WEBVTT - Smallpox: Gone but Not Forgotten from Incubation 0:00:01.960 --> 0:00:05.160 Hey, it's Jacob and I've been working on another podcast 0:00:05.280 --> 0:00:09.639 that's just coming out. It's called Incubation, and it's about viruses. 0:00:09.920 --> 0:00:12.920 It's about how viruses attack us, how we fight back, 0:00:13.240 --> 0:00:16.240 and what humanity has learned in the course of fighting 0:00:16.239 --> 0:00:19.680 with viruses for hundreds of years. In each episode, we'll 0:00:19.720 --> 0:00:23.160 tell you the story of one virus. The first episode 0:00:23.200 --> 0:00:27.960 starts with a particularly nasty virus, smallpox. You can listen 0:00:27.960 --> 0:00:31.240 to Incubation wherever you get your podcasts. Here's the show. 0:00:31.480 --> 0:00:32.239 I hope you like it. 0:00:36.040 --> 0:00:39.960 We heard a lot about coronaviruses over the past few years, 0:00:40.000 --> 0:00:44.239 really a lot, maybe too much, definitely more than we 0:00:44.280 --> 0:00:47.240 ever expected to hear, but we heard a lot less 0:00:47.320 --> 0:00:55.640 about other viruses, and viruses are amazing. Viruses are older 0:00:55.640 --> 0:01:00.560 than animals, they're older than plants. Some scientists thinkviruses may 0:01:00.560 --> 0:01:04.399 be the origin of all life on Earth. Viruses have 0:01:04.480 --> 0:01:09.720 been infecting humans, sometimes invisibly, sometimes with terrible consequences, for 0:01:09.760 --> 0:01:13.319 as long as there have been humans. The story of 0:01:13.400 --> 0:01:16.720 viruses is the story of humanity's survival as a species, 0:01:17.160 --> 0:01:19.640 and we're going to tell some of those viral stories 0:01:19.680 --> 0:01:23.959 on this podcast. I'm Jacob Goldstein and This is Incubation, 0:01:24.360 --> 0:01:27.840 a show about the other viruses. It's about science and 0:01:27.880 --> 0:01:31.759 about culture. It's about how viruses attack people and how 0:01:31.800 --> 0:01:36.200 people fight back. On each episode of Incubation, we're going 0:01:36.280 --> 0:01:39.440 to tell the story of one virus, and we're starting 0:01:39.480 --> 0:01:43.720 off with one of the deadliest viruses in history, smallpox. 0:01:44.319 --> 0:01:48.639 Smallpox stalked humanity for thousands of years. It gave people 0:01:48.760 --> 0:01:52.680 rashes and blisters all over their bodies, and often it 0:01:52.800 --> 0:01:57.920 killed them. Smallpox killed hundreds of millions of people, but 0:01:58.120 --> 0:02:04.880 we humans fought back in profound and brilliant ways. Our 0:02:04.920 --> 0:02:08.080 episode today starts with the story of Edward Jenner, a 0:02:08.160 --> 0:02:11.560 doctor in the British countryside, and it ends centuries later 0:02:11.840 --> 0:02:15.160 with thousands of people working together to wipe smallpox from 0:02:15.160 --> 0:02:20.080 the face of the earth. My first guest today is 0:02:20.160 --> 0:02:23.560 Gareth Williams. He's the author of Angel of Death, The 0:02:23.639 --> 0:02:27.520 Story of Smallpox, and Gareth he knows a lot about 0:02:27.639 --> 0:02:28.280 Edward Jenner. 0:02:28.800 --> 0:02:33.520 He was a great fields naturalist, and he also worked 0:02:33.520 --> 0:02:37.120 at something about the migration of birds, which was completely 0:02:37.200 --> 0:02:40.160 unknown before that. People thought that swallows went off and 0:02:40.240 --> 0:02:43.440 hid in mud under riverbanks and things like this. 0:02:43.639 --> 0:02:46.320 I read that he built a hydrogen balloon that flew 0:02:46.360 --> 0:02:50.560 twelve miles. That he played the violin, that he wrote poetry. 0:02:50.680 --> 0:02:52.600 He did only above. He played the flute. I think 0:02:52.680 --> 0:02:54.520 rather beten. He played the fiddle. He sang, He had 0:02:54.520 --> 0:02:57.000 a good singing voice. I can recite one of his 0:02:57.120 --> 0:02:58.600 poems if you'd like it. 0:02:58.680 --> 0:03:00.000 Of course, give it to my mony. 0:03:01.840 --> 0:03:04.760 That he wrote it when a man called doctor Weight 0:03:05.240 --> 0:03:10.079 died and doctor Weight had made medicinal gingerbread biscuits gingerbread nuts, 0:03:10.320 --> 0:03:14.120 which not only tasted good, but actually killed intestinal worms. 0:03:14.240 --> 0:03:16.960 Talking about tapeworms and things that round to twenty feet 0:03:17.040 --> 0:03:18.720 or more. So, here's a put on the death of 0:03:18.720 --> 0:03:21.120 doctor Weight. It begins with the Latin names of the 0:03:21.120 --> 0:03:27.320 worms ascarides, tearies, Lumbricki, and all the kyle sucking insects 0:03:27.320 --> 0:03:31.600 that tremblingly crawl. No more, be afraid you're quite safe 0:03:31.600 --> 0:03:34.800 in our guts, for Dr Weight has finished making his 0:03:34.920 --> 0:03:36.800 gingerbread nuts. 0:03:37.960 --> 0:03:42.600 So in addition to writing poems about nuts, non trivially, 0:03:42.680 --> 0:03:47.160 Jenner also invented the first vaccine in human history. Let's 0:03:47.160 --> 0:03:48.880 talk about that. That's really what we're here to talk 0:03:48.920 --> 0:03:52.960 about today. He's born in seventeen forty nine. He's growing 0:03:53.040 --> 0:03:54.960 up in England in the you know, second half of 0:03:55.000 --> 0:03:58.560 the seventeen hundreds. What would his experience of small parks. 0:03:58.320 --> 0:04:01.880 Have been in Jenna's day? If you got smallpox and 0:04:02.080 --> 0:04:04.760 you had roughly a one in three chance of getting 0:04:04.760 --> 0:04:07.240 it during your lifetime, then you had about a one 0:04:07.280 --> 0:04:10.480 in four chance of being killed by it. He went 0:04:10.520 --> 0:04:12.760 to boarding school when he was eight. Both his parents 0:04:12.800 --> 0:04:16.080 had died by then, and he had to be protected 0:04:16.080 --> 0:04:19.080 against smallpox which had broken out nearby. 0:04:19.520 --> 0:04:21.360 And this thing happens to him where somebody, if I 0:04:21.440 --> 0:04:26.360 understand right, cuts open his arm and puts dried out 0:04:26.440 --> 0:04:30.640 pus from a smallpox patient into the cut on Jenner's arm. 0:04:31.080 --> 0:04:31.960 What's going on here? 0:04:32.839 --> 0:04:37.039 This was what was called variolation. And variola is the 0:04:37.120 --> 0:04:40.360 Latin word for speckled or spotted. It's the old name 0:04:40.400 --> 0:04:42.919 for smallpox, and it's the name of the virus that 0:04:43.000 --> 0:04:46.799 causes small pox, of Variola virus. And in brief, variolation 0:04:47.000 --> 0:04:51.760 was giving healthy people, usually children, the real thing, in 0:04:51.839 --> 0:04:55.680 the hope that the artificial infection wouldn't kill them, and 0:04:55.760 --> 0:04:59.440 that it would somehow leave them protected against future attacks 0:04:59.480 --> 0:05:03.360 of nature re acquired smallpox. It was about a one 0:05:03.360 --> 0:05:07.160 in fifty mortality, so very very much lower. You got 0:05:07.160 --> 0:05:08.960 a little bit of small pox puss from one of 0:05:09.000 --> 0:05:12.880 those revolting blisters that covered people in the tens and thousands, 0:05:13.480 --> 0:05:16.960 and you would scratch a little bit of that revolting 0:05:17.040 --> 0:05:19.719 fluid into the skin on the arm of a healthy child. 0:05:20.440 --> 0:05:21.159 Does it work? 0:05:21.800 --> 0:05:27.480 It's mad, bad, crazy, dangerous, sounds completely counterintuitive. The amazing 0:05:27.480 --> 0:05:29.919 thing is it did work, very much so. And the 0:05:29.960 --> 0:05:32.600 other thing is that if you were vari related, even 0:05:32.640 --> 0:05:37.000 if you survived while you had your artificial dose of smallpox, 0:05:37.080 --> 0:05:39.840 you had the real thing. So even though you might 0:05:39.960 --> 0:05:41.920 get over it in two or three weeks, you could 0:05:42.000 --> 0:05:46.320 spread it to other non immune people. You had people 0:05:46.320 --> 0:05:49.680 going back into the community causing little mini outbreaks of 0:05:49.720 --> 0:05:52.960 small pox and killing lots of other people bi collateral damage. 0:05:53.160 --> 0:05:53.600 Wow. 0:05:54.800 --> 0:05:58.240 So okay, So this is the world Jenner is born 0:05:58.320 --> 0:06:02.840 into the world where you can either get smallpox and 0:06:02.920 --> 0:06:05.040 a good chance of dying from it if you get it, 0:06:05.800 --> 0:06:08.719 or if you're sort of lucky in a weird way, 0:06:08.760 --> 0:06:12.240 you can get violated and have a non trivial chance 0:06:12.360 --> 0:06:15.520 of getting and dying of small pox and maybe spreading 0:06:15.520 --> 0:06:16.159 it to other people. 0:06:16.200 --> 0:06:16.640 That was it. 0:06:16.680 --> 0:06:19.960 Those were the options. Absolutely, How does he go from 0:06:20.000 --> 0:06:22.279 being an eight year old boy getting very related to 0:06:22.360 --> 0:06:24.200 inventing the first vaccine in the world. 0:06:24.560 --> 0:06:28.200 Okay, if you want the conventional story, yeah. 0:06:28.080 --> 0:06:29.440 I feel like you're going to give me two stories. 0:06:29.480 --> 0:06:29.880 What is it? 0:06:30.000 --> 0:06:32.480 Jenner classic, So give me gener classic. 0:06:32.920 --> 0:06:35.800 The gender classic is he is a medical apprentice in 0:06:35.839 --> 0:06:40.240 his early teens and he meets a milkmaid smallpox has 0:06:40.360 --> 0:06:44.440 reappeared nearby, and she allegedly says to him, look, Gov, 0:06:44.520 --> 0:06:46.919 you don't need to worry about me having that, because 0:06:47.360 --> 0:06:49.680 I've had cowpox and that means that I can never 0:06:49.720 --> 0:06:54.040 ever catch smallpox. And this was complete news to January'd 0:06:54.080 --> 0:06:56.760 never come across it. But it was also complete news 0:06:56.760 --> 0:06:59.960 to all his teachers. It simply wasn't part of conventional 0:07:00.080 --> 0:07:03.520 medical knowledge. It was common knowledge in the farming community. 0:07:03.920 --> 0:07:06.120 It was folk knowledge that had not sort of crossed 0:07:06.200 --> 0:07:09.200 over to kind of high brow medical knowledge. 0:07:09.320 --> 0:07:11.680 A lot of people didn't want to believe it because 0:07:11.680 --> 0:07:13.080 it had come up from the peasantry. 0:07:13.920 --> 0:07:16.880 Interesting, so you're saying that's kind of the classic tale. 0:07:16.920 --> 0:07:17.760 Do you think it's true. 0:07:18.720 --> 0:07:22.080 I'd like to believe it's true. The alternative story is 0:07:22.120 --> 0:07:25.960 that one of Jenna's medical colleagues in Thornbury was actually 0:07:25.960 --> 0:07:31.120 a varulator, very successful one, and he noted, apparently independently, 0:07:31.680 --> 0:07:35.280 that some people that evarulated the e varulation didn't take. 0:07:36.000 --> 0:07:38.160 In otherwords, there was no sign that they'd caught this 0:07:38.280 --> 0:07:42.560 artificial dose of smallpox. And this man was called John Fuster. 0:07:43.440 --> 0:07:45.560 And story B if you like, is that it was 0:07:45.600 --> 0:07:49.520 actually Feuster who made the original observation. Jenna was a 0:07:49.520 --> 0:07:52.800 close friend of his, and Jenna may have decided to 0:07:52.800 --> 0:07:54.880 pick up on it. Feusa didn't want to pursue it 0:07:55.200 --> 0:07:57.400 because he was making so much money as a valulator. 0:07:57.440 --> 0:08:00.360 He didn't see the need for any particular improved. 0:08:01.080 --> 0:08:05.560 Okay, so Jenner has this idea, whether it's from the 0:08:05.560 --> 0:08:11.360 milkmaid or from his colleague, this idea that cowpox, which 0:08:11.400 --> 0:08:14.400 we should say is not a deadly disease in humans, right, 0:08:15.000 --> 0:08:20.160 can protect humans against a small pox. What does he 0:08:20.200 --> 0:08:21.520 do with this idea. 0:08:22.560 --> 0:08:25.040 Well, he doesn't do anything with it for over thirty years. 0:08:25.240 --> 0:08:28.320 He goes off he finishes his medical studies in London. 0:08:28.720 --> 0:08:33.479 In seventeen ninety six, he gets the idea of collecting 0:08:33.640 --> 0:08:37.160 cases of people who've had cowpox and look to see 0:08:37.200 --> 0:08:41.360 if they appear to be protected against smallpox. And he 0:08:41.400 --> 0:08:43.959 collects a number of cases and the story appears to 0:08:44.000 --> 0:08:46.880 be true. And then he moves beyond that to actually 0:08:46.920 --> 0:08:50.560 test the hypothesis that giving somebody an artificial dose of 0:08:50.600 --> 0:08:55.080 cowpox will protect them against smallpox. The killer and his 0:08:55.160 --> 0:09:00.280 first guinea pig is his gardener's son, James Phipps. And 0:09:00.920 --> 0:09:04.320 the ethics might be regarded as a bit dodgy, because 0:09:04.320 --> 0:09:07.240 back then, if you were the gardener's son, then you 0:09:07.280 --> 0:09:10.080 were effectively the property of the lord of the manor. 0:09:10.160 --> 0:09:14.840 II Jenna, and he introduced cowpox into the arm of 0:09:15.320 --> 0:09:18.640 James Phipps, who was eight years old. And what Jenna 0:09:18.679 --> 0:09:21.080 did was to find a case of cowpox with a 0:09:21.080 --> 0:09:23.800 lovely juicy cowpox bister on the back of her hand. 0:09:24.360 --> 0:09:26.560 He stuck a lancid in that collected the juice and 0:09:26.600 --> 0:09:29.920 scratched the cowpox juice into the arm of James Phipps, 0:09:30.920 --> 0:09:33.920 and that all went well. The lad got a bit 0:09:33.960 --> 0:09:36.240 of a local reaction, he's got a bit of a fever. 0:09:36.720 --> 0:09:39.079 Two weeks later he was back to normal. So Jenna 0:09:39.160 --> 0:09:42.480 now has to test his hypothesis to see if the 0:09:42.559 --> 0:09:46.000 lad is protected against smallpox. The killer gave him a 0:09:46.040 --> 0:09:49.400 small dose of smallpox and it didn't take. So that, 0:09:49.520 --> 0:09:51.120 if you like, was the Eureka moment. 0:09:52.000 --> 0:09:54.760 So he just invented the first vaccine in the history 0:09:54.760 --> 0:09:57.959 of the world, a vaccine against maybe the most deadly 0:09:58.000 --> 0:10:01.360 infectious disease. Truly one of the great discoveries in the 0:10:01.400 --> 0:10:03.800 history of medicine and the history of public health. What's 0:10:03.840 --> 0:10:05.440 the first thing he does to try and tell. 0:10:05.320 --> 0:10:08.960 The world, Well, he writes it all up as a paper, 0:10:09.760 --> 0:10:13.400 and he sends it off to the Royal Society, and amazingly, 0:10:13.480 --> 0:10:15.320 the Royal Society reject the paper. 0:10:17.200 --> 0:10:21.520 They reject his paper, They reject the guy just invented vaccines. 0:10:21.840 --> 0:10:24.840 Well, they probably wouldn't have appreciated the full significance, but 0:10:24.920 --> 0:10:27.680 you're right. It is one of the great pinnacle publications 0:10:27.679 --> 0:10:29.040 in the history of medicine science. 0:10:29.240 --> 0:10:31.199 But he doesn't give up. What's he doing next? 0:10:31.679 --> 0:10:34.360 So he writes it up as a pamphlet. It's always 0:10:34.360 --> 0:10:37.640 known as the Inquiry, okay, and it was published by 0:10:38.200 --> 0:10:42.120 private printer in Soho came out in September seventeen ninety eight. 0:10:42.600 --> 0:10:46.559 Jenna did not attempt to hide or make secret his invention. 0:10:46.720 --> 0:10:49.680 He wanted everybody to know. He wanted everybody to do 0:10:49.760 --> 0:10:51.840 it because he wanted to conquer smallpox. 0:10:52.400 --> 0:10:55.320 But you're saying he could also have not published it 0:10:55.440 --> 0:10:59.200 and just tried to sell vaccination himself and be the 0:10:59.200 --> 0:11:01.280 sort of soul purveyor of it. 0:11:01.480 --> 0:11:04.360 That's exactly it. His aim was to spread the words 0:11:04.600 --> 0:11:07.280 as widely and as quickly as possible. It really takes 0:11:07.320 --> 0:11:12.880 off and people recognize the value of vaccination immediately, and 0:11:12.920 --> 0:11:15.360 within a few months, it's on the continent of Europe, 0:11:15.400 --> 0:11:19.080 it's widespread across England, it's making its appearance in North America. 0:11:19.280 --> 0:11:22.520 You said within months, within months and months within. 0:11:22.520 --> 0:11:25.400 This is an era when there's obviously no electronic communication. 0:11:25.480 --> 0:11:27.600 They're going to have to put the inquiry on a 0:11:27.640 --> 0:11:30.240 ship and sail it across the ocean. But you're saying 0:11:30.240 --> 0:11:33.120 it spreads basically immediately. 0:11:32.559 --> 0:11:35.640 In the absolute absolutely, What do we. 0:11:35.559 --> 0:11:38.559 Know about, how how many people are being vaccinated, how 0:11:38.559 --> 0:11:41.080 widespread it is? Like, tell me more about that. 0:11:42.400 --> 0:11:46.080 Well, it's still the preserve of the rich and wealthy 0:11:46.080 --> 0:11:49.280 who could afford to pay for medical services, so it's 0:11:49.320 --> 0:11:54.280 not widespread and philanthropic. But in terms of geographical reach, 0:11:54.360 --> 0:11:59.800 it is very impressive. It reaches Switzerland very quickly, the Inquiry, 0:12:00.000 --> 0:12:03.240 which is the King of Spain, and he arranges for 0:12:03.679 --> 0:12:06.000 the divine gift of vaccination to be sent out to 0:12:06.040 --> 0:12:10.160 all the Spanish colonies and the Caribbean, South America around 0:12:10.200 --> 0:12:11.040 the back of the world. 0:12:11.280 --> 0:12:13.800 So this is all happening in his lifetime, right, He's 0:12:13.800 --> 0:12:16.040 seeing this happen well. 0:12:16.200 --> 0:12:19.480 Jenna works very hard actually trying to spread the word. 0:12:20.280 --> 0:12:23.040 He is always one of the great saints of medicine. 0:12:23.040 --> 0:12:25.760 But he wasn't a perfect man in any sense, and 0:12:25.840 --> 0:12:27.679 one of the things that he got wrong quite early 0:12:27.920 --> 0:12:30.520 was to be able to con himself into thinking that 0:12:30.640 --> 0:12:35.120 vaccination was absolutely perfect, whereas in fact it did have 0:12:35.200 --> 0:12:38.360 side effects. For example, you could get a farmyard infection 0:12:38.480 --> 0:12:41.880 from kylepox having get scratched into your arm. And the 0:12:41.920 --> 0:12:43.840 other thing was that it needed to be topped. 0:12:43.559 --> 0:12:46.280 Up, meaning like a booster, you needed what. 0:12:46.360 --> 0:12:51.200 To absolutely so other countries were giving boosters in the 0:12:51.240 --> 0:12:54.040 early teenage years, and again if smallpox broke out again, 0:12:54.080 --> 0:12:58.040 say in Germany, then people nearby would be revaccinated again. 0:12:58.440 --> 0:12:59.880 So that was one of the things that he got 0:13:00.120 --> 0:13:01.000 tragically wrong. 0:13:02.320 --> 0:13:03.360 What's the end of his story? 0:13:04.720 --> 0:13:08.400 He gets gifts and accolades from all over the world. 0:13:08.440 --> 0:13:12.000 He gets diamond ring from the Empress of Russia. He 0:13:12.040 --> 0:13:15.240 spent his declining years, if you like, after his wife died, 0:13:16.400 --> 0:13:19.360 being the vaccine clerk to the world. That's the way 0:13:19.360 --> 0:13:23.280 he described himself. He was sitting in his office writing 0:13:23.360 --> 0:13:25.840 letters back to all the fan mail that poured in 0:13:25.840 --> 0:13:29.120 from across the world. He was able to look around 0:13:29.120 --> 0:13:32.280 the world and see a world that was already changing. 0:13:34.040 --> 0:13:35.360 By the way, how does he come up with the 0:13:35.400 --> 0:13:36.280 name vaccine? 0:13:36.840 --> 0:13:39.439 Well, the name was actually coined by somebody else. It's 0:13:39.440 --> 0:13:44.640 from the Latin vacca meaning cow, and Louis pasteur. When 0:13:44.679 --> 0:13:49.320 he invented his rabies vaccine and various other vaccines, he 0:13:49.400 --> 0:13:54.920 suggested that all such immanising or protective preparations should be 0:13:54.960 --> 0:13:57.800 called vaccines in honor of Jena. So that's why we 0:13:57.840 --> 0:14:00.080 call them all vaccines today. 0:14:01.520 --> 0:14:03.560 Thank you for your time. Was a delight to talk 0:14:03.600 --> 0:14:03.840 with you. 0:14:04.000 --> 0:14:05.880 Pleasure, Thank you for yours. 0:14:06.840 --> 0:14:10.920 Edward Jenner died in eighteen twenty three. In the twentieth century, 0:14:11.160 --> 0:14:13.800 his vaccine would serve as the inspiration for one of 0:14:13.840 --> 0:14:16.720 the most ambitious public health projects in the history of 0:14:16.720 --> 0:14:21.720 the world to wipe out every single case of smallpox forever, 0:14:22.920 --> 0:14:31.520 We'll be right back. In the first half of the 0:14:31.520 --> 0:14:35.880 twentieth century, Edward Jenner's vaccine continued to spread, but huge 0:14:35.920 --> 0:14:40.200 swaths of the population remained unvaccinated, and hundreds of millions 0:14:40.200 --> 0:14:43.160 of people continued to die of smallpox. The world had 0:14:43.160 --> 0:14:46.520 become smaller and more connected. Air travel was taking off, 0:14:46.560 --> 0:14:49.560 and smallpox was happy to hitch a ride. Even countries 0:14:49.600 --> 0:14:52.520 that thought they'd eliminated smallpox found out that they could 0:14:52.520 --> 0:14:54.200 only keep it at bay for so long. 0:14:57.480 --> 0:15:00.000 A smallpox scare grips Great Britain, and. 0:15:00.120 --> 0:15:02.720 Weight of five deaths attributed to the disease that was 0:15:02.760 --> 0:15:04.640 all but wiped out in Western nations. 0:15:04.960 --> 0:15:07.880 Tens of thousands throughout the nation line up at health 0:15:07.920 --> 0:15:11.040 centers to be inoculated. The outbreak of a red. 0:15:10.840 --> 0:15:13.640 Disease is checked by modern medical science. 0:15:17.600 --> 0:15:20.080 In the middle of the twentieth century, leaders around the 0:15:20.080 --> 0:15:24.119 world cooked up an audacious plan to drive the smallpox 0:15:24.200 --> 0:15:27.400 virus to extinction, to eradicate it from the face of 0:15:27.440 --> 0:15:32.240 the earth. Donald Hopkins directed the smallpox eradication campaign in 0:15:32.360 --> 0:15:35.320 Sierra Leone in the late nineteen sixties, just as the 0:15:35.360 --> 0:15:38.880 global eradication project was getting started. When he arrived in 0:15:38.960 --> 0:15:41.760 Sierra Leone, the West African nation had the highest smallpox 0:15:41.840 --> 0:15:46.000 rate in the world. You get to this country, what 0:15:46.080 --> 0:15:47.600 do you see on the ground? 0:15:48.360 --> 0:15:52.480 Well, I see, first of all, a beautiful country, and 0:15:52.520 --> 0:15:56.360 then I'm introduced to the health workers that I'm going 0:15:56.400 --> 0:15:59.560 to be working with and find that they are very capable, 0:16:00.160 --> 0:16:05.320 very enthusiastic. I'm young, and very optimistic as well. Yes, 0:16:05.360 --> 0:16:09.000 people were dying, but the upshot of that was that 0:16:09.080 --> 0:16:12.520 people were eager. Most people were eager to get vaccinated, 0:16:12.800 --> 0:16:16.280 and so we did not have a problem of trying 0:16:16.360 --> 0:16:21.600 to persuade people to cooperate with the program, and that 0:16:21.840 --> 0:16:24.200 made things a lot easier. 0:16:24.720 --> 0:16:27.440 Yeah, easier, but this is still a country where there 0:16:27.440 --> 0:16:29.240 are a lot of places that are just hard to 0:16:29.320 --> 0:16:32.840 get to, right, I mean, are there any particular instances 0:16:32.880 --> 0:16:35.320 you remember that were especially challenging. 0:16:35.880 --> 0:16:38.720 So in the summer of nineteen sixty eight, it's the 0:16:38.840 --> 0:16:41.880 rainy season in sily Young, we get a message that 0:16:41.960 --> 0:16:46.240 there is an outbreak in this area southeast of the capital, 0:16:46.360 --> 0:16:51.400 the area called Moyamba. So I went there with a 0:16:51.480 --> 0:16:54.880 driver and a couple of the Siri lell and public 0:16:54.880 --> 0:17:01.200 health workers and the village that we were were summoned 0:17:01.200 --> 0:17:06.439 to visit, in fact, was about a forty five minute 0:17:06.560 --> 0:17:11.439 trek from the nearest road. I'm afraid of snakes, and 0:17:11.480 --> 0:17:14.760 this was a this was a trek through the forest. 0:17:14.920 --> 0:17:18.160 You're like Indiana Jones. You're wearing a hot. 0:17:20.200 --> 0:17:22.520 No hat I had. I had a full head of 0:17:22.520 --> 0:17:24.760 hair then, so I didn't I didn't have to wear 0:17:25.000 --> 0:17:28.719 a hat. But to beget into this get into this village, 0:17:29.000 --> 0:17:32.200 and there are lots of people with smallpox, including most 0:17:32.359 --> 0:17:37.959 notably a newborn infant only a few days old, that 0:17:38.240 --> 0:17:42.679 was lying on a mat between its mother and the 0:17:42.720 --> 0:17:44.439 mother's co wife. 0:17:44.840 --> 0:17:46.640 When you say co wife, what does that mean? 0:17:47.160 --> 0:17:50.680 That means that they were both married to the same man. Okay, 0:17:50.760 --> 0:17:54.879 and uh. The child had not been vaccinated, but both 0:17:54.880 --> 0:17:58.240 of these two women were in the full throws of 0:17:58.320 --> 0:18:04.080 smallpox infections, and so that infant had been exposed. Fortunately, 0:18:04.119 --> 0:18:06.800 I had vaccine with me. I was able to vaccinate 0:18:07.280 --> 0:18:11.520 the infant, and later about ten days later, when I 0:18:11.640 --> 0:18:15.120 came back, I saw that the vaccination was taking and 0:18:15.200 --> 0:18:16.639 that baby was saved. 0:18:16.920 --> 0:18:21.320 And just to just because you know, I've never seen smallpox. Thankfully, 0:18:21.840 --> 0:18:25.600 when you say that two women were in the throes 0:18:25.640 --> 0:18:27.040 of infection. What did they look like? 0:18:27.200 --> 0:18:30.639 Well, it's hard to see people suffering so much, because 0:18:30.680 --> 0:18:34.920 it's not only that people their bodies are swollen. They're 0:18:34.960 --> 0:18:38.360 covered in all of these pustules. But it's very painful. 0:18:38.800 --> 0:18:41.960 People described it as feeling as if your skin was 0:18:42.040 --> 0:18:46.920 on fire. Smallpox caused a generalized rash over most of 0:18:46.960 --> 0:18:52.800 the body. It was most intense over the face, the hands, 0:18:52.840 --> 0:18:56.439 and the feet. But in this instance you could see 0:18:56.680 --> 0:19:03.200 these raised pimples. First you get little bumps that turn 0:19:03.440 --> 0:19:10.480 into blisters that then fill with puffs, which then these 0:19:10.520 --> 0:19:16.320 blisters break, and if you're lucky and survive the broken 0:19:16.359 --> 0:19:20.640 blisters and puffs, that all drives up and gradually, over 0:19:20.640 --> 0:19:23.800 the course of two three weeks the scabs drop off. 0:19:24.080 --> 0:19:27.720 But all of that is infectious, and people when they're 0:19:27.760 --> 0:19:31.000 just even before the rash starts, when they start feeling 0:19:31.040 --> 0:19:37.359 headache fever, they're already breathing out smallpox virus onto other people. 0:19:37.640 --> 0:19:42.040 And so the challenge is the situation like that, to 0:19:42.119 --> 0:19:45.360 vaccinate as many people who do not yet have smallpox 0:19:45.800 --> 0:19:47.600 as quickly as you can. 0:19:48.040 --> 0:19:50.480 So, okay, so you get to this village, you see 0:19:50.480 --> 0:19:53.840 these two women and the baby. The women are clearly sick. 0:19:53.960 --> 0:19:57.120 You vaccinate the baby because the smallpox vaccine can actually 0:19:57.359 --> 0:19:59.880 help people who are in the early stages of an infection. 0:20:00.640 --> 0:20:02.679 What do you do next? What else is happening in 0:20:02.720 --> 0:20:03.480 this village? 0:20:04.280 --> 0:20:09.720 In this census, we learned very quickly that two weeks before, 0:20:10.359 --> 0:20:13.560 a very prominent man in that village who was head 0:20:13.600 --> 0:20:17.720 of a secret society, had gotten smallpox and had died. 0:20:18.720 --> 0:20:23.520 Because he was so prominent, people came from other villages 0:20:23.640 --> 0:20:27.520 to visit him when he was ill, and people came 0:20:27.600 --> 0:20:28.480 for his funeral. 0:20:29.760 --> 0:20:32.800 This is a giant alarm bell. This is very bad 0:20:32.880 --> 0:20:34.480 news for you in nineteen. 0:20:34.200 --> 0:20:38.119 Sixty eight, very very bad news, because we also began 0:20:38.320 --> 0:20:40.879 learning when I was there. What we were seeing was 0:20:40.920 --> 0:20:44.840 that many people had come from other villages as well 0:20:45.040 --> 0:20:50.040 surrounding this village, and so this was a much bigger 0:20:50.040 --> 0:20:52.119 outbreak than what we were expecting. 0:20:52.480 --> 0:20:55.359 So tell me about what containment meant at this time 0:20:55.400 --> 0:20:56.200 in this context. 0:20:56.320 --> 0:20:59.800 Yes, when we first began working in the smallpox program, 0:21:00.080 --> 0:21:04.760 the strategy was to mass vaccinate eighty percent or more 0:21:04.840 --> 0:21:10.080 of the population. The containment surveillance strategy was developed where 0:21:10.119 --> 0:21:15.600 the strategy became find out where the current cases of 0:21:15.680 --> 0:21:22.680 smallpox are go there, give priority to vaccinating people in 0:21:22.840 --> 0:21:28.760 those households and that village and nearby villages. So called 0:21:29.080 --> 0:21:32.760 ring vaccination, because if you could do that, you could 0:21:32.800 --> 0:21:36.639 stop the virus from spreading to other people. That was 0:21:36.680 --> 0:21:40.840 a much more efficient way of getting after the virus 0:21:40.880 --> 0:21:45.240 to stop transmission, because now you're looking to vaccinate three 0:21:45.400 --> 0:21:48.399 four five percent of the population rather than eighty percent 0:21:48.400 --> 0:21:49.119 of the population. 0:21:49.240 --> 0:21:52.480 It's like you draw a circle, a big circle around 0:21:52.600 --> 0:21:55.359 the village where the infection is, and you vaccinate everybody 0:21:55.400 --> 0:21:59.160 inside that circle. So it's like you're surrounding the virus 0:21:59.320 --> 0:22:00.760 with immune people. 0:22:01.200 --> 0:22:04.000 That's exactly what you're doing. And the radius of that 0:22:04.080 --> 0:22:06.840 circle was at least five miles. 0:22:07.359 --> 0:22:10.480 Okay, so you have your information right, you have your 0:22:11.000 --> 0:22:14.879 epidemiological surveillance, you have your your ring on a map. 0:22:15.640 --> 0:22:16.240 What do you do? 0:22:16.720 --> 0:22:21.200 We then come back with several other vaccinators and have 0:22:21.280 --> 0:22:25.119 a plan to assign different groups to go to each 0:22:25.200 --> 0:22:30.159 of these villages and make sure that everyone there is vaccinated. 0:22:30.359 --> 0:22:32.400 And you just show up in a village with your 0:22:32.640 --> 0:22:36.880 briefcase full of a vaccine and say here we are 0:22:37.000 --> 0:22:38.159 come line up. 0:22:38.359 --> 0:22:42.720 The villagers had had warning, and in fact, we discussed 0:22:43.000 --> 0:22:45.760 with the village chief and the senior people in the 0:22:45.840 --> 0:22:50.359 village to agree on a mutual time when was most 0:22:50.400 --> 0:22:53.680 convenient for them for us to come back and make 0:22:53.720 --> 0:22:56.400 sure everybody was vaccinated. You had to give them notice 0:22:56.400 --> 0:22:59.480 in advance, because otherwise, if you just show up, people 0:22:59.520 --> 0:23:01.800 are out on the farms, which could be two or 0:23:01.840 --> 0:23:04.800 three miles away in many different directions, et cetera. 0:23:05.240 --> 0:23:08.000 So how long does it take you to with your 0:23:08.000 --> 0:23:11.000 team go to all of the villages inside this ring 0:23:11.240 --> 0:23:13.000 and vaccinate everybody. 0:23:13.520 --> 0:23:16.919 That took a matter of a few days fast. So 0:23:17.040 --> 0:23:20.640 each team only had to go to one or two villages, 0:23:20.680 --> 0:23:22.879 and so we were able to get there in a 0:23:22.880 --> 0:23:25.800