Public healthDebate rages over U.S. purchases of smallpox medicine

Published 14 March 2013

The U.S. government paid Siga Technologies $463 million to buy enough smallpox drugs to treat two million people. Expert sharply disagree about the wisdom of the move: some say it was a reasonable purchase at a reasonable price, while others say the government purchased too large a quantity of the drug and too high a price.

The  U.S. government purchased a significant amount of a new smallpox medicine, enough to treat two million people in the event of a bioterrorism attack. The purchase, however, has stirred a debate, with some experts arguing that  the government has bought too much of the drug and has paid too much for it.

Smallpox was eradicated in 1980s and the only remaining samples of the virus are in government laboratories in the United States and Russia. The New York Times reports that there are persistent rumors of  renegade stocks that could be used in bioterrorism attacks. Experts also say that the virus could be re-engineered.

The vaccine, known as Arestvyr, is not approved by the Food and Drug Administration (FDA) except for  emergencies. The vaccine has never been tested on humans because the disease has been eradicated, but it has been known to prevent death in monkeys who have been injected with lethal doses of smallpox or monkey pox.

Some experts argue the $436 million purchase was a sound idea, while other say it was  a foolish decision.

According to Siga Technologies, the price is fair. Robin Robinson, the director of theBiomedical Advanced Research and Development Authority, which is part of the Department of Health and Human Services, defended the size and price of the order. He said the amount purchased was what analysts predicted would be needed if an outbreak were to occur in a large city.

The price is “fair and reasonable” compared to the price of other commercial antiviral drugs.

Dr. Donald Henderson, who led a government advisory panel on biodefense in the wake of the 9/11 attacks, noted that back in 2001,  the medicine was expected to only cost $5 to $10 per course.

Dr. Richard Ebright, a bioweapons expert at Rutgers University, said there was no need to purchase so much of the medicine. “Is it appropriate to stockpile it? Absolutely,” Ebright told the Times. “Is it appropriate to stockpile two million doses? Absolutely not. Twenty thousand seems like the right number.”

Dr. Henderson and Dr. Philip Russell, who previously ran the Walter Reed Army Institute of Research, said they expected the government to pay far less for an antiviral drug since they cost little to make and the alternative, vaccines, cost the government $3 a dose. “If they’re talking $250 a course, they’re a bunch of thieves,” Dr. Russell told the Times.

Eric Rose, the president of Siga, said that compared to AIDS antiretrovirals which cost $20,000 a year, and cancer drugs that cost more than $100,000, the Smallpox medicine is cheap.

If left untreated the disease can kill about one-third of its victims, but the response time is much longer than most diseases, as it can take up to two weeks before an infected person becomes seriously ill and up to five days before the infected person begins to infect others.

Experts have said that if a large-scale outbreak were to occur, health officials would be able to get control of the situation quickly.

“If we had to, we could vaccinate the entire country in three days,” Dr. William Foege, another leader of the smallpox eradication effort who now advises the Bill & Melinda Gates Foundation, told the Times. This vaccine does not use a syringe, but a forked pin that Dr. Foege said he could “train anyone to use in 10 minutes.”