Viruses, Plagues, and History

that led me to medical school and a career in biomedical research. Hilary Kaprowski, Jonas Salk, Albert Sabin, John Enders, Tom Weller, Frank Fenner, Joe Smadle, Bernie Moss, Joe Esposito, Bob Shope, Fred Murphy, Bob Gallo, Luke Montagnier, D.A. Henderson, Jordi Casals, Rob Webster, D. Carlton Gadjusek, Joe Gibbs, Stanley Prusiner, Bruce Chesbrough, Jeffrey Taubenberger, Peter Pelisse, Ed Kilbourn, Yoshi Kawaoka, Gary Nabel, Ian Wilson, and James Paulson, all of whom figure in the stories told here about viral diseases. In tracing the history of struggles to find each agent of these diseases, I have asked what was known from its initial description, what unique problems existed, what actions were the most critical in solving the problems, why these decisions were made, and at what point community and governmental support provided the essential resources or stood in the way of progress. To accomplish this task, I selected as examples four viral diseases, smallpox, yellow fever, measles, and poliomyelitis, that science has controlled despite the unrestrained devastation and misery they once caused. These success stories are contrasted with those of seven viral infections that currently remain out of control, Lassa fever virus, Ebola virus, Hantavirus, SARS, West Nile virus, and human immunodeficiency virus. And with the continuing threat from influenza, now reasonably contained, but with the potential to revert to a worldwide pandemic disaster. I also tell the story of an unusual group of progressive neurologic disorders, the spongiform encephalopathies, scrapie, mad cow disease, variant Creutzfeldt-Jakob disease, chronic wasting disease of deer and elk, and the debate as to whether they are caused by a virus or a prion, protein. A common thread of fear, superstition, and irrational behavior run through all 12 stories, testifying to our human fallibility. Unsubstantiated rumors or beliefs that the poliovirus vaccine was the cause of HIV, that autism results from vaccination with measles virus, and so forth, have led to refusal to take vaccines with resultant outbreaks of virus infections that should not have occurred. However, the motivation and skill of scientists, along with the right community and governmental leaders and support, have led to important victories over some viral plagues. And there will be more. This book commemorates the enormous magnitude of these achievements, too often forgotten. Recall that smallpox killed over 300 million people in the 20th century alone, and now has been totally eradicated from our planet. Measles, which once killed millions each year globally, and still kills roughly 400,000 in third world countries, today harms few in the industrial countries of the world. Yellow fever virus devastated populations along the Mississippi River and several port cities in the United States, and was responsible for closing operations of the American government in 1793. Now this infectious disease has been largely eradicated from the United States, with only a handful of cases imported into the country. Although it still exists in rain forests of South America and Africa, poliomyelitis virus, the cause of infantile paralysis, was at one time the fifth leading killer of children in Scandinavia and pervasive in North America. I remember my parents' fear of poliomyelitis each summer, a fear that is still vivid in the minds of many of us over 50 years of age, who saw siblings, schoolmates, or friends stricken, then either die or become crippled. Yet once the American people and a private foundation, as well as governments, invested in scientific research, poliomyelitis was brought under control, so that in neither Scandinavia nor North America is there a case of wild-type poliomyelitis today. The most important benefit of controlling infectious diseases is alleviation of pain and suffering. There is also a substantial benefit, the monetary savings. Thus, funds are no longer required for hospitalization and treatment. Individuals who would otherwise have been incapacitated are now healthy and are able to work, buy goods, and pay taxes. A safe estimate is that for each dollar invested by the government in basic research...