Undoing greatest victory of 20th century medicine

November 05, 2001|By Ellen Goodman

BOSTON - I am sitting here trying to parse the government's instructions. How do I go about my normal life but remain on heightened alert?

In front of me is my plane ticket to Newark. Does living normally now mean getting to the airport two dark and grim hours ahead of my 7 a.m. flight? Does being alert mean bagging the trip?

And what does the "new normalcy" that Ari Fleischer coined mean for the innocuous but anonymous envelope before me? Should I steam iron it or dump it?

This is how health and safety have been redefined in a matter of weeks. In early September we were debating research on the cutting edge of medical science: How many angels can dance on the head of a stem cell? In early November we are debating how to deal with scourges from the past: anthrax and smallpox.

Smallpox? I thought we won that one. I know we won that one.

To me, smallpox, even more than anthrax, has become the symbol of living in the shadow of bioterrorism. Not because smallpox is the most likely threat, but because it offers the most poignant view of history and humanity.

Smallpox once killed one out of every three people it infected and scarred many more. It was so lethal and widespread that in the 18th century, the early form of inoculation was considered a boon even though it killed one out of 100 recipients.

This disease had the dubious honor of becoming the first biological weapon. In 1763, beleaguered British troops gave out infected blankets to Native Americans.

In the 20th century, smallpox killed 300 million people across the world, more than all the wars combined. Then in the late 1960s, the World Health Organization launched a hugely ambitious campaign to wipe it out.

Elizabeth Fenn, historian and author of Pox Americana, looks back at that public health victory with awe. "The fact that all the nations of the world could cooperate through the belligerence of the Cold War to eradicate the disease is a beam of sunlight on a dour period of history," she says.

After 13 years and $100 million, smallpox was officially defeated, the first infectious disease to be eradicated. We stopped vaccinating. Indeed, public health officials talked about the vaccination bonus - money that could be spent on other public health measures.

Even then there was a dark side. Just as we conquered smallpox in nature, the Soviets broke the international "gentleman's agreement" to ban germ warfare and stockpiled military-grade smallpox.

Nevertheless, there hasn't been a case of smallpox since 1978. Today we are all "Native Americans," unvaccinated and vulnerable. Jonathan Tucker, who wrote about the once and future threat of smallpox in Scourge, calls this "the bitter irony." The disease that was deliberately and laboriously and morally eradicated could be deliberately and simply and immorally reintroduced to the world.

Getting rid of smallpox was, Mr. Tucker says, "the greatest achievement of public health in the 20th century." But the possibility of its return as a weapon "shows the highs and lows of human nature and human achievement in a pretty dramatic way."

The odds that smallpox would be chosen for biological warfare may seem small. After all, there's no precise way to target it. Mr. Tucker calls it a "doomsday weapon" likely to work its devastating way back to any country that uses it. But with the fresh image of suicide attackers, the government has ordered 300 million doses of vaccine.

Smallpox? We won that one. We are now on the verge of eradicating polio; AIDS and TB are on the agenda. Yet we have to gear up to fight a disease that's been eradicated.

Smallpox re-emerges as a symbol of something familiar: war's terrible waste. It is symbolic not only of the way warriors can undo great humanitarian successes, but of the diversion of time, energy, commitment.

The best scientific minds of the "greatest generation" were mobilized into the Manhattan Project to build the atomic bomb. How many of our best minds and energies will turn back to the future of safer vaccinations for such threats as anthrax and smallpox? Biological warfare is called "public health in reverse." Like some evil twin, it dispenses "medicine" to produce disease. This is why they call war a pox on the world.

Ellen Goodman is a columnist for the Boston Globe. Her e-mail address is ellengoodman@globe.com.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.