Forks in the Road
Five decision points. Three were settled and settled well. One was settled deliberately, with the cost accepted at the time and arriving forty years later. One has been reopened five times in thirty years and is still open.
Finding cases vs. vaccinating everyone
The intensified programme of 1967 was built around mass vaccination. The strategy that ended smallpox was found by someone running out of vaccine: in eastern Nigeria during a shortage, Bill Foege vaccinated only the family and close contacts of known pati
This is the fork most worth borrowing. The winning strategy was not designed, funded or planned. It was improvised under a shortage by someone in the field, and the programme was willing to change its mind mid-flight. Both halves of that were necessary.
Funding the goal vs. declaring it
The World Health Assembly resolved to eradicate smallpox in 1959. For the next eight years little happened, because few staff and few funds reached WHO for smallpox work. [3] The fork was not 1959, it was 1967, when the Assembly endorsed an intensified pr
Independent certification vs. self-certification
Eradication was not declared by the people who achieved it. An independent scientific commission certified it in December 1979, after special certification procedures in the 35 formerly endemic countries and 44 others judged at special risk. [2] The stand
Stopping routine vaccination vs. keeping it
Once smallpox was gone the vaccine was the only remaining source of smallpox-like harm, and the risk of dying from vaccination now exceeded the risk of dying from the disease. WHO recommended stopping. Most countries had by 1982 and all had by 1984. [21]
Read this one next to the ozone slate's HFC fork. Both are fixes whose side effect fell outside the terms of reference of the body that made the decision. The smallpox programme was asked to end smallpox, and it did. Nobody was asked what happens to a population's orthopoxvirus immunity over the following forty years, so nobody answered.
Retaining the virus vs. destroying it
In 1996 the Assembly called for the remaining stocks to be destroyed. [11] The 1999 deadline passed and the stocks were kept. [10] They were kept again in 2002, reviewed in 2007, reaffirmed for destruction without a date in 2011, and retained again in 202
Years the destruction question has been open since 1996
30 yr
Times retention has been revisited and renewed [6] [8] [9]
5
Next scheduled review [9]
2029
Four of these five forks are closed. The two that still shape the problem are the one that was closed correctly and cost something anyway, and the one nobody has been willing to close at all.