Short Wave - 'Speedboat Epidemiology': Eradicating Disease One Person At A Time

Episode Date: August 30, 2023

Smallpox is a deadly virus. At one point, it killed almost 1 in 3 people who had it. Almost 300 million of those deaths were in the 20th century alone. It was extremely painful, highly contagious and many people thought it would be impossible to wipe out—until it was. On May 8, 1980. the 33rd World Health Assembly declared the world free of smallpox. This marked the first—and only—time a human disease was eradicated globally. Epidemiologist and host of the podcast Epidemic: Eradicating Smallpox Céline Gounder has been looking into this history. Today, she shares the intense journey to eradicate smallpox in Bangladesh (spoiler alert: there are literal speedboats) and reflects on what this history tells us about the importance of healthcare that meets the needs of individuals and communities today. Click here to check out the second season of Céline's podcast from NPR partner KFF Health News. What science story do you want to hear next on Short Wave? Email us at [e-mail] pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, short wavers. Regina Barber here with a special guest, Dr. Celine Gounder. Hey, Celine. Hi, Gina. So, Celine, you're an epidemiologist with decades of experience working with HIV and tuberculosis in Brazil and South Africa, Ebola and West Africa, and COVID-19 in New York City. And most recently, you've been looking into the history of smallpox as a part of eradicating smallpox. Smallpox, the second season of your podcast epidemic.

Yeah, so let's just dive into the smallpox picture. Smallpox is a deadly virus. It's been around for millennia, at least since the third century BC in the Egyptian Empire. And at one point, killed almost one in three people who had it. In the 20th century alone, there were 300 million deaths, particularly in South America, Asia, and Africa. Right. And patients got high fevers, body aches, rashes, and fluid-filled sores in their mouths and on their body. And it was really painful and highly contagious.

People never believed that the world would be free of smallpox, especially India. There's no reason to believe you could cure it. Any outbreak was an emergency. And so for basically hundreds of years, people thought it would be impossible to get rid of until smallpox became the first and only human disease to be wiped out globally. And how did that eradication effort shape up? Well, the World Health Organization first considered eradicating smallpox in the 1950s. Many did not think it could be done.

And they thought that they'd have to vaccinate every last person in the world against smallpox to eradicate the disease. Really an impossible task. But early success in West Africa helped pave the way and convince some of those skeptics. Wow. So how did they get rid of it? Three words, search and containment. That's the revolutionary public health strategy that finally started to slow the virus around the world. And it's what would eventually help eliminate smallpox in Bangladesh in 1975. So today on the show, putting one foot in front of the other, how meeting people where they are.

helped eradicate smallpox. And why the wisdom of that approach is just as invaluable today. You're listening to Shortwave from NPR. Okay, so, Celine, can you break it down for me? What did search and containment look like on the ground in Bangladesh? It's really specific. It involves active searches for cases, contact tracing, isolation, and vaccination. It also relies a lot in forging partnerships with people who really know the area you're working in,

with someone who understands the communities needs, culture, terrain. And this is what public health experts today know works, direct contact with people, taking some extra steps to go to these places to meet people where they are. And occasionally you have to park your motorcycle, take your shoes and socks off, and walk across a leech-infested paddy field to get to the next case. That's Tim Minor. In the early 70s, he'd worked on the World Health Organization. Global Smallpox Eradication Team in Bangladesh.

When he showed up in Dhaka, he was the youngest foreign non-physician on the team. And over the next few months, he would work extremely closely with local members of the eradication team, like a Bangladeshi man, Shadul Haq Khan. I'm maximum hand-dory-dur-dry. Maximum, jade. I'm at a minute I had had to hand-dory-dry. And we'd take, and then we'd take. Most of the time, I'd take.

I escorted him across the bamboo bridge. I took his bag and held his hand and helped him across. You learned to walk and not look down and just, you know, hang on to the poles. And unfortunately, I never fell in. We didn't let him fall. Their makeshift home base, at least in the first few months of Tim and Shadul working together, was a hospital ship called Niramoy, which means cure in Bengali. It was a good base camp because it could move from port to port carrying supplies.

We would receive reports of cases and we would get down from the ship in our speedboat, and the speedboat driver would take us as far as the boat could go. And we would walk, do the investigation, and find out who the contacts were and vaccinate the village and surrounding areas. Tim calls it speedboat epidemiology. Can I just say speedboat epidemiology, searching containment, it all sounds really cool, and it ultimately worked like smallpox was eradicated, but it sounds like it has a lot of moving parts. Yeah, it's not for the faint of heart or the low in stamina. Squashing a virus like smallpox requires tactics specific to each community and their worries about the vaccine itself. And it requires everyone to be willing to do that on an individual level virtually around the clock.

Even when you're exhausted, you've been hopping on speedboats, walking long distances, knocking on doors, and doing it all over again the next day and the next day after that. When Tim thinks back to his time working to eradicate smallpox in the field, he remembers working so much because he and all the others believe so much in this effort that was paying off that he ended up sleeping on tables more than once. Any place he could get horizontal and sleep. And what happened when they met someone who was skeptical of getting vaccinated? I mean, that's a problem today. And surely it was a problem back then, too. Yeah, I mean, they did run into this problem from time to time. And honestly, it was devastating when it happened.

Shadu remembers returning to the hospital ship after a long day of work. And he had to tell Tim he couldn't vaccinate a pregnant woman. I couldn't. I couldn't take up to take up. I didn't. I don't know. I can't pack up. I couldn't convince her at all.

He immediately told us to pack up. He stopped the work and said, let's go. Immediately at that very moment. And so they all just got back in the speedboat and headed back to try again. So did they get through to her? Yes, with empathy. understanding where she was coming from and lots of patients.

I fully understood why this woman hesitated to be vaccinated. She was expecting a child and she didn't want to do anything to jeopardize her life or the life of the unborn child. So we were very gentle in talking with her and answering her questions. It was time well spent. That day was one of the most memorable of my life. Wow, it seems like they did as much as they could to make people comfortable. And I feel like that kind of thing sometimes doesn't really happen today.

They did. And some people today say this is exactly what we need more of in public health efforts today. Like Joe Asmanson, a microbiologist at New York University. We know what the problems are, and yet we seem. reluctant to actually do the right thing, which is to build processes that meet people where they're at. Joe is a public health advocate, and he acted as a community liaison for the New York City Department of Health to help coordinate responses to MPox, the virus that causes a painful blistering rash, and spread mostly last summer among men who have sex with men.

I'm a microbiologist by training, but I also just do tons of advocacy and activism as a queer person who believes in equal access to the best biomedicine available. So did Joe have similar outreach ideas like a 22 version of Speedboat epidemiology? Mobile vans to quickly bring vaccines to places where people who were at higher risk of getting MPOCs already were. Okay, cool. And I can imagine that's much harder than it sounds. It is.

You're fighting a disease, but in many ways you're also fighting. against the discrimination and inequities that have made people mistrust medical institutions and doctors. Like the New York City Department of Health had a history of people going undercover in queer spaces and shutting them down. So Joe said for good reason, there's a lot of mistrust in the community for city officials today. So many queer people don't have affirming doctors, don't feel comfortable asking about sexual health with their physicians. So you can put a van outside with affirming physicians and actually provide. that preventative care that actually stops the infection. So how did he convince them?

Well, it came back to trust, like Tim and Chaudul when they built relationships with the people they wanted to help. So because, again, they perceived me as being like a part of their community, it was very easy to talk to people and just asking, you know, hey, have you had your vaccine yet? Have you had both doses? If not, you know, it'll take 15 minutes. I can walk you down to the van and get you that dose tonight. Were they successful massively?

We were giving 60, 80 doses per event when the event might only have 140 people. So we were vaccinating 60% of these parties. That's the other magic of the mobile units was that you had queer people talking to queer people. And queer people of color talking to queer people of color and offering the care in terms that that community knows how to respond to and also just has more inherent trust with. I know this isn't always the case for everyone, though, right? M-Pox vaccination rates were disproportionately low in black and Hispanic communities in New York, right? You're right. And Joe said it was a remarkable mistake that cities, beyond just New York, worried first about just getting people vaccinated and then thought about equity.

We know that if you don't do equity as the foundation, you will be chasing disparities. So what can we do? Like, how do we apply this model to everyone and beyond M-Pox? So this strategy literally bringing vaccines and health care to people works beyond M-Pox, beyond smallpox. And when we're thinking about equity, Joe talked about connecting people with clinicians who take the steps to understand the specific needs of each community. We have experts. We have clinicians. We have epidemiologists. We have scientists who are in the community who know the science just as well as health officials. And communication needs to go two ways. And that means getting out of the clinic and the hospital, going to schools, rec centers, nursing homes, and yes, even sex parties if that's where people are going to be. Thank you so much, Celine, for sharing your work with us today.

Of course. Thank you. Celine is with our partner KFF Health News. Her podcast is epidemic. The second season, eradicating smallpox is out now. Check it out wherever you get your podcasts. This episode was produced and fact-checked by Rachel Carlson. It was edited by managing producer Rebecca Ramirez, and the audio engineer was Robert Rodriguez. Beth Donovan is our senior director, and Anya Grunman is our senior vice president of programming.

I'm Regina Barber. Thank you for listening to Shorewave from NPR.