Saturday, November 12, 2016

Hopes and Fears


As man advances in civilisation, and small tribes are united into larger communities, the simplest reason would tell each individual that he ought to extend his social instincts and sympathies to all the members of the same nation, though personally unknown to him. This point being once reached, there is only an artificial barrier to prevent his sympathies extending to the men of all nations and races.
Charles Darwin, 1871. The Descent of Man

The hopes and fears of all the years are met in thee tonight.
Phillip Brooks, 1868, O Little Town of Bethlehem,

The world was sick, and the ills from which it was suffering were mainly due to the perversion of man, his inability to live at peace with himself. The microbe was no longer the main enemy; science was sufficiently advanced to be able to cope with it admirably, if it were not for such barriers as superstition, ignorance, religious intolerance, misery and poverty.
Brock Chisholm, first Director-General of the World Health Organization, 1948

Like many nineteenth century Christian hymns, the Christmas carol O Little Town of Bethlehem is a little overblown and, even at the time of its creation, was factually dubious as the quest for the historical Jesus had already recast the contradictory accounts of his birth as mere myths. And yet one sentence from the hymn rang true on 16th October 1975: not applied to a Judean village, but to an island settlement half a world away. The hopes and fears of all the years were met that day in the Bangladeshi village of Kuralia on Bhola Island, situated at the mouth of the Meghna River in the mighty Ganges Delta.
The last case of variola major, the life-threatening form of smallpox. The culmination of a global eradication campaign stretching back nearly two centuries to Jenner. In England’s green and pleasant land, where Jenner kick-started the process of eradication, every town and village sports a memorial to the dead of two world wars. Yet you look in vain for a list of the pox-dead. Responsible for a third to a quarter of a billion deaths in the twentieth century alone—more than double the combined death toll of all that century’s the wars—smallpox outdid Stalin, Hitler or Mao Zedong as a mass murderer during humanity’s bloodiest century. To memorialise the twentieth-century pox-dead would require five thousand Menin Gates or a Vietnam-style Memorial Wall 250 miles long.

Around the same time that American priest Phillip Brooks was writing O Little Town of Bethlehem, English naturalist, Charles Darwin was writing The Descent of Man, in which he predicted an expanding circle of sympathy “extending to the men of all nations and races”. From a global perspective, the century that connected the 1870s to the 1970s provided scant evidence for Darwin’s “expanding circle of sympathy”, with an unending litany of manmade megadeaths: imperialist wars across the globe from China to the southern tip of Africa, “manifest destiny” as an excuse for the US to massacre Native Americans, the decimation of the Congo Free State, two World Wars and the Holocaust. The second half of the twentieth century saw a world splintered into two by the Cold War. Stalin’s gulag and Mao’s Great Leap Forward. The Korean War. By October 1975, the Vietnam War had come to an end a few months earlier with the fall of Saigon; Cambodia’s killing fields were about to swallow two million dead.
And yet the candle of civilisation was never extinguished, nor the dream of eradication. At spes infracta. And yet hope unbroken, as the motto goes. Darwin’s expanding circle of sympathy was keeping pace with man’s inhumanity to man.

BY THE END OF WORLD WAR II, smallpox was no longer circulating among the populations of Europe and North America. Nonetheless, there were still frequent importations from the rest of the world, often triggering troublesome outbreaks. Vaccination in the rest of the world was hampered by the instability of the smallpox vaccine, which would start to lose potency after just a few days at ambient temperature. Widespread deployment of the vaccine meant the establishment and maintenance of a cumbersome “cold chain” to protect the vaccine.
American researchers had developed a method of freeze-drying the vaccine. However, their method added phenol to the vaccine to prevent bacterial contamination and, unhelpfully, the phenol rendered the vaccinia virus less active. In the late 1940s, a young English virologist, Leslie Collier (1921–2011), working at the Lister Institute of Preventive Medicine in Elstree, about thirteen miles north of London, came up with a solution. Collier added a crucial component to the process: peptone, a soluble protein extract that protected the virus during freeze-drying. Collier’s method delivered a heat-stable vaccine in powdered form that health workers could carry for weeks or months in their bags with no loss of potency.
In 1950, under the guidance of visionary American epidemiologist Frederick Soper, the Pan-American Health Organization launched a campaign to eradicate smallpox from the Western Hemisphere. Progress was slow, but, by 1958, the disease had been eliminated from all but four countries in the Americas: Argentina, Brazil, Colombia, Ecuador.
In many ways, smallpox was a sitting duck. We had a heat-stable vaccine that worked. Smallpox was an exclusively human disease, with no known substantial or durable animal or environmental reservoir. It was relatively easy to diagnose on clinical examination and distinctive enough even for the non-expert to spot. And yet, in the late 1950s, two million people were still dying from smallpox every year!

If the world were run on realism, it would be grey and miserable place. Repeatedly over the last two hundred years, idealists have set new targets, which realists would judge unrealistic; not feasible; not even desirable, if one thinks through all the potential consequences. In France, the nineteenth century opened to the cry of “liberté, egalité, fraternité”, while in Britain it saw the abolition of slavery and the emancipation of Catholics. During the late nineteenth and early twentieth century, a wave of political idealism took hold in the Anglo-Saxon world, with Gladstone and later Woodrow Wilson articulating and enacting foreign policies that reflected the internal ideals of their societies—in effect, aiming to remake the whole world anew and in the image of their own societies.
Such idealism was soon to be subsumed into ideology in the brutal middle decades of the twentieth century. But even at the height of the cold war, both the West and the Soviets subscribed, however imperfectly, to the common ideals of feeding the hungry, educating the ignorant and healing the sick.  
After the Second World War, this sense of common humanity led to the formation of the United Nations and its subsidiary agencies, including the World Bank, the International Monetary Fund, the Food and Agriculture Organisation, the United Nations Educational, Scientific and Cultural Organization (UNESCO) and crucially the World Health Organisation or WHO.

The WHO was LAUNCHED in 1948 under the stewardship of Dr Brock Chisholm, a maverick Canadian psychiatrist, whose conviction politics had earned him the title of “Canada's most famously articulate angry man”. It was Chisholm’s idealism and high hopes for the new organisation that led to it being named the World Health Organisation, with a global rather being merely international mission. In harmony with its grand ambitions, the new organisation took up home in le Palais des Nations in Geneva, Switzerland; this former home of the League of Nations, overlooking Lake Geneva and with a clear view of the French Alps, peacocks roaming freely in the surrounding park, ranks as the second-largest building complex in Europe, second only to Versaille.
The new organisation’s policies and goals, in pursuit of Chisholm’s heady ideal of “World Health”, were set by the World Health Assembly (WHA), which acted as the WHO’s legislative and supreme body and met yearly in Geneva. Repeatedly during its first decade, in 1950, 1953, 1954 and 1955, the Wold Health Assembly discussed the global problem of smallpox. Chisholm himself proposed a smallpox eradication programme to the Sixth World Health Assembly in 1953, but his plans came to nought—after two years, after much debate, the Eighth World Health Assembly rejected the concept as unrealistic.
To mark the organization’s tenth anniversary, delegates from the over eighty member states of the WHO convened at the Eleventh World Health Assembly, for a three-week meeting that took place between May 28 and June 13, 1958. There was a crucial break with tradition—instead of the usual Switzerland, this time the United States of America played host to the meeting, thanks to the efforts of Hubert Humphrey, Senator for Minnesota and a long-time internationalist who wanted to highlight American support for the organization. The Eleventh WHA opened in Minneapolis, under the chairmanship of Dr Leroy E. Burney, Surgeon General of the US Public Health Service, with a two-day special session commemorating the Organization's tenth anniversary.
There was another change that year. Since just after its inception, the Soviet Bloc had boycotted the WHO, protesting that it did not allocate sufficient resources to Eastern Europe. During its first decade, the WHO stubbornly ignored Soviet absenteeism, arguing that its constitution contained no provision for withdrawal and so all these countries still counted as members. This left the door open for subsequent Soviet engagement with the organization. In line with Soviet premier Nikita Khrushchev’s new policy of “peaceful coexistence” with the West, that year, for the first time, the Soviet Union sent a delegation to the WHA: a delegation headed by the Soviet Union’s Deputy Health Minister, Victor Zhdanov.
And so, it was here in Minneapolis in the American Midwest, thanks to the hospitality of an American idealist and the intervention of a clear-sighted Russian clinician, the WHO finally grasped the thorny rose of idealism with the firm and decisive hand of realism and set in motion a train of events that still counts as one of humanity’s greatest achievements.

Victor Mikhailovich Zhdanov was born in 1914 into the family of a rural doctor in the village of Shtepin, tucked away in the southeastern corner of the Ukraine in what is now the Donetsk region, close to the Aral Sea. As a hint of the greatness that was to come, while at school, the young Zhdanov wrote a physics textbook for his classmates. On leaving school, to fund his medical studies and to gain preferential treatment during the admissions process, he worked on a farm for several months, where his natural leadership skills soon led to him being elected foreman.
Zhdanov then moved a few hundred miles north to the Ukraine’s second city, Kharkov to start his medical training. While studying at the Kharkov Medical Institute, the lively medical student enjoyed a full programme of extra-curricular activities, including playing the piano as an accompaniment to silent movies and writing and directing an opera. He graduated from the Institute at the age of twenty-two, then spent ten years in the “school of hard knocks”, working his way up the ranks as an army doctor in Novokuznetsk and Chita in Siberia, and then in Ashkhabad in Turkmenistan, eventually becoming a Major General. During this time, he learnt how to deal with bureaucrats and gained a mastery of epidemiology out in the field. Crucially, he was involved in efforts to eliminate malaria and dysentery, in the development and implementation of quarantine measures and in the containment of imported infections, all of which laid the foundations for his later thinking
In 1946, at the age of thirty-two, Zhdanov defended a doctoral thesis entitled Infectious hepatitis (Botkin's disease): Etiology and Epidemiology and throughout his life he maintained the critical mindset of a research scientist. That same year, following his release from the army, he became Chief of the Epidemiology Department in the Metchnikoff Institute of Epidemiology and Microbiology in Kharkov. Within two years, he had become Director of the Institute.  Within four years, he was a professor and had been elected a corresponding member of the USSR’s Academy of Medical Sciences.
A good listener, hard-working, well-organised, sharp-witted, encyclopaedically knowledgeable, with an extraordinary thirst for life, Viktor Zhdanov had all the makings of an inspiring and effective leader. In 1951, he became Chief of the Department of Sanitary and Epidemiological Services, with responsibility for communicable disease control across the whole of the Soviet Union. Fuelled by Soviet idealism and Soviet successes in controlling smallpox and Guinea-worm, combined with a keen intellect and warm humanitarianism, he was increasingly drawn to the idea of disease eradication. In 1952, with fellow microbiologist Vladimir Dmitrievich Timakov, Zhdanov published a report outlining the prospects for eliminating selected infectious diseases, stressing that increased investment in the short term was sure to deliver decisive savings in the long term.
In 1955 Zhdanov became Deputy Minister of Health and Chief Medical Officer, serving under the Soviet Minister of Health, the neurologist Dr. Maria Kovrigina. In this role, he formulated a strategy for tackling health problems that combined scientific analysis, wide-ranging discussion and decisive action. Such an approach was to serve him—and the world—well, when he turned his mind to the eradication of smallpox not just from the Soviet Union, but from the entire globe.
And so in 1958, as spring was turning into summer in Minneapolis, Zhdanov presented a report to the eleventh WHA. According to the official history of smallpox eradication, the report was rather long and couched in overly formal language, but few other declarations have had such power to change the course of history. As a sophisticated orator, Zhdanov tailored his rhetoric to the local audience, opening his address with an uplifting exhortation from US founding father Thomas Jefferson, in his 1806 letter to Edward Jenner: “future nations will know by history only that the loathsome small-pox has existed.”
Zhdanov’s report rammed home the point that no nation was free of the risk of smallpox until all were free of the disease, highlighting the recurrent costs of vaccination and revaccination across the globe and stressing that there were good grounds for believing that eradication was theoretically and practically possible. Zhdanov recommended that a system used in England to manage the disease, the so-called Leicester system, be adopted widely: this system encompassed prompt identification and isolation of new cases together with quarantine and surveillance of contacts. His report concluded with a bold claim: “As regards its complete eradication throughout the world, we think that this can be achieved within the next ten years.”

Zhdanov did not single-handedly and instantaneously win over his audience in 1958. The delegates did, however, ask the Director-General of the WHO to give fuller consideration to the prospect of smallpox eradication. The Soviet Union, and its ally Cuba, quickly followed up Zhadnov’s suggestion with practical help by supplying the WHO with 25 million and two million vials of vaccine, respectively. At the subsequent World Health Assembly in 1959, agreement was finally reached to launch a global eradication campaign for smallpox.

Although the speech that launched the eradication campaign had been given in America, the USA was initially slow to follow the Soviet Union’s lead. However, in 1964, which as International Cooperation Year marked the twentieth anniversary of the United Nations, President Lyndon B. Johnson pledged his country’s commitment to this bold effort. In a nice symmetry with the Soviet Union’s Zhdanov, one American, Donald “D.A.” Henderson, was subsequently propelled into a leadership role in the eradication campaign. Henderson was an epidemiologist working in the Epidemic Intelligence Service of the US. Centers for Disease Control (CDC) and he had become obsessed with smallpox. Henderson’s work in expanding an US-led effort to eradicate measles from West Africa to embrace smallpox control caught the attention of the then WHO Secretary-General, Chisholm’s successor, Marcelino Candau. In 1966, the WHA agreed on a ten-year intensified eradication campaign and Henderson was tipped into the role of Director of the WHO Smallpox Eradication Office. From his cramped headquarters in Geneva, Henderson led the campaign during its most active phase, channelling efforts through WHO Regional Offices to over 150,000 field workers.

This is not the place to document the details of how smallpox was squeezed out of every corner of the globe: the story of this campaign has been told many times before, most notably in the mammoth WHO publication, often dubbed “the Big Red Book”, Smallpox and its Eradication and in Henderson’s own account of the campaign, Smallpox—Death of a Disease. Suffice it to say that the campaign overcame numerous hurdles, both physical (mountains, rivers, floods) and social (ignorance, political wrangling, vested interests, national pride, fraudulent under-reporting of cases, famine, war, displacement of people) and every conceivable form of transport was used to deliver vaccine to its targets: jeeps, motorcycles, pushbikes, mules, boats, even elephants! One by one the regional goliaths of endemic smallpox fell to the slingshot of freeze-dried vaccine delivered by bifurcated needle—Brazil and Indonesia, West Africa, the Indian Subcontinent. An incursion by smallpox into Yugoslavia in 1970 was soon seen off. By 1975, smallpox was confined to two localities and only in one of them did the serious form, variola major, still inhabit human flesh and blood.

Wednesday, May 15, 2013


VIRUSES ARE LIKE ZOMBIES: they are not quite dead and, to keep going, they have to feed on living flesh. But they are not quite alive either. When a bacteriologist wants to needle a virologist, she dismisses viruses as “infectious chemicals”, not properly living things. Properly living things are made of cells, membrane-bound bags of vibrant chemical reactions. At best, viruses can be characterised as “minimal biological entities”.

In classical Latin, the word virus was applied to any poisonous secretions or venoms, or metaphorically to anything with a virulent or malignant quality. Cicero uses it this way in his De Amicitia, with his turn of phrase evomat virus acerbitatis suae meaning “spits out the venom of their own bitterness”. In English, the word had started to take on a more modern meaning as "material that causes infectious disease" by the eighteenth century. Edward Jenner in his groundbreaking text from 1798 AN INQUIRY INTO THE CAUSES AND EFFECTS OF THE VARIOLÆ VACCINÆ uses the term “virus” more than twenty times to describe the infectious material that causes cowpox.

Louis Pasteur, one of the founders of medical microbiology, is buried in a neo-Byzantine chapel within the Institut Pasteur at the heart of Paris. The walls of the crypt are lined with exquisite marble, above which sit mosaics providing vignettes from Pasteur’s highly productive life. The penultimate vignette carries the inscription “1880 virus vaccins” and refers to Pasteur’s work on the production of artificial vaccines against chicken cholera and anthrax. The final inscription refers to Pasteur’s work on vaccination against rabies.

Pasteur was puzzled by rabies. He could grow and/or use a microscope to visualise the causative agents of most of the infectious diseases on which he worked—these agents we now call bacteria. But the cause of rabies eluded him—and for good reason, as we now know it was caused by a virus rather than a bacterium. However, one of his staff, Charles Chamberland, laid the groundwork for the discovery of what we now call viruses, by inventing the Chamberland-Pasteur filter. This filter, made from unglazed porcelain, had such a small pore size (less than a millionth of a metre), that it could be used to remove bacteria from a liquid suspension.

In the early days of the new Germ Theory of Infection, it was thought that all infectious agents could be retained by filters and grown on a nutrient medium. However, in the last decade of the nineteenth century, it became clear that some infectious agents did not comply with these expectations. In 1892, Dmitri Ivanowski, working in St Petersburg, used a filter candle on an extract of plants with tobacco mosaic disease and showed that, even after filtration, the extract remained infectious. But he didn’t quite get clear in his head what had happened—he thought perhaps what he was seeing was a toxin produced by a bacterium.

Six years later, the Dutch scientist Martinus Beijerinck described his own similar experiments with infectious bacteria-free extracts of tobacco mosaic disease, but this time made the conceptual leap to the idea of a new kind of infectious agent, which he termed “filterable virus” that would grow only in the presence of living cells. The adjective was soon dropped and modern usage of the term “virus” became widespread.

In 1906, the Italian pathologist, Adelchi Negri showed that Jenner’s vaccine virus was also a “filterable virus” and soon afterwards, the causative agent of smallpox was also shown to be viral in nature.

But what aside from size makes viruses different from bacteria?...

Tuesday, May 14, 2013


The art is long, life is short, opportunity fleeting, experiment dangerous, judgment difficult.
Hippocrates of Cos

Janet’s parents had grown tired of watching over their ailing daughter, as her condition went from bad to worse. They called their own GP, Dr Annis Price, to Myrtle Avenue to see Janet. Dr Price decided things were serious enough for a hospital opinion. He referred Janet Parker to the local infectious disease hospital with a diagnosis of “Rash and Fever”.

Janet made the nine-mile journey to East Birmingham Hospital in an ordinary ambulance. At three o’clock that afternoon she was admitted to a single isolation cubicle in Ward 32. Shortly afterwards, she was seen by the Duty Consultant Physician for the Department of Communicable and Tropical Disease, who that day happened to be Professor Hugh Vivian Morgan.

A quietly spoken Welshman, with deep Christian convictions, Hugh Morgan had been Professor of Medicine at the University of Khartoum in the Sudan from 1952 to 1968. In this role, he had criss-crossed the country in a truck-cum-trailer that acted as a mobile clinic and laboratory, ministering to the medical needs of the local population. His services to medicine and medical education in Africa culminated in the award of a CBE in 1966.

By the time he encountered Janet Parker, Morgan had been in Birmingham for over ten years, his clinical experience overseas and his good grasp of Arabic proving valuable in dealing with immigrants from the Tropics and Middle East. Now sixty-two years old, bald on top, with a wide-domed forehead, a warm friendly smile and an unthreatening avuncular demeanour, Morgan was close to the end of long and distinguished career. His memory was starting to falter—the nurses had already nicknamed him “the absent-minded professor”. Sadly, a few years later, in retirement, his forgetfulness was to be transformed into full-blown Alzheimer’s disease. But on that fateful day in 1978, although he might have started to loose his grip on the superficial trivia of the here-and-now, Morgan was still in full possession of a fine-tuned diagnostic acumen and of a rich treasure trove of clinical experience. Most importantly, from textbook knowledge and from face-to-face encounters in Africa, smallpox was seared deep into his intellect.

“Judgment difficult”, Hippocrates had said. What to do when faced with a difficult diagnosis? There is a saying among medics that “common things occur commonly”. This is applied as a corrective to those who have spent more time with textbooks than with patients, to prevent them jumping straight to the rare small print stuff when making a diagnosis. The three GPs who had seen Janet Parker—all good solid chaps, trained at the Medical School in Birmingham— had obviously been working to this rule. And not unreasonably: a year after it had been eradicated, not just from England’s green and pleasant land, but from the whole planet, smallpox had to rank as the smallest of small print in any differential diagnosis. In fact, it was quite frankly impossible!

Another medical aphorism along similar lines is “when you hear the sound of hooves, think horses, not zebras”. Smallpox, in suburban Birmingham in the summer of 1978, was not even a zebra; it was a unicorn!

But faced with Janet’s signs and symptoms, Morgan was worried. He trusted what his senses and his intellect were telling him—for someone with his tangible experience of the disease, smallpox, however improbable, could not be dismissed as impossible. Yet the quietly spoken veteran of Khartoum was no sensationalist. He was not going to announce triumphantly to the world, or even to his colleagues, that he had single-handedly diagnosed a case of smallpox. Instead, he did what any sensible person would do when confronted with a unicorn in the garden—he performed a sanity check: he sought a second opinion. He turned for advice to Birmingham’s designated smallpox consultant, a scotsman named Alasdair Geddes.

Geddes had held this position since he had returned from a stint working on the eradication campaign in Bangladesh in 1973. In this role, he had been called out half a dozen times in the previous five years to examine suspected cases of smallpox. All so far had turned out to be false alarms: either bad cases of chickenpox or a nasty rash from a condition known as Stevens-Johnson syndrome. Yet each time, he had been paid the princely sum of twenty pounds.

At 7.30pm, the Welshman phoned the Scotsman and asked him to come in and see what he called “a lady with an unusual rash who worked in the east wing of the Medical School”. Morgan might have fleetingly raised the possibility of smallpox, but for him it still didn’t make much sense. You didn’t get unicorns on the lawn in England.

Nirvana in the Laboratory: PAKISTAN, FEBRUARY 1970

Lives of great men all remind us 
We can make our lives sublime 
And departing leave behind us 
Footprints on the sands of time.
A Psalm of Life,

PAKISTAN: A LAND BETWEEN East and West, where the Eurasian and Indian plates collide: the Indus valley, flanked to the west by the Baluchistan plateau and to the north by the foothills of the Himalayas.

Historians may argue over whether great men really do shape history or merely ride its currents. Yet, several great men had clearly left footprints on the sands of time of this landscape. Sometime before 400 BCE, Siddhartha Gautama, established a new religion, Buddhism, which rapidly permeated the region.

In the third century BCE, the Macedonian general, Alexander the Great, swept in from the West, ushering in a new era of Indo-Greek civilization. To the East, the Indian emperor Ashoka, made Buddhism the state religion of a multi-ethnic empire. The resulting fusion of Greek sculpture with Buddhist religious art culminated in the now-familiar statues of the Buddha scattered across the Southern and Eastern Asia. In what is now central Afghanistan, monumental standing Buddhas carved into a cliff face stood for nearly fifteen centuries, before they were destroyed in a fit of intolerance by the Taliban. Buddhism itself lasted a thousand years in Pakistan before, in the eight century of the common era, the region fell under the influence of another great man, Muḥammad ibn ‘Abd Allah, and another religion, Islam.


IN 1970, THE SMALLPOX eradication campaign was in full swing, but there were still thousands of cases every year in Pakistan. For a dumb virus, the variola major virus, the cause of the more lethal form of smallpox, was proving surprisingly tenacious. Surviving for thousands of years here, this virus had become a microcosm of Buddhism, caught up in an endless cycle of reincarnation, jumping every few weeks from one human body to the next.

But the virus evolved. Every infection represented a lineage that had completed the cycle of reincarnation thousands of times—transmitted endlessly from Buddhist to Buddhist, from Buddhist to Muslim and then from Muslim to Muslim. In recent years, a new lineage had emerged, producing a slightly different profile of proteins and behaving differently when grown in the laboratory. It might even have been a little more virulent. It was to spread as far south as Vellore in India and was to track through the Middle East before jumping into Yugoslavia, deep within Europe.

In February 1970, two samples of the new lineage were taken from patients in Pakistan, one from a three-year old boy called Abid (who, if alive, would now be in his forties), the other from an eighteen-year old man called Taj (who, if alive, would now be in his sixties). Each sample was packed full of variola major poxviruses: a million virus particles or more.

Freighted by air, these representatives of what we might call the "Abid dynasty", ascended high into the stratosphere. The viral pilgrims migrated northward from Pakistan into the heart of the Soviet Union. There, they joined an elite set of reference strains, sent to research centres around the world. Within a few years, the Abid lineage had colonised laboratories in three continents, including the laboratory of Professor Keith Dumbell at St. Mary's Hospital Medical School in London, On 26th May 1978, the Abid lineage made the hundred-mile journey from London to Birmingham.


FREED FROM THE ENDLESS CYCLES of host-to-host transmission—from the samsara of entry, infection, and escape from human flesh—the Abid Dynasty had achieved viral enlightenment, nirvana in the laboratory. Whether propagated endlessly in a paradise of laboratory culture or left to sleep frozen or freeze-dried, the virus had become immortal, tamed, other-worldly.

But within twelve weeks of its arrival in Birmingham, there would be a convergence of the twain: virus and victim. The virus was to escape back into the real world, the wild world of human flesh and blood. And when it did, it would call to mind a concept not from Buddhism, but from the newer faith of Islam: YAWM AD-DIN or JUDGMENT DAY.

A Child is Born, ENGLAND, 1938

The world is on the brink of a World War. A baby girl, called Janet, is born to Hilda Whitcomb and her husband Frederick. Smallpox still looms large on the world stage, menacing every continent and almost every country. In a broad swathe of territories bounding the Tropics, from Brazil via sub-Saharan Africa and the Indian subcontinent to Indo-China, the most severe form of smallpox, variola major, is still a clear and present danger, killing 30% of those it infects. Most of those that aren’t killed are left blind or horribly scarred for life.

Curiously, in the West, for several decades, a milder form of the disease, variola minor or alastrim, with a death rate of less than 1% had taken root. But globally, there were still tens of millions of cases, millions of deaths that year from smallpox. With smallpox packed into humans of every creed and colour, the planet carried a viral load of variola virus that topped ten thousand million million virus particles. There were more smallpox virus particles on Earth than there were stars in our home galaxy, the Milky Way. But within the lifetime of that baby girl Janet every viral star in the variola firmament will be extinguished. And she will play her own tragic part in our story.

A couple of snippets from the Preface

Here are a couple of snippets from the Preface.

The M5 Motorway, England 

England’s M5 motorway is not particularly notable. It wasn’t the country’s first motorway to be built, nor is it the longest—those honours both go to its northerly neighbour, the M6. But it has a hidden importance, as it links the Gloucestershire village of Berkeley to Britain’s second city, Birmingham: the beginning-of-the-end and the end-of-the-end of smallpox. Historically, a full nine score years and two separate Berkeley from Birmingham, but by a curious twist of fate, geographically they are less than sixty-six miles apart—a short drive of just an hour and twenty-three minutes, most of it along the M5.

On 14 May 1796, at his home in Berkeley, the English scientist Edward Jenner inoculated James Phipps, the eight-year-old son of his gardener, with material from cowpox blisters on the hand of Sarah Nelmes. A short while later, he challenged him with material from a smallpox patient and found that the boy was protected against the deadly infection.

Ten years later, Thomas Jefferson, founding father of the American Republic, wrote in a prophetic letter to Jenner ‘Future generations will know by history only that the loathsome smallpox existed and by you has been extirpated.’ The last naturally occurring case of smallpox was diagnosed in Ali Maow Maalin, a hospital cook in the picturesque seaport of Merca, Somalia, on 26 October 1977.


In August 1978, the smallpox virus crept like a thief in the night from a laboratory in Birmingham to reinhabit human flesh and blood. But, fortunately, more than thirty years on from those last days of smallpox in Birmingham 1978, Jefferson’s dictum is now an established fact: most of the population knows smallpox only from the history books.

In this book, I set out to give an account of the 1978 Birmingham outbreak, drawn from records of the time and the reminiscences of some of those who lived through it. To put that last outbreak in context, I provide an series of additional vignettes from the life of this vanquished virus. Writing for the English-speaking world, I have focused primarily on what happened when this virus repeatedly struck Britain during the twentieth century.

The twenty-first century reader will find the Britain haunted by smallpox both a familiar place, with its school trips and pubs, youth clubs and folk dances, and, at the same time, an unfamiliar place, where there was no Internet, no mobile phones, no DNA sequencing, and no modern immunology or cell biology."


It is easy to look back at the ten years leading up to 1978— the tail end of the sixties and the seventies that followed and—as a decrepit decade, a time of dreary deadlock and a world divided. The assassination of Martin Luther King. The Vietnam War and the Cold War. The Oil Crisis. Industrial discord, frequent power cuts, the three-day week and the IRA’s mainland bombing campaign. 

But let’s not forget that this was also a time when Americans sent men to the moon “in peace for all mankind” and celebrated their bicentenary with photos from the surface of Mars. This was a time when cold war adversaries shook hands in space and the first space station orbited our planet. This was a time when humankind sent Voyager probes off on a grand tour of the solar system, turning half-glimpsed smudges in the night sky into newly mapped worlds. This was a time when we humans first began to refashion the genetic legacy of nature to our own ends and laid the foundations of the home recording and computer age. This was a time before the mind virus of neoliberalism infected our politics; when British society stood at a peak of equality unseen before or since. This was a time when we could fly from London to New York on Concorde in three hours, faster than the speed of sound, and arrive before we set off.

And let’s also not forget that this was a time when we took on a microbial adversary that had killed more humans than all the wars in history—and won! 

This was a time when we drove a vicious virus out of every ounce of human flesh on the planet.  

These were the last days of smallpox! 

The Game's Afoot!

On this date in 1796, at his home in Berkeley, the English scientist Edward Jenner (left) inoculated James Phipps, the eight-year-old son of his gardener, with material from cowpox blisters on the hand of a milkmaid Sarah Nelmes and set in motion a train of events that led to the eradication of smallpox. It is thus a fitting date for me to announce that I am writing a book entitled The Last Days of Smallpox, which not only covers events in Birmingham in 1978, but also several other twentieth-century smallpox outbreaks, with details of context and reactions. In many interesting ways, these outbreaks hold up a mirror to the society of the time, but also resonate with our own times.

Like my previous book, The Rough Guide to Evolution, this is a labour of love, which I am having to fit in around my usual academic work of doing research and teaching, writing papers and grants. I have now managed to get 30,000 words down on the page, which gives me the confidence to believe I will actually get this book written, although there is still much more to do. But I think I am now ready to let others join me in this adventure, so that on this blog I will share my journey as an author and also release drafts of some parts of the book in the hope of eliciting constructive comment, garnering a few words of encouragement to keep me going and whetting the reader's appetite for the completed work!

In this age of disintermediation, I am aiming to self-publish via Amazon or some equivalent service, but sorting all that out, together with marketing of the book will also be an adventure worth sharing.

To start the ball rolling, the next few posts will be samples from the current draft of the book. Later, I will share my experiences in finding sources, witnesses and information and, maybe, even get readers to help me in my research.