THE ERADICATION OF DISEASE

It all began in 1958, when Dr Viktor Zhdanov (1914-1987), Deputy Minister of Soviet Health, proposed that Smallpox could be eradicated. Although Smallpox Vaccine had been available since 1795, no one, until 1958, had suggested that any disease could be eradicated.?

It took several decades for the idea to sink in, but finally the World Health Organization (WHO) asked my former boss at the CDC, Dr D. A. Henderson, to lead the charge. Going country by country, and dealing with vaccine shortages by the use of cluster vaccination - vaccinating only those who had been in contact with a known case - the world was officially declared free of smallpox in 1980! This is a fact that everyone in the world should know and understand.

From 1900 to 1975, there had been 300,000,000 (three hundred million) deaths worldwide from smallpox! The entire cost of eradication was $300 million, less than the cost of one wing of a B-2 bomber. In the ensuing quarter century since eradication, it has been estimated conservatively that $43,000,000,000 (forty-three BILLION dollars) has been saved. During that time, no one contracted smallpox, no one was scarred by smallpox, no one died from smallpox, and there were no medical costs of caring for what might have been 100 million cases of smallpox! In this century, the savings, now available for other health issues, can be estimated at $170 Billion. Does it not make sense to now spend whatever it takes to eradicate a disease, since the return on investment and the reduction of human suffering is so vast?

Is it not utter nonsense to fail to do this? This too is a fact that everyone in the world should know and understand.

To get rid of a mosquito-borne disease, we do not have to eliminate all mosquitoes. We must break the chain of transmission from person to person, and then the organism causing the disease will have nowhere to go, and will die out. This becomes complicated if there are alternative hosts - other animals that can become diseased.

Since its founding in 1948, WHO has been involved with controlling many diseases. The limitations have been willpower, enough money and sufficient support from affected nations.

Its successes, in recent years, have been possible only with outside assistance. There have been two extraordinary eradication successes, as yet incomplete.

In 1979, Rotary International took up the cause of eradicating Polio. Members contributed over $1 Billion, and they persuaded governments to provide an additional $10 Billion. The Western Hemisphere and Africa have officially been declared free of polio, and the only two countries in the world with endemic polio are Pakistan and Afghanistan. Work on complete eradication continues as we speak, driven mainly by oral vaccine.

In the 1980’s, it was estimated that there were 3.5 million cases of the dreaded Guinea Worm Disease (Dracunculiasis) worldwide. The Carter Center in Atlanta, Georgia, spearheaded by one doctor, Dr Donald R Hopkins, got involved, and at recent count (2022), there were only 13 cases in the world! This remarkable result was achieved without a vaccine. It is based, like most other diseases, on an understanding of how the infectious agent behaves. This disease is complicated by alternate hosts - dogs and baboons. People are now being paid to restrain dogs from entering bodies of water where they could pick up the disease by drinking the water. If this is successful, there will soon be no larva in the water to infect anyone. Clearly, the final push is often the most difficult, but the end result is a contribution to world health that cannot be overestimated.

The year 2024 will be stressful in the United States. We will be fighting to retain our democracy, which has never been so threatened before. It will be a blessing to have something useful to do in preparation for World Health Year (WHY) in 2025. Doctors and nurses, frustrated by being told what to do by administrators whose goal is the bottom line, not what is best for the patient, can consider a sabbatical year, and sign up to help eradicate one or more diseases in a country of their choice. With sufficient support, they can be paid. If not, they have the option to volunteer. Others, with a bit of training, can volunteer to really make a difference. Millions have already done so, administering polio vaccine by mouth to millions of children worldwide. Still others, without leaving home, can contribute funding, and also help create awareness of this unique opportunity.