A Pox on All of Us

Little did Jonathan Tucker know that a Senate office building and a D.C. post office would become targets of an anthrax attack the same week his book about the smallpox virus hit the bookstores. Who would have guessed that, for a bright shining moment, he’d become one of the nation’s most coveted talking heads, coiffed and poised to shape immediate public policy decisions? A Michael Beschloss he is not (in fact, his television voice resembles that mechanized voice on the weather channel), but Tucker nonetheless assumed the mantle of national prognosticator on all matters related to biological weaponry with admirable competence. He has since all but disappeared from the punditry circuit but, during his 15 minutes, he at least got to plug his important book, Scourge: The Once and Future Threat of Smallpox.

Smallpox was a ruthless, indiscriminate killer. In case we had missed this point after three chapters of this chilling story, the author quotes a doctor’s description of a 1958 smallpox outbreak in Bombay. “The head [of a patient] was usually covered with what appeared to be a single pustule,” Dr. Albert Herrlich recalled. “When the tightly filled vesicles burst, the pus soaked throughout the bedsheet, became smeared on the blanket, and formed thick, yellowish scabs and crusts on the skin… Wails and groans filled the rooms.” His choice excerpts of suffering recall the descriptions conveyed by Spaniards conquering the New World, and thus drive home the point that this disease has been kicking our collective human ass for centuries. I repeatedly found my face set in a tight cringe while reading this book.

After dealing with these descriptions one hates to recall that smallpox still is a ruthless, indiscriminate killer. Tucker not only chronicles in vivid detail the gruesome history of smallpox and the successful worldwide effort to remove the virus from human circulation, but he confronts the ongoing political dilemma that worldwide eradication has created. The elimination of smallpox from human circulation may have been a global healthcare victory, but it sparked an intense geopolitical debate over what to do with the stockpiled virus samples that the United States and Russia have stubbornly refused to destroy. The details of this gut-wrenching international divide, conveyed by Tucker in clear if sometimes stiff prose, confirm the ominous reality of a virus whose history knows no boundaries, especially that boundary known as the nation state.

Tucker, a scholar with the Monterey Institute of International Studies, begins with one of medical history’s more flagrant violations. Edward Jenner, an English doctor who witnessed a cowpox outbreak in 1796, had a hunch. A cowpox inoculation, he speculated, might induce human immunity to smallpox. In what Tucker somewhat disingenuously calls a “bold experiment,” Jenner tested his hypothesis by injecting the paste from a cowpox pustule into the innocent arm of an eight-year-old farm worker. After the expected blister formed around the inoculation site, scabbed over, and healed, Jenner proceeded to ensure his place as exhibit A in the future field of medical ethics. He injected the boy—he was only a farm boy, you will recall—with pus obtained from a local smallpox case to see if the anticipated immunity had indeed developed.

Fortunately for everyone involved, it had, and Jenner, never one burdened by self-doubt, promptly announced to the medical community: “It now becomes too manifest to admit of controversy, that the annihilation of the Small Pox, the most dreadful scourge of the human species, must be the final result of this practice.” Big words. It would take 180 years, but the future would again prove Jenner’s hunch to be correct.

At this point, historically minded readers might wish that Tucker had, well, entered an archive. His book conspicuously fails to trace the historical developments connecting Jenner’s renegade experiment to the World Health Organization’s 1980 declaration that the planet was, for all intents and purposes, free of smallpox. For better or worse, though, that’s not his goal. Tucker, a political scientist who’s interested in selling a book that won’t become this year’s most popular doorstop, skips ahead to “the final inch” of that long history and carefully chronicles the WHO’s concentrated effort to eradicate the virus between 1958 and 1980. He leaves the connecting details for a future historian to hash out in a book that probably won’t even enjoy the honor of becoming a popular doorstop.

So we miss out on several relevant historical changes, including the rise of the modern medical profession, the birth of international health organizations, and the transition to a molecular approach to understanding disease. But the payoff to Tucker’s seemingly casual historical fast-forwarding becomes evident in his revelation that the eradication campaign harbored some strange political bedfellows. At the height of the Cold War, with the arms race raging, scientific communities in the United States and the Soviet Union cooperated under the WHO’s umbrella to rid the world of smallpox. Their cooperation might have been a short, freakish scene in a long drama, but Tucker correctly sees it as one well worth highlighting.

This unlikely Cold War coalition encountered endless hurdles, but “the real challenge,” according to Tucker, “was to develop the organizational, managerial, and logistical structures needed to carry out vaccination campaigns on a large scale.” Ugh; sounds like policy-wonkish muck ahead. But Tucker’s decision, once again, turns out to be a pretty good one, as he manages to turn the bureaucratic machinations behind the eradication campaign into the stuff of a sharp narrative. His tactic here is simple enough: Rather than discussing intricate policy strategies in dreadful Public Policy drivel, he casts the vaccination campaign as a Manichean struggle between Good and Evil. Even Dubya might be able to follow this one.

A globe-galloping, multinational quest for justice ensues, with doctors heroically chasing the smallpox virus across the earth as if it were an escaped fugitive. The virus feigns defeat and then, when least expected, erupts in deadly defiance. In an especially poignant scene, doctors literally storm a village in India and force vaccinations on reluctant, religiously opposed patients. The virus retaliates by finding hosts in political refugees fleeing to regions where smallpox had been recently eradicated. Countries routinely understate their smallpox outbreaks to avoid bad publicity. Others panic and predict Armageddon. Through it all, though, the hurdles gradually become fewer and lower. The virus, for all its stealth, diminishes under the persistence of its tireless, vaccination-wielding foes. By 1980, it’s gone. Good has triumphed over Evil.

Almost. It turns out that the Soviets and Americans were less cozy bedfellows than it may have seemed, and their mutual suspicion convinced them to store samples of the virus under tight wraps—the U.S at the Center for Disease Control in Atlanta and the Soviets in a lab outside Moscow. The U.S. Secretary of Health and Human Services, Louis W. Sullivan, declared in 1990 that “there is no scientific reason not to destroy the remaining stocks of wild virus.” The Pentagon, however, begged to differ. Although they remained mum until 1995, U.S. intelligence leaked evidence that the Soviets, at the same time as they were openly working to eradicate smallpox, were secretly studying the virus’s potential as a bio-warfare agent. Should the Soviets threaten a biochemical attack, the Pentagon argued, the U.S. would require the means to counterattack. To destroy the virus was to lose crucial geopolitical leverage. It was arms race redux, but this time with a virus.

This biochemical posturing spilled over into the post-Soviet era, well into the Clinton Administration. Tucker accordingly completes his book with a detailed examination of post-Cold War arguments for and against U.S. retention of the virus. He examines these arguments with relative disinterest, but it slowly becomes clear that he favors the scientific plea for complete eradication over the military insistence on strategic retention. In one of the book’s rare analytical lapses, however, Tucker presents this debate and gently adds his own two cents without addressing the issue of whether or not the United States may have been conducting its own bio-warfare tests with the smallpox virus. Given the secrecy with which the U.S. government has conducted previous defense initiatives, it seems a fair to question to have asked, if not investigated.

What makes Tucker’s story most frightening is the irony that our first chance to quash a disease that has spent centuries wiping out human beings might be undermined by the terribly human decision to organize ourselves into nation-states. Throughout history, human societies have built borders to protect and define their collective existence and identity. We have instinctively worked to shield ourselves from harm and, at the same time, promote and protect our values through these borders. The smallpox virus has no use for these boundaries, and the world is only a small step away from destroying it forever. Nevertheless, the U.S. and Russia (and now who knows about the members of the Axis of Evil) continue to harbor these agents of destruction. As we have recently learned, our societies—no matter how robust our boundaries may seem—remain vulnerable places. If we cannot think of a better way to organize ourselves, why not at least minimize the vulnerabilities that we can? The question seems tragically apt.

James McWilliams has a smallpox vaccine scar on his left shoulder.