WEBVTT - Smallpox: Gone but Not Forgotten 0:00:03.960 --> 0:00:07.880 We heard a lot about coronaviruses over the past few years, 0:00:07.920 --> 0:00:12.160 really a lot, maybe too much, definitely more than we 0:00:12.200 --> 0:00:15.120 ever expected to hear, But we heard a lot less 0:00:15.240 --> 0:00:23.560 about other viruses. And viruses are amazing. Viruses are older 0:00:23.560 --> 0:00:28.280 than animals, they're older than plants. Some scientists think viruses 0:00:28.320 --> 0:00:32.199 may be the origin of all life on Earth. Viruses 0:00:32.240 --> 0:00:37.080 have been infecting humans, sometimes invisibly, sometimes with terrible consequences, 0:00:37.479 --> 0:00:41.159 for as long as there have been humans. The story 0:00:41.159 --> 0:00:44.640 of viruses is the story of humanity survival as a species, 0:00:45.080 --> 0:00:47.559 and we're going to tell some of those viral stories 0:00:47.600 --> 0:00:51.880 on this podcast. I'm Jacob Goldstein, and this is Incubation, 0:00:52.280 --> 0:00:55.760 a show about the other viruses. It's about science and 0:00:55.800 --> 0:00:59.640 about culture. It's about how viruses attack people and how 0:00:59.680 --> 0:01:04.120 people fight back. On each episode of Incubation, we're going 0:01:04.200 --> 0:01:07.360 to tell the story of one virus, and we're starting 0:01:07.400 --> 0:01:11.640 off with one of the deadliest viruses in history, smallpox. 0:01:12.200 --> 0:01:16.559 Smallpox stalked humanity for thousands of years. It gave people 0:01:16.680 --> 0:01:20.600 rashes and blisters all over their bodies, and often it 0:01:20.720 --> 0:01:25.840 killed them. Smallpox killed hundreds of millions of people, but 0:01:26.040 --> 0:01:32.800 we humans fought back in profound and brilliant ways. Our 0:01:32.840 --> 0:01:36.000 episode today starts with the story of Edward Jenner, a 0:01:36.080 --> 0:01:39.479 doctor in the British countryside, and it ends centuries later 0:01:39.760 --> 0:01:43.040 with thousands of people working together to wipe smallpox from 0:01:43.080 --> 0:01:48.000 the face of the earth. My first guest today is 0:01:48.080 --> 0:01:51.520 Gareth Williams. He's the author of Angel of Death, the 0:01:51.560 --> 0:01:55.440 Story of Smallpox, and Gareth he knows a lot about 0:01:55.560 --> 0:01:56.200 Edward Jenner. 0:01:56.720 --> 0:02:01.440 He was a great fields naturalist, and he also worked 0:02:01.440 --> 0:02:05.040 out something about the migration of birds, which was completely 0:02:05.120 --> 0:02:08.079 unknown before that. People thought that swallows went off and 0:02:08.160 --> 0:02:11.320 hid in mud under riverbanks and things like this. 0:02:11.560 --> 0:02:14.240 I read that he built a hydrogen balloon that flew 0:02:14.280 --> 0:02:17.920 twelve miles, That he played the violin, that he wrote poetry. 0:02:18.600 --> 0:02:20.359 He did all the above. He played the flute I 0:02:20.400 --> 0:02:22.240 think rather bet, and he played the fiddle. He sang. 0:02:22.280 --> 0:02:24.720 He had a good singing voice. I can recite one 0:02:24.760 --> 0:02:26.440 of his poems if you'd like it. 0:02:26.560 --> 0:02:29.600 Of course, give it to me, okay. 0:02:29.760 --> 0:02:32.680 That he wrote it when a man called doctor Weight 0:02:33.160 --> 0:02:37.880 died and doctor Weight had made medicinal gingerbread biscuits gingerbread nuts, 0:02:38.240 --> 0:02:42.000 which not only tasted good but actually killed intestinal worms, 0:02:42.160 --> 0:02:44.880 talking about tapeworms and things that around to twenty feet 0:02:44.960 --> 0:02:46.640 or more. So here's a put on the death of 0:02:46.639 --> 0:02:49.040 doctor Weight. It begins with the Latin names of the 0:02:49.040 --> 0:02:55.240 worms Ascarides, Tearies, Lumbricki, and all he Kyle sucking insects 0:02:55.240 --> 0:02:59.480 that tremblingly crawl. No more be afraid You're quite safe 0:02:59.480 --> 0:03:02.720 in our gun, for Dr Waite has finished making his 0:03:02.840 --> 0:03:04.400 gingerbread nuts. 0:03:05.880 --> 0:03:10.520 So in addition to writing poems about nuts, non trivially, 0:03:10.600 --> 0:03:15.080 Jenner also invented the first vaccine in human history. Let's 0:03:15.080 --> 0:03:16.800 talk about that. That's really what we're here to talk 0:03:16.840 --> 0:03:20.880 about today. He's born in seventeen forty nine. He's growing 0:03:20.960 --> 0:03:22.880 up in England in the you know, second half of 0:03:22.919 --> 0:03:26.600 the seventeen hundreds. What would his experience of smallpox have. 0:03:26.680 --> 0:03:30.080 Been in Jenner's day? If you got smallpox and you 0:03:30.120 --> 0:03:32.720 had roughly a one in three chants of getting it 0:03:32.800 --> 0:03:35.280 during your lifetime, then you had about a one in 0:03:35.360 --> 0:03:38.520 four chance of being killed by it. He went to 0:03:38.600 --> 0:03:40.840 boarding school when he was eight. Both his parents had 0:03:40.920 --> 0:03:44.440 died by then, and he had to be protected against 0:03:44.600 --> 0:03:47.000 smallpox which had broken out nearby. 0:03:47.440 --> 0:03:49.280 And this thing happens to him where somebody, if I 0:03:49.360 --> 0:03:54.280 understand right, cuts open his arm and puts dried out 0:03:54.360 --> 0:03:58.760 pus from a smallpox patient into the cut on Jenner's arm. 0:03:59.000 --> 0:03:59.920 What's going on there? 0:04:00.760 --> 0:04:04.960 This was what was called variolation. And variola is the 0:04:05.040 --> 0:04:08.280 Latin word for speckled or spotted. It's the old name 0:04:08.320 --> 0:04:10.760 for small pox, and it's the name of the virus 0:04:10.760 --> 0:04:14.120 that causes small pox, of Variola virus. And in brief, 0:04:14.200 --> 0:04:18.800 varilation was giving healthy people, usually children, the real thing 0:04:19.600 --> 0:04:23.200 in the hope that the artificial infection wouldn't kill them 0:04:23.440 --> 0:04:26.760 and that it would somehow leave them protected against future 0:04:26.920 --> 0:04:31.080 attacks of naturally acquired small pox. It was about a 0:04:31.080 --> 0:04:34.839 one in fifty mortality, so very very much lower. You 0:04:34.920 --> 0:04:36.800 got a little bit of small pox pus from one 0:04:36.839 --> 0:04:40.080 of those revolting blisters that covered people in the tens 0:04:40.160 --> 0:04:44.039 and thousands, and you would scratch a little bit of 0:04:44.080 --> 0:04:46.800 that revolting fluid into the skin on the arm of 0:04:46.800 --> 0:04:47.960 a healthy child. 0:04:48.360 --> 0:04:49.080 Does it work? 0:04:49.720 --> 0:04:55.400 It's mad, bad, crazy, dangerous, sounds completely counterintuitive. The amazing 0:04:55.400 --> 0:04:57.839 thing is it did work, very much so. And the 0:04:57.880 --> 0:05:00.680 other thing is that if you were variolated, even if 0:05:00.720 --> 0:05:04.919 you survived while you had your artificial dose of smallpox. 0:05:05.040 --> 0:05:07.720 You have the real thing. So even though you might 0:05:07.880 --> 0:05:09.880 get over it in two or three weeks, you could 0:05:09.920 --> 0:05:14.159 spread it to other non immune people, you know, people 0:05:14.240 --> 0:05:17.560 going back into the community, causing little mini outbreaks of 0:05:17.640 --> 0:05:20.880 smallpox and killing lots of other people bi collateral damage. 0:05:21.080 --> 0:05:25.680 Wow. So okay, So this is the world. Jenner is 0:05:25.920 --> 0:05:30.600 born into the world where you can either get smallpox 0:05:30.720 --> 0:05:32.560 and a good chance of dying from it if you 0:05:32.600 --> 0:05:36.200 get it, or if you're sort of lucky in a 0:05:36.200 --> 0:05:39.239 weird way, you can get variolated and have a non 0:05:39.240 --> 0:05:43.039 trivial chance of getting and dying of smallpox and maybe 0:05:43.040 --> 0:05:44.920 spreading it to other people. That was it. Those were 0:05:45.000 --> 0:05:45.599 the options. 0:05:45.720 --> 0:05:46.360 Absolutely. 0:05:46.560 --> 0:05:48.840 How does he go from being an eight year old 0:05:48.880 --> 0:05:51.720 boy getting very related to inventing the first vaccine in 0:05:51.760 --> 0:05:52.120 the world. 0:05:52.480 --> 0:05:56.120 Okay, if you want the conventional story, yeah. 0:05:56.000 --> 0:05:57.520 I feel like you're gonna give me two stories. One 0:05:57.600 --> 0:06:00.159 is it Jenner classic, So give me Jenner clas. 0:06:00.839 --> 0:06:03.720 The Jena classic is he is a medical apprentice in 0:06:03.760 --> 0:06:08.000 his early teens and he meets a milkmaid small pox 0:06:08.040 --> 0:06:12.400 has reappeared nearby, and she allegedly says to him, look, Gov, 0:06:12.480 --> 0:06:14.839 you don't need to worry about me having that, because 0:06:15.279 --> 0:06:17.599 I've had cowpox and that means that I can never 0:06:17.640 --> 0:06:21.839 ever catch smallpox. And this was complete news to January, 0:06:22.000 --> 0:06:24.679 never come across it. But it was also complete news 0:06:24.680 --> 0:06:27.880 to all his teachers. It simply wasn't part of conventional 0:06:27.960 --> 0:06:31.440 medical knowledge. It was common knowledge in the farming community. 0:06:31.839 --> 0:06:34.040 It was folk knowledge that had not sort of crossed 0:06:34.120 --> 0:06:37.120 over to kind of high brow medical knowledge. 0:06:37.240 --> 0:06:39.599 A lot of people didn't want to believe it because 0:06:39.600 --> 0:06:40.960 it had come up from the peasantry. 0:06:41.839 --> 0:06:44.800 Interesting, so you're saying, that's kind of the classic tale. 0:06:44.839 --> 0:06:45.680 Do you think it's true. 0:06:46.640 --> 0:06:50.000 I'd like to believe it's true. The alternative story is 0:06:50.040 --> 0:06:53.880 that one of Jenna's medical colleagues in Thornbury was actually 0:06:53.880 --> 0:06:59.040 a variolator, very successful one, and he noted, apparently independently, 0:06:59.560 --> 0:07:03.159 that some people that he valulated the varulation didn't take. 0:07:03.920 --> 0:07:06.080 In otherwords, there was no sign that they'd caught this 0:07:06.200 --> 0:07:10.480 artificial dose of smallpox. And this man is called John Fuster. 0:07:11.360 --> 0:07:13.480 And story B if you like, is that it was 0:07:13.520 --> 0:07:17.440 actually Feusta who made the original observation. Jenna was a 0:07:17.440 --> 0:07:20.720 close friend of his, and Jenna may have decided to 0:07:20.720 --> 0:07:22.800 pick up on it. Feusa didn't want to pursue it 0:07:23.120 --> 0:07:25.320 because he was making so much money as a valulator. 0:07:25.360 --> 0:07:28.080 He didn't see the need for any particular improvement. 0:07:29.000 --> 0:07:33.480 Okay, so Jenner has this idea, whether it's from the 0:07:33.480 --> 0:07:39.000 milkmaid or from his colleague, this idea that cow pox, 0:07:39.080 --> 0:07:42.320 which we should say is not a deadly disease in humans, right, 0:07:42.920 --> 0:07:48.240 can protect humans against a smallpox. What does he do 0:07:48.320 --> 0:07:51.920 with this idea. 0:07:50.440 --> 0:07:53.000 Well, he doesn't do anything with it for over thirty years. 0:07:53.160 --> 0:07:56.240 He goes off he finishes his medical studies in London. 0:07:56.640 --> 0:08:01.400 In seventeen ninety six, he gets the idea of collecting 0:08:01.560 --> 0:08:05.080 cases of people who've had cowpox and look to see 0:08:05.120 --> 0:08:09.240 if they appeared to be protected against smallpox. And he 0:08:09.320 --> 0:08:11.880 collects a number of cases and the story appears to 0:08:11.920 --> 0:08:14.800 be true. And then he moves beyond that to actually 0:08:14.840 --> 0:08:18.480 test the hypothesis that giving somebody an artificial dose of 0:08:18.520 --> 0:08:22.920 cowpox will protect them against smallpox. The killer and his 0:08:23.080 --> 0:08:28.120 first guinea pig is his gardener's son, James Phipps. And 0:08:28.840 --> 0:08:32.240 the ethics might be regarded as a bit dodgy, because 0:08:32.240 --> 0:08:35.160 back then, if you were the gardener's son, then you 0:08:35.200 --> 0:08:38.000 were effectively the property of the Lord of the manor 0:08:38.080 --> 0:08:42.679 III Jenna, and he introduced cowpox into the arm of 0:08:43.240 --> 0:08:46.560 James Phipps, who was eight years old. And what Jenna 0:08:46.600 --> 0:08:49.000 did was to find a case of cowpox with a 0:08:49.000 --> 0:08:51.720 lovely juicy cowpox blister on the back of her hand. 0:08:52.280 --> 0:08:54.480 He stuck a lancid in that collected the juice and 0:08:54.520 --> 0:08:57.800 scratched the cowpox juice into the arm of James Phipps, 0:08:58.840 --> 0:09:01.840 and that all went well. The lad got a bit 0:09:01.880 --> 0:09:04.120 of a local reaction, he got a bit of a fever. 0:09:04.640 --> 0:09:07.000 Two weeks later he was back to normal. So Jenna 0:09:07.080 --> 0:09:10.400 now has to test his hypothesis to see if the 0:09:10.480 --> 0:09:13.920 lad is protected against smallpox. The killer gave him a 0:09:13.960 --> 0:09:17.320 small dose of smallpox and it didn't take So that, 0:09:17.440 --> 0:09:19.040 if you like, was the Eureka moment. 0:09:19.920 --> 0:09:22.680 So he just invented the first vaccine in the history 0:09:22.679 --> 0:09:25.880 of the world, a vaccine against maybe the most deadly 0:09:25.920 --> 0:09:29.280 infectious disease. Truly one of the great discoveries in the 0:09:29.320 --> 0:09:31.720 history of medicine and the history of public health. What's 0:09:31.760 --> 0:09:33.920 the first thing he does to try and tell the world. 0:09:34.880 --> 0:09:37.880 Well, he writes it all up as a paper and 0:09:38.040 --> 0:09:41.320 he sends it off to the Royal Society, and amazingly, 0:09:41.400 --> 0:09:43.240 the Royal Society reject the paper. 0:09:45.120 --> 0:09:49.439 They reject his paper, They reject the guy just invented vaccines. 0:09:49.760 --> 0:09:52.760 Well, they probably wouldn't have appreciated the full significance. But 0:09:52.800 --> 0:09:55.600 you're right. It is one of the great pinnacle publications 0:09:55.600 --> 0:09:56.959 in the history of medicine and science. 0:09:57.160 --> 0:09:59.120 But he doesn't give up. What's he doing next? 0:10:00.000 --> 0:10:02.439 He writes it up as a pamphlet. It's always known 0:10:02.480 --> 0:10:06.480 as The Inquiry, okay, and it was published by private 0:10:06.520 --> 0:10:10.040 printer in Soho came out in September seventeen ninety eight. 0:10:10.520 --> 0:10:14.480 Jenna did not attempt to hide or make secret his invention. 0:10:14.640 --> 0:10:17.600 He wanted everybody to know. He wanted everybody to do 0:10:17.679 --> 0:10:19.760 it because he wanted to conquer smallpox. 0:10:20.320 --> 0:10:23.240 But you're saying he could also have not published it 0:10:23.360 --> 0:10:27.120 and just tried to sell vaccination himself and be the 0:10:27.120 --> 0:10:29.200 sort of soul purveyor of it. 0:10:29.400 --> 0:10:32.120 That's exactly it. His aim was to spread the word 0:10:32.200 --> 0:10:35.199 as widely and as quickly as possible. It really takes 0:10:35.240 --> 0:10:40.800 off and people recognize the value of vaccination immediately, and 0:10:40.840 --> 0:10:43.280 within a few months it's on the continent of Europe, 0:10:43.320 --> 0:10:47.040 it's widespread across England. It's making its appearance in North America. 0:10:47.200 --> 0:10:50.679 You said within months, within months, months, within This is 0:10:50.720 --> 0:10:53.679 an era when there's obviously no electronic communication. They're going 0:10:53.720 --> 0:10:56.040 to have to put the inquiry on a ship and 0:10:56.400 --> 0:10:58.679 sail it across the ocean. But you're saying it spreads 0:10:59.080 --> 0:11:00.679 basically a media in. 0:11:00.640 --> 0:11:03.240 That absolute absolutely. 0:11:03.000 --> 0:11:06.240 What do we know about how many people are being vaccinated? 0:11:06.320 --> 0:11:09.000 How widespread it is, Like, tell me more about that. 0:11:10.320 --> 0:11:14.000 Well, it's still the preserve of the rich and wealthy 0:11:14.000 --> 0:11:17.160 who could afford to pay for medical services, so it's 0:11:17.240 --> 0:11:22.200 not widespread and philanthropic, but in terms of geographical reach 0:11:22.280 --> 0:11:27.760 it is very impressive. Reaches Switzerland very quickly. The inquiry 0:11:27.800 --> 0:11:31.720 reaches the King of Spain and he arranges for the 0:11:31.760 --> 0:11:34.040 divine gift of vaccination to be sent out to all 0:11:34.080 --> 0:11:38.200 the Spanish colonies and the Caribbean, South America around the 0:11:38.200 --> 0:11:38.960 back of the world. 0:11:39.200 --> 0:11:41.719 So this is all happening in his lifetime, right, He's 0:11:41.720 --> 0:11:42.560 seeing this happen. 0:11:43.679 --> 0:11:47.400 Well, Jenna works very hard actually trying to spread the word. 0:11:48.200 --> 0:11:50.959 He is always one of the great saints of medicine. 0:11:50.960 --> 0:11:53.679 But he wasn't a perfect man. In any sense. And 0:11:53.760 --> 0:11:55.600 one of the things that he got wrong quite early 0:11:55.840 --> 0:11:58.480 was to be able to connon himself into thinking the 0:11:58.559 --> 0:12:02.920 vaccination was absolutely per effect, whereas in fact it did 0:12:02.960 --> 0:12:05.839 have side effects. For example, you could get a farmyard 0:12:05.880 --> 0:12:09.200 infection from kyle pox having get scratched into your arm. 0:12:09.559 --> 0:12:11.760 And the other thing was that it needed to be topped. 0:12:11.480 --> 0:12:14.200 Up, meaning like a booster, you needed what. 0:12:15.840 --> 0:12:19.439 Absolutely so other countries were giving boosters in the early 0:12:19.520 --> 0:12:22.199 teenage years. And again if smallpox broke out again, say 0:12:22.240 --> 0:12:26.440 in Germany, then people nearby would be revaccinated again. So 0:12:26.520 --> 0:12:28.920 that was one of the things that he got tragically wrong. 0:12:30.240 --> 0:12:31.280 What's the end of his story. 0:12:32.640 --> 0:12:36.320 He gets gifts and accolades from all over the world. 0:12:36.400 --> 0:12:39.920 He gets diamond ring from the Empress of Russia. He 0:12:39.960 --> 0:12:43.160 spent his declining years, if you like, after his wife died, 0:12:44.360 --> 0:12:47.280 being the vaccine clerk to the world. That's the way 0:12:47.280 --> 0:12:51.199 he described himself. He was sitting in his office writing 0:12:51.280 --> 0:12:53.760 letters back to all the fan mail that poured in 0:12:53.760 --> 0:12:57.040 from across the world. He was able to look around 0:12:57.040 --> 0:13:00.000 the world and see a world that was already changed. 0:13:01.960 --> 0:13:03.280 By the way, how does it come up with the 0:13:03.320 --> 0:13:04.199 name vaccine? 0:13:04.760 --> 0:13:07.360 Well, the name was actually coined by somebody else. It's 0:13:07.360 --> 0:13:12.560 from the Latin vaca, meaning cow, and Louis pasteur. When 0:13:12.600 --> 0:13:17.199 he invented his rabies vaccine and various other vaccines, he 0:13:17.320 --> 0:13:22.880 suggested that all such immanising or protective preparations should be 0:13:22.880 --> 0:13:25.720 called vaccines in honor of Jenna. So that's why we 0:13:25.760 --> 0:13:27.079 call them all vaccines today. 0:13:29.440 --> 0:13:31.480 Thank you for your time. Was a delight to talk 0:13:31.520 --> 0:13:31.760 with you. 0:13:31.920 --> 0:13:33.400 Pleasure. Thank you for yours. 0:13:34.760 --> 0:13:38.840 Edward Jenner died in eighteen twenty three. In the twentieth century, 0:13:39.080 --> 0:13:41.719 his vaccine would serve as the inspiration for one of 0:13:41.760 --> 0:13:44.640 the most ambitious public health projects in the history of 0:13:44.640 --> 0:13:49.640 the world, to wipe out every single case of smallpox forever. 0:13:50.840 --> 0:13:59.400 We'll be right back. In the first half of the 0:13:59.400 --> 0:14:03.800 twentieth century, Edward Jenner's vaccine continued to spread, but huge 0:14:03.840 --> 0:14:08.120 swaths of the population remained unvaccinated, and hundreds of millions 0:14:08.120 --> 0:14:11.080 of people continued to die of smallpox. The world had 0:14:11.080 --> 0:14:14.440 become smaller and more connected. Air travel was taking off, 0:14:14.480 --> 0:14:17.480 and smallpox was happy to hitch a ride. Even countries 0:14:17.520 --> 0:14:20.440 that thought they'd eliminated smallpox found out that they could 0:14:20.440 --> 0:14:26.280 only keep it at Bay for so long. A smallpox 0:14:26.320 --> 0:14:29.080 scare grips Great Britain. In the wake of five deaths 0:14:29.080 --> 0:14:31.560 attributed to the disease that was all but wiped out 0:14:31.560 --> 0:14:35.240 in Western nations, tens of thousands throughout the nation line 0:14:35.320 --> 0:14:37.160 up at health centers to be inoculated. 0:14:37.600 --> 0:14:38.880 The outbreak of a bad. 0:14:38.760 --> 0:14:41.560 Disease is checked by modern medical science. 0:14:45.520 --> 0:14:48.000 In the middle of the twentieth century, leaders around the 0:14:48.000 --> 0:14:52.040 world cooked up an audacious plan to drive the smallpox 0:14:52.120 --> 0:14:55.320 virus to extinction, to eradicate it from the face of 0:14:55.360 --> 0:15:00.200 the earth. Donald Hopkins directed the smallpox eradication campaign in 0:15:00.280 --> 0:15:03.240 Sierra Leone in the late nineteen sixties, just as the 0:15:03.280 --> 0:15:06.800 global eradication project was getting started. When he arrived in 0:15:06.880 --> 0:15:09.680 Sierra Leone, the West African nation had the highest smallpox 0:15:09.760 --> 0:15:13.920 rate in the world. You get to this country, what 0:15:14.000 --> 0:15:15.160 do you see on the ground? 0:15:16.280 --> 0:15:20.400 Well, I see, first of all a beautiful country, and 0:15:20.440 --> 0:15:24.280 then I'm introduced to the health workers that I'm going 0:15:24.320 --> 0:15:27.480 to be working with and find that they are very capable, 0:15:28.040 --> 0:15:33.240 very enthusiastic. I'm young and very optimistic as well. Yes, 0:15:33.280 --> 0:15:36.920 people were dying, but the upshot of that was that 0:15:37.000 --> 0:15:40.440 people were eager. Most people were eager to get vaccinated, 0:15:40.720 --> 0:15:44.240 and so we did not have a problem of trying 0:15:44.280 --> 0:15:49.480 to persuade people to cooperate with the program, and that 0:15:49.760 --> 0:15:52.120 made things a lot easier. 0:15:52.640 --> 0:15:55.360 Yeah, easier, but this is still a country where there 0:15:55.360 --> 0:15:57.160 are a lot of places that are just hard to 0:15:57.240 --> 0:16:00.760 get to, right. I mean, are there any particular instances 0:16:00.800 --> 0:16:03.240 you remember that were that were especially challenging. 0:16:03.800 --> 0:16:06.640 So in the summer of nineteen sixty eight, it's the 0:16:06.760 --> 0:16:09.800 rainy season in sily On, we get a message that 0:16:09.840 --> 0:16:14.200 there's an outbreak in this area southeast of the capital 0:16:14.360 --> 0:16:19.720 area called Moyamba. So I went there with a driver 0:16:20.000 --> 0:16:23.840 and a couple of the Sierra Leone and public health workers. 0:16:24.840 --> 0:16:29.600 And the village where that we were summoned to visit, 0:16:30.200 --> 0:16:35.600 in fact, was about a forty five minute trek from 0:16:35.640 --> 0:16:39.720 the nearest road. I'm afraid of snakes, and this was 0:16:39.720 --> 0:16:42.680 a This was a trek through the forest. 0:16:42.840 --> 0:16:46.040 You're like Indiana Jones, You're wearing a hot. 0:16:48.120 --> 0:16:50.440 No hat I had. I had a full head of 0:16:50.440 --> 0:16:52.680 hair then, so I didn't I didn't have to wear 0:16:52.920 --> 0:16:56.000 a hat. But to we get into this get into 0:16:56.080 --> 0:16:58.720 this village, and there are lots of people with smallpox, 0:16:58.800 --> 0:17:05.520 including most notably a newborn infant only a few days old, 0:17:05.800 --> 0:17:10.439 that was lying on a mat between its mother and 0:17:10.480 --> 0:17:12.359 the mother's co wife. 0:17:12.760 --> 0:17:14.560 When you say co wife, what does that mean? 0:17:15.080 --> 0:17:18.600 That means that they were both married to the same man. Okay, 0:17:18.680 --> 0:17:22.879 and the child had not been vaccinated. But both of 0:17:22.920 --> 0:17:27.640 these two women were in the full throes of smallpox infections, 0:17:27.960 --> 0:17:32.400 and so that infant had been exposed. Fortunately, I had 0:17:32.520 --> 0:17:36.240 vaccine with me. I was able to vaccinate the infant, 0:17:36.400 --> 0:17:40.120 and later about ten days later, when I came back, 0:17:40.200 --> 0:17:43.960 I saw that the vaccination was taken and that baby 0:17:44.080 --> 0:17:44.560 was saved. 0:17:44.840 --> 0:17:49.240 And just to just because you know, I've never seen smallpox, thankfully. 0:17:49.760 --> 0:17:53.520 When you say that two women were in the throes 0:17:53.560 --> 0:17:54.959 of infection, what did they look like? 0:17:55.119 --> 0:17:58.560 Well, it's hard to see people suffering so much, because 0:17:58.600 --> 0:18:02.840 it's not only that people their bodies are swollen. They're 0:18:02.880 --> 0:18:06.280 covered in all of these pustules. But it's very painful. 0:18:06.720 --> 0:18:09.879 People describe it as feeling as if your skin was 0:18:09.960 --> 0:18:14.840 on fire. Smallpox caused a generalized rash over most of 0:18:14.880 --> 0:18:20.720 the body. It was most intense over the face, the hands, 0:18:20.760 --> 0:18:24.359 and the feet. But in this instance you could see 0:18:24.600 --> 0:18:31.119 these raised pimples first you get little bumps that turn 0:18:31.359 --> 0:18:38.400 into blisters that then fill with puffs, which then these 0:18:38.440 --> 0:18:44.240 blisters break, and if you're lucky and survive the broken 0:18:44.280 --> 0:18:48.560 blisters and puffs, that all dries up, and gradually, over 0:18:48.560 --> 0:18:51.720 the course of two three weeks the scabs drop off. 0:18:52.000 --> 0:18:55.640 But all of that is infectious, and people when they're 0:18:55.680 --> 0:18:58.919 just even before the rash starts, when they start feeling 0:18:58.960 --> 0:19:05.280 headache fever, they're already breathing out smallpox virus onto other people. 0:19:05.560 --> 0:19:09.960 And so the challenge is the situation like that, to 0:19:10.040 --> 0:19:13.280 vaccinate as many people who do not yet have smallpox 0:19:13.720 --> 0:19:15.720 as quickly as you can. 0:19:15.960 --> 0:19:18.399 So, okay, So you get to this village. You see 0:19:18.400 --> 0:19:21.760 these two women and the baby. The women are clearly sick. 0:19:21.880 --> 0:19:25.040 You vaccinate the baby because the smallpox vaccine can actually 0:19:25.280 --> 0:19:27.840 help people who are in the early stages of an infection. 0:19:28.560 --> 0:19:30.600 What do you do next? What else is happening in 0:19:30.640 --> 0:19:31.399 this village? 0:19:32.200 --> 0:19:37.640 In this sensance, we learned very quickly that two weeks before, 0:19:38.280 --> 0:19:41.480 a very prominent man in that village who was head 0:19:41.520 --> 0:19:45.639 of a secret society, had gotten smallpox and had died. 0:19:46.640 --> 0:19:51.440 Because he was so prominent, people came from other villages 0:19:51.560 --> 0:19:55.440 to visit him when he was ill, and people came 0:19:55.520 --> 0:19:56.400 for his funeral. 0:19:57.680 --> 0:20:01.080 This is a giant alarm bell. It's very bad news 0:20:01.119 --> 0:20:02.760 for you. In nineteen sixty. 0:20:02.440 --> 0:20:06.560 Eight, very very bad news, because we also began learning 0:20:06.600 --> 0:20:09.000 when I was there. What we were seeing was that 0:20:09.960 --> 0:20:13.640 many people had come from other villages as well surrounding 0:20:13.840 --> 0:20:18.560 this village, and so this was a much bigger outbreak 0:20:18.800 --> 0:20:20.040 than what we were expecting. 0:20:20.400 --> 0:20:23.280 So tell me about what containment meant at this time 0:20:23.320 --> 0:20:24.119 in this context. 0:20:24.240 --> 0:20:27.840 Yes, when we first began working in the smallpox program, 0:20:27.960 --> 0:20:32.680 the strategy was to mass vaccinate eighty percent or more 0:20:32.760 --> 0:20:38.000 of the population. The containment surveillance strategy was developed where 0:20:38.040 --> 0:20:43.520 the strategy became find out where the current cases of 0:20:43.600 --> 0:20:50.600 smallpox are go there, give priority to vaccinating people in 0:20:50.760 --> 0:20:56.680 those households and that village and nearby villages, so called 0:20:57.000 --> 0:21:00.640 ring vaccination, because if you could do that, you could 0:21:00.720 --> 0:21:04.560 stop the virus from spreading to other people. That was 0:21:04.600 --> 0:21:08.760 a much more efficient way of getting after the virus 0:21:08.800 --> 0:21:13.160 to stop transmission. Because now you're looking to vaccinate three 0:21:13.320 --> 0:21:16.320 four five percent of the population rather than eighty percent 0:21:16.320 --> 0:21:17.040 of the population. 0:21:17.200 --> 0:21:20.440 It's like you draw a circle, a big circle around 0:21:20.520 --> 0:21:23.280 the village where the infection is and you vaccinate everybody 0:21:23.320 --> 0:21:27.080 inside that circle. So it's like you're surrounding the virus 0:21:27.240 --> 0:21:28.679 with immune people. 0:21:29.119 --> 0:21:31.920 That's exactly what you're doing. And the radius of that 0:21:32.000 --> 0:21:34.240 circle was at least five miles. 0:21:35.280 --> 0:21:38.399 Okay, so you have your information right, you have your 0:21:38.920 --> 0:21:42.800 epidemiological surveillance, you have your your ring on a map. 0:21:43.560 --> 0:21:44.160 What do you do? 0:21:44.640 --> 0:21:49.080 We then come back with several other vaccinators and have 0:21:49.200 --> 0:21:53.040 a plan to assign different groups to go to each 0:21:53.119 --> 0:21:58.080 of these villages and make sure that everyone there is vaccinated. 0:21:58.280 --> 0:22:00.119 And you just show up in a village where if 0:22:00.200 --> 0:22:04.800 your briefcase full of a vaccine and say here we are, 0:22:04.920 --> 0:22:05.920 come line up. 0:22:06.280 --> 0:22:10.640 The villagers had had warning, and in fact, we discussed 0:22:10.920 --> 0:22:13.680 with the village chief and the senior people in the 0:22:13.760 --> 0:22:18.240 village to agree on a mutual time when was most 0:22:18.320 --> 0:22:21.600 convenient for them for us to come back and make 0:22:21.640 --> 0:22:24.320 sure everybody was vaccinated. It had to give them notice 0:22:24.320 --> 0:22:27.400 in advance, because otherwise, if you just show up, people 0:22:27.480 --> 0:22:29.720 are out on their farms, which could be two or 0:22:29.760 --> 0:22:32.720 three miles away in many different directions, et cetera. 0:22:33.160 --> 0:22:35.920 So how long does it take you to with your 0:22:35.920 --> 0:22:38.920 team go to all of the villages inside this ring 0:22:39.160 --> 0:22:40.919 and vaccinate everybody. 0:22:41.440 --> 0:22:44.840 That took a matter of a few days fast, so 0:22:44.960 --> 0:22:48.560 each team only had to go to one or two villages, 0:22:48.600 --> 0:22:50.800 and so we were able to get there in a 0:22:50.800 --> 0:22:53.720 few days and get them vaccinated, and we were able 0:22:53.760 --> 0:22:57.480 to stop that particular outbreak in only three or four 0:22:57.480 --> 0:22:58.480 weeks max. Wow. 0:22:58.800 --> 0:22:59.439 So it worked. 0:22:59.480 --> 0:23:02.040 It worked. Not only worked in Sierra Leone, but when 0:23:02.480 --> 0:23:06.840 we sent a telegram back to CDC headquarters to let 0:23:06.880 --> 0:23:10.240 them know what had happened, they were ecstatic. And of 0:23:10.280 --> 0:23:14.919 course this was one of the first big demonstrations of 0:23:14.960 --> 0:23:20.360 the power of this new ring vaccination strategy, and so 0:23:20.560 --> 0:23:26.320 it electrified the entire global smallpox eradication program to see 0:23:26.600 --> 0:23:30.520