500 Million, But Not A Single One More

On December 9th, and probably for future Decembers 9th, we will feature this post on the front page to commemorate Smallpox Eradication Day. 

(Some places use May 8th as the date to celebrate smallpox eradication; we've seen both dates used in different places, so we'll stick with Jai's date.)

Remember that hard problems can be solved, and that we are capable of working together when the conditions are correct.

I'm curating this post, which is an EA classic. Curation isn't generally for older posts, but we have lots of new users coming in (so a classic might be more helpful than usual), and we're soon approaching smallpox eradication day, anyway.

And as often, I love the Our World in Data entry on the subject. Here's a chart from that entry:

I think this is one of the best pieces of EA creative writing of all time.

The Rational Animations team has animated this, with narration by Robert Miles. It's great, as is the rest of their growing body of work.
 

A French translation of this post is available here.

The Effective Altruism Forum Podcast has created an audio version of this post here: https://anchor.fm/ea-forum-podcast/episodes/500-Million--But-Not-A-Single-One-More-e15ff61

This post takes a well-known story about impact (smallpox eradication), and makes it feel more visceral. The style is maybe a little heavy-handed, but it brought me along emotionally in a way that can be useful in thinking about past successes. I'd like to see somewhat more work like this, possibly on lesser-known successes in a more informative (but still evocative) style.

Today, May 7 2023, I am planning to make some updates to this piece for historical accuracy. As part of this update, I'm including some citations and commentary in this comment.

I feel torn writing about some of these, because it's attempting to summarize and quantify an incomprehensible quantity of suffering and death. The numbers are important, to recognize what was lost, to honor the fallen as best we can, and to emphasize the importance of killing Smallpox. But quantifying that loss, for me at least, requires temporarily embracing a detached attitude, especially when the clues are many and uncertainty is abundant. So that is how I will be describing citations and numbers for the remainder of this comment - and then, when I've collected as many citations and clarified as many estimations as I can, I will grapple with them as a human.

Much of the narrative is just from Wikipedia's page on the History of Smallpox. This has changed a bit since 2014.

The figure "500 Million" comes from Donald Henderson by way of Our World in Data.

"Five million in India" comes from this article by Eugene D. Robin, Robert F. McCauley in the Indian Journal of Medical Ethics, 1997.

"[A] thousand Europeans every day in the 18th century" is from the Wikipedia page. Specifically, "400,000" annual deaths.

[Update] The text originally said that Smallpox killed "more than fifty million Native Americans". I cannot find any source I might have originally used for this claim. When attempting to research this more recently, I came across the 2019 paper "Earth system impacts of the European arrival and Great Dying in the Americas after 1492", which estimates 55 million all-cause deaths from European contact across the Americas between 1492 and 1600. "Counting the Dead: Estimating the Loss of Life in the Indigenous Holocaust, 1492-Present" is part of a body of literature exploring the interplay between disease and intentional violence, which further complicates things. Lots of things can make people vulnerable to disease. If a family is forced to relocate, goes hungry, and subsequently are weaker when they fall ill, it seems incorrect to say that the illness alone killed them. All told, disease is widely agreed to be the most significant contributor to the great dying of the Indigenous Peoples of the Americas, and of the diseases Smallpox was probably the most significant killer. Given the complexities and uncertainties here, when I finish writing this comment, I intend to update the text to "over ten million Native Americans" as a lower bound that I feel 80% confident about. I think I could refine this further with more research - this is still extremely ad hoc - but this is as much time as I can afford at the moment.

 "more soldiers and civilians than any weapon, any soldier, any army": See Wikipedia's "List of anthropogenic disasters by death toll"

[Update] "In China, in the 10th century, humanity began to fight back." I believe I originally got this figure from Our World In Data, but now believe it to be inaccurate. There are "references" that say the tradition dates back to the tenth century, but the evidence is sparse. Going by Wikipedia's article on Variolation, I'm updating this to "the 15th century". 

Edward Jenner, 1796: Wikipedia. I'm choosing the day of the first inoculation (James Phipps) on May 14, 1796 rather than the publication date of the resulting paper, Inquiry into the Variolae vaccinae known as the Cow Pox, in 1798.

From here on most of the narrative can be traced through the Eradication section of Wikipedia's article on Smallpox:
 - "On August 26, 1807, Bavaria became the first country in the world to introduce compulsory vaccinations."
 - "In Northern Europe a number of countries had eliminated smallpox by 1900". 
 - "In 1958 Professor Viktor Zhdanov, Deputy Minister of Health for the USSR, called on the World Health Assembly to undertake a global initiative to eradicate smallpox."
 - "In 1966 an international team, the Smallpox Eradication Unit, was formed under the leadership of an American, Donald Henderson.^[127] In 1967, the World Health Organization intensified the global smallpox eradication by contributing $2.4 million annually to the effort, and adopted the new disease surveillance method promoted by Czech epidemiologist Karel Raška."
 - "To eradicate smallpox, each outbreak had to be stopped from spreading, by isolation of cases and vaccination of everyone who lived close by.^[129] This process is known as "ring vaccination"."
 - "The WHO established a network of consultants who assisted countries in setting up surveillance and containment activities."
 - "donations of vaccine were provided primarily by the Soviet Union and the United States"
 - "The last naturally occurring case of indigenous smallpox (variola minor) was diagnosed in Ali Maow Maalin, a hospital cook in Merca, Somalia, on 26 October 1977"
 - "The global eradication of smallpox was certified, based on intense verification activities, by a commission of eminent scientists on 9 December 1979 and subsequently endorsed by the World Health Assembly on 8 May 1980."

This reminds of Nick Bostrom's story, "The Fable of the Dragon-Tyrant". Maybe somebody will write a story like this about ageing instead of smallpox in the future.

In all of human history, there had been no other disease like smallpox. It was vicious: It killed at least a third of those infected, and scarred or blinded most of the survivors. It was fast-moving, traveling everywhere that men had gone, carried by armies and traders and missionaries and slaves. It was relentless, roaring up into periodic epidemics, but never fully disappearing in between.

And it had always been there. The written records of its assaults on humanity went back more than three thousand years. Over the centuries, smallpox had devastated cities, changed the course of battles, and stalled the growth of empires. It had shuffled the leadership of dynasties like a pack of playing cards, decimating the royal houses of England, Holland, France, and Austria, and killing rulers in India, China, and Japan.

— From Beating Back the Devil

Thanks Jai! I thought this piece was outstanding. I also loved What Almost Was.

Sharing this here for those viewing this post today (Dec. 9, 2020): 

The Future of Life Institute (an EA-aligned org) is awarding their annual Future of Life Award in about 8 hours time to Viktor Zhdanov and Bill Foege, for their critical contributions to the eradication of smallpox!

If you'd like to attend the event, learn more about it here: https://www.facebook.com/events/1324489021234988

The event will include the following people:
- Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases,
- Bill Gates, Microsoft co-founder and philanthropist,
- Jennifer Doudna, Berkeley Biochemist and 2020 Nobel Laureate.
Previous winners are Vasili Arkhipov, Stanislav Petrov and Mathew Meselson, who helped prevent two nuclear wars and one bioweapon arms race, and they/family members will join the celebration. The event will also feature a panel discussion moderated by MIT Prof. Max Tegmark about interesting issues relevant to this year’s award. You can find more information about the award here: https://futureoflife.org/future-of-life-award/
 

To attend the event, join via the following links:
Zoom: https://us02web.zoom.us/j/88376985987?pwd=V0tzY3ltNEwrZHFTWGVrRmNSZS9idz09
Youtube: https://www.youtube.com/channel/UC-rCCy3FQ-GItDimSR9lhzw

It is remarkable what humans can do when we think carefully and coordinate.

This short essay inspires me to work harder for the things I care about. Thank you for writing it.

On the battle's cost and cost-effectiveness:

The annual cost of the smallpox campaign between 1967 and 1979 was $23 million. In total, international donors provided $98 million, while $200 million came from the endemic countries. The United States saves the total of all its contributions every 26 days because it does not have to vaccinate or treat the disease.

Source

 

Re-read this again just now and truly is a tremendous piece!

Maybe someone will write an essay like this about aging in a few decades when we find a solution for it.