The Coming Plague (9 page)
Authors: Laurie Garrett
But the general finally relented, the last outbreak was stifled, and champagne was poured in Dhaka. Tarantola greedily guzzled the champagne, exultant after years of round-the-clock viral pursuit.
The next morning victory once again disappeared when word came that smallpox had surfaced on Bhola, an island off Bangladesh. For the third time the team was forced to remobilize after having been convinced the war was over. This time, when all the affected islanders had been vaccinated, Henderson held his breath a bit before announcing success.
On November 1975, D. A. Henderson was able to announce to the world that a three-year-old Bangladeshi girl named Rahima Banu had been cured, and represented the last case of wild variola major in human history. Two years later, on October 26, 1977, the last case of the less virulent variola minor would be found in Merka, Somalia.
By then Dr. Isao Arita had been in charge of the international effort for ten months, Henderson having retired. The Japanese physician ran the program with at least as much energy as the tall, bombastic American, but with a personal style that was more low-key and witty. In times of tension, Arita told jokes.
His humor was put to the test in the Horn of Africa in early 1977, just weeks after military leader Mengistu Haile Mariam seized power in Ethiopia, installing a Soviet-backed, communist government. The military government in Somalia laid claim to Ogaden, a region then part of eastern Ethiopia, and full-scale war was underway. Ethiopia, backed by Soviet arms and Cuban troops, mounted a powerful defense of Ogaden. But Somalia, despite its left-wing leanings, successfully obtained Cold War countersupport from the United States. As war raged, more than a million civilian refugees fled the area, pouring into nearby Somali and Ethiopian rural
provinces that were in the throes of their second and third years of drought and starvation.
provinces that were in the throes of their second and third years of drought and starvation.
It was in that areaâOgadenâthat the world's last known cases of smallpox variola minor could be found, primarily among Somali Muslims.
Arita knew that UN flags and WHO credentials would offer little protection to his scientific team members in such a volatile situation, yet he also felt time was running out. It was February 1977, and the Hajj was just ten months away. During the Hajj thousands of devout Somali Muslims would make their pilgrimage to Mecca, where they would eat, sleep, and pray for several days with some 2 million other followers of Islam from all over the world. If infected pilgrims were part of the hajj, all efforts to eradicate smallpox would end in failure.
For months the multinational team struggled against the elements, avoided the war's front, and tracked down smallpox cases among the refugees and villagers of Ogaden. By October the numbers of rumored cases seemed small, and despite the onset of the rainy season, Arita ordered the team to push on. Half the team got mired in mud floes during those rainy days, and one American scientist, Joe McCormick, spent three days alone in Ogaden, stranded in a Land-Rover stuck in a three-foot-deep wall of mud.
Finally, in Merka, Somalia, the team found the world's last case of variola minor.
All Maow Maalin would be cured, and all forms of smallpox disappeared. Smallpox had been conquered.
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Their jobs completed, smallpox team members dispersed to public health jobs all over the world. Surprisingly, they were not eagerly snatched up by WHO, or congratulated individually for their magnificent efforts. On the contrary, the brash young smallpox scientists were considered arrogant and thoughtless. They violated too many WHO bureaucratic guidelines. And they operated with a single goal in mindâa perspective quite unlike that of those who usually drove the vaguely pro-health WHO and national ministries of health worldwide.
“Science really suffers from bureaucracy,” Arita would later declare, adding, “If we hadn't broken every single WHO rule many times over, we would never have defeated smallpox. Never.”
Even Arita and Henderson, the heroic leaders of the smallpox eradication effort, were criticized for crossing too many WHO lines. Arita shrugged it off and returned to his hometown, Kumamoto, to run Japan's National Hospital.
After a period of being the target of animosity in the Geneva headquarters of WHO, Tarantola was thrilled to be assigned to an overseas job, running childhood vaccination campaigns in Indonesia. Francis was burned out, so he followed his girlfriend to Harvard, where he planned to do virology research. Heymann moved to Atlanta, signing on with the CDC. All three
men would work together again, over a decade later, to combat another global epidemic.
men would work together again, over a decade later, to combat another global epidemic.
Eradication took eleven years, involving about a hundred highly trained professionals and thousands of local health workers and staff worldwide. It was achieved at a cost of $300 million.
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On May 8, 1980, the World Health Assembly formally declared that “the World and all its peoples have won freedom from smallpox, which was a most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness, and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia, and South America.”
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A very different outcome awaited those who fought to eradicate malaria worldwide. Between 1958 and 1963 alone, $430 million was spent on a series of failed attempts to eliminate malaria. In 1991 dollars that constituted an expenditure of over $1.914 billion.
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Between 1964 and 1981, the United States spent an additional $793 million.
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Between 1964 and 1981, the United States spent an additional $793 million.
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When the international effort began, there were millions of cases of malaria every year, largely concentrated in Southeast Asia and Africa. Though reliable numbers were not available for most parts of the world, it was estimated that, for example, about 1 million people had malaria that year in Sri Lanka, some 100 million in India, and untold numbers, roughly estimated in the “hundreds of millions,” in Africa.
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On the other hand, humanity possessed powerful weapons. Chloroquine and quinine were effective treatments that, when properly and speedily used, stopped most cases of the disease in a matter of days. And chlorinated hydrocarbon insecticidesânotably DDT
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âcould kill not only adult mosquitoes that carried malarial parasites but their progeny as well, because the chemicals were virtually nonbiodegradable and their insect toxicity could be expected to eliminate pests that landed on sprayed surfaces for months, even years, after chemical treatment.
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âcould kill not only adult mosquitoes that carried malarial parasites but their progeny as well, because the chemicals were virtually nonbiodegradable and their insect toxicity could be expected to eliminate pests that landed on sprayed surfaces for months, even years, after chemical treatment.
Even without such chemical weapons, some countries had dramatically reduced their malaria problem; chief among them was the United States. There was disagreement in research circles about the origins of malaria in the Americas,
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but whatever the case, by the eighteenth century malaria was a serious endemic disease from Montreal to southern Chile.
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but whatever the case, by the eighteenth century malaria was a serious endemic disease from Montreal to southern Chile.
For the U.S. military, malaria was an enormous problemâin some theaters of combat, its chief hardshipâsince the creation of George Washington's Continental Army in 1776. At least a million soldiers suffered malaria during the Civil War, and the disease was a major killer in America's southern states well into the 1930s. U.S. troops also suffered serious malaria problems overseas; 19,000 doughboys contracted the disease during World War I, and over 500,000 GIs had malaria during World War 11.
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But during the construction of the Panama Canal (1904â14), General William C. Gorgas directed the U.S. Army Medical Corps on a successful
campaign to drain swamps, treat local people with quinine, and kill mosquito larvae floating atop pools of water. He did not have DDT at his disposal in those early years, yet the result was virtual eradication of Panamanian malaria. Similar drainage efforts throughout the U.S. sunbelt were already bringing malaria down to negligible levels by 1947.
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campaign to drain swamps, treat local people with quinine, and kill mosquito larvae floating atop pools of water. He did not have DDT at his disposal in those early years, yet the result was virtual eradication of Panamanian malaria. Similar drainage efforts throughout the U.S. sunbelt were already bringing malaria down to negligible levels by 1947.
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Then Egypt embarked on the first successful campaign using DDT to eliminate the
Anopheles gambiae
mosquito. Its initial results were so dramatic that the U.S. Congress allocated $7 million in 1947 for a DDT-based program to eradicate malaria within the forty-eight states. Five years later, the program was abandoned when not one case of malaria could be found within the U.S. borders.
Anopheles gambiae
mosquito. Its initial results were so dramatic that the U.S. Congress allocated $7 million in 1947 for a DDT-based program to eradicate malaria within the forty-eight states. Five years later, the program was abandoned when not one case of malaria could be found within the U.S. borders.
Similar successes were reported across the European continent, though malaria stubbornly hung on in parts of Italy, Spain, and Greece well into the 1950s. Buoyed by Brazil's success a decade earlier controlling the A. gambiae
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mosquito population, the 1954 Pan American Sanitary Conference held in Santiago, Chile, resolved to eradicate malaria-carrying mosquitoes from all countries in the Americas, from the Arctic to Antarctica.
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mosquito population, the 1954 Pan American Sanitary Conference held in Santiago, Chile, resolved to eradicate malaria-carrying mosquitoes from all countries in the Americas, from the Arctic to Antarctica.
In 1956, malariologist Paul Russell, then at Harvard University's School of Public Health, authored a report for the International Development Advisory Board (IDAB)
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recommending immediate global eradication of malaria. In the report Russell reflected mainstream scientific views of the day when he argued that DDT was such a powerful tool that a multimillion-dollar worldwide campaign could eliminate all malaria-carrying mosquitoes on the planet within less than a decade.
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recommending immediate global eradication of malaria. In the report Russell reflected mainstream scientific views of the day when he argued that DDT was such a powerful tool that a multimillion-dollar worldwide campaign could eliminate all malaria-carrying mosquitoes on the planet within less than a decade.
Â
Generally, it takes four years of spraying and four years of surveillance to make sure of three consecutive years of no mosquito transmission in an area. After that, normal health department activities can be depended upon to deal with occasional introduced cases ⦠. Eradication can be pushed through in a community in a period of eight to ten years, with not more than four to six years of actual spraying, without much danger of resistance. But if countries, due to lack of funds, have to proceed slowly, resistance is almost certain to appear and eradication will become economically impossible.
Time is of the essence
[his emphasis] because DDT resistance has appeared in six or seven years.
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Time is of the essence
[his emphasis] because DDT resistance has appeared in six or seven years.
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Â
Lest anyone in Congress miss the IDAB report's point, Russell added the following strong words:
Â
This is a completely unique moment in the history of man's attack on one of his oldest and most powerful disease enemies. Failure to proceed energetically might postpone malaria eradication indefinitely.
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Russell's plan caught the imagination of several key figures in the American political arena of the late 1950s: Secretary of State George Marshall, Senators John F. Kennedy and Hubert H. Humphrey, and President Dwight
D. Eisenhower. Though malaria no longer existed in the United States, America was, in 1957, the center of virtually all cash reserves on earth. Europe, Japan, and the U.S.S.R. were still smarting from World War II devastation, and what is now called the developing world was largely in the yoke of colonialism or severe underdevelopment. Having won World War II, Americans were of a mind to “fix things up”: it just seemed fitting and proper in those days that Americans should use their seemingly unique skills and common sense to mend all the ailments of the planet.
D. Eisenhower. Though malaria no longer existed in the United States, America was, in 1957, the center of virtually all cash reserves on earth. Europe, Japan, and the U.S.S.R. were still smarting from World War II devastation, and what is now called the developing world was largely in the yoke of colonialism or severe underdevelopment. Having won World War II, Americans were of a mind to “fix things up”: it just seemed fitting and proper in those days that Americans should use their seemingly unique skills and common sense to mend all the ailments of the planet.
Thus, in 1958 Russell's battle for malaria eradication began, backed directly by $23.3 million a year from Congress.
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Because Russell had been so adamant about the time frame, Congress stipulated that the funds would stop flowing in 1963. In addition to the $23.3 million to be spent annually by IDAB, Congress shelled out funds generously between 1958 and 1963 for WHO (contributing 31 percent of its overall budget and more than 95 percent of its malaria budget), the Pan American Health Organization (PAHO, which got 66 percent of its funds directly from the U.S. Congress), and UNICEF (underwriting 40 percent of the UN Children's Fund budget).
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It was a staggering economic commitment, the equivalent of billions of dollars in 1990. Remarkably, American politicians didn't complain about spending so much money to control diseases few U.S. citizens ever contracted, and the effort enjoyed bipartisan support. President Eisenhower called for the “unconditional surrender” of the microbes, George Marshall foresaw the “imminent conquest of disease,” and Senator Kennedy predicted that children born in the next decade would no longer face the ancient scourges of pestilence.
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Because Russell had been so adamant about the time frame, Congress stipulated that the funds would stop flowing in 1963. In addition to the $23.3 million to be spent annually by IDAB, Congress shelled out funds generously between 1958 and 1963 for WHO (contributing 31 percent of its overall budget and more than 95 percent of its malaria budget), the Pan American Health Organization (PAHO, which got 66 percent of its funds directly from the U.S. Congress), and UNICEF (underwriting 40 percent of the UN Children's Fund budget).
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It was a staggering economic commitment, the equivalent of billions of dollars in 1990. Remarkably, American politicians didn't complain about spending so much money to control diseases few U.S. citizens ever contracted, and the effort enjoyed bipartisan support. President Eisenhower called for the “unconditional surrender” of the microbes, George Marshall foresaw the “imminent conquest of disease,” and Senator Kennedy predicted that children born in the next decade would no longer face the ancient scourges of pestilence.
The stage was set. The scientists had everything going for them: political support, money, DDT, and chloroquine. So certain were they of victory that malaria research came to a virtual halt. Why research something that will no longer exist?
Yet when Andy Spielman had started graduate school just five years earlier at Johns Hopkins School of Medicine, the budding young Colorado scientist was convinced he would have a lifetime's worth of parasite research puzzles to solve. Socially awkward because of a stuttering speech impediment, Spielman delighted in the introspective world of science. Baltimore colleagues quickly admired his wit, warmth, and ready intelligence. Spielman anticipated decades of studying insects and the parasites they carried.
He had, however, been in Baltimore less than two months when his mentor, Lloyd Rozeboom, grabbed Spielman by the collar and said, “Let's get a beer.”
The downcast Rozeboom bought Spielman a pint and after a few quaffs said, “Look, I've got to get this off my chest. I'm conscience-stricken.”
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