1 00:00:02,460 --> 00:00:03,300 Speaker 1: Happy Saturday. 2 00:00:03,540 --> 00:00:07,020 Speaker 2: Since we mentioned our episode on the eradication of smallpox 3 00:00:07,100 --> 00:00:10,580 Speaker 2: this week, we are bringing it out as today's Saturday classic. 4 00:00:11,160 --> 00:00:14,400 Speaker 2: At the end of this episode, we mentioned guinea worm disease, 5 00:00:14,580 --> 00:00:19,570 Speaker 2: also called draconchioliasis, as a disease that could potentially be eradicated. 6 00:00:20,310 --> 00:00:23,690 Speaker 2: According to the World Health Organization, in 2025, there were 7 00:00:23,690 --> 00:00:31,090 Speaker 2: 10 reported cases of draconchioliasis. There were 15 in 2024, 8 00:00:31,090 --> 00:00:34,300 Speaker 2: 14 in 2023, and. 9 00:00:33,260 --> 00:00:34,180 Speaker 1: 13 in 2022. 10 00:00:34,180 --> 00:00:38,330 Speaker 2: This episode originally came out September 1st, 2021. Enjoy! 11 00:00:41,170 --> 00:00:44,150 Speaker 1: Welcome to Stuff You Missed in History Class, a production 12 00:00:44,250 --> 00:00:45,330 Speaker 1: of iHeartRadio. 13 00:00:51,810 --> 00:00:54,730 Speaker 2: Hello and welcome to the podcast. I'm Tracy V. 14 00:00:54,770 --> 00:00:56,300 Speaker 1: Wilson. And I'm Holly Frey. 15 00:00:57,330 --> 00:01:00,710 Speaker 2: Late March of last year, I researched and wrote our 16 00:01:00,770 --> 00:01:05,110 Speaker 2: episode on the eradication of render pests. Because in that moment, 17 00:01:05,150 --> 00:01:07,089 Speaker 2: it just felt really weird to me to work on 18 00:01:07,190 --> 00:01:12,200 Speaker 2: episodes that were not about the pandemic somehow. Because that 19 00:01:12,240 --> 00:01:16,740 Speaker 2: was dominating everything in our lives. But at the same time, 20 00:01:16,800 --> 00:01:19,420 Speaker 2: I wanted to work on something that felt kind of optimistic. 21 00:01:20,160 --> 00:01:24,500 Speaker 2: Because the pandemic was dominating our lives. So now it's 22 00:01:24,700 --> 00:01:28,319 Speaker 2: almost a year and a half later. Here in the U.S., 23 00:01:28,400 --> 00:01:33,310 Speaker 2: we had a pretty hopeful springtime regarding the progress of 24 00:01:33,370 --> 00:01:35,770 Speaker 2: the pandemic. I know that was not the case in 25 00:01:35,810 --> 00:01:39,709 Speaker 2: the whole world, but we had what was looking like 26 00:01:40,130 --> 00:01:45,450 Speaker 2: improved situations. That obviously has taken a turn once again 27 00:01:45,510 --> 00:01:49,540 Speaker 2: for the worst, or at least the worst, maybe not 28 00:01:49,580 --> 00:01:53,190 Speaker 2: the worst of ever, but definitely worse. I wanted to 29 00:01:53,220 --> 00:01:56,010 Speaker 2: kind of return to the idea of wiping a disease 30 00:01:56,070 --> 00:02:00,090 Speaker 2: off the face of the earth. So, rinderpest and smallpox 31 00:02:00,130 --> 00:02:03,110 Speaker 2: are the only two diseases that have been eradicated through 32 00:02:03,170 --> 00:02:07,470 Speaker 2: human activity. Neither one of them is technically extinct because 33 00:02:07,490 --> 00:02:10,570 Speaker 2: there are some samples of both viruses that still exist 34 00:02:10,610 --> 00:02:14,070 Speaker 2: in labs. They're no longer circulating out in the wild, though. 35 00:02:14,680 --> 00:02:17,859 Speaker 2: And we've talked about smallpox a bit on the show before. 36 00:02:17,900 --> 00:02:20,650 Speaker 2: We had our episode on Edward Jenner and the smallpox 37 00:02:20,690 --> 00:02:23,990 Speaker 2: vaccine and how the vaccine was developed and then Jenner's 38 00:02:24,110 --> 00:02:25,030 Speaker 2: efforts to try. 39 00:02:24,870 --> 00:02:26,750 Speaker 1: To make it more widely available. 40 00:02:27,490 --> 00:02:31,329 Speaker 2: More recently, we did the episode on the Royal Philanthropic 41 00:02:31,470 --> 00:02:34,790 Speaker 2: Vaccine Expedition, and that was all about Spain's efforts to 42 00:02:34,870 --> 00:02:38,769 Speaker 2: transport the smallpox vaccine to the Americas, which required a 43 00:02:38,850 --> 00:02:40,329 Speaker 2: chain of living human hosts. 44 00:02:41,220 --> 00:02:41,880 Speaker 1: We mentioned. 45 00:02:42,830 --> 00:02:46,549 Speaker 2: pretty briefly, the eradication of smallpox in both of those episodes, 46 00:02:46,590 --> 00:02:50,970 Speaker 2: but we have not gone into detail about how that happened. 47 00:02:51,720 --> 00:02:55,480 Speaker 2: That's what we're going to talk about today. And when 48 00:02:55,580 --> 00:02:57,860 Speaker 2: Tracy mentioned it to me, I said, we've covered that. 49 00:02:58,100 --> 00:03:00,720 Speaker 1: Nope. It just keeps coming up. It just keeps coming up. 50 00:03:01,160 --> 00:03:03,780 Speaker 2: We've said in like a sentence how it was done, 51 00:03:03,880 --> 00:03:07,140 Speaker 2: but it's more than a sentence worth of explanation. Yeah. Yeah. 52 00:03:08,419 --> 00:03:12,010 Speaker 1: It's just, it's been... just peppered in enough that my 53 00:03:12,050 --> 00:03:15,630 Speaker 1: brain was like, yeah, that was an episode, right? Nope. Nope. 54 00:03:16,270 --> 00:03:19,830 Speaker 1: So smallpox is a viral disease that has existed for millennia. 55 00:03:20,389 --> 00:03:23,000 Speaker 1: When it was circulating in the wild, it spread from 56 00:03:23,030 --> 00:03:27,240 Speaker 1: person to person through the air, usually through face-to-face contact, 57 00:03:27,600 --> 00:03:30,299 Speaker 1: and it can also be spread through contact with contaminated 58 00:03:30,480 --> 00:03:35,640 Speaker 1: objects and surfaces. People who contracted smallpox typically developed a 59 00:03:35,700 --> 00:03:38,260 Speaker 1: high fever and body aches, and that was followed by 60 00:03:38,300 --> 00:03:42,170 Speaker 1: a distinctive rash. There are two different strains of the 61 00:03:42,210 --> 00:03:47,140 Speaker 1: variola virus that were causing smallpox, variola major and variola minor. 62 00:03:47,800 --> 00:03:52,080 Speaker 1: As that name suggests, variola major caused more serious illnesses. 63 00:03:52,240 --> 00:03:55,190 Speaker 1: As many as a third of people who were infected 64 00:03:55,230 --> 00:03:58,430 Speaker 1: with variola major died. As many as 90% of babies died. 65 00:04:00,720 --> 00:04:04,720 Speaker 2: It was also particularly lethal anytime it was introduced somewhere 66 00:04:04,760 --> 00:04:08,000 Speaker 2: that it hadn't existed before, such as when Europeans started 67 00:04:08,060 --> 00:04:11,980 Speaker 2: arriving in the Americas. And in those cases, smallpox usually 68 00:04:12,040 --> 00:04:15,760 Speaker 2: killed about half the people who contracted it. Among the 69 00:04:15,780 --> 00:04:19,260 Speaker 2: people who survived the disease, smallpox could also be both 70 00:04:19,360 --> 00:04:20,840 Speaker 2: disabling and disfiguring. 71 00:04:21,820 --> 00:04:26,220 Speaker 1: There was and is no cure for smallpox. So even 72 00:04:26,339 --> 00:04:29,760 Speaker 1: as science and medicine progressed, it continued to be deadly. 73 00:04:30,360 --> 00:04:32,400 Speaker 1: but it also had some traits that made it a 74 00:04:32,460 --> 00:04:37,279 Speaker 1: good candidate for a worldwide eradication campaign. Smallpox was easy 75 00:04:37,360 --> 00:04:41,120 Speaker 1: to recognize and diagnose, unlike, say, the flu, which can 76 00:04:41,160 --> 00:04:45,760 Speaker 1: resemble a lot of other respiratory infections. Smallpox passed directly 77 00:04:45,839 --> 00:04:49,490 Speaker 1: from person to person and only infected humans, so there 78 00:04:49,550 --> 00:04:52,510 Speaker 1: were no hidden reservoirs of the virus that could potentially 79 00:04:52,570 --> 00:04:56,670 Speaker 1: start a new outbreak. That's different from something like yellow fever, 80 00:04:56,730 --> 00:05:00,880 Speaker 1: which also infects other primates, and is transmitted by mosquitoes. 81 00:05:01,680 --> 00:05:05,640 Speaker 1: Another plus, once a person had recovered from smallpox, they 82 00:05:05,660 --> 00:05:09,789 Speaker 1: were immune for life. For a number of reasons, smallpox 83 00:05:10,000 --> 00:05:15,370 Speaker 1: outbreaks also tended to develop relatively slowly. Once people were contagious, 84 00:05:15,430 --> 00:05:18,470 Speaker 1: they were usually also too sick to really leave home, 85 00:05:18,730 --> 00:05:22,089 Speaker 1: so outbreaks tended to cluster around members of the same 86 00:05:22,190 --> 00:05:26,099 Speaker 1: household and their immediate neighborhood. And then once an outbreak 87 00:05:26,140 --> 00:05:30,080 Speaker 1: was identified, swift action could keep it from spreading very far. 88 00:05:30,810 --> 00:05:34,450 Speaker 1: And most importantly, there was a way to disrupt transmission 89 00:05:34,490 --> 00:05:38,330 Speaker 1: of the disease, in this case, a vaccine. In terms 90 00:05:38,370 --> 00:05:42,289 Speaker 1: of the smallpox vaccine, at first, people prevented smallpox using 91 00:05:42,330 --> 00:05:47,470 Speaker 1: a technique called variolation that involved intentionally introducing material from 92 00:05:47,610 --> 00:05:52,640 Speaker 1: one person's smallpox sore or scab into another person. Practitioners 93 00:05:52,700 --> 00:05:55,640 Speaker 1: in Asia were doing this as early as the 11th century, 94 00:05:56,080 --> 00:05:59,219 Speaker 1: and the technique spread from there. Then, in the late 95 00:05:59,480 --> 00:06:02,839 Speaker 1: 18th century, people started to make a connection between smallpox 96 00:06:03,320 --> 00:06:06,980 Speaker 1: and another much milder disease that was called cowpox. The 97 00:06:07,020 --> 00:06:11,660 Speaker 1: smallpox and cowpox viruses are both in the genus Orthopoxvirus, 98 00:06:11,880 --> 00:06:16,140 Speaker 1: and people who had contracted cowpox seemed immune to smallpox. 99 00:06:16,820 --> 00:06:21,419 Speaker 1: Several people, including Edward Jenner, tried deliberately exposing people to cowpox, 100 00:06:22,210 --> 00:06:26,050 Speaker 1: as a way to prevent smallpox. Jenner called this vaccination 101 00:06:26,270 --> 00:06:27,810 Speaker 1: after the Latin word for cow. 102 00:06:28,550 --> 00:06:33,390 Speaker 2: So both variolation and vaccination could prevent smallpox, but since 103 00:06:33,450 --> 00:06:38,790 Speaker 2: variolation could also cause full-blown smallpox, vaccination was a lot safer. 104 00:06:39,510 --> 00:06:43,370 Speaker 2: At the same time, though, vaccination in its earliest forms 105 00:06:43,470 --> 00:06:47,539 Speaker 2: carried some of the same risks that variolation did, including 106 00:06:47,580 --> 00:06:51,820 Speaker 2: the potential for transmitting other illnesses like syphilis and hepatitis 107 00:06:51,920 --> 00:06:57,039 Speaker 2: from person to person during these person-to-person vaccination chains. Sometime 108 00:06:57,080 --> 00:07:00,820 Speaker 2: in the 19th century, people shifted from using cowpox to 109 00:07:00,960 --> 00:07:04,900 Speaker 2: using vaccinia virus, which is another orthopox virus, to make 110 00:07:04,960 --> 00:07:09,860 Speaker 2: smallpox vaccine. The origins of the vaccinia virus are unclear. 111 00:07:10,040 --> 00:07:12,660 Speaker 2: It is possible that it's actually some kind of hybrid 112 00:07:12,740 --> 00:07:16,470 Speaker 2: of cowpox and and smallpox, or that it developed over 113 00:07:16,510 --> 00:07:20,290 Speaker 2: time as cowpox virus was passed through multiple hosts in 114 00:07:20,330 --> 00:07:26,120 Speaker 2: the process of making vaccines. Eventually, vaccinia virus replaced cowpox 115 00:07:26,180 --> 00:07:30,700 Speaker 2: virus for vaccination purposes, just as vaccination with cowpox had 116 00:07:30,780 --> 00:07:36,420 Speaker 2: previously replaced variolation with smallpox itself. At first, vaccines made 117 00:07:36,440 --> 00:07:39,620 Speaker 2: with vaccinia virus were grown in the skin of live 118 00:07:39,820 --> 00:07:44,410 Speaker 2: animals like calves, sheep, and rabbits. Eventually, that shifted to 119 00:07:44,470 --> 00:07:47,770 Speaker 2: growing the virus in tissue cultures or in chicken eggs. 120 00:07:48,550 --> 00:07:52,850 Speaker 2: These methods replaced those arm-to-arm vaccination chains that we talked 121 00:07:52,890 --> 00:07:56,410 Speaker 2: about in our episode on the Royal Philanthropic Vaccine Expedition. 122 00:07:57,050 --> 00:08:01,000 Speaker 2: Countries actually started to outlaw arm-to-arm vaccinations in the late 123 00:08:01,190 --> 00:08:05,100 Speaker 2: 19th century. Many of the vaccinia strains used to make 124 00:08:05,160 --> 00:08:09,520 Speaker 2: vaccines were attenuated or weakened by repeatedly passing them through 125 00:08:09,640 --> 00:08:14,920 Speaker 2: a non-human host. things like chick embryo cells, eggs, or mice. 126 00:08:15,580 --> 00:08:18,380 Speaker 2: This process resulted in a virus that produced an immune 127 00:08:18,440 --> 00:08:21,520 Speaker 2: response when a person was vaccinated with it, but couldn't 128 00:08:21,580 --> 00:08:24,990 Speaker 2: reproduce in that person's body and make them sick. So 129 00:08:25,010 --> 00:08:28,610 Speaker 2: while vaccination with cowpox virus was safer than variolation with 130 00:08:28,670 --> 00:08:33,510 Speaker 2: smallpox virus, vaccination with an attenuated version of vaccinia virus 131 00:08:33,850 --> 00:08:39,089 Speaker 2: was also safer than vaccination with live, unattenuated cowpox. Yeah, 132 00:08:39,130 --> 00:08:43,550 Speaker 2: there were still potentials for various complications, but this was 133 00:08:43,590 --> 00:08:47,979 Speaker 2: an improvement overall. It really didn't take long after the 134 00:08:48,000 --> 00:08:52,000 Speaker 2: development of vaccines for people to wonder whether vaccines could 135 00:08:52,020 --> 00:08:56,570 Speaker 2: be used to eliminate smallpox entirely. But early attempts to 136 00:08:56,620 --> 00:08:59,670 Speaker 2: do this faced a lot of obstacles. As we talked 137 00:08:59,730 --> 00:09:03,280 Speaker 2: about in our episode on the Royal Philanthropic Vaccine Expedition, 138 00:09:03,620 --> 00:09:08,040 Speaker 2: early versions of smallpox vaccine lost their potency really quickly, 139 00:09:08,140 --> 00:09:11,580 Speaker 2: especially in hot weather. And that continued to be true 140 00:09:11,880 --> 00:09:16,520 Speaker 2: after vaccinia replaced cowpox as the preferred virus for smallpox vaccines. 141 00:09:17,520 --> 00:09:21,490 Speaker 2: But then in the 1940s, people started working on dehydrated 142 00:09:21,630 --> 00:09:25,690 Speaker 2: and freeze-dried versions of the vaccine. The Vaccine Institute in 143 00:09:25,750 --> 00:09:30,050 Speaker 2: Paris produced a freeze-dried, vacuum-packed vaccine that had a longer 144 00:09:30,090 --> 00:09:34,340 Speaker 2: shelf life. In the 1950s, Leslie Harold Collier at the 145 00:09:34,380 --> 00:09:37,880 Speaker 2: Lister Institute studied the preservation methods that were in use 146 00:09:37,960 --> 00:09:40,940 Speaker 2: and how effective they were, and he developed a process 147 00:09:40,960 --> 00:09:45,860 Speaker 2: that didn't require refrigeration, even in tropical temperatures. Once the 148 00:09:45,900 --> 00:09:49,160 Speaker 2: vaccine was reconstituted, it still had a short shelf life, 149 00:09:49,660 --> 00:09:51,969 Speaker 2: but until that point, it could survive in the field 150 00:09:52,020 --> 00:09:56,100 Speaker 2: for months. It also protected people from smallpox infection for 151 00:09:56,140 --> 00:09:59,569 Speaker 2: at least 10 years and offered protection against dying of 152 00:09:59,610 --> 00:10:03,890 Speaker 2: smallpox for some time after that. Collier's method eventually became 153 00:10:03,929 --> 00:10:07,420 Speaker 2: the World Health Organization standard for vaccine used for the 154 00:10:07,460 --> 00:10:13,709 Speaker 2: eradication campaign. Smallpox was eliminated in North America in 1952 155 00:10:13,710 --> 00:10:17,230 Speaker 2: and in Europe in 1953. And that was done primarily 156 00:10:17,309 --> 00:10:20,729 Speaker 2: through mass vaccination campaigns, especially ones that were done in 157 00:10:20,790 --> 00:10:24,640 Speaker 2: response to outbreaks. And this success came in spite of 158 00:10:24,840 --> 00:10:29,980 Speaker 2: increasing resistance to vaccines and to compulsory vaccine programs. In 159 00:10:30,000 --> 00:10:33,840 Speaker 2: the United States, this resistance led to a Supreme Court 160 00:10:33,920 --> 00:10:38,240 Speaker 2: case in 1905, The city of Cambridge, Massachusetts, had been 161 00:10:38,290 --> 00:10:41,819 Speaker 2: trying to stop a smallpox outbreak and had ordered all 162 00:10:41,960 --> 00:10:45,240 Speaker 2: adults to be vaccinated or to pay a $ 5 fine. 163 00:10:45,940 --> 00:10:49,840 Speaker 2: Henning Jacobson refused to be vaccinated, and then after being fined, 164 00:10:49,900 --> 00:10:52,219 Speaker 2: he took the matter to court. In the words of 165 00:10:52,240 --> 00:10:56,080 Speaker 2: the court's decision, quote, the liberty secured by the Constitution 166 00:10:56,120 --> 00:10:59,260 Speaker 2: of the United States does not import an absolute right 167 00:10:59,380 --> 00:11:02,300 Speaker 2: in each person to be at all times and in 168 00:11:02,360 --> 00:11:06,750 Speaker 2: all circumstances wholly freed from restraint. nor is it an 169 00:11:06,830 --> 00:11:10,030 Speaker 2: element in such liberty that one person or a minority 170 00:11:10,050 --> 00:11:13,830 Speaker 2: of persons residing in any community and enjoying the benefits 171 00:11:13,870 --> 00:11:17,449 Speaker 2: of local government should have power to dominate the majority 172 00:11:17,530 --> 00:11:20,670 Speaker 2: when supported in their action by the authority of the state. 173 00:11:21,510 --> 00:11:23,510 Speaker 2: It is within the police power of a state to 174 00:11:23,580 --> 00:11:26,580 Speaker 2: enact a compulsory vaccination law, and it is for the 175 00:11:26,640 --> 00:11:29,400 Speaker 2: legislature and not for the courts to determine in the 176 00:11:29,440 --> 00:11:32,980 Speaker 2: first instance whether vaccination is or is not the best 177 00:11:33,040 --> 00:11:36,080 Speaker 2: mode for the prevention of smallpox, and the protection of 178 00:11:36,100 --> 00:11:39,720 Speaker 2: the public health. We'll get some more on the campaign 179 00:11:39,760 --> 00:11:43,110 Speaker 2: to eradicate smallpox in the rest of the world after 180 00:11:43,140 --> 00:11:56,730 Speaker 2: a sponsor break. The World Health Organization's decision-making body is 181 00:11:56,770 --> 00:12:01,569 Speaker 2: called the World Health Assembly. And in 1953, the WHA 182 00:12:01,710 --> 00:12:05,650 Speaker 2: didn't consider smallpox to be a candidate for global eradication. 183 00:12:05,690 --> 00:12:09,130 Speaker 2: It just wasn't a priority. But five years later, a 184 00:12:09,510 --> 00:12:14,390 Speaker 2: delegate to the WHA proposed a 10-year eradication plan. That 185 00:12:14,470 --> 00:12:18,670 Speaker 2: delegate was Professor Viktor Zhdanov, who was deputy health minister 186 00:12:18,700 --> 00:12:23,209 Speaker 2: of the Soviet Union. And this proposal included vaccine donations 187 00:12:23,270 --> 00:12:26,929 Speaker 2: that would be provided by the USSR. But even with 188 00:12:26,970 --> 00:12:30,350 Speaker 2: the promise of donated vaccines, this proposal still didn't pass. 189 00:12:30,830 --> 00:12:33,270 Speaker 2: At the time, the World Health Organization was working on 190 00:12:33,290 --> 00:12:37,070 Speaker 2: an anti-malaria program, and that was really just drawing most 191 00:12:37,110 --> 00:12:42,410 Speaker 2: of the focus. In 1959, the Soviet Union's proposal was reintroduced, 192 00:12:42,830 --> 00:12:45,630 Speaker 2: and this time it was passed as a voluntary global 193 00:12:45,670 --> 00:12:51,340 Speaker 2: vaccine campaign. Countries where smallpox was endemic, that is, freely circulating, 194 00:12:51,660 --> 00:12:55,310 Speaker 2: were asked to institute mass vaccine programs with a goal 195 00:12:55,390 --> 00:12:59,449 Speaker 2: of vaccinating 80% of their populations. And the countries where 196 00:12:59,490 --> 00:13:02,809 Speaker 2: it wasn't, which were generally richer, were asked to contribute 197 00:13:02,890 --> 00:13:07,530 Speaker 2: funding or vaccines toward the effort. At that point, smallpox 198 00:13:07,570 --> 00:13:11,699 Speaker 2: was being reported in 63 countries, and together those countries 199 00:13:11,770 --> 00:13:18,490 Speaker 2: reported 77,555 cases of the disease. but it became obvious 200 00:13:18,610 --> 00:13:21,859 Speaker 2: really fast that that number was way, way too low. 201 00:13:22,429 --> 00:13:25,980 Speaker 2: For one thing, those 63 countries only included the ones 202 00:13:26,020 --> 00:13:29,480 Speaker 2: that were members of the World Health Organization, and some 203 00:13:29,540 --> 00:13:33,179 Speaker 2: countries where smallpox was endemic were not members at that point, 204 00:13:33,240 --> 00:13:35,820 Speaker 2: and that included China, which had a population of more 205 00:13:35,860 --> 00:13:40,929 Speaker 2: than 660 million people. But even in those 63 countries, 206 00:13:41,050 --> 00:13:44,069 Speaker 2: reporting was all over the place. In countries without a 207 00:13:44,090 --> 00:13:48,420 Speaker 2: lot of public health infrastructure, smallpox cases weren't really being tracked. 208 00:13:48,800 --> 00:13:51,660 Speaker 2: But even in places where that wasn't the case, sometimes 209 00:13:51,720 --> 00:13:55,480 Speaker 2: the only smallpox infections being reported were the ones that 210 00:13:55,520 --> 00:13:59,260 Speaker 2: ended up in hospitals. In reality, the countries where smallpox 211 00:13:59,280 --> 00:14:02,600 Speaker 2: was still endemic in 1959 were home to more than 212 00:14:02,700 --> 00:14:06,370 Speaker 2: half the world's population. And that total number of annual 213 00:14:06,400 --> 00:14:11,130 Speaker 2: cases was probably more like 50 million, not 77,000. This 214 00:14:12,190 --> 00:14:16,830 Speaker 2: voluntary program was focused on national vaccine campaigns And at 215 00:14:16,870 --> 00:14:20,510 Speaker 2: least in theory, each nation's campaign would be tailored for 216 00:14:20,570 --> 00:14:25,550 Speaker 2: its own culture, needs, resources, and infrastructure. But that also 217 00:14:25,610 --> 00:14:29,050 Speaker 2: meant there was really no central strategy at work. The 218 00:14:29,080 --> 00:14:32,680 Speaker 2: World Health Organization's role was mostly just making sure that 219 00:14:32,700 --> 00:14:36,600 Speaker 2: there was enough vaccine available and providing assistance if nations 220 00:14:36,860 --> 00:14:40,720 Speaker 2: asked for it. It wasn't really coordinating efforts or doing 221 00:14:40,760 --> 00:14:44,680 Speaker 2: a lot of tracking and monitoring. And because under-reporting of 222 00:14:44,760 --> 00:14:48,200 Speaker 2: cases continued to be a huge problem, it was almost 223 00:14:48,320 --> 00:14:52,360 Speaker 2: impossible to tell whether these national programs were even working. 224 00:14:53,120 --> 00:14:55,960 Speaker 2: That made it much harder to secure funding or to 225 00:14:56,060 --> 00:15:00,120 Speaker 2: rally support from nations that had already eradicated smallpox within 226 00:15:00,160 --> 00:15:03,450 Speaker 2: their own borders. And for the most part, these early 227 00:15:03,510 --> 00:15:06,710 Speaker 2: national campaigns were not working, at least not very well. 228 00:15:07,470 --> 00:15:10,530 Speaker 2: In many places, success was measured by how many vaccines 229 00:15:10,570 --> 00:15:14,810 Speaker 2: were administered. Sometimes this led vaccinators to go after the 230 00:15:14,910 --> 00:15:18,790 Speaker 2: easiest targets first, like vaccinating all the students at a school. 231 00:15:19,510 --> 00:15:22,250 Speaker 2: But that meant that children in more outlying areas who 232 00:15:22,290 --> 00:15:26,570 Speaker 2: were not attending school were not being vaccinated. Since there 233 00:15:26,690 --> 00:15:30,190 Speaker 2: often weren't clear records, it wasn't unheard of for vaccinators 234 00:15:30,250 --> 00:15:33,820 Speaker 2: to go back to the same school and vaccinate children again, 235 00:15:34,170 --> 00:15:38,780 Speaker 2: even though a successful smallpox vaccine typically left a recognizable scar. 236 00:15:39,700 --> 00:15:42,210 Speaker 2: Because of issues like this, at one point, India was 237 00:15:42,280 --> 00:15:47,070 Speaker 2: reporting a vaccination rate of 140% because so many people 238 00:15:47,130 --> 00:15:51,510 Speaker 2: were being vaccinated more than once. Things moved pretty slowly 239 00:15:51,550 --> 00:15:56,410 Speaker 2: with all this for about five years. But then in 1964, Dr. 240 00:15:56,470 --> 00:16:00,790 Speaker 2: Karel Rashka of Czechoslovakia, who was a huge advocate of 241 00:16:00,850 --> 00:16:05,450 Speaker 2: smallpox eradication, became director of the Division of Communicable Diseases 242 00:16:05,570 --> 00:16:09,940 Speaker 2: at the World Health Organization. In 1965, the World Health 243 00:16:10,020 --> 00:16:15,940 Speaker 2: Organization established a dedicated smallpox eradication unit. And that same year, 244 00:16:16,020 --> 00:16:19,680 Speaker 2: President Lyndon Johnson announced that the United States would start 245 00:16:19,740 --> 00:16:24,100 Speaker 2: supporting the global smallpox eradication program. Soon, the U.S. was 246 00:16:24,140 --> 00:16:27,580 Speaker 2: supporting the work of the Pan American Health Organization in 247 00:16:27,640 --> 00:16:31,840 Speaker 2: South America and also funding major vaccine efforts in Western 248 00:16:31,880 --> 00:16:36,270 Speaker 2: and Central Africa. These years also saw improvements in how 249 00:16:36,330 --> 00:16:41,030 Speaker 2: smallpox vaccines were administered. Most vaccines that people receive today 250 00:16:41,130 --> 00:16:44,270 Speaker 2: are administered as shots. They go into the muscle or 251 00:16:44,340 --> 00:16:48,580 Speaker 2: the subcutaneous skin layer using a needle. But smallpox vaccine 252 00:16:48,640 --> 00:16:52,960 Speaker 2: goes into the skin's superficial layers. By the mid-1960s, there 253 00:16:53,000 --> 00:16:56,040 Speaker 2: were a few different methods for doing this. One was 254 00:16:56,080 --> 00:16:58,760 Speaker 2: to scratch a person's skin with a needle or lancet, 255 00:16:59,200 --> 00:17:01,520 Speaker 2: and another was to repeatedly press the tip of the 256 00:17:01,560 --> 00:17:05,750 Speaker 2: needle into a person's skin. Neither of these methods was 257 00:17:05,830 --> 00:17:09,730 Speaker 2: very precise. Depending on how skilled the vaccinator was, they 258 00:17:09,760 --> 00:17:12,240 Speaker 2: might press the needle too far into the skin or 259 00:17:12,280 --> 00:17:15,840 Speaker 2: not far enough. The amount of vaccine on the needle 260 00:17:16,140 --> 00:17:19,060 Speaker 2: usually depended on things like how deeply it had been 261 00:17:19,200 --> 00:17:23,730 Speaker 2: inserted into the vaccine vial. Excess vaccine was often left 262 00:17:23,810 --> 00:17:26,810 Speaker 2: behind on a person's skin and left to either dry 263 00:17:26,850 --> 00:17:27,990 Speaker 2: there or be wiped away. 264 00:17:28,010 --> 00:17:31,310 Speaker 1: It was kind of wasteful. It's so fascinating to me 265 00:17:31,390 --> 00:17:34,889 Speaker 1: to think about this when I think most of the 266 00:17:34,930 --> 00:17:38,600 Speaker 1: vaccines I've received are like those pre-measured, very carefully, like 267 00:17:38,640 --> 00:17:41,960 Speaker 1: you open the dose and that's it. 268 00:17:42,600 --> 00:17:42,980 Speaker 2: Yeah. 269 00:17:43,200 --> 00:17:45,820 Speaker 1: So the margin for error of it is a little 270 00:17:45,840 --> 00:17:46,920 Speaker 1: bit mind-boggling. 271 00:17:47,280 --> 00:17:49,730 Speaker 2: Yeah. And there are for sure vaccines that are not 272 00:17:49,850 --> 00:17:53,149 Speaker 2: administered with shots at this point, but the shots, at 273 00:17:53,190 --> 00:17:55,889 Speaker 2: least here in the U.S., are the majority of them. 274 00:17:56,210 --> 00:18:00,340 Speaker 1: The standard, yeah. Yeah. Jet injector devices were made to 275 00:18:00,380 --> 00:18:02,830 Speaker 1: try to address some of this and to make vaccinating 276 00:18:02,869 --> 00:18:07,510 Speaker 1: more efficient. In theory, these could vaccinate 1,000 people an hour. 277 00:18:08,130 --> 00:18:11,980 Speaker 1: But in practice, they were limited. Some required electricity to 278 00:18:12,020 --> 00:18:15,390 Speaker 1: work and others were operated with a foot pedal. That 279 00:18:15,410 --> 00:18:18,770 Speaker 1: was clunky. So these were only really practical in places 280 00:18:18,810 --> 00:18:21,129 Speaker 1: where you could bring huge groups of people to one 281 00:18:21,170 --> 00:18:25,429 Speaker 1: location to be vaccinated. Plus, these devices were expensive and 282 00:18:25,450 --> 00:18:27,429 Speaker 1: they were hard to clean and they were prone to 283 00:18:27,470 --> 00:18:28,250 Speaker 1: breaking down. 284 00:18:29,270 --> 00:18:33,850 Speaker 2: But then Dr. Benjamin A. Rubin developed the bifurcated needle, 285 00:18:34,130 --> 00:18:37,960 Speaker 2: which was patented in July of 1965. This was a 286 00:18:38,040 --> 00:18:41,720 Speaker 2: simple needle, and when it was inserted into a vaccine vial, 287 00:18:41,859 --> 00:18:45,690 Speaker 2: it picked up one measured dose of liquid in between 288 00:18:45,730 --> 00:18:49,270 Speaker 2: the two prongs. The prongs themselves were designed to keep 289 00:18:49,310 --> 00:18:52,030 Speaker 2: the needle at the correct angle and depth with a 290 00:18:52,050 --> 00:18:55,790 Speaker 2: person's skin, and the two-pronged structure meant that it needed 291 00:18:55,970 --> 00:18:59,060 Speaker 2: fewer presses into the skin to administer each vaccine. 292 00:18:59,800 --> 00:19:01,880 Speaker 1: This made everything way more efficient. 293 00:19:02,440 --> 00:19:05,919 Speaker 2: One vial of vaccine could be used to vaccinate four 294 00:19:06,040 --> 00:19:09,340 Speaker 2: times as many people, and people could be trained to 295 00:19:09,440 --> 00:19:13,679 Speaker 2: administer the vaccine with the bifurcated needle in about 15 minutes, 296 00:19:14,010 --> 00:19:16,369 Speaker 2: even if they had no previous medical experience. 297 00:19:17,109 --> 00:19:21,030 Speaker 1: Plus, the bifurcated needles were cheap to produce. Although they 298 00:19:21,070 --> 00:19:24,450 Speaker 1: were originally intended to be disposable, at the World Health 299 00:19:24,510 --> 00:19:27,590 Speaker 1: Organization's request, they were made from a steel alloy that 300 00:19:27,609 --> 00:19:38,100 Speaker 1: could hold up Boilable containers were designed so that vaccinators 301 00:19:38,160 --> 00:19:41,200 Speaker 1: could drop used needles into the container as they went 302 00:19:41,609 --> 00:19:43,870 Speaker 1: and boil the whole thing at the end of a shift. 303 00:19:44,869 --> 00:19:49,050 Speaker 2: Also, it was standard practice to clean a person's arm 304 00:19:49,109 --> 00:19:52,040 Speaker 2: with pads that were soaked in alcohol or soap before 305 00:19:52,100 --> 00:19:55,399 Speaker 2: giving them the vaccine. I know every time I've gotten 306 00:19:55,440 --> 00:19:59,179 Speaker 2: a shot, there's been a little alcohol wipe down on 307 00:19:59,200 --> 00:20:03,200 Speaker 2: the injection site. But studies had suggested that this wasn't 308 00:20:03,420 --> 00:20:07,500 Speaker 2: actually removing bacteria or other contaminants. It was just sort 309 00:20:07,520 --> 00:20:11,669 Speaker 2: of moving things around. Studies confirmed that the number of 310 00:20:11,770 --> 00:20:16,790 Speaker 2: complications and secondary infections after smallpox vaccination was the same, 311 00:20:17,270 --> 00:20:21,209 Speaker 2: regardless of whether the vaccine site was wiped down beforehand 312 00:20:21,270 --> 00:20:25,790 Speaker 2: or not. So most vaccination programs, especially in like more 313 00:20:25,840 --> 00:20:30,200 Speaker 2: impoverished areas, dropped this step. And together, all of this 314 00:20:30,320 --> 00:20:34,500 Speaker 2: brought the cost for smallpox vaccination down to about 10 315 00:20:34,500 --> 00:20:39,910 Speaker 2: cents a person. By 1966, smallpox was endemic in 31 countries. 316 00:20:40,290 --> 00:20:43,290 Speaker 2: That was down from the 63 or more reported back 317 00:20:43,869 --> 00:20:47,590 Speaker 2: in 1959. The number of estimated worldwide cases had dropped 318 00:20:47,630 --> 00:20:51,600 Speaker 2: from about 50 million to somewhere between 10 and 15 million, 319 00:20:52,080 --> 00:20:56,220 Speaker 2: although the officially reported tally was still much lower. Somewhere 320 00:20:56,260 --> 00:20:59,659 Speaker 2: between 1.5 and 2 million people were still dying of 321 00:20:59,720 --> 00:21:03,609 Speaker 2: smallpox per year. This was better. obviously, but it was 322 00:21:03,690 --> 00:21:08,109 Speaker 2: also clear that a voluntary vaccination program wasn't going to 323 00:21:08,150 --> 00:21:12,080 Speaker 2: be enough to eradicate smallpox. So the World Health Assembly 324 00:21:12,200 --> 00:21:17,360 Speaker 2: backed a proposal for an intensified smallpox eradication program, which 325 00:21:17,400 --> 00:21:22,010 Speaker 2: would start on January 1st, 1967. Its goal was to 326 00:21:22,130 --> 00:21:27,609 Speaker 2: eradicate smallpox worldwide within 10 years, with the last naturally 327 00:21:27,730 --> 00:21:30,840 Speaker 2: occurring case being found and isolated by December 31, 1976. 328 00:21:30,830 --> 00:21:34,170 Speaker 2: The intensified program was given an initial budget of $ 2. 5 million, 329 00:21:34,190 --> 00:21:42,880 Speaker 2: and this was more money than before. But those 31 330 00:21:42,880 --> 00:21:46,860 Speaker 2: countries where smallpox was still endemic also had neighbors that 331 00:21:46,900 --> 00:21:50,440 Speaker 2: needed to be protected from introduced cases. So this only 332 00:21:50,480 --> 00:21:54,199 Speaker 2: worked out to about. 333 00:21:52,660 --> 00:21:56,369 Speaker 1: $ 50, 000 per country. Donald A. Henderson, who was chief of 334 00:21:56,410 --> 00:22:00,450 Speaker 1: the Centers for Disease Control's Smallpox Eradication Program, was made 335 00:22:00,550 --> 00:22:04,669 Speaker 1: chief medical officer of the Intensified Eradication Program. And in 336 00:22:04,750 --> 00:22:08,169 Speaker 1: his account, this 10-year goal was pretty arbitrary. It had 337 00:22:08,190 --> 00:22:11,670 Speaker 1: been inspired by John F. Kennedy's declaration that the U.S. 338 00:22:11,730 --> 00:22:14,190 Speaker 1: could land a man on the moon within 10 years. 339 00:22:14,930 --> 00:22:18,340 Speaker 1: He also described the World Health Organization as pessimistic about 340 00:22:18,380 --> 00:22:23,480 Speaker 1: the chances of success. WHO Director General Dr. Marcolina Kandao 341 00:22:23,520 --> 00:22:27,700 Speaker 1: was from Brazil and thought smallpox eradication would be impossible 342 00:22:27,820 --> 00:22:31,830 Speaker 1: just in the Amazon basin, much less anywhere else. According 343 00:22:31,869 --> 00:22:35,310 Speaker 1: to Henderson, the World Health Organization wanted an American to 344 00:22:35,390 --> 00:22:38,370 Speaker 1: head the program so that if it failed, the U.S. 345 00:22:38,470 --> 00:22:40,810 Speaker 1: would shoulder some of the blame, rather than all of 346 00:22:40,869 --> 00:22:42,810 Speaker 1: it falling on the WHO. 347 00:22:43,630 --> 00:22:48,930 Speaker 2: I read a write-up that Henderson wrote briefly about this campaign, 348 00:22:49,619 --> 00:22:52,460 Speaker 2: and he had sort of spelled out how it sort 349 00:22:52,500 --> 00:22:55,740 Speaker 2: of seemed like things were happening almost immediately. on a whim, 350 00:22:56,080 --> 00:22:59,400 Speaker 2: and he was like, I'm writing this to disabuse you 351 00:22:59,460 --> 00:23:02,400 Speaker 2: of the notion that there may have been extensive planning 352 00:23:02,440 --> 00:23:07,190 Speaker 2: involved in the outset of this. We will get to 353 00:23:07,250 --> 00:23:11,030 Speaker 2: how this intensified program, even though it still seemed a 354 00:23:11,050 --> 00:23:15,490 Speaker 2: little haphazard, how it successfully eradicated smallpox after another quick 355 00:23:15,530 --> 00:23:29,020 Speaker 2: sponsor break. When the World Health Organization established the Intensified 356 00:23:29,100 --> 00:23:34,160 Speaker 2: Smallpox Eradication Program, smallpox was still endemic in multiple countries 357 00:23:34,240 --> 00:23:39,490 Speaker 2: in Asia, South America, and Sub-Saharan Africa. And especially at first, 358 00:23:39,550 --> 00:23:41,790 Speaker 2: a lot of the financial support and a lot of 359 00:23:41,830 --> 00:23:45,590 Speaker 2: the vaccines for the program were coming from wealthier nations 360 00:23:45,650 --> 00:23:50,020 Speaker 2: where smallpox had already been eradicated, nations like the United States. 361 00:23:50,940 --> 00:23:54,680 Speaker 2: And for these countries, their motive was not just humanitarian. 362 00:23:54,800 --> 00:23:58,160 Speaker 2: There was also a lot of money and politics involved. 363 00:23:59,020 --> 00:24:03,680 Speaker 2: For example, if smallpox was eradicated worldwide, these nations would 364 00:24:03,720 --> 00:24:07,760 Speaker 2: not need to fund vaccination programs in other countries or 365 00:24:07,880 --> 00:24:12,970 Speaker 2: spend money vaccinating their own populations anymore. For wealthier countries, 366 00:24:13,070 --> 00:24:17,850 Speaker 2: these smallpox vaccination programs also served as opportunities to vaccinate 367 00:24:17,890 --> 00:24:21,800 Speaker 2: people for other diseases, and to try to build political 368 00:24:21,980 --> 00:24:26,740 Speaker 2: influence and goodwill in the places where the programs were operating. Also, 369 00:24:26,960 --> 00:24:31,160 Speaker 2: countries where smallpox had been eradicated still occasionally faced outbreaks 370 00:24:31,200 --> 00:24:35,260 Speaker 2: that were usually introduced through travel. Although these tended to 371 00:24:35,300 --> 00:24:38,520 Speaker 2: be very small and quickly contained, they were still disruptive 372 00:24:38,700 --> 00:24:43,750 Speaker 2: and expensive and sometimes sparked a public panic. Global smallpox 373 00:24:43,810 --> 00:24:46,429 Speaker 2: eradication would mean not having to deal with any of 374 00:24:46,490 --> 00:24:49,990 Speaker 2: that anymore. Yeah, there was a lot of self-interest involved 375 00:24:50,050 --> 00:24:54,490 Speaker 2: in the wealthier nations who gave money and vaccine and 376 00:24:54,590 --> 00:24:59,750 Speaker 2: other support to this whole program. Although each nation still 377 00:24:59,790 --> 00:25:03,189 Speaker 2: needed a plan that was customized to its own needs, 378 00:25:03,500 --> 00:25:06,780 Speaker 2: there also needed to be a better unifying strategy behind 379 00:25:06,800 --> 00:25:11,160 Speaker 2: this whole program, something beyond a target of vaccinating 80% 380 00:25:11,160 --> 00:25:12,080 Speaker 2: of the population. 381 00:25:13,160 --> 00:25:13,660 Speaker 1: That number. 382 00:25:14,480 --> 00:25:16,300 Speaker 2: I feel like it keeps getting repeated today as like 383 00:25:16,340 --> 00:25:19,080 Speaker 2: the standard for what is needed, but it had not 384 00:25:19,180 --> 00:25:23,120 Speaker 2: really been based on epidemiology or on public health data. 385 00:25:23,380 --> 00:25:27,000 Speaker 2: It had just seemed like a reasonable operational goal for 386 00:25:27,040 --> 00:25:30,870 Speaker 2: the voluntary program. And it had also become clear that 387 00:25:30,920 --> 00:25:35,369 Speaker 2: the number of vaccines administered did not really work as 388 00:25:35,470 --> 00:25:39,129 Speaker 2: the goal, since teams might wind up vaccinating the same 389 00:25:39,190 --> 00:25:43,290 Speaker 2: people more than once daily. driving up their vaccination numbers 390 00:25:43,350 --> 00:25:47,530 Speaker 2: without actually vaccinating more of the population. One big gap 391 00:25:47,550 --> 00:25:51,430 Speaker 2: that needed to be filled with this was surveillance. Reporting 392 00:25:51,470 --> 00:25:54,370 Speaker 2: methods were still all over the place, and eradication was 393 00:25:54,450 --> 00:25:57,990 Speaker 2: only possible if health officials actually knew when and where 394 00:25:58,100 --> 00:26:01,460 Speaker 2: outbreaks were happening. This was something that just required a 395 00:26:01,540 --> 00:26:05,040 Speaker 2: ton of communication from the World Health Organization and all 396 00:26:05,119 --> 00:26:08,199 Speaker 2: through every level of a nation's government's all the way 397 00:26:08,240 --> 00:26:12,649 Speaker 2: down to individual doctors, hospitals, and community leaders who needed 398 00:26:12,670 --> 00:26:16,170 Speaker 2: to report any suspected cases in order for this to work. 399 00:26:17,130 --> 00:26:21,710 Speaker 2: Another gap was standards for the vaccine itself. The Soviet 400 00:26:21,850 --> 00:26:25,070 Speaker 2: Union and the United States were the two biggest donors 401 00:26:25,230 --> 00:26:30,260 Speaker 2: of vaccines, with the USSR donating 140 million doses a 402 00:26:30,320 --> 00:26:34,380 Speaker 2: year and the United States donating 40 million doses. Other 403 00:26:34,460 --> 00:26:39,119 Speaker 2: countries donated as well, but in smaller amounts. In 1967, 404 00:26:39,119 --> 00:26:43,740 Speaker 2: the World Health Organization asked vaccine manufacturers to submit samples 405 00:26:43,800 --> 00:26:48,940 Speaker 2: of their smallpox vaccine, and only 30% of them met 406 00:26:49,280 --> 00:26:53,790 Speaker 2: WHO standards for quality and potency. Some of the submitted 407 00:26:53,850 --> 00:26:58,170 Speaker 2: vaccine samples did not contain any vaccinia virus at all. 408 00:26:58,510 --> 00:27:02,420 Speaker 2: Others were contaminated with bacteria. This led to the WHO 409 00:27:02,540 --> 00:27:07,179 Speaker 2: establishing more stringent standards for the vaccines and then monitoring 410 00:27:07,240 --> 00:27:10,240 Speaker 2: them to make sure the vaccines actually met those standards. 411 00:27:11,140 --> 00:27:13,899 Speaker 2: As all of this was happening, of course, wars and 412 00:27:14,000 --> 00:27:18,000 Speaker 2: other unrest were making vaccination programs difficult in some places 413 00:27:18,060 --> 00:27:22,229 Speaker 2: where smallpox was still circulating. The Nigerian Civil War began 414 00:27:22,330 --> 00:27:25,530 Speaker 2: in 1967, which made things more dangerous for health workers 415 00:27:25,990 --> 00:27:29,110 Speaker 2: and their patients, and it also led to a vaccine shortage. 416 00:27:29,820 --> 00:27:32,180 Speaker 2: But this shortage also led to a shift in how 417 00:27:32,220 --> 00:27:37,200 Speaker 2: smallpox vaccinations were prioritized. Since there wasn't enough vaccine available 418 00:27:37,240 --> 00:27:41,199 Speaker 2: for the whole population, health officials focused on vaccinating family 419 00:27:41,220 --> 00:27:45,220 Speaker 2: members and other close contacts of anyone who developed smallpox. 420 00:27:45,940 --> 00:27:47,920 Speaker 2: This turned out to be an effective way to stop 421 00:27:47,960 --> 00:27:51,580 Speaker 2: the spread of the disease, and Nigeria's last smallpox case 422 00:27:51,619 --> 00:27:56,690 Speaker 2: was reported in May of 1970. The focus on monitoring 423 00:27:56,810 --> 00:28:00,430 Speaker 2: and reporting cases that was so necessary for the program's 424 00:28:00,470 --> 00:28:04,129 Speaker 2: success also made it easier to see trends in how 425 00:28:04,250 --> 00:28:09,600 Speaker 2: and where smallpox outbreaks developed. Vaccinators started taking better advantage 426 00:28:09,630 --> 00:28:13,280 Speaker 2: of seasonal variations. They would use all that surveillance work 427 00:28:13,320 --> 00:28:16,679 Speaker 2: to trace people's contacts and to vaccinate more people at 428 00:28:16,720 --> 00:28:20,060 Speaker 2: the start of the season when the smallpox case numbers 429 00:28:20,100 --> 00:28:25,230 Speaker 2: were lower to contain those outbreaks before they spread. By 1973, 430 00:28:25,230 --> 00:28:32,150 Speaker 2: smallpox existed in only five countries. Bangladesh, India, Nepal, Pakistan, 431 00:28:32,230 --> 00:28:36,109 Speaker 2: and Ethiopia. Bangladesh had previously been free of the disease, 432 00:28:36,150 --> 00:28:38,830 Speaker 2: but it had been reintroduced there as refugees fled the 433 00:28:38,910 --> 00:28:42,800 Speaker 2: Indo-Pakistani War. And by this point, about 80% of the 434 00:28:42,820 --> 00:28:45,300 Speaker 2: vaccines being used for this effort were being made in 435 00:28:45,320 --> 00:28:48,980 Speaker 2: the countries where they were being administered. And at least 95% 436 00:28:48,980 --> 00:28:52,020 Speaker 2: of the vaccines that the World Health Organization tested met 437 00:28:52,060 --> 00:28:57,650 Speaker 2: its standards. Having only five countries remaining was obviously a 438 00:28:57,830 --> 00:29:03,080 Speaker 2: huge accomplishment. But at the same time, more than 700 439 00:29:03,080 --> 00:29:07,060 Speaker 2: million people lived in Bangladesh, India, Pakistan, and Nepal. They 440 00:29:07,080 --> 00:29:10,960 Speaker 2: were all neighboring countries, and it had become really obvious 441 00:29:11,000 --> 00:29:14,550 Speaker 2: that a mass vaccination program just wasn't going to be 442 00:29:14,690 --> 00:29:18,690 Speaker 2: able to eradicate the disease in this region. These neighboring 443 00:29:18,770 --> 00:29:22,730 Speaker 2: nations had been trying to vaccinate their whole populations for years. 444 00:29:23,290 --> 00:29:27,700 Speaker 2: There were 120,000 health staff working on the program in 445 00:29:27,860 --> 00:29:32,900 Speaker 2: India alone. So the strategy shifted to mirror what had 446 00:29:32,960 --> 00:29:37,470 Speaker 2: actually worked in Nigeria in the late 1960s. Health officials 447 00:29:37,530 --> 00:29:42,240 Speaker 2: quarantined anyone who contracted smallpox. and used extensive contact tracing 448 00:29:42,700 --> 00:29:46,420 Speaker 2: to determine who else might have been exposed. They vaccinated 449 00:29:46,460 --> 00:29:50,520 Speaker 2: their immediate families and the surrounding communities. This became known 450 00:29:50,580 --> 00:29:53,700 Speaker 2: as the ring method, basically making a ring of vaccinated 451 00:29:53,740 --> 00:29:57,480 Speaker 2: people around each active smallpox case so that the disease 452 00:29:57,530 --> 00:30:02,440 Speaker 2: just could not spread. Monitoring and surveillance were critically important 453 00:30:02,480 --> 00:30:05,300 Speaker 2: to this process since health workers could only make a 454 00:30:05,400 --> 00:30:08,840 Speaker 2: vaccinated ring around cases of smallpox that they knew about. 455 00:30:09,440 --> 00:30:15,090 Speaker 2: So health workers traveled from place to place, educating local doctors, healers, leaders, 456 00:30:15,130 --> 00:30:19,630 Speaker 2: and officials about smallpox reporting and seeking out and isolating 457 00:30:20,150 --> 00:30:23,870 Speaker 2: active smallpox cases and then vaccinating anyone who may have 458 00:30:23,910 --> 00:30:28,350 Speaker 2: come into contact with these patients. Using this method, Pakistan 459 00:30:28,390 --> 00:30:32,270 Speaker 2: saw its last reported case of smallpox in October of 1974, 460 00:30:32,270 --> 00:30:39,310 Speaker 2: Nepal in April of 1975, India in May of 1975, 461 00:30:39,310 --> 00:30:45,230 Speaker 2: and Bangladesh in October of 1975. Unfortunately, although Ethiopia's last 462 00:30:45,290 --> 00:30:49,600 Speaker 2: case of smallpox was reported in August of 1976, by 463 00:30:49,660 --> 00:30:53,200 Speaker 2: that point it had been reintroduced into neighboring Somalia, which 464 00:30:53,260 --> 00:30:59,180 Speaker 2: was still experiencing active cases. In 1977, Donald Henderson resigned 465 00:30:59,290 --> 00:31:03,209 Speaker 2: as the head of the Intensified Eradication Program. He was 466 00:31:03,270 --> 00:31:06,530 Speaker 2: replaced by Asao Arita, who had been medical officer of 467 00:31:06,590 --> 00:31:09,830 Speaker 2: infectious disease control in the Ministry of Health and Welfare 468 00:31:09,890 --> 00:31:16,640 Speaker 2: in Japan before joining the World Health Organization. That same year, 1977... 469 00:31:16,640 --> 00:31:20,520 Speaker 2: authorities started trying to contain an outbreak of variola minor 470 00:31:20,760 --> 00:31:24,160 Speaker 2: among nomadic peoples in the desert region that spans parts 471 00:31:24,240 --> 00:31:30,130 Speaker 2: of Ethiopia, Somalia, and Kenya. Smallpox was reintroduced into Kenya, 472 00:31:30,310 --> 00:31:34,750 Speaker 2: but that introduction was quickly contained, and Kenya reported its 473 00:31:34,810 --> 00:31:38,790 Speaker 2: last case in February of 1977. In July of 1977, 474 00:31:40,840 --> 00:31:44,680 Speaker 2: Somalia and Ethiopia went to war over control of part 475 00:31:44,700 --> 00:31:47,760 Speaker 2: of this region, and then that hampered efforts to control 476 00:31:47,800 --> 00:31:52,900 Speaker 2: this ongoing outbreak in Somalia. Somalia actually reported 300 cases 477 00:31:52,940 --> 00:31:56,940 Speaker 2: of smallpox in 1977. The last one was the case 478 00:31:57,000 --> 00:32:00,110 Speaker 2: of Ali Ma'o Malin, who was a cook at Mirka Hospital. 479 00:32:00,770 --> 00:32:05,510 Speaker 2: On October 12, 1977, a driver carrying two smallpox patients 480 00:32:05,550 --> 00:32:08,950 Speaker 2: to an isolation camp stopped at the hospital to ask 481 00:32:08,990 --> 00:32:12,130 Speaker 2: for directions. Malin got into the car and rode with 482 00:32:12,170 --> 00:32:14,979 Speaker 2: them for 15 minutes or less. He did that so 483 00:32:15,020 --> 00:32:16,660 Speaker 2: he could guide them to where the leader of the 484 00:32:16,720 --> 00:32:21,440 Speaker 2: smallpox surveillance team lived. These two patients were siblings, six 485 00:32:21,580 --> 00:32:24,060 Speaker 2: and one and a half years old, and when authorities 486 00:32:24,140 --> 00:32:28,410 Speaker 2: traced their contacts, Malin was overlooked. Although Malin worked in 487 00:32:28,450 --> 00:32:32,710 Speaker 2: a hospital, he wasn't vaccinated against smallpox. In an interview 488 00:32:32,770 --> 00:32:34,730 Speaker 2: later in his life, he said that he had been 489 00:32:34,770 --> 00:32:38,100 Speaker 2: afraid of the vaccine. There are a couple of accounts 490 00:32:38,160 --> 00:32:40,880 Speaker 2: that said that he had been vaccinated, but his vaccine 491 00:32:40,920 --> 00:32:43,840 Speaker 2: hadn't taken, and that disagrees with the interview that he 492 00:32:43,860 --> 00:32:48,310 Speaker 2: gave later. He started feeling sick on October 22nd, 1977, 493 00:32:48,310 --> 00:32:52,370 Speaker 2: and at first doctors thought he had malaria. Then he 494 00:32:52,390 --> 00:32:55,990 Speaker 2: developed a rash on October 26th, and he was initially 495 00:32:56,030 --> 00:32:59,970 Speaker 2: diagnosed with chickenpox. He started to worry that he had 496 00:33:00,070 --> 00:33:04,520 Speaker 2: smallpox on October 29th, and on October 30th, somebody reported 497 00:33:04,560 --> 00:33:07,540 Speaker 2: to health officials that he had a potential smallpox case. 498 00:33:08,300 --> 00:33:11,100 Speaker 2: His diagnosis was confirmed through lab tests that day. 499 00:33:11,780 --> 00:33:15,270 Speaker 1: The effort to prevent Malene's smallpox case from sparking another 500 00:33:15,420 --> 00:33:18,810 Speaker 1: outbreak really demonstrates what was involved in all of this. 501 00:33:19,270 --> 00:33:24,910 Speaker 1: Contact tracing identified 161 possible exposures. some of them as 502 00:33:24,990 --> 00:33:30,440 Speaker 1: far as 120 kilometers away. This included hospital staff, family, 503 00:33:30,580 --> 00:33:33,400 Speaker 1: and friends, many of whom had visited him while he 504 00:33:33,460 --> 00:33:38,560 Speaker 1: was ill. Authorities identified 33 face-to-face contacts who had no 505 00:33:38,660 --> 00:33:42,460 Speaker 1: evidence of prior smallpox infection and had not been vaccinated 506 00:33:42,500 --> 00:33:45,380 Speaker 1: within the past three years, and 12 of those had 507 00:33:45,480 --> 00:33:48,969 Speaker 1: no prior evidence of a smallpox infection or vaccine at all. 508 00:33:50,360 --> 00:33:54,160 Speaker 2: All those people were vaccinated, along with all known and 509 00:33:54,200 --> 00:33:59,160 Speaker 2: possible contacts and their families. During an 18-day surveillance period, 510 00:33:59,280 --> 00:34:03,450 Speaker 2: health workers made multiple in-person visits to each person who 511 00:34:03,490 --> 00:34:07,410 Speaker 2: had potentially been exposed. The number and frequency of those 512 00:34:07,490 --> 00:34:11,489 Speaker 2: visits depended on the person's relative level of exposure and 513 00:34:11,510 --> 00:34:13,330 Speaker 2: their risk. So if they had been around him a 514 00:34:13,670 --> 00:34:17,850 Speaker 2: long time and were not vaccinated, They got multiple different 515 00:34:18,010 --> 00:34:20,830 Speaker 2: visits from the health staff, but if they had been 516 00:34:20,850 --> 00:34:22,650 Speaker 2: vaccinated and it was a shorter time, they might get 517 00:34:22,790 --> 00:34:26,969 Speaker 2: two check-ins. In the end, though, none of those 161 518 00:34:26,969 --> 00:34:28,549 Speaker 2: contacts developed smallpox. 519 00:34:29,340 --> 00:34:33,320 Speaker 1: But it did not stop with those 161 contacts. Warning 520 00:34:33,380 --> 00:34:36,460 Speaker 1: signs were posted at Merca Hospital, which was placed under 521 00:34:36,480 --> 00:34:40,840 Speaker 1: 24-hour guard. Vaccines were administered to everyone who worked at 522 00:34:40,860 --> 00:34:44,239 Speaker 1: the hospital and all of the patients. Patients in the 523 00:34:44,280 --> 00:34:47,890 Speaker 1: surgical ward were quarantined until November 13th, and in the 524 00:34:47,930 --> 00:34:51,990 Speaker 1: medical ward, they were quarantined until November 17th. The hospital 525 00:34:52,090 --> 00:34:57,670 Speaker 1: also suspended all non-emergency care, referred outpatient procedures to other facilities, 526 00:34:57,950 --> 00:35:02,359 Speaker 1: and required daily temperature checks for patients and staff. There 527 00:35:02,400 --> 00:35:05,860 Speaker 1: was also a mass vaccination campaign in the ward of 528 00:35:05,900 --> 00:35:10,029 Speaker 1: the city where Malene lived and the hospital was. This 529 00:35:10,070 --> 00:35:14,150 Speaker 1: was a multi-phase process with vaccinators going house to house 530 00:35:14,210 --> 00:35:17,259 Speaker 1: to vaccinate everyone and to look for any signs of 531 00:35:17,320 --> 00:35:21,549 Speaker 1: smallpox cases and then returning to vaccinate anybody who had 532 00:35:21,610 --> 00:35:25,319 Speaker 1: arrived since the last pass or whose first vaccines showed 533 00:35:25,400 --> 00:35:28,920 Speaker 1: no evidence of a vaccine scar. Once that ward of. 534 00:35:28,900 --> 00:35:31,660 Speaker 2: The city was done, health workers did the same for 535 00:35:31,700 --> 00:35:35,339 Speaker 2: the rest of the city. Checkpoints were established at all 536 00:35:35,400 --> 00:35:39,310 Speaker 2: the roads and footpaths leading into Merca and Anyone who 537 00:35:39,350 --> 00:35:42,399 Speaker 2: was coming or going was advised of this possible outbreak. 538 00:35:42,600 --> 00:35:45,680 Speaker 2: They vaccinated everybody who was passing through. And then on 539 00:35:45,739 --> 00:35:48,040 Speaker 2: top of all of that, there was a massive public 540 00:35:48,100 --> 00:35:53,040 Speaker 2: information campaign with a reward for reporting smallpox cases. In 541 00:35:53,080 --> 00:35:56,469 Speaker 2: the end, Ali Maomalin was the last person to contract 542 00:35:56,550 --> 00:36:01,009 Speaker 2: naturally occurring smallpox. That was 10 years, 9 months, and 543 00:36:01,010 --> 00:36:04,350 Speaker 2: 26 days after the start of the intensified eradication campaign. 544 00:36:04,739 --> 00:36:07,950 Speaker 2: So it just barely missed that 10-year goal, even if 545 00:36:08,010 --> 00:36:13,850 Speaker 2: it had been arbitrary. After recovering from smallpox, Malin later 546 00:36:13,910 --> 00:36:17,190 Speaker 2: became part of the effort to eradicate polio, working as 547 00:36:17,250 --> 00:36:21,359 Speaker 2: a vaccinator and organizing door-to-door campaigns. He would share his 548 00:36:21,560 --> 00:36:24,219 Speaker 2: own story about how he had been afraid to be 549 00:36:24,260 --> 00:36:27,980 Speaker 2: vaccinated for smallpox and then had ultimately become the last 550 00:36:28,080 --> 00:36:33,520 Speaker 2: smallpox patient. Somalia was declared free of polio in 2007, 551 00:36:33,520 --> 00:36:37,750 Speaker 2: but it re-emerged there in 2013. When that happened, Malin 552 00:36:37,930 --> 00:36:41,390 Speaker 2: went back to his vaccinating work. He suddenly became ill 553 00:36:41,469 --> 00:36:44,890 Speaker 2: not long afterward, and he died on July 22, 2013, 554 00:36:44,890 --> 00:36:47,890 Speaker 2: of what was diagnosed as malaria. 555 00:36:48,750 --> 00:36:51,450 Speaker 1: But the last person to die of smallpox contracted it 556 00:36:51,710 --> 00:36:56,080 Speaker 1: after Malin did. That was Janet Parker, a medical photographer 557 00:36:56,140 --> 00:36:59,420 Speaker 1: who was infected on the job at England's Birmingham University 558 00:36:59,460 --> 00:37:04,529 Speaker 1: Medical School in 1978. The microbiology lab was one floor 559 00:37:04,570 --> 00:37:07,029 Speaker 1: below her darkroom in the office that she used to 560 00:37:07,070 --> 00:37:11,049 Speaker 1: make phone calls. It is not clear exactly how she 561 00:37:11,090 --> 00:37:14,549 Speaker 1: came into contact with smallpox virus from the lab. At 562 00:37:14,590 --> 00:37:17,610 Speaker 1: the time, the prevailing theory was that it was through 563 00:37:17,650 --> 00:37:20,989 Speaker 1: a shared air vent, but later studies suggested that that 564 00:37:21,030 --> 00:37:25,629 Speaker 1: was actually unlikely. Parker had been vaccinated for smallpox, but 565 00:37:25,710 --> 00:37:29,060 Speaker 1: as we mentioned earlier, the vaccine's protection was expected to 566 00:37:29,100 --> 00:37:32,140 Speaker 1: last for about 10 years, and she had been vaccinated 567 00:37:32,180 --> 00:37:36,620 Speaker 1: back in 1966. The strain she was exposed to was 568 00:37:36,739 --> 00:37:41,940 Speaker 1: also a particularly deadly one. Her mother, Hilda Whitcomb, contracted 569 00:37:42,000 --> 00:37:46,620 Speaker 1: smallpox while caring for her, but she recovered. But Janet's father, Frederick, 570 00:37:46,719 --> 00:37:51,040 Speaker 1: died of an apparent heart attack while in quarantine. Hilda 571 00:37:51,080 --> 00:37:55,030 Speaker 1: missed both his and Janet's funerals because of her own illness. 572 00:37:55,810 --> 00:38:00,469 Speaker 1: Health workers quarantined hundreds of people who had possibly been exposed, 573 00:38:00,930 --> 00:38:04,049 Speaker 1: and at least 500 people were vaccinated to keep this 574 00:38:04,190 --> 00:38:08,210 Speaker 1: outbreak from spreading any further. This lab had been scheduled 575 00:38:08,230 --> 00:38:11,300 Speaker 1: to close as the World Health Organization tried to reduce 576 00:38:11,340 --> 00:38:14,440 Speaker 1: the number of facilities that had samples of the virus. 577 00:38:15,219 --> 00:38:18,060 Speaker 1: Although the lab had previously been inspected and was allowed 578 00:38:18,080 --> 00:38:21,360 Speaker 1: to continue operation... it didn't have a lot of basic 579 00:38:21,420 --> 00:38:25,219 Speaker 1: safety measures in place to contain deadly pathogens. Things like 580 00:38:25,300 --> 00:38:29,760 Speaker 1: changing facilities, dedicated showers, and airlocks. It also had been 581 00:38:29,780 --> 00:38:33,790 Speaker 1: the source of another smallpox case, also involving a medical photographer, 582 00:38:34,210 --> 00:38:35,410 Speaker 1: back in 1966. 583 00:38:35,410 --> 00:38:39,350 Speaker 2: It really seems like when they inspected the lab and 584 00:38:39,390 --> 00:38:41,410 Speaker 2: they were like, it doesn't have all these things that 585 00:38:41,430 --> 00:38:45,419 Speaker 2: we recommend to control potential spread of pathogens, but like 586 00:38:45,640 --> 00:38:49,290 Speaker 2: only three people work here, so it's probably fine. This 587 00:38:49,350 --> 00:38:54,320 Speaker 2: became a huge scandal later. The lab's director, Dr. Henry Bedsen, 588 00:38:54,380 --> 00:38:56,279 Speaker 2: had been trying to finish as much of his work 589 00:38:56,340 --> 00:39:00,460 Speaker 2: as possible before the lab was closed. He blamed himself 590 00:39:00,500 --> 00:39:03,089 Speaker 2: for Parker's illness and took his own life a few 591 00:39:03,110 --> 00:39:07,910 Speaker 2: days before her death, which was on September 11, 1978. 592 00:39:07,910 --> 00:39:11,550 Speaker 2: As this was happening, health officials were still closely monitoring 593 00:39:11,630 --> 00:39:15,800 Speaker 2: other countries to confirm that smallpox was no longer circulating there. 594 00:39:16,570 --> 00:39:20,930 Speaker 2: On October 26, 1979, A ceremony was held in Nairobi 595 00:39:21,010 --> 00:39:24,120 Speaker 2: to announce that smallpox had been eradicated in the Horn 596 00:39:24,160 --> 00:39:27,839 Speaker 2: of Africa. That was two years after Ali Ma'aumaline had 597 00:39:27,920 --> 00:39:32,360 Speaker 2: first developed a smallpox rash. On December 9, 1979, the 598 00:39:32,400 --> 00:39:38,460 Speaker 2: Global Commission for the Certification of Smallpox Eradication declared smallpox eradicated. 599 00:39:38,480 --> 00:39:42,630 Speaker 2: And on May 8, 1980, the World Health Organization confirmed 600 00:39:42,690 --> 00:39:47,360 Speaker 2: the disease's eradication. There's been some stuff floating around social 601 00:39:47,400 --> 00:39:51,080 Speaker 2: media lately about how this was only possible because everyone 602 00:39:51,160 --> 00:39:55,030 Speaker 2: did their part, either implying or just flat out saying 603 00:39:55,610 --> 00:39:59,509 Speaker 2: that everybody accepted the vaccine during this process. But that 604 00:39:59,570 --> 00:40:02,870 Speaker 2: is just not true. There was a lot of resistance 605 00:40:02,910 --> 00:40:07,430 Speaker 2: and hesitancy, especially in campaigns to vaccinate children. A lot 606 00:40:07,450 --> 00:40:09,629 Speaker 2: of parents just didn't want to do something that might 607 00:40:09,710 --> 00:40:13,070 Speaker 2: hurt their child or make them sick. The process of 608 00:40:13,540 --> 00:40:16,939 Speaker 2: Administering the vaccine also evolved over the years, and some 609 00:40:17,000 --> 00:40:20,560 Speaker 2: parents had had, like, pretty traumatic vaccine experiences that they 610 00:40:20,700 --> 00:40:24,770 Speaker 2: didn't want repeated with their child. Anti-vaccine activists such as 611 00:40:24,950 --> 00:40:28,870 Speaker 2: Lily Lote, who worked for the National Anti-Vaccination League and 612 00:40:29,010 --> 00:40:34,130 Speaker 2: edited its journal, distributed literature against vaccines in general and 613 00:40:34,170 --> 00:40:39,050 Speaker 2: against the smallpox vaccine specifically well into this eradication effort. 614 00:40:39,950 --> 00:40:43,390 Speaker 2: Aside from that, because earlier versions of the smallpox vaccine 615 00:40:43,410 --> 00:40:46,649 Speaker 2: were grown in the skin of live animals, animal rights 616 00:40:46,770 --> 00:40:51,850 Speaker 2: activists and anti-vivisectionists objected to their use. When methods progressed 617 00:40:51,890 --> 00:40:55,790 Speaker 2: to using tissue cultures, mistrust of science led people to 618 00:40:55,850 --> 00:40:59,690 Speaker 2: object to this method as well. In places like India, 619 00:40:59,930 --> 00:41:03,190 Speaker 2: smallpox vaccination had been a routine part of the public 620 00:41:03,230 --> 00:41:07,350 Speaker 2: health service since 1947, and yet there were still outbreaks 621 00:41:07,410 --> 00:41:10,969 Speaker 2: for decades after that. This led people to claim that 622 00:41:11,030 --> 00:41:14,469 Speaker 2: the vaccine was worthless, or even that it was what 623 00:41:14,530 --> 00:41:18,640 Speaker 2: had been causing the smallpox. Nations stopped vaccinating people for 624 00:41:18,680 --> 00:41:22,140 Speaker 2: smallpox once the disease had been eradicated from within their borders, 625 00:41:22,430 --> 00:41:26,140 Speaker 2: and in some people, this just reinforced that perception. Like, 626 00:41:26,840 --> 00:41:29,819 Speaker 2: there were no vaccines happening anymore. That must be why 627 00:41:29,840 --> 00:41:34,120 Speaker 2: there's no smallpox happening anymore. There were also religious objections 628 00:41:34,180 --> 00:41:39,590 Speaker 2: to smallpox vaccinations. Various peoples and cultures interpreted smallpox as 629 00:41:39,670 --> 00:41:43,590 Speaker 2: coming from divine will, or interpreted existing methods of smallpox 630 00:41:43,650 --> 00:41:48,049 Speaker 2: prevention or treatment as religiously significant. And most of the 631 00:41:48,090 --> 00:41:51,540 Speaker 2: last nations to eradicate smallpox were the same ones that 632 00:41:51,580 --> 00:41:54,640 Speaker 2: had a long history of being colonized and exploited by 633 00:41:54,739 --> 00:41:59,900 Speaker 2: European powers. So people were understandably suspicious of this largely 634 00:41:59,980 --> 00:42:04,219 Speaker 2: Western-led public health effort. So the global eradication of smallpox 635 00:42:04,280 --> 00:42:08,040 Speaker 2: happened in spite of hesitancy and resistance, not in the 636 00:42:08,180 --> 00:42:15,050 Speaker 2: absence of it. So that is how smallpox was finally eradicated. 637 00:42:15,070 --> 00:42:16,730 Speaker 2: It does still exist in a couple of labs. There 638 00:42:16,750 --> 00:42:20,250 Speaker 2: have been ongoing conversations about destroying those remaining stocks, and 639 00:42:20,410 --> 00:42:24,750 Speaker 2: it keeps getting postponed. I would really like it if 640 00:42:24,850 --> 00:42:29,160 Speaker 2: we as a global society could get control of the 641 00:42:29,420 --> 00:42:33,420 Speaker 2: COVID-19 pandemic, because unless. 642 00:42:33,120 --> 00:42:34,540 Speaker 1: The Carter Center program. 643 00:42:35,450 --> 00:42:40,070 Speaker 2: successfully eradicates guinea worm disease in the immediate future. We 644 00:42:40,310 --> 00:42:43,830 Speaker 2: don't have any more eradications of diseases to cover on 645 00:42:43,870 --> 00:42:48,009 Speaker 2: this show when I need an optimistic story related to 646 00:42:48,070 --> 00:42:48,450 Speaker 2: all this. 647 00:42:49,170 --> 00:42:54,170 Speaker 1: Right. That would be great to report as a history 648 00:42:54,210 --> 00:42:57,819 Speaker 1: in the making, but fingers crossed. 649 00:43:03,460 --> 00:43:06,460 Speaker 2: Thanks so much for joining us on this Saturday. If 650 00:43:06,480 --> 00:43:08,420 Speaker 2: you'd like to send us a note, our email address 651 00:43:08,480 --> 00:43:13,610 Speaker 2: is historypodcast at iheartradio.com. And you can subscribe to the 652 00:43:13,640 --> 00:43:17,029 Speaker 2: show on the iHeartRadio app, Apple Podcasts, or wherever you 653 00:43:17,070 --> 00:43:18,430 Speaker 2: listen to your favorite shows.