Fig. 1.World Health. May 1980.

Cover of World Health, May 1980. Courtesy of the World Health Organization

July 25, 2016

by Farren Yero

On June 24, 1965, President Lyndon B. Johnson received a letter from the former director of the Pan American Health Organization (PAHO), Dr. Fred Soper, commending him for his pledge to champion the cause of global smallpox eradication. Soper, a famously staunch supporter of disease eradication, insisted that although a vaccine for smallpox had been in use for over a hundred and fifty years, it was only now that smallpox could truly be overcome on a global scale. By aiding the world in eradicating smallpox, Johnson would, as Soper opined, fulfill the prophecy of yet another US president, Thomas Jefferson.

Jefferson was a known supporter of the vaccine. In 1806, he optimistically foretold “future nations will know by history only that the loathsome smallpox has existed” (Jefferson to Jenner, May 14, 1806, Monticello, Virginia). But neither Soper nor Johnson lived to see Jefferson’s dream come to fruition. It was not until 1980, almost two hundred years after the discovery of the vaccine, that the World Health Organization (WHO) officially declared smallpox eradicated.

The WHO smallpox eradication program has often been celebrated as the greatest accomplishment of twentieth-century global health—an example of what international health agencies can accomplish when they work effectively with one another and with local communities. And to an extent, this rings true, especially compared with the failed campaign to eradicate malaria, the WHO’s first choice for global eradication. Delegates to the World Health Assembly selected malaria for the first global eradication campaign in 1955, while rejecting proposals for smallpox eradication again and again.

Eradication started from the premise that scientific medicine had developed the expertise and tools to completely master disease. WHO believed that it would be possible to eradicate malaria because of the introduction of new drugs and the insecticide DDT, the spraying of which was thought to destroy the most dangerous species of the Anopheles mosquitoes that transmitted the disease. However, when eradication enthusiasts realized that they would not be able to control the environmental conditions under which malaria thrived, the WHO finally turned to smallpox as a more likely target.

L0027419 (Left) face of a man suffering from smallpox; (right) vaccin Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org (Left) face of a man suffering from smallpox; (right) vaccination against smallpox. Colour process print. Print Circa 1940 Published: [ca. 1940] Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

c. 1940 Public Health Poster. Courtesy of Wellcome Images

Research on the WHO smallpox eradication program in the Global South has focused almost exclusively on regions where the virus held out, remaining endemic up until the last few years of the global campaign. With the exception of Brazil, most Latin American countries reported zero cases of smallpox during the intensified period of the SEP (1967-1980). Presumably because of this, their stories have remained absent from the history of the WHO program. Given that PAHO (which effectively became the regional office of the World Health Organization in 1948) was the first to support smallpox eradication efforts, having launched their own regional program in 1950, I became curious about the role of the Americas in developing and implementing public health strategies that would eventually result in global eradication.

As a historian of Mexico, I was especially curious to learn how smallpox eradication was first imagined and implemented in Central America, a site that international health administrators, including Dr. Fred Soper, celebrated as being free of smallpox early on. Compared to the nightmare that was malaria eradication, the smallpox program was presented as almost effortless. In that same letter to President Johnson, Soper assured him that “nothing in the whole field of disease prevention can benefit so many people for relatively so little effort as the completion of smallpox eradication.” WHO’s 1988 self-described “definitive history” of the SEP echoes this message, suggesting that because smallpox could not be perpetuated through an animal reservoir, unlike malaria and other viruses transmitted by mosquitos, it’s eradication was a hard-won, but ultimately, inevitable achievement.

Fig. 3.1935. Dept. de Salubriad Publica. Vacunacion

Instructivo Sobre Vacunación Antivariolosa, Departamento de Salubridad Pública, 1935

Although we know very little about the smallpox program in Mexico, scholarship on the malaria campaign recalls the numerous conflicts that emerged due not only to the problems of controlling a vector-borne disease, but more importantly, of those born of intercultural miscommunication (Cueto, 2007). Anthropologists working in Mexico during that time were tasked with reporting on these very concerns for the benefit of Mexican Secretariat of Health. Isabel Kelly, in a study for the Estudios Experimentales en Salubridad Pública, highlighted the discrepancies in ideas about blood sampling, importantly drawing attention to indigenous beliefs about the religious and historical meanings of blood in some rural areas.

Health workers for the national campaign against smallpox, launched in 1942, encountered a different set of problems in the field. One epidemiologist, Leocadio Morales Guerrero, reported that an elderly woman from Nayarit refused to allow her family to be vaccinated, because as she recounted to him, she had already performed the act using a thorn to remove live lymph from a pustule raised on an infected person. The woman reported to him that she had read about the procedure, many years before, in a small pamphlet on an English doctor who had vaccinated people in a similar manner using secretion from cow udders. Although the woman didn’t name the physician, the tract undoubtedly referred to Edward Jenner, whose discovery Thomas Jefferson illustriously prophesized about in his 1806 letter, which Dr. Fred Soper drew inspiration from, time and again, to persuade and promote the cause of global eradication.

Fig.4. Vaccination of Laborers

1949 vaccination of Mexican laborers. Courtesy of the National Library of Medicine.

This summer I will be conducting archival research at the U.S. National Library of Medicine, in order to trace the global smallpox eradication campaign, as it was first organized and deployed in Mexico, initially under the Campaña Nacional Contra la Viruela, alongside the Pan American Health Organization, and eventually, under the World Health Organization, so as to understand how international health was imagined and ultimately operated during the Cold War.

In summing up his letter to President Johnson, Soper highlighted what he believed to be the requisite tools of eradication: a newly developed vaccine that could be preserved in tropical climate through freeze-dry technology and, most importantly, effective international collaboration. In an unusually candid moment, Soper profiled the political expediency of supporting the global smallpox program:

 

Politically, tying support for smallpox eradication to the International Cooperation Year is an intelligent move. The initial proposal for the global eradication of smallpox came from the USSR delegation to the World Health Assembly in Minneapolis in 1958. The USSR has registered its disappointment with the limited support given smallpox eradication in the past seven years. The United States drive to finish the job is thus an important example of international cooperation.

International health programs, although theoretically supposed to maintain neutrality, were always framed by the political contexts in which they operated. As Marcos Cueto has importantly argued, “Cold War crusaders eagerly promoted the belief that solving important rural health problems in poor countries would consolidate commercial agriculture and prevent the spread of communism to these areas” (2017). My research this summer asks how the smallpox eradication program, a humanitarian project intended to improve global health, functioned as part of this transnational effort to achieve various foreign policy objectives by mastering the non-human world.

 

 

 

 

 

 

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