forum discussion #38

How to Kill a Killer Disease

Photo by Tom Paulson

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Listen to our interview with William Foege here.

William Foege was one of the scientists who led the global campaign to eradicate smallpox, a deadly disease that plagued humankind for centuries. At the time, he was working for the U.S. Centers for Disease Control. His new book about the eradication campaign is called House on Fire: The Fight to Eradicate Smallpox.

Foege is now a senior fellow at the Bill and Melinda Gates Foundation, and he is our guest in this Science Forum discussion.

When Foege first started working for the smallpox eradication campaign in the late 1960s, the plan was to vaccinate everyone in affected countries. But while working in Nigeria, he found himself facing a shortage of vaccine supplies. So he enlisted local missionaries to find affected communities and only vaccinate people in the immediate vicinity of patients. The strategy is what public health officials call “surveillance and containment,” and it ultimately succeeded in eradicating the disease globally.

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More than thirty years later, smallpox remains the only human disease to be eradicated. (The United Nations has just announced the first eradication of a livestock disease—rinderpest. Click here to read/listen to our story.) There are efforts to eradicate other diseases like polio, Guinea worm, and malaria.

Is eradication a feasible goal for all diseases? When should we decide to eradicate a disease versus just control it?

Bring your thoughts and questions for Foege. He’ll be participating in this discussion until July 12th.

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Your Comments

  1. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

    It has been a third of a century since smallpox was eradicated. Some assumed there would be no other human disease eradicated and some feel it would not be a good use of resources to focus on single diseases given the great health burdens of the world. The tools continue to improve and make eradication of diseases a possibility. Should guinea worm, polio, measles and other eradication programs be encouraged at this time?

    I look forward to hearing your thoughts, and answering your questions.

  2. Ron Burke

    Dear Mr. Foege:

    Thank you for your contributions to the betterment of the world. In the USA we now have a disturbing problem of certain celebrities with no scientific back rounds who believe, based on study that has since been proven to be a fraud, that autism is related to vaccines. We are now beginning to see outbreaks in schools here of illnesses and diseases that were believed to be eradicated due to parents not having their children vaccinated.

    What is your opinion on this and do you have any ideas on how we can convince people to continue to vaccine their children?

    Thank you again,
    Ron

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Dear Ron, thank you. It is a sad development due to parents no longer seeing the diseases that vaccines prevent and being presented with incorrect information.

      Two immediate actions: First every pregnant woman should understand her child does not have congenital rubella syndrome because other children were immunized and prevented the virus from reaching her unborn child. There is a social contract involved. Second parents refusing immunization should sign a waiver making it clear they understand the consequences for their children and others and also understand their children will be at greater risk later in life if they travel to other countries. Thank you, Bill

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Rhitu Chatterjee

      Hi Ron,

      The World’s science reporter here. I wanted to point out one of our past Science Forum discussions. We featured author Seth Mnookin about his book Panic Virus, which chronicles this phenomenon that you mention, of the recent decline in vaccination rates in the US and UK, because of the unproven connection between vaccines and autism.

      http://www.world-science.org/forum/seth-mnookin-panic-virus-vaccine-autism-wakefield-lancet-disease/

      I think you and others interested in this issue will want to check out our online conversation with Mnookin. (the discussion is now closed, but our interview with him is worth listening to and the online conversation worth reading)

      Thanks,
      Rhitu

  3. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Elsa Youngsteadt

    Hello William,
    So why *is* it so hard to eradicate a disease? Is it lack of resources to deliver vaccines, ability of the disease to circumvent a vaccine, or what? (Or, put differently, was there something special about smallpox and rinderpest that made them achievable targets for eradication?)
    Thanks,
    Elsa

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Dear Elsa, the diseases we still have are the ones with a long history of evolving to be successful in their own survival. Often they involve other species which limits our ability to vaccinate the other species. That was the problem with yellow fever where a good vaccine is available but the virus spreads in primates in the jungle.

      Smallpox and rinderpest were restricted to one species, good vaccines were available and surveillance of the disease made it possible to pinpoint the problem. More diseases will be in on the list of potentially eradicable as our tools improve. Thanks, Bill

  4. Verne

    This is hard to talk about, but it seems that eradicating widespread diseases can be a dangerous and short sighted persuit. With eradication of a disease like Malaria there will be, as a result, a huge increase in population size. It should be obvious that this will cause starvation and countless other problems unless we also implement realistic population growth control. Thoughts?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Thanks Verne. That seems obvious on the surface until you examine the statistics and find that the highest infant and child death rates are in the countries with the highest birth rates and population increases. Likewise the lowest death rates are associated with the lowest population increases. The reduction of deaths and suffering has a profound impact on lowering birth rates and population growth.

      I am very much in favor of simultaneous population programs and the right of all people to choose when they have children and how many. Many don’t have that choice. Thanks, Bill

  5. Ed M

    Sit back for a second, close your eyes and appreciate the age we live in. All the destructive “miracles” of the bible are the act of a petulant child compared to the true miracle of science’s eradication of two diseases. The idea that we will live long enough to see six more disappear fills me with awe. These ARE the days of miracles and wonder.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Ed, well said. Roger Bacon in his report on science to the Pope 700 years ago decride the fact that science has no moral compass. I tell students to love science but don’t worship it. Better than scienc is science with a moral comapass, in the service of humanity. Thanks, Bill

  6. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? David Baron

    I’m the health & science editor for PRI’s The World. We are grateful to have you in the forum!

    I’m curious to hear your thoughts on the recent controversy over what should be done with laboratory samples of smallpox virus that continue to be held by the U.S. and Russia. Many countries would like those samples destroyed because there’s a danger the virus could escape unintentionally or even be released intentionally (by a terrorist group, for instance). The U.S. government says we should keep the samples for scientific purposes. Where do you stand?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Thanks David. Both sides are passionate in their arguments. The precautions with the two stockpiles are incredible. I am always left with the feeling that we are spending so much energy over the fate of those two stockpiles while my real concern is about what we don’t know. Are there other stockpiles unknown to us? If so, that should be the focus of our attention. Thanks, Bill

  7. Susan Sencer

    Dear Bill, It was thrilling to hear you on the radio this evening, and I’m so excited that your important book has received so much attention. As always, you are erudite and make the difficult scientific questions intriguing and accessible to the lay public. Sometime, let me know what you think about the theory–perhaps only my own and Annie’s–that oncology is today’s infectious disease. Meaning, that it is the intellectual arena where cutting edge science meets real world possibilities.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Thanks Susan. It is indeed that and therefore has attracted some of the best scientists in the world. Several overlaps with infectious diseases. The first is that it often acts like an infectious disease growing at the expense of normal cells. Second, if cancer is an extension of Darwin’s law, and any cell with an advantage over other cells will replicate faster it is possible for infectious agents to be the trigger that stimulates tissues to mutate for an advantage. That seems to be the case with Hepatitis B virus and liver cancer and Human Papilloma virus and cervical cancer. The past 75 years have revealed enough infectious disease secrets to make dozens of vaccines possible. The next 75 years will see similar improvements in cancer prevention and therpy. Thanks, Bill

  8. Ed Gross

    Dr Foege,
    Thank you for doing such an immeasurably valuable work throughout your career……Great job. Ed Gross formerly of Eldorado’s Dover #2

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Thanks Ed. It is great to hear from Eldorato people. There aren’t that many of us! Until his death two years ago I kept in contact with Norman Borlaug who also grew up on the Turkey River. Thanks for your comment. Best, Bill

  9. avv84501.1015@gmail.com

    Lady Mary Wortley Montagu’s letters back to England from Turkey (Her husband was Ambassador, late 1700′s)revealed a local inocculation which led to significant drop in the virulence of Small Pox in that patient.

    Dr Foege, your comment?

    Thank goodness for our e-mail, communications abilities and the ability to spread news.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      You are correct and this form of immunization, called variolation, was widely adopted in England. The approach had been used in China, India and Africa and the method was actually brought to the US by slaves, leading to lower mortality rates in blacks versus whites in an outbreak investigated by Cotton Mather in Boston. But it was not widely used in America. The protection offered British troops in the Battle of Quebec, at a time when American troops were encountering high rates of smallpox, finally convinced George Washington to variolate US troops. This may have been one of his most important tactical decisions and by the time the fighting had moved South, the US troops had the same immunity to smallpox enjoyed by British troops. Thanks for the comment and question. Bill

  10. Ada van Vloten

    Liotard was the portraitist who traveled from Geneva to Constantinople with the Montagues. The account has come down through our family. I am pleased to see HOUSE ON FIRE has this bit of history, and I look forward to learning much more from your writings, Sir.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Thanks for this bit of history. Very interesting. Bill

  11. Gary Brown

    I love the notion of “surveillance and containment.” It’s essentially how a wildfire team would contain a fire — burn out a span of land between what you want to save and the part already lost. It makes me wonder if the same technique is widely applicable with the width of the span burned out being a direct ratio to the ferocity of the disease. Can you calculate how far out the perimeter needs to be cleared? Where does it fail?

    Thanks so much for the great work…

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Thanks Gary. It has many similarities with fire-fighting. With smallpox a width of 6 feet is probably sufficient under most circumstances, however, as with fires jumping a fire line there are many things that can go wrong. Virus can be carried by air currents beyond that. Infected clothing may be taken out for washing and spread the virus. An immune person could carry the virus passively on clothes etc.

      With other diseases it depends less on the ferocity and more on the method of spread. With tuberculosis, for example, some people are “spreaders” and provide organism droplets of the right size for longer transmission, in one case spreading from a choir director with lower rates as distance increased from director to choir member. Thanks for the question, Bill

  12. Robert Greene

    Aren’t there small collections of the virus responsible for small pox held by the Centers of Disease Control in the US and in Moscow at a comparable facility? Isn’t there the danger that some may escape? Aren’t there dozens of varieties of pox still in existence, monkey pox, cow pox and others that are similar in the genetic makeup of the small pox virus? After all, our small pox vaccines were derived from cow pox. Since the 1970′s, vaccination in the US was discontiued, and the majority of the population no longer has been vaccinated.

    I just hope that the scourge of small pox will have been put to rest in spite of the continued existence of the virus with CDC and in Russia.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Thanks Robert. Yes there are collections in the two places. They are under continous monitoring and strict control. You are correct that there are many pox viruses but most seem unable to infect humans. They are species specific. An exception is monkeypox which clinically looks like smallpox in humans. On the plus side it spreads with difficulty from person to person and has been easily controlled. Monkeys may also be accidental hosts and research continues in Africa to understand the natural cycle.

      The fear of a natural or deliberate resurgence is always present. We now keep stores of vaccine and could respond quickly but we worry about training responders for the day when all current smallpox fighters are gone. Thanks, Bill

  13. Robert Greene

    Thank you for the confirmation that the SP virus still exists in the US CDC and Russian CDC and the existence of “stores of vaccine” with which we could “respond quickly” in case of an outbreak. With the historic reality of political and economic upheavals, the weakness of human behavior, the continued existence of viable viri in secure custody of our fellow human beings is not altogether reassuring. How do we assure that we “trust and verify” secure custody?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

      Thanks Robert. The fact that there is no absolute way to verify means that we will always have to have a response contingency. That we have and the ability to continue making vaccine does not require that we have the virus so it should be possible to always retain the response capacity. Thanks, Bill

  14. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? William Foege

    Thanks to everyone who responded. The subject of smallpox eradication allows us to rejoice that the world is free of this scourge and at the same time reminds us that we will have to be vigilant forever. Bill Foege

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