1 00:00:15,370 --> 00:00:26,210 Speaker 1: Pushkin. In nineteen eighty, the World Health Organization announced a 2 00:00:26,290 --> 00:00:31,010 Speaker 1: landmark in the history of public health. Smallpox had been eradicated. 3 00:00:32,290 --> 00:00:35,210 Speaker 1: Two years had passed since the last case of smallpox, 4 00:00:35,330 --> 00:00:38,170 Speaker 1: a disease that killed three in ten of those it 5 00:00:38,290 --> 00:00:42,930 Speaker 1: infected and scarred or blinded many more. After waiting for 6 00:00:42,970 --> 00:00:46,370 Speaker 1: a while to be sure smallpox was truly gone, the 7 00:00:46,570 --> 00:00:53,730 Speaker 1: who made it official decades later, a physician in Oklahoma 8 00:00:53,810 --> 00:00:57,450 Speaker 1: City saw a patient complaining of fever and mouth hulsers. 9 00:00:58,050 --> 00:01:01,090 Speaker 1: It's not surprising she didn't think of smallpox as a 10 00:01:01,130 --> 00:01:06,370 Speaker 1: possible explanation, But then came another patient and another in 11 00:01:06,490 --> 00:01:11,050 Speaker 1: surgeries and emergency rooms across ok Homer City. What was 12 00:01:11,090 --> 00:01:14,690 Speaker 1: going on. Specialists were called in from the Centers for 13 00:01:14,730 --> 00:01:20,210 Speaker 1: Disease Control and Prevention. They confirmed the shocking news smallpox 14 00:01:21,010 --> 00:01:25,370 Speaker 1: was back, and not just in Oklahoma. Reports started coming 15 00:01:25,370 --> 00:01:29,570 Speaker 1: in from Philadelphia and Atlanta. Investigators figured out that in 16 00:01:29,690 --> 00:01:33,290 Speaker 1: each of the three cities, all the smallpox patients had 17 00:01:33,290 --> 00:01:36,450 Speaker 1: been at the same mall at the same time several 18 00:01:36,530 --> 00:01:41,530 Speaker 1: days earlier. What had happened was all too clear. It 19 00:01:41,570 --> 00:01:49,250 Speaker 1: was a deliberate, synchronized terrorist attack. The very olavirus, which causes. 20 00:01:49,330 --> 00:01:53,850 Speaker 1: Smallpox is highly contagious, even before it developed into the distinctive, 21 00:01:54,010 --> 00:01:59,610 Speaker 1: disfiguring rash postules filled with thick opaque fluid that cover 22 00:01:59,730 --> 00:02:04,010 Speaker 1: the body. Just six days after the Oklahoma news there 23 00:02:04,010 --> 00:02:08,090 Speaker 1: were two thousand cases. Authorities are trying desperately to trace 24 00:02:08,170 --> 00:02:12,090 Speaker 1: all their contacts. A vaccine will work if you administer 25 00:02:12,130 --> 00:02:16,650 Speaker 1: it soon after exposure, but things aren't looking good. The 26 00:02:16,770 --> 00:02:21,290 Speaker 1: virus has spread to fifteen states and Canada, Mexico, and 27 00:02:21,330 --> 00:02:27,650 Speaker 1: the United Kingdom. If you're wandering when this was and why, 28 00:02:27,730 --> 00:02:31,250 Speaker 1: you don't remember, it happened in two thousand and one, 29 00:02:31,890 --> 00:02:35,530 Speaker 1: and you don't remember because what I've just described was 30 00:02:35,570 --> 00:02:40,610 Speaker 1: a simulation, Operation dark Winter, a training exercise to see 31 00:02:40,690 --> 00:02:44,930 Speaker 1: how decision makers would respond. All the events I've described 32 00:02:45,210 --> 00:02:49,930 Speaker 1: took place only in the training scenario. The smallpox bio 33 00:02:50,050 --> 00:02:55,290 Speaker 1: terrorism attack didn't happen, but it was no game. Operation 34 00:02:55,450 --> 00:02:58,890 Speaker 1: dark Winter took a lot of effort to research and prepare. 35 00:02:59,410 --> 00:03:02,850 Speaker 1: Some very senior people gave it their time. It wasn't 36 00:03:02,850 --> 00:03:06,370 Speaker 1: for fun. The organizers wanted to learn about a threat 37 00:03:06,530 --> 00:03:11,410 Speaker 1: they took very seriously. So perhaps I should say the 38 00:03:11,530 --> 00:03:19,210 Speaker 1: smallpox bio terrorism attack hasn't happened. Yet, I'm Tim Harford, 39 00:03:20,090 --> 00:04:03,650 Speaker 1: and you're listening to cautionary tales. In sixteen sixty six, 40 00:04:04,210 --> 00:04:08,850 Speaker 1: smallpox came to Boston, Massachusetts. It wasn't too bad this time, 41 00:04:09,210 --> 00:04:12,970 Speaker 1: just a few dozen died. The next epidemic, in sixteen 42 00:04:13,050 --> 00:04:18,690 Speaker 1: seventy seven was worse. A teenage Bostonian called Cotton Mather 43 00:04:19,050 --> 00:04:22,850 Speaker 1: described the scene at burial sites, corpses following each other 44 00:04:22,930 --> 00:04:27,930 Speaker 1: close at their heels. Smallpox came again in sixteen eighty nine. 45 00:04:28,810 --> 00:04:32,090 Speaker 1: Mather was then a well known Puritan minister about to 46 00:04:32,210 --> 00:04:36,170 Speaker 1: unwisely fan the flames of hysteria in the notorious Salem 47 00:04:36,290 --> 00:04:40,250 Speaker 1: witch Trials. He would lose many people's respect in the process. 48 00:04:41,530 --> 00:04:45,850 Speaker 1: In a smallpox outbreak in seventeen o two, the Boston 49 00:04:45,890 --> 00:04:49,610 Speaker 1: authorities limited the tolling of bells to make it less 50 00:04:49,650 --> 00:04:54,210 Speaker 1: appallingly obvious how many people were dying, and with smallpox 51 00:04:54,250 --> 00:04:58,490 Speaker 1: returning every ten or fifteen years, another outbreak was evidently 52 00:04:58,890 --> 00:05:03,810 Speaker 1: just a matter of time. By seventeen fifteen, Cotton Mather, 53 00:05:04,210 --> 00:05:07,050 Speaker 1: now in his fifties, was wandering when the next one 54 00:05:07,090 --> 00:05:11,610 Speaker 1: would come. Working hard to redeem his reputation as a 55 00:05:11,690 --> 00:05:15,330 Speaker 1: man of science, he had been admitted to the Royal 56 00:05:15,410 --> 00:05:19,210 Speaker 1: Society in London, no mean feat. His letters to the 57 00:05:19,290 --> 00:05:24,050 Speaker 1: society covered subjects from hummingbirds to rainbows. He had just 58 00:05:24,170 --> 00:05:27,570 Speaker 1: sent them his observations on measles, which one historian has 59 00:05:27,610 --> 00:05:33,170 Speaker 1: called a classic of early American medicine. On slavery, Mather 60 00:05:33,330 --> 00:05:36,170 Speaker 1: wasn't quite so far ahead of his time. He was 61 00:05:36,210 --> 00:05:39,410 Speaker 1: a slave owner himself, and even received a slave as 62 00:05:39,410 --> 00:05:45,490 Speaker 1: a gift from his congregation. He renamed this enslaved man 63 00:05:45,730 --> 00:05:50,090 Speaker 1: one Issimus, a biblical name. Thinking one day about the 64 00:05:50,170 --> 00:05:54,970 Speaker 1: overdue smallpox epidemic, he asked Oneissimus if he'd ever had 65 00:05:55,010 --> 00:06:00,170 Speaker 1: the disease. Yes, and no, One Issimus reply. As a 66 00:06:00,250 --> 00:06:02,850 Speaker 1: child in Africa, he had had a kind of operation. 67 00:06:03,690 --> 00:06:07,210 Speaker 1: He explained to Mather what had involved. You take fluid 68 00:06:07,330 --> 00:06:10,810 Speaker 1: from a smallpox blister, You cut the arm of a 69 00:06:10,850 --> 00:06:14,170 Speaker 1: healthy person, and you put in a drop of the fluid. 70 00:06:14,890 --> 00:06:18,050 Speaker 1: After a few days, they'd get ill, but usually not 71 00:06:18,130 --> 00:06:24,090 Speaker 1: too badly, and then they never got smallpox again. Monissimus 72 00:06:24,130 --> 00:06:30,890 Speaker 1: showed Mather the scar on his arm. Mather would later 73 00:06:30,930 --> 00:06:35,450 Speaker 1: interview other Africans around Boston, contemptuously grumbling about the way 74 00:06:35,490 --> 00:06:39,130 Speaker 1: they told their story, but for all his racism, there 75 00:06:39,290 --> 00:06:43,650 Speaker 1: was one fact Mother was willing to hear. Inoculation was 76 00:06:43,730 --> 00:06:48,650 Speaker 1: widely practiced in West Africa. The next year passed with 77 00:06:48,810 --> 00:06:52,770 Speaker 1: still no epidemic. Mather eagerly took delivery of the Royal 78 00:06:52,850 --> 00:06:57,570 Speaker 1: Society's latest volume of Philosophical Transactions, looking forward to seeing 79 00:06:57,610 --> 00:07:00,730 Speaker 1: his thoughts in print. But it was another article that 80 00:07:00,850 --> 00:07:04,370 Speaker 1: caught his eye. It was written by a Greek physician 81 00:07:04,690 --> 00:07:11,250 Speaker 1: in Turkey, an account history of the procuring of these 82 00:07:11,290 --> 00:07:16,290 Speaker 1: small pox by incision or inoculation, as it has for 83 00:07:16,330 --> 00:07:24,410 Speaker 1: some time been practiced at Constantinople. Mather realized that this 84 00:07:24,530 --> 00:07:28,490 Speaker 1: was just what Monissimus had described. Not only did they 85 00:07:28,530 --> 00:07:31,930 Speaker 1: know about inoculation in West Africa, they knew about it 86 00:07:31,970 --> 00:07:34,930 Speaker 1: in Turkey too, but it just hadn't got to Western 87 00:07:34,970 --> 00:07:39,810 Speaker 1: Europe or America. Yet. Mather was electrified. When the next 88 00:07:39,930 --> 00:07:45,970 Speaker 1: smallpox epidemic hit, he could save the city. That happened 89 00:07:46,090 --> 00:07:49,690 Speaker 1: five years later. Stephen Coss tells the story in his 90 00:07:49,730 --> 00:07:54,130 Speaker 1: book The Fever of seventeen twenty one. Infected sailors came 91 00:07:54,170 --> 00:07:57,650 Speaker 1: on a ship from Barbados. Attempts to quarantine the early 92 00:07:57,730 --> 00:08:03,490 Speaker 1: cases failed, the disease started to spread This was Mather's moment. 93 00:08:03,930 --> 00:08:07,090 Speaker 1: He wrote to every doctor in Boston explaining what had 94 00:08:07,130 --> 00:08:11,370 Speaker 1: learned about inoculation and urge them to experiment. But they 95 00:08:11,370 --> 00:08:16,250 Speaker 1: all had the same reaction. Copy the Africans and deliberately 96 00:08:16,250 --> 00:08:23,050 Speaker 1: give people smallpox. Mather had lost his mind. Actually, not 97 00:08:23,250 --> 00:08:28,770 Speaker 1: quite all. There was one doctor willing to listen, Zabdiel Boylston, 98 00:08:29,090 --> 00:08:32,370 Speaker 1: forty two years old, a surgeon whose face bore the 99 00:08:32,450 --> 00:08:35,290 Speaker 1: scars of his own battle with smallpox as a younger man, 100 00:08:36,170 --> 00:08:39,410 Speaker 1: and perhaps mother's idea didn't sound quite so strange to Boylstone, 101 00:08:39,610 --> 00:08:43,490 Speaker 1: because Boylstone's scars were the result of deliberately exposing himself 102 00:08:43,530 --> 00:08:46,290 Speaker 1: to the disease. To work as a doctor, he'd have 103 00:08:46,330 --> 00:08:49,250 Speaker 1: to become immune sooner or later. Might as well get 104 00:08:49,290 --> 00:08:52,970 Speaker 1: it over with. He'd crossed his fingers for a quick recovery. 105 00:08:53,570 --> 00:08:57,850 Speaker 1: He nearly died. Boylstone's father was also a physician and 106 00:08:57,930 --> 00:09:01,290 Speaker 1: traveled widely and learned from the indigenous people he met. 107 00:09:02,010 --> 00:09:05,930 Speaker 1: Boylstone's father took their remedies seriously, and so did Boylstone. 108 00:09:06,330 --> 00:09:10,650 Speaker 1: So while other doctors scorned the notion that African slaves 109 00:09:10,730 --> 00:09:15,090 Speaker 1: or Greek old women could possibly have anything useful to say, 110 00:09:15,330 --> 00:09:20,890 Speaker 1: Boylstone did not inoculations seemed worth trying. He decided to 111 00:09:20,930 --> 00:09:25,290 Speaker 1: inoculate his slaves, a father and two year old son, 112 00:09:25,970 --> 00:09:30,810 Speaker 1: Jack and little Jackie. Experimenting on enslaved people makes us 113 00:09:30,970 --> 00:09:34,890 Speaker 1: gasp with horror today, But of course that's not what 114 00:09:35,050 --> 00:09:39,650 Speaker 1: scandalized the Bostonians of three centuries ago. No, what horrified 115 00:09:39,690 --> 00:09:44,570 Speaker 1: them was that Boylstone also inoculated Thomas, his six year 116 00:09:44,610 --> 00:09:48,490 Speaker 1: old son. After all Boylstone reasons, he'd soon be seeing 117 00:09:48,530 --> 00:09:51,890 Speaker 1: lots of smallpox patients, it seemed unlikely that young Thomas 118 00:09:51,890 --> 00:09:55,290 Speaker 1: could escape being exposed. If inoculation might give him a 119 00:09:55,330 --> 00:09:59,130 Speaker 1: milder case, why not give it a go. Boylstone took 120 00:09:59,170 --> 00:10:03,010 Speaker 1: fluid from a patient's blisters and hurried home. He sliced 121 00:10:03,210 --> 00:10:06,730 Speaker 1: into his son's arm and inserted a drop of the fluid, 122 00:10:07,530 --> 00:10:12,890 Speaker 1: and he waited. The citizens of Boston were appalled, both 123 00:10:12,930 --> 00:10:16,810 Speaker 1: at Boylstone's seeming recklessness and at Mather for putting him 124 00:10:16,890 --> 00:10:20,450 Speaker 1: up to it. Both men were unnerved by this horrid clamor, 125 00:10:20,650 --> 00:10:24,410 Speaker 1: as Mather put it, Boylstone was even more unnerved when 126 00:10:24,530 --> 00:10:28,770 Speaker 1: Thomas developed a high fever that stubbornly refused to subside. 127 00:10:29,450 --> 00:10:32,930 Speaker 1: Jack was hardly affected. Young Jackie had only a mild fever, 128 00:10:33,530 --> 00:10:39,290 Speaker 1: but Thomas was delirious. Boylstone sat anxiously by his son's bed, 129 00:10:40,170 --> 00:10:44,650 Speaker 1: but eventually the fever broke. Thomas came out in postules, 130 00:10:44,650 --> 00:10:51,450 Speaker 1: but not many, and soon he felt absolutely fine. But 131 00:10:51,570 --> 00:10:55,530 Speaker 1: if Boylstone expected this news to mollify the citizens of Boston, 132 00:10:55,810 --> 00:10:59,410 Speaker 1: he was in for a disappointment. The town's most eminent 133 00:10:59,450 --> 00:11:04,610 Speaker 1: doctor called inoculation wicked and criminal, and Boylstone a quack. 134 00:11:05,410 --> 00:11:09,930 Speaker 1: The New England Courante carried screed after scream, attacking the 135 00:11:10,290 --> 00:11:18,690 Speaker 1: doubtful and dangerous practice, And well it was dangerous. Innocules 136 00:11:18,730 --> 00:11:23,890 Speaker 1: became contagious, some got very ill. Indeed, but not everyone 137 00:11:24,050 --> 00:11:27,290 Speaker 1: was yelling abuse at Boylstone in the street. A few 138 00:11:27,330 --> 00:11:32,330 Speaker 1: approached him quietly as to trickle, then a steady stream. 139 00:11:32,530 --> 00:11:37,010 Speaker 1: Boylston inoculated anyone who asked. He kept careful notes of 140 00:11:37,130 --> 00:11:43,210 Speaker 1: every case. In October seventeen twenty one, Boston's outbreak reached 141 00:11:43,210 --> 00:11:47,370 Speaker 1: its peak. Four hundred people died that month from a 142 00:11:47,450 --> 00:11:52,290 Speaker 1: population of only twelve thousand. New clients started to arrive 143 00:11:52,410 --> 00:11:55,770 Speaker 1: from nearby towns where the epidemic was just taking hold. 144 00:11:56,410 --> 00:11:58,770 Speaker 1: Cotton mother invited his nephew to come and stay with 145 00:11:58,850 --> 00:12:03,570 Speaker 1: him for a Boylston inoculation. Bostonians who'd managed to avoid 146 00:12:03,570 --> 00:12:08,290 Speaker 1: the smallpox were incensed just as their own outbreak finally 147 00:12:08,290 --> 00:12:11,210 Speaker 1: seemed to be way. The last thing they wanted was 148 00:12:11,250 --> 00:12:13,890 Speaker 1: an influx of visitors who might set it off again. 149 00:12:15,130 --> 00:12:20,010 Speaker 1: One disgruntled citizen decided to act. He or she they 150 00:12:20,010 --> 00:12:24,050 Speaker 1: were never identified, composed a note addressed to Cotton Mather, 151 00:12:25,050 --> 00:12:28,770 Speaker 1: you dog. It read damn you, I will inoculate you 152 00:12:28,850 --> 00:12:33,090 Speaker 1: with this with a pox to you. This person also 153 00:12:33,170 --> 00:12:38,090 Speaker 1: made a bomb, a ball of iron containing turpentine and gunpowder. 154 00:12:38,530 --> 00:12:41,770 Speaker 1: At three o'clock in the morning, they took the note 155 00:12:42,330 --> 00:12:46,090 Speaker 1: and the bomb and made their way to Cotton Mather's house, 156 00:12:47,490 --> 00:13:04,050 Speaker 1: and they lobbed the bomb at his window. We left 157 00:13:04,130 --> 00:13:09,690 Speaker 1: Operation Dark Winter with an imagined terrorist attack spreading small fast. 158 00:13:10,770 --> 00:13:14,490 Speaker 1: Let's check back on the scenario. It's not going well. 159 00:13:15,610 --> 00:13:19,450 Speaker 1: Thirteen days into the simulated epidemic, there are now sixteen 160 00:13:19,770 --> 00:13:24,530 Speaker 1: thousand cases in twenty five states. It's no longer feasible 161 00:13:24,570 --> 00:13:29,010 Speaker 1: to identify all the contacts, and vaccines anyway are running out. 162 00:13:29,450 --> 00:13:32,810 Speaker 1: There are only twelve million in stock. It's nowhere near enough. 163 00:13:33,770 --> 00:13:36,530 Speaker 1: Factories are making new ones, but they're at least four 164 00:13:36,570 --> 00:13:40,930 Speaker 1: weeks away. Until then, there's only social distancing. If that 165 00:13:40,970 --> 00:13:47,810 Speaker 1: doesn't work, the experts warn of a million deaths. This 166 00:13:48,170 --> 00:13:52,370 Speaker 1: terrifying training exercise did exactly what the team behind Dark 167 00:13:52,410 --> 00:13:56,530 Speaker 1: Winter had hoped it would. It startled decision makers into action. 168 00:13:57,610 --> 00:14:01,130 Speaker 1: We heard in an earlier episode that warnings aren't always heeded, 169 00:14:01,410 --> 00:14:06,050 Speaker 1: but in one important respect, this one was. Now the 170 00:14:06,170 --> 00:14:10,330 Speaker 1: US has three hundred million small pot vaccine doses. It 171 00:14:10,370 --> 00:14:14,170 Speaker 1: should be much better prepared in case Dark Winter ever happens. 172 00:14:15,090 --> 00:14:19,970 Speaker 1: But hold on, If smallpox was eradicated in nineteen eighty, 173 00:14:20,610 --> 00:14:24,690 Speaker 1: how could the scenario in Dark Winter happen? There are 174 00:14:24,690 --> 00:14:29,130 Speaker 1: a lass a few possibilities. Samples of smallpox still exist 175 00:14:29,210 --> 00:14:34,970 Speaker 1: in two ultra secure facilities, one in America, one in Russia, 176 00:14:35,050 --> 00:14:39,010 Speaker 1: but nowhere, of course, can be completely secure. For years, 177 00:14:39,050 --> 00:14:43,250 Speaker 1: the World Health Organization has debated destroying these remaining stocks 178 00:14:43,250 --> 00:14:46,530 Speaker 1: of smallpox, and you might wonder why there's still room 179 00:14:46,570 --> 00:14:50,570 Speaker 1: for debate, Why take chances? One problem is that more 180 00:14:50,650 --> 00:14:55,650 Speaker 1: smallpox might exist unofficially somewhere else. A few years ago 181 00:14:55,970 --> 00:14:59,610 Speaker 1: employees of the US National Institutes of Health were clearing 182 00:14:59,650 --> 00:15:02,970 Speaker 1: out a long forgotten storeroom when they came across some 183 00:15:03,050 --> 00:15:08,330 Speaker 1: cardboard boxes. Inside were vials packed in white cotton with 184 00:15:08,450 --> 00:15:14,370 Speaker 1: faded labor. Just one word was legible, veryola. It was 185 00:15:14,450 --> 00:15:19,570 Speaker 1: freeze dried smallpox virus from the nineteen fifties, still quite 186 00:15:19,650 --> 00:15:24,290 Speaker 1: capable of infecting someone. The vials were safely destroyed. A 187 00:15:24,330 --> 00:15:29,930 Speaker 1: problem in inventory control came the embarrassed explanation, who knows 188 00:15:29,970 --> 00:15:34,930 Speaker 1: if there are undiscovered inventory problems elsewhere? There was certainly 189 00:15:34,970 --> 00:15:37,770 Speaker 1: plenty of smallpox around. At the end of the Cold War. 190 00:15:38,490 --> 00:15:41,370 Speaker 1: The Soviet Union made up to a hundred tons a 191 00:15:41,490 --> 00:15:46,650 Speaker 1: year for specially designed biological weapons. Thankfully they were never used. 192 00:15:48,650 --> 00:15:53,090 Speaker 1: When the Soviet Union collapsed. Was all that smallpox carefully 193 00:15:53,090 --> 00:15:57,570 Speaker 1: accounted for? We can't be sure. And now it's becoming 194 00:15:57,650 --> 00:16:01,130 Speaker 1: easier and cheaper to make all kinds of pathogens in 195 00:16:01,170 --> 00:16:05,770 Speaker 1: the lab. In twenty seventeen, researchers caused a stir by 196 00:16:05,850 --> 00:16:10,890 Speaker 1: synthesizing the horsepox virus, harmless to us but closely related 197 00:16:10,930 --> 00:16:15,050 Speaker 1: to smallpox. The same year, Bill Gates warned that the 198 00:16:15,090 --> 00:16:19,170 Speaker 1: next epidemic could be a terrorist using genetic engineering to 199 00:16:19,170 --> 00:16:23,010 Speaker 1: create a synthetic version of the smallpox virus. Bill Gates, 200 00:16:23,610 --> 00:16:27,050 Speaker 1: He's been right before, and if smallpox might come back, 201 00:16:27,250 --> 00:16:31,010 Speaker 1: the argument goes, we should keep researching it. Medical knowledge 202 00:16:31,010 --> 00:16:34,010 Speaker 1: is advancing all the time, and we want better vaccines. 203 00:16:34,250 --> 00:16:37,890 Speaker 1: The current ones not safe for pregnant women or cancer survivors. 204 00:16:38,370 --> 00:16:42,410 Speaker 1: It's a little risky for everyone else. Destroy those remaining 205 00:16:42,490 --> 00:16:48,170 Speaker 1: smallpox samples and research gets trickier. It's a conundrum. There's 206 00:16:48,210 --> 00:16:56,450 Speaker 1: no easy answer. Back in Boston, seventeen twenty one, at 207 00:16:56,490 --> 00:16:59,730 Speaker 1: three o'clock in the morning, a bomb has been hurled 208 00:16:59,770 --> 00:17:03,210 Speaker 1: at the window of the unsuspecting household of Cotton Mava, 209 00:17:04,130 --> 00:17:06,730 Speaker 1: But the window at which the bomb is aimed has 210 00:17:06,770 --> 00:17:10,970 Speaker 1: an iron casement. The bomb hits, Matt knocks out the fuse, 211 00:17:11,330 --> 00:17:18,090 Speaker 1: which fizzles and dies without igniting the turpentine and gunpowder. Instead, 212 00:17:18,810 --> 00:17:22,210 Speaker 1: the iron ball thuds harmlessly to the floor next to 213 00:17:22,290 --> 00:17:29,050 Speaker 1: a bed containing Cotton. Mather's startled nephew, so mother survived 214 00:17:29,090 --> 00:17:31,690 Speaker 1: to write to his friends at the Royal Society in London, 215 00:17:32,010 --> 00:17:36,650 Speaker 1: describing the inoculation efforts at Doctor Boylstone. London was in 216 00:17:36,690 --> 00:17:39,610 Speaker 1: the midst of its own smallpox outbreak and its own 217 00:17:39,650 --> 00:17:43,450 Speaker 1: dispute about inoculation. They had seen, of course, the same 218 00:17:43,490 --> 00:17:47,730 Speaker 1: account as Mather in the Philosophical Transactions describing the customs 219 00:17:47,730 --> 00:17:53,810 Speaker 1: in Constantinople. What's more, Lady Mary Wortley Montague had actually 220 00:17:53,850 --> 00:17:58,450 Speaker 1: lived in Constantinople, had her own children inoculated, and now 221 00:17:58,610 --> 00:18:01,450 Speaker 1: she was back in London urging others to do the same. 222 00:18:02,970 --> 00:18:06,690 Speaker 1: Few were ready to listen. Lady Mary was not a doctor. 223 00:18:07,330 --> 00:18:11,610 Speaker 1: She was also not a man, but she was determined, 224 00:18:11,770 --> 00:18:14,490 Speaker 1: and she was friends with Princess Caroline, wife of the 225 00:18:14,570 --> 00:18:18,450 Speaker 1: future King George the Second. They persuaded the current king 226 00:18:18,530 --> 00:18:23,450 Speaker 1: to sanction a few experiments on prisoners and orphans. Medical 227 00:18:23,490 --> 00:18:27,250 Speaker 1: ethics have evolved a bit since then. The results were promising, 228 00:18:27,290 --> 00:18:32,330 Speaker 1: but small scale cotton. Mather's report from Boston was perfectly 229 00:18:32,330 --> 00:18:36,610 Speaker 1: timed to strengthen the case. Five days after his letter 230 00:18:36,770 --> 00:18:40,690 Speaker 1: was read to the Royal Society, Princess Caroline had her 231 00:18:40,770 --> 00:18:46,170 Speaker 1: daughters inoculated. Two The Royal Society invited Boylston to London 232 00:18:46,250 --> 00:18:49,730 Speaker 1: to discuss his work. Two hundred and eighty two people 233 00:18:49,810 --> 00:18:53,770 Speaker 1: had been inoculated in the Boston area. Six had died. 234 00:18:55,050 --> 00:18:58,210 Speaker 1: The Society advertised for doctors in England to send in 235 00:18:58,250 --> 00:19:02,290 Speaker 1: their accounts. Added up the numbers and they were remarkably similar. 236 00:19:02,570 --> 00:19:05,930 Speaker 1: A death rate from inoculation of a little over two percent. 237 00:19:06,650 --> 00:19:10,570 Speaker 1: That's not a trivial risk. It was vastly lower than 238 00:19:10,610 --> 00:19:14,610 Speaker 1: the death rate from smallpox itself. So the seventeen twenties 239 00:19:14,650 --> 00:19:18,650 Speaker 1: all this was groundbreaking stuff, the first known example of 240 00:19:18,730 --> 00:19:23,090 Speaker 1: statistics being used to evaluate what was effectively a clinical trial. 241 00:19:23,930 --> 00:19:28,250 Speaker 1: So the practice spread. Even the top Boston doctor who 242 00:19:28,250 --> 00:19:32,050 Speaker 1: had said it was wicked and criminal, grudgingly started to 243 00:19:32,090 --> 00:19:40,410 Speaker 1: inoculate his patients. At the end of the eighteenth century, 244 00:19:40,650 --> 00:19:43,970 Speaker 1: there was a breakthrough in safety. An English doctor named 245 00:19:44,090 --> 00:19:47,930 Speaker 1: Edward Jenner had noticed that having cow pox made you 246 00:19:47,970 --> 00:19:51,810 Speaker 1: immune to smallpox, and cow pox was a far less 247 00:19:51,930 --> 00:19:57,370 Speaker 1: dangerous disease. Jenna thought, if he inoculated someone with cow pox, 248 00:19:57,650 --> 00:20:01,290 Speaker 1: wouldn't that make them immune to smallpox too. It did, 249 00:20:01,970 --> 00:20:05,250 Speaker 1: and unlike the traditional inoculation, it didn't have a two 250 00:20:05,290 --> 00:20:09,530 Speaker 1: percent chance of killing you. The Latin for cow is vacca, 251 00:20:10,130 --> 00:20:14,650 Speaker 1: hence the term vaccine. Jenna knew he had made a 252 00:20:14,690 --> 00:20:19,650 Speaker 1: big discovery. The vaccine, he said, could extirpate smallpox from 253 00:20:19,690 --> 00:20:24,450 Speaker 1: the earth. That was optimistic, but in nineteen sixty seven, 254 00:20:24,490 --> 00:20:27,930 Speaker 1: the World Health Organization raised funds for a ten year 255 00:20:28,010 --> 00:20:31,490 Speaker 1: program to make it happen. There were still over ten 256 00:20:31,570 --> 00:20:35,090 Speaker 1: million cases a year in countries where mass vaccination was 257 00:20:35,130 --> 00:20:39,530 Speaker 1: a challenge, so the smallpox eradication program's first task was 258 00:20:39,570 --> 00:20:43,530 Speaker 1: to get vaccines into those hard to reach places, and then, 259 00:20:43,850 --> 00:20:46,530 Speaker 1: when cases were few enough, to send a team to 260 00:20:46,610 --> 00:20:51,450 Speaker 1: every new smallpox case and track every contact until the 261 00:20:51,530 --> 00:20:56,530 Speaker 1: virus at last had nobody left to infect. The end 262 00:20:56,570 --> 00:21:05,930 Speaker 1: of smallpox is one of human kind's greatest achievements. I 263 00:21:05,970 --> 00:21:09,730 Speaker 1: started this mini series of COVID themed tale with a 264 00:21:09,810 --> 00:21:14,570 Speaker 1: confession I hadn't seen the current crisis coming. I interviewed 265 00:21:14,570 --> 00:21:18,290 Speaker 1: an epidemiologist back in February twenty twenty who told me 266 00:21:18,330 --> 00:21:20,770 Speaker 1: the pandemic was on its way, that the death rate 267 00:21:20,850 --> 00:21:23,930 Speaker 1: might be one percent or maybe half, that most of 268 00:21:23,970 --> 00:21:27,570 Speaker 1: the world might get it. I believed her, and I 269 00:21:27,730 --> 00:21:30,090 Speaker 1: never imagined that it might lead to the shutting down 270 00:21:30,130 --> 00:21:35,330 Speaker 1: of societies and a deep economic recession. Perhaps I shouldn't 271 00:21:35,370 --> 00:21:39,090 Speaker 1: be too hard on myself. Perhaps it wasn't really obvious. 272 00:21:39,410 --> 00:21:42,770 Speaker 1: Back in two thousand and one, the organizers of Operation 273 00:21:42,930 --> 00:21:46,930 Speaker 1: Dark Winter had been interested to explore how far decision 274 00:21:46,930 --> 00:21:50,410 Speaker 1: makers would be willing to go. Among the uncertainties, should 275 00:21:50,690 --> 00:21:54,930 Speaker 1: national travel restrictions be imposed, how can disease containment best 276 00:21:54,970 --> 00:21:58,770 Speaker 1: be balanced against economic disruption and the protection of civil liberties? 277 00:21:59,250 --> 00:22:04,810 Speaker 1: And this was smallpox, So no, it really wasn't obvious 278 00:22:04,850 --> 00:22:07,490 Speaker 1: what price would be willing to pay to contain a 279 00:22:07,570 --> 00:22:11,690 Speaker 1: virus like the one that is COVID nineteen. It turns 280 00:22:11,690 --> 00:22:15,930 Speaker 1: out that price is high. That's a new data point, 281 00:22:16,410 --> 00:22:19,570 Speaker 1: and it's an interesting one for rogue states and terrorists, 282 00:22:19,770 --> 00:22:23,170 Speaker 1: say experts like Ellen Laipson, the former vice chair of 283 00:22:23,210 --> 00:22:27,610 Speaker 1: the US National Intelligence Council. They will have learned, she writes, 284 00:22:28,250 --> 00:22:31,450 Speaker 1: that nothing is more destructive to the modern liberal order 285 00:22:32,010 --> 00:22:35,690 Speaker 1: than a biological agent. They'll have learned that to bring 286 00:22:35,850 --> 00:22:39,970 Speaker 1: societies and economies to a crunching halt, you don't need 287 00:22:40,010 --> 00:22:43,970 Speaker 1: a pathogen that's as dangerous as smallpox. You don't even 288 00:22:44,010 --> 00:22:48,810 Speaker 1: need one that's as dangerous as a smallpox inoculation. I 289 00:22:48,930 --> 00:22:53,010 Speaker 1: asked in an earlier episode, what if COVID nineteen is 290 00:22:53,050 --> 00:22:56,530 Speaker 1: the warning, And to be more specific, what if it's 291 00:22:56,530 --> 00:23:00,130 Speaker 1: a warning that the next pandemic might not be an 292 00:23:00,130 --> 00:23:05,610 Speaker 1: accident but let's not get ahead of ourselves. First, we've 293 00:23:05,610 --> 00:23:08,370 Speaker 1: got to get on top of this pandemic. And here 294 00:23:08,490 --> 00:23:12,930 Speaker 1: the story of smallpox is both cautionary and inspiring. It 295 00:23:13,050 --> 00:23:17,050 Speaker 1: shows that humans can beat diseases, and how by following 296 00:23:17,050 --> 00:23:20,850 Speaker 1: the example of Zabdiel, Boylstone and Mary Wortley Montague, an 297 00:23:20,970 --> 00:23:24,890 Speaker 1: openness to new thinking, no matter its source, a willingness 298 00:23:24,930 --> 00:23:28,770 Speaker 1: to take risks, the determination to collect good data, and 299 00:23:28,850 --> 00:23:31,690 Speaker 1: the courage to follow where the data lead even as 300 00:23:31,730 --> 00:23:35,010 Speaker 1: people panic around you. And then, by learning from the 301 00:23:35,130 --> 00:23:40,010 Speaker 1: who's small Pox of Adication Program, sheer logistical effort to 302 00:23:40,090 --> 00:23:43,050 Speaker 1: roll out the solutions to the places where they're needed most. 303 00:23:43,970 --> 00:23:47,850 Speaker 1: But it also shows something else that victory over disease 304 00:23:48,410 --> 00:23:52,770 Speaker 1: can't be final. Even when we think we've won, we 305 00:23:52,850 --> 00:24:03,050 Speaker 1: can never afford to relax. This was the final episode 306 00:24:03,090 --> 00:24:06,210 Speaker 1: of this mini season of Cautionary Tales. Thank you so 307 00:24:06,290 --> 00:24:08,650 Speaker 1: much for listening. I'll be back later this year with more. 308 00:24:09,090 --> 00:24:12,170 Speaker 1: Please stay tuned, leave a review and tell your friends. 309 00:24:13,810 --> 00:24:16,810 Speaker 1: This episode of Cautionary Tales as a debt to Stephen 310 00:24:16,890 --> 00:24:20,850 Speaker 1: Coss's book The Fever of seventeen twenty one. Ibraham ex 311 00:24:20,930 --> 00:24:24,570 Speaker 1: Kendy's book Stamped from the Beginning, and an article about 312 00:24:24,730 --> 00:24:28,730 Speaker 1: Dark Winter written by Tara O'Toole, Michael Mayer, and Thomas Ingoldsby. 313 00:24:29,370 --> 00:24:31,650 Speaker 1: For a full list of our sources, please see the 314 00:24:31,690 --> 00:24:37,250 Speaker 1: show notes at Tim Harford dot com. Cautionary Tales is 315 00:24:37,250 --> 00:24:40,410 Speaker 1: written and presented by me Tim Harford, with help from 316 00:24:40,410 --> 00:24:43,490 Speaker 1: Andrew Wright. The show was produced by Ryan Dilley with 317 00:24:43,570 --> 00:24:47,010 Speaker 1: support from Pete Norton. The music, sound design, and mixing 318 00:24:47,090 --> 00:24:50,210 Speaker 1: are the work of Pascal Wise. The scripts were edited 319 00:24:50,210 --> 00:24:54,330 Speaker 1: by Julia Barton. Special thanks to Mia LaBelle, Carlie Miliori, 320 00:24:54,690 --> 00:25:00,050 Speaker 1: Heather Fane, Maya Kanig, Jacob Weisberg, and Malcolm Gladwell. Cautionary 321 00:25:00,050 --> 00:25:02,490 Speaker 1: Tales is a Pushkin Industry's production