A Global Great Society.

December 1, 2011, 7:25 pm

[Editor's Note: Bob Reinhardt, a PhD candidate in our department, submitted this TDIH before the late unpleasantness on our campus. He then asked if I would hold off on posting for a bit. Well, a bit has passed, and it's time to talk about smallpox. Really, though, when isn't it the right time to talk about smallpox? Thanksgiving dinner, I suppose. Anyway, thanks, Bob, for doing this.]

23 November

On this day in 1965, President Lyndon Johnson declared all-out war on a universally despised enemy. The announcement didn’t concern Vietnam — Johnson had escalated that police action months before — nor poverty, against which the US had allegedly been fighting an “unconditional war.” This particular declaration targeted a different enemy, older and perhaps more loathsome than any ideological or socioeconomic affliction: smallpox. As the White House Press Release explained, the US Agency for International Development and the US Public Health Service (specifically, the Communicable Disease Center, now the Centers for Disease Control and Prevention) had launched an ambitious campaign to eradicate smallpox (and control measles) in 18 West African countries.* That program would eventually lead to the first and only human-sponsored eradication of a disease, and would also demonstrate the possibilities — and limits — of liberal technocratic expertise.

For Johnson and others in his administration, smallpox eradication represented the first step towards a Global Great Society. As the domestic Great Society sought to address the universal needs of all Americans — to education, work, health care, and the good life — the smallpox campaign would confront a universally hated disease, a scourge that attacked without regard to race, class, creed, or nationality. The program’s absolute and unconditional goal matched the ambitious spirit of the Great Society, as did its means. The CDC ‘s young and energetic staff went to Africa with a confidence in American medical expertise and equipped with the most advanced products of American technological and manufacturing prowess: Dodge four-wheel-drive trucks, Wyeth Laboratories freeze dried vaccine, and the Ped-O-Jet vaccination gun, manufactured by the Scientific Equipment Manufacturing Company of Lodi, New Jersey. These tools, methods, and objectives would master the nonhuman world for the benefit of all humans, as would other proposals for the Global Great Society: an International Health Act that would send American doctors and medical technology throughout the world, for instance, or a “Tennessee Valley Authority” for the Mekong Delta. And it would all start with smallpox eradication, which embodied a technocratic liberal utopianism that sought to transcend the complexities of politics and culture in pursuit of a better world for everyone.

The program scored rapid and remarkable victories. CDC doctors, health workers, and administrators began taking their African stations in January 1967. One year later, the CDC celebrated the 25 millionth vaccination with a garish ceremony in Ghana, highlighted by Surgeon General William Stewart sweating through his suit and tie as he danced with local tribal leaders. By May 1970, smallpox had disappeared from West Africa, as it would soon throughout the rest of the world. Inspired by the CDC campaign, the WHO’s global eradication program deployed many of the same tools, strategies, and even personnel (on loan from the CDC) to the disease’s ancient strongholds in the Asian subcontinent, as well as other parts of Africa. In 1977, the WHO and CDC cornered the last naturally occurring case of smallpox, in Somalia, and in 1980, the World Health Assembly officially confirmed smallpox’s eradication.

There were, of course, limits to and unintended consequences of smallpox eradication. The CDC’s West Africa program did not initiate a Global Great Society; the International Health Act died in a congressional committee and the Mekong Delta never got its TVA. The CDC program itself fell short of its potential. Thanks to backlash against liberal spending and the priorities of a new presidential administration, the CDC left Africa in 1972, and measles — the other stated target of the West Africa program — returned with a vengeance. It turned out that this campaign could not, in fact, transcend the complexities and pressures of politics and culture, despite the hopes of technocratic liberals. Similarly, the pressures of the Cold War truncated the success of global eradication, as the United States and the Soviet Union refused to deliver the final blow and eliminate their laboratory stocks of the virus. Thus did the program create a paradoxical legacy: though the world has been free of smallpox the disease for over 30 years, we are still haunted by the presence of the smallpox virus: in high-security labs in Atlanta and Siberia; perhaps in the hands of rogue states employing former Soviet scientists; and in anxious imaginations since 9/11.

But it hardly seems fair to focus on such problems when the success of the program is literally so tangible. Just feel the outside of your upper left arm. If you were born in the United States after 1972, you won’t find the telltale scar of the smallpox vaccine, which could have painful and even deadly side effects. If you do have the scar, you possess a relic of a different, and in many ways worse, world. And for that, you might give thanks to the technocratic liberal utopians who pursued their objective with such dedication, enthusiasm, and confidence.

* The eighteen: Cameroon, Central African Republic, Chad, Dahomey, Gabon, Gambia, Ghana, Guinea, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo, and Upper Volta. USAID later added Congo-Brazzaville.

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