Eradicating Smallpox (14:22)
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Key Ideas
As this video progresses, key ideas will be introduced to invoke discussion.
Think about the following questions as you watch the video
- According to Dr. Larry Brilliant, what made smallpox the worst disease in history?
- What is variolation?
- Who created the first smallpox vaccine? According to Dr. Larry, how did that person discover and test vaccines?
- What was ring vaccination?
- According to Dr. Larry, what was the most important factor in 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
: 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