Prize for the Conquerors

The Egyptian Pharaoh Ramses V may have died of it. England's Queen Elizabeth I was so badly stricken at age 29 that she became bald and began wearing red wigs. Even George Washington bore its telltale scars. Their common affliction was smallpox, a fearful scourge with no known cure that until recently still took millions of lives* in Africa, Asia and other parts of the Third World. Now, after perhaps the most extraordinary disease-prevention campaign of all time, it may finally be wiped off the face of the earth.

Prestigious Prize. Last week the public health officers who waged that heroic global effort received one of medicine's highest accolades. The Albert and Mary Lasker Foundation awarded a special prize to the World Health Organization (WHO) in recognition of its decade-long smallpox-eradication program. Even while they were accepting the prestigious $10,000 award in Manhattan last week, WHO Director-General Halfdan Mahler of Denmark and the Cleveland-born chief of the eradication program, Dr. Donald A. Henderson, were in touch with aides in the East African nation of Somalia, where the last two known cases of smallpox were discovered Oct. 29 and Nov. 4. If no further cases are reported, smallpox could become the first disease ever to be totally eradicated by man.

Unlike other viral diseases transmitted by insects, birds or mammals, smallpox is spread by man himself. Its sole "vector" is a person actually afflicted with the disease; he is contagious only during the four weeks between the appearance of the disfiguring rash and the scaling off of the ugly scabs that form on its pustules. If all those who come in contact with the victim during that period have already been vaccinated or are immune from previous infection, the human transmission chain is broken and the disease is not passed on.

Because of this distinctive characteristic of smallpox, WHO officials realized at the start of their ambitious program in 1967 that they had to locate every victim, keep all of them totally isolated during the infectious period and inoculate as many people as possible in the vicinity. These were formidable goals, and many health authorities were openly skeptical that they could be achieved during WHO'S self-imposed timetable of only ten years. In some regions local tribesmen were suspicious of visiting WHO workers; in Ethiopia, two health workers were shot and killed. Some backward people refused to reveal that members of their family had smallpox. One ploy that was successfully used in Bangladesh: a $17 bounty was given to anyone who reported a case. More often, though, the workers had to make painstaking house-to-house searches to seek out suspected victims.

Moreover, the vaccine had to be specially freeze-dried to survive in the tropics without refrigeration. To administer it effectively--not always an easy task in areas where modern medicine is virtually unknown--WHO used a simple two-pronged needle developed by Wyeth Laboratories. It held just a single drop of vaccine between the points and could be used to make 15 quick jabs into the skin--a nearly foolproof technique that almost anyone could master.

Still, WHO suffered many setbacks. After a major outbreak in India as late as 1974, some people despaired of ever freeing the subcontinent of smallpox. In East Africa last August, Henderson and his colleagues thought that they had tracked down the last few pockets of the disease in isolated areas of Ethiopia. Then just as they were ready to announce the end of smallpox, they learned of several new cases among nomads in neighboring Somalia. The most recent victim is a 20-year-old woman named Maryam Ali Gureh, who is now recovering under the watchful eye of local WHO officials. If she can be kept from having any contact with unvaccinated people, she may go down in history as the world's last smallpox case.

The foundation gave two other 1976 prizes, also worth $10,000 each:

> Honored for clinical research were Pharmacologists Raymond P. Ahlquist of the Medical College of Georgia and Dr. J.W. Black of University College of London. Their work led to the development of the drug propranolol (Inderal), which the Lasker jurors, headed by Heart Surgeon Michael DeBakey, hailed as one of the most important drugs of the century for its role in the treatment of high blood pressure (hypertension) and heart disease, the nation's No. 1 killer.

> Cited for basic research was Rosalyn S. Yalow of the Bronx Veterans Administration Hospital, both the first woman and first nuclear physicist to win a Lasker prize. Together with the late Dr. Solomon A. Berson, she developed a sophisticated new tool called radioimmunoassay (RIA) for measuring minuscule quantities of pharmacological and biological substances. Using radioactive isotopes as tracers in antigen-antibody reactions, the technique is becoming increasingly important in everything from diagnosing disease to finding poisons in murder victims.

* Despite the fact that British Physician Edward Jenner showed in 1796 that the disease could be prevented by inoculation with cowpox serum.

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