How the World Wins When Presidents Survive Disease

Sep 15

As Barack Obama’s presidency comes to an end, there’s a lot of discussion about legacy and predictions about how he’ll be remembered. It has me thinking about how we remember the other men who have held that high office. Those who are considered our top presidents have profound epitaphs, but their contributions to public health barely make it onto their Wikipedia pages.

Mount Rushmore

What if more U.S. presidents were remembered for their contributions to public health?

Our first president, George Washington, was the incredibly skilled commander of the Continental Army, he was the first to sign the U.S. Constitution, and he was unanimously elected president in the country’s first two elections.

Well before all of that, when Washington was 19 years old, he contracted smallpox. He survived the disease, which killed 1 of 3 people who were infected, and lived with its characteristic facial scarring for the rest of his life.

Whatever lessons Washington may have learned from this experience, perhaps the most valuable was the lesson that because he had been infected with and survived smallpox, he wouldn’t be at risk of getting it in the future. He was immune, like all the others who had survived the disease.

He had to act on that lesson as a military leader. The formation of the Continental Army itself was the first time that so many men from across the colonies came together in one place (since people didn’t usually travel much then), so it was a natural breeding ground for disease. In some ways, it was the first, albeit accidental, laboratory for public health in the U.S.

Whenever there was an outbreak or a situation in which smallpox might be a factor, Washington would send in soldiers that had already endured the disease to avoid an outbreak among his troops. It was an effective strategy, but Washington knew that variolation (a method of immunizing with a mild form of the disease) was far better—especially as it was believed that the British were using smallpox as a form of biological warfare.

There was a lot of skepticism and objection to the practice of vaccination in Washington’s day. But he pressed forward, saying: “Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army . . . we should have more to dread from it, than from the Sword of the Enemy.”

Washington had to resist the desire to inoculate all the troops at once because he knew that he couldn’t survive the war with all of his men sidelined for the month necessary to recuperate. Instead, he instituted a controversial system where new recruits would be inoculated with smallpox immediately upon enlistment. As a result, soldiers would contract the milder form of the disease at the same time that they were being outfitted with uniforms and weapons. Soldiers would consequently be completely healed, inoculated, and supplied by the time they left to join the army.

By the end of 1777, nearly 40,000 troops had been inoculated, and the smallpox infection rate among soldiers dropped from 17 to one percent. Washington showed the soldiers and people of his time that the best way to avoid diseases like smallpox was vaccination.

It took more than 200 years after Washington’s contributions, but in 1979 the World Health Organization (WHO) declared the global eradication of smallpox. It is one of only two infectious diseases that has been eradicated globally—the other is rinderpest, a cattle-borne disease eradicated in 2011.

Nearly 150 years after Washington was in office, Franklin Delano Roosevelt established his own legacy: he ended Prohibition, pulled the country out of the Great Depression, and bolstered Allied Forces during World War II.

FDR also had polio, which he contracted at age 39 in 1921.

As president, FDR founded the organization that eventually became the March of Dimes. Donations to the March of Dimes funded research seeking a cure for the disease and laid the foundation for Jonas Salk’s successful development and implementation of a vaccine against the virus in 1952. Polio was declared eradicated in the United States in 1979.

Despite this success, polio still hasn’t achieved worldwide elimination. Learning that there were less than 100 cases diagnosed in 2015 might lead you to believe that worldwide eradication is imminent. Frustratingly, it’s not. In a 2011 New York Times article, Don McNeil reported: “Although caseloads are down more than 99 percent since the [global eradication] campaign began in 1985, getting rid of the last 1 percent has been like trying to squeeze Jell-O to death. As the vaccination fist closes in one country, the virus bursts out in another.”

The good news is that we have the diagnostic tools to detect polio and an effective intervention (a vaccine), so in theory it’s possible to eradicate the disease. India is the latest country to have officially stopped transmission of polio—with its last reported case in 2011. Only three countries remain where the disease is endemic—Afghanistan, Pakistan, and Nigeria.

So while we’re inundated with stories of email servers and 50 ft. walls this election season, a more important topic of conversation is what type of public health legacy our next president has the opportunity to leave. The reality is that a president doesn’t have to survive disease for the world to win. When our next president leaves office, polio or another disease could be eradicated. I think it’s a worthy and achievable goal.

This entry was posted on Thursday, September 15th, 2016 at 3:08 pm and is filed under Policy, Public Health. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

2 Responses to “How the World Wins When Presidents Survive Disease”

  1. Jennifer Wayman says:

    Awesome post, Junia!

  2. Junia Geisler says:

    Thanks Jen! It was especially interesting to learn about George Washington’s connection to smallpox.