WATCH: Eradicating Smallpox

An invisible enemy stalked our species for  thousands of years. It killed 3 out of 10   people it touched. Those who survived were left  scarred for life. The killer's name? Smallpox.   Among the many diseases that have plagued  human history, few are so deadly or so enduring   as the smallpox virus. It brought mighty  empires to their knees, killing king and   commoner alike. In the 20th century alone,  smallpox killed more people than World War I,   more than the Spanish Flu, and more than World  War II combined. All this long, terrible history,   and you probably never think about smallpox,  do you? Why not? Because it's gone—eradicated.   Humanity declared victory against its old enemy  on May 8th, 1980. Today in the year 2022, we look   back on over two years of the COVID-19 pandemic.  Many questions about our future remain unanswered:   when will the pandemic end? Can we eradicate  COVID-19 virus altogether, like we did with   smallpox? As we confront this uncertain future,  we might look to history for guidance. History   won't help us predict the future, but as the only  human infectious disease we've ever eradicated,   the long history of smallpox holds important  lessons for today and for tomorrow as we seek   to prevent the next pandemic.  To understand this history,   I turned to someone who lived it, Dr Larry  Brilliant, an epidemiologist. In the 1970s,   Dr Larry joined the WHO in India as part  of a global effort to eradicate smallpox. Smallpox is the worst, the most lethal  disease in history. It has that combination   of how rapidly it spreads and how many people it  kills to make it the worst disease in history.   One case of smallpox would lead to four or five  or six other cases. It's very transmissible. But   unlike COVID or flu, instead of killing one  person out of a thousand, out of a hundred,   one out of every three people who got smallpox  died, and they were usually little children. 90-  95 percent of the time, it was spread by  respiration like the flu or like COVID.   But when it got into your body, it attacked all of  the mucous surfaces: the inside of your nose, the   inside of your mouth, the inside of your throat,  your intestinal system, all throughout your body.   And every place on your skin, you would  get pustules and boils. And in some of   the worst cases that I saw, there wasn't  a single piece of skin that was normal,   you could put your finger,  it was covered with boils. Human societies in every part of the world  have suffered from smallpox outbreaks   for centuries. It traveled with  us, spreading between societies.   But as the disease spread, so too did methods  of fighting it: first in China and India,   and then spreading through the Islamic world to  Europe and West Africa. Physicians experimented   with Variolation: a method of giving people a  tiny bit of smallpox virus from another person's   pistols in the hope of provoking a milder  infection and lifelong immunity. It wasn't   a safe procedure by today's standards. One  out of every 10 who got Variolated would die.   But it's far better if you think about the  mathematics of survival to risk one out of   ten dying than the inevitable three or four  out of ten dying. To this day, we don't have a   treatment for smallpox, which is why in the  end we had to prevent it and eradicate it. In 1796, a country doctor in Berkeley,  England, named Edward Jenner, sparked a major   innovation in the fight against smallpox:  the first vaccine. And this country doctor   couldn't understand why one community didn't  have pox, didn't have scars, and he noticed   a milkmaid named Sarah Nelms, who was milking a  cow named Blossom—that was the name of the cow—   and a Blossom had an infection on her udders that  were like pox marks, and when Sarah Nelms was   milking Blossom the disease spread  from the cow to her fingers.   And somehow, Edward Jenner thought, "That  must be it, if you have a pox on your finger,   you won't get punks on your face." And it has  to be considered a great leap of imagination—a   great belief that there could be special  transmission of immunity. Using material from   a cowpox sore, on milkmaid Sarah Nelson's hand,  he inoculated the eight-year-old James Phipps,   later exposing him to smallpox as an experiment.  Thankfully for young James, and for us,   the vaccine worked. And that was the moment that  the idea that you could prevent a disease—now  remember, this is before Germ Theory, nobody  knew about viruses, bacterias, we didn't have   microscopes then—and with that breakthrough,  came the idea that by getting the cowpox,   you could prevent the more deadly  smallpox. That was the first vaccination. Armed with the new tool of vaccines,  wealthy nations launched programs   to vaccinate their citizens against smallpox,  often facing anti-vaccination protests.   By the end of the Second World War, most of  the world's wealthiest nations had eradicated   smallpox within their borders. But smallpox was  far from defeated. Let's vaccinate everybody—we   call that mass vaccination and some countries  were able to push smallpox out of the country   by vaccinating everybody. Countries like Burma  and China, which had more strict governments,   could accomplish that. Countries like the United  States, which were wealthy, could accomplish that   by having routine vaccination mandatory of all  kids before they went to school and all travelers.   But for most of the world it didn't work.  We had that smallpox vaccine for 200 years   and we weren't able to eradicate smallpox. After  the Second World War, humanity had a new tool   in its fight against smallpox: the United Nations,  more specifically, the World Health Organization,   enabled international cooperation of a scale  and efficiency never seen before. In 1967,   the organization launched the Intensified Smallpox  Eradication Program led by scientists and doctors   like William Feige and D.A. Henderson. The  organization set out on an ambitious mission:   to rid the world of smallpox. In 1972,  Dr Larry Brilliant joined their ranks.   So Bill Feige—who was this wonderful  epidemiologist working in Nigeria   during the Civil War in Nigeria in the 60s,  the Igbo Civil War—Bill was a missionary doctor   and he was working in a little village, and he  had only a little bit of smallpox vaccine. And   there was a big outbreak, and Bill, who was a  very moral person, asked himself, "What do I do   with this little bit of vaccine? Who do I save?  Who do I protect?" And, you know, usually that   may have been in a different scenario: the  richest person, or only women, or only children or   something like that. Bill said, "I guess the most  important person that I need to vaccinate is the   one who's going to give the disease to five  other people." And so he located those people   who were surrounding, living  near somebody who had smallpox,  and the people that he vaccinated. And suddenly,  the entire epidemic stopped. So Bill came up with   the idea of surveillance and containment. People  later on called it ring vaccination. That strategy   was what broke through the centuries  of difficulties that populist countries   like India had, who couldn't do mass vaccination.  Now, we go far away from the realm of science,   we have to understand that the most important  thing to eradicate a disease is public will. With   public will you can do anything, without public  will you can't do anything. At the time that the   smallpox eradication campaign began in the 70s,  there was public will to eradicate smallpox.   It was a Russian professor who came to the World  Health Organization and said, "We must eradicate   smallpox." The whole world assembly voted to have  a campaign. They hired an American, D.A Henderson,   to run it. People came from 50 different countries  to work together. We had every language spoken.  Our meetings—you would see people with every color  of skin. You had people who were Islamic, Jewish,   Protestant, Catholic, Shintu, Hindu,  Buddhist—every religion you could think of   speaking dozens of languages. But the horror, the  agony of this disease, and the fear that it would   spread, made us forget about our differences  and look at what we cherished together, and   what we cherished was a world free of this damn  disease. It evoked such a hatred for the disease.   We thought of it as the demon, we thought of it as  our enemy, and we considered that we were at war   with smallpox. Incredibly, despite civil wars  and a global Cold War, the campaign succeeded.   In October 1977, Ali Maow Maalin, a Somalian  hospital cook, was the last person to be   naturally infected with smallpox. He survived and  later became a vaccination campaigner himself,   promoting the polio vaccine. On May 8, 1980,  the WHO officially declared smallpox eradicated. I hope that polio joins smallpox as the second  disease to be eradicated because those of us   who worked in the smallpox program—we call  ourselves smallpox warriors—we're very lonely.   We don't want to be in a world where  only one disease has been eradicated.   And the next one is going to be polio—in fact, I think this year there have only been about 15   cases of polio in the whole world. There are  only three or two, or maybe even one countries,   that has not eradicated polio. So polio will  be eradicated in our lifetimes, and that's   magic and wonderful. After that, it gets harder.  People talk about a measles eradication program,   they talk about a malaria eradication program,  we've tried to eradicate three other diseases.   Yaws is one of them. I'm hopeful that we can do  it. I don't think we have that feeling for COVID.   It's unfortunate, because in its own way, COVID is  a horrible disease. And how many more will there   be like that? We haven't done very well in trying  to stop COVID, a lot of great science and creating   vaccines, anti-virals, treatments. But the guts  of it, the program, the communications, people   working together as friends and not bringing  politics in it. We haven't done a very good job.   So, we've missed the public will part.  So, we have smallpox, we will soon have   polio, they should inspire us, they should  make you want to go into public health,   they should make you get excited about global  health. But it isn't clear that the best science   in the world is enough. And so, a lot of times  you hear public health people saying, "I don't   want to get politics into it." Yes, we do. We have  to bring politics into it, and said another way,   we have to bring public health into politics. And  that's my hope. That's my hope: for one of the   great lessons of smallpox eradication. The long  history of humanity's struggle against smallpox   and the story of its eradication is evidence  that we have the knowledge, resources,   and ability to eradicate diseases and  prevent future pandemics before they start.   Dr Larry has said before that "Outbreaks  are inevitable but pandemics are optional."   Humanity can eradicate diseases. We can prevent  future pandemics. We need only to find the   willpower to work together across borders and  differences and use the tools we already have.