-Breaking news tonight. The coronavirus outbreak declared
a global pandemic.
A never-before-seen infectious disease, Covid-19,
has the world on edge.
-Breaking news tonight.
America shuts down.
A new reality sets in with the coronavirus crisis.
The National Guard moving in.
This isn’t the first time the world has grappled with how to
confront the outbreak of a deadly disease.
Decades ago, we faced off against smallpox,
which killed an estimated 300 million people
in the 20th century alone.
So what lessons can we learn from that experience and from
Dr. Larry Brilliant, the man who helped eradicate smallpox and
who has spent his life fighting pandemics?
Brilliant’s story begins in the early 1970s.
-The possibility that I would go and work for W.H.O. seemed so
much larger than me or anything I’d ever done before.
And I was 27!
Dr. Larry Brilliant was a young physician who blazed an
unconventional trail into the world of public health.
-Wavy Gravy, who was the master of ceremonies at
Woodstock, and a clown, he said, let’s go to Nepal.
And that seemed like a great idea.
We had these 40-foot-long buses and there were 40 kids
living in unimaginable sleeping arrangements.
I mean, we were not very conservative.
Brilliant would make his way to India and became a disciple of
one of the country’s most famous gurus.
-For about a year, I would sit there and meditate as we all
would, and he would start throwing apples at my testicles.
And then one day he called me over and he said, “Dr. America!”
that’s the name he gave me, I want you to go to W.H.O.
and I want you to be part of a program to eradicate smallpox.
-The World Health Assembly in Geneva voted to undertake a
ten-year program to eradicate smallpox throughout the world.
-I walked into W.H.O. and I said, oh, I live in the Himalayas.
I’m a doctor. My guru, who lives
in the Himalayas too, he said that I’m supposed to work for
you and God is going to help eradicate smallpox.
And they kicked me out.
I went back and they kicked me out again and again.
Then one day, there was a, uh, telegram that said,
come to report to work for W.H.O. on Monday morning.
In 1973, he became one of the youngest doctors ever to join the
World Health Organization’s smallpox eradication campaign
in India.
-There were a quarter of a million, mostly children,
who got smallpox.
Sometimes I would go into a village and there would be
bodies stacked like cords of wood, and eyes blinded by the
disease, boils all over his or her body.
Mothers would come and bring their children and say,
Doctor, heal my child. And
there was nothing you could do.
There’s no treatment for smallpox.
It was a very contagious disease, and a very
lethal disease.
A third of those who were infected would die, but not
before passing on the virus to an average of seven more people.
The best way to stop smallpox from spreading was to vaccinate
everyone around an infected individual.
But finding hidden cases in a chaotic country was
not that easy.
-Here you go.
-Thank you.
-Indian popcorn.
-Shukria.
A few years ago, Brilliant returned to a market in
India where he first searched for smallpox in 1973.
-And we would do marketplace surveillance in addition to
house-to-house surveillance.
So we’d have to come here, and we
would do something spectacular, we’d get a clown, we’d give kids
stuff and everyone would come and we’d say, have you
seen anybody who looked like this, and we’d hold up a picture
of a child with smallpox.
And we’d say “suchna dehna wala
ko, ek hazaar inaam milay ga.”
So the first person who finds a case like this we’ll give them a
thousand rupees.
-In an era before cell phones and satellite maps, over a
hundred million households were checked repeatedly by an army
of Indian health workers.
-We weren’t finding all the cases of smallpox.
Children would run away and we couldn’t
vaccinate them.
And the District Magistrate said,
You need to have an elephant.
You need to have an elephant and a parade,
and horns.
And if you have a parade, all the children will come.
And you can find any hidden cases.
And that’s what I did.
W.H.O. had a very
dim view of what I was doing.
It certainly was not part of our protocol, but it worked.
And I don’t think that we could have
eradicated smallpox as quickly as we did without breaking rules.
On October 16, 1975, two-year-old Rahima Banu was
the last person to be diagnosed with Variola Major, the deadliest
strain of the smallpox virus.
-I remember looking at her and thinking, when her scabs fell off
and she coughed out whatever viruses were still in her lungs
and they landed on the ground in Bangladesh and the sun
baked them, that was the end of a disease that had been the
worst disease in history.
In 1988, energized by the success of the smallpox
program, the global public health community moved to tackle
another ancient scourge: polio, a killer virus which paralyzed more
than 300,000 people that year.
The new campaign surged ahead, and polio was eliminated
from 118 countries in only 14 years.
But then…
-Suddenly the disease is spreading again.
-Religion and suspicion have helped fuel the disease
in the north.
In 2003, distrust between Muslim leaders and the
Nigerian government spawned a rumor that polio vaccination
was a Western ploy to sterilize Muslim youth.
-In Nigeria, the imams issued a fatwa against the polio program
and, in doing so, created an epidemic of polio.
-The impact of this boycott led to reimportation of the virus to
nearly 20 countries.
Heidi Larson maps the rumors that can lead to resistance
to vaccines.
In Nigeria, these stories were as contagious and
lethal as the virus.
-This is a map that we put up to mark all the negative vaccine
reports that we were getting.
The underlying issue was distrust,
in a big way.
When you have a vaccine that’s brought to your
door repeatedly, when you’re not getting many of the other very
basic health needs that you feel like you need more, it prompts
suspicion.
The Nigerian boycott drove home a hard lesson that even
with scientific advances and a globalized world, the key to an
eradication campaign is public trust.
And it can disappear in an instant.
-The United States has conducted an operation that
killed Osama bin Laden, the leader of Al Qaeda.
-The C.I.A. has admitted it used a fake vaccination program in
2011 to collect blood samples in the search for
Osama Bin Laden.
In Pakistan, opposition to the polio program exploded following
these reports.
-This was exactly an example of throwing a firecracker in the
midst of a highly fertile, suspicious ground and it really
set things back.
-A two-day killing spree in Pakistan.
-Over the past year, there have been a number of attacks on
health workers distributing the polio vaccine for which the
Pakistani Taliban has claimed responsibility.
-Suspicions around C.I.A. involvement in mass vaccination
campaigns have been there for years.
A decade ago, I could confidently go to communities
and sit with them saying, you know, this is for the best interest
of children, this is not a covert effort.
And I could not say that now.
The polio eradication campaign seems to be back on track.
-A lot of people in the world thought that was the end of the
polio program and that they would never succeed.
It certainly makes you realize the interplay
between global politics and disease control.
Today, as coronavirus spreads around the globe, Larry Brilliant
says the tension between politics and public health is
still playing out.
-In every epidemic I’ve worked, government always has the
tendency to underestimate or underplay how
bad the epidemic is.
In recent interviews, he’s expressed frustration that the
world has not learned the lessons of the past, pointing to
the U.S. government’s reluctance to do the kind of widespread
community testing that worked in taming smallpox and polio.
-If you have a cough, if you have a fever, so what if we are testing
testing more people than have the disease?
That is what we do with every test we do in
medicine because it is so important to find people who
actually have the disease we’re looking for.
Brilliant says the U.S. should speed up the mobilization of
medical supplies and building of field hospitals in the most
affected areas.
And think out of the box, as the smallpox
eradication effort did, including the kind of radical transparency
that South Korea is using to keep the public informed.
-The South Korean government is sending out text messages
to every individual in the country saying,
there is a corona case near you,
here’s what you can do, please tell us how you are doing.
Uh, publishing the daily counts, publishing the mistakes
that are being made.
I think when you’re looking back at the lessons from
both smallpox eradication and polio eradication, we have to
remember that they helped us put the "public" back in public
health, whether you’re talking about public trust, or public value,
or public will, those are the keys.