We pay attention to epidemics when they scare us and threaten us, but as soon as we seem to be getting them under control we lose interest. We let our guard down and this makes us more vulnerable to the next threat. People are much more likely to seek treatment for a problem that has already struck close to home or affected them personally than they are to be interested in prevention.
This is part of the problem with responding to each new pandemic. We mount an effective response when the threat is most visible, but once the problem has been minimized we forget that it ever happened.
Even worse, we are lulled into such complacency that we forget about preparing for the next attack.
May 8th marked exactly 43 years ago that the World Health Organization declared that smallpox had been defeated and the world celebrated the official eradication of this dreaded terror. In the last century alone, smallpox killed more than 300 million people. When the person became sick with smallpox their body would be covered with pustules that were extremely painful. The pustules would appear on the face, on the genitals, all over the body and they represented putrefied patches of skin and other organs. It was said that one could tell where there was a victim of smallpox even at a distance of 50 yards because the smell would be so horrendous. People were rotting while they were still alive.
Eradication of smallpox was the holy grail for public health. It was a spectacular achievement, the first time that a human disease had ever been eradicated from the face of the earth. It created a level playing field where the risk of getting smallpox was the same for everyone, young and old, rich and poor, in wealthy countries or impoverished places. The risk was zero, even for those yet unborn. This was the ultimate goal of public health in three small words: global health equity.
This was an extraordinary achievement of many people in many organizations in many nations working together. And it is precisely because we continue to face extreme threats that we think it is important to learn the lessons that can help us address threats that have the potential to become global disasters. With the help of many others we have drawn 9 lessons that we learned from the eradication of smallpox. They constitute a framework that we think will be very useful in tackling current and future threats to global health and well-being.
These lessons are not the only lessons one can draw from this public health success, but they are 9 very important lessons that are widely applicable to most problems, not only problems in global health. The most important lesson is number 9 because social justice is the moral compass for public health: the best solutions move us closer to global health equity. The rest of the lessons help us get there.
1.) This is a cause and effect world. If you understand the causes, you can change the effects and you can change the outcomes for the better. Science is the tool we use for understanding the relationship between cause and effect.
2.) Know the truth, share the truth and act on the truth. Truth is required to change effects.
3.) Coalitions are essential. Leadership is the central lesson to explain the most successful coalitions.
4.) Avoid certainty, “the achilles heel of science.” With certainty comes an end to the search for more knowledge.
5.) Build in consequential evaluation and continuous improvement.
6.) Respect the culture. Culture matters. When ignored it can cancel the best efforts.
7.) The best decisions are based on the best science but the best outcomes also require strong leadership and management.
8.) Mobilize political will because with it, anything is possible; without it, nothing is. Invest politicians in the outcomes of a program, not just the funding of that program.
9.) The best solutions move us closer to global health equity.
We believe that these lessons may help the future leaders of global health address, prevent and effectively stop future threats. These include the threats of global warming, nuclear war, newly emerging infectious disease agents and threats that may be the result of artificial intelligence which gets out of hand.
These are lessons that we have learned and synthesized from our combined 120 years of experience in global health and with invaluable help from many others who went before us or with us. We realize that when we choose to go into public health we should not expect to get rich or to get thanks for preventing problems that no one experiences.
But we do have a chance to become better ancestors by equipping future generations with the tools that will help them create better lives for everyone.
Dr. Mark Rosenberg worked on the smallpox eradication campaign in 1976 and was later instrumental in establishing CDC’s National Center for Injury Prevention and Control and became its first permanent director. He also served as assistant surgeon general. He was president and CEO of The Task Force for Global Health from 2000 to 2016. Under his leadership, The Task Force grew to be one of the largest nonprofit organizations in the country.
Dr. William “Bill” Foege is an epidemiologist and was instrumental in the successful campaign to eradicate smallpox in the 1970s. Dr. Foege served as director of the Centers for Disease Control under both Presidents Carter and Reagan. Dr. Foege co-founded The Task Force for Child Survival, now The Task Force for Global Health and joined The Carter Center as its first executive director. He has served as senior medical advisor for the Bill and Melinda Gates Foundation.
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