Smallpox bioterrorism scenarios and reactive intervention protocol: mathematical model-based analysis

Smallpox, caused by the variola virus, is one of the most devastating diseases in human history and was eradicated through global vaccination efforts by 1980. Despite its eradication, the virus remains in high-security laboratories for research purposes, posing the potential risk of bioterrorism. This study developed a mathematical model to analyze potential smallpox epidemics by incorporating factors such as age groups, heterogeneous contact patterns, and various intervention strategies including contact tracing, ring vaccination, and mass vaccination. The model simulations indicated that the Republic of Korea’s current plans for negative-pressure isolation beds should suffice under most scenarios, but extreme worst-case scenarios could overwhelm healthcare capacity. This study highlights the critical importance of non-pharmaceutical interventions and strategic vaccination prioritization for controlling outbreaks. These findings provide valuable guidance for public health officials and policymakers in preparing for potential bioterrorism threats and emerging infectious diseases. Furthermore, emphasizes the need for comprehensive preparedness and robust response strategies. The proposed framework applies to smallpox and to other infectious diseases, offering insights for future outbreak management.