The remaining smallpox stocks: the healthiest outcome

By the late 1990s, there was increased concern about the potential for a return of smallpox, as some terrorist groups expressed their desire to use biological agents for nefarious purposes.1 As a result, the WHA instituted an ambitious research and development agenda to create new antiviral drugs, improve diagnostics, and develop a new generation of vaccines against variola to increase global security.2 As indicated by reports from the US National Academy of Sciences' Institute of Medicine in 1999 and 2009,3 live virus is crucial for this research. Monkeypox is carried by rodents and there have been human outbreaks in the Democratic Republic of the Congo, Republic of the Congo, and Sudan in 2003 and 2006.4,5 In some outbreaks, the virus has displayed multigenerational human-to-human transmission.4 Over 30 years after the end of routine smallpox vaccination (which provided cross-protection), monkey pox is now an important public health concern in central Africa, with a 20-times increase in reported infections since 1980.6 Yet experimental evidence shows that the advances that result from smallpox research, such as safer vaccines and safe and effective oral antiviral agents, will be useful for prevention and control of monkeypox.