Small Pox, Poliomyelitis and the United Nations
It is said that in colonial times people didn’t count their children until they had survived small pox. The mortality was 30-some percent. When I talk to my public about this, I find that only about one half know that WHO (World Health Organization), an agency of the U.N., undertook in 1967 to eliminate small pox world wide with success in 1980. Prior to 1967, 10 to 15 million people died of small pox annually. This accomplishment of the U.N. probably justifies their entire budget up to 1980.
Small pox was a good candidate for eradication because: 1) it is a single entity without multiple strains like colds or AIDS, 2) there is no animal reservoir, 3) vaccination is so effective that even people already exposed can be protected, 4) it is easily recognized from its characteristic rash, and 5) there is no carrier state – only obvious cases can transmit it.
When we went to Afghanistan as Peace Corps volunteers in 1968, some of our fellow volunteers were assigned as vaccinators. We couldn’t see how they could possibly vaccinate nearly everyone in a backward, mountainous, closed society. In the early 1970s, one of the prime movers of the program addressed the University of Wisconsin Medical School. He described the learning process of the leaders of the program in India where they succeeded early and below budget and after they had vaccinated only about half of the susceptible population. Items of their resourcefulness: they found that they could vaccinate about a 20 mile radius around an outbreak and stop its spread, like a firebreak around a forest fire. In order to identify cases promptly, they instituted a reward system paid to those who reported new cases. As fewer cases occurred, they increased the reward. The last reward paid was 3,000 rupees, a small fortune, but the reward system was effective and saved money. When they found that they had paid more than one reward for the same patient transported to a new village by wheelbarrow, they caught on and fingerprinted the patients.
The last case of naturally transmitted small pox was in 1977 in Somalia and WHO declared small pox eradicated in 1980, a first for mankind. Stocks of small pox virus are kept for research purposes in Atlanta at the U.S. Center for Disease Control and by a similar institution in Moscow. Several dates for eradication of these stocks have been set and postponed for “research purposes”. The chemical structure of small pox virus is known so that it could be recreated by a major and very sophisticated effort so the “research purpose” is no longer an excuse for retaining the live virus which could be stolen and propagated by a very small effort compared to its synthesis.
Elimination of poliomyelitis is well on the way. Guinea worm disease, leprosy, measles and rubella (a minor illness with serious consequences to the fetus when it occurs during pregnancy) are under consideration.
Nearly 30 years ago at a A.A.A.S. (American Association for Advancement of Science) meeting in Washington, a group of experts from all over the world were assembled by the Organization of American States to discuss elimination of polio from the western hemisphere. We attended because the sessions were open to the scientific public at large. These experts really know their stuff. Polio was eradicated from the western hemisphere over ten years ago by the methods outlined at that session.
Polio is a much different problem from small pox. There are three strains. Furthermore, the vast majority of cases are unrecognized, masquerading as a mild illness with fever and aching muscles without paralysis. The key concept in overcoming the problem of surveillance of outbreaks was that any paralytic case recognized was accompanied by hundreds of others with unrecognized illness. So on a report of a suspicious case of paralysis, a team could go to the locale of the case and do random virus cultures for polio in the population even two to three weeks later. If the index case were polio, the virus would still be circulating in the community and readily be detected without even examining the index case. Some of the experts suggested where to locate the surveillance teams and laboratories based on their knowledge of existing resources and suggested the need for subsidizing the poorest nations to prevent failure of the whole program. WHO is now close to eradicating polio in the rest of the world. Years later, when the western hemisphere program succeeded, my respect for visiting experts was retroactively enhanced. So the World Health Organization functioned well in spite of obvious political problems, especially when the iron curtain was in place. I am proud of my profession worldwide. They are physicians first, Communists, Democrats, Republicans, Muslims, Hindus, etc., second. Public health is a uniquely human activity, which by its very nature must transcend political, ethnic and religious boundaries.
John A. Frantz
Chairman, Monroe Board of Health
October 1, 2001
Fred Hoyle was an eminent astronomer and cosmologist whose life has spanned most of the twentieth century. He was an opponent of the Big Bang Theory of cosmology. Actually he coined the term impulsively while making fun of the new theory at a public scientific meeting. The new name, Big Bang Theory, caught on and was widely used to the consternation of its originators, who considered Big Bang frivolous and derogatory.
In hopes of arriving at a more acceptable name the originators of the new theory contributed to a fund of a few thousand dollars as a prize to the best submitted entry for a new name. The evaluating committee of these entries rejected all the new names and awarded the prize to Fred Hoyle who presumably had not even submitted his entry. So the Big Bang it has been ever since, a trivial but emotionally satisfying example of collegiality in science.
June 8, 2002