Book Recounts Challenges Of Eradicating Smallpox

In Smallpox: The Death of a Disease, Dr. D.A. Henderson recounts the history of the deadly virus, from the development of the first vaccine in the late 18th century to his involvement in the successful global eradication campaign in the 1960s and 70s.

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IRA FLATOW, host:

Up next, in 2003, former vice president Dick Cheney and the Homeland Security Council wanted to vaccinate the entire country against smallpox, a disease that has been eradicated some 25 years before. Why? Well, my next guest was a central player in that saga, and he's here to tell us the back story on those vaccination plans. It's one of the stories in his book, "Smallpox: The Death of a Disease."

He is Dr. D.A. Henderson, distinguished scholar at the Center for Biosecurity and part of the University of Pittsburgh Medical Center. He's also - was also a director of the World Health Organization's Global Smallpox Eradication Campaign from 1966 to '77. He joins us from WYPR in Baltimore.

Welcome back to SCIENCE FRIDAY, Dr. Henderson.

Dr. D.A. HENDERSON (Center for Biosecurity, University of Pittsburgh Medical Center): Thank you very much. Happy to be here.

FLATOW: Can you fill in the details of that story for us? What happened?

Dr. HENDERSON: Well, the great concern after 9/11 was that there was going to be a second attack of some sort, and it was rumored that it might be biological. And we were most concerned at that time that it would be smallpox or anthrax. These were the two principal agents that the Soviet Union had as their priorities and where they were doing a lot of research. So we were concerned about vaccination, but we had stopped vaccinating in the United Sates back in 1972.

We had very little vaccine available in - we'd made the last in 1978. So we came up to the time right after 2001, we had very little vaccine. We were - neither did any other country have vaccine. And we had no vaccine production facilities. We were worried, and we undertook a - the government did a massive program, rapid program to produce a lot of smallpox vaccine. And by the early '73, it was - I'm sorry, 2003. It became apparent that we were going to have a fair amount of vaccine come the autumn of 2003. And this is where the vice president took a particular interest in it and felt, well, we should vaccinate everybody, and then there'll be no risk. And that became a point of real contention.

FLATOW: And so he asked you. What was your advice?

Dr. HENDERSON: Well, the smallpox vaccine is not innocuous. It produces - I think many people have forgotten what it was like, but you inoculated a person, and they would get a - like a pustule on their arm. It would develop over four or five days. It would be - look very angry. You'd have some fever. And some people would have very serious illnesses, even to the point of requiring hospitalization and occasionally death.

So, if we're going to go out and vaccinate a lot of people, this is a risk that we're subjecting a lot of people to. And what's the benefit? And the question was: How big was this risk of small pox being released? And that was a question we simply couldn't answer. We had no idea what possibly people could do, people that we don't know, nations we don't know.

And so, the question was: What was the benefit? What was the risk? The vice president and his group were very determined they were going to vaccinate the entire country. And we were absolutely saying, no way. It's not a good idea. Vaccinate 100 million people, say, we'll have 100 deaths. And I don't think that's acceptable.

FLATOW: All right. We're going to take a break, come back and talk a lot more with D.A. Henderson, author of "Smallpox - The Death of a Disease: The Inside Story of Eradicating a Worldwide Killer." Our number: 1-800-989-8255. Also, you can tweet us at @scifri, @S-C-I-F-R-I, and join us in Second Life. Stay with us. We'll be right back after this break.

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FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR News.

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FLATOW: You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. Our number: 1-800-989-8255. We're talking with D.A. Henderson. Dr. Henderson is author of the new book, "Smallpox - The Death of a Disease: The Inside Story of Eradicating a Worldwide Killer." And I'm just looking at the cover of this book because I don't think I've ever seen the actual needle that they scrape on your skin.

(Soundbite of laughter)

FLATOW: I remember - when I was a kid, everybody was getting smallpox, right? They stopped giving the vaccine, what, in 1972, something like that?

Dr. HENDERSON: The vaccine was stopped in 1972. And it's very interesting, Ira, that you look at it, that was the only vaccine that a child was required to have before he went to school. And it had been 23 years since we'd had our last case in the United States. People were really - the countries, U.S. and others, were fearful of this disease and having it imported and perhaps spreading.

FLATOW: Well, why is it that of all the diseases, smallpox is the most feared disease out there? And, you know, why did the vice president say: Let's not worry about anthrax. Let's not worry about other stuff. Let's worry about smallpox.

Dr. HENDERSON: Well, this is a disease which has a 30 percent death rate, and there's absolutely no treatment. So, once the individual gets the disease, the best you can do is provide food and water, and that's it. At one time, smallpox in - was present worldwide, every country, whether you were in the tropics or way up north, you would eventually encounter smallpox.

And so as you go back through history, you will find that there are gods and goddesses in many different cultures for smallpox. It's the only disease for which there are gods and goddesses. And this was true in Japan and China and India and Africa. And I think all countries were that deeply concerned about it.

FLATOW: Mm-hmm. I remember we did a show about 10 years ago - we were looking at the logs here - when we talked about the imminent destruction of the last remaining vials of smallpox. Whatever happened to those vials? Did they get rid of them?

Dr. HENDERSON: Well, about 10 years ago, we thought we had - there was a World Health Organization Expert Committee had agreement that it would be a good idea to destroy it. A lot of people felt that at that point, we had enough information to do any research in the future that we needed, and why keep the virus and risk perhaps this virus escaping from a laboratory or otherwise being used, and to have some sort of commitment in the general assembly or World Health assembly saying that anyone with this virus after X date is automatically guilty of crimes against humanity.

Well, at the last minute, we had some investigators on the - in the Defense Department who felt we really ought to go ahead and try to develop a new vaccine that would be - probably cause less reactions than the present vaccine. Or perhaps we'd develop a drug that could be - that could treat smallpox if it happened that we had cases.

So there was an argument that went on about this where they felt we ought to go ahead and do it. There were others who said, you're gong to spend 800, $900 million developing another vaccine which we never hope to use. This didn't make a lot of sense when we actually had a vaccine that - although it caused reactions - we could stop an epidemic.

So we felt we were pretty prepared, and a lot of people did. But at the last moment, there were objections. And it's become a real point of contention between many of the developing countries who would like to see it destroyed. And the U.S. and Russia at this point are primarily the ones on the other side.

FLATOW: Mm-hmm. Well, today, we have advanced DNA synthesis technology. Does it even matter if we destroyed the vials? Couldn't someone just make smallpox from scratch in a laboratory?

Dr. HENDERSON: Well, in fact, theoretically, you could. It wouldn't be easy. It would be very difficult. But, in theory, you could. The thing of it is, though, that if it is not available readily in a laboratory, it's going to take some pretty sophisticated biologist to go ahead and create - fabricate the virus again.

FLATOW: Mm-hmm.

Dr. HENDERSON: So I think that it would be not an absolute guarantee if you destroyed the virus nothing would ever happen. But it really would put a major barrier in there, and I think this is important.

FLATOW: Mm-hmm. 1-800-989-8255. Brian in Grand Rapids, Michigan. Hi.

BRIAN (Caller): Hi. Thanks for taking my call.

FLATOW: You're welcome.

BRIAN: I was wondering what - if there had been any studies on the people that had been vaccinated back in the '60s and '70s, how immune they still are to the disease and whether that discounts the viability of using that disease as viability of using that disease as a weapon at all? I'll take my call off the air. Thanks.

FLATOW: All right. Good question.

Dr. HENDERSON: Well, our impression is that along about nine, 10 years, immunity begins to fade, and that when you get out then 20, 30 years, that there's an increasing susceptibility, although perhaps some protection against death. But at some point, the immunity goes completely. So we haven't vaccinated anybody since 1972, except some in the military. And we would guess right now that probably 75 percent of the population is susceptible, and if they were exposed, would get the disease.

FLATOW: Mm-hmm. I noticed that my little scar is gone. Used always look at it, right? Everybody had a scar. Looked at their arm, there was a scar.

Dr. HENDERSON: Yeah. You had the little vaccination scar, and it was a real mark that you'd been vaccinated. After a while, in many people, it does fade. And it's not - it's been a problem examining them, too, because in the earlier days, they used to put it to vaccinate little girls in some place where it wouldn't be evident�

FLATOW: Right.

Dr. HENDERSON: �that the scar was there.

FLATOW: Heavens forbid.

Dr. HENDERSON: But as time has gone on, it's become more difficult to find a place. So�

FLATOW: Yeah. Yeah.

(Soundbite of laughter)

FLATOW: A lot of - I'm sure that a lot of people have asked you, well, what's next? What's the next disease you're going to eradicate? And what do you say to them when they ask you that question?

Dr. HENDERSON: Well, at the present time, there's a major program that's been going on now since 1988, 21 years, to try to eradicate polio. And this is very, very difficult. It's down to about probably six to seven countries where it's still circulating. But it's very persistent there, and it's in some very difficult areas. There's polio continuing to circulate up in the northwest frontier of Pakistan, southern Afghanistan, the eastern part of Congo and so forth. It's areas where there's continuing fighting.

FLATOW: Mm-hmm.

Dr. HENDERSON: And polio is a lot more difficult to get rid of than smallpox, simply because you're not quite sure where it is. The estimate is that you get 200 individuals who are infected with polio and - for one that gets paralyzed. So you find one paralytic case, you have to assume you get 200 cases, somewhere around there. And you can't sort of zero in, as we were able to do and focus just on that area where the outbreak was because we know that everybody who got infected with smallpox would show a decided rash.

FLATOW: Are there still cases in Mexico of polio? I remember reading years back there may be three or four cases a year.

Dr. HENDERSON: No. The - there's been no small - polio circulating in the Americas at all since 1991.

FLATOW: Mm-hmm.

Dr. HENDERSON: There'd been occasional importations that have occurred from countries that have had it, but not any in quite a while now. So polio is gone from the whole of the Western Hemisphere.

FLATOW: Well, let me just - in the couple of minutes we have left, let me see if I can bring you Dick Cheney story all the way to a complete circle. When you - who eventually - did the decision go all the way up to the president, President Bush, not to vaccinate the whole country?

(Soundbite of laughter)

Dr. HENDERSON: Well, at one time, we were told we should - the next day that we should not tell anybody where we're going and that we should go out to Andrews Air Force Base, which we did. And there was Dick Cheney and Scooter Libby and one of his staff, and I had three of my staff. And we flew in Air Force Two down to Atlanta, where the Centers for Disease Control was, and - to talk with them about this whole issue. And not surprisingly, they had exactly the same view as we had, that it would not be advisable to vaccinate.

We came back, got off the plane about five, 5:30. And I think we talked among ourselves, our own staff. And we said, at last. We've persuaded them this is not a good idea. And I got home that night and - 7:30, and my wife said, you've got to go in tomorrow morning early because they're going to announce the vaccination of the country. And I thought, oh, my goodness. Well, I got an early train and went down. I found a couple of my staff members sitting and rather casually drinking coffee. And at this point, I figure we've got - the press conference, I have around 10:00. We've got to be - we're going to have a lot of information we're going to have to provide, and questions and answers and so forth. Well, it turned out - they said, they just called from the White House. They've cancelled the press conference.

And as we were later to learn - what happened? Why did we not have this program? And I was told later, and it became evident, that the president had intervened and said, we will not.

FLATOW: Hmm.

Dr. HENDERSON: And the fact was, I had been with the president up to Pittsburgh - this is George W. Bush. He'd given a speech. And flying back, he's - we spent an hour talking about biological weapons and what we are doing and that sort of thing. And we talked about the vaccination and how would we stop an outbreak and what was the danger or the risk. And he took no notes, just sat in front of the big desk in front of Air Force One, and I didn't see him again for probably five, six months. And it was during this time that, apparently, he'd decided to overrule the vice president. So, very interesting.

FLATOW: That's the rest of story. If you want to hear more of the story about small smallpox, a great read is "Smallpox: The Death of a Disease," author D.A. Henderson.

Dr. Henderson, thank you all for coming in. It's always a pleasure having you on SCIENCE FRIDAY.

Dr. HENDERSON: Thank you very much.

FLATOW: Good luck with the book.

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