In Steven Pinker's latest book Enlightenment Now the psycholinguist makes an interesting observation about the first line in a Wikipedia entry: "Smallpox Was An Infectious Disease."
The keyword here: "War . "
Although the virus disease killed more than 300 million people in the 20th century, it is a thing of the past – the only scourge that has been spread to humans, was eradicated. (The other disease that has been eradicated, rinderpest, was mainly spread in cattle.)
Today is the 38th anniversary of this achievement. On May 8, 1
In his excellent book, 2011 House on Fire the 82-year-old physician and epidemiologist describes how he and other health workers have come down to smallpox eradication – through dreams, ingenuity in politics, and fear of breaking the rules Break, and develop the brilliant Ringimpfstrategie. The unique approach to immunization meant that instead of vaccinating entire populations to prevent disease, the limited supply of vaccines could be distributed to the most vulnerable: the contacts of the infected.
Building on this success, people have almost completely eliminated measles and polio, significantly reduced the incidence of malaria and HIV / AIDS, and invented a successful Ebola and HPV vaccine among many other public health milestones.
Recently, however, we have forgotten about these accomplishments – mainly because many people no longer see the diseases that science has caused. This year was also the 20th anniversary of Andrew Wakefield's research work, which helped to catalyze the modern anti-vaccine movement by suggesting vaccines that cause autism. (The same movement has been linked to recent measles and whooping coughing.) The anniversary of smallpox eradication seemed like a good time to take stock.
I called Foege to talk about his life's work, how he feels about the anti-vaccine movement, and what illnesses he's taking on next for humans. Our conversation was worked on length and clarity.
In your book, you start by discussing a smell – the smell of decaying flesh from smallpox pustules that hit you before you even entered the room with the infected patient. And you continue to say that hundreds of years before you started working on smallpox, the source of the dream to eradicate it started with Edward Jenner, who invented the smallpox vaccine. Today, we live in this moment when many discussions about vaccines are being negated – many people have forgotten how horrible diseases like smallpox were and what success vaccines have.
I think vaccines are really the foundation of public health. I often say that modern public health began in the spring of 1796, when Jenner made the first smallpox vaccine. He took material from the cowpox lesion and put it in the arm of a boy named James Phipps. Weeks later, he tried to [smallpox] [Phipps] and was unsuccessful.
That was the beginning of modern public health – the first time we had a tool. The vaccine era took some time to get going.
In the early 1980s [many of]our vaccine diseases had dropped to almost zero. We have really done an incredible job in this country. And in 2000 we even had the measles transfer interrupted. Measles are so contagious, everyone thought that would be an impossible goal. So it went pretty well, until Andrew Wakefield made his article Lancet [suggesting there’s a link between the measles-mumps-rubella vaccine and autism] .
He specifically said the MMR vaccine was the problem. He was expelled in England for the fakes of his [data]. He still has many people who believe that this relationship is the cause of autism among their children. These parents are trying to do the best for their children. I always start from this premise. He really spoiled the situation.
Sometimes, when I read about the anti-vaccine movement, I wonder how you need to feel, what an unpleasant and painful smallpox disease was, and knowing how to help eliminate vaccines, and that there are people who now reject vaccines.
We are very frustrated when we know that the truth is not understood.
But the vaccination campaign started right after Jenner. You've seen cartoons in which the head of a cow came out of the arm of a vaccinated child, something like that.
The second thing is, parents are trying to do the right thing, but nowadays [some] can only see the risk of vaccination. You can no longer see the risk of illness.
You combine this with reluctance, many people have to believe the government. That's really a problem. I therefore see the problem as even bigger in the future.
What impressed me in India, even though they had a pox goddess – what they considered a positive thing – they changed their mind when they could see this vaccine protected against smallpox. They did not want their children to have smallpox. This belief was quickly overcome by the facts. And you would hope that the same thing could happen with education, that parents would understand what the risk of the disease's return is, and that they could imagine that in comparison to the risk of vaccines.
What current efforts to eliminate disease make you most hopeful? Polio? Guinea worm?
I think there are some bright spots on the horizon. I have argued that all obstetricians should tell their pregnancy patients that they never have to worry about their child's rubella syndrome. The reason is that rubella is no longer circulating in this country. So many children receive the vaccine, they have protected your child. This is part of the social contract that protects your child – and you are required to continue the social contract in your future.
Polio has proved much more of a social problem than a scientific problem. That means that in Pakistan and Afghanistan we are dealing with the difficulties of politics. And much of that, of course in Pakistan, is due to the US trying to use the polio program to find out which house Osama bin Laden was in. This angered the people of Pakistan to the point of killing polio vaccines. Who could have thought that a dozen years ago? The fact that we did not get this over so quickly has led to one complication after another. We will still get rid of it; it only takes longer.
There is no vaccine involved with the guinea worm. [Eradication involves community-based interventions to reduce transmission.] That should give us the courage to look beyond vaccine-preventable diseases.
The Carter Center had a disease eradication task force that looked at dozens of diseases and asked what information we needed to eradicate the disease. That's another question to say, can we eradicate this disease? As we go through this process, we develop the research agenda.
I think after Polio and Guinea worm we might consider river blindness, lymphatic filariasis – and I think that measles should be on the list because we have a good vaccine again and the number of measles deaths is 3 million per Year has gone to about 100,000 in the last year. This is a very significant reduction and it shows that we know a lot about how to stop this disease.
In your book, you talk a lot about the importance of optimism – and it seems you hold on to that optimism, even with all the setbacks you've described.
I think we're at the beginning of an eradication era – because of the vaccines – and as we learn more about logistics, cold chains, and the development of vaccines that do not require refrigeration, do it I do not need needles and syringes, I think the future is very rosy for the eradication of the disease.
I say in the book that some things have to be believed to be seen. I think that is very true with the eradication of the disease. You have to believe that a disease can be eradicated; then you have to put up with all the frustrations about things that are not working right. … then you stay with your vision of what the last mile is.