The Irony of Achievement The same technology that wiped out some diseases can be used to bring them back in forms more lethal and magnitude greater than at any other time in human history
By Jin Paul De Guzman
Although millions still fall ill and perish from infectious diseases every year, the deaths resulting from these diseases are proportionally lower now than ever. If in previous centuries falling victim to an epidemic immediately meant a sure, accelerated death, now death is hardly an option. What medicine and the rest of the sciences can do now are things people from previous ages could only ascribe to divine intervention. These benefits were not solely brought about by medical technology-something as elementary as improvement in sanitary practices or as elaborate as the systematization of health care delivery significantly contributed to the improved health of people. Also, people's understanding of how their bodies and their environments work has never been more acute. It can probably be said that more than in any other century people are at their healthiest today. Medical technology has of course made its mark in the fight against infectious disease. And perhaps along with the development of antibiotics, vaccines are among the most significant human achievements in history.
It took nearly 200 years since the discovery of the smallpox vaccine before the disease virtually disappeared from the face of the earth. For a disease that had existed for nearly 10,000 years, smallpox had killed royalty, freemen and freewomen, even entire populations of certain civilizations. Ramses V of the 20th ancient Egyptian dynasty, while dealing with foreign invasions and the usurpation of power by Egyptian high priests, succumbed to smallpox. When the disease landed on the shores of America in the 1500s the Aztecs and the Incas, with one fell swoop, vanished. As late as the 1970s, about 10 million people were believed to be infected with smallpox. Towards the end of the 18th century, British doctor Edward Jenner made one of medicine's most significant discoveries-the first vaccine. After observing that people who had previous exposure to cowpox showed resistance to smallpox, Jenner made the first step to developing protection against smallpox. He took pus from someone infected with cowpox, and inoculated a healthy boy with it. A week later the boy suffered from mild illness, and the points of inoculation developed blisters, but these eventually disappeared. The boy was inoculated with smallpox a little more than a month later, but no disease arose from this move. This heightened not only the fight against smallpox itself, but against infectious disease in general. Louis Pasteur developed the first vaccine for rabies. Emil von Behring and Shibasaburo Kitasato paved the way for the development of antitoxic serums against diphtheria. Jonas Salk developed the first injectable polio vaccine made of inactivated viruses, while Albert Sabin came up with the oral polio vaccine, which is made up of attenuated virus strains. More people, corporations, and institutions have also dedicated themselves to the fight-and by the last quarter of the 20th century, the first major achievement in the fight was achieved.
In the 1900s Northern Europe was virtually free of smallpox, and other European countries were on their way to finally eradicating the disease. This of course was due to the institution of routine immunizations. While the eradication efforts in these areas were bearing valuable fruit, some countries still had to deal with epidemics. For instance, between 1910 and 1914, close to 200,000 Russians died of the disease, with 25,000 more in neighboring countries. In the United States in 1921, more than 100,000 people were recorded to have suffered from the disease. This led to intensified vaccination efforts. By the 1930s, the only cases of smallpox in Europe involved non-European residents, Spaniards, and Portuguese. In the Philippines, routine immunizations against smallpox did not start until the American occupation. During the Spanish period virtually no public health and sanitation projects were instituted-with the exception of the Carriedo water system, which, according to History of Philippine Medicine 1899-1999 (Dayrit, Santos Ocampo, and dela Cruz, 2002), was not put up until the third century of the Spanish rule. This naturally brought about recurrent epidemics of cholera, dysentery, smallpox, and the plague. "Spain did not make any real attempt to protect the population with the already proven effective smallpox vaccine. That Manila was like a 'pigsty' well describes the state of 'unsanitation' prevalent during the Spanish period." Although there was an actual Vaccination Law in effect during the period, it was never enforced too well-if at all-to have an impact. Within a month of the Americans' arrival in 1898 they set up the City of Manila Board of Health. One of its first acts was the enforcement of the Vaccination Law. Several people were mobilized to do citywide smallpox immunization in reaction to an epidemic. A smallpox hospital was also established. Massive immunization efforts led to the gradual diminution of the smallpox problem: by 1953 all of Europe was smallpox-free; Canada followed in the 1940s; Japan halted the disease's spread by the 1950s. It was not until 1967 however that there was a global concerted effort for this end. In 1966 the World Health Assembly allocated the World Health Organization an annual budget of US$2.3 million for the eradication of smallpox, to be accomplished in 10 years. Endemic smallpox was eradicated in 20 western and eastern African countries in 1970; all of Asia was smallpox-free in 1975. The last case of naturally occurring smallpox was recorded in Somalia in 1977. Two laboratory-acquired cases of the disease were recorded in 1978. In 1980, WHO officially declared the world smallpox-free.
Following the hugely successful smallpox eradication effort was the drive to render polio extinct. With the institution of national days of immunization, more children at risk of the disease have been reached. In 1995 alone, nearly half of the world's children-or 300 million-benefited from the drive to oust the disease: even political unrest-plagued Sri Lanka saw the importance of polio immunization that a daylong truce called the "Day of Tranquillity" was observed. As early as 1979 the US was already free from the disease. The last polio case in the Americas-a boy from Peru-was recorded in 1991. After that more and more countries reported zero polio incidence, most notably the Western Pacific (in which the Philippines belongs) in 2000. In June, this year the WHO certified Europe polio-free. Other areas such as the Middle East, North, South, and East Africa are also nearing totally eradicating of the disease. If things go as planned, polio will be extinct by 2005.
Although the biggest challenge to the elimination of vaccine-preventable diseases is still ensuring that the vaccines reach and benefit all-emphasis on "all"-people, there are other more insidious and definitely more fearsome possibilities that could, in no time, render worthless all efforts at disease eradication. Actually vaccinating-which, it goes without saying, requires a steady supply of vaccines and the maintenance of an efficient delivery and monitoring system-people remains a primary concern. The development of vaccines for such diseases as HIV-AIDS is also going on. Although some kinks have arisen-such as the controversy that arose in the Philippines a few years ago that alleged the tetanus toxoid had abortifacient properties, or the establishment of some movements, specifically in the US, that claim vaccines are more dangerous than safe-nothing could be more potent than the possible use of microorganisms for terrorism. The use of biological agents for purposes of destruction has been going on for a long time-the Tatars catapulted corpses of plague victims into castles they were attacking in the 14th century, while British soldiers distributed blankets of smallpox patients to uncooperative Native Americans in the 18th century. In 1995 the Aum Shinrikiyo cult used nerve gas to terrorize Tokyo commuters. But only after the September 11 attacks on the US-when the "Us" v. "Them" division in the world became more violently pronounced-did the fear of bioterrorism intensify, as exemplified by the circulation of inhalation anthrax via the US postal system in October 2001. Dr. Steven Opal, professor of medicine at New York's Brown University, spoke about bioterrorism at the Philippine College of Physicians annual convention in May. He said that aside from anthrax, one of the biological agents that could be used as a weapon is smallpox. "One of the greatest accomplishments of the 20th century-which is the elimination of smallpox in the world by human intervention-[coming] back as a bioterrorist weapon…would be the ultimate irony," he said. Dr. Opal said that the former Soviet Union had stockpiled "thousands of kilograms of weaponized smallpox," and that if people get their hands on it and decided to use it, "it would be devastating to the world's population." Since the eradication of the disease, no one has been immunized against it. "Ninety-nine percent of the world's population is susceptible to smallpox now," he pointed out. However, a recent study published in September by the New England Journal of Medicine showed that the smallpox vaccine could actually last 30 years or longer. Said coauthor Jeffrey Frelinger: "Given the general belief that the vaccinations lasted only seven to 10 years, we were surprised how durable the CTL responses were." Meanwhile, the journal Science reported that some researchers have synthesized the poliovirus using mail-order materials and a genetic code. The State University of New York study reported that the synthetic virus was practically the same as the original, and that lab mice injected with it died following paralysis. This has brought fears that some groups may use the poliovirus as a bioterrorist weapon, and considering how easy it is to get information on virus genomes on the internet, this poses a big threat. Said James LeDuc of the CDC: "It is a little sobering that folks in the chemistry lab can basically create a virus from scratch." However, scientists believe terrorists would prefer to set their sights on more destructive agents-like the larger and more complex smallpox virus. Said researcher Eckard Wimmer: "It is much more difficult to do currently, but with progress in science and technology it will be possible in 10 to 15 years to make smallpox." |
