by Adam Bardaro
In 1974 the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) poured their efforts into eradicating smallpox from India and Bangladesh. By October of the same year, India’s smallpox cases were reduced from 8,403 cases in May to 1000 smallpox cases.[i] Bangladesh suffered only 91 outbreaks in the same period. However, by January the cases jumped from 91 to 572 cases.[ii] The cases in Bangladesh jumped because smallpox is a seasonal virus that spreads in spring when it is dry right before the summer monsoons. In 1974, the summer monsoons caused floods throughout Bangladesh which caused people to flee into city slums. “A few of them carried smallpox with them, and by December, variola major had begun to flicker unseen through the bustees of Dhaka, the capital.”[iii] Smallpox started to spread throughout the capital and the government responded by bulldozing the city slums which exacerbated the spread by pushing infected people out of the city.
Soon in February 1975, smallpox had a foothold in twelve hundred places across Bangladesh. As Richard Preston describes in Demon in the Freezer, “[Smallpox] seemed to rise out of nowhere and everywhere, coalescing out of bushfires into a viral crown fire across the country.”[iv] For a moment the containment and ring vaccination plan that the WHO and CDC implemented seemed to be failing as two hundred cases emerged every two weeks. However, leaders of the WHO and along with the combined efforts from smallpox eradicators around the world implemented a stringent containment and ring vaccination program to stop the spread of the outbreak. Through their efforts, they stopped the outbreak on September 15, 1975, and the last case was reported in Chittagong, Bangladesh. An article by the New York Times stated, “The World Health Organization announced today that Asia was free of smallpox for the first time in history.”[v] The Smallpox Eradication Program (SEP) team leader in charge of Bangladesh, Dr. Stanley O. Foster, received telexes from the WHO and the CDC congratulating the team for one of the greatest achievements in history. However, at the same time, Dr. Foster received a telex reporting, “ONE ACTIVE SMALLPOX CASE DETECTED [IN] VILLAGE KURALIA…BHOLA.”[vi]
Dr. Foster and his team arrived on Bhola Island and quickly began their work of containment and ring vaccination. Dr. Foster and his team entered a house in the village and found a three-year-old little girl, Rahima Banu, covered in scabs caused by a moderate case of smallpox. Within weeks the team organized ring vaccination policies within the village by vaccinating everybody who was potentially exposed to the virus. Afterward, the team searched thoroughly across the island for new cases, but none were found, thus finally uprooting smallpox from Asia. Dr. Foster collected scabs from Rahima and sent them to Geneva and subsequently to the CDC in Atlanta, Georgia. (This is standard procedure – the WHO usually obtains samples collected in the field where the samples are inspected and then distributes them evenly between the CDC and the Institute for Viral Preparations in Moscow, Russia.)
The history of the Smallpox Eradication Program was one in which the world came together to end one of the many pathogens that plagued human civilizations. It took the efforts of the international community and cooperation between world governments that seemed impossible during the Cold War. While proxy wars raged between two superpowers throughout Southeast Asia and Africa, there was also a major joint effort to eradicate smallpox. In the height of the Cold War, there was an international effort led by the WHO and the CDC which included the U.S and the Soviet Union to eradicate smallpox from the world; however, in secrecy, the U.S. and Soviet Union also used the smallpox disease to develop biological weapons for offense and defense against each other. Thus, Cold War politics dominated a biological weapons race between the superpowers despite the international efforts to eradicate smallpox.
Smallpox is scientifically called a variola, and the type that has plagued mankind is known as variola major, which the virus is a member of the orthopoxviral family. Smallpox is a unique virus that only infects humans, meaning it can only be transmitted from human to human. Incubation for the disease is ten to fourteen days before the infected person shows signs of any symptoms and becomes infectious, developing a rash on their skin and lesions in their mouth and throat.[vii] The virus is transmitted through face-to-face contact by infected droplets from a patient’s cough or physical contact with the patient or contaminated articles of clothing. Initially, patients developed symptoms of fever, headache, backache, and vomiting. After two days, lesions developed in the mouth and throat.
Additionally, patients developed red bumps all over their bodies that then become pustules. These pustules would erupt and stain the patient’s bed and clothing with pus and blood. The survivors of smallpox were left permanently scarred with pockmarks on their skin and, at times, some were left blind. In different cases, patients did not live long enough to develop pustules but died from hemorrhagic fever instead. Overall, the mortality rate for smallpox was estimated – at thirty percent.[viii] Hence, the international community decided to act during the Cold War and eradicate smallpox as a scourge from the world.
After being established in 1948, the World Health Organization had its first meeting in July of that year and decided that “the Expert committee on International Epidemiology and Quarantine should form a joint study group on smallpox.”[ix] By 1955, the director-general of the WHO—Dr. Brock Chisholm—proposed a five-year program with an annual budget of $131,000 to eradicate smallpox. The World Health Assembly (WHA) rejected the proposal.[x] Instead, two years later the WHA accepted an expensive and complex program to eradicate another deadly disease – malaria. Currently, the Soviet Union did not take part in the WHA.
Three years later, though, at the 1958 World Health Assembly held in Minneapolis, Minnesota, the Soviet Union sent a representative after a nine-year hiatus. The Russian representative, Dr. Viktor Zhdanov, proposed a five-year vaccination campaign to eradicate smallpox. Dr. Zhdanov presented an altruistic report of the benefits of eradicating smallpox, but later Zhdanov disclosed to Dr. D.A. Henderson the selfish political reasons of the Soviet Union. At the time, Dr. Henderson was the Chief of the Surveillance section at the CDC but soon became the Chief of the Smallpox Eradication unit for the WHO. Henderson revealed that Zhdanov explained the real reason for the Soviet Union’s interest in eradicating smallpox to be “prompted by frequent cases coming from neighboring Asian countries and causing outbreaks in Russia’s smallpox-free Central Asian Republics.”[xi] Regardless of the ulterior motive behind the Soviet Union’s proposal to eradicate smallpox globally, the WHA unanimously accepted the proposal. In return, the Soviet Union pledged to provide massive quantities of vaccines to the program while the WHO called for mass vaccinations in each country to vaccinate at least eighty percent of the population. Moreover, the WHO’s role was to provide technical advice, contribute to vaccine production, and provide funding support annually of $100,000.[xii] Thus, in 1958, the Soviet Union convinced the world to join in a cooperative effort to eradicate smallpox globally.