Issue: August 2020
August 21, 2020
2 min read
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Which disease will be eliminated or eradicated next?

Issue: August 2020
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Only one human disease has ever been eradicated: smallpox. Efforts are underway to eliminate or eradicate others. Which effort will succeed first? We asked Jeffrey R. Starke, MD, infection control officer at Texas Children’s Hospital.

I must preface my remarks with two reasons why I may be particularly jaded on this subject. First, I have been involved with international tuberculosis control efforts for more than 35 years and remain mystified by the lack of effort, or even interest, to try to eliminate this leading infectious disease killer of humans. The vaccine efforts have been pathetically small and the budgets woefully inadequate, given the size of the problems. Second, I am writing this in early July 2020, in Houston, the current epicenter of the coronavirus pandemic in the United States, where the abject failure of human behavior is filling our ICUs and morgues.

Jeffrey R. Starke, MD
Jeffrey R. Starke

The last and only human disease to be eradicated was smallpox 40 years ago. In retrospect, we should marvel at the success of the herculean effort made by international public health to achieve this. We got close with polio, but we seem to be falling backward. Dracunculiasis (Guinea worm disease) may be next, but the disease persists at very low levels. Although eradication of polio requires administration of a vaccine, an active step for the individual, the eradication of dracunculiasis relies on maintaining a safe water supply, a passive action for the individual. And the latter is more likely to be successful.

We last landed a person on the moon in 1972, 5 years before the last case of naturally occurring smallpox. I draw a parallel between the manned space program and smallpox eradication. They were achieved with much less technology than we now possess but required tremendous effort and sheer will: quoting a line from the movie Apollo 13, “Failure is not an option.” But we haven’t “returned” on either front. We seem to have lost the drive and determination that were the hallmarks of these two programs. We have lost our willpower to accomplish truly big things.

Recent events also make me a bit pessimistic. Pandemics and social disruption make vaccine eradication efforts extremely difficult. The Ebola epidemic in West Africa in 2013-2016 disrupted vaccination efforts, leading to greatly increased case rates of measles; fortunately, polio has not apparently recurred in the three affected countries. The early evidence suggests that the current coronavirus pandemic will do the same in wealthy and poor countries throughout the world. And this will not be our last pandemic. Continued armed conflict in many countries is another difficult barrier to vaccination. The rise of populism has led to the almost inexplicable development of the anti-vaccine movement, and now the even more inexplicable anti-masking movement. Both of these are rooted in the politically motivated origin of distrust of science, which is not easily repelled by our usual ammunition of facts, reason and logic. When will people trust science again?

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I don’t think the question is whether we have the ability or technology to eradicate other infectious diseases; the question is whether we have the willpower and social cohesiveness to get it done. I hope I am wrong, but I just don’t see it happening anytime soon.

Click here to read the Cover Story, "COVID-19 pandemic ‘could be quite damaging’ to efforts to end other diseases."