Coronavirus: Lessons From Past Epidemics

ARCHIVAL (NBC, NIGHTLY NEWS, 3-11-20):
LESTER HOLT: Breaking news tonight – the coronavirus outbreak declared a global pandemic!

NARRATION: A never before seen infectious disease, Covid-19, has the world on edge.

ARCHIVAL (CBS, EVENING NEWS, 3-12-20):
NORA O’DONNEL: Breaking news tonight. America shuts down. A new reality sets in with the coronavirus crisis. The National Guard moving in.

NARRATION: This isn’t the first time the world has grappled with how to confront the outbreak of a deadly disease.

Decades ago, we faced off against smallpox – which killed an estimated 300 million people in the 20th century alone. So what lessons can we learn from that experience… and from Dr. Larry Brilliant, the man who helped eradicate smallpox and who has spent his life fighting pandemics?

Brilliant’s story begins in the early 1970s.

LARRY BRILLIANT (BOARD CHAIRMAN, ENDING PANDEMICS): The possibility that I would go and work for WHO seemed so much larger than me or anything I’d ever done before. And I was 27!

NARRATION: Dr. Larry Brilliant was a young physician who blazed an unconventional trail into the world of public health.

LARRY BRILLIANT: Wavy Gravy who was the master of ceremonies at Woodstock, and a clown, he said, “Let’s go to Nepal.” And that seemed like a great idea. We had these 40- foot long buses and there were 40 kids living in unimaginable sleeping arrangements. I mean, we were not very conservative.

NARRATION: Brilliant would make his way to India and became a disciple of one of the country’s most famous gurus.

LARRY BRILLIANT: For about a year, I would sit there and meditate as we all would, and he would start throwing apples at my testicles. And then one day he called me over and said, “Dr. America!” that’s the name he gave me, “I want you to go to WHO and I want you to be part of a program to eradicate smallpox.”

ARCHIVAL (WORLD HEALTH ORGANIZATION, 1967):
NEWS REPORT: The World Health Assembly in Geneva voted to undertake a ten year program to eradicate smallpox throughout the world.

LARRY BRILLIANT: I walked into WHO and I said, “Oh, I live in the Himalayas. I’m a doctor and my guru who lives in the Himalayas too, he said that I’m supposed to work for you and God is going to help eradicate smallpox.” And they kicked me out. I went back and they kicked me out again and again. And then one day, there was a telegram that said, “Come to report to work for WHO on Monday morning.”

NARRATION: In 1973, he became one of the youngest doctors ever to join the World Health Organization’s smallpox eradication campaign in India.

LARRY BRILLIANT: There were a quarter of a million, mostly children, who got smallpox. Sometimes I would go into a village and there would be bodies stacked like cords of wood, and eyes blinded by the disease, boils all over his or her body. Mothers would come and bring their children and say, “Doctor heal my child.” And there was nothing you could do. There’s no treatment for smallpox. It was a very contagious disease, and a very lethal disease.

NARRATION: A third of those who were infected would die, but not before passing on the virus to an average of seven more people. The best way to stop smallpox from spreading was to vaccinate everyone around an infected individual. But finding hidden cases in a chaotic country was not that easy.

SAMINA AHMED (STREET VENDOR): Here you go.

LARRY BRILLIANT: Thank you.

SAMINA AHMED: Indian popcorn.

LARRY BRILLIANT: Shukria.

NARRATION: A few years ago, Brilliant recently returned to a market in India where he first searched for smallpox in 1973.

LARRY BRILLIANT: And we were doing marketplace surveillance in addition to house-to-house surveillance. So we’d have to come here, and we would do something spectacular, we’d get a clown, we’d give kids some stuff and everyone would come and we’d say have you seen anybody who looked like this, and we’d hold up a picture of a child with smallpox. And we’d say “suchna dehna wala ko, ek hazaar inaam milay ga.” So the first person who finds a case like this we’ll give them a thousand Rupees.

NARRATION: In an era before cell phones and satellite maps, over a hundred million households were checked repeatedly by an army of Indian health workers.

LARRY BRILLIANT: We weren’t finding all the cases of smallpox. Children would run away and we couldn’t vaccinate them. And the District Magistrate said, “You need to have an elephant. You need to have an elephant and a parade, and horns. And if you have a parade, all the children will come. And you can find any hidden cases.” And that’s what I did. WHO had a very dim view of what I was doing. It certainly was not part of our protocol, but it worked. And I don’t think that we could have eradicated smallpox as quickly as we did without breaking rules.

NARRATION: On October 16, 1975 two-year-old Rahima Banu was the last person to be diagnosed with Variola Major–the deadliest strain of the smallpox virus.

LARRY BRILLIANT: I remember looking at her and thinking, when her scabs fell off and she coughed out whatever viruses were still in her lungs and they landed on the ground in Bangladesh and the sun baked them, that was the end of a disease that had been the worst disease in history.

NARRATION: In 1988, energized by the success of the smallpox program, the global public health community moved to tackle another ancient scourge: polio, a killer virus which paralyzed more than 300,000 people that year.

The new campaign surged ahead, and polio was eliminated from 118 countries in only 14 years. But then…

ARCHIVAL (CBS, 6-25-04):
NEWS REPORT: Suddenly the disease is spreading again.

ARCHIVAL (CCTV, 5-5-14):
NEWS REPORT: Religion and suspicion have helped fuel the disease in the North.

NARRATION: In 2003, distrust between Muslim leaders and the Nigerian government spawned a rumor that polio vaccination was a Western ploy to sterilize Muslim youth.

LARRY BRILLIANT: In Nigeria, the imams issued a fatwa against the polio program and in doing so, created an epidemic of polio.

HEIDI LARSON (DIRECTOR, VACCINE CONFIDENCE PROJECT, LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE): The impact of this boycott led to reimportation of the virus to nearly 20 countries.

NARRATION: Heidi Larson maps the rumors that can lead to resistance to vaccines. In Nigeria, these stories were as contagious and lethal as the virus.

HEIDI LARSON: This is a map that we put up to mark all the negative vaccine reports that we were getting. The underlying issue was distrust, in a big way. When you have a vaccine that’s brought to your door repeatedly, when you’re not getting many of the other very basic health needs that you feel like you need more, it prompts suspicion.

NARRATION: The Nigerian boycott drove home a hard lesson, that even with scientific advances and a globalized world, the key to an eradication campaign is public trust. And it can disappear in an instant.

ARCHIVAL (WH.GOV, 5-1-11):
PRESIDENT PRESIDENT BARACK OBAMA: The United States has conducted an operation that killed Osama bin Laden, the leader of Al Qaeda.

ARCHIVAL (NBC, 11-30-14):
ANNE CURRY: The CIA has admitted, it used a fake vaccination program in 2011 to collect blood samples in the search for Osama Bin Laden.

NARRATION: In Pakistan, opposition to the polio program exploded following these reports.

HEIDI LARSON: This was exactly an example of throwing a firecracker in the midst of a highly fertile, suspicious ground and it really set things back.

ARCHIVAL (CNN, 12.19.2012):
NEWS REPORT: A two day killing spree in Pakistan.

ARCHIVAL (AL JAZEERA, 10-7-13):
NEWS NEWS REPORT: Over the past year there have been a number of attacks on health workers distributing the polio vaccine for which the Pakistani Taliban has claimed responsibility.

HEIDI LARSON: Suspicions around CIA involvement in mass vaccination campaigns, have been there for years. A decade ago, I could confidently go to communities and sit with them saying, ‘You know, this is for the best interest of children, this is not a covert effort.’ And I could not say that now.

NARRATION: The polio eradication campaign seems to be back on track.

LARRY BRILLIANT: A lot of people in the world thought that was the end of the polio program and that they would never succeed. It certainly makes you realize the interplay between global politics and disease control.

NARRATION: Today, as coronavirus spreads around the globe, Larry Brilliant says the tension between politics and public health is still playing out.

ARCHIVAL (CNN, 3-12-20):
LARRY BRILLIANT: In every epidemic I’ve worked, government always has the tendency to underestimate or underplay how bad the epidemic is.

NARRATION: In recent interviews, he’s expressed frustration that the world has not learned the lessons of the past, pointing to the US government’s reluctance to do the kind of widespread community testing that worked in taming smallpox and polio.

ARCHIVAL (BBC NEWS, 3-3-20):
LARRY BRILLIANT: If you have a cough, if you have a fever, so what if we are testing more people than have the disease? That is what we do with every test we do in medicine because it is so important to find people who actually have the disease we’re looking for.

NARRATION: Brilliant says the US should speed up the mobilization of medical supplies and building of field hospitals in the most affected areas. And think out of the box, as the smallpox eradication effort did, including the kind of “radical transparency” that South Korea is using to keep the public informed.

ARCHIVAL (AUDIO FROM THE COUNSEL ON FOREIGN RELATIONS, 3-13-20):
LARRY BRILLIANT: The South Korean government is sending out text messages to every individual in the country saying, ’there is a corona case near you, here’s what you can do, please tell us how you are doing.’ Publishing the daily counts, publishing the mistakes that are being made, and that’s the best way to deal with the pandemic.

LARRY BRILLIANT: I think when you’re looking back at the lessons from both smallpox eradication and polio eradication, we have to remember that they helped us put the public back in public health, whether you’re talking about public trust, public value, or public will, those are the keys.

(END)