June 12, 1958

Minneapolis, United States

Who might have been the one individual to have done the greatest good to the world? Could a relatively unknown Soviet health minister be a contender? Some people make a convincing case for this.1 Back in the late 1950s, around the time John F. Kennedy declared that mankind would place a human on the face of the moon by the end of the 1960s, an intrepid and visionary Soviet minister coaxed the world to eradicate smallpox. Speaking at the eleventh World Health Assembly (WHA) in Minneapolis in 1958, Viktor Zhdanov, the Soviet deputy minister of health urged delegates from across the world to apply themselves to the important task of eradicating smallpox. Unsurprisingly, his speech did not gather outright enthusiasm. However, the assembly delegates could not dismiss Zhdanov either.

There were several reasons for such an ambivalent response. This was 1958, after all: the Anglo-European Northern world had just carved itself and the rest of the world into first, second and third world categories. A health minister from the ‘second world’ (the Soviet Bloc) giving a speech at a ‘first world’ city, goading everyone to apply the force of their goodwill to eradicate a disease, which by then was primarily afflicting people in the ‘third world’ was probably going to have the response it did owing to the geopolitical equation of the time. The delegates did not exactly know what to make of the proposal. Was Zhdanov serious? Was it a political move to counter the United States? Right after the formation of the United Nations, the Soviets had withdrawn from the multilateral agency and its apparatuses, citing the United States’ undue influence over it. They had begun to reengage with the UN in 1956 following Nikita Khrushchev’s new focus on ‘peaceful co- existence’, and the 1958 WHA was the first one the Soviets were attending. The WHA delegates wanted to make sure that the Soviets felt welcome and stayed inside the tent of the relatively new World Health Organization. Without the powerful Soviets inside the tent, the organization risked irrelevance as it would hardly be representative of the entire world, an idea its founders had worked hard to pursue.

However, this was not the first time a similar proposal had been tabled. An earlier proposal for smallpox eradication in 1953 had gone nowhere. Additionally, the world had tried eliminating or eradicating diseases before: hookworm, yaws, malaria. These attempts had not gone well. Only a few years ago, the WHA had committed to the hugely ambitious task of eradicating malaria from the world. The Global Malaria Eradication Program (GMEP), approved in 1955, was consuming most of the WHO’s energies, as well as resources.4 There were those who had valid concerns, whether the world was capable of pulling off another disease eradication program on top of the hugely burdensome malaria campaign. Therefore, it was hardly surprising that the WHA delegates took time warming up to Zhdanov’s speech.

But Zhdanov, who was an able virologist, also turned out to be a persuasive diplomat and a wily negotiator. He understood the importance of selling his ideas, especially to the skeptical Americans, who had already committed themselves to the malaria eradication program. Zhdanov appealed to the delegates’ moral high ground. He even quoted the American founding father and President Thomas Jefferson’s message to Edward Jenner, given a few years after Jenner’s 1796 discovery of the smallpox vaccine: ‘I avail myself of this occasion of rendering you a portion of the tribute of gratitude due to you from the whole human family. Medicine has never before produced any single improvement of such utility … You have erased from the calendar of human afflictions one of its greatest. Yours is the comfortable reflection that mankind can never forget that you have lived. Future nations will know by history only that the loathsome small-pox has existed and by you has been extirpated.’5 Zhdanov made a case that the eradication of smallpox was an opportunity to realize Jefferson’s vision of a world free from the ‘loathsome smallpox’. In order to jump-start the smallpox eradication campaign, Zhdanov even committed 25 million doses of smallpox vaccine and programmatic assistance toward the campaign.6 Such an evocative and persistent appeal to eradicate the disease made it difficult to dismiss his proposal. On June 12, 1958, as the eleventh WHA was concluding, it passed resolution WHA 11.54 asking the Director-General to explore the possibility of eradicating smallpox and report back to the executive board.

It was not merely at the WHA that Zhdanov had to use the power of persuasion to make a case for the eradication of smallpox. After Khrushchev’s policy changes, the Soviets had wanted to make a splashy re-entry at the global stage. Zhdanov saw that he could exploit the emerging political landscape to advocate for smallpox eradication. However, even before Zhdanov tabled a proposal at the WHA and convinced the world, he had to spend considerable energy to win over the skeptics at home — that smallpox could indeed be eradicated from the entire world. Zhdanov’s unflinching conviction did not come out of nowhere: he knew what he was getting the world into when he made that passionate appeal. In fact, in large swathes of the industrialized world, this had already been done. The last case of indigenous smallpox seen in the United States was in 1934, although imported cases were seen as late as 1949. In Britain, the disease had ceased to be endemic after the 1930s.9 The Soviets had similarly eliminated the disease as a public health problem from their expansive territory, often comprised of inhospitable terrain hard to reach by road, rail or sea.

Earlier in his career, Zhdanov had spent a large part of his time working as an army doctor and later researching viruses. He had seen up close the success of the Soviet attempts at eradicating smallpox from their vast Union. So Zhdanov spoke from experience. His efforts and persuasion fulfilled the hugely important and difficult role of proselytizing and convincing an unsure world of the feasibility of smallpox eradication. He deployed significant political capital, technical vision and moral conviction; he also exploited the favorable political tailwinds that buffeted the Soviet delegation at the 1958 WHA in creating a momentum for the eradication of smallpox.

After the WHO Director-General reported back with a feasibility study, the 1959 WHA approved the Smallpox Eradication Program, but it was not until 1966 — when Americans started throwing their weight behind it — that the program began in earnest. Zhdanov’s speech was the catalytic event that built the political momentum for the eradication program. That momentum was carried forward by the inspired leadership of people like Donald A. Henderson, M. I. D. Sharma, Nicole Grasset and many others. By the end of the 1970s, smallpox had been eradicated from the planet.

If the smallpox eradication campaign had Viktor Zhdanov, its elder cousin, the malaria eradication program, had its own evangelist and proselytizer — Fred Soper. People like Zhdanov and Soper were proof of the fact that a select few individuals played outsized roles in determining the post-War health agenda across the world. In the early 1950s, Soper was almost single-handedly responsible for getting the world to commit to the astonishingly ambitious task of eradicating malaria. Soper, born in Kansas, was a physically imposing man and had an equally formidable personality. He trained at Johns Hopkins, and spent a considerable part of his professional life at the Rockefeller Foundation, mostly working on yellow fever and malaria eradication campaigns.13 In a way, Soper took off from where William Gorgas had left. In the 1930s, malaria eradication experts were divided on what the real enemy was: the malaria-causing protozoan, or mosquito — the vector responsible for transmitting it. Soper decidedly belonged to the latter camp.

Even before the insecticidal properties of the chemical dichloro-diphenyl-trichloroethane (DDT) had been discovered in the late thirties, Soper had been a big proponent of vector control via breeding ground inspections, drainage and chemical sprays — diesel oil, an arsenic compound called Paris green and pyrethrum. In South America, he had perfected malaria inspections to the exactitude of a military drill. When the African variety of mosquito, Anopheles gambiae began spreading malaria in coastal Brazil, Soper had an 18,000 square mile malaria-infested area sprayed in less than two years, a task that was thought as impossible, and controlled malaria. His malaria inspectors dressed in uniforms, and their days

were scheduled down to the minute. They covered every single square foot of the designated area, inspecting and spraying as they went. It is said that once in Rio de Janeiro, there was an explosion at an arsenal close to where a malaria inspector was scheduled to be. Soper, thinking of the worst, wrote condolences to the inspector’s widow and sent her a check. The next day, when the inspector was found to be still around, Soper summarily fired the inspector for not sticking to his schedule!12 Soper’s military-like approach to disease control saw similar success in controlling typhus in Cairo, Algiers and Naples during the Second World War.12 It was in Italy, during this time, that Soper came across DDT for the first time.12

DDT was first discovered in the 1870s. In 1938, Paul Müller, a chemist working for the Swiss company J. R. Geigy was attempting to discover a chemical to protect clothes against moths when he accidentally came to discover that traces of DDT were remarkably effective in killing houseflies. Soon it was found that DDT was a powerful insecticidal. Several kilograms of this chemical were manufactured and sent to Geigy’s New York office for further testing and development. From there DDT made its way to the US army. Diseases like typhus and malaria had been inflicting heavy casualties upon allied forces during the Second World War, and the army soon began its own research into DDT. When the chemical’s efficacy in killing insects was confirmed, industrial production of tons of DDT began, in secret, and it was shipped to Italy. In Naples, the army was able to use DDT to control lice, and virtually eliminate scrub typhus, making it possible for General Patton’s troops to advance and control Italy.