Lab Leak: Could Smallpox Come Back?

To get to the hospital, you drive half a mile out of the village down a narrow lane flanked by hedgerows and fields. The hospital is a big, old building and twenty acres of grounds. The year is nineteen seven eight. You might expect this to be a journey. Ron Fleet knows well. Funeral directors do tend to become familiar with their local hospitals. But no. The hospital in the village of Catherine de Barnes hasn't seen a death for years.

It hasn't seen a patient for years. It's an isolation hospital, kept empty but ready just in case someone gets some appalling infectious disease that requires them to be confined safely away from the public. Year after year after year, the hospital's husband and wife caretakers have kept award with sixteen beds on constant standby, ready for patients who mercifully never came. But now they have had a patient and she's died. Ron Fleet assumes that the body he's come to collect

will be in a morgue or a fridge. It isn't. He's directed to a garage some distance away from the main hospital building. In the garage, he finds a transparent body bag. It's clear that this woman must have suffered terribly. Her body and face are covered with saws, scars, and fluid filled pustules, and the body's on the floor, not a trolley. How's he going to get it into his van? He goes back to the main building to ask someone to help him. Nobody seems keen. Fleet opens the back

doors of his van and heaves the body inside. Some kind of liquid sloshes around inside the transparent body bag. I really hope this bag doesn't split, thinks ron Fleet. I'm Tim Harford, and you're listening to cautionary tales. By the nineteen sixties, smallpox had become rare enough in England that when someone got it, it was often misdiagnosed. In nineteen sixty six, for example, a young man called Tony

became ill with what seemed like flu. Tony called in sick to his job as a medical photographer at the University of Birmingham and spent a few days in bed with aches and a fever. Then came the rash, when he thought he'd better get a doctor to look at it. Maybe a sweat rash, said the doctor. You'll have been sweating with that fever, or it could be a reaction to the medicine you've been taking. Anyway, nothing to worry about. Tony starts to feel better, well enough to resume his

social life. He needs to freshen up a bit, so he borrows his dad's raisor to shave. He's got to be careful as he's still got that rash on his face, and he accidentally slices through one of the pustules. He goes to the pub with his dad and his girlfriend. The barman winces sympathetically nasty attack of acne. A week and a bit later, Tony's dad gets a spot on his face where he's nicked himself with the razor Tony borrowed.

He then gets a fever and more spots. An old man who'd been drinking in the pub gets hilled too, who he infects his teenage grandson, who infects a hitchhiker he meets at a roadside cafe while on a trip to the beach. A couple of hours drive away. The hitchhiker gets home to another part of the country and infects his mum. Various people go to doctors who say, probably flu or that looks like chicken pox. It's eight weeks before someone sees a doctor who seen smallpox before

and says, hmm, let's test for that. There are two types of smallpox. Veriola major was the one you really didn't want. It killed about thirty percent of those it infected. Veriola minor was much less serious, but still no joke. Its fatality rate was one percent, comparable to COVID. Once the tests confirmed that Variola minor is at large, the medical authorities start to put the pieces together. They find

seventy three people who've been infected. Luckily, nobody's died. The medics trace back the roots of infection, and they seemed to converge on young Tony. But where had Tony got it? Well, smallpox might have been rare in England at the time that it was still common enough in the Indian subcontinent. The last outbreak of small pox in Britain four years earlier turned out to have started with people recently arrived from Karachi. Birmingham had a high rate of immigration from

the subcontinent. Tony enjoyed a varied social life with friends from all backgrounds. It was perfectly possible, as Tony's own case showed, to go out on the town while not realizing you're infectious with a mild case of Veriola minor. Most likely Tony had picked it up from someone he had met at a party. The building at the University of Birmingham where Tony worked as a medical photographer, also

housed a laboratory that did research on smallpox. The lab was run by a man called Henry Bedson, a well respected smallpox expert. Bedson had been cultivating strains of Variola minor just over a week before Tony's symptoms started. The incubation period for smallpox is typically between a week and a fortnight. Quite a coincidence. Was it just a coincidence? Nobody seemed too worried. At the time, the university didn't

feel the need to hold an investigation. Tony's office wasn't even on the same floor as the smallpox lab, and everyone knew smallpox didn't spread that easily. It needed both close personal contact and a dose bad luck. Think about the outbreak Tony started. Yes, it passed it on to a few people, but he met many more who didn't get infected. In eight weeks, only seventy three people had

picked it up. The idea that virus particles might have found their way out of Bedson's lab and wandered around the building, missing everyone else, until they met Tony on the floor above seemed fantastical. Still, the coincidence was striking. It occurred to Bedson's boss, the head of the department, that he should probably get an outside opinion. He asked another smallpox expert to visit the university and check that Bedson was taking adequate precautions. All looks perfectly standard, said

the expert, Same as any other smallpox lab. By nineteen seventy eight, twelve years later, Henry Bedson has moved up in the world. He's still at the University of Birmingham, but he's now the head of Department of Medical Microbiology. He's forty eight years old, married with three young kids. He looks like a stereotypical academic scientist, bald, softly spoken,

tweed jacket. With his new departmental duties, Bedson no longer has time to be so hands on in his old smallpox lab, but he has a PhD student doing research, and that research is important. In those twelve years, much has changed. Smallpox is no longer common on the Indian subcontinent, or indeed anywhere. It's been wiped off the face of

the earth. Teams of workers led by the World Health Organization have been visiting the furthest flung villages of the world's poorest countries, persuading people to be vaccinated, tracing contacts where they find a case. Henry Bedson himself has been involved the who sent him to Afghanistan and Pakistan as part of an expert committee, and all that hard work has succeeded. It's been eight months now since the last report of a case of smallpox anywhere in the world.

That case was in Somalia. It looks likely to go down in history as the very last time any human gets this terrible disease. Ever, but what if there was a way smallpox might come back? What if there was a similar virus lurking in some population of wild animals, liable to cross over to humans at any time? Smallpox, after all, like many human diseases, originally came from animals, maybe camels, gerbils. It's not entirely clear, and two recent

discoveries were troubling Henry Bedson. Researchers in the Netherlands and Russia had found a virus that looked very much like smallpox, lurking in samples taken from wild monkeys and rodents. This new mystery virus had become known as whitepox. But what was whitepox? How exactly did it differ from the various strains of Variola major? Might it pose a threat to humans? These were the questions Henry Bedson had his PhD student investigating that Bedson had a problem because the wighthow was

worried about another way smallpox might come back. What if it leaked from a lab? Plenty of labs around the world, like Bedson's, were working on smallpox viruses. The wh show wanted to restrict all future research to just a handful of labs that would meet more stringent new safety standards. Bedson's lab was not on the list. Henry Bedson wrote to the World Health Organization, Can I have a few more months to finish up my white box research? My lab's been scaling down. I promise I'll be done by

the end of the year. Bedson was arguably being economical with the truth. The lab had scaled down compared to a few years ago. It had just one PhD student now, but in the hope of completing his white box work before his lab had to close, Bedson had just scaled up his stocks of smallpox, taking delivery of twenty two new samples of different strains of the virus. The World Health Organization wrote back, okay, then just until the end of the year. Bedson was relieved, and then one evening

in August at home, his phone rang. It was a doctor he knew, calling from the hospital. Henry said the voice, I've got a patient here with a suspected case of smallpox. Cautionary tales will be back after the break. By nineteen seventy eight, young Tony has left his job as the medical photographer at the University of Birmingham. There's a new photographer now working on the floor above Henry Bedson's smallpox lab. Her name is Janet Parker and she's forty years old.

On the second Friday in August, Janet begins to feel unwell. A few days later, she starts to get a rash. She sees a doctor chicken pox. She also has sostiitis, and the doctor prescribes antibiotics for that. A couple of days later, the rash is much worse. She sees a second doctor, maybe an allergic reaction to the antibiotic. He prescribes a different antibiotic. Days go by and Janet's condition gets worse and worse. She sees a third doctor. This

doctor calls the infectious diseases unit at the hospital. I don't think it's chicken pox, she says. But I'm stumped. Can one of your infectious disease specialists visit her home and take a look. We don't do home visits, say the hospital. That's the policy. Well, let it's smallpox. No chance of that, says Janet's doctor. She hasn't been out of the country for five years. The hospital will send an ambulance and it is admitted to the infectious diseases unit.

The specialist there takes a close look at Janet and makes some notes. Parsicular rash, most pronounced on the face, lesions half a centimeter, white fluid, more advanced lesions with darkened centers, no lesions in the mouth, febrile question mark drug reaction, then question mark, question mark, question mark variola. The doctor consults her colleagues it can't be smallpox, but they're sufficiently puzzled to want to rule it out. The

trouble is none of them have experienced with smallpox. They've only seen it in textbooks. But they still have access to a designated regional smallpox consultant, a doctor who's worked in Bangladesh and knows the disease. They find his number. It's seven point thirty in the evening, and the regional smallpox consultant is about to open a bottle of wine

at home when his phone rings. He doesn't get many calls like this, maybe once a year, but he doesn't mind because he gets a fee for every call out. So far, it's always been either a bad case of chicken pox or an allergic reaction to a drug. He puts his wine aside, drives to the hospital, finds Janet's room and that looks like smallpox. But who is this woman and how on earth has she got smallpox in Birmingham, eight months after the world's last recorded case in Somalia.

The doctors fill him in on Janet's details. She works as a medical photographer at the University of Birmingham. Hm. The consultant, of course, knows all about the smallpox lab at the university. It'd better call Henry Bedson, Henry, he says. When Bedson answers the phone, I've got a patient here with a suspected case of smallpox. It's a lady who works as a photographer at the medical school at the other end of the line. Henry Bedson is too stunned

to speak. The consultant takes a sample of the fluid from Janet's postules and drives to the medical school to meet Henry Bedson. Together the two men open up the lab and put the slide under the microscope. Bedson looks first without a word. He moves aside to let the consultant see. There's no doubt it's smallpox. They'll need to run more tests to confirm that its very ola major and find out exactly which strain. Bedson sets the tests

in motion. The regional smallpox consultant picks up the phone and makes the call that he's never had to make before, open up the isolation hospital at Catherine de Barnes. As the fictional Dr Duffenschmertz might put it, if I had a nickel for every time a medical photographer at the University of Birmingham got smallpox, I'd have two nichols, which isn't a lot, but it's weird that it happened twice.

Back in nineteen sixty six, when Tony got smallpox, it had seemed ludicrous to think that the virus might have gone walk about from Henry Bedson's lab around the building. But soon after, in nineteen seventy, a young man in Germany developed fever and a rash a week and a half after flying home from a backpacking trip to Karachi. With that travel history, German doctors suspected smallpox right away.

They put the man in strict isolation. Still, somehow, seventeen other people in the hospital developed smallpox, including patients two floors distant who never left their room. How One explanation was that smallpox might be more capable of airborne transmission than had previously been thought. Investigators set off a smoke device in the room where the man had been and tracked how the smoke wafted into the corridors, up the stairwells, and into other rooms. The results mapped pretty well onto

the pattern of infections at the University of Birmingham. Henry Bedson and his colleagues stand in the courtyard ou side the medical school. They're checking how close the photographer's office is to the smallpox lab. Not very close. They're at least forty feet apart. If the virus particles wafted through the air to Janet, it's far from obvious what route they might have taken. By now, various authorities are competing

to take the situation in hand. One insists that everyone who has anything to do with the smallpox lab has to go into quarantine, including Henry Bedson. That seems like overkill. Bedsen's been thoroughly vaccinated, and if it'd got smallpox at the same time as Janet Parker, he'd have known about it long before now. Still, though Bedson's told stay at

home you can't be too careful. Another authority insists that the smallpox lab be immediately fumigated to kill any virus particles that might be Only afterwards that they realize this means they've killed the samples from Janet Parker that Bedson had been testing to identify which strain of smallpox she'd got. That Bette get another sample while they still can. At the hospital in Catherine de Barnes. Janet is still just

about clinging to life. They call the smallpox lab at the University of Liverpool and ask one of the professors to drive the one hundred miles to Birmingham to visit Janet and take samples back for testing. We'll arrange a police escort, of course, they say. As the professor leaves the motorway near Birmingham, he's met by a policeman on a motorcycle who leads him through the city and down the quiet country lanes to the twenty acre site of

the hospital at Catherine de Barnes. The policeman thinks his job is done and says farewell. The professor is confused, Wait, you're leaving me here, but surely the whole point of a police escort is to get me safely back to my lab when I'll have highly contagious samples of smallpox in my car. Now, the Policeman's confused. Nobody's told me anything about that, sir. All the way back to Liverpool. I've finished my shift at five o'clock. At five o'clock,

they're still gridlocked in central Birmingham. The policeman waves goodbye, screw this, Thanks the professor. He decides to give the rush hour traffic time to clear and detours into the suburbs to call in at the home of his old friend, Henry Bedson. Bedson is not coping well with quarantine. He hates being holed up at home when he could be doing something to help. The phone keeps ringing, and he keeps thinking he'd better answer it in case it's important.

But it's always some journalist trying to get into admit that he's to blame for all the chaos that's unfolding in the city. The desperate search to trace and quarantine and vaccinate anyone Janet Parker might have met. Bedson's friend tries to lift his spirits, but the next morning Bedson writes a note I'm sorry to have misplaced the trust which so many of my friends and colleagues have placed

in me and my work. Bedson writes. I realize this act is the least sensible thing I have done, but it may allow my wife and children to get some peace. Bedson calls to his wife, I'm just going to the garden shed. Cautionary tales will be back in a moment. Henry Bedson is still alive when his wife finds him in the shed, though he's losing a lot of blood. She runs back to the house. As she's about to pick up the phone, it starts to ring local radio news.

Can I speak to Professor Bedson? Get off the line, yells Bedson's wife. She slams the receiver down and picks it up again. I don't know it's the wife, she says. She wants us to get off the line. Henry Bedson survives for five days on life support before doctors conclude that he won't recover. Five days after that, Janet Parker's life finally ebbs away. Funeral director Ron Fleet is sent to collect her body. Janet is cremated, then they fumigate

the crematorium just to be safe. Janet Parker has infected only one other person, her mum. Once her mum recovers, humanity is once again free from smallpox. But if it's going to stay that way, it might help to find out how had Janet got it. The government appointed a committee to investigate. They tried the same kind of test as in the German hospital, setting off a smoke device in the smallpox lab to understand where the airflow might go. The smallpox lab was a small inner room connected to

a larger outer lab. If the door between those rooms was open, the air from the smallpox lab could get into the outer lab, and the door was open sometimes because the smallpox samples were stored in that outer lab, But if smallpox parts got loose in that outer lab, it shouldn't pose a risk. Everyone who was allowed into

the outer lab had been vaccinated against smallpox. But a little bit of the smoke drifted further, some beyond the outer lab and into a corridor, and some into a service duct, and from the service duct threw a badly fitted access panel into a room on the floor above not Janet Parker's office, another room used for storage, but

that also had a telephone with an outside line. Janet Parker's office phone didn't have an outside line, so when she needed to make orders for supplies of photographic materials, should use the phone in that storage room, sitting close to the badly fitted panel. The investigators determined that Janet had placed an unusually large number of orders on the line last Tuesday in July, two and a half, weeks before she began to feel ill. That timeline doesn't quite

stack up. The usual incubation period for smallpox is one to two weeks, not two and a half. And you can query how relevant that German hospital really is. There you had a young man with smallpox coughing up clouds of virus particles. Here you had a lab with workers trying carefully to minimize contamination. Still, the investigators conclude infection through the service duct is the most probable route that

they could find. Armed with the investigator's report, a government agency decides to sue the University of Birmingham for failing to ensure health and safety at work. In his book The Last Days of Smallpox, the author Mark Pallin describes the case in detail. Witness after witness attests that Henry Bedson was known for being meticulous about safety procedures. You can't eliminate all risks from lab work. As one expert

witness says, perfection is impossible. But Henry Bedson's smallpox lab was doing nothing ntypical by the standards of the time. What about the pox in the ducts hypothesis? The university's

lawyer calls a professor to testify for the defense. I've been doing some calculations, the professor says, based on how much smoke made it from the smallpox lab into the room with a telephone, and how many virus particles typically get into the air from routine lab work, I reckon you might expect virus particles to make it into the telephone room at the rate of one particle every two to twenty thousand years. The lawyer for the Health and Safety agency calls an expert witness, too, but it seems

that he hasn't researched his experts views. When asked about the investigator's theory that Janet had got the virus through the service duct, the expert says he thinks it's highly implausible. The lawyer's taken aback his own witness has just dismissed the central plank of his case. But if we discount the duct hypothesis, the lawyer asks, with what does that leave us? The expert replies, it leaves you with a puzzle. Say the words lab leak. Now, of course, and the

city that springs to mind isn't Birmingham, It's Wuhan. A novel coronavirus pandemic just happens to start in a city which has a lab that does research on novel coronaviruses. Quite a coincidence. Was COVID a lab leak? That debate rumbles on, But I wondered if the Birmingham story might give us any general lessons about lab leaks. I think there are two lesson. Number one, the puzzle might never

be solved. We might only ever have competing stories and our own best guess as to which makes most sense. The second lesson starts with another observation from that trial, Perfection is impossible. No matter how careful you try to be, there'll always be something you might overlook. Think about that

evening before Henry Bedson despairingly went to his garden. Shed Bedsen's at home, forced to quarantine because you can't be too care but parked outside on his drive is his friend's car containing highly dangerous smallpox samples from Janet Parker. The professor then drives his car one hundred miles up the motorway with no police escort. What if it had a crash? Or think about fumigating the crematorium after Janet

Parker's body was burned just to be safe. Yet nobody had thought about the risk to funeral director Ron Fleet, who had to lug Janet's corpse into his van without help, praying the body bag wouldn't burst. There'll always be something you might overlook. In twenty fourteen, in a lab in Bethesda, Maryland, half a dozen glass pals of smallpox were discovered in a cardboard box at the back of a cupboard, forgotten

since the nineteen fifties. If we're going to do research on deadly viruses, we have to accept some risk that something will go wrong in some way we hadn't considered. So the second lesson I want to suggest is this, we'd better be damn sure that that research is worth it. Perhaps in the case of Birmingham, the puzzle has an answer. In twenty eighteen, the author Mark Pallin tracked down the lawyer who had represented the university in the court case.

The lawyer was now eighty five years old. The author asked, do you know what really happened? Well, said the lawyer, there was a rumor, a very strong rumor. I could never get anyone to say it on the record, but the rumor went like this, back in the nineteen seventies, Remember, nobody had smartphones or digital cameras. To make holiday photos, you needed roles of film, and they were pricey. A photographer at an institution like a medical school could buy

those films in bulk at a discount. There was a well established tradition in the medical school. The rumor went that the photographer would get you cut price films. That might explain why Janet was placing so many orders in the last week of July, just before everyone went on their summer holidays. And what if a few days later, Janet had gone around the building delivering to her colleagues the supplies she'd got for them. What if she had popped into the outer lab just for a moment to

drop off a roll of film. What if this year she had chosen just the wrong moment when there were virus particles in the air or on a surface she happened to touch. It's only a rumor, just one more competing story. But if Janet had encountered the virus a few days after the investigator's guessed, it would make the

incubation period line up. And if the tradition of photographers delivering film to their colleagues went back to young Tony, that would also neatly solve the two nickel question of why an infection might have happened twice as one more loose end to tie up. One final irony was the research worth it. Henry Benson, remember had been anxious to complete his work on whitepox, the mysterious virus from labs

in the Netherlands and Russia. If whitepox was similar to smallpox, it might live in wild populations of monkeys and rodents and then jump back to humans. After Bedson's death, other researchers finished the job. They found that white pox was a mirage. These viruses weren't just like smallpox, they were smallpox, and the smallpox didn't come from the animals. The samples from rodents and monkeys in the Dutch and Russian labs

had been contaminated with smallpox. In the labs themselves. The monkeys and rodents had never had a pox like virus at all. That kind of contamination shouldn't happen in a lab, of course, but sometimes it does. Perfection is impossible. If the work in Henry Bedson's lab had been perfect, Janet Parker could never have got smallpox. But if the Dutch and Russian labs had been perfect, Bedson wouldn't have been

doing that work in the first place. A key source for this episode was Mark Pallon's book The Last Days of Smallpox Tragedy in Birmingham. For a full list of our sources, see the show notes at Timharford dot com. Cautionary Tales as written by me Tim Harford with Andrew Wright, Alice Fines, and Ryan Billy. It's produced by Georgia Mills and Marilyn Rust. The sound design and original music are the work of Pascal Wise. Additional sound design is by

Carlos san Juan at Brain Audio. Bend Dafhaffrey edited the scripts. The show features the voice talents of Melanie Guttridge, Stella Harford, Oliver Hembrough, Sarah Jupp, Massaam Monroe, Jamal Westman, and rufus Wright. The show also wouldn't have been possible without the work of Jacob Weisberg, Greta Cohene, Sarah Nix, Eric Sandler, Carrie Brody, Christina Sullivan, Kira Posey, and Owen Miller. Cautionary Tales is a production of Pushkin Industries. It's recorded at Wardoor Studios

in London by Tom Berry. If you like the show, please remember to share, rate and review. It really makes a difference to us and if you want to hear the show, add free sign up to Pushkin Plus on the show page, on Apple Podcasts or at pushkin dot fm, slash plus