Of Microbes and Men — and Women and Children

Update: I see I inadvertently bigfooted Adam. (This is the only context in which that statement could be remotely plausible).  But I figure the Jackals can read below, comment, and then, when they get around to it and if interested, read something else. Consider this is a proof-of-concept experiment.

Self-aggrandizement apology.

I’ve got a long piece (by newspaper standards) up now at The Boston Globe:  “The world defeated smallpox.  Why does polio still exist?” (Dead tree version comes out on Sunday.)

What I’m really on about (and I’m on and on and on about it — no one ever accused me of excessive terseness) is what it means when the institutions and norms of collective action erode.

Smallpox eradication can be understood in many frames, but a key one is that it was a Cold War phenomenon.  It was so not just in the sense it occurred over the same years that the Soviet Union and the US maneuvered around the edge of direct, hot conflict, but as a skirmish within the larger competition as well.  Not to be nostalgic for hair-trigger nuclear confrontation, but in a bipolar world in which international institutions could both call on superpower resources and, in essence, play a kind of intermediary role, coalition efforts towards the common good could take place.

That capacity, that ability to play a kind of virtuous game, has degraded over the last several decades, and my story is the long way round to this conclusion:

There were just 22 wild-polio infections worldwide last year, all in Pakistan and Afghanistan. So far in 2018, there have been only two new cases, both in Afghanistan. It’s conceivable that polio incidence may drop to zero before the end of the decade.

If and when that occurs, it will be a monument to the power of public health work. But the question will remain: Why was the end of polio so long in coming? It wasn’t because, after solving smallpox’s riddles, human reason couldn’t solve the problem, or that science or medicine failed. Rather, it was because such achievements exist within history, the way human beings construct our world at any given time.

The history still being made of polio eradication reveals the costs that follow when the ability to pursue common goals degrades within and between nations. Infectious disease, pollution, and conflict itself do not respect borders, not even those of countries that build big, beautiful walls.

That is:  there are so many subtle ways in which Donald Trump and the entire Republican Party are both deluded and dangerous. Infectious disease is one arena where we can see the risks and consequences of their malign folly play out.

There’s one more little story that follows that thought, a tragic one, as you might expect, a kind of foretaste of what happens if we are going to get this kind of thing wrong going forward. Anyway, if you’re interested, check it out  — and if you are so moved, comment there (as well as, or instead of) here.

Image: Anonymous, Christ cures a leper; an apostle holds a garment in front of HimWellcome Collection, undated.






60 replies
  1. 1
    stinger says:

    Congratulations on the Globe article, Tom. Now if we can only get it to display on Fox or CNN chyrons….

  2. 2
    WereBear says:

    Wonderful piece, Tom. Sad bookends.

  3. 3
    SiubhanDuinne says:

    Haven’t clicked yet — I will, when in a less-interruptible setting — but am wondering whether you address the fact that there are still stocks of live smallpox virus in labs to this day: some at the CDC, some at a lab in Siberia, and some, I think, in the custody of the WHO (don’t know physical location/s). It’s a scenario worthy of Michael Crichton or Stephen King to imagine their being released either accidentally or through deliberate sabotage.

  4. 4

    I shared to both FB and twitter, Tom. Very thoughtful piece.

  5. 5
    Tom Levenson says:

    @SiubhanDuinne: I don’t. That’s truly scary, and a whole can of worms, but not what I was after in this piece.

  6. 6
    kindness says:

    Why is there still polio? I’m going to blame Jill Stein. For a whole bunch of things.

  7. 7
  8. 8

    Thanks, I’ll have to read it tonight or tomorrow!

  9. 9
    SiubhanDuinne says:

    @Tom Levenson:

    Well, I’m looking forward to reading it later, at a more leisured time. Sorry I can’t give it full attention now.

  10. 10
    JPL says:

    The proposed cuts to the CDC and NIH endangers even the 1 percent receiving a large tax break. It’s unfortunate that this subject is not gaining wider traction.

  11. 11
    Brachiator says:

    Congratulations, Mr Levenson. Skimmed the piece, and I look forward to reading it later, when I have more time.

    A little tidbit for now.

    After a family dinner, I recall my young nephew remarking on the small smallpox scar on my shoulder, a remnant of vaccination. His shoulder is, of course, unmarked. He couldn’t imagine such a procedure! And has little idea of what a scourge smallpox once was.

  12. 12
    Tom Levenson says:

    @JPL: I’m pursuing some stuff there. Not that it’ll move hearts and minds, but at least it will get that brute fact a bit more on the record.

  13. 13
    TenguPhule says:

    I blame anti-vaxxers for contributing to the problem.

    We could have eradicated mumps and measles in our lifetime if not for so many stupid evil insane people.

  14. 14
    JPL says:

    @Tom Levenson: Imagine if you will, a President Trump during the outbreak of the Ebola virus.

  15. 15
    JPL says:

    @TenguPhule: Trump is an anti-vaxxer. just sayin

  16. 16
    TenguPhule says:

    @JPL: Imagine?

  17. 17
    WereBear says:

    I must admit I’ve been toying with a science fiction novel where the uber-rich lay waste to the US and flee to their Dubai penthouses only they have destroyed the educational and research systems that produces doctors and medical devices and how to purify water and they still need servants so it goes all Edgar Allan Poe’s Masque of the Red Death.

    …oh, wait, I live in this dystopia. Never mind.

  18. 18
    SiubhanDuinne says:

    @Brachiator:

    Mine is on my right thigh, not my arm. It’s huge, about the diameter of a 50¢ piece. Apparently I jerked away in pain and/or outrage and ended up getting a double jab. I’m sure that experience is at the root of my severe needle-phobia, which plagues me to this day.

  19. 19
    TenguPhule says:

    @SiubhanDuinne: What’s terrifying is that many of us do not have that shot, being born after the eradication, but there are still cultures left of the damn thing both in the US and Russia. And not all of them have been secured well.

  20. 20
    Le Comte de Monte Cristo, fka Edmund Dantes says:

    OT-I see that Bernie-aligned True Progressive darling Ellison has a Farrahkhan problem.

    Surprise!

  21. 21
    SiubhanDuinne says:

    @JPL:

    Wasn’t he suggesting a correlation between vaccination and autism during the 2015-16 GOP primary debates? And implying some personal knowledge or experience? (FTR, I think another candidate — was it Carly? — was also a noisy anti-vaxxer.)

  22. 22
    SiubhanDuinne says:

    @TenguPhule:

    Yep. See my comment @ 3.

  23. 23
    Ken Pidcock says:

    The points are well taken, but it should be acknowledged that differences between the agents contribute to the challenges of eradicating polio. Smallpox infection was never inapparent and its transmission was never waterborne.

  24. 24
    Ruckus says:

    @Tom Levenson:
    Read the article and saw another one of yours, the big risk of surgery, infection.
    I’ve been unfortunate to suffer massive infections, twice. ER visits in the middle of the night for both. And that’s after the prophylactic pre administration of antibiotics. And of course the only thing that can be done is massive doses of other antibiotics. Not sure, OK that’s not true, I am, that the cure isn’t worse than the disease in the long run. But what else do we have?

  25. 25
    chris says:

    @SiubhanDuinne: Mine is on my shoulder. It’s one of the few clear memories of elementary school, standing in line with all the other terrified kids, waiting to be stabbed with a hundred needles. All at once! (IIRC it was six needles that barely pierced the skin.)

  26. 26
    Baud says:

    @Le Comte de Monte Cristo, fka Edmund Dantes:

    Ellison is ok. He’s more like Tom Perillo than Dennis Kucinich. From what I understand, the Farrahkhan thing was an old thing being dredged up by the right.

  27. 27

    @Ruckus: Science Friday had an interview today with a scientist who’s working on some sort of virus as an antibiotic. It sounded like phlages or something. I was driving at the time.

  28. 28
    joel hanes says:

    @Brachiator:

    [He] has little idea of what a scourge smallpox once was

    I remember being in public school when they lined us all up and gave every one of us the improved oral Sabin polio vaccine. Every single one. Free.

    I was still too young and ignorant to understand why some of the teachers were weeping.

  29. 29
    Tom Levenson says:

    @Dorothy A. Winsor (formerly Iowa Old Lady): Phages. Old idea made new

  30. 30
    Ruckus says:

    @SiubhanDuinne:
    I hate needles as well. And yet I get stabbed fairly often, what with my fun health issues. I’ve learned that some people should never be allowed to give shots and others should be anointed to sainthood for what they can do with the same instrument.

  31. 31
    Aleta says:

    Great article.

    On small pox, I saw this last month or so, about synthesis of horsepox virus in a Canadian university lab.
    Did Pox Virus Research Put Potential Profits Ahead of Public Safety?

    In the brave new world of synthetic biology, scientists can now brew up viruses from scratch using the tools of DNA technology.

    The latest such feat, published last month, involves horsepox, a cousin of the feared virus that causes smallpox in people. Critics charge that making horsepox in the lab has endangered the public by basically revealing the recipe for how any lab could manufacture smallpox to use as a bioweapon.

    The scientist who did the work, David Evans of the University of Alberta in Canada, has said his team had to synthesize horsepox because they wanted to study the virus and there was no other way to get it.

    There was another possibility, NPR has learned. Evans could have done research on a specimen of horsepox collected from the wild, but he didn’t pursue that alternative.

    He says using the natural virus might have prevented the pharmaceutical company he is working with from commercializing horsepox as a new vaccine for smallpox. But the head of the company told NPR that he had not been aware that this stored sample of horsepox was potentially available — and would not have wanted to synthesize the virus from scratch if he had known.

    “There was some confusion,” Evans told NPR, “probably my fault although I’d thought we’d discussed it back around 2014.”

    If he didn’t talk about it with the company, Evans says, it’s because his own inquiries had convinced him that the stored virus “wasn’t suitable for our goals.”

    Evans says the virus-making techniques his team has developed will advance the field of pox viruses and help turn them into new vaccines or therapies for diseases like cancer.

    “To say that somehow we shouldn’t take advantage of the technology that’s out there — and which is being used in all sorts of different ways in all areas of biology — and put off limits, somehow, one virus doesn’t make a whole lot of sense to me,” he says.

  32. 32
    Yutsano says:

    @Baud: It’s old hat. I recall them using something like this during his first race. Didn’t seem to make much difference there.

  33. 33
    oatler. says:

    Check out John Crowley’s “The Girlhood of Shakespeare’s Heroines” for a tragic story about polio.

  34. 34
    central texas says:

    Love to read it but the Globe thinks anyone who uses the “private browsing” option of Firefox is evil and should not be allowed to visit their website.

  35. 35
    Brachiator says:

    @joel hanes:

    I remember being in public school when they lined us all up and gave every one of us the improved oral Sabin polio vaccine. Every single one. Free.

    Yep. I’m sure I could not really understand it or articulate it, but I swear I had a sense that I understood that something important was happening, and that my mother had tried to impart some recognition that we were defeating polio.

  36. 36
    Ruckus says:

    @joel hanes:
    I remember standing in line with the whole famn damily, outside a bank, of all places, to be given the first polio vaccination. I was 4 or 5. I also remember what a nice disease it is, going to school for 12yrs with a girl who had it and having two of my friends moms with it.

  37. 37
    jharp says:

    My parents grew up in the polio age and my older sister was among those who received the first mass vaccinations at her school.

    Teachers were crying they said. What an utterly horrible and frightening disease. I clearly remember those who it struck and who survived.

  38. 38
    sigaba says:

    One of the little historical tidbits about the Osama Bin Laden hunt that I remember is that villagers in rural Pakistan militantly refused to go to UN or western-sponsored polio eradication clinics, because they believed they were a covert CIA plot to kill off Muslims.

    They were only half right. The clinics were actually working with the CIA, to collect DNA from people around the Bin Laden compound in an attempt to confirm Bin Laden family members lived there.

  39. 39
    trollhattan says:

    Signs of polio were common when i was a kid–people relegated to life with leg braces and crutches and even if you didn’t know anybody using one, iron lungs were on view in odd places, as well as worked into TV show plots.

    If I ever heard anybody bitching about having to take the vaccine I sure don’t recall it. We’re much more sophisticated today, “luckily.”

  40. 40
    Aleta says:

    @Ruckus: Never had a needle phobia until I fell into the hands of an unskilled person, only about 10 years ago. I think I’m getting over it, since I make a point of going to a small hospital’s lab where they are good at it. Was thinking today that the really good ones seem to have the sensitivity of a good masseuse in the way they treat skin and muscle.

  41. 41

    @Brachiator: @SiubhanDuinne: Me 3. I have both small pox and polio vaccinations.

  42. 42
    trollhattan says:

    @Aleta:
    Got the shingles vaccine last year and it hurt like acid, and for days afterward. Jabs normally don’t bother me–just went through six months of biweekly allergy shots–but Did Not Like that one.

  43. 43
    Tom Levenson says:

    @Ruckus: yikes! Thanks for reading and very sorry to hear of your troubles.

  44. 44
    Brachiator says:

    @Tom Levenson: I love this caption accompanying one of the pictures in your article.

    Ali Maow Maalin, the last known person in the world with smallpox, in Merka, Somalia.

    Days of miracle and wonder, even noting the sad outcome delineated in the article.

  45. 45
    Brachiator says:

    @trollhattan:

    Got the shingles vaccine last year and it hurt like acid, and for days afterward.

    By the way, there is a new shingles vaccine available. Consult your medical person for more details.

    In October 2017, the FDA approved a new shingles vaccine, called Shingrix. This January, the CDC officially recommended that adults 50 and over get the new vaccine to prevent this painful, blistering disease instead of the previous one, Zostavax.

    How is Shingrix different from Zostavax?

    Shingrix is more than 90% effective at preventing shingles and a painful complication called postherpetic neuralgia (PHN) in all age groups. Zostavax only lowers the odds of getting shingles by 51%, and of PHN by 67%. It’s even less effective in people ages 70 and older.

  46. 46
    Sloane Ranger says:

    I got my smallpox vaccination at a small village primary school in the mid 1960’s. I remember we all had to take a letter home to our parents about a week earlier and my parents were thrilled after they read it.

    I think there are people today isolated on large estates or in gated communities who think they can avoid infection while people in “shithole” countries are decimated and the “surplus population” at home reduced. And think this is a good thing.

  47. 47
    SiubhanDuinne says:

    When I was newly married — long before I had discovered the joys of drip, or French press, or cold brew coffee — I had a (wedding gift) percolator. Very noisy and wheezy it was. I’ll never forget a dinner guest who kept cocking an ear kitchenwards and finally asked, with some embarrassment, “Um, is there someone in an iron lung in the next room?”

  48. 48
    mainmata says:

    Not just Trump and the GOP but, in the cases of Afghanistan and Pakistan, the Taliban assassinating WHO people trying to vaccinate people.

  49. 49
    SiubhanDuinne says:

    @trollhattan:

    I had a nasty attack of shingles about ten years ago. The only good thing about it was being told by my doctor that I wouldn’t need to have the vaccine, as the disease itself would immunize me. Since I faint and throw up at the very thought of needles, that was welcome news. But shingles itself (themselves?) sucks (suck?) donkey balls.

  50. 50
    Gretchen says:

    The smallpox scar was a plot device in the timetravelling Outlander series – one timetraveller from the 20th century who ends up in the 18th realizes that another woman who is being burned as a witch also has a smallpox vaccine scar.

  51. 51
    Uncle Omar says:

    Every time I hear one of the anti-vaxxers yakking about their insane beliefs, I remember when I was six years old and visiting one of my classmates who had contracted polio at her home as she lay in her iron lung. No wonder my folks were delirious when the Salk vaccine for polio came out. A round of three shots and even then I knew it would keep me out of the iron lung. May all the anti-vaxxers rot in hell.
    Also, a new book out by Kyle Harper, “The Fate of Rome” discussing the climate change, three plagues, and distant volcanic eruptions that essentially sapped the vitality of the Roman Empire and led to its demise. Small pox, he argues persuasively, was the first of the great plagues.

  52. 52
    drdavechemist says:

    @Dorothy A. Winsor (formerly Iowa Old Lady):
    Phages are viruses that attack bacteria. Lots of research that I’m aware of (because the spousal unit has collaborated with a group at Pitt) on finding bugs that will attack resistant strains of tuberculosis and other mycobacteria. Spousal unit and her undergrad students actually discovered a phage on their home campus that has been used as part of a “cocktail” of three phages to kill a mycobacterium that causes skin infections. It’s very cool stuff, and I will have to check out the program to see if her group gets mentioned.

  53. 53
    Percysowner says:

    I’m one who had not only the smallpox vaccine (scar on my left shoulder) but both polio vaccines. I got the Salk vaccine when I was too young to remember, and then I stood in line with most of my city during Sabin Oral Sunday (SOS) and we all took our sugar pills to make sure we never got polio.

    I got all the measles, rubella and chickenpox, but not mumps. I had a classmate who almost lost his sight because his case of measles was so severe. I just don’t understand the anti-vaxxers. They have no clue how bad the supposedly innocuous childhood illnesses can be.

  54. 54
    Ruckus says:

    @Percysowner:
    I got encephalitis from the measles. And I had the mumps along with all the rest that you had.
    Fun times.

  55. 55
    debg says:

    Fantastic artcle, Tom. I shared it on Facebook.

    I lurk here on BJ and rarely comment, or even dive into the comments section–though you all are great fun–just because I don’t have the time. But every time Tom recommends a book, I want to rush out and buy a copy. Sometimes I even do so, because your history of science recommendations are right up my alley.

  56. 56
    opiejeanne says:

    @joel hanes: I’ve mentioned several times that there was one summer in the 1910s when polio wiped out every child below the age of 17 in several villages in the Ozarks. Every child and baby just gone. Most families had several children.

  57. 57
    opiejeanne says:

    @Ruckus: I have a fairly large smallpox vaccination scar on my upper arm. Mom told me that the first one didn’t take, the doctor said I was too healthy. Some mothers insisted that their daughters be vaccinated on the inner thigh or inside the upper arm in case they wanted to enter a beauty pageant when they were older.

    the Salk vaccine was administered by the school nurse to a line of children. I was 5 and so terrified of the needle that they separated me from the pack so the other kids didn’t stampede. They tried to shame me in front of the other kids my age but I didn’t care. No one had bothered to explain any of this to us and I think that made it more scary. A teacher of an older grade took me to another room and explained it all to me, so I went and got my shot, squinched up my face and stopped crying, but I did say OW kind of loudly.
    A couple of months later a classmate came back to visit; she had disappeared from school about a month before the vaccination day but we didn’t know why. She was in a wheelchair but she could walk a little. She was one of the lucky ones, not left badly crippled or dead, or in an iron lung. I never pitched a fit about a shot after that despite being terrified of needles.

  58. 58
    Tom Levenson says:

    @debg: many thanks for these kind words.

  59. 59
    Kayla Rudbek says:

    I was vaccinated for smallpox because I was a military brat, so the thought process was that the military and dependents would be vaccinated against bio weapons. This reminds me that I should get my vaccinations up to date

  60. 60
    Ruckus says:

    @opiejeanne:
    I’m not terrified of needles, I just hate that about 1/3 of the people that poke me are not good at it. Not at all good at it. There was one young girl at one VA clinic who I would never feel insert the needle. I could watch her do it and still never know she had. OTHO I was put in the hospital in boot camp for a week, I got sick 1 day after we got our shots. (That’s all of your foreign travel shots in about 20 seconds. Both arms with several pneumatic guns and one with a needle.) Temp of 105, felt like a sack of warm shit. The corpsman who admitted me to the hospital was on his first day out of corps school. Had never stuck a living thing. After about 5 or 6 tries to find a vein I told him to get someone else or he was going to be picking me up after I passed out. He gets a more experienced guy and he won’t poke me himself, has to use me to teach the new guy. Fun times.

Comments are closed.