Pox_ An American History - Michael Willrich [196]
The eradicators developed a strategy, known as “ring vaccination” or “surveillance-containment,” that resembled a modern, high-tech version of the methods employed by Manhattan’s turn-of-the-century vaccination corps. As each new outbreak of smallpox was reported, a vaccination team descended on the scene, vaccinating everyone they could find in the immediate vicinity and placing the area under close surveillance until the outbreak had subsided. Taking the fight to smallpox, rather than striving for universal vaccination, the surveillance-containment strategy enabled the eradicators to cut short the transmission of smallpox, even in countries that had poorly vaccinated populations. The eradicators had to work around civil wars and surmount cultural barriers; in rural Afghanistan, for example, vaccinators ran up against purdah traditions that limited their access to women and children.11
When containment teams met outright resistance, they responded with verbal pressure, legal coercion, and, in extreme cases, forcible vaccination. One senior WHO epidemiologist, a physician from the American Centers for Disease Control and Prevention (CDC) named Dr. Stanley Music, recalled how his team’s initial efforts to carry out the containment policy in rural Bangladesh “resembled an almost military style attack on infected villages.... In the hit-and-run excitement of such a campaign, women and children were often pulled out from under beds, from behind doors, from within latrines, etc. People were chased and, when caught, vaccinated.” Dr. Music explained the thinking of the vaccinators. “We considered the villagers to have an understandable though irrational fear of vaccination,” he said. “We just couldn’t let people get smallpox and die needlessly. We went from door to door and vaccinated. When they ran, we chased. When they locked their doors, we broke down their doors and vaccinated them.” The strategy proved highly effective at containing smallpox. But it came at a high price. As one historian of the South Asia eradication program delicately observed, “coercion can leave behind a residue of resentment that sours public attitudes toward the next vaccination campaign.”12
As reported smallpox cases dwindled, teams conducted “scar surveys” of high-risk areas, inspecting people for vaccination scars or facial pockmarks, just as U.S. military surgeons had done when the Army moved across Luzon during the Philippine-American War. The last naturally occurring case of variola major occurred in a young girl in Bangladesh in late 1975. The final case of variola minor was reported in a hospital cook in Merca, a port town in southern Somalia, on October 31, 1977. On May 8, 1980, the World Health Assembly declared, “[T]he 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 time, leaving death, blindness and disfigurement in its wake.” The Assembly recommended that countries across the world discontinue smallpox vaccination.13
The smallpox eradication program severed smallpox from its human host—a monumental achievement. Alas, the campaign did not annihilate the variola virus. As immunization levels around the world fell after 1980, the virus took on a new and ominous existence in the laboratory.
The WHO had authorized two laboratories to keep frozen stocks of variola—the CDC in Atlanta and the Research Institute for Viral