TheMarketForIdeas

The death of Dr. Donald Henderson in August 2016 went largely unremarked by the wider world. Instead of the evening news, I learned of it from an Economist obituary but, by rights, the event should have been a global opportunity to meditate on his life’s work, which involved saving at least a hundred million people from death by smallpox and another three hundred million from the disfiguring effects of infection. In 1966, the World Health Organization (WHO) was given the task of getting rid of smallpox. Donald Henderson had already been studying the disease in over 50 countries. By 1977, Henderson was observing the last natural recorded case of smallpox and, by 1980, the WHO had announced the success of the Smallpox Eradication Program (SEP), something previously thought unachievable. 

Eradicating smallpox was not only about developing a better vaccine. The first one was developed 1796 by Edward Jenner, following up on intuitive practices such as “variolation”, who noticed that milkmaids had become immune to smallpox after contracting cowpox from their proximity to cows. Given the disfiguring effects of smallpox, should one survive it, the attractive health of a milkmaid’s skin became proverbial and associated with milk consumption rather than having gained immunity. Even the word “vaccine” is derived from Jenner’s name for cowpox, “Variolae Vaccinae”. Eradicating smallpox was about the logistics of inoculation, the dynamics of infection spread and the understanding of best practices for the annihilation of the disease not only in technologically developed countries, but throughout the entire world.

Edward Jenner Advising a Farmer to Vaccinate His Family 

Dr. Donald Henderson remained active in the issue of smallpox, by getting involved in debates regarding the storage of the virus (which he wanted destroyed), the stockpiling of vaccines (which he wanted increased) and the potential weaponization of the virus (which he dreaded).

After his tremendous success, Dr. Donald Henderson remained active in the issue of smallpox, by getting involved in debates regarding the storage of the virus (which he wanted destroyed), the stockpiling of vaccines (which he wanted increased) and the potential weaponization of the virus (which he dreaded). 

A faithful companion

Smallpox killed more people in the 20th Century than the First and the Second World Wars combined. It is a very contagious and virulent disease which has afflicted humanity for over 5,000 years, with high mortality (up to a third) and survivors who are permanently scarred with pock marks, particularly on their faces. An immunologically naive population experiences up to 80% childhood mortality when exposed to smallpox. 

Europeans had the greatest natural resistance through the domestication of cows in European villages, one of the overlooked examples of human co-evolution with another lifeform, of which the principal example is our relationship with dogs. After the beneficial mutation of being able, even as adults, to digest the milk of other animals arose just a few thousand years ago, it spread throughout the population through the increased fitness of those who have it. To this day, Europeans have the largest level of lactose tolerance among the main “population groupings” (a politically correct euphemism for race) in the world. The proximity and the widespread consumption of unpasteurized milk and cheese provided inadvertent wide spread immunity from cowpox infection which also gave immunity to smallpox. What epidemiologists have long known is that it is not necessary for everyone in the population to be immunized in order to gain the benefits of stopping the spread of diseases. Just enough to break the chain of transmission and provide herd immunity to those who had not been as close to the cows as others. 

Edward Jenner's experiments with the “Vaccinia Virus” confirmed the natural process. Armed with immunity but unknowingly harboring disease, English sailors and Spanish soldiers wreaked havoc across the New World, as per Jared Diamond’s “Guns, germs and steel”. 

Smallpox has killed more Indians than European colonial war and violence waged with guns and cannons since the arrival of Columbus 500 years ago. This was not a one-sided affair – syphilis was brought from the New World along with corn, potatoes and tobacco, and spread like wildfire across Europe. Plenty of Europeans were also cut down by tropical diseases, which was the impetus for the slave trade that brought resistant Africans as laborers in the plantation system (the European indentured servants kept dying). 

Ultimately, the bodycount of imperialists, fascists or communists was no match for the mercilessness of nature. 

A lingering threat 

While eliminated from the wild, smallpox remained in two secure laboratories of the United States (the CDC in Atlanta) and the Soviet Union (and, later, the Russian Federation – VECTOR in Novosibirsk). All other stocks were supposed to have been destroyed. There have been incidents, such as eight children becoming sick in Vladivostok in 2000 after playing with discarded smallpox vaccine ampoules[1], and vials of smallpox virus being found in a storage room at the National Institute for Health in Bethesda[2]. Donald Henderson fought for its complete elimination, but was overruled by an equally skilled lobby that was in favor of maintenance of the natural strain for future study. An even more important aspect was the development of future vaccines, which cut down on the potential side effects of the ones used in the eradication, and their stockpiling to avert future outbreaks. Before the fall of the Soviet Union, Donald Henderson was outspoken about the possibility of weaponized smallpox being used during armed conflict. According to mainstream publications, the Soviet Union had the capacity to produce 100 tons of weaponized smallpox annually. “Germs: Biological Weapons and America's Secret War” by Judith Miller, William Broad and Stephen Engelberg gave the following table for the American and Soviet biological weapons production: After the fall of the Soviet Union, the world focused mostly on the insecurity of nuclear materials, nuclear devices and nuclear knowledge, but the other two letters of the NBC acronym – nuclear, biological and chemical – provoked just as much anxiety in certain circles. Former Soviet specialists, like Kanatzhan Alibekov, who immigrated to the United States, became outspoken about the accessibility of biological attacks for terrorists, such as in his book “Bioterrorism and Infectious Agents: A New Dilemma for the 21st Century”. 

Japan and Israel, as highly urbanized and densely populated nations, are the only two other countries that maintain enough vaccine for their entire population.

As the Director of the US Office of Public Health Preparedness, in the early 2000s, Donald Henderson argued that the existing 15 million doses of smallpox vaccine were insufficient (though, with dilution, they could have sufficed for around 50 million people) and campaigned for over 250 million doses, enough for the entire population of the United States as recorded at the time. With the perception of American exposure to terrorist attack after the 9/11 attacks (and the simultaneous but not very well remembered anthrax-by-mail attacks), the plan was put into motion. The webpages for the Center for Disease Control[3] confirm that stockpiles for full inoculation had been maintained since 2004. Dr. William H Foege, advisor to the Bill and Melinda Gates Foundation stated, “If we had to, we could vaccinate the entire country in three days”[4]. Japan and Israel, as highly urbanized and densely populated nations, are the only two other countries that maintain enough vaccine for their entire population. 

However, the maintenance, storage, development and replenishment of vaccines has also become a political issue, with the perception of cost influencing decision makers towards dialing down their commitment. When the first proposals to store enough vaccine for all Americans were advanced, the quoted sale price was 8 dollars per unit[5]. By 2013, when the authorities were buying a batch of 2 million vaccines of a new type, the price had gone up to 200 dollars per unit[6], not as manufacturing cost (which would be the price in case of a government takeover of production facilities for emergency purposes), but as cost incorporating the 80 million dollar invested in research and other factors, such as an appropriate return on investment. 

Military value 

The Soviet Union is alleged to have used tularemia in a biological attack against German soldiers during the siege of Stalingrad, when the Axis had already occupied territories with 40% of the USSR’s population. If there had been any card up the Soviet sleeve, Stalingrad was the precise moment to use it. It was also reported to have been running a significant biological weapon research and production program throughout the Cold War. The Soviet Union leadership probably invested so much in the program later on for the same reason they had become tank warfare enthusiasts – because they had seen it up close and personal in prior conflicts. 

Smallpox is almost the ultimate biological weapon – it is very contagious, and some strains are highly lethal.

In some ways, smallpox is almost the ultimate biological weapon – it is very contagious, and some strains are highly lethal. Of course, high lethality deters easy transmission, which is why many diseases have become less lethal over the course of history, by selecting for strains that could also be easily transmitted. Of course, with today’s delivery measures, high lethality becomes an advantage, not a hindrance. And it is also easy to control, as opposed to the radioactive fallout in the upper atmosphere from nuclear attacks – you can easily shield your population through the appropriate vaccine. Back in the 1970s, however, almost everyone was vaccinated, so weaponized smallpox would have been useless. 

As new and unvaccinated generations arose and those previously vaccinated weakened, the military efficacy of smallpox has been on a constant upward trend.

People were routinely vaccinated for as long as smallpox was still an issue in the Third World. But people stopped vaccinating when it was eradicated in 1980, since there was no apparent reason to endure the dangers of the side effects. Vaccinated individuals lose their protection over time (the most likely effective rate is 3 to 5 years). As new and unvaccinated generations arose and those previously vaccinated weakened, the military efficacy of smallpox has been on a constant upward trend. At some point, the World Health Organization disposed of its stockpile of vaccine, amounting to a few hundred million units, to reportedly save on the expense of the refrigeration required. 

Considering that the Soviet Union was always among the strongest proponents of worldwide eradication of smallpox, dating back to the 1950s when the idea was dreamt up, one has to wonder about the possibility of combining humanitarianism with excellent military considerations. Successful eradication eventually transformed smallpox into a superweapon, though the most vulnerable likely moment came before the hardening of US paranoia during 9/11. However, many countries, especially in the developing and dysfunctional world, are nowhere near some sort of basic health coverage, let alone being able to inoculate their populations should something happen. And one also has to take into account the population explosion in places like India and Africa, which has taken place alongside the maintenance of absolute poverty. 

The future for eradication programs 

In 2011, the second disease to have been completely eradicated was announced – rinderpest. Highlighting how important globalization has become as a factor in the potential spread of diseases, ten years have elapsed between the last confirmed natural case of the horrible disease and the declaration that all countries are now free from it and the WHO can step down its field operations. The second disease to have been eradicated should have been poliomyelitis, also within the prior century, a disease which affected the First World, as well as the Third, and led to numerous heartbreaking cases of children with lifelong physical impairments. However, despite an effective vaccine (beginning with the one created by Dr. Jonas Salk) and the dedication of important resources, the Third World (places like Pakistan and Nigeria) has never been completely rid of the disease, as conflicts or distrust of doctors and of vaccination slowed efforts enough for the disease to regain a foothold. With mass uncontrolled migrations today, new diseases are appearing in the West, which are not native to its areas, as well as old ones like poliomyelitis, which were thought eradicated or irrelevant. With the center of global population having moved to what are still euphemistically called “developing countries” and with the cachet of Western medicine exhausted in places that have fallen back under the spell of religious atavism, the prospects for completely eliminating any future diseases are grim.

[1] http://www.who.int/csr/don/2000_06_20e/en/

[2] https://www.washingtonpost.com/national/health-science/smallpox-vials-found-in-storage-room-of-nih-campus-in-bethesda/2014/07/08/bfdc284a-06d2-11e4-8a6a-19355c7e870a_story.html?utm_term=.c158479fd411

[3] https://emergency.cdc.gov/agent/smallpox/vaccination/facts.asp

[4] http://www.healthmap.org/site/diseasedaily/article/us-stockpile-costly-smallpox-drug-deemed-unnecessary-experts-31513

[5] http://www.ph.ucla.edu/epi/bioter/smallpoxvaccineforall.html

[6] http://www.healthmap.org/site/diseasedaily/article/us-stockpile-costly-smallpox-drug-deemed-unnecessary-experts-31513