Latest / Daniel and Kelly’s Extraordinary Universe / Killing the Speckled Monster: How We Eradicated Smallpox

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Killing the Speckled Monster: How We Eradicated Smallpox · Daniel and Kelly’s Extraordinary Universe

• 0:00
  Speaker 1: Hello friends. First of all, a heads up. We're talking
• 0:03
  Speaker 1: about smallpox today and descriptions of the disease may be
• 0:06
  Speaker 1: upsetting for some listeners. It was pretty awful and we're
• 0:10
  Speaker 1: super lucky we don't have to deal with it anymore. Second,
• 0:13
  Speaker 1: I'm heading to the UK in August. The Royal Society
• 0:16
  Speaker 1: is sending me to the Edinburgh Book Festival. I'm going
• 0:19
  Speaker 1: to be doing events on August twelfth and the thirteenth,
• 0:22
  Speaker 1: and on August twelfth the Royal Society will announce the
• 0:25
  Speaker 1: shortlist for their twenty twenty five book Prize at the
• 0:27
  Speaker 1: end of the event i'm doing. If you're at the
• 0:29
  Speaker 1: book Festival, please come by and introduce yourself. I would
• 0:33
  Speaker 1: love to meet you. All Right on with the show.
• 0:46
  Speaker 1: No disease has ever been so instantly recognized or so
• 0:50
  Speaker 1: widely known and feared. Smallpox was hideous and unforgettable for me.
• 0:56
  Speaker 1: The memory of award full of smallpox victims thirty five
• 0:59
  Speaker 1: years ago in Dhaka, Bangladesh is still vividly etched in
• 1:03
  Speaker 1: my mind. Anxious, pleading, pock deformed faces, the ugly penetrating
• 1:08
  Speaker 1: odor of decaying flesh that hung over the ward, the
• 1:11
  Speaker 1: hands covered with pustules reaching out as people begged for help.
• 1:16
  Speaker 1: Neither water nor food offered comfort. Puss filled lesions covered
• 1:20
  Speaker 1: the insides of their mouth, making it painful for them
• 1:23
  Speaker 1: to even chew or swallow Flies were everywhere, thickly clustered
• 1:28
  Speaker 1: over eyes half closed by the pustules. More than half
• 1:31
  Speaker 1: the patients were dying, and there was no drug, no
• 1:34
  Speaker 1: treatment that we could give to help them. This was
• 1:38
  Speaker 1: a paragraph from D. A. Henderson's twenty nineteen book Smallpox,
• 1:42
  Speaker 1: The Death of a Disease. Smallpox is estimated to have
• 1:45
  Speaker 1: taken hundreds of millions of lives, and the story of
• 1:49
  Speaker 1: how humanity eradicated smallpox is the story of one of
• 1:53
  Speaker 1: our greatest victories. Coordinating across cultures and continents, we harnessed
• 1:58
  Speaker 1: science to spare future generations from this devastating scorge. Today,
• 2:03
  Speaker 1: we're going to talk about a project coordinated through the
• 2:06
  Speaker 1: World Health Organization and led by D. A. Henderson to
• 2:09
  Speaker 1: drive smallpox out of our bodies. However, smallpox remains in
• 2:14
  Speaker 1: our labs, and we'll talk about the risk that poses
• 2:17
  Speaker 1: for humanity. Welcome to Daniel and Kelly's Smallpox Free Universe.
• 2:35
  Speaker 2: Hi, I'm Daniel, I'm a particle physicist. I've never had smallpox.
• 2:39
  Speaker 2: I did have chicken pox, and I've always wanted to say,
• 2:42
  Speaker 2: a pox on both your houses.
• 2:45
  Speaker 1: I'm Kelly Waiter Smith. I study parasites and space. I
• 2:48
  Speaker 1: have also never had smallpox, thank goodness. I don't think
• 2:51
  Speaker 1: anyone has had smallpox since the nineteen eighties. And I
• 2:54
  Speaker 1: also lived in the era of chicken pox and had
• 2:59
  Speaker 1: that pox upon my house.
• 3:03
  Speaker 2: Welcome to Talk some Pox, new podcast.
• 3:09
  Speaker 1: I'm pretty glad I never had to see my kids
• 3:11
  Speaker 1: with chicken pox.
• 3:12
  Speaker 2: Hmm, Yeah, I remember it being pretty miserable. Yeah, it's
• 3:16
  Speaker 2: like a few days home trying desperately not to scratch
• 3:20
  Speaker 2: all those itchy spots.
• 3:21
  Speaker 1: Well, you know what was even worse. So Zach got
• 3:23
  Speaker 1: chicken pox, and when you're older, shingles is essentially chicken
• 3:28
  Speaker 1: pox waking up. Yeah, And right after our second child
• 3:31
  Speaker 1: was born, Zach got shingles on his back, and our
• 3:36
  Speaker 1: son wasn't vaccinated because he had just been born, and
• 3:39
  Speaker 1: I didn't want him to get chicken pox, and so
• 3:41
  Speaker 1: I had to stay upstairs with our newborn and didn't
• 3:45
  Speaker 1: let Zach up, and Zach stayed downstairs with our three
• 3:48
  Speaker 1: year old, who did not at all care that Zach
• 3:51
  Speaker 1: was suffering mightily, and so she would like smack him
• 3:55
  Speaker 1: on the back where he had his shingles spot, and
• 3:58
  Speaker 1: she'd be like, take me to the zoo, carry me around.
• 4:01
  Speaker 1: Then he was such a saint because he was miserable.
• 4:04
  Speaker 1: Shingles is the worst.
• 4:06
  Speaker 2: Yeah, And shingles is also like maybe the most terrifying
• 4:09
  Speaker 2: name for a disease. Yeah, you know the other ones
• 4:11
  Speaker 2: like cow pox, smallpox, measles, whatever. It's sort of an
• 4:14
  Speaker 2: abstract thing, but shingles makes me feel like you're gradually
• 4:17
  Speaker 2: turning into a house or something. I don't know. The
• 4:20
  Speaker 2: visual that conjures up in my mind is terrible.
• 4:22
  Speaker 1: Yeah, I think because I was reading about smallpox and
• 4:25
  Speaker 1: I saw a bunch of pictures of people with smallpox.
• 4:28
  Speaker 1: That is a worse image to me than a house.
• 4:31
  Speaker 2: Yeah.
• 4:31
  Speaker 1: I think I'd rather turn into a house than a
• 4:33
  Speaker 1: smallpox victim.
• 4:35
  Speaker 2: Well, it's unfortunately an appropriate time to be talking about
• 4:38
  Speaker 2: smallpox and vaccinations and the science behind disease and pathogens
• 4:42
  Speaker 2: and infection. So we're dedicating today's episode to that topic.
• 4:47
  Speaker 1: Yes we are. Yeah, it's a scary time. I just
• 4:49
  Speaker 1: got a message my daughter's starting a summer school, and
• 4:52
  Speaker 1: I got a message about measles being in the area
• 4:55
  Speaker 1: and how we all need to be alert to make
• 4:57
  Speaker 1: sure our kids don't bring measles to camp or I'm
• 5:00
  Speaker 1: home with measles from camp.
• 5:01
  Speaker 2: Killers of the past are returning like zombies.
• 5:04
  Speaker 1: Yes, but let's hope smallpox doesn't come back, which we
• 5:06
  Speaker 1: will return to at the end of the episode.
• 5:09
  Speaker 2: All right, so you asked our listeners a question about smallpox.
• 5:13
  Speaker 1: Yeah. So, while we are living in a moderately depressing
• 5:16
  Speaker 1: time in terms of measles making a comeback, at least
• 5:19
  Speaker 1: in the US, there is a lot to be excited
• 5:23
  Speaker 1: about that has happened in the past in terms of
• 5:25
  Speaker 1: disease control. And so I asked our listeners. D A.
• 5:29
  Speaker 1: Henderson led the effort to eradicate which deadly disease. And
• 5:34
  Speaker 1: I will tell you that DA Henderson is one of
• 5:36
  Speaker 1: my heroes, and I think everybody should know his name
• 5:39
  Speaker 1: because many of us probably owe our lives to the
• 5:42
  Speaker 1: fact that this man lived on this planet. So let's
• 5:44
  Speaker 1: see what our listeners had to say.
• 5:46
  Speaker 3: Could it have been polio?
• 5:48
  Speaker 2: We will be a gift.
• 5:49
  Speaker 3: But to extrap a light from eradication, I have to
• 5:55
  Speaker 3: guess to these small books.
• 5:56
  Speaker 4: Da Henderson worked tirelessly to help eradicate disco fever.
• 6:03
  Speaker 2: I have no idea what disease da Henderson tried to eradicate.
• 6:10
  Speaker 5: I don't recognize the name. But there's only two diseases
• 6:13
  Speaker 5: that have been eradicated, smallpox and renderpest. Might be one
• 6:17
  Speaker 5: of those, or it's something that he tried to eradicate
• 6:19
  Speaker 5: and did not succeed, in which case I have no idea.
• 6:23
  Speaker 3: I do believe that we've only eradicated one actual disease
• 6:28
  Speaker 3: and the rest are just minimized but still happened. So
• 6:31
  Speaker 3: I'm going to guess at smallpox that I don't know.
• 6:35
  Speaker 4: This person in their work just goes to show that
• 6:38
  Speaker 4: a lot of research and effort goes into saving lives
• 6:42
  Speaker 4: and making lives better without notoriety.
• 6:45
  Speaker 2: I don't know what dia Henderson helped that with.
• 6:47
  Speaker 3: Maybe polio or tuberculosis, but I don't know. I think
• 6:51
  Speaker 3: you you're the disease of using initials for first and
• 6:55
  Speaker 3: middle names.
• 6:57
  Speaker 1: Good mix of answers here.
• 7:01
  Speaker 2: What are da Henderson's first and middle names and why
• 7:04
  Speaker 2: does he go by initials?
• 7:05
  Speaker 1: Well, let's look it up already, Like good start all right,
• 7:13
  Speaker 1: Donald Ainsley Henderson.
• 7:15
  Speaker 2: That's not so bad. Why did we go by Da?
• 7:17
  Speaker 1: I don't know someone whose last name is Wienersmith. It
• 7:20
  Speaker 1: sounds totally reasonable to me. I'm not sure what he's
• 7:22
  Speaker 1: so embarrassed about. He should be loud and proud. But
• 7:26
  Speaker 1: as I suspected, there actually weren't a lot of people
• 7:29
  Speaker 1: who immediately were like DA Henderson helped eradicate smallpox. I
• 7:34
  Speaker 1: know that name, yeah, you know, it's as important a
• 7:36
  Speaker 1: name to me as Lincoln or something like that. But
• 7:38
  Speaker 1: this man probably saved many, many, many lives. Smallpox was
• 7:42
  Speaker 1: a horrible scourge on humanity for like thousands of years,
• 7:47
  Speaker 1: and he played a huge role in eradicating it. So
• 7:50
  Speaker 1: how much do you know about smallpox, Daniel?
• 7:52
  Speaker 2: I know that it sounds terrible, okay, and that I
• 7:55
  Speaker 2: don't have to worry about it, for which I'm grateful
• 7:57
  Speaker 2: to people whose research is actually practical unlike mine.
• 8:01
  Speaker 1: And I would like to point out how amazing it
• 8:03
  Speaker 1: is that smallpox is not at the forefront of like
• 8:07
  Speaker 1: anyone's mind in our generation. You know, I was born
• 8:10
  Speaker 1: in eighty two, which is two years after the declaration
• 8:13
  Speaker 1: that smallpox was eradicated, and so I don't think much
• 8:16
  Speaker 1: about this, but if you were born in the eighteen hundreds,
• 8:20
  Speaker 1: for example, there was a good chance that you would
• 8:22
  Speaker 1: lose someone in your family to smallpox.
• 8:24
  Speaker 2: I think it has interestingly a different cultural impact than polio.
• 8:28
  Speaker 2: Polio we sort of know more about, and we've heard
• 8:31
  Speaker 2: maybe more about the vaccination and the success there. And
• 8:34
  Speaker 2: I wonder if it's because polio didn't kill all of
• 8:37
  Speaker 2: its victims, it left them paralyzed. And so there are
• 8:40
  Speaker 2: people around today like Mitch McConnell who suffered from polio
• 8:44
  Speaker 2: as a kid and like can talk about it, whereas smallpox'
• 8:47
  Speaker 2: victims are like, you know dead.
• 8:49
  Speaker 1: Well, polio still is around, right, Polio is coming back
• 8:53
  Speaker 1: you Yeah, smallpox is gone.
• 8:55
  Speaker 2: Yeah.
• 8:55
  Speaker 1: No one has had smallpox for what forty plus years
• 9:00
  Speaker 1: now or something, which is incredible wood knock on wood.
• 9:03
  Speaker 1: But but I mean people who did have it, it
• 9:04
  Speaker 1: was horrible. So there's Yeah, smallpox is caused by a virus,
• 9:08
  Speaker 1: and there's two main versions. There's Variola major and veryola minor.
• 9:13
  Speaker 1: The major one is majorly awful. It kills something like
• 9:17
  Speaker 1: thirty percent of the people who get infected. Oh wow, Yeah,
• 9:21
  Speaker 1: it was really common in asia, and then there's variola minor.
• 9:24
  Speaker 1: The death rate is lower, it's about one to two percent,
• 9:27
  Speaker 1: which still, like, you know, if my kid got infected
• 9:29
  Speaker 1: by smallpox, I wouldn't like those odds. That's petrifying.
• 9:31
  Speaker 2: Nobody wants to roll that die.
• 9:33
  Speaker 1: Yeah, no, absolutely not. And it was miserable. So you
• 9:35
  Speaker 1: mentioned that polio leaves a lot of people debilitated for
• 9:38
  Speaker 1: the rest of their lives. Smallpox creates you know, sort
• 9:41
  Speaker 1: of like chicken pox, but much worse, pos all over
• 9:44
  Speaker 1: your body. Often they scar and they'd leave sort of
• 9:46
  Speaker 1: pits in your skin that you'd have for the rest
• 9:49
  Speaker 1: of your life. And if the smallpox ended up getting
• 9:53
  Speaker 1: into your eyes, you would also go blind. And so
• 9:56
  Speaker 1: smallpox was a leading cause of blindness, and so it
• 9:58
  Speaker 1: would also leave a life of people debilitated if it
• 10:01
  Speaker 1: didn't happen to kill them.
• 10:03
  Speaker 2: Right, And how does it actually work? Like what is
• 10:05
  Speaker 2: the virus doing?
• 10:06
  Speaker 1: Well? So, typically the way you get infected by the
• 10:08
  Speaker 1: viruses you breathe it in. So like if somebody talks
• 10:11
  Speaker 1: in some of their like saliva, it gets aerosolized and
• 10:14
  Speaker 1: then you breathe it in. A couple days later, you
• 10:17
  Speaker 1: start showing symptoms. The symptoms include puss filled lesions that
• 10:21
  Speaker 1: cover your entire body, including inside of your mouth. Oh
• 10:26
  Speaker 1: and yes, and these lesions start, you know, like weeping puss,
• 10:30
  Speaker 1: and that puss is contagious, and it becomes almost impossible
• 10:34
  Speaker 1: to drink water, to breathe, and I think your you know,
• 10:38
  Speaker 1: your immune system probably just gets overwhelmed. To be honest,
• 10:40
  Speaker 1: I'm not one hundred percent sure what it is that's
• 10:42
  Speaker 1: killing someone, but you just end up covered in these
• 10:46
  Speaker 1: horribly painful lesions. And we didn't have a treatment, so
• 10:49
  Speaker 1: if you got it, you just had to work your
• 10:51
  Speaker 1: way through it. There wasn't like a medicine for it.
• 10:53
  Speaker 2: So no antivirals, no treatment even for the symptoms.
• 10:56
  Speaker 1: Uh no, wow, No, I mean so like there's a
• 10:59
  Speaker 1: quote for the opening from da Henderson where he was
• 11:02
  Speaker 1: describing seeing this in a hospital in Bangladesh and they
• 11:06
  Speaker 1: were just all of these people suffering, they couldn't drink water,
• 11:08
  Speaker 1: and he was lamenting that there was just nothing we
• 11:11
  Speaker 1: could do for them once they got infected. But for
• 11:15
  Speaker 1: a while, we actually did have some pretty good ways
• 11:18
  Speaker 1: of preventing people from getting infected. So smallpox is one
• 11:22
  Speaker 1: of our early stories about figuring out ways to vaccinate people,
• 11:25
  Speaker 1: which is kind of amazing. Initially we did this thing
• 11:28
  Speaker 1: called vari elation. And so the idea here is that
• 11:32
  Speaker 1: there's some strains of smallpox that are more lethal than others.
• 11:36
  Speaker 1: And so if somebody in your family comes down with
• 11:39
  Speaker 1: a mild case of smallpox, you like managed to hit
• 11:41
  Speaker 1: that incredible jackpot where they got smallpox, but not the
• 11:44
  Speaker 1: really bad one. Ye, you would take the puss from
• 11:47
  Speaker 1: one of their lesions and you would use a needle
• 11:51
  Speaker 1: to like inject it under your own skin.
• 11:53
  Speaker 2: Oh my god.
• 11:54
  Speaker 1: Couple things. So, One, you're getting a less virulent strain,
• 11:58
  Speaker 1: and if you breathe that in, it's worse for you
• 12:02
  Speaker 1: than if you get it through your skin. I don't
• 12:04
  Speaker 1: think we totally understand why that is the case.
• 12:06
  Speaker 2: But the big picture strategy here is get infected by
• 12:09
  Speaker 2: the lesser one, which will protect you against the worse one.
• 12:12
  Speaker 1: Yes, exactly, but you know, you'd still often get covered
• 12:16
  Speaker 1: in those pocks and you'd be you know, scarred for
• 12:19
  Speaker 1: the rest of your life, but you had a better
• 12:21
  Speaker 1: chance of surviving. But a problem with this method is
• 12:23
  Speaker 1: you were still infected by smallpox, and you were more mobile,
• 12:27
  Speaker 1: you could move around more because you had a less
• 12:29
  Speaker 1: bad case.
• 12:30
  Speaker 2: Oh so you're spreading it exactly, Yes.
• 12:32
  Speaker 1: So you're breathing it out. And there's some stories about
• 12:35
  Speaker 1: people like sending vary related individuals into war zones to
• 12:39
  Speaker 1: try to like get the other side infected by smallpox.
• 12:42
  Speaker 1: Oh gosh, I know, absolutely horrible, like early examples of biowarfare.
• 12:46
  Speaker 2: How far back in history is this, Like have people
• 12:49
  Speaker 2: been infected by smallpox for all of human history? Or
• 12:52
  Speaker 2: is it a recent thing?
• 12:52
  Speaker 1: Yeah, so we don't know exactly when it first popped up.
• 12:55
  Speaker 1: We think that it was first infecting rodents, and what
• 12:58
  Speaker 1: probably happened is there were a couple instances where it
• 13:00
  Speaker 1: jumped from rodents to humans and then it probably fizzled
• 13:03
  Speaker 1: out and didn't go from human to human. But one
• 13:06
  Speaker 1: of those times when smallpox jumped from a rodent to
• 13:08
  Speaker 1: a human, it also had the ability to go from
• 13:11
  Speaker 1: human to human after that.
• 13:13
  Speaker 2: Are we blaming this on rodents with good data or
• 13:15
  Speaker 2: we just bigoted against rats because I'm pro rat.
• 13:18
  Speaker 1: We have established that you and I are both pro rat.
• 13:21
  Speaker 1: I've been looking into adopting a rat, but it would
• 13:23
  Speaker 1: have to live in my office, and then it might
• 13:24
  Speaker 1: mess up our audio, So I think I might not
• 13:26
  Speaker 1: adopt a rat.
• 13:28
  Speaker 2: I think the listeners would like hearing a few stups
• 13:31
  Speaker 2: from a rat now, and then I think they might.
• 13:33
  Speaker 1: They might have could play in my lap while we're
• 13:34
  Speaker 1: having these conversations.
• 13:36
  Speaker 2: We'll see we can interpret it sounds as whether it's
• 13:38
  Speaker 2: agreeing with you or disagreeing with you. It'd be fun.
• 13:41
  Speaker 2: I vote yes.
• 13:42
  Speaker 4: I vote rat include citations, Kelly, workshop that joke a
• 13:48
  Speaker 4: bit more, Kelly, calm down, rat it to me.
• 13:52
  Speaker 1: I'll get to it.
• 13:53
  Speaker 2: I think we're envisioning the rats like those grumpy guys
• 13:55
  Speaker 2: on the Muppets, you know, sitting in the theater.
• 13:58
  Speaker 1: I love those two those But anyway, back on track,
• 14:01
  Speaker 1: So are.
• 14:02
  Speaker 2: The rats really to blame here or are they just
• 14:04
  Speaker 2: escapegoat or escape rat?
• 14:05
  Speaker 1: Yeah, we can't be one hundred percent sure, but there's
• 14:07
  Speaker 1: pretty good evidence that smallpox is similar to viruses that
• 14:11
  Speaker 1: you find in rats, So there's a good chance that
• 14:13
  Speaker 1: it jumped.
• 14:13
  Speaker 2: So why didn't we call it rat pox? Because the
• 14:15
  Speaker 2: other one we call it cowpox or chicken pox, right,
• 14:17
  Speaker 2: so why do we call it rat pox?
• 14:19
  Speaker 1: I believe that those are also not very well named poxes.
• 14:23
  Speaker 1: I think that we encounter cow pox when it's in cows,
• 14:26
  Speaker 1: but I think that that also is often in rats,
• 14:29
  Speaker 1: And so I think these viruses are often in rats,
• 14:32
  Speaker 1: but then it jumps into other organisms that we interact
• 14:35
  Speaker 1: with more regularly, and then we name it after that.
• 14:38
  Speaker 2: So rats are to blame for rat pox and cowpox
• 14:41
  Speaker 2: and chicken pox.
• 14:42
  Speaker 1: I no, I'm not going on the record for all
• 14:44
  Speaker 1: of those. I'm sure there's some variability, but I think
• 14:47
  Speaker 1: I remember reading that cow pox also is often in rats.
• 14:50
  Speaker 1: But you know, that's not relevant to us. What's relevant
• 14:52
  Speaker 1: is that when we're milking the cows, we see the pustules.
• 14:55
  Speaker 2: All right, so we think it came from rats. But
• 14:57
  Speaker 2: how long ago are we talking about? What's the earliest
• 14:59
  Speaker 2: record forward evidence of smallpox?
• 15:01
  Speaker 1: I don't know exactly when the earliest recorded evidence is.
• 15:04
  Speaker 1: I did come across in eleven fifty seven BC. Ramsey's
• 15:07
  Speaker 1: the fifth in ancient Egypt, appears to have died from smallpox.
• 15:11
  Speaker 1: You can see the like pox in his mummy.
• 15:14
  Speaker 2: Wow.
• 15:14
  Speaker 1: So it's been around for a while. And you know,
• 15:17
  Speaker 1: we were talking about variolation, which is when you like
• 15:19
  Speaker 1: pass less virulent strains. We have evidence that that started
• 15:24
  Speaker 1: in India sometime around one thousand BC, and about two
• 15:28
  Speaker 1: thousand years later it was introduced into China. And so
• 15:30
  Speaker 1: we've been as a species dealing with this thing for
• 15:33
  Speaker 1: thousands of years. But this very clever species that we
• 15:37
  Speaker 1: are managed to eradicate it in the nineteen eighties. So
• 15:40
  Speaker 1: that's pretty amazing.
• 15:41
  Speaker 2: Actually, it is amazing when you live in a turning
• 15:44
  Speaker 2: point in human history, right where you have like thousands
• 15:46
  Speaker 2: of years where we live one way and then we've
• 15:48
  Speaker 2: done something to change fundamentally to human experience. That's incredible
• 15:51
  Speaker 2: to live in those moments.
• 15:52
  Speaker 1: Right, Yes, Yeah, I mean like when my daughter was born,
• 15:56
  Speaker 1: I had very high anxiety post part of anxiety, and
• 15:59
  Speaker 1: so almost every day I would think to myself, I
• 16:01
  Speaker 1: am so lucky that I don't have to worry about
• 16:03
  Speaker 1: smallpox on top of everything else, Like, there's no way
• 16:06
  Speaker 1: my daughter's getting smallpox. How lucky am I? But yeah, no,
• 16:10
  Speaker 1: this is a fundamental difference in what parents and people
• 16:14
  Speaker 1: need to worry about.
• 16:15
  Speaker 2: I'm like an anxious person also and a worrier as
• 16:17
  Speaker 2: a parent, but I've never worried about smallpox. I've worried
• 16:20
  Speaker 2: about cars, I've worried about lightning. I've worried about coyotes.
• 16:23
  Speaker 2: I've worried about all sorts of crazy stuff, but never
• 16:25
  Speaker 2: a small fox. That's amazing. Where did that even come
• 16:28
  Speaker 2: from in your mind?
• 16:30
  Speaker 1: When my daughter was born, I had trouble sleeping at night,
• 16:33
  Speaker 1: and Da Henderson's story about eradicating smallpox. Where a bunch
• 16:37
  Speaker 1: of these facts today come from was what I read
• 16:40
  Speaker 1: in the middle of the night when I couldn't fall asleep.
• 16:42
  Speaker 2: And maybe not a great idea from middle of the
• 16:45
  Speaker 2: night reading I'm a new parent.
• 16:46
  Speaker 1: No, I made a lot of bad choices with my
• 16:49
  Speaker 1: reading materials back then. But that was the same year
• 16:52
  Speaker 1: where we found in one of the labs in the
• 16:54
  Speaker 1: United States old vials of smallpox that somebody had not
• 17:00
  Speaker 1: destroyed like they were supposed to. They had forgotten them,
• 17:02
  Speaker 1: and they were in a closet somewhere. And if that
• 17:04
  Speaker 1: had gotten out, yea, we would have like And so anyway,
• 17:07
  Speaker 1: I was thinking, oh my gosh, do we still have
• 17:09
  Speaker 1: like vaccine stockpiles somewhere? What would happen if smallpox came out?
• 17:13
  Speaker 1: But anyway, we're going to get back to that at
• 17:14
  Speaker 1: the end. So getting back to solutions.
• 17:17
  Speaker 2: So for thousands of years we've been suffering with smallpox.
• 17:20
  Speaker 2: We had this variolation strategy to minimize the impact of smallpox.
• 17:25
  Speaker 2: When did things change? When did humanity like step up
• 17:28
  Speaker 2: our approach to this.
• 17:29
  Speaker 1: Well, so the variolation technique was great. It brought death
• 17:33
  Speaker 1: rates from like thirty percent to one percent, but it
• 17:36
  Speaker 1: was still a risky procedure. You know, there was still
• 17:38
  Speaker 1: some chance that you were going to end up killing
• 17:40
  Speaker 1: your kid when you variolate to them. So in seventeen
• 17:43
  Speaker 1: ninety six, Jenner makes this amazing observation, which is that
• 17:48
  Speaker 1: women who work with cows who like milk cows, they'll
• 17:51
  Speaker 1: get these like pustules on their hands. So the cows
• 17:53
  Speaker 1: get cow pox, which is a closely related but different
• 17:57
  Speaker 1: virus causing these poxes. The women who are milking the cows,
• 18:02
  Speaker 1: you know, become very close to the puss that's produced
• 18:06
  Speaker 1: by these pustuls, and they end up getting cow pox
• 18:08
  Speaker 1: on their hands. But it's not a big deal. But
• 18:11
  Speaker 1: that virus is closely related enough to smallpox that getting
• 18:15
  Speaker 1: those pustuls on your hands was correlated with not getting
• 18:19
  Speaker 1: smallpox throughout the course of your life. And so this
• 18:22
  Speaker 1: had become sort of anecdotal, and then someone started taking
• 18:24
  Speaker 1: it seriously and they were like, hold on, what if
• 18:27
  Speaker 1: we just start purposefully infecting people with the puss from
• 18:32
  Speaker 1: these you know, these poxes on cows and see if
• 18:35
  Speaker 1: we can use that to protect people from smallpox.
• 18:38
  Speaker 2: Let's go from correlation to causation.
• 18:40
  Speaker 1: Yeah, that's right. And so they started like purposefully infecting
• 18:43
  Speaker 1: people with puss from these like boils on the cows.
• 18:47
  Speaker 1: And the people who got this method of vaccination and
• 18:51
  Speaker 1: it was called vaccination because vodka is a word for cow.
• 18:55
  Speaker 2: Oh my gosh, isn't that where vaccine comes from? From vodka?
• 19:00
  Speaker 2: I had no idea.
• 19:01
  Speaker 1: Yeah, so cool, so cool.
• 19:03
  Speaker 2: We should call it vakapox.
• 19:06
  Speaker 1: It rolls off the tongue a little bit.
• 19:07
  Speaker 2: Better better than cow box.
• 19:09
  Speaker 1: But I mean, this was like about one hundred years
• 19:12
  Speaker 1: before the germ theory of disease, and there was just
• 19:14
  Speaker 1: this like correlation that someone picked up on and they
• 19:17
  Speaker 1: were like, let's try it, and many lives were saved.
• 19:20
  Speaker 1: But it also wasn't a perfect method, do you.
• 19:22
  Speaker 2: Know what they were thinking? Like, they didn't have the
• 19:24
  Speaker 2: germ theory, but they obviously were being kind of scientific
• 19:27
  Speaker 2: about it, right, They're looking for evidence finding, correlations making, hypotheses,
• 19:30
  Speaker 2: testing these things. Did they have an idea for why
• 19:33
  Speaker 2: it would work?
• 19:34
  Speaker 1: Yeah, So I can't say that I have read widely
• 19:37
  Speaker 1: what people were thinking at that time, but I would
• 19:39
  Speaker 1: guess that the thought process wants something like you only
• 19:42
  Speaker 1: get smallpox once in your life, Like if somebody lives
• 19:45
  Speaker 1: through smallpox, they're not going to get it again. And
• 19:47
  Speaker 1: we knew that, and they probably noticed that, like, look,
• 19:51
  Speaker 1: this other person is getting some sort of pustial POxy
• 19:54
  Speaker 1: related thing and then they don't get smallpox. And I
• 19:57
  Speaker 1: don't know why that is, but let's lean into it, like,
• 20:00
  Speaker 1: you know, assumed it was some kind of immunity.
• 20:02
  Speaker 2: And that might sound sort of like ad hawk to people,
• 20:04
  Speaker 2: But don't forget that there's lots of modern medicine that
• 20:07
  Speaker 2: we rely on because it's effective, but still don't fully
• 20:10
  Speaker 2: understand how it works. Like Katrina was telling me the
• 20:13
  Speaker 2: other day, we don't understand the molecular basis for like
• 20:16
  Speaker 2: tile and all, wow, why exactly that works? Well? All right,
• 20:19
  Speaker 2: but we have a lot of data that it does,
• 20:21
  Speaker 2: so we feel safe.
• 20:23
  Speaker 1: And we talked a couple episodes ago about how we
• 20:25
  Speaker 1: don't really understand how general anesthesia works at a like
• 20:28
  Speaker 1: molecular level, but you know, you make these steps forward
• 20:32
  Speaker 1: and you kind of try to figure out why they
• 20:34
  Speaker 1: worked after the fact. But if it works, you know,
• 20:36
  Speaker 1: you keep moving forward.
• 20:37
  Speaker 2: And this is a really important point for public health,
• 20:39
  Speaker 2: right because in fundamental science, we can like you know,
• 20:43
  Speaker 2: twitter around for years wondering about what's the nature of
• 20:46
  Speaker 2: space and time and try to figure it out and
• 20:48
  Speaker 2: take a decade or whatever. But public health, like you
• 20:50
  Speaker 2: have to make decisions. You got to say, like what
• 20:52
  Speaker 2: are we doing, are we doing this, we're doing that?
• 20:54
  Speaker 2: Are we recommending this to kids? And were recommending that?
• 20:57
  Speaker 2: And so the scientific debates can and should still canntinue,
• 21:00
  Speaker 2: but you also have to make policy decisions even without
• 21:03
  Speaker 2: perfect information. So it's like super.
• 21:05
  Speaker 1: Challenging, Oh my gosh. And in the next segment we're
• 21:07
  Speaker 1: going to get into more detail about how difficult it was.
• 21:10
  Speaker 1: You know, when you decide that you need to vaccinate
• 21:12
  Speaker 1: like most of the world to try to eradicate smallpox,
• 21:15
  Speaker 1: what do you do about the people who say, I
• 21:17
  Speaker 1: don't want to take the vaccine. Yeah, yeah, it's complicated.
• 21:20
  Speaker 1: And so this vaccinating using cowpox worked great, but there
• 21:24
  Speaker 1: were some problems. You know, cows aren't always producing lesions
• 21:27
  Speaker 1: at the time when you want to vaccinate people. Sometimes
• 21:30
  Speaker 1: cows get puss filled lesions caused by other stuff, and
• 21:34
  Speaker 1: so instead of actually vaccinating somebody, you've just injected some
• 21:38
  Speaker 1: bacteria into their body and so not perfect. And then
• 21:42
  Speaker 1: often what would happen is that you would use the
• 21:44
  Speaker 1: lesion from the cow to infect the first person, and
• 21:47
  Speaker 1: then that person would get a lesion on their arm,
• 21:50
  Speaker 1: and then you would transfer it from one person to another.
• 21:53
  Speaker 1: So there's stories about kids with lesions on their arms
• 21:56
  Speaker 1: getting sent across the sea to like move that vaccine
• 22:00
  Speaker 1: from person to person to like bring the vaccine to America,
• 22:03
  Speaker 1: because it was easier to do that than to do
• 22:05
  Speaker 1: it with a cow.
• 22:06
  Speaker 2: Children are smaller than cows, that's true. It's easier to
• 22:09
  Speaker 2: shift than I found. Yeah, it's a smaller box required.
• 22:11
  Speaker 1: Right, Some of them cooperate better than cows. Two not
• 22:14
  Speaker 1: all of them, but at least they're smaller, so you know,
• 22:17
  Speaker 1: you can push them around. But sometimes they would also
• 22:20
  Speaker 1: transmit tuberculosis, and not necessarily for the children, but if
• 22:24
  Speaker 1: you were doing this with adults, sometimes you'd transmit syphilis
• 22:27
  Speaker 1: from person to person. So also not a perfect method.
• 22:31
  Speaker 2: All right, so we moved past just suffering through smallpox
• 22:34
  Speaker 2: and pasted variolation to minimize the impact into early forms
• 22:39
  Speaker 2: of vaccination. Let's take a break, and when we come back,
• 22:41
  Speaker 2: we'll hear more about the modern approaches to vaccination and
• 22:45
  Speaker 2: the role played by D. A. Henderson and keeping Kelly
• 22:48
  Speaker 2: up at night. All Right, we're back, and we're hearing
• 23:11
  Speaker 2: about humanity's struggle and victory against smallpox, the macroscopic beings
• 23:16
  Speaker 2: finally winning out over the microscopic It's amazing that we
• 23:18
  Speaker 2: can eradicate smallpox, but not rats, right, Rats just seem
• 23:23
  Speaker 2: like they're going to be here forever.
• 23:24
  Speaker 1: Yeah, No, they absolutely are. I would not center your
• 23:28
  Speaker 1: hopes high for eradicating rats. There's a lot of kinds
• 23:30
  Speaker 1: of rats. It's complicated.
• 23:32
  Speaker 2: Yeah. Yeah, And I like rats anyway, So I'm not
• 23:35
  Speaker 2: saying we should. I'm just saying it's amazing how we
• 23:38
  Speaker 2: can actually squash out an entire form of life because
• 23:41
  Speaker 2: we decided it's too dangerous.
• 23:43
  Speaker 1: Yeah. So, I mean, we were successful at squashing smallpox,
• 23:45
  Speaker 1: but we've tried. I mean, the amount of money that
• 23:47
  Speaker 1: has gone into trying to squash malaria has been intense,
• 23:51
  Speaker 1: but we have not succeeded. And we were trying at
• 23:54
  Speaker 1: the same time to eradicate malaria as we were trying
• 23:56
  Speaker 1: to eradicate smallpox. But one of the quote unquote nice
• 24:00
  Speaker 1: things about smallpox is that it just infects people, and
• 24:04
  Speaker 1: so that makes it a little bit easier to eradicate.
• 24:07
  Speaker 1: And we were able to create a vaccine that was effective,
• 24:10
  Speaker 1: whereas attempts to eradicate malaria using vaccines haven't been as successful.
• 24:15
  Speaker 1: And I'm queuing up an episode with an expert on
• 24:18
  Speaker 1: why it's so hard to make vaccines for parasites. But
• 24:21
  Speaker 1: we got lucky that smallpox was easy to control with
• 24:24
  Speaker 1: the vaccine and only impacted people, so we didn't have
• 24:27
  Speaker 1: to also control something like mosquitoes.
• 24:29
  Speaker 2: All right, So then tell us about how we started
• 24:31
  Speaker 2: to make more rapid progress against smallpox.
• 24:34
  Speaker 1: Yeah, So this method of using cows to help vaccinate
• 24:38
  Speaker 1: people and then vaccinating arm to arm was difficult and laborious,
• 24:42
  Speaker 1: and it was hard to do mass vaccination. But then
• 24:45
  Speaker 1: we figured out ways to dry the vaccine and then
• 24:48
  Speaker 1: rehydrate it so that you could essentially have a farm
• 24:52
  Speaker 1: with loads of cows. You could collect a bunch of pus.
• 24:55
  Speaker 1: You could dry it out and then it would be
• 24:57
  Speaker 1: stable for longer periods of time, and then you could
• 25:00
  Speaker 1: rehydrate it wherever you decided that you needed it.
• 25:03
  Speaker 2: But we're still using essentially cowpus as a vaccine for smallpox,
• 25:07
  Speaker 2: that's right, Yeah, And you said that started in the
• 25:09
  Speaker 2: late seventeen hundreds. How long did.
• 25:11
  Speaker 1: That go on for till we eradicated smallpox? As much
• 25:15
  Speaker 1: as possible, We were using cowpox to vaccinate people instead
• 25:19
  Speaker 1: of smallpox because it was just safer.
• 25:20
  Speaker 2: So early part of last century, early nineteen hundreds, were
• 25:23
  Speaker 2: still using cowpus to fight smallpox.
• 25:25
  Speaker 1: So when I was reading about this in the nineteen fifties,
• 25:27
  Speaker 1: they were talking about how they learned how to freeze
• 25:30
  Speaker 1: dry the viruses for the vaccine, and they were still
• 25:34
  Speaker 1: using cows, and they thought it was cow pox that
• 25:38
  Speaker 1: they were using, but then when they genotyped it later on,
• 25:41
  Speaker 1: it looked like they were using vaccinia, which is another
• 25:44
  Speaker 1: closely related virus, and so maybe that virus got into cows,
• 25:48
  Speaker 1: but we were using stuff collected from cows, is the point,
• 25:53
  Speaker 1: because it was just less likely to kill people. But
• 25:55
  Speaker 1: it was still a problem for immunocompromise people. There were
• 25:58
  Speaker 1: still some people who had very bad reactions and some
• 26:01
  Speaker 1: who passed away from using this vaccine.
• 26:03
  Speaker 2: So we started out not knowing at all how it worked.
• 26:06
  Speaker 2: And then we developed germ theory while we were still
• 26:09
  Speaker 2: doing this, and then we kept using it even after
• 26:11
  Speaker 2: we had a deeper understanding of like the microbiology of
• 26:14
  Speaker 2: what's going on here. That's fascinating.
• 26:16
  Speaker 1: Yeah, I mean, we kept using it, but we got better,
• 26:18
  Speaker 1: and you know, we ended up with better techniques, and
• 26:20
  Speaker 1: at some point, like during the World Wars, we had
• 26:23
  Speaker 1: created essentially this like vaccine gun where somebody would come
• 26:26
  Speaker 1: by and it was like hydraulically operated and it would
• 26:29
  Speaker 1: like inject the vaccine and then you could get the
• 26:31
  Speaker 1: next person in and now you could do a thousand
• 26:33
  Speaker 1: people in an hour, and that really sped things up.
• 26:36
  Speaker 1: But the method that ended up being used to eradicate
• 26:39
  Speaker 1: smallpox was much easier. So they created this cheap, very
• 26:43
  Speaker 1: short needle that was bifurcated, so it's like a fork
• 26:46
  Speaker 1: with only two times, and what you do is you
• 26:48
  Speaker 1: would stick it into vaccine that had been freezed, dried,
• 26:51
  Speaker 1: and then rehydrated, and surface tension would hold the water
• 26:55
  Speaker 1: with the virus particles between the times.
• 26:59
  Speaker 2: Like a fork. We're talking a fork basically.
• 27:01
  Speaker 1: Like a fork. Yeah, and then they'd stab you in
• 27:02
  Speaker 1: the arm a bunch of times and it didn't hurt
• 27:05
  Speaker 1: that much because it didn't need to like go too
• 27:07
  Speaker 1: far in, but they would like get it under your
• 27:09
  Speaker 1: skin by doing that over and over and over again.
• 27:11
  Speaker 1: But they could do it really fast, and then when
• 27:13
  Speaker 1: they were done, they'd put it in another container and
• 27:15
  Speaker 1: at night they would sterilize those containers and you could
• 27:18
  Speaker 1: use the needles over and over and over again. And
• 27:21
  Speaker 1: they were cheap. They didn't require a lot of training.
• 27:23
  Speaker 1: You could literally train someone by giving them an orange
• 27:25
  Speaker 1: and being like practice stabbing this orange, and then they'd
• 27:29
  Speaker 1: be good.
• 27:32
  Speaker 2: So then when you're sitting down to get stabbed, and
• 27:34
  Speaker 2: you asked your nurse have you done this before? And
• 27:35
  Speaker 2: she says, oh, I vaccinated lots of oranges, mangoes, soap apples,
• 27:39
  Speaker 2: I'm super experienced. Yeah, that's right.
• 27:41
  Speaker 1: Any fruit you can think of I have stabbed.
• 27:45
  Speaker 2: Thank you to all the oranges who suffered so the
• 27:47
  Speaker 2: humans could survive. Really, that's taking it for the team. Yeah,
• 27:51
  Speaker 2: So this is really a step forward, not in terms
• 27:53
  Speaker 2: of like virology or microbiology, but in engineering, right, this
• 27:58
  Speaker 2: is just like, how do we get this vaccine rapidly
• 28:00
  Speaker 2: to a lot of people?
• 28:01
  Speaker 1: I mean yes and no. So like that jet injector
• 28:03
  Speaker 1: we were talking about, that was an amazing step forward
• 28:06
  Speaker 1: at the time, but it still broke a lot and
• 28:07
  Speaker 1: you needed to bring replacement equipment with you. And when
• 28:10
  Speaker 1: you're going to really remote places, if you ran out
• 28:13
  Speaker 1: of replacement equipment, you'd be in a lot of trouble.
• 28:15
  Speaker 1: Where's these bifurcated needles? This was a very simple solution.
• 28:18
  Speaker 1: It was about five dollars for a thousand of them.
• 28:20
  Speaker 1: They could be reused one hundred times. You could sterilize
• 28:23
  Speaker 1: them in boiling water. It becomes much easier. And so
• 28:27
  Speaker 1: sometimes it's not about like the most complicated engineering solution,
• 28:30
  Speaker 1: it's just finding the thing that is cheap and efficient,
• 28:34
  Speaker 1: and in this case, it was a bifurcated needle.
• 28:37
  Speaker 2: But I think that is the best engineering solution, right,
• 28:39
  Speaker 2: not like over engineered, but just like, how can we
• 28:41
  Speaker 2: use our manufacturing process and deal with the reality situation
• 28:45
  Speaker 2: to solve this problem efficiently, effectively and cheaply. I think
• 28:48
  Speaker 2: that's great engineering.
• 28:49
  Speaker 1: Yeah, yeah, amazing, and they even like would shorten the
• 28:52
  Speaker 1: needle to get the cost down so that they could,
• 28:54
  Speaker 1: you know, use less metal for each one. Okay, so
• 28:57
  Speaker 1: that is how we made and delivered the vaccine that
• 29:00
  Speaker 1: eventually eradicated smallpox.
• 29:02
  Speaker 2: And so we're still again using the cow sourced one, right, Yeah,
• 29:06
  Speaker 2: that's surprising me. I thought this whole story was gonna
• 29:08
  Speaker 2: be like and then we figured out how to actually
• 29:10
  Speaker 2: build a vaccine again smallpox by like crippling it or
• 29:14
  Speaker 2: one of the typical vaccination strategies. But you're saying we
• 29:17
  Speaker 2: used one disease against another the whole time.
• 29:19
  Speaker 1: Yeah, it's incredible.
• 29:20
  Speaker 2: That's amazing.
• 29:21
  Speaker 1: What that is? Amazing?
• 29:23
  Speaker 2: Yeah, all right, so tell us about the campaign to
• 29:25
  Speaker 2: eradicate smallpox.
• 29:26
  Speaker 1: Amazingly, it kind of starts with the Soviet Union. So
• 29:28
  Speaker 1: during the Cold War, the Soviet Union kind of like
• 29:30
  Speaker 1: backed away from the international community, and after Stalin died,
• 29:35
  Speaker 1: thank goodness, Stalin died. Wish he had died sooner, but
• 29:37
  Speaker 1: he didn't.
• 29:38
  Speaker 2: So anyway, speaking ill of the dead, is that what
• 29:42
  Speaker 2: you're doing?
• 29:42
  Speaker 1: He just decided, like millions of people, Yes, I am so. Anyway,
• 29:46
  Speaker 1: in nineteen fifty nine, the Soviet Union is like stepping
• 29:50
  Speaker 1: back into the World Health Assembly and trying to get
• 29:52
  Speaker 1: involved in the international community again. And they propose, hey,
• 29:57
  Speaker 1: let's eradicate smallpox and we we will volunteer to donate
• 30:02
  Speaker 1: freeze dried doses of vaccines, literally millions of them, and
• 30:06
  Speaker 1: this is their way of kind of like getting good
• 30:08
  Speaker 1: with the international community and the international community. I think
• 30:12
  Speaker 1: the idea at the time was, you know, we probably
• 30:15
  Speaker 1: can't actually eradicate smallpox. There have been some efforts to
• 30:18
  Speaker 1: eradicate other diseases that had kind of fallen flat on
• 30:20
  Speaker 1: their face. People weren't super optimistic this was going to work,
• 30:23
  Speaker 1: but they were sort of humoring the Soviets because they
• 30:26
  Speaker 1: were happy that they were back. And so while this
• 30:28
  Speaker 1: proposal was accepted, not a lot of momentum happened. Not
• 30:32
  Speaker 1: a lot of people were dedicated to the project. There
• 30:35
  Speaker 1: wasn't a lot of money dedicated, but it was clear
• 30:37
  Speaker 1: that the Soviets were on board. So around the mid
• 30:40
  Speaker 1: nineteen sixties, USAID, which I'll note we tanked, got doged. Yes, right,
• 30:47
  Speaker 1: so USAID got doged. Doesn't exist anymore, which I think
• 30:52
  Speaker 1: is devastating. But anyway, so they teamed up with the
• 30:54
  Speaker 1: Center for Disease Control, or the CDC in the US,
• 30:57
  Speaker 1: and they started trying to eliminate smallpox and measles from
• 31:01
  Speaker 1: twenty countries in West Africa. So they were starting to
• 31:04
  Speaker 1: get the ball rolling and momentum is starting to build,
• 31:07
  Speaker 1: and the World Health Organization, with the US's input, passes
• 31:12
  Speaker 1: this proposal that Okay, we're going to take eradicating smallpox seriously.
• 31:16
  Speaker 1: And there was a bit of contention here, so there
• 31:19
  Speaker 1: was enough members of the community thinking that this was
• 31:21
  Speaker 1: actually impossible that when it kind of got pushed by
• 31:24
  Speaker 1: the US DA, Henderson got put in charge almost as punishment.
• 31:29
  Speaker 1: So the guy in charge of the World Health Organization
• 31:32
  Speaker 1: thought this was going to fail, and because the Americans
• 31:35
  Speaker 1: had pushed it, he wanted an American leading it so
• 31:39
  Speaker 1: that when it failed, the blame would fall on the Americans.
• 31:42
  Speaker 2: Wow, the politics, the politicist. So but tell us who
• 31:46
  Speaker 2: is Dea Henderson. Now he's appeared in our story. But
• 31:49
  Speaker 2: what's he been doing this whole time?
• 31:50
  Speaker 1: Yeah, so he's been studying public health. He was working
• 31:53
  Speaker 1: at the CDC on that project where they were trying
• 31:56
  Speaker 1: to eradicate smallpox and measles. And it turns out he's
• 32:00
  Speaker 1: it's just really great at organizing stuff. He's a really
• 32:04
  Speaker 1: great administrator, and he is really good at like cutting
• 32:08
  Speaker 1: through the bullsh and just getting stuff done. And he
• 32:13
  Speaker 1: sort of gets a really good reputation for being a
• 32:16
  Speaker 1: person who makes things happen.
• 32:17
  Speaker 2: And it's fascinating that this is basically the obstacle, right, Like,
• 32:20
  Speaker 2: at this point, we have the technology, We even have
• 32:23
  Speaker 2: the engineering to manufacture these things so they're simple and
• 32:26
  Speaker 2: cheap and robust. He's just a question of like getting
• 32:28
  Speaker 2: all these things to all the arms in the world. Right,
• 32:31
  Speaker 2: it's really just a paperwork and organization.
• 32:34
  Speaker 1: Yeah, it's paperwork and organization, but it's also like the
• 32:36
  Speaker 1: cleverness to think through the right system. So initially the
• 32:39
  Speaker 1: thought was, you know what if we can vaccinate eighty
• 32:43
  Speaker 1: percent of the people in the countries where you're still
• 32:46
  Speaker 1: getting smallpox, right, we'll get what's called herd immunity. And
• 32:50
  Speaker 1: the idea is that there's enough people who are resistant
• 32:53
  Speaker 1: to the disease that it will run out of people
• 32:56
  Speaker 1: can infect and it'll fizzle out. But it turned out
• 32:59
  Speaker 1: eighty percent just wasn't high enough. There were still there
• 33:02
  Speaker 1: were enough people being born, especially in places like India,
• 33:05
  Speaker 1: where population density is really high, that this herd immunity
• 33:08
  Speaker 1: at eighty percent wasn't doing the.
• 33:09
  Speaker 2: Trick walking me through the thinking here. So even if
• 33:12
  Speaker 2: you have twenty percent of the population that still is
• 33:14
  Speaker 2: susceptible to smallpox, they're like surrounded by a buffer of
• 33:18
  Speaker 2: people who are immune, and so the disease just like
• 33:21
  Speaker 2: fizzles out because it can't jump into another host. How
• 33:24
  Speaker 2: do you calculate that eighty percent number? Doesn't it depend
• 33:26
  Speaker 2: on like density and interactions and all sorts of stuff.
• 33:29
  Speaker 1: Everything you said is correct. Oh yeah, they started off
• 33:32
  Speaker 1: thinking eighty percent was going to be enough, and then
• 33:35
  Speaker 1: when they actually started observing things out there, they would
• 33:37
  Speaker 1: hit eighty percent, and the disease still had plenty of
• 33:40
  Speaker 1: people to infect, plenty of new babies being born, and
• 33:44
  Speaker 1: it could still it's so contagious that that twenty percent
• 33:47
  Speaker 1: that were left, ye, were enough to keep that disease going.
• 33:51
  Speaker 2: Because if I had to calculate this, like eighty percent
• 33:53
  Speaker 2: seems like, I don't know, it's a reasonable figure, But
• 33:55
  Speaker 2: if I had to estimate it, I would have guessed
• 33:57
  Speaker 2: like ninety nine points something. Yeah, because as it is
• 34:00
  Speaker 2: an infectious disease, right, and it came from one origin, right,
• 34:04
  Speaker 2: so in principle, one person with it still out there
• 34:06
  Speaker 2: could infect new.
• 34:07
  Speaker 1: People absolutely, and so that ended up being the reality
• 34:10
  Speaker 1: on the ground was that eighty percent was not enough,
• 34:13
  Speaker 1: and there was some discussion about, well, maybe if we
• 34:15
  Speaker 1: kick it up to ninety percent, and so, you know,
• 34:17
  Speaker 1: part of it I think is well, what number do
• 34:20
  Speaker 1: we think mathematically will work, and then another part of
• 34:22
  Speaker 1: it is well, what realistically could we accomplish. And another
• 34:26
  Speaker 1: problem they were experiencing was like, so you know, the
• 34:28
  Speaker 1: Soviets were donating a lot of vaccine, but a lot
• 34:31
  Speaker 1: of the vaccine they were donating was low quality and
• 34:34
  Speaker 1: wasn't working, and so that was also causing them some problems.
• 34:37
  Speaker 1: And what they ended up deciding was that, like, look
• 34:39
  Speaker 1: for this disease in particular, hitting some percentage is not
• 34:43
  Speaker 1: going to work. So what they did was they vaccinate
• 34:45
  Speaker 1: as many people as they could, and then they would
• 34:47
  Speaker 1: do contact tracing, so essentially they would wait to hear
• 34:51
  Speaker 1: if someone got infected, and when they got the message
• 34:54
  Speaker 1: that there was an infected person in some city, some village,
• 34:57
  Speaker 1: some herding community, they would go out there. They would
• 35:01
  Speaker 1: lock down that person, they would figure out everybody that
• 35:04
  Speaker 1: person had interacted with, and then who those people.
• 35:08
  Speaker 2: They would kill them and they would kill them.
• 35:10
  Speaker 1: No, and no, they.
• 35:12
  Speaker 2: Would send them to a farm where they can run
• 35:14
  Speaker 2: and jump all day long.
• 35:15
  Speaker 1: No, no, it was much nicer than they would offer
• 35:18
  Speaker 1: them free vaccines.
• 35:20
  Speaker 2: Oh okay, yes, but they've already been infected, right.
• 35:22
  Speaker 1: Well maybe yes, maybe no. And so you know, just
• 35:25
  Speaker 1: because you have encountered somebody doesn't necessarily mean you got infected.
• 35:30
  Speaker 1: And then also to try to make sure, like if
• 35:31
  Speaker 1: those people did get infected, you want to make sure
• 35:33
  Speaker 1: that they don't pass it to other people. And so
• 35:35
  Speaker 1: you not only vaccinate the first group of people who
• 35:39
  Speaker 1: you think contacted the initial infected person you know of,
• 35:42
  Speaker 1: you also vaccinate all of the contacts of those people.
• 35:46
  Speaker 1: And in this way you make the most use of
• 35:49
  Speaker 1: your vaccine, and you like take the oxygen out of
• 35:52
  Speaker 1: the fire that could have started there.
• 35:54
  Speaker 2: So you're pouring water on all the embers just to
• 35:56
  Speaker 2: make sure they don't spread uncontrolled.
• 35:58
  Speaker 1: Yes, exactly. And one of the things that we lucked
• 36:00
  Speaker 1: out with is you know, like with a disease like syphilis,
• 36:02
  Speaker 1: there's also a sort of moral judgment that gets passed
• 36:06
  Speaker 1: on the person who gets infected smallpox didn't have that
• 36:09
  Speaker 1: kind of moral judgment, and so people were more likely
• 36:12
  Speaker 1: to come forward if they had a case, they would
• 36:15
  Speaker 1: be less likely to hide it. And in some cases
• 36:18
  Speaker 1: and in some countries, to try to really encourage people
• 36:20
  Speaker 1: to come forward or to encourage people to rat out
• 36:23
  Speaker 1: other people, we would offer monetary rewards.
• 36:26
  Speaker 2: Listen to you using the word rat in a negative way.
• 36:29
  Speaker 2: Oh maybe, I mean language, This is where it comes from, Kelly.
• 36:32
  Speaker 2: You're propagating anti rat bigotry.
• 36:35
  Speaker 1: Thank you so much for pointing that out. I will
• 36:37
  Speaker 1: work on doing a better job.
• 36:39
  Speaker 2: You need to be in a rat ally.
• 36:40
  Speaker 1: I mean really, I think of myself as a rat
• 36:43
  Speaker 1: ally as long as they're not in my chicken coop.
• 36:46
  Speaker 1: I didn't like them there anyway.
• 36:49
  Speaker 2: But this is a good point where we need to
• 36:50
  Speaker 2: know where the outbreaks are and we can only know
• 36:52
  Speaker 2: that if people report. So it's important that people are
• 36:56
  Speaker 2: not embarrassed.
• 36:56
  Speaker 1: Yeah, yeah, that's right. It's important that people aren't embarrassed.
• 36:59
  Speaker 1: And the other thing that I think what's important to
• 37:00
  Speaker 1: learn here is they learned over the course of the
• 37:04
  Speaker 1: work that they were doing, and they adjusted the way
• 37:08
  Speaker 1: that they were working. You know, so when you're doing science,
• 37:10
  Speaker 1: so often you start off with one plan and then
• 37:13
  Speaker 1: when the rubber hits the road, you need to be like,
• 37:15
  Speaker 1: this isn't working. What can we do that's better? And
• 37:18
  Speaker 1: so they adjusted and man, this is an amazing story
• 37:22
  Speaker 1: of people adjusting to so many different conditions.
• 37:25
  Speaker 2: For example.
• 37:26
  Speaker 1: For example, so when the World Health Organization decided that
• 37:28
  Speaker 1: they were going to really try to eradicate this disease,
• 37:31
  Speaker 1: it was still pretty common in about thirty one different
• 37:34
  Speaker 1: countries and there were a lot of complicated things happening
• 37:38
  Speaker 1: in those countries. So, for example, they had wiped out
• 37:40
  Speaker 1: smallpox in Bangladesh and then partition happened and the war
• 37:45
  Speaker 1: broke out between Pakistan and Bangladesh. And when that happened,
• 37:48
  Speaker 1: Bangladeshis crossed the border into India en mass where they
• 37:53
  Speaker 1: picked up smallpox again refugee camps, yes, And then India
• 37:57
  Speaker 1: went in and kicked out the Pakistanis and the Bangladeshis
• 38:02
  Speaker 1: went back home and they brought smallpox with them.
• 38:05
  Speaker 2: Oh boy.
• 38:05
  Speaker 1: So the World Health Organization was in there and they
• 38:07
  Speaker 1: were trying to keep people from getting smallpox and trying
• 38:10
  Speaker 1: to contain it as it moved back into a country,
• 38:13
  Speaker 1: but there were a number of different cases where civil
• 38:15
  Speaker 1: wars or wars of one sort or another would break out,
• 38:18
  Speaker 1: and there were people who were trying to eradicate smallpox
• 38:21
  Speaker 1: who would sort of die through this process. But they were,
• 38:24
  Speaker 1: you know, doing the best they could to figure out,
• 38:25
  Speaker 1: like how do you vaccinate people when you have all
• 38:28
  Speaker 1: of these refugees moving from one place to another, and
• 38:31
  Speaker 1: how do you track things? But amazingly they did it.
• 38:34
  Speaker 1: And then there were a couple cases where, you know,
• 38:36
  Speaker 1: we talked about how there's not really a stigma around smallpox,
• 38:40
  Speaker 1: there was a stigma around being a nation that still
• 38:43
  Speaker 1: had smallpox in an era where it was being eradicated.
• 38:46
  Speaker 1: So there was a setback. In nineteen seventy one, Iran
• 38:49
  Speaker 1: got a case of smallpox, but they didn't want anybody
• 38:52
  Speaker 1: to know because they wanted to commemorate the two thy,
• 38:55
  Speaker 1: five hundredth anniversary of the Persian Empire. So the Iranian
• 39:00
  Speaker 1: government wanted to have this big celebration. But you don't
• 39:03
  Speaker 1: want people from all over the world descending on your
• 39:05
  Speaker 1: country if you have smallpox. Yeah, and so they were
• 39:09
  Speaker 1: trying to eradicate it with a mass vaccine campaign sort
• 39:12
  Speaker 1: of kept on the down low, but their stocks were
• 39:15
  Speaker 1: of poor quality and it wasn't working. So the World
• 39:18
  Speaker 1: Health Organization eventually got involved. They brought their better freeze
• 39:22
  Speaker 1: dried vaccine and they managed to wipe it out. But
• 39:24
  Speaker 1: there were all of these cases of like things came up,
• 39:27
  Speaker 1: and you know, I can just imagine that if I
• 39:29
  Speaker 1: was at the World Health Organization at smallpox broke out,
• 39:32
  Speaker 1: and it was because some countries rulers were like trying
• 39:36
  Speaker 1: to make sure I didn't find out about it. Man,
• 39:38
  Speaker 1: at some point you got to be like, how are
• 39:39
  Speaker 1: we ever going to do this? Like this is never
• 39:41
  Speaker 1: going to happen. I quit, amazing, But Dea Henderson never quit.
• 39:44
  Speaker 1: He just kept going and it's amazing.
• 39:47
  Speaker 2: And what was he like as a bureaucrat? Was he
• 39:49
  Speaker 2: like a rule follower? Was he like a tyrant?
• 39:53
  Speaker 1: He was not a rule follower. If you read the
• 39:56
  Speaker 1: book that he wrote about eradicating smallpox, it is mostly
• 39:59
  Speaker 1: a story about how he was told to do one
• 40:01
  Speaker 1: thing and he did another.
• 40:04
  Speaker 2: And that's how you get stuff done, folks.
• 40:06
  Speaker 1: Well that's how he got this done. And you know,
• 40:08
  Speaker 1: each different nations would have different bureaucracies that you had
• 40:12
  Speaker 1: to understand or route around. So, for example, there were
• 40:15
  Speaker 1: instances where he had to send mail through an intermediary
• 40:18
  Speaker 1: and he wouldn't get a response back on a timescale
• 40:21
  Speaker 1: that was useful for trying to attack an outbreak. And
• 40:25
  Speaker 1: so even though he was supposed to send the mail
• 40:27
  Speaker 1: through an intermediary, he started sending the mail to the
• 40:31
  Speaker 1: intermediary at the same time as he sent it directly
• 40:33
  Speaker 1: to the other person. And he knew he wasn't supposed
• 40:36
  Speaker 1: to do that, but there were all sorts of cases
• 40:37
  Speaker 1: where he was like, look, if I don't break this rule,
• 40:40
  Speaker 1: we are not eradicating small box. So I'm doing it.
• 40:43
  Speaker 1: And so yeah, he was he was a bit of
• 40:45
  Speaker 1: a character.
• 40:48
  Speaker 2: Well, sometimes you got to break a few constitutional eggs
• 40:51
  Speaker 2: to make me Onlet right, and so let's take a break,
• 40:54
  Speaker 2: and when we come back, we'll hear about the last
• 40:56
  Speaker 2: gasps of smallpox, eradicating it finally and string humans from
• 41:01
  Speaker 2: that suffering. All right, we're back, and we're hearing about
• 41:23
  Speaker 2: the story of smallpox, humanity's victory over the microbe. So
• 41:28
  Speaker 2: we're near the end of this. Tell us what were
• 41:30
  Speaker 2: the last battles in eradicating smallpox?
• 41:33
  Speaker 1: So towards the end India still had about sixty percent
• 41:35
  Speaker 1: of the remaining cases. There's a lot of people in India.
• 41:38
  Speaker 1: That density and the fact that this country is huge
• 41:42
  Speaker 1: made it really hard to eradicate. And as we mentioned,
• 41:45
  Speaker 1: there was that conflict happening with Pakistan and Bangladesh. There
• 41:48
  Speaker 1: were people crossing borders. It was getting really hard to
• 41:51
  Speaker 1: get this stuff under control. Additionally, there was an issue
• 41:54
  Speaker 1: because there was a small community who had a religious
• 41:57
  Speaker 1: leader that was refusing the vaccine and was refusing the
• 42:01
  Speaker 1: vaccine for the rest of the community as well. So
• 42:04
  Speaker 1: we talked earlier about like, you know, what, what do
• 42:06
  Speaker 1: you do in this case? Like so, at this point,
• 42:08
  Speaker 1: almost all the countries in the world had smallpox eliminated.
• 42:12
  Speaker 1: They were closing in on being able to eradicate this
• 42:15
  Speaker 1: disease which has killed millions of people millions of people
• 42:18
  Speaker 1: in our history for thousands of years yea for thousands
• 42:21
  Speaker 1: of years. And so the question is do you respect
• 42:24
  Speaker 1: this religious leader's desire to not get the vaccine when
• 42:28
  Speaker 1: it has been documented that smallpox cases are popping up
• 42:31
  Speaker 1: in this community and are then spreading to surrounding regions.
• 42:34
  Speaker 1: And so this is not something that will burn out
• 42:37
  Speaker 1: on its own this has been causing problems that are spreading.
• 42:40
  Speaker 1: And what they end up deciding they need to do
• 42:43
  Speaker 1: is they essentially pin the religious leader down and vaccinate
• 42:47
  Speaker 1: him wow, against his will. And once he's vaccinated, he
• 42:51
  Speaker 1: says something to the effect of, all right, well I
• 42:54
  Speaker 1: guess that was God's will. Everybody else should ge vaccinated
• 42:57
  Speaker 1: to that's a good handle, yeah, I guess, and so
• 43:02
  Speaker 1: but yeah, so there were some very difficult ethical questions.
• 43:05
  Speaker 1: I think in general, what they would try to do
• 43:07
  Speaker 1: is they would in every country where they started a
• 43:10
  Speaker 1: program for eradication, they would try to find local medical
• 43:14
  Speaker 1: people and get them on board and have talked to
• 43:16
  Speaker 1: them about how the vaccine worked and help them talk
• 43:20
  Speaker 1: to the community so that people could have their questions answered.
• 43:23
  Speaker 1: And this could be done in the most like ethical,
• 43:26
  Speaker 1: not like pushy way possible. But at the end there,
• 43:30
  Speaker 1: I don't think there were a lot of cases where
• 43:31
  Speaker 1: people were pinned down and vaccinated, but at the end
• 43:34
  Speaker 1: there they were like, look, we are closing all the loops.
• 43:37
  Speaker 2: Yeah. Well, it's a fascinating question and a real puzzle
• 43:40
  Speaker 2: for policymakers, right how to deal with these things and
• 43:44
  Speaker 2: their arguments for it on both sides. Right, it's clearly
• 43:46
  Speaker 2: a balance between like public good and individual freedom. Yeah right,
• 43:50
  Speaker 2: It's not clear where to draw that line, and it's
• 43:52
  Speaker 2: different in every case. And I'm a philosopher or an ethicist.
• 43:56
  Speaker 2: You know, imagine somebody is like walking around shooting guns
• 43:59
  Speaker 2: out them directions in public areas. You'd be like, yeah,
• 44:02
  Speaker 2: that's not allowed. That's clearly over the line. You could
• 44:05
  Speaker 2: make the argument that, you know, walking around spreading a
• 44:07
  Speaker 2: disease is similar to that, And so I'm not making
• 44:10
  Speaker 2: that argument. I don't want to be authoritarian about lockdowns whatever.
• 44:13
  Speaker 2: I know this is a really touchy subject. Yeah, I
• 44:16
  Speaker 2: just want to highlight that there's never an easy answer
• 44:18
  Speaker 2: here for public health officials.
• 44:19
  Speaker 1: You know, so many times during COVID I would hear
• 44:22
  Speaker 1: people complaining about how things were being managed, and my
• 44:25
  Speaker 1: response every time was, I am so glad I'm not
• 44:28
  Speaker 1: in charge right now. Like me too, I would hate
• 44:31
  Speaker 1: to make these decisions because you know, lives are on
• 44:34
  Speaker 1: the line. Every decision that you make has a downside
• 44:38
  Speaker 1: no matter what you do, and even if you do nothing,
• 44:40
  Speaker 1: then you're sort of still on the hook for a
• 44:42
  Speaker 1: bunch of deaths.
• 44:43
  Speaker 2: And the scientific understanding is evolving, right, Like, we don't
• 44:46
  Speaker 2: understand how is this spread, what works, what doesn't work.
• 44:49
  Speaker 2: And as we were saying earlier, you need clear policies, right,
• 44:51
  Speaker 2: you can't always convey like, hey, everybody, go read these papers.
• 44:54
  Speaker 2: Let's discuss. You know, somebody's going to make a decision
• 44:57
  Speaker 2: like do we close schools or not. Yeah, those are
• 45:00
  Speaker 2: hard decisions to make, and science informs them. But in
• 45:03
  Speaker 2: the end it's a political decision. Right, how do you
• 45:05
  Speaker 2: balance this versus that this risk versus that risk. Science
• 45:08
  Speaker 2: doesn't make the decisions, it just informs them. And sometimes
• 45:12
  Speaker 2: science is wrong, right, It's never fully settled and it's
• 45:15
  Speaker 2: always in flux. So yeah, wow, it's hard to be
• 45:17
  Speaker 2: a public health official.
• 45:19
  Speaker 1: Oh my gosh. Yeah, so hard and so important that
• 45:22
  Speaker 1: we are spending this time when there isn't a major
• 45:24
  Speaker 1: pandemic killing a bunch of people, that we try to
• 45:27
  Speaker 1: spend that time helping the public to understand science and
• 45:31
  Speaker 1: trying to build trust. Yeah, that we then get to
• 45:34
  Speaker 1: benefit from, you know, when something like that happens. But anyway,
• 45:38
  Speaker 1: so tell us.
• 45:39
  Speaker 2: About the victory. Right, So people worked in India. They
• 45:41
  Speaker 2: pinned down this religious leader to stamp out those last
• 45:44
  Speaker 2: embers was that the end of smallpox.
• 45:46
  Speaker 1: I believe the last case in nineteen seventy five was
• 45:49
  Speaker 1: a homeless person on a railway platform that they found
• 45:52
  Speaker 1: and they treated and quarantined and it didn't get passed.
• 45:56
  Speaker 1: And then Ethiopia was the last country to have smallpox.
• 45:59
  Speaker 1: That a little complicated because there were a lot of
• 46:01
  Speaker 1: nomadic herders, so it was hard to get in touch with,
• 46:05
  Speaker 1: you know, each herd to make sure there hadn't been
• 46:07
  Speaker 1: any cases of smallpox. So we had a period where
• 46:10
  Speaker 1: no smallpox cases were reported. We thought we had eradicated it.
• 46:14
  Speaker 1: We waited for an additional two years where people were
• 46:18
  Speaker 1: hired to like go around the world looking for cases
• 46:21
  Speaker 1: and like go into communities trying to find it. And
• 46:24
  Speaker 1: after two years of looking hard for smallpox and not
• 46:27
  Speaker 1: finding it, we declared in nineteen eighty that smallpox had
• 46:31
  Speaker 1: been eradicated. Amazing, yay. But this wouldn't be an episode
• 46:36
  Speaker 1: run by Kelly if there wasn't something scary at the end.
• 46:40
  Speaker 1: So one of the difficult things about smallpox is that
• 46:44
  Speaker 1: it looks like chicken pox and monkey pox, and so
• 46:49
  Speaker 1: when you're trying to figure out if you've eradicated it
• 46:51
  Speaker 1: or not. If a pox case pops up, you want
• 46:54
  Speaker 1: to send a sample of that virus to a lab
• 46:57
  Speaker 1: to confirm, Hey, this is definitely chicken pox, for example,
• 47:00
  Speaker 1: smallpox popping back up again. And so during this eradication procedure,
• 47:05
  Speaker 1: it was regularly the case that samples of the pox
• 47:09
  Speaker 1: were sent to labs in the Soviet Union and the
• 47:12
  Speaker 1: United States, and they split the case load because it
• 47:15
  Speaker 1: was a lot of work verifying you know, what virus
• 47:17
  Speaker 1: was which. But at the end of this process, a
• 47:21
  Speaker 1: lab in the United States and a lab in the
• 47:23
  Speaker 1: Soviet Union had lots of different virus samples in their freezers.
• 47:29
  Speaker 2: Oh I see.
• 47:30
  Speaker 1: So at the end of this process, the virus had
• 47:33
  Speaker 1: been eradicated in the wild and had been eradicated in
• 47:37
  Speaker 1: human bodies, but it was still existing in labs.
• 47:40
  Speaker 2: And Kelly at three in the morning as a new mom,
• 47:43
  Speaker 2: where you worried about this escaping from labs and affecting
• 47:46
  Speaker 2: your children.
• 47:46
  Speaker 1: Not initially, but as I said, in twenty fourteen, they
• 47:49
  Speaker 1: found some smallpox vials that were in a lab in
• 47:53
  Speaker 1: the US that were just in some stinking closet where
• 47:56
  Speaker 1: somebody had forgotten them there. And at this point we
• 48:00
  Speaker 1: probably don't have immunity anymore, none of us, and so
• 48:04
  Speaker 1: if it got out, it could spread quickly, and it
• 48:06
  Speaker 1: does get out of labs sometimes it does.
• 48:08
  Speaker 2: Are there documented cases of that?
• 48:10
  Speaker 1: Yeah, So in nineteen seventy eight there was a woman
• 48:12
  Speaker 1: who was working in a lab above a UK lab
• 48:16
  Speaker 1: that studied smallpox, and smallpox must have gotten into the
• 48:20
  Speaker 1: ventilation system and ended up in her lab and she
• 48:24
  Speaker 1: got smallpox and died, And so we know that sometimes
• 48:28
  Speaker 1: it does get out. And I think after that the
• 48:30
  Speaker 1: UK was like, you know what, we'll just destroy all
• 48:33
  Speaker 1: of our stores. But the scientific community has decided to
• 48:37
  Speaker 1: not get rid of all of our samples. And there's
• 48:40
  Speaker 1: a complicated reason why. So in nineteen seventy two, a
• 48:43
  Speaker 1: bunch of countries agreed, look, we're not going to try
• 48:46
  Speaker 1: to make biological weapons anymore. And so nations were supposed
• 48:50
  Speaker 1: to stop doing that kind of research, but the Soviet
• 48:53
  Speaker 1: Union kept doing it, and in particular, they kept doing
• 48:55
  Speaker 1: research on how you could weaponize smallpox. And there's some
• 49:00
  Speaker 1: reason to believe that they thought the US was doing
• 49:02
  Speaker 1: it too, and so they had to do it to
• 49:04
  Speaker 1: keep up. But the US wasn't doing it or at
• 49:07
  Speaker 1: least if the US was doing it, that has not
• 49:09
  Speaker 1: become public. And so the Soviet Union continued to do it.
• 49:12
  Speaker 1: And so around the time when there was discussions about like, okay,
• 49:16
  Speaker 1: all the labs that still have smallpox, we should destroy it,
• 49:20
  Speaker 1: this news came out that the Soviet Union had been
• 49:23
  Speaker 1: using it for biological weapons. And now the US didn't
• 49:25
  Speaker 1: want to eradicate THEIRS, because what if a biological weapon
• 49:30
  Speaker 1: made from smallpox does get released? If you have smallpox
• 49:34
  Speaker 1: in your lab, then you've got a starting point for
• 49:36
  Speaker 1: doing research to figure out how you can, you know,
• 49:40
  Speaker 1: maybe make more vaccines or how you can address this.
• 49:43
  Speaker 1: And so it ended up being determined that the US
• 49:47
  Speaker 1: didn't want to eradicate theirs, and then the Soviet Union
• 49:50
  Speaker 1: didn't want to eradicate THEIRS. And then when the Soviet
• 49:52
  Speaker 1: Union fell apart, scientists who had access to the vaccines
• 49:56
  Speaker 1: ended up all over the place, and there was some
• 49:58
  Speaker 1: concern that, you know, a lot of the scientists during
• 50:01
  Speaker 1: the fall of the Soviet Union didn't have enough money
• 50:03
  Speaker 1: to feed their families. So are they selling it to
• 50:06
  Speaker 1: you know, nations that might like to have smallpox to
• 50:09
  Speaker 1: make their own biological weapons. And so it is still
• 50:12
  Speaker 1: the case that we have these samples in our freezers
• 50:17
  Speaker 1: and hopefully they never get out a lot of I mean,
• 50:19
  Speaker 1: they're under many layers of security, but they're kept for
• 50:22
  Speaker 1: a variety of reasons. The bio warfare stuff we talked about. Also,
• 50:25
  Speaker 1: you know, maybe if monkey pocks jumps to humans in
• 50:27
  Speaker 1: a way where it's even more transmissible than it has
• 50:30
  Speaker 1: been in the past, maybe understanding smallpox could help us
• 50:32
  Speaker 1: with that. And so there's a bunch of different science
• 50:35
  Speaker 1: related reasons that we've come up with. But the point
• 50:38
  Speaker 1: is smallpox still exists on this planet, and that keeps
• 50:42
  Speaker 1: Kelly up at night.
• 50:46
  Speaker 2: So why don't we just keep vaccinating people? Like, yeah,
• 50:48
  Speaker 2: we eradicated it, but it sure would be nice to
• 50:50
  Speaker 2: be immune. What's the cost of vaccination?
• 50:53
  Speaker 1: Yeah, so difficult is with vaccination is another reason why
• 50:58
  Speaker 1: some people argue that we need to keep smallpox around.
• 51:01
  Speaker 1: So the current vaccine that we have using that cowpox
• 51:04
  Speaker 1: is dangerous for people who are immunocompromised. So, for example,
• 51:08
  Speaker 1: people with HIV AIDS could die if they got this vaccine.
• 51:12
  Speaker 1: And so there are folks who argue, like, look, we
• 51:14
  Speaker 1: need to keep smallpox around because we might be able
• 51:17
  Speaker 1: to as you mentioned earlier in the show, maybe we
• 51:19
  Speaker 1: could genetically modify smallpox so that we could create a
• 51:22
  Speaker 1: vaccine that makes people immune to smallpox without killing people
• 51:28
  Speaker 1: who are immunocompromised. And so, because we don't have a
• 51:32
  Speaker 1: perfect vaccine, maybe you want to keep smallpox around in
• 51:35
  Speaker 1: case you need to do more vaccine research in the future.
• 51:38
  Speaker 1: To more clearly address your question, you asked, why don't
• 51:40
  Speaker 1: we just vaccinate everybody? So one you'd have to always
• 51:44
  Speaker 1: vaccinate everybody for a disease that isn't in circulation right now.
• 51:47
  Speaker 1: That would be incredibly expensive. And this vaccine is not
• 51:52
  Speaker 1: without risks, And so if you vaccinated everybody, there would
• 51:54
  Speaker 1: be a subset of the population who would die from
• 51:56
  Speaker 1: this vaccine every year, which seems unnecessary at a time
• 52:01
  Speaker 1: when this disease is not spreading in the United States
• 52:04
  Speaker 1: or in the world.
• 52:04
  Speaker 2: Yeah, yeah, so there really are risks there, and you
• 52:07
  Speaker 2: don't just want to vaccinate people, yeah.
• 52:09
  Speaker 1: Just for the heck of it. Although, man, in twenty fourteen,
• 52:12
  Speaker 1: if you had told me I could vaccinate my daughter
• 52:14
  Speaker 1: for smallpox, I might have. I might have gone for
• 52:17
  Speaker 1: it because I was a little crazy in the middle
• 52:19
  Speaker 1: of the night. I was talking to a friend who's
• 52:22
  Speaker 1: in the military, and I think he said that he
• 52:24
  Speaker 1: did get vaccinated for smallpox. And so I think there
• 52:27
  Speaker 1: are some people working in some government job where if
• 52:30
  Speaker 1: you are not immunal compromised, you might still get the
• 52:32
  Speaker 1: vaccine on the off chance that you would be the
• 52:34
  Speaker 1: kind of person who would encounter a bio weapon on
• 52:37
  Speaker 1: the front line. But this conversation I had was like
• 52:40
  Speaker 1: over a decade ago, So maybe we don't do that anymore.
• 52:42
  Speaker 2: All right, Well, it's amazing what humanity can do when
• 52:45
  Speaker 2: they come together and get organized and decide that we
• 52:48
  Speaker 2: all have the same goal and we're going to make
• 52:50
  Speaker 2: the sacrifices and used the resources necessary to achieve that goal.
• 52:54
  Speaker 2: It's incredible.
• 52:55
  Speaker 1: It is incredible. And so you know, when I was
• 52:56
  Speaker 1: rereading da Henderson's book, and I also reread School by
• 53:00
  Speaker 1: Jonathan Tucker, And while I was rereading these stories.
• 53:03
  Speaker 2: I love your pronunciation of that word scurge.
• 53:06
  Speaker 1: How do you say it?
• 53:07
  Speaker 2: Scourge?
• 53:08
  Speaker 1: Scourge? Oh? No, is it like three up prions where
• 53:11
  Speaker 1: I'm saying it wrong?
• 53:13
  Speaker 2: No one of us is all right.
• 53:15
  Speaker 1: Well, okay, sounds good. But so, while I was reading
• 53:19
  Speaker 1: those stories, you know, I was, I was getting pretty depressed.
• 53:22
  Speaker 1: So I was uplifted by the fact that our species
• 53:24
  Speaker 1: came together and cooperated across nations to eradicate this disease
• 53:28
  Speaker 1: that had killed millions of us for thousands of years.
• 53:31
  Speaker 1: But on the other hand, us AID is not around anymore,
• 53:35
  Speaker 1: and the World Health Organization the United States has pulled
• 53:38
  Speaker 1: out of that. And I don't want to pretend that
• 53:40
  Speaker 1: the World Health Organization is without problems, because da Henderson
• 53:44
  Speaker 1: complains about the bureaucracy and that organization over and over
• 53:48
  Speaker 1: and over again. But he was still able to coordinate
• 53:52
  Speaker 1: this effort that brought all the nations of the world
• 53:55
  Speaker 1: together and brought all of our resources together, and the
• 53:58
  Speaker 1: strength of this organization and with this particular person in charge,
• 54:03
  Speaker 1: was able to eradicate this disease. And you know, I'm
• 54:05
  Speaker 1: worried that we, you know, instead of fixing institutions that
• 54:09
  Speaker 1: have problems in the United States, we're just pulling out
• 54:12
  Speaker 1: of them. And I worry that the next time we
• 54:14
  Speaker 1: need to coordinate, we are going to be in a
• 54:16
  Speaker 1: less good position to do that. And so anyway, I was,
• 54:19
  Speaker 1: on the one hand, very proud of our species for
• 54:22
  Speaker 1: eradicating smallpox and a bit scared for our ability to
• 54:25
  Speaker 1: do something like that again in the future.
• 54:27
  Speaker 2: Well, as scientists, the best we can do is to
• 54:29
  Speaker 2: help people understand how this works, what's going on, what
• 54:32
  Speaker 2: do we know, what do we not know, what are
• 54:34
  Speaker 2: the risks, what are the benefits? And we hope that
• 54:37
  Speaker 2: that helps people be informed when they make their decisions,
• 54:40
  Speaker 2: policy makers and individuals.
• 54:42
  Speaker 1: Yep, yep. But to end on a high note, you know,
• 54:44
  Speaker 1: I do think it's worth sitting and thinking how lucky
• 54:47
  Speaker 1: we are that most of us don't have to worry
• 54:50
  Speaker 1: about tuberculosis or smallpox. We can be vaccinated for measles
• 54:53
  Speaker 1: and for polio. There's so many things that would have
• 54:56
  Speaker 1: occupied so much time and worry for parents or you know, anyone,
• 55:01
  Speaker 1: for people living in the past that you know, we
• 55:04
  Speaker 1: we can forget about today. So many people have never
• 55:06
  Speaker 1: thought about smallpox more than five seconds. And what a
• 55:11
  Speaker 1: blessing isn't the word I'm looking for. What's the word
• 55:12
  Speaker 1: I'm looking for? What a luxury that is?
• 55:15
  Speaker 2: What a what a mitzvah that is?
• 55:19
  Speaker 1: What a mitzvah that is? And so anyway, we are
• 55:22
  Speaker 1: very lucky to live in the time we live in.
• 55:24
  Speaker 2: Yeah. And also it's a testament to what humans can accomplish. Right.
• 55:27
  Speaker 2: We have changed the nature of life on Earth. We've
• 55:29
  Speaker 2: removed a big source of suffering and misery. Yeah, and
• 55:33
  Speaker 2: that tells me that we can do more, We can
• 55:35
  Speaker 2: improve lives. Science really does help us improve the quality
• 55:38
  Speaker 2: of our life.
• 55:40
  Speaker 1: Yay science, Yay science. Let's end on that.
• 55:43
  Speaker 2: So thank you Toda Anderson for coordinating that massive international
• 55:47
  Speaker 2: project to improve all of our lives, and thank you
• 55:49
  Speaker 2: all for joining us on this historical tour of a
• 55:51
  Speaker 2: human victory.
• 55:59
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