Toward the end of the meeting, Henderson gave his views. He spoke for forty-five minutes in his gravelly voice, with passion and restrained anger. He said that Osama bin Laden represented a danger to the world. He said that bin Laden could get smallpox and would use it. He said that the Aum Shinrikyo sect in Japan could get smallpox and use it. He said if smallpox was used as a bioterror weapon, everyone on earth was in danger, and it was imperative that the leading countries of the world agree to destroy the official stocks of variola. Looking straight at Sandakhchiev and at his old colleague Marennikova, he said he believed that smallpox existed in at least three places in Russia. He said that several biowarfare scientists from Russia had “gone south”—to countries in the Middle East. He spoke of his opposition to any further research with variola in the laboratory, and he posed a question to the room: “How many requests for experiments with variola have you actually had in the past twenty years?”
Lev Sandakhchiev firmly insisted that he and his people hadn’t been doing anything with smallpox until very recently.
As for the CDC, it had had virtually no requests for experiments with smallpox. The smallpox had been sleeping peacefully in the freezer, except when the Rahima strain was taken out and its DNA was sequenced by Esposito and Venter. But Peter Jahrling wanted to awaken the smallpox stocks and use them in research. Speaking from his seat as an onlooker, he said, “D.A., the tools of molecular biology have advanced quite a bit in the past twenty years. Just because there hasn’t been any demand for variola in the past, it doesn’t mean there won’t be demand for variola in the future.”
Henderson answered by saying that the arguments for keeping smallpox in order to do research for antiviral drugs or better vaccines were completely specious. He said that a new vaccine would require an animal model, and that we would never have. Smallpox would not infect an animal; it was a virus of people. It is safe to say that D. A. Henderson was in almost unbearable agony as he gave that speech.
The meeting ended with a vote on whether to keep or destroy the stocks. It went five to four in favor of destroying smallpox—a narrow victory for Henderson. But the virus had already passed out of the control of the WHO, and Lev Sandakhchiev had more or less said so. Henderson felt terrible regret that he and the other members of the committee hadn’t voted to destroy the stocks in 1980, right after the Eradication. Everyone would have agreed to it, and they could have done it then.
THE EXECUTION DATE of smallpox, June 30th, 1999, began to loom. In April, the Institute of Medicine issued a report saying that if the world wanted to have a new vaccine or an antiviral drug for smallpox, then the virus would need to be kept for scientific experiments. President Bill Clinton had personally favored the destruction of smallpox, but the report changed his mind, and the White House now strongly endorsed the idea of keeping the stocks. A month later, the WHO General Assembly voted to keep smallpox alive for another three years, until June 30th, 2002. Researchers—principally Peter Jahrling and his group—could use that time to see if it would be possible to cure smallpox with a drug or if it would be possible to find an animal that could be infected with smallpox so that new vaccines could be tested.
The stakes could not have been higher for Jahrling. He felt that a smallpox emergency could be as bad as a nuclear emergency. “Smallpox is the one virus that can basically bring the world to its knees. And the likelihood of smallpox being visited on us is far greater than a nuclear war, in my opinion,” he said to me. Now he had three years to do something about it. There were times when he woke up, bolt upright in bed, sleepless at three o’clock in the morning with Pocken-angst, with anxiety about smallpox. He would talk to D. A. Henderson in his head: Goddamn it, D.A. . . . He and the eradicator agreed perfectly on the nature of variola—it was the mother of all biological weapons. But they could not agree on what to do about it.
A WOMAN WITH A PEACEFUL LIFE
Lisa Hensley
ON THE FIRST of September 1998, a twenty-six-year-old civilian scientist named Lisa Hensley reported to work for the first time at USAMRIID. She was a postdoctoral researcher with a fellowship from the National Research Council. Hensley rented a one-bedroom apartment in Germantown, about twenty minutes outside Frederick. She furnished the apartment with a couch and a television set that she had inherited from her grandmother.
Lisa Hensley is of medium height, with hazel eyes and dark brown hair that she usually wears tied back in a ponytail; when she’s working in the laboratory, she ties her hair up so that it won’t fall into her experiments. She has an open face, a calm, unruffled manner, and a rapid, precise way of speaking. She was an All-American varsity-lacrosse player at Johns Hopkins, and she has broad shoulders and an athletic way of moving. She usually wears khaki slacks, square-toed loafers, and gold earrings decorated with small pearls. She rarely takes off the earrings, even when she’s inside a biohazard space suit. Hensley is a scuba diver, and she likes to dive on wrecks and into underwater caves. Cave diving is not for people who get claustrophobia, and the sport has a high rate of accidents. She finds it calming, she says.
Lisa’s father, Dr. Michael Hensley, works in the pharmaceutical industry. When he was younger, Mike Hensley rode horseback and fenced with sabers, but during his medical internship he had what he describes as an interesting event—a hemorrhage. He learned that he had a mild form of hemophilia, a genetic disease that occurs only in men but is inherited through female carriers. Hemophilia ran in the Hensley family. Many men with hemophilia have died of AIDS, having received blood transfusions tainted with HIV during the years when blood wasn’t tested for it.
When Lisa was eight years old, HIV was just beginning to be understood. Mike Hensley received blood transfusions during that time, but he didn’t become infected. Lisa was extremely close to her father. He took her into his laboratory and taught her how to grow bacteria on petri dishes, and he gave her bottles of seawater to look at in his microscopes. She saw that a tiny droplet of the sea was an ecosystem packed with life. She told her parents that she wanted to be a marine biologist, and at twelve she was certified as a diver.
In high school, she was a jock who was bored out of her mind with her studies, including biology. She became a state-champion lacrosse goalie with a string of varsity letters, and applied to the U.S. Naval Academy to become an aviator. Then, at the last minute, she changed her mind and went to Johns Hopkins, which recruited her to play lacrosse.
At Johns Hopkins, Hensley began taking courses in public health. When she was a junior, Mike Hensley invited her to attend a scientific conference in San Francisco on HIV, and it electrified her. She became fascinated with the idea that if you really understood how viruses emerge, you might be able to stop a disease like AIDS before it could spread. She graduated from Johns Hopkins in four years with a master’s degree in public health.
Hensley went on to get a Ph.D. in epidemiology and microbiology in three years at the University of North Carolina at Chapel Hill, and at the same time she got a second master’s degree in public health. She had pretty much no social life in graduate school and devoted herself to the laboratory. She moved viruses from one type of host to another and watched trans-species jumps occur in the lab, before her eyes. She learned the standard methods of virus engineering—how to change the genes of a virus, altering the strain.
Hensley had an apartment across the street from her lab at Chapel Hill, so that she could spend nearly every waking minute in the lab, with the goal of having three advanced degrees by her twenty-fifth birthday. She didn’t sleep much, and when she did she had recurrent dreams, focused on her hands. In the dreams, she was working faster and faster, trying to finish an experiment, yet she could never make her hands go fast enough. . . . She was falling behind. . . . Her grant money was running out. . . . Life was too short. . . . And she would wake up. She’d grab a Diet Coke for breakfast and stumble across the street to the lab, where she would work all day and half the night.
At USAMRIID, Lisa Hensley bega
n doing research on SHF, a Level 3 virus that is harmless to humans but is devastating to monkeys. It was a virus that could emerge as a human disease someday. Her social life had opened up, and she had begun dating a virologist at the National Institutes of Health in Bethesda, Maryland. Things didn’t work out well between them. The problem was that when they argued with each other, it was about viruses. Scientific people are competitive types, and they like to be right. Any sort of discussion about viruses with her friend could turn into an emotional fight. One time, they were in his apartment debating some minor point about a virus, and he said, “You’re wrong about that.” She went over to a shelf, grabbed a textbook, and opened it to the page that showed she was right. She placed it on the kitchen table and walked out. Hensley admitted to herself that this was perhaps not emotionally shrewd. When they broke up, she vowed to herself, No more scientists, they’re a headache.
The head of Lisa Hensley’s division at USAMRIID was Colonel Nancy Jaax, an experienced pathologist with a strong interest in Ebola virus. Hensley had zero interest in Ebola. The space suits at USAMRIID are blue, and from the day she arrived there Hensley made a point of saying, “The people who work in the blue suits are nuts. I’m not putting on a blue suit for Ebola. You have to be crazy to do that.”
Nancy Jaax heard about Hensley’s cracks about people who worked with Ebola being crazy. It was felt that cautious people would be less likely to have an accident in Level 4. The last thing anyone wanted was a researcher getting cocky around a hot agent.
One day Hensley walked into a regular staff meeting, in a windowless conference room on the second floor of the Institute, and, as a junior scientist, took her place at the foot of the table. The meeting droned on for a while, typically, until Nancy Jaax suddenly looked down the table at Hensley and announced that her mission was about to change. “I’m going to have you refocus your efforts, Lisa,” Jaax said. “We’ll get you trained in the blue suits, and we’ll start you working with Ebola Zaire.”
Lisa Hensley came out of the meeting feeling dizzy and a little unsteady on her feet. She teetered back to her cubicle and fell into a chair. The cubicle was a cluttered space, piled with papers. There was a computer, a stereo, and pictures of her mother and father and other members of her family. They’re going to start me with Ebola Zaire? she thought.
Death from Ebola comes about five to nine days after you break out with symptoms, and it occurs with spurts of blood coming from the orifices and a collapse of blood pressure, an event that Army people call the crash and bleed-out. In some cases, the virus causes a near-total loss of blood—an Ebola exsanguination. They were paying Hensley thirty-eight thousand dollars a year, but was it worth it? If you infected yourself with Ebola, that was it.
Hensley was closer to her parents than to anyone else in the world. Her mother, Karen, called her three times a week to find out how things were going. Lisa told her that the powers at the Institute had redirected her career into Ebola virus.
“You’re going into a BL-4 suite to work with Ebola? Isn’t there anything else they could have you do?”
Lisa tried to play things down. “Oh, Mother. I’m much safer in a space suit. Really.”
“Mike! Mike! Come talk to your daughter.”
Lisa’s father thought it was a good opportunity for her, and they decided to give Karen a tour of the laboratories, so she could see that everything was safe.
The tour wasn’t quite as successful as they had hoped. Karen Hensley is an economist, and she didn’t have a natural feel for biohazard containment. She noticed a door marked CRASH DOOR. That didn’t sound too good, but it was a safety feature. If a fire or other emergency occurs in Level 4, you can burst out through the crash door, and you end up standing in the hallway in your space suit. (So far, no crash door has been used for that purpose at USAMRIID.) What really bothered her was the fact that the edges of the crash door were sealed with brown duct tape, which ran all around the door frame. “Why do they have tape around that door, Lisa? Is that how they seal the doors around here? Just with tape?”
Lisa explained to her mother that the hot suites were under negative air pressure, and air was constantly flowing into the labs, so the tape was actually to prevent dust and contaminants from entering and messing up the experiments.
Karen Hensley didn’t like the look of the tape, period. Then she discovered what you wear inside a biohazard space suit: green cotton surgical scrubs, latex surgical gloves, and socks. That is all. Underwear is forbidden in a hot lab. Karen Hensley was mortified for her daughter. She could not imagine why they would make any woman work in a laboratory without a bra.
HENSLEY WAS TRAINED in blue-suit work by an older postdoc at USAMRIID named Steven J. Hatfill, a big, muscular man in his forties with a mustache and a medical degree—a civilian medical doctor with a background in the U.S. Special Forces. He showed her how to put on the suit, how to do a safety check on it for leaks, how to maintain it properly, and how to go in and out through the decon-shower air lock in Level 4. Steve Hatfill was known around the Institute as a “blue-suit cowboy.” He seemed fearless in a blue suit, and he thrived in Level 4. He had a thirst for adventure: he had been a soldier in Africa, where he said he had served in Rhodesia with the white Rhodesian Special Air Squadron—the SAS—during the years when black insurgents were trying to overthrow Rhodesia’s white government. Later, he got a medical degree in Zimbabwe, and he worked as a doctor in Antarctica for a year and a half with a team of South African scientists. Hatfill had become convinced that a bioterror event was likely to happen. He served as a consultant to emergency planners in New York City, and he kept a strip of reflective tape on the roof of his car, so that in the event of a bioemergency the state-police helicopters could find him.
Lisa Hensley found Steve Hatfill likable and entertaining, quite a character. He was bright, a super lab worker, and he taught her some techniques. He was researching the coagulation of monkey blood infected with Ebola virus. Ebola blood became hemorrhagic and wouldn’t coagulate, but it needed to be clotted in the lab for study; he taught her how to do this. He had all kinds of gadgets running in Level 4—assay machines, that sort of thing.
During one of her first training sessions, Hensley looked over at Hatfill and noticed that he was hunched inside his space suit. One arm of his suit was hanging limp, as if he had had a stroke. At first, she didn’t know what was going on: was he suffocating or what? Hatfill had pulled his arm up inside the sleeve of his space suit, and he was eating a candy bar.
LISA HENSLEY was a rising star at the Institute. Postdocs like her tended to move on quickly if they got bored, and she was assigned to work in Peter Jahrling’s group. Despite his growing involvement with smallpox and national policy, Jahrling had continued to do research into Ebola virus, working closely with Tom Geisbert. They not only were scientific collaborators but had become personal friends. Lisa Hensley went to work for Geisbert, who was running Ebola experiments in Level 4. She did lab work on samples of monkey blood infected with Ebola. On her own, she began developing tests for detecting the presence of Ebola virus inside individual cells. The tests made infected cells glow red or green under a fluorescent microscope. You could see how Ebola virus was invading cells in the immune system and doing clever things that seemed to trigger a cytokine storm. She was getting closer to understanding how Ebola overwhelms the human immune system. This was important work, because there might never be a vaccine or cure for Ebola unless scientists understood how it killed.
Hensley found that she liked the peaceful feeling of working alone in a space suit in Level 4, with nobody to distract her, nothing but the green cinder-block walls and her dishes of Ebola. She felt cozy inside the suit, even though the rooms around her were hot with the virus. It was like scuba diving. A space suit was a sanctuary from the hubbub of the world. You could do your work without being interrupted by people asking questions or calling on the telephone, and you could press a little deeper into nature.
Hensley was growing Ebola in virus cultures. Viruses are grown in plastic well plates containing a liquid cell-culture medium. In the bottom of the wells there is a carpet of living human cells, alive and bathed in the liquid. (The cells are HeLa cells, cervical-cancer cells derived from an African-American woman named Henrietta Lacks, who died in Baltimore in 1951. Her cancer cells have become a cornerstone of medical research and have saved many human lives.) Hensley would infect plates of cells with Ebola, and in a few days virus particles would begin budding out of them. Ebola particles are shaped like spaghetti, and they grow out of the cells like hair. The strands break off and drift away in the liquid. The virus is amplified in the well plate, and in a few days the liquid becomes a virus soup, rich with particles of Ebola.
Hensley became good at making amplified Ebola soups. Using a pipette, she moved droplets of Ebola soup around from well to well, from vial to vial. She would hold the pipette in her heavy yellow rubber gloves, push a button on the pipette with her thumb, pick up a small quantity of the Ebola soup, and then drop it into a vial.
Ebola soups are pale red, the color of a watered ruby, and sparkling clear. A well plate full of Ebola soup contains up to five million lethal doses of the virus—in theory, enough Ebola to make half of New York City crash and bleed out. Yet handling Ebola soup is no more dangerous than walking down a busy street. You could be killed if you stepped in front of a bus, but careful people watch where they are going. Hensley wore earplugs, and she heard nothing but the distant roar of cool, sterile air running in her space suit. It sounded like surf on a beach.
Hensley spent so many hours working in her suit with Ebola that she began to get those dreams again. In her Ebola dreams, she would be moving droplets of Ebola soup from well to well, from vial to vial, working faster and faster, trying to complete an experiment, and there was never enough time to find out what she longed to know about viruses. In her dreams, she was always in control of Ebola virus, and Ebola never had control over her.