oberlin alumni magazine  
dancing with death

by Richard Levin, professor of biology

Chinese girl suffering from smallpox: watercolor

(Images provided by the Granger Collection)

"All things are delicately interconnected," goes an old adage,words that have been elegantly acknowledged in story and verse throughout history. Now, in the most unlikely of arenas, the timeliness of this observation is striking. The threads that bind disconnected events threaten to turn one of our greatest public health accomplishments, namely, the elimination of smallpox, into a potential vehicle for a tragedy of worldwide proportions.

It was the eighth of May, 1980, and you could almost hear the champagne corks popping in virus laboratories all over the world. On that day the World Health Organization (WHO) accepted the final report of the Global Commission for the Certification of Smallpox Eradication that declared the world cleansed of smallpox. TheWHO declaration was not areckless claim. With the exception of one smallpox death in 1978, the result of a bizarre laboratory accident, the last known case was reported in Somalia in 1977. After an appropriately cautious three-year delay, the jubilant announcement seemed fully justified, and we felt free of the disease that has been described as the most terrible of all the ministers of death. Two decades have since elapsed, and smallpox has never reappeared.

Some parts of the story are well known. Of all of the infectious killers in history, smallpox ranks number one. As a mortal enemy it has surpassed malaria, tuberculosis, amoebic dysentery, measles, epidemic typhus, bubonic plague, cholera, typhoid, sleeping sickness, and influenza. In our own time, the toll of AIDS, which we have known for only 19 years, has yet to be reckoned with and will likely compete for the top rung of that deadly ladder. These infectious diseases and others are the handiwork of the greatest microbial assassins of all time.

In 1953 one discovery changed the course of biology. The structure of DNA was revealed and the floodgates of inquiry burst open. Questions that could never be addressed before were now amenable to investigation. Certainly this was among the most important scientific achievements of all time. As the new, sophisticated molecular biology developed, scientists quickly took advantage of the new molecular insights and technological advances. Microbiology, virology, immunology, genetics, and the molecular biology of infectious disease were among the fields in which the pace of progress was stunning. It seemed that we might even be able to look forward to a time when some of the deadliest diseases could be controlled.

Curing certain bacterial diseases had been a tantalizing priority since the 1940s, when penicillin, streptomycin, and a veritable zoo of other antibiotics were introduced as therapeutic drugs that killed or inhibited disease-producing bacteria. Expectations rose that syphilis, bubonic plague, tuberculosis, and cholera would eventually succumb to these potent new drugs, but those presumptions have never been realized. Bacteria mutate to antibiotic resistance so easily that not a single bacterial disease has been eliminated, and it appears unlikely that our powerful antibiotics will ever wipe out all traces of these old enemies.

But smallpox was another story. It was not the action of virus-destroying chemicals that contained and finally conquered the disease; it was the laborious effort of the Smallpox Eradication Unit of the World Health Organization. Teams of workers, led by Oberlin graduate Donald A. Henderson '50, scoured the globe from 1966 to 1977, poking into every village on earth until there were no cases reported anywhere in the world. Their methods were the tried-and-true public health techniques of mass vaccinations of the uninfected and a rigorous quarantine of those who were sick.

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