

Mr. PRESTON: It's intimidating and it changes the balance of power. Now if
the United States government thinks that Iraq has genetically engineered
smallpox, then that changes the equation of power as these two countries, the
United States and Iraq, maneuver toward a war.

GROSS: Does the United States think Iraq has genetically engineered smallpox?

Mr. PRESTON: I really don't know. You know, again and again, as I was
researching this book, I came up across the question of what's classified?
And when you're interviewing people who clearly have security clearances and
access to classified stuff, you find all of a sudden that the interview goes
dead because they're not even allowed to tell you that there's something
classified here that you're getting on to. But what happens is that you end
up with shadow shapes. If you interview enough people, you begin to see the
shapes of classified things by where the interview stops. And by that way,
you get a feel, a kind of gut feel for what's believed by the intelligence
services of the US. And I can tell you that the shadow or the shape that I'm
seeing is that they really don't know whether Iraq has genetically engineered
smallpox, but it's just so darned easy apparently that one has to proceed on
the assumption that probably.

There is also another rather disturbing and dark shadow shape and that's the
one in the Russian Federation. There appear to be two military lab (technical
difficulties). One is called Sergiyev Posad or Zagorsk. And the other one
is called Pokrov. And both are near Moscow. Both have been totally closed to
outside inspection. Both are believed or known to have had large stocks of
smallpox virus in them as recently as 10 or 11 years ago. And nobody knows
what's going on there today and the Russian Federation is completely
stonewalling outside inspectors. And the shape that I see or sense is that
Russia today has at least one strain of smallpox that is vaccine resistant,
maybe superlethal, but may not be genetically engineered. It may just be a
really hot natural strain that Soviet scientists collected somewhere.

GROSS: My guest is Richard Preston. His new book, "The Demon in the
Freezer," is about smallpox and anthrax. We'll talk more after our break.
This is FRESH AIR.

(Soundbite of music)

GROSS: Richard Preston is my guest, and his new book, "The Demon in the
Freezer," is about smallpox and anthrax. His previous book was the
best seller "The Hot Zone," which was about Ebola.

One of the difficult decisions facing the government and doctors now is, you
know, should we start vaccinating the American public in case there's some
kind of smallpox attack? Or should we just not do that and only do it if
there really is an attack? One of the problems, apparently, is that a lot of
people--an unacceptable number of people could die from the vaccination
itself. What are some of the vulnerabilities that we have with the actual
vaccination?

Mr. PRESTON: The vaccine is pretty potent stuff. It's actually a live virus
called vaccinia, which is mild in most people. But when you become infected
with vaccinia you get a little pustule on your arm where they scratched your
arm with it.

GROSS: And a lot of us have scars on the side of our arm from when we got
these vaccinations as kids.

Mr. PRESTON: Yes. It's a little scar on your upper arm about the size of a
dime or a nickel. That means you were successfully vaccinated. But the
vaccine wears off starting about five years later, so such folks are no longer
probably very immune to it. So some unknown number of people can become very
sick with this virus. People who have compromised immune systems because of
chemotherapy, being HIV-positive, having a history of eczema and also...

GROSS: Why eczema?

Mr. PRESTON: I'm not really sure why, but eczema is a skin disease and it's,
I believe, an autoimmune-type disorder and these pox viruses, of which the
vaccinia is another type of pox, they're life forms. They're really actually
extremely interesting. The way they succeed in taking over and multiplying in
their hosts is they confuse the immune system. They throw off all kinds of
proteins and enzymes that make your immune system go haywire. By the way,
that's believed what the mechanism of smallpox killing a human being is,
something along those lines, but the virus causes something called a cytokine
storm in the body. This is a complete derangement of the immune system. Your
immune system essentially goes into crash mode and the virus then is able to
multiply unopposed. With a case of the vaccine, the virus can sometimes
multiply unopposed in a person if their immune system is a little bit off.
This is the worry.

So should we be vaccinating people now? It seems to me that it would be
logical to at least begin some limited program of vaccination with health care
and emergency people. Then the government could get some experience in what
happens and how to deal with it. And there are going to be problems that are
going to crop up, but with experience and practice comes knowledge and that
could help everyone later.

GROSS: How much of a stock of vaccine do we have? Like, if the government
decided to vaccinate the American public, would there be enough vaccine to do
it?

Mr. PRESTON: Oh, I think there is actually right now. And I think there's
going to be even more. There's a company that's making large quantities of
the vaccine very rapidly. It's a British-American company based in
Massachusetts. And what I heard was that the factory there in Massachusetts
was surrounded by military security and the vaccine, as it comes off the line
and is verified and tested, is being dispersed to secret locations around the
United States, probably military airfields where it can be flown quickly into
a city or a place where there's an emergency.

So, yeah, there is probably enough vaccine. Whether the vaccine could be
gotten quickly into people--if you think about this, just in your own
community, what if doctors in the local hospital had to vaccinate 100,000
people all at once within a week or so? What would they do? There isn't
really any plan. And it would be, you know, a very chaotic and frightening
time if, heaven forbid, smallpox were ever to break out. In my gut, I don't
feel that doomsday is coming. And I have faith that--particularly we as
Americans, we have an incredible natural ingenuity and we have a
resourcefulness and a flexibility to deal with things as they come along. And
I have no doubt that this country can handle an outbreak of smallpox, no doubt
at all about that.

GROSS: You've talked about this a little bit, but I certainly get the
impression from reading your book that the experts know more than they're
telling us. One example that you allude to is a secret meeting held by
leaders of the National Institute of Health that was held in April of 2002.
What do you know about that meeting?

Mr. PRESTON: Well, what I heard about that meeting from someone who was there
was that it was a meeting of experts in the spread of infectious disease, and
these are people who use computers and models to try to model how things
spread. And they were given the assignment to model the spread of smallpox in
the modern world to find out whether various strategies of vaccinations, such
as the ring vaccination strategy that was used so successfully during the
eradication, would work. And in true scientific style, the experts disagreed
with one another, as they always do. And the bottom line was that they
couldn't agree on what smallpox would do in the modern world, but many
members, maybe the majority, felt that it would really be bad and that the
virus could spread very rapidly from a very small number of cases.

So I've heard statements such as if a terror attack resulted in, say, 10 cases
of smallpox in a city like New York, that it might be necessary to quickly
vaccinate 40 million people in order to have a hope of stopping the outbreak.
The other concern that one has, of course, is that even if the United States
is protected with a stockpile of the vaccine and even if the vaccine is
effective and does work, the rest of the world has very little or no
protection. The World Health Organization some years ago, having decided that
smallpox had been eradicated, destroyed its entire stocks of the vaccine in
order to save about $25,000 a year in electricity costs for freezers that were
holding the vaccine. And today the World Health Organization's stockpile of
the vaccine is one dose for every 12,000 people on Earth. That is completely
nothing. And if the virus were to get going in countries such as Bangladesh
and Africa, you know, and places, you know, in Asia where the human population
is large, there could be a really significant mortality.

GROSS: The technique for eradicating smallpox was this technique of
vaccinating a ring of people around where the disease was. So that was, as
you described, almost like a fire wall of immunity around the disease. It
seems to me that would be really hard to create now because there's so much
jet travel in and out of places that you can vaccinate people in a ring around
the epicenter of the disease, but unless there's an enormous quarantine
program, people are going to be coming and going, you know, inside and outside
of that ring.

Mr. PRESTON: The incubation period of smallpox is about 11 to 12 days and it
runs like clockwork. The incubation period is the time when you have the
virus in your body but you don't have any symptoms and don't feel sick at all.
How many Americans can answer the question: Where will you be in the next 11
or 12 days? Many will answer that they're going to be somewhere else during
that period of time and some will be traveling to foreign countries and they
will be traveling to different states and in and out of cities, commuters and
so on. Ring vaccination worked in rural societies, in peasant societies when
people didn't travel, and also when people knew there was smallpox and then
they would become very frightened and the village would basically shut down.
And in rural Africa, for example, people practice what is known as reverse
quarantine where, if it was known that smallpox was in the area, people would
close their villages to the outside world. They would just shut the village
off.

GROSS: And that would be really difficult to do now in an area like the
United States.

Mr. PRESTON: It's almost unimaginable.

GROSS: You've said that you wanted the tone of your new book, "The Demon in
the Freezer," about smallpox and anthrax to just be straightforward. You
know, you're not trying to be alarmist or sensationalist or to underplay the
problem, either; to just kind of present things the way you understand them.
It seems to me this is a kind of issue that probably scientists and
politicians are having to deal with a lot right now. How should they portray
the possibility of bioweapons? What kind of words should they use? How
dramatic should they make it? How frightening should they make it seem or how
much should they allay people's fears? Did you get any winds of that like
inside conversation about what language to use? What kind of issues are they
facing about that?

Mr. PRESTON: My sense of it is that the public officials who are aware of
this problem and really think about it are probably more alarmed than they let
on with the public. If you're an elected official or a government person, you
really don't want to just be out there scaring the public and you want to make
sure that people understand that you've got things under control because,
after all, you're an authority. So, you know, you find people saying, `You
know, let's everybody calm down and let's be rational about this,' and that's
exactly the right thing to do.

But I'm coming out of it from a different point of view. I'm trying to tell
the story as it really is and if it's scary, well, it's scary. But it
shouldn't be just alarming. It also should be interesting. And what I find
is that even when you're talking about these horrible viruses and so on, that
they are a work of nature. They're nature. We're the human species and we
have to get along with nature somehow and we also have to understand nature.
And when you really understand nature, it almost always ends up being quite
aesthetically beautiful. And many virus experts have said to me that they
find viruses aesthetically incredibly beautiful, even when they think about
what it does to the human body, even when they think about the suffering and
death that a virus can cause. There is also a kind of stark and elemental
beauty to viruses that is like watching a lion make a kill. It may be
horrible, but it is the universe.

GROSS: I think the movie was called "Outbreak"--Is that right?--the movie
with Dustin Hoffman that seemed to be either based or loosely based on your
Ebola book, "The Hot Zone." I'm not sure it was officially based on that or
not. What...

Mr. PRESTON: The movie "Outbreak" was unofficially based on "The Hot Zone."
It was inspired by "The Hot Zone" I think is what they said.

GROSS: So you had no hand in it?

Mr. PRESTON: No, not really.

GROSS: I wonder what you thought of that movie and whether you thought it--I
didn't see it, so I have no opinion but I wonder if you thought it
sensationalized anything or, you know, was more frightening than it needed to
be or whatever.

Mr. PRESTON: Well, I thought it had a very strong opening but then it
weakened up. The problem with many virus movies, maybe all of them, is that
Hollywood always demands a cure for the virus at the end. In this case we had
to cure Rene Russo, who was dying of Ebola virus. She was dying beautifully
of Ebola, by the way, and how to do that. Well, Peter Jahrling, you know,
who's the Army scientist who is featured in both these books, he was at home
and his telephone rang at 3:00 in the morning and there was a familiar voice
on the line. `Dr. Peter Jahrling, this is Dustin Hoffman. I'm on location
out in Hawaii right now and this script is terrible and we can't figure out
how to end this movie. You've got to tell us how can we cure Ebola virus.
We've got to do it fast because Rene Russo is dying.' So, you know, he
answered. Meanwhile, Peter's wife got silently on the other end of the line
and was listening away to this conversation with Dustin Hoffman and she
thought it was really cool. So at any rate, Peter said, `Well, OK, what you
could do is you could cure it with monoclonal antibodies.' `Well, how do you
make them?' Well, and he told him how to make them. And at the ending of the
movie, everybody gets cured with this IV bag that looks like it's filled with
Tang.

GROSS: Thank you so much for talking with us.

Mr. PRESTON: Thank you, Terry.

GROSS: Richard Preston's new book about smallpox and anthrax is called "The
Demon in the Freezer."

Coming up, Ken Tucker reviews a new CD featuring Pam Tillis performing songs
written by her father, Mel Tillis. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: New album "It's All Relative: Tillis Sings Tillis"
showcases Mel and Pam Tillis at their very best
TERRY GROSS, host:

Country singer-songwriter Mel Tillis had a string of hits, reaching his
commercial peak in the '70s. His daughter, Pam Tillis, had country successes
in the early '90s. Neither is very popular nowadays, but Pam has just put out
an album covering songs written by her father, called "It's All Relative:
Tillis Sings Tillis." Rock critic Ken Tucker says it showcases both
performers at their very best.

(Soundbite of music)

Ms. PAM TILLIS: (Singing) Tonight I'm burning old love letters, photographs
and memories of you, hoping somehow I'll feel better and when the smoke is
gone I won't want you.

KEN TUCKER reporting:

That's Pam Tillis setting fire to "Burning Memories," a song that went to
number two on the country charts in 1964 for Ray Price. It was written by
Tillis' father, Mel Tillis, whom some of you may remember as a fixture on '70s
TV talk shows as a stuttering comedian and in Burt Reynolds movies like
"Cannonball Run" and "W.W. and the Dixie Dancekings."

Mel's comic demeanor paid the rent and more, but it obscured his excellence as
a songwriter, as on this tune, a 1962 hit for Patsy Cline, delivered here by
his daughter with similar torch song passion.

(Soundbite of music)

Ms. TILLIS: (Singing) I've been so wrong, oh, so long. Thought I could live
without the love that you give. I was wrong, so wrong.

TUCKER: That's Pam Tillis with harmonies by The Jordanaires, who had also
backed up Patsy Cline. If Mel Tillis' skill as a songwriter was obscured by
his second career as a comic personality, Pam's first career as a solid
songwriter and interpreter of Nashville ballads was derailed by the late '90s
rise of sexpot stars like Shania Twain and totally usurped by an act like the
Dixie Chicks, who project both allure and creative autonomy.

Tillis never pushed her own looks and on her hits was perhaps a bit more
assertively feminist than Nashville likes its stars to be. So in a sense,
this project rehabilitates both father and daughter and, for that matter, the
daughter's friends, as on this cut.

(Soundbite of song)

Ms. TILLIS and DOLLY PARTON: (Singing) Roses are red, violets are blue, I'm
sending red, red roses to you. If you care to send some flowers to me, then
send me some violets. I'm blue as can be.

TUCKER: That was the first single Mel wrote that got him on the charts as a
solo artist in 1958. On Pam's fine open-throated version, she's joined by
Dolly Parton on the chorus. Parton is another case study in the way country
women have to reposition themselves to sustain a career. She's now recording
semi-pure bluegrass for an independent label, Sugar Hill. Like Pam Tillis,
she doesn't fit into the skinny jeans and rock guitar trend that now dominates
the field. Luckily for them, the field is a shrinking one. Country music
sales are on the decline and listeners are so starved for good country music,
they're looking beyond what gets played on rigidly formatted country stations
that would never play a prime Mel Tillis oldie like this.

(Soundbite of song)

Ms. TILLIS: (Singing) I ain't never, I ain't never seen nobody like you;
never have I ever seen nobody like you. Well, you call me up, say you'll meet
me at nine. Have to hurry, hurry, but I'm there on time. I walk right up,
knock on your door; landlord said, `He ain't here no more.' I ain't never...

TUCKER: Mel Tillis has said that there have been more than 30 covers of that
song, a hit he co-wrote with the great Webb Pierce 40 years ago. And that
version by his daughter epitomizes the swagger, lust and recklessness that's
drained out of most country music now.

Pam's salute to her daddy may be something of a desperation move, an attempt
to jump-start her career by piggybacking on her father's shoulders, but aren't
daddies supposed to give their daughters good piggyback rides?

GROSS: Ken Tucker is critic at large for Entertainment Weekly. He reviewed
"It's All Relative: Tillis Sings Tillis" by Pam Tillis. Ken has just won an
ASCAP Deems Taylor Award for an article he wrote on country singer and
songwriter Webb Pierce. Congratulations.

I'm Terry Gross.

(Soundbite of song)

Ms. TILLIS: Well, how could you have the unmitigated gall to come back now
and expect me to fall right down on my knees and kiss your feet. Yeah, feet.
Feet that one day went a-walking out on me with a fast-talking slob, you
hardly knew her name...

(Credits)
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