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0:00 Intro

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Lucas Perry: Welcome to the Future of Life Institute Podcast. I’m Lucas Perry. Today’s podcast is with Beatrice Fihn. Beatrice is the Executive Director of the International Campaign to Abolish Nuclear Weapons. That’s ICAN for short. ICAN is a broad, inclusive campaign, focused on mobilizing civil society around the world to support the specific objective of prohibiting and eliminating nuclear weapons. ICAN played a key role in advancing the Treaty on the Prohibition of Nuclear Weapons at the UN, which goes into force on January 22nd, 2021. The treaty completely outlaws nuclear weapons under international law for nations that are party to it. It specifically prohibits the development, testing, production, stockpiling, stationing, transfer, use, and threat of use of nuclear weapons, as well as the assistance or encouragement of the prohibited activities. For ICAN’s work on the ban, and together with Hiroshima survivor Setsuko Thurlow, Beatrice accepted the 2017 Nobel Peace Prize on behalf of ICAN for their work on the treaty.  Beatrice has over a decade of experience in disarmament diplomacy and civil society mobilisation, through her work with ICAN, the Women’s International League for Peace and Freedom and the Geneva Centre for Security Policy. She has written extensively on weapons law, humanitarian law, civil society engagement in diplomacy and multilateral institutions, and gender perspective on disarmament work.

This conversation focuses on the modern nuclear weapons strategic landscape, and specific policy proposals that may help to reduce the risks of accidental and intentional nuclear war, such as renewing the New START Treaty, removing presidential authority for the use of nuclear weapons, removing hair-trigger alert, retiring the ground based missile leg of the nuclear triad, and adopting a no first use policy. We also discuss the theory of mutually assured destruction, the theory of deterrence, and the possibility of the treaty and related efforts succeeding and leading to the complete elimination of nuclear weapons. 

When we get into considering the complete elimination of nuclear weapons, I invite you to keep in mind the distinction between how we use protective force in life and the world, and the various shapes and forms that power takes. Power in the case of nuclear weapons can be viewed as the raw physical destructive power they hold, but also the political, interpersonal, experiential, and social power we collectively participate in imbuing them with through our perceptions about them. It may not always simply be that the social and political power that we give something is solely, rationally, wisely, and objectively related to the physical power of the thing. We can consider the following quote by James P. Carse who says, “Strength is paradoxical. I am not strong because I can force others to do what I wish as a result of my play with them, but because I can allow them to do what they wish in the course of my play with them.” An example of this might be that we can be physically bullied by someone with more physical power than us and through our own beliefs and perceptions allow ourselves to experience the physical violence from the perspective of victimization and also bestow social and even political power upon the bully through our unwitting choice to experience the world as and play the role of a victim who suffers the actions of the other. Rather, strength would be knowing one’s truth in relation to the bully, and being free from suffering the bully’s actions by being capable of allowing them to do what they wish without playing the role of a victim or bestowing any social or political power to them that is not in accordance with your truth. 

We have a choice with nuclear weapons to take away various forms of power and prestige that we bestow upon them, like we have a choice with the role we play in relation to and powers we bestow upon bullies. So, I invite you to consider what you think about the paradox of power, in its various forms, and the role of protective force in relation to the physical power of nuclear weapons as we explore deterrence theory and the total elimination of nuclear weapons. 

And with that, let’s get into our conversation with Beatrice Fihn.

Thanks again for doing this. I’m excited and pretty eager to know more about the current landscape of nuclear weapons dynamics and the political and strategic elements that are going on today. What kind of policy proposals are being suggested for minimizing the risk of accidental nuclear war or intentional nuclear war? So to start things off here, I’m curious to know if you could give an overview of and details about the most dangerous aspects of the current global nuclear weapons, strategic and geopolitical situations.

Beatrice Fihn: Yeah, I think, that many experts such as the Bulletin of the Atomic Scientists, the United Nations Institute for Disarmament Research, and many others have concluded this past year that the risk of nuclear use is as high as it has ever been, equally high or higher than incidents like the Cuban Missile Crisis, for example. What makes it different this time where we might not have that kind of very tense standoff that we can sort of see and watch in real time, and what makes it, for me, even more scary is that we have more nuclear armed states than ever. We have nine now. We have a difficult security situation in the world globally, a lot of authoritarian leaders, these macho leaders that feed off of threats, and violence, and things of that.

We also have things like a huge revolution in the militaries, things like artificial intelligence, cyber warfare, and all these things can accidentally trigger certain decision making. The risk of stumbling into nuclear war by accident is growing. We’ve seen all these flare-ups in relationships as well. We saw over a year ago between India and Pakistan, between India and China. We’ve seen very tense these last years between the US and North Korea. An increased tense situation between the United States and Russia and NATO and Russia.

There’s just all these kind of hotspots in the world, and eventually something will go wrong. I’m actually really, really worried. Then, of course, we have situations like right now in the United States with an outgoing president, that from the outside seems like he’s about to lose his mind, behaving in an irrational way, and has the absolute authority to launch the US nuclear weapons if he wants to, and he doesn’t seem to care about what he leaves after himself, really, at this point. I think it’s actually a very dangerous situation right now.

Lucas Perry: Could you talk a little bit more about the nine nuclear weapon states and the relative risks of accidental versus intentional nuclear war?

Beatrice Fihn: You have the nine, of course, the United States, Russia, China, UK, France, India, Pakistan, Israel, and North Korea. These are the countries that have nuclear weapons.

And as I said, we’ve seen some quite tense moments in recent years. For example, I think, it’s three years now since the false alarm in Hawaii, where Hawaii’s citizens woke up one morning with a text message saying, “incoming ballistic missile”. What we forget now today is that that week, Trump and Kim Jong-un were exchanging threats on Twitter. It wasn’t after the meetings. It was before their meeting and stuff, and so, it was an incredibly tense situation. Had I been in Hawaii, I would have taken it seriously.

We’ve also seen, of course, an armed conflict flare-up between India and Pakistan, in Kashmir, where you also saw that both leaders of those countries consulted with their generals about nuclear weapons options. That was part of the conversations on how to respond, obviously, in ways to kind of intimidate the other side. Still, at some point, things can very quickly tip over, and they have to follow through on their threats. Then, of course, India and China as well, I can’t really remember when it was, because this past year is kind of like time warped. Again, there was a very tense situation. I think we’ve seen those kinds of things happening.

In addition to that, you also see things like cyber-attacks, for example, on the US Nuclear Security Administration very recently. You’ve seen also huge reasoning and disinformation campaign, sharing information that’s not true, kind of feverish nationalism in Russia, in the United States, in India, in Pakistan. I think that we are seeing all of these potential things. It’s very hard to say, “This is the one that will go wrong.” I don’t think we know that until it happens, and by then, it will be too late.

Lucas Perry: Yeah. I have some kind of understanding that the risks of accidental nuclear war were higher than intentional. But yeah, when you put together all those kinds of possible tensions together, it makes more of a country’s narrative around intentional nuclear war being….

Beatrice Fihn: It can also be a mix, it can be an accident that triggers responses, or there can be disinformation that puts countries on very high alert status, very nervous, very jumpy. I think that all of those things can escalate together, but of course, we’ve seen many throughout history, and the more nuclear states we have, the more likely this will happen in the future as well. Pure accidents where something has gone wrong, something has broken, something has fallen off that triggers really near case scenarios.

Lucas Perry: Okay. At the Future of Life Institute, we have a close call timeline of more than 30 times that accidental nuclear war was almost started. A lot of this has to do with the fallibility of human and machine systems working in tandem about threats. Could you speak more specifically about this kind of accidental nuclear war that involves instrumentation and early warning systems?

Because one might expect that given more time that we would update the computer systems, which would become more reliable and become more secure, and then the risk of accidental nuclear war would decrease. Is this the case? Is it not the case? What is your perspective on instrumentation and accidental nuclear war?

Beatrice Fihn: I think that what we’re seeing is not just a more advanced technology, we’re also seeing more complex systems, and things that are very closely linked with other things, which means that you also have a lot of vulnerabilities that you might not even think about first, you might not test for, that only will be evident given certain things happening on this side, and then that triggered something there, and that triggered something there.

So I think it’s really important to also stay a bit humble in terms of technology and the power that they have. In particular, when we’re talking about a weapon that could literally kill the whole world, it’s not just, “Listen to the tech guys, they got this covered.” I think we have to have a very critical view of this and try to minimize risk. For us, of course, the only way to guarantee that nuclear weapons will not be used is to eliminate them.

I think that we’ve seen in historic examples also in the past where systems have failed, such as Stanislav Petrov, the man who saved the world, the Soviet missileer, who had these incoming warning systems that detected that incoming US missiles. His orders were really to put that decision to launch nuclear weapons up to their President, which he didn’t do, because he decided that the systems seemed to be wrong, and he just used his judgment. He had no facts to base that on. He just didn’t feel right.

Of course, that saved us, it could have been a huge crisis. We know scenarios like this, but there’s also a lot of things that we don’t know. And some of the nuclear armed states are very non-transparent about accidents. We have for example, Eric Schlosser, American author who wrote a really great book about American accidents, and he also compares the statistics for industrial accidents between the United States and these other countries and how they have a higher rate of accidents in their industries, but no transparency.

So we just don’t know. We don’t know what is happening in India and Pakistan. We don’t even know what happens in France. France is really bad at transparency. And the people in power that have these weapons are telling us, “Trust us, it’s all fine.” I don’t know, should we?

Lucas Perry: Can you add any more clarity about the current risk going into 2021 relative to other decades? There is the general zeitgeist of humanity around nuclear weapons issues, and it’s pretty in part defeatist, and there seems to be a lot of feeling like we can’t do anything about it, one, and also some mix of views about the relative risks of it.

Some people think that it is very risky, but there’s nothing we can do about it. Then, other people are not even really sure that they still exist. It seems that some people view the current nuclear arms dynamics as being inherently stable, that mutually assured destruction is leading to a sufficiently stable system, that there’s nothing that we should focus on, or be doing anything about it. How would you address or what would you say to this kind of general mindset that exists on nuclear weapons issues today?

Beatrice Fihn: The risks are really real. The risks will go up and down depending on what some governments say, and do, and how they act. But the risk will always be greater than zero, which means that given enough time, eventually will happen.

It’s really important to remember that this is not something that people are warning about just for fun. I find that we have that in our society, right? If it doesn’t happen, it was all very unnecessary to think about it. Even the Millennium bug, for example, it was not a big thing, but it was also because people took action to prevent it. I think that that gets very underestimated in the public mindset because if we can’t see it, you don’t think it’s a real threat.

For decades, I work here in Geneva, next door to the WHO, have a lot of friends who work in health, WHO, and also in my previous work in bio weapons, we had a lot of conversations with them. They’ve known that a pandemic is coming for decades. They’ve said it many, many times. I’ve heard so many presentations and doctors saying, experts, scientists, “The pandemic is going to come. We don’t know when. We don’t know how deadly it will be, but it’s going to come.” Yet, we’re quite shocked and unprepared when it happens.

Same thing with climate change. Scientists have warned about this for a very, very long time, but it wasn’t until people actually felt it themselves. For me, I’ve always been very active on climate change, but it was really, when was it, summer of 2018, when it was so hot in Europe, and there were fires, and you see all these kinds of consequences. When you start feeling it, that’s when you change it. The problem with nuclear weapons is that when we feel it, it’s too late.

Thinking about what could happen this year, I don’t think that we should feel that, “Oh great, Trump is out of power. We’re now good.” Because you have other people like Putin, like Netanyahu, like Modi, like Johnson. These are not the kind of people that I trust they have the best intentions for the rest of the world.

I think that that’s also one of the points here is that what a lot of people in the nuclear armed states don’t think about is that whatever decisions the United States do on nuclear weapons, or North Korea does, that impacts me here in Switzerland. It’s literally also my future and security at stake. All these countries are gambling with the whole world, not just their own country.

We’ve had these conversations with governments. There’s been international conferences that have discussed this. They’ve really tried to estimate the risk, which is obviously very difficult to do, but they keep saying that the risk is real and there is no preparedness for handling a nuclear war. Even one nuclear detonation would overwhelm healthcare, emergency services. It would be so devastating that we have no capacity to respond effectively.

For me, that’s just an unacceptable risk in the long term. We might survive today. We might survive tomorrow. At some point, it’s going to go off if we keep them forever. The question is, are you comfortable waiting, just hoping that you’ll avoid it, or leave it to your kids to fix, but someone has to fix this, right? At some point, someone has to get rid of the nuclear weapons, and who’s going to do that?

Lucas Perry: Yeah, so two things are essentially coming to my mind. The first is that at the Future of Life Institute, this bias that you’re talking about, I think we feel that it’s particularly pernicious, the bias of low risk but high impact events are not things that we prepare for, for one.

If we do something about them, and they don’t occur, then it’s sometimes very hard to tell that our efforts are what mitigated the risk. Humanity, collectively, is falling asleep to these risks. If we go extinct in the 21st century, then this bias probably has a large role to play in it. It might be a mixture of different kinds of biases. What is the bias when there are collective issues, and then people don’t care about them because they think someone else will take care of them? Like maybe there’s an adult in some room who will take care of this, and there’s enough adults in rooms that’ll be like, “It’ll be fine” or something like that.

First of all, there’s that, and I have no idea how to address that, besides, I think, Anthony Aguirre at the Future of Life Institute is behind and pushing this idea of spreading expected value calculations as part of our reasoning in decision making, because I think his view is something like, often what is going on is that we assume the event is most likely to happen, and then we just plan for that, rather than taking our probability distributions across all of the events, and then multiplying the probability by the value it obtains if that event occurs, and then allocating resources across the possible futures with relation to the distribution of expected value.

That would mean allocating much more money to low probability high risk events. That might be something for correcting it. I think that’s important for thinking in terms of nuclear weapons. The value is almost infinite if we go extinct and lose out on billions of years of life because of nuclear weapons. Then, the second one, is you bring up all these leaders and it’s making me think of just toxic personality traits. The way that humanity props up, and not all these people have been selected by their populations, but there’s this way that these really toxic personalities make their way to the heads of states. I see it almost as a kind of self-work, or almost spiritual problem.

Beatrice Fihn: For me, the pandemic has really showcased the flaws in that kind of leader style. We have this outdated view that strength is about threats, it’s about weapons, and that’s power, the very kind of toxic masculinity thing that, “I’m the toughest one, don’t you dare come here and tell me what to do.”

In our culture where we undervalue compromise and negotiations and soft power in that way, even though the academic studies show that that is much more effective in terms of protecting people. I think that we see that from everything from guns in your society, for example, that communities with less guns have less people being shot. And communities with much, much more guns have the higher risk of being injured by a gun, if you have a gun, of course. But somehow, we think it’s weak to give up our weapons.

I think that’s also one of the things that we have to think about as a society and really looking at these, I think, we have a very unique moment right now. Almost all of the nuclear armed states’ leaders are that kind of personality, and to see how they handle a real security crisis, like the pandemic, for example, where in the United States, for example, 400,000 people have died. It’s huge. It’s more than any war. To see how they are incapable of actually protecting people in that situation, where people are actually dying, and people are needing leadership, needing health care, needing all these resources, they are abandoned by the government. And to prioritize those things are still seen by people as weak.

We need to kind of unpack what we think leaders should be like, what is strength. I see a lot of conversations around gender equality, racial equality, hopefully being able to support that the more women, the more people of color, the more people with other perspectives that have perhaps other values and have been trained by society to value different things, the more we can open up to that view that perhaps diplomacy is a strength, negotiation is power.

Lucas Perry: Yeah, that’s right. I see the importance here of the humanities being integrated in. In terms of the personality traits, this is both clearly a technical strategic and geopolitical issue. It’s also an issue of human beings and gender to some extent, there are versions of, you can call it say, sacred femininity or sacred masculinity that are just simply not being embodied by the world leaders.

And so it seems to some extent, we clearly have various versions of toxic masculinity controlling the most powerful weapons on Earth. With a lack of women, you miss out on the wisdom of the feminine, which is important, because it goes about dealing with issues in a way that is different than how men traditionally deal with issues. There are sacred versions of both. By sacred I simply mean, a wholesome, holistic, and aligned and enlightened version, and that seems to clearly be lacking.

There’s this deep interdependency, I think, we’re ignoring where it’s also about self-work, a collective self-worth issue, collective conversations about social issues and what are the kinds of values and personality traits that we’d like to have our leaders most embody.

Beatrice Fihn: I think that we kind of ignore, these threats and kind of boasting and being aggressive, always gets a lot more attention as well, instead of the peaceful solutions from ourselves and the way we react to them. Also media, there’s so much more being written about the ripping up of treaties, than it is about the making of the treaties, and the kind of diplomacy part. You don’t write the success stories of these kind of initiatives that have worked peacefully, they just are taken for granted once they’ve happened.

I think that for the nuclear weapons field, had it not been such a strong movement against nuclear weapons throughout the Cold War, with huge demonstration, masses of people organizing, we might have not been here today. Obviously, you can’t really prove that in a way, but I think that there’s a natural instinct to look at the threats and the violence and take that as facts and all the other things that are happening, it just kind of swooped away because they’re not so visible and they’re not getting so much attention.

We constantly undervalue those things, then. I think so many times when I talk to people, people say, “Oh, the UN doesn’t work, nobody cares about it,” because they have one example of when it didn’t work. And the 2500 examples that I can provide that when it did work, when it has changed things, they’re just like, “Whatever.” It’s a narrative we tell ourselves about the world that we need to kind of break and challenge.

Lucas Perry: Yeah, I mean, this is also in part why I view self-understanding as so important in the 21st century. I mean, if you’re saying things like that, I think, it comes from a place of lacking self-understanding. I’d be interested in talking about this a lot more, but I think we could spend the whole time talking about this, in particular.

I want to pivot now into actual policy proposals, especially given the change in the seats in government in the United States. Given the current risks of nuclear devastation and intentional or accidental nuclear war, what do you see is the highest priority policy proposals and global efforts that ought to be made, both internally inside of nuclear weapons states and also internationally for reducing the risks of both accidental and intentional nuclear war?

Beatrice Fihn: We still have, of course, the United States and Russia with, I think, 90% of the nuclear arsenals. I mean, they are unmatched in their nuclear arsenals. I mean, the other ones are still dangerous, are still a big problem but the enormous stockpile of the US and Russia have is the biggest problem out of them all, I think. What we hope to see from the Biden administration is, of course, immediately an extension of New START – which is not a step forward, it’s just maintaining the current situation.

A lot of people will portray it as the biggest victory of the decade if it happens, but it’s basically just continuing the way that we have.

Lucas Perry: Can you explain New START?

Beatrice Fihn: The New START, it’s a treaty that was negotiated by Medvedev and Obama in 2010, that caps the US and the Russian nuclear arsenals and verifies that. It’s the limit on their arsenals. They can’t legally go above the threshold. That was part of a whole negotiating process in 2010, where they set that and they disarmed a lot of nuclear weapons and they met those levels. That treaty expires in February. The US administration under Trump have not been interested in renegotiating it. They’ve argued that we have to have China at the table. China with their 300 nuclear weapons, compared to the US and Russia’s 12,000, whatever they have together, is very dishonest.

It’s like “look at China,” they have 300 and our caps are several thousand. Obviously, that failed. If it expires in February, there is no legal limits to the US and Russian nuclear arsenal. What we know is, of course, the Biden administration is very supportive of New START and I think wants to extend it. Of course, that’s not enough, you need to have further reductions. I mean, these current arsenals are really, really high. In New START, there’s also provisions for extending it and then continuing to negotiate further reductions.

Lucas Perry: Why do they feel the need to have so many? If we accept mutually assured destruction as a way of maintaining global stability, then you want some number that will maintain reasonable deterrence, like credible deterrence. Why is it thousands and not hundreds?

Beatrice Fihn: I think it’s a very difficult conversation. Because if you accept deterrence, right, and say, “These weapons protect us,” then you have to protect so they don’t get knocked out. Then, you need more for that and you need to have them mobile, you need to have submarines, you need to have missile silos, you need to have the airplanes and it kind of never stops for the people who very much believed in nuclear weapons. That’s why, for us, I mean, we are very convinced that reductions are very necessary as an intermediate step like something that’s done now.

But we also have to work on policies that kind of question the whole reasoning for having them. Maybe it’s not true that we’re safer with these weapons. Maybe we’re actually more unsafe, because they make us a target and we engage in this kind of behavior where we actually put our own cities up as a human shield for our leadership. Really, what we need to do on the international level, and what ICAN has been working on is a treaty that prohibits nuclear weapons, that don’t distinguish between how we treat biological and chemical weapons and nuclear weapons.

They’re not special or magic. They don’t have any sprinkle of peace dust over the world and nuclear weapons and everything is fine. I mean, if you believe that nuclear weapons stops all wars and stops conflict, then why are we having a problem with everyone having them? There’s a very flawed logic behind nuclear weapons. So what we’ve been doing is to work on this new treaty, Treaty on the Prohibition of Nuclear Weapons that will enter into force just two days after the Biden administration comes into power.

It’s modeled after the bans of chemical weapons and the bans of biological weapons and landmines and cluster munitions. Weapons that indiscriminately target civilians as a part of their function should be illegal under international law, because we have all agreed to the laws of war that civilians are not targets, that’s already something that even the nuclear armed states have agreed to. Of course, that kind of follows on and then it can’t be legal to use nuclear weapons, it has to be illegal.

That’s what we’re working on now to also shift this idea that nuclear weapons are a benefit, and make it much more of a stigmatized weapon in the same way as chemical weapons and biological weapons are.

Lucas Perry: If the United States and Russia, for example, ever get into a nuclear war, it’s basically going to end civilization, either permanently or at least for 100 years or more, killing most people on the planet, and then maybe we’ll slowly crawl our way out of that hole over hundreds of years, maybe. A limited exchange between, say, India and Pakistan would still kill hundreds of millions, if not billions, by inducing a small nuclear winter that would destroy crops and create a global food shortage.

In those ways, we can reflect on how actually having nuclear weapons just makes everyone less safe. We talked about toxic personalities a little bit earlier. Who knows how toxic of a personality will be the next person who comes to power in some state? If we’ve abided by a treaty where we give up nuclear weapons, then we won’t have anything to stop such a person if they have control of nuclear weapons from taking the entire planet hostage.

The view is also that they protect the existential security of smaller countries. For example, part of I think the policy of when we will use nuclear weapons is when the existential status of, say, Russia or the United States is under threat via a ground based army. So it helps to preserve the existence of the country itself and the leadership, which is why it seems like Kim Jong-un, for example, really wants them. The Korean War was particularly vicious to North Korea, I believe that the United States created a lot of civilian casualties in bombings.

Again, this is like the smaller person being able to defend themselves against someone much larger by investing in this technology. What is your perspective on these kinds of views?

Beatrice Fihn: I think that that’s the sort of mainstream view, right, from the people in the defense community, maybe. This is rational. I mean, it’s very similar to the gun debate. “I’m a good guy, I need the weapon because the bad guys otherwise will bomb things.” What happens is that you end up shot yourself. I think that by having nuclear weapons, you are a target of nuclear weapons. Even though of course, because of the environmental impact and the devastating nuclear winters that would be as a consequence, they’re not targeting Geneva, that’s not where the coordinates of nuclear weapons are programmed for. They are targeted for, maybe San Francisco, Los Angeles, New York, Seattle, Mumbai, Beijing.

These are weapons that also create that kind of threat. North Korea has been very close to war for a long time, and being invaded, and they are seen as a pariah state and they’re seen as a threat. There are lots of military plans on how to invade them. Without nuclear weapons, it probably wouldn’t have been the case. So they also create conflict and they create tension and they create this kind of scenario where you are pushing the line towards conflict as much as you can, hoping that you will go over, and one day you will go over.

I think that also, we have to remember that nuclear weapons are really bad weapons. They are extremely clumsy. They don’t serve much military purpose. They are meant to wipe out whole cities and burn and maim people and poison people, civilians. They are not precision guidance weapons that takes out a specific military target in a war quickly or to achieve that. When you use nuclear weapons, you are also left with addressing the aftermath. I honestly feel like a country like the United States should be the country who’s leading disarmament efforts on nuclear weapons because it is the one that has the most other better weapons if I can say so.

Even if North Korea would nuke an American city, I am not sure that the most effective way to respond, ending the war quickest and saving American lives quickest, would be to use nuclear weapons back. This idea that you want to have the ability to inflict all that maximum pain, for what, an existential threat. I mean, it’s not always clear, and intentionally vague on how they would use them and in which case scenario.

Lucas Perry: So for example, they violate international humanitarian law because they indiscriminately are intended to and used for targeting civilians. I think I’d like to table for the moment this argument about the total elimination of nuclear weapons because I think that there’s a lot of ground that is much easier to agree upon around reducing the risks of accidental and unintentional nuclear war. As we get through that argument of reducing and cooperating, I think, then we can step back into the arguments around the total elimination of them.

We were talking a little bit earlier about the New START treaty and re-implementing that. That will cap the number of nuclear weapons which we possess. Then, there’s also this unilateral or multilateral reduction in nuclear weapons, which helps to begin to develop rapport and trust around this de-escalation of the situation. International parties or teams, which are being sent to each other’s countries to verify disarmament and facilities, perhaps to aid in reducing the risks of early warning detection systems malfunctioning.

This all seems good. Then, there are other things which we can talk about, like adopting a policy of no first use, removing the ground based missile systems from the nuclear triad. Removing hair-trigger alert. I think that those are the central three ones, I think I want to start with.

Beatrice Fihn: Yeah, there’s also the presidential authority to use nuclear weapons, removing that.

Lucas Perry: Removing that. Okay.

Beatrice Fihn: I think that that is how we’re going to get to reducing the risk and eliminating nuclear weapons, but the main problem that stands between us and these steps is this ingrained belief that these weapons protect us. There’s this kind of sense in this conversation that all governments have agreed that nuclear weapons are really bad. That’s why we need to reduce the risk, right? That’s why we take these steps and we need to cut the arsenals and do reductions.

But they also say nuclear weapons are really good. If they’re so good, then why are we reducing it? If they protect us, why would we reduce nuclear weapons arsenals? I think it’s really hard to decouple it from the idea of challenging the existence of nuclear weapons. I see very much how Republican senators, for example, are refusing to ratify the Comprehensive Test Ban Treaty. This is the treaty that banned testing of nuclear weapons because it’s really dangerous to people and poisons environments and things like that.

The US signed it in ’96, I think, and then the US Senate hasn’t ratified it because it has this ingrained view, right, to a lot of people, that actually nuclear weapons are good. Why would we agree to even cap it if they’re so good? So I really do think that we need to make progress on challenging the whole reason around nuclear weapons and kind of dismantling that in order to get these steps. Those things have to happen a little bit in parallel. It’s a little bit like trying to do non-proliferation of nuclear weapons, stopping other countries from having nuclear weapons while refusing to talk about your nuclear weapons.

It doesn’t actually work like that, because a country like North Korea is looking very much like, “well, you’re doing it, so why am I not allowed to do it? If you’re telling me the United States, France, Russia, China are telling me that the only way to be safe, even the biggest military power in the world cannot feel safe without these weapons of mass destruction, then, I won’t.” It’s one of those issues where you have to be able to think of simultaneous tracks.

I think that’s also how we change the world. It’s a constant approaching it from different angles and trying different things, so I see very much for example the treaty banning nuclear weapons as a way to generate more public pressure on the political context in a country like the United States to agree to these reductions and risk reducing measures. But I think that if we only focus on them and make them the big battle, we are kind of losing the underlying reason for having them.

Lucas Perry: I don’t seem to share the view that the implementing no first use, getting rid of the ground based missiles, removing hair-trigger alert, removing presidential authority, I don’t see these things as ultimately or fundamentally undermining mutually assured destruction or the real or imagined benefits of nuclear weapons.

Beatrice Fihn: There is a reason why these measures haven’t been taken. There’s a reason why they don’t want to agree to remove the presidential authority, because it would slow down decision making progress in a crisis. Then, maybe your enemy will know, that will take you a bit longer to respond, and then they won’t be so scared of you anymore. Same thing with no first use, if we know that the United States will never use nuclear weapons, then we can push them to the limits of conventional so they can do as much damage as we can, they will not use nuclear weapons, so then deterrence get rattled.

Lucas Perry: The point of usability is an interesting one, in the trillion dollar nuclear upgrade, they also talked about miniaturizing nuclear weapons to make them more usable. That sounds to me insane.

Beatrice Fihn: Yeah. It’s extremely concerning and scary.

Lucas Perry: I understand what you’re saying. The question then is about how much firepower and speed do you need in order to maintain credible deterrence? Beyond the question of whether we even need any deterrence at all, it seems to me that, and I’m not a nuclear expert, that implementing these things still maintains a credible degree of deterrence. You could have a few hundred nuclear weapons. Maybe you can have 600, you can have 300 deployed and 300 of them stored around the world or wherever you like. You’ve got them all on nuclear submarines, you’ve got them on bombers, you’ve gotten rid of the hair-trigger alert, the ground based nuclear weapons systems, because they’re very susceptible to accidental nuclear war.

We’ve adopted a no first use policy. Then, we’re very clear about the conditions under which we would use nuclear weapons. So, doing all that to me seems like I can’t see how that would change the current nuclear weapons and the global stability situation very much at all, except improve the risks of accidental and intentional nuclear war.

Beatrice Fihn: Yeah, absolutely. I mean, I think, that definitely would be one of those things that would drastically reduce the risk of nuclear weapons use. Very important. To me, of course, I feel very much that, yeah, you could do that today in the United States. It wouldn’t change much in terms of your military ability or power, or things like that. Probably improve it. It’s a huge waste of money as well. It takes away resources from other ways. I mean, we’re not fighting with ICBMs in Russia, we are fighting on Facebook.

The new type of armed conflicts are very, very different and clinging on to these weapons from 1945 that was developed in a whole another context, where you behave in a different way and the military plans were very different, it’s still extremely outdated, right? I think that you could do those measures extremely quickly and meet these arguments where they make very detailed arguments about why no first use would be difficult to do. We can’t do that because of this. We can’t do that, because of that. There will always be reasons why. I think that that’s why it’s so important with strengthening the public pressure on this issue as well.

Lucas Perry: I’m not as familiar with the arguments against these policy proposals. Can you present the DoD, the military, government military strategist arguments for why we can’t get rid of the ground based nuclear weapons, adopt no first use, remove hair-trigger alert and reduce stockpiles to hundreds of weapons and not thousands?

Beatrice Fihn: I struggle a little bit because they don’t really make a lot of sense to me. It’s a lot of inconsistent arguments. I think the things like no first use, what we’ve heard, for example, is that we need to be able to use it in case there’s a chemical weapons attack, for example, or biological weapons attack or if one of our allies… In the end of the Obama administration, he was considering doing a no first use policy for the US and got a lot of pushback from allies, for example, Japan and Poland who said that, “No, we don’t want that. We want you to threaten the countries next to us.”

Lucas Perry: Wouldn’t you just want to be clear about the conditions under which you would use them or with some fuzziness there?

Beatrice Fihn: Yeah, I mean, I think that there’s also this kind of ambiguity that there’s an incentive to have ambiguity in order for it to work. I think that this is also one of the weaknesses around deterrence theory, in general, this idea that you will behave rationally all the time, that countries would not know if you’re bluffing or not. The only way for deterrence to work is if you’re really serious about using it, and you’re actually able, willing and prepared to use it. Otherwise, other governments know. So you have to mean it. And if you mean it, it can happen.

That’s the whole problem as well. To say that we’re not going to have these operational weapons, we’re just having them as deterrence. But if you admit that, then you also lose the threat of the weapon. There’s a lot of concerns, especially in neighboring countries, where you really wonder, would the United States start a nuclear war? Would they actually follow through on these things? If Russia invades Estonia, would the current president start nuclear war with Russia to protect Estonia?

Lucas Perry: Why couldn’t that be a condition in a no first use policy proposal? We are never going to, say, nuke your 100 biggest cities out of nowhere, because we want to conquer the world. We might do it if you begin threatening the existential security of sovereign nations. Why can’t we just be clear like that?

Beatrice Fihn: I think these are the kind of inherent built in incentives for the military not to be clear on these things. There are countries of course, China has no first use policy, India has one as well, where they are clear that they will never be the first ones to use nuclear weapons. There’s definitely countries doing that.

Lucas Perry: I see. I mean, there could be limited no first use policies adopted. No first use in terms of nuclear weapons in particular, but first use conditioned upon other things, like people care about chemical weapons or protecting the global stability of the planet by not allowing large countries to annex smaller countries. Is that not part of the conversation?

Beatrice Fihn: Yeah. But I think that it’s also important to remember that as long as you have them, it doesn’t matter what the policy is, you can make a decision to do it anyway. That’s just the policy. It’s not law. It would still be up to the judgment of the people in power. I do think that going in the direction of having a no first use policy, for example, is the right way. But I do think that there needs to be a stronger push that makes that happen, right? Because currently, we’re still in this belief that these weapons protect us and then you have all these arguments, and then you have all these things that even if they do it, they might undo it as soon as there’s a conflict.

I think that in many ways, what needs to happen is that the bar for using nuclear weapons needs to just kind of be pushed up constantly through norms, through behavior, through public pressure, through laws, and other things.

Lucas Perry: Okay. Adopting a no first use policy can be a softer, more squishy tool and a set of policies, which begin to de-escalate the risks of intentional nuclear war. We also talked about removing hair-trigger alert, the ground based missile portion of the nuclear triad. You also mentioned presidential first use. These seem to be needed because they helped to maintain a very threatening stance, which maintains a stronger version of credible deterrence. If they were removed, their credibility would diminish in ways which would threaten global stability, is the view?

Beatrice Fihn: Yeah, I think that that’s the balance. The risk of use and the credible threat of use, right. If you do risk reduction measures, to actually reduce the likelihood of use of nuclear weapons would also diminish the threat of use of nuclear weapons. There’s a lot of actors at the moment who don’t want to do that. That’s where these policy proposals have gotten stuck and need more of a push in terms of questioning those things.

Lucas Perry: Just briefly, if listeners aren’t familiar with the nuclear triad, it involves the nuclear bombers that we have positioned around the world, that we have on nuclear submarines which also contain nuclear weapons. Then, we have ground based missiles. The ground based missiles are all on hair-trigger alert, because Russia knows, for example, where they all are. We know where Russia’s ground based missiles are. They need to be fired within 40 minutes in order to ensure that they get off the ground to connect with enemy targets so that mutually assured destruction is ensured and thus there’s credible deterrence.

There are proposals to remove the ground based missile silos because, one, the question is why do we need to destroy the top 300 cities of Russia? Or to hit cities multiple times? I’m just going to Google this right now. What is the 100th biggest city in Russia? It’s Abakan, sorry for butchering that Russians, which has 186,000 people. It gets pretty small pretty quickly. Why do you need to be hitting more than the top 100 biggest cities in a country to maintain credible deterrence?

Beatrice Fihn: And they’re obviously not military targets.

Lucas Perry: Yes, and they’re not military targets. If you have all of your nuclear weapons in submarines and bombers, you could retaliate in days, rather than within 40 minutes. That would maintain credible deterrence. The views against this, that I’m aware of, are concerns around the ocean becoming more transparent, given the proliferation of more advanced radar technology and drone technology. If we had all of our nukes on submarines and on bombers, then it would create a vulnerability in the nuclear weapons systems where those places could get attacked.

Then, we wouldn’t be able to maintain credible deterrence if Russia, for example, was able to take out enough submarines or bombers that we couldn’t retaliate. Then, there’s the need to be more risky and aggressive, because that maintains a stronger version of credible deterrence. How do you see the kind of technological arguments against the feasibility of moving to just submarines and bombers without hair-trigger alert?

Beatrice Fihn: I think this is also really what I mentioned earlier in the beginning, the kind of technological developments that are changing the kind of security calculations in a lot of these things. Putting the old notions that we had around deterrence and what protects and how to defend ourselves and how to have the strategic balance and calculations are changing very rapidly. We can actually see, we’ve had in our conversation with different experts and investigators a little bit.

You can make the argument that all these technologies makes it more attractive to use nuclear weapons first and early. Because there’s such a high level of uncertainty what the other party can do to your nuclear weapons, so that you better use it now, quickly. You will always be able to create hypothetical arguments, right? If x does this then y does that, and we need this if they do this. That will never go away, there will always be people making those arguments. I’ve had a lot of conversations with people arguing that you can actually use nuclear weapons without any civilian casualties and without environmental impact, but that’s not what the 13,000 nuclear weapons are for.

I think, to dwell too much like x does this and y does this and then we have to do this, and then we have to do that. I think that’s the way that the military thinks, is they think about all these things. It’s up to the civilian population to set limits on that. If the military could choose, they would have any weapons in the world, they will be able to do whatever they want, they will have maximum flexibility, no rules, no guidelines. I think that it’s our job to look at the risks as well and to rein in that and say, actually, this space of maneuvering is good enough for you. That’s how we’re going to be fine.

I think that that has already happened. I mean, there was a lot of arguments from Margaret Thatcher, for example, that they didn’t want to ban chemical weapons, because what if they needed a credible chemical deterrent? There was lots of arguments about landmines, for example, or even biological weapons that we shouldn’t be doing this, this will undermine this, they will result in that. But then, it happens, right? Then, it gets restricted and then you just adjust as well. I think that that’s also how it will happen to nuclear weapons.

Civilian leaders and politicians need to kind of need those conversations based on the enormous risk that nuclear weapons have and the fact that they have no plans for responding to it. I mean, the United States has, what, 5,800 nuclear weapons or something.

Lucas Perry: I think the argument here that we’re arriving at now, that you’re interested in is the total elimination of nuclear weapons, which is a more difficult opinion to defend in relation to the more gradual approach. It’s a lot more different than the current world. Whereas implementing some of these changes are closer to the world that we have today. Can you explain to us what your view and argument is around the total elimination of nuclear weapons and what your work at the UN has been with regards to developing and having the treaty on the prohibition of nuclear weapons be ratified?

Beatrice Fihn: I think that these weapons are real bombs, right, there’s real airplanes and submarines, but they’re also so symbolic. So much of its power is not actual physical power, but also kind of the mental power, like how we view them and how we characterize them and what we wish that they will do and what we hope that they will do or what we fear that they will do. But at the end of the day, it’s just a bomb. It’s bigger but it’s not really that much different than a chemical weapon or a biological weapon. Of course, I know there’s differences but I mean, it’s a weapon. It’s a weapon that will be used or not used, depending on what people decide to do.

I think we’re never going to get nuclear disarmament and the elimination of nuclear weapons, unless we make it unattractive to have these weapons, unless the value of nuclear weapons is reduced. I think that that needs to happen in the same way as the value of chemical weapons was reduced and the value of biological weapons were reduced and the value of other behavior in the international arena has changed drastically, right, like things that were acceptable is no longer acceptable.

We’ve stopped doing certain things that we thought was completely fine and legal and now we don’t do it. We used to smoke inside. Now we don’t do it, because that will be weird. But it was perfectly normal at some point. I think that the arguments around nuclear weapons assumes that nuclear weapons are somehow fixed, when there are constant decisions to take every day to maintain them, and to keep them and to upgrade them and modernize them and fund them and all those things.

I don’t believe that there will be a moment when the nine nuclear armed states all sit around a table and they hold hands and they sign a document and they will get rid of them. I think nuclear weapons will be irrelevant at some point. That’s when we’re really going to see the serious disarmament happening when they are not usable, signs of shame and stigma, clumsy, costly, and it’s really just an inconvenience. I think that we can get to that when we constantly raise the cost of having them.

Lucas Perry: Yeah. I’ve heard you use the language elsewhere, that you’d like to remove the power and prestige of having nuclear weapons. How do you remove the power of a technology, which intrinsically gives you the power to destroy cities and thus deter certain kinds of action?

Beatrice Fihn: There is no question that the United States has the military power to destroy almost all cities with conventional weapons. The question is more like is that power? Is a terrorist with the suicide vest, is that a powerful person just because they have explosive power and can cause harm? Was Asad one of the most powerful people in the world because he had chemical weapons. If you don’t recognize its power and if you don’t see it as power, but more like as a terrorist, if you don’t respect these weapons, they lose power.

Their power is in the awe and the fear that they create in other people. Because why would they use it? Why would you mass murder a million people that has nothing to do with the conflict, right?

Lucas Perry: Historically, people have mass murdered people, genocides happen, right? Clearly, human beings are capable of genociding each other.

Beatrice Fihn: Oh, yeah, absolutely.

Lucas Perry: So beyond transcending my own, and perhaps our own collective fear of annihilation, I understand what you’re saying. Things only have as much power as we give them. In the realm of our attachment to even existing in the first place, it’s hard not to give power to technologies, which if someone came up to me and put a gun to my head, I could totally just not care if I have meditated for the last 50 years.

Beyond that, I think, the argument against the total removal of them is again, we just don’t know who will be in power, we don’t know what their intentions will be. Human beings are capable of doing extremely horrible things. And so it seems that only way of deterring someone like that is to have the same kind of power.

Beatrice Fihn: Then, we don’t know who’s going to be in power. Should I have a nuke? Should I dig down landmines in my garden? Because I don’t know what’s going to happen, right?

Lucas Perry: I mean, that’s all the reasons why people want guns. Yeah.

Beatrice Fihn: Yeah, but I mean, disassemble that, right? If I’m scared of being burglarized or something like that. I have a house, I want to dig a big line of landmines in my garden in case someone comes, right. That would probably deter a burglar but your kids will also step on it, right?

Lucas Perry: Your kids will also step on it.

Beatrice Fihn: Yeah. Or the mailman, or me when I’m a little bit tipsy coming home one night. At some point, just the explosiveness of it doesn’t make sense based on the risk and the consequences of that. I could have a suicide vest constantly on me and say, “if you try to pickpocket me, I would blow us all up.” It could probably work but it wouldn’t be a great idea, right?

Lucas Perry: Yeah, I mean, it’s like we’re standing in rooms of gasoline and our rooms are not connected. We both have Molotov cocktails and I will throw mine into your room if you throw yours into my room. The difference is if I get rid of my Molotov cocktail, you can still throw yours into my room. You said that your children may step on a landmine, or you may step on the landmine — there’s this difference between the safety and assurance of the technology, which is a different argument that I don’t think is being made here about let’s maintain credible deterrence, but let’s make the systems more reliable.

That would mean, I don’t know, marking or doing something with the landmines in your garden so that you wouldn’t step on them, or that accidents wouldn’t happen. I don’t feel like I completely understand the way that deterrence is fundamentally transcended. Couldn’t the same argument be used for our military? We should just not have a military at all?

Beatrice Fihn: That’s one of the points, like deterrence doesn’t have to be nuclear. I mean, the military is deterrence, right. As long as we have a military, there’s a certain amount of threat.

Lucas Perry: Right. Nuclear weapons deter any ground based military.

Beatrice Fihn: Well we hope it does, we don’t know.

Lucas Perry: Okay. Yeah. I guess we don’t know. I can’t imagine a military being able to set up a base of operations without it getting destroyed or wiped out or having most of the people killed by nuclear weapons. That’s how, for example, North Korea could defend itself against an invasion by the United States and South Korea.

Beatrice Fihn: I think again, North Korea would be obliterated, so it would actually be an option to use them? It might be an option, right, for a leader who has no regard for their people. I’m not saying that they all have regard for their people. There’s no way that North Korea can use nuclear weapons and remain unharmed.

Lucas Perry: Yeah. If their existence is being threatened then having a toxic personality at the head of it, they might not care and if you target it appropriately, you can just make kind of a nuclear wasteland that makes conventional army movement impossible.

Beatrice Fihn: But you also, then, of course, kill South Koreans and Chinese. You have this kind of argument about how North Korea use nuclear weapons, would the United States respond with nuclear weapons, we don’t know, maybe not. Because then they would nuke South Korea and impact China, for example. That would trigger a response in China. One of the weaknesses with nuclear weapons is, of course, also this idea that there’s somehow this magic that’s governing everything, which is not really the case.

There is so much that you can do in the world, but you don’t do it. State could occupy smaller neighbors or steal resources, but they don’t, because we also have certain rules and we have certain regulations. I think that that shows also that we are able to control behavior, not flawlessly, but in a way that has shifted the world over the last 100 years.

Lucas Perry: Right. Those rules and regulations that smaller countries abide by are enforced through certain mechanisms that begin at going to court, or being sued, or rise to conventional armies enforcing them, then rises to nuclear weapons enforcing those laws and rules and regulations.

Beatrice Fihn: Yeah. There’s exceptions, right? When someone violates it, they will or will not be consequences. I mean, there are sometimes when there are no consequences for violating the laws, but most countries follow them anyway. In the same way as domestic laws. Most things that we do is just behavior that’s shaped through norms and laws, and they might not be a consequence, butI don’t do that anyway, because it’s frowned upon. We don’t behave like that.

Lucas Perry: It’s stigmatized to behave like that.

Beatrice Fihn: Exactly. I think we also have to see this in a longer perspective in terms of going back 100, 120 years ago, where the ways they behaved towards each other was very different than right now. And we’ve seen a drastic change in terms of how we respect borders, sovereign nations, how we avoid occupation, how we don’t occupy countries. I’m not saying that there aren’t exceptions, obviously, but if you compare to 1890, in the way that states behaved, and what they felt that they had the right to do, the world is drastically different in terms of how we have shaped these rules that we kind of abide with.

There’s no one who forces governments to do that. It’s just the way it is.

Lucas Perry: Aren’t they forced by the global community which enforces that stigma by doing sanctions or stopping trade or taking actual military action? I mean, the United Nations has an international military to some extent, which will use the second highest form of force, guns and conventional weapons, to enforce international law?

Beatrice Fihn: Yeah, of course. That’s the normative and the kind of stigmatizing processes that all these changes in behavior comes from. They’ve decided that certain things are unacceptable or certain things are acceptable. You cannot control everything. You cannot stop every murder in the world. But that’s still not a reason not to have the laws. There’s a lot of arguments on international law, for example, saying, well, Syria used chemical weapons so the Chemical Weapons Convention was completely useless. But had chemical weapons being legal and normal and totally fine, we would have seen a lot more than Syria.

These kind of things were pushing governments into a direction. They will stray off and they will come back and they will go in and out. They will be in compliance. Then, someone will violate. It’s about a process of herding governments.

Lucas Perry: That’s what you see the prohibition of nuclear weapons is doing?

Beatrice Fihn: Yeah. The people who deeply, deeply believe in the structure of nuclear weapons, in deterrence theory, it’s not about convincing them, right? It’s about convincing people around them. Building the pressure from the outside and shepherding them towards having to adjust to the rest of the world.

Lucas Perry: Yeah, that makes a lot of sense. I really don’t want to live in a world with nuclear weapons. I feel quite compelled by the arguments around adopting no first use and removing hair-trigger alert and the lack of need for the ground based missiles. I think that will go a great way to de-escalating the issues while also maintaining credible deterrence. Even though I want to live in a world without nuclear weapons, perhaps I need to be exorcised of the view that they still seem necessary to some extent.

To give up that level of power ceases to constrain the worst that humanity has to offer. Just less than 100 years ago, we had World War Two, we had the fascist imperialist component of human nature come out in full force. And the only thing that could constrain it at that point in time was basically most of the world sending all of its like hundreds of thousands of people to go fight a war about this problem.

I don’t see that kind of toxic personality, that problem of fascism and imperialism and narcissism and egoism as having gone away. I don’t know how to constrain it without maintaining some control over the most powerful weapons which exist.

Beatrice Fihn: But we don’t control them, the narcissistic toxic people control them. Literally in the United States, Donald Trump has the authority to decide today that he wants to nuke everyone.

Lucas Perry: I know it’s not a great situation, but having our own toxic personality to fight even more toxic personalities is maybe better than the alternative. I mean, the United States has such a system that is more impervious than others to having, hopefully, someone like Hitler come about, or someone who’s more inclined to genocide. Other countries don’t have institutions which are that strong.

Beatrice Fihn: I mean, from Switzerland right now, the US is looking pretty shaky and the government pretty fascist.

Lucas Perry: I understand. I understand.

Beatrice Fihn: I wouldn’t lie, in a different context with four more years in a worse scenario where there could be ethnic cleansing, or there could … I mean, these things don’t happen to others just by accident. These things happen to people. And what happens in Rwanda or in Myanmar can happen here, too.

Lucas Perry: Yeah. If we turned into that, wouldn’t Switzerland want nuclear weapons to stop the fascist version of the United States from invading Switzerland and making concentration camps?

Beatrice Fihn: I guess we would really, really regret that we’d let them have nuclear weapons for so long. We should have gotten rid of them already. As we talked about earlier, I do not have faith in these people, or that we’ll always, under all circumstances, forever and ever make the right decision, that there will not be mistakes, that there will not be accidents. There will always be violence, there will always be conflict. I don’t think we always have to have armed conflict and big wars in that way. But conflict between people and between … this is human nature, there will always be.

I mean, we have some better times we have some worse times. This has been a bad time. We might have some better times ahead of us but there will be bad times again. At some point, they’re going to push the button, someone. It’s statistically impossible that it will never happen if we keep them forever.

Lucas Perry: Right. I have some optimism that the fundamental human condition will change in a way that would make them irrelevant. You say this is like fundamental human nature and so we’ll be like that forever, though human nature is evolving constantly and will evolve alongside technology. So with the promotion of synthetic biology and artificial intelligence coming in the 21st century, I think, the most benevolent and cooperative parts of ourselves can be more deeply expressed.

Beatrice Fihn: Yeah. I don’t say that there’s this situation, it’s also recognizing that conflict will continue to happen. What we have to do and what we have been doing in the past is to slowly chip away at the weapons available and we have rules in conflicts and laws in conflict, and we have legal measures to address it. We have banned chemical weapons. They could have been seen just as nuclear weapons. We have biological weapons. You can make the same argument as you make with nuclear weapons today with these weapons.

We’ve had weapons that the military thought were essential that we stopped using, right, because actually, the consequences of using them outweighs the perceived benefits.

Lucas Perry: Right. My feeling around the arguments around things like chemical and biological weapons and laser blinding weapons, is that it’s like a spectrum of power, they’re somewhere in the middle between small arms and larger ammunitions, and they have particular strategic roles that are not completely necessary and are satisfied by other kinds of munitions. Like, you don’t need biological and chemical weapons if you have artillery and people on the ground and other kinds of explosives. They’re easier to let go of because they don’t necessarily maintain a certain kind of deterrence.

Beatrice Fihn: I would argue that that’s just something that people decided to believe. You could also make and people have made the argument that they were absolutely essential. In certain cases, this is the only option and that’s what we have to have. And you can make that argument with any weapon. We have three weapons of mass destruction and they have these kind of indiscriminate impact on civilians, which makes them useless in actual military operations.

Lucas Perry: Isn’t that useful in military operations, if you don’t care about civilians, and also as a way of deterring people that do care about civilians?

Beatrice Fihn: I mean, obviously, there’s an enormous amount of civilian casualties in warfare. But since 1945, I think that we’ve seen the idea of wiping out a whole city, for example, has decreased very much since World War Two, as a military objective.

Lucas Perry: Yeah, I think that it’s true that there is this increasing standards due to stigmatization about how conflict is engaged in. There’s more mindfulness about casualties, right? I agree that that exists.

Beatrice Fihn: Again, just because it happens doesn’t mean that it’s okay. We also see, of course, how governments consistently lie about it. They call them terrorists. They say they were actually fighters because it is very shameful and frowned upon to mass murder civilians. So even when drown strikes take out whole weddings, no, it was actually terrorists. Same thing with chemical weapons in Syria, for example, that it also is a recognition, right, that it is very uncomfortable for them to admit it.

One of the things that we have to know is that we never know how the future will be. I’ve heard a lot like, we will keep nuclear weapons until there’s a better, more dangerous weapon. And I honestly think that those weapons are already here. I mean, we have artificial intelligence, we have cyber warfare, we have this kind of disinformation things that are happening, which is being used in warfare, to carry out military operations and to destabilize countries.

The future in warfare is already happening, right. Nuclear weapons is kind of a relic from the past that we keep dragging with us into this very volatile and unpredictable and extremely complex situation.

Lucas Perry: It’s really not safe. It’s hard to be exorcised from me the feeling that for example, yes, warfare is evolving. We have AI, we have cyber warfare, yet nuclear weapons still occupy a particular strategic role that is deeply important, it would seem. For example, a sufficiently sophisticated cyber attack and disinformation attack could be seen as an existential threat. Then nuclear weapons become your option, right?

Like, would we nuke in Russia if they took down our entire power grid, which would kill a huge fraction of people in the United States? If you took down all of our electricity? Maybe, our military people would say …

Beatrice Fihn: I think it’s important to remember also that 180 countries do not have nuclear weapons.

Lucas Perry: Yeah.

Beatrice Fihn: And out of those, around 150 countries do not believe that nuclear weapons are a legitimate way of protecting yourself. And it is not because these countries do not have security threats.

Lucas Perry: Yeah, they have security threats.

Beatrice Fihn: Probably more so than maybe the United States in many cases. Who do we listen to in this question? Who gets paid what? Who gets to create the norm? Who gets to represent the world?

Lucas Perry: Yeah, I mean, the question is, how do you maintain security once you’ve given up your biggest physical power, your biggest means of destruction?

Beatrice Fihn: Ask South Africa, for example, they gave up nuclear weapons. Or a country like Brazil, who had a long advanced nuclear weapons program in the ’50s and ’60s. Sweden and Switzerland were both considering developing nuclear weapons and were far along in that process, and decided that, no, actually, there’s other ways to maintain security than to threaten to mass murder civilians. Otherwise, why would these countries not have nuclear weapons?

It’s not a barrier that these countries really want nuclear weapons. Any government who wants nuclear weapons can have them. North Korea showed that very clearly. If the poorest least developed country can get them, it’s not a question of ability. It’s an analysis, right? It’s not actually in our security interest.

Lucas Perry: I mean, Iran, seems to think it’s very much in its security interest, because it gives it a lot of leverage and power in international politics and for creating treaties, although, it hurts it very much by creating a lot of sanctions. I mean, Iran and North Korea share sort of the same existential issues when you have powers as big as Russia and the United States, which like to become involved in the affairs of other countries. It just comes back down to power, like do you have enough power?

Beatrice Fihn: Nuclear weapons, also, it comes with the added sort of disadvantage is that anyone can take that power, right? Kim Jung-un is suddenly from being in a completely irrelevant country, no economic power, no influence on international arena, no one listens to what they say, no one cares, to having this welcome party with Trump in Singapore. So we also, by allowing nuclear weapons, for a country like the United States, right, who doesn’t actually need them, because they have pretty much every other weapon at their disposal. They are completely unmatched, the United States, in military power. The fact that North Korea can manage to be equal with just this dirty bomb is pretty bizarre, right? It’s a huge weakness in the structure.

Lucas Perry: I see what you mean. There’s two facets to this though, there is the actual just literal physical power of the bomb, and then there is the social and the political power which we give to people which possess them. When you say that you want to take away the power and the prestige of nukes, it sounds like what you mean is taking away the social and the political power of them, by ceasing to respect countries which generate them, because this incentivizes the creation and proliferation of further nuclear weapons.

There’s a real way in which you can do that. Yet, it seems seemingly difficult when one is also reflecting on the mere physical power of the nuclear weapon.

Beatrice Fihn: Yeah, I think it’s definitely a challenge. But again, I think that pure physics behind it and the power there doesn’t have to kind of translate into actual power, like you can have the power to destroy but can you have the power to get people to do what you want? I mean, this is like dictatorship, right? The person in power can force the population to do what they want. You can threaten the people, like if you speak out of me, if you try to form organizations, or do anything politically, like I will put you in prison, I will murder you, we will do all those horrible things. And it works, but it doesn’t work forever.

That’s also against human nature. The threats don’t always work. People will somehow try to get around it, which must be true for nuclear weapons as well, like at some point, it will not work.

Lucas Perry: It will not maintain critical deterrence.

Beatrice Fihn: Yeah. Or it will fail. Or someone will use them, and mutually assured destruction, meaning that we don’t use nuclear weapons, because we know the consequences will fail.

Lucas Perry: All right. We’re coming up to about the end here. I’d like to do a little bit of rapid fire questions here if that’s possible. If we haven’t completely covered it here, in a minute or two, can you describe or explain the significance of the treaty on the prohibition of nuclear weapons? It seems like there’s this aspect of generating stigma. There is creating and setting a new norm around nuclear weapons. You use the phrase of kind of like shepherding or herding nuclear weapons states into a particular policy or strategic landscape, given what other countries are doing. Are there any other aspects to this treaty that you find are very valuable or that people should know about?

Beatrice Fihn: It’s the first treaty that bans nuclear weapons, setting the standard on international law. We’re also really kind of eager to work with it to utilize the financial pressure, which we haven’t really got into today. It’s also a whole aspect, right? These arguments against no first use and removing the land based missiles, there’s financial interest behind all this. The companies that get these contracts are enormous, right. It’s just blank checks, $1 trillion over the next 20 years or something like that. It’s a huge amount of money for a weapon that you can’t use.

There’s only that kind of financial incentive. We’re going to use the treaty to stop putting pressure on banks and pension funds to pull out their investments of nuclear weapons producers. We’ve seen that be very effective in other treaties banning weapons, such as landmines and cluster munitions, for example. Another thing that we want to do as well is it has provisions on victim assistance and environmental remediation. So states parties to this treaty have to address and support the rights of victims of nuclear detonations and tests. That’s for example a lot of indigenous communities in Nevada, Kazakhstan, Algeria, Marshall Islands, Pacific Islands, very colonial racism, where we’ve tested nuclear weapons.

That is very concrete work that can actually help people with or without the nuclear armed states ever joining this treaty, this treaty can be the platform where we can start addressing some of the health challenges and community challenges in these communities. For me, this treaty is also about supporting the people that are suffering from this weapon. That’s also something that we’re missing a lot in these conversations about strategic stability and deterrence, is that there’s ongoing harm from these weapons. In that way, I feel it’s very similar to the kind of conversations we’ve had this past year about Black Lives Matter and defunding the police. This institution that is supposed to protect, but it harms.

It protects the leaders and it harms the indigenous communities where they test these weapons. That’s also something we want to work with the treaty. Then, using it to move forward oppositions, to stigmatize, to kind of create a conversation a new norm, use culture, use scientists, use all of these to stop thinking that this is normal behavior and make it abnormal, right, and make it like the smoking ban. I can’t make you stop smoking, but I can make you go outside.

Lucas Perry: All right. How do we elevate activism and excitement around nuclear weapons topics? How do we involve more of the younger generation? Basically, how do we better message on nuclear weapons?

Beatrice Fihn: To be completely honest, I don’t think we’re going to see the kind of million people marches that we had in the ’80s on nuclear weapons, unless there’s nuclear war and a nuclear accident or something like that. Hopefully, that won’t happen. So what I do think is we need to connect it to other issues, like we talked about in the beginning about the sort of toxic masculinity, connect it to gender equality, connect it to anti-racism, connect it to redistribution of resources. I mean, the military budget is enormous, that should go to actually saving people’s lives. If it’s about protecting Americans, why not putting it into healthcare and actually saving American lives?

Consistently in polling, we see quite strong support for nuclear disarmament but people feel that it’s too difficult, too overwhelming, too technical, so I think we need to connect it to other movements, rather than having it be completely on its own. It’s a part of climate change. It’s a part of social justice. It’s a part of anti-racism. It’s a part of gender equality. It’s connected to all those things. I think that that’s how we’ll get through to people better.

Lucas Perry: What are some of the main ideas that you think the public needs to understand in order to help establish new norms about nuclear weapons?

Beatrice Fihn: I think people need to understand that there’s a lot of actors involved. I think that one of the paralysis is that we’re focusing so much on the leaders of the nuclear states, these nine men. I feel completely powerless to change their opinions, right? I’m not going to be able to do that. But it’s all part of the government. It’s in the budget negotiations. It’s in the banks and pension funds. It’s the universities, for example, we have University of California has been involved in building every single nuclear weapon of the United States, John Hopkins, and Texas A&M and these other universities… To understand that it’s everywhere. It’s structures that uphold this and there’s constant decisions being made to keep these weapons, and ways to engage on small pieces of it that will contribute to the whole thing.

Lucas Perry: All right. Do you have any last minute things that you’d like to share with the audience or with me that you feel like you haven’t said that you feel is really important and crucial to this issue that you wish more people understood and connected with?

Beatrice Fihn: One of the things we know is that nuclear armed states and the people who want to keep nuclear weapons, hate this treaty with a vengeance, and they hate it because they know it’s working. And it can be quite daunting to go up against the very, very powerful actors. But you know that when the people in power are reacting, it’s because they know that it’s threatening something. So changing things always have to be challenging, and challenging the people in power.

Lucas Perry: If listeners are interested in participating or doing anything about nuclear weapons issues, what do you suggest that they do?

Beatrice Fihn: They can go to icanw.org, our website and read more about the facts about nuclear weapons and ways to get engaged.

Lucas Perry: All right, Bea. Thank you so much for coming on. It’s really been a pleasure.

Beatrice Fihn: Thank you.

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 Topics discussed in this episode include:

 

Timestamps: 

0:00 Intro

3:13 Part 1: How William Foege got into smallpox efforts and his work in Eastern Nigeria

14:12 The USSR’s smallpox eradication efforts and convincing the WHO to take up global smallpox eradication

15:46 William Foege’s efforts in and with the WHO for smallpox eradication

18:00 Surveillance and containment as a viable strategy

Citations:

Future of Life Award page

Future of Life Award Ceremony 2020

 

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Lucas Perry: Welcome to the Future of Life Institute Podcast. I’m Lucas Perry. Today’s episode is with the recipients of the 2020 Future of Life Award. The Future of Life Award is an annual prize we give out to an individual who, without receiving much recognition at the time, has helped make today dramatically better than it may have been otherwise. The 2017 and 2018 winners of the Future of Life Award were Vasili Arkhipov and Stanislav Petrov. Two heroes of the nuclear age that helped prevent accidental nuclear war.

The 2019 winner was Dr. Matthew Meselson for his crucial efforts behind the 1972 Biological Weapons Convention, an international ban that has prevented one of the most inhumane forms of warfare known to humanity. This year, we are awarding Viktor Zhdanov and William Foege for their crucial efforts in the eradication of smallpox. Viktor Zhdanov passed away in July of 1987, so his stepson Michael Burkinsky and son, Victor, will be receiving the prize in his honor. William Foege, Michael Burkinsky, Victor Zhdanov Jr., and his wife, Katia, have all joined us today to discuss the award.

For a little background on the 2020 award, smallpox has been around for at least 3000 years and claimed the lives of about 300 million people in the 20th century alone. UNICEF estimates that smallpox eradication has saved close to 200 million lives so far. While serving as the Soviet Union’s deputy minister of health, Dr. Viktor Zhdanov, persuasively argued at the 11th World Health Assembly meeting in 1958, that the world could eradicate smallpox within a decade with a united effort, and successfully lobbied the Soviet Union to donate 25 million doses of the smallpox vaccine to kickstart the effort in developing countries.

The World Health Assembly accepted his proposal in 1959 under resolution WHA 11.54. While working for the Centers for Disease Control in Africa as chief of the Smallpox Eradication Program, Dr. William Foege developed the highly successful surveillance and ring vaccination strategy to contain smallpox spread. This greatly reduced the number of vaccinations needed, ensuring that the limited resources available sufficed to make smallpox the first infectious disease to be eradicated in human history. This podcast is broken into three parts.

The first is with William Foege on his experience in the efforts to eradicate smallpox. We then introduce Michael Burkinsky, Victor Zhdanov Jr., and his wife, Katia Zhdanov, where we discuss Viktor Zhdanov Sr. and their memories and accounts of his life. We end by pivoting back to William Foege where he offers us a history of the smallpox virus, as well as his perspective on biological issues in the 21st century. Without further ado, I’m happy to introduce this conversation with the 2020 Future of Life Award recipients.

Thanks again for coming on. I’m excited to take a tour with you through your life’s history and the history of smallpox, and also get into a bit of more contemporary problems for the 21st century that are relevant to the Future of Life. Let’s start off with your personal life and then we’ll get into smallpox more specifically. Could you give a little bit of background about your life’s history and life occupation? What it is that has really driven you and captured your heart and mind and attention throughout your life?

William Foege: Okay. I spent my first 10 years in rural Iowa, and then we moved to the Northeast section of the state of Washington. When I was 15, I ended up in a body cast in a town that had no television and therefore reading was the only thing that I could really concentrate on, but I did a lot of reading. At that time, one of the books that caught my attention was by Albert Schweitzer. Albert Schweitzer, a little over a hundred years ago, went to Africa where he spent the rest of his life running a medical center. What was unusual about him is he is what we would now call a polymath.

That is, he was interested in so many things. By the time he was 30, he already had three earned PhD degrees. I mean, that’s just incredible. At the same time, he was an accomplished organist, so good that he would give concerts around Europe. He was probably the world’s expert on Bach at that time. In addition, he was the world’s expert on organ building. He was just interested in so many things. At the age of 30, he decided, “Up until this time I’ve spent my life doing what I wanted to do. Now I’m going to spend the rest of my life doing something for others.”

At the age of 30, he entered medical school, got his fourth doctoral degree, then went to Africa and that’s what he did. He spent the rest of his life in what is now Gabon. I was so taken by his story that I became interested in both Africa and in medicine. By the time I was out of high school, I was already getting literature from the World Health Organization and from CDC in Atlanta. Now, CDC was quite new at that time, I don’t even recall how I got on their mailing list, but I did. When I started medical school, I found that there were very few people interested in global health.

At the University of Washington in Seattle, I could only find a couple of people that even had an interest. One of them was a very interesting person by the name of Rei Ravenholt. He just died last month at the age of 95. What he said to me is, “If you’re actually interested in global health, there is no good pathway.” It’s not like you want to become a pediatrician and there are residencies that you enroll in it. He said global health, you have to make your own way. He told me at that time, “If you’re truly interested, go to Atlanta, join the Epidemic Intelligence Service at CDC.

You’ll find other people interested in global health and they will end up as colleagues for the rest of your life.” That’s what I did. I ended up going to CDC. While there I was stationed in Denver, Colorado working for the entire state, but I got a call one afternoon asking me to investigate what was a suspected case of smallpox in a Navajo child. They told me the book I should get from the library, which was a book by an author by the name of Dixon. I went to the library, found it was checked out by a medical student who was writing a paper.

It took me some time to find that medical student, and of course he didn’t want to give up the book, but I finally talked him out of the book. By the time I got to Farmington, New Mexico that night, I had a pretty good idea on how to differentiate smallpox and chickenpox. I entered the hospital that night and as I walked in the patient’s door, a little child, less than a year old, I knew looking across the room that I had no idea what that child had. That humbles you very fast because here I was, the out-of-town expert coming in to diagnose smallpox.

I did an examination. I called my bosses back in Atlanta, we discussed what I was finding. They could not make a diagnosis, and so we had to treat it as suspected smallpox. For the next three days, that’s what we did. We found all the people who had been in contact with either the patient or their parents. That was my first interest in smallpox. A year later, I went to India because a Peace Corps physician had become ill. I went for three months to replace the physician while they recruited. That’s when I saw my first cases of smallpox.

I had read about it, but I had not anticipated what an ugly disease it actually was. The people with smallpox were so disfigured in the hospital that even the staff did not want to deal with them. I came to realize that that was their introduction to, “Even if I survive, people will probably not want to deal with me in the future.” About a third of the people died, about a third ended up scarred for life. These poor people had trouble finding marriage partners and they had trouble finding jobs and so forth.

It was then in 1965 that I was at the Harvard School of Public Health, getting a degree in tropical medicine that I did my first paper on smallpox. It was a seminar for a man by the name of Tom Weller, who was a Nobel Laureate for having been one of three people to perfect the growing of polio virus in the lab. This allowed Jonas Salk then to make his vaccine, which came out in 1955. I presented a paper at his seminar class and he was so questioning of everything I said that it made me nervous.

Afterwards, a member of his staff said, “Tom Weller never embarrasses a student. What you saw was true interest. He was so interested in what you were saying, he had to keep asking questions.” Well, I went off to Africa, not intending to do anything in smallpox, but I had agreed with a church group to run a medical center. While I was there, CDC sent me a letter asking if I would be a consultant for a new program that they were starting in West Africa. That’s how I got into smallpox.

Even before that program started, I was called to an outbreak only to find we didn’t have enough vaccine because it was not due to arrive until the next month. We had to figure out how to use the vaccine most efficiently. What we did was to call the missionaries in the area by radio. I found out that they had a network. They would get on the radio every night at seven o’clock just to make sure no one was in dire need of something. I got on the radio, we divided the area up and asked each missionary to send runners to the villages the next day.

24 hours later, we got back on the radio and now we knew exactly which villages had smallpox. We were able to use our limited vaccine in those villages and the remaining vaccine in marketplaces where we thought it might spread next. With less than 7% of the population vaccinated in that area, the outbreaks shopped. It totally surprised us because up until this point, everyone said you had to get 80% coverage in order to get what’s called herd immunity. This led us down a road of asking, is there a more efficient way to get rid of smallpox?

We started what we called surveillance-containment. We spent our attention not on vaccinating everybody, but on trying to find where the virus was. The virus leaves a trail because you either find sick people or you find people with pockmarks. You can find out by questioning them how long ago they got those pockmarks. You can actually trail smallpox and know where it’s been. What we found was that using that approach, we were able to get rid of smallpox in all of Eastern Nigeria, which is where I was working at the time, in six months’ time. It happened so fast.

Then we started to the same approach in the rest of West and Central Africa. In this area of 20 countries, which was now the project of CDC funded by USAID with a five-year goal of getting rid of smallpox, we were able to do it in three years and six months and under budget. That’s the way the smallpox story changed. Then we went on to India, which was an even bigger problem. In India, we went from high number of cases, in fact, in May of 1974, one state alone, Bihar, was having 1,500 new cases of smallpox every day, which meant 1500 new investigations every day.

It required a large army of people being hired and trained in order to do that. Once we got the system going in India, they went from these high rates to zero in the entire country in 12 months’ time. I think it was probably the most exciting 12 months in all of global health up to that point.

Lucas Perry: What year is it that you’re graduating medical school and being told that global health isn’t really a … there’s not really a clear pathway to work in that? It’s not really established as a field or an endeavor yet.

William Foege: This was in the late 1950s and I graduated from medical school in 1961, went to CDC first and then to Africa in 1965. We intended to spend our life there, but a civil war broke out between Nigeria and a breakaway region that named itself Biafra. The Biafra and Nigerian Civil War, and our medical center was overrun in the first weeks of the war that we had to flee. I went back then to work in the relief action in 1968. That war went on until the early 1970s.

I always intended to go back, but after years of working now in smallpox at CDC, I was so enamored with the idea of smallpox eradication, I couldn’t leave. I continued then in CDC on smallpox eradication.

Lucas Perry: On this timeline, where do the efforts with regards to the WHO to begin having conversations about a possible smallpox eradication program, where does that fit in?

William Foege: Well, in the late 1950s, the Soviet Union began pushing who to do this. Dr. Zhdanov and others that the Soviet Union came in with a proposal. The very first vote at WHO only three countries agreed to get into a smallpox eradication program. Then the Soviet Union found that by joining up with the U.S., this increased the force and the U.S. and the Soviet Union together we’re able to get WHO in 1964 to agree to this. At first there was no money. It was not until 1966 that they allocated money for smallpox eradication and so the program in West and Central Africa began in January of 1967.

Lucas Perry: Okay. You’re working in Nigeria before the WHO has commenced this program.

William Foege: That’s correct.

Lucas Perry: Then once Zhdanov helps to push this program through, you’re then funded and the area for which you’re working on smallpox increases throughout West Africa.

William Foege: 20 countries of West and Central Africa. From Senegal all the way over to the CAR, the Sahel countries, Mali, Niger and so forth, right down to the ocean with Ghana, Nigeria, Togo, it’s now Benin, and so forth.

Lucas Perry: What was your involvement in the WHO specifically in terms of the strategy for smallpox eradication?

William Foege: Well, the head of the smallpox program at CDC right at the beginning was D.A. Henderson. D.A. Henderson was then seconded from CDC to WHO in order to start the global program. The CDC was asked to take this 20-country area of West and Central Africa because initially people thought this would be the most difficult place in the world. They had the highest rates of smallpox, poorest communications, poorest transportation. I think that there was some idea at WHO this couldn’t succeed. There were lots of people at WHO that didn’t really want it to succeed.

They had been burned twice with the idea of eradication programs. The first time with yellow fever, where they instituted a eradication program, only to find out that the yellow fever virus was prevalent in primates in the forest. Short of being able to figure out how to vaccinate primates, you simply could not contain this with the vaccination of people only. That program was stopped. Then they had a program for malaria eradication and they were simply too early.

The technology wasn’t there, the ability wasn’t there, so they spent a lot of effort on malaria eradication, but were not successful. Now comes a request to try a third eradication program and there were many people who had no interest in this at all. Some of them actually were hoping it would not succeed. I think that’s one reason that they gave CDC what they regarded as the most difficult area in the world. Of course, the surgeon general of the United States years later said the CDC people who went to do that were so young that they didn’t know they couldn’t.

That’s why it succeeded. That’s partially true. They were very energetic zealots and nothing would get in the way. There were about 43 of them assigned to the 20 countries, both medical officers and operational officers. These were exceedingly hard-working people so the goal of five years was met early, and as I say, it was under budget. It turned out to be a great success, but now it gave the strategy for the rest of the world. That is, you don’t have to go through the first part, which is to seek herd immunity.

You don’t have to have a mass vaccination program. You can start right in the middle and find the virus. Then it becomes a battle between you and the virus. Are you good enough to find the virus and figure out who’s at risk now? Not who’s going to be at risk in nine months.

Lucas Perry: Right. I think the jargon for this is surveillance and containment?

William Foege: Correct.

Lucas Perry: Surveillance and containment has demonstrated to be successful in West Africa and so then this is going to get implemented throughout the world to finish off the smallpox eradication program. Can you take us to that larger worldwide perspective in places like India and Southeast Asia, where smallpox is still widespread and where we are on this timeline?

William Foege: Yes. The year after West Africa became free of smallpox, Brazil became free using the same technique of surveillance-containment. In 1973, most countries in Asia had become free except for Pakistan, India, Bangladesh, and Afghanistan so now we could concentrate on those countries. The concentration in India started in October of 1973 and the same for Bangladesh. The amount of smallpox in these countries was so great. We were not sure that this new approach could actually work.

In October of 1973, we did our first pilot of trying to figure out, could we do surveillance in a way that you could go to villages and find out very rapidly whether they had smallpox? We tried in four different states to do this. I was so naive that the instructions that I wrote for doing the search indicated we won’t find much smallpox because it’s the low season of transmission of smallpox, but we’re going to learn how to find smallpox. We’re going to learn the technique going to the village, who should we be talking to? What should we do when we’re there?

To my great surprise and horror, I might add, six days later in just two states, which are Pradesh and Bihar, the searchers had found 10,000 new cases of smallpox that we didn’t know about. Suddenly we’re overwhelmed. There’s no way we can respond with containment to that many cases of smallpox. There were some people that suggested, “Let’s never do this again. It’s finding too much smallpox.” Well, it’s finding too much smallpox because this is the best surveillance we’ve ever done, and we’re going to keep doing it and we’ll do it every month. That’s what we did.

Every month we took six days to search and to find what we could find, and every month we got better at it. Instead of just talking to school teachers and maybe the village chief, and maybe some school children, we started going house by house, asking people if they’d seen smallpox. Each month, the searchers would have to put a mark of some kind on the door that was changed every month, but it allowed a chalk mark so that the people doing the appraisal afterwards could estimate what percentage of houses were actually visited.

The search really became very good, but we weren’t satisfied with that. We did secondary surveillance in marketplaces, and again, asking people if they’ve seen smallpox. We set up tertiary surveillance systems in areas likely to have smallpox such as bigger communities or people working on brick hills, where they would move from village to village. Surveillance in about six months became exceedingly good. Containment was more difficult because we had a much bigger job than what we anticipated. At first, we couldn’t even get to all the villages that reported smallpox.

The ones we did get to, people would vaccinate the household and a few houses around and then move on to the next place. As we got better and were able to hire more people, we could do a larger ring around every affected person that had small box. There were so many people you could not send them to a hospital so you quarantined them at home. That meant we had to have watch guards at the house, not so much to keep people from visiting, but to keep people from visiting who were not vaccinated.

We had learned in Africa that if you vaccinated a person, the day they were exposed, they would be protected. Anyone that came to visit the sick people, we would vaccinate them before they would go to the house and they would not get smallpox. You have to have two watch cards because the first one has to take breaks, has to go to the bathroom and has to go get food. That sort of thing. If you have two, you need at least four, even if they work 12-hour shifts, and maybe you need six people in order to have eight-hour shifts. It required a lot of people.

In May of 1974, where surveillance was now really at a very good level, containment was beginning to improve. When Bihar reported 1500 new cases a day, that meant 1500 new investigations a day. It meant hiring new watch guards. At one point I think we had about a hundred thousand watch guards on our payroll. It was a big operation. As I say, we went from those high rates to zero in 12 months’ time. The system worked, it just took a while to perfect it. India, Pakistan and Bangladesh were the big ones in the early 70s.

By 1975, we had finished in May in India. By that fall, Bangladesh had finished, Pakistan had finished and so now we had the last case of Asian smallpox in the fall of 1975. Now, the only part left in the world is Ethiopia. Ethiopia is a very difficult country to work in for lack of roads and very difficult terrain. Now we could concentrate on that. Ethiopia had a strain of smallpox that did not have high death rates and so you can understand that they were less interested than a country like India.

In India, 30% of people getting smallpox would die. In Ethiopia, it was just one or 2% would die and so you can see why it would be difficult to get their interest. Now that they were the last country in the world, a lot of people put a lot of resources, even bringing in helicopters in order to finish Ethiopia. Ethiopia finished and people started celebrating that this was now the end of smallpox in the world, only to learn that in that last week of smallpox in Ethiopia, it had somehow migrated from there to Somalia.

Somalia was a difficult country, always at war internally, not a safe place to work, but now we had to concentrate on Somalia. It took several more years to finish Somalia. Then that was the end of smallpox in the world. We thought. What happened next? There was a case of smallpox in Birmingham, England that came from a lab and it infected a woman that worked in the story above the lab. She was a photographer. She ended up in the hospital and they had some trouble making a diagnosis at first because no one was actually suspecting smallpox and she eventually died.

Her father came to the hospital, had a heart attack and he was admitted as a patient and he died. Then her mother got smallpox, but her mother recovered. That turned out to be the end of smallpox in the world, but it took that odd twist at the end. When you think that the answer to smallpox started in England in 1796, and now the last case in the world ends up in England also, the irony of that is really something.

Lucas Perry: The Birmingham case is because there was smallpox in the lab and so there’s this distinction we can make between the last naturally-occurring incidence of smallpox and the last lab escape version. I wasn’t aware of this less fatal variation on smallpox that was in Ethiopia and Somalia. I thought I heard somewhere that the last case of maybe the more fatal version was in Southeast Asia?

William Foege: That’s correct. In Bangladesh. On the 30th anniversary of smallpox eradication in India, I was invited back to give a talk, which I did and met that last case. She was now a mother and her husband came, who was a farmer in Bangladesh, and so for me, it was a nice completion of the circle to meet her.

Lucas Perry: That concludes the first portion of my conversation with Bill Foege. Now I’m happy to introduce my conversation with Michael Burkinsky as well as Victor and Katia Zhdanov. I’m really happy to have you guys here. I’m really grateful for this opportunity and to be able to learn more about your lives and the life of Viktor Zhdanov. Could you guys just start off by explaining the family structure and we can also have you introduce yourselves?

Michael Burkinsky: I’m a stepson of Viktor Zhdanov. My mom married him when I was about 11 or 12. We lived for some time before Victor was born, so Victor can say a little more about what he remembers.

Victor Zhdanov: Well, then I was a little boy, because I don’t remember much, but my memories maybe start when I was five years old or four years old. Every weekend we went to our country house from Friday to Monday morning or to Sunday evening, then went back. Then I went to school.

Katia Zhdanov: That’s all you remember?

Victor Zhdanov: Almost.

Lucas Perry: Victor, when were you born in relation to when Viktor Zhdanov was introduced to Michael’s life?

Katia Zhdanov: Victor is 15 years-

Victor Zhdanov: 15 years, actually. Yeah.

Katia Zhdanov: … younger than Michael.

Michael Burkinsky: Right. It was probably three/four years after my mom married Viktor Zhdanov. Yeah.

Katia Zhdanov: It was second marriage for both of them. For Victor’s dad and Michael’s stepdad and Victor’s and Michael’s mom.

Lucas Perry: Right. Your mother’s name is Elena?

Katia Zhdanov: Alissa.

Michael Burkinsky: A-L-

Lucas Perry: So your mother’s name is Elena?

Katia Zhdanov: Alissa.

Michael Burkinsky: A-L-I-S-S-A. Elena is her name in the book because she wrote this book as if it’s fictional, but all these people there who have different names, they are real people.

Lucas Perry: Hey, it’s post-podcast, Lucas here. The book that Michael is referring to is by Viktor Zhdanov Sr’s wife. It’s titled Viktor Zhdanov, My Husband, Elena Tatalova’s Diary. It covers much of his life from her perspective and gets into a lot of the events surrounding smallpox and the eradication efforts. All right. Back to the episode.

So Alissa and Viktor Zhdanov the father, they had a similar intellectual and professional background. Could you explain what that was?

Michael Burkinsky: Alissa was a scientist in the Institute of Virology and Viktor Zhdanov was the director of the Institute of Virology. My mom worked on Influenza and Viktor worked on different viruses including influenza so they had some common interests, but the main thing is that they were both very virologists.

Victor Zhdanov: That’s how they met.

Lucas Perry: Both of you have also studied medicine, correct?

Victor Zhdanov: Correct.

Lucas Perry: Could you explain to me what your personal relationship is like with medicine and biology now and throughout your life?

Michael Burkinsky: Well, I pursued a career in medicine and biology, and specifically in virology. Victor switched to a different area.

Victor Zhdanov: Yeah, I prefer business actually. From the very beginning I was in business.

Michael Burkinsky: He went to medical school mostly not to disappoint.

Katia Zhdanov: The parents.

Victor Zhdanov: Correct.

Lucas Perry: Okay. I see. So let’s stick with a bit more about your personal experience growing up in the family and what Victor and Alissa was like before we get into the actual work on eradicating smallpox. So I will start with you Michael. You were 12 at the time that Viktor Zhdanov was introduced to your life. What are your earliest memories and what was it like growing up with him and having two parents that were deeply embedded in quite academic scientific fields?

Michael Burkinsky: When my mom married Viktor, he was actually the Director of the Institute, so immediately I felt that he is a little bit far away from me in terms of his position. He was really a senior boss in terms of his social position and the stuff, he had a personal car for example, and in USSR at that time, a personal car was a sign of really very high position and stuff like that. So I was kind of scared of him in a sense. In the beginning, I didn’t even know how to call him, so I didn’t call any name. And then he started to kind of making contact with me, I guess, showing that he is not really a high above person, but a normal guy. He went with me to children’s shows for example. Of course, we went together to the country house as Victor has said, and basically it started some kind of relationship.

In the end much later of course it was really pretty close, especially when I started working this virology field. But that was much later. He tried very hard to make my life comfortable. For example, when I was in senior classes in school, of course, as all kids do, you need some money to go places and stuff like that, and he never rejected. He would always give me whatever I asked for. Although I should say that he was very focused on his work, and the science, and business relations, so he didn’t really have much time to talk to me and to spend with me. His days were extremely busy. He woke up early, went to work, came back late in the evening. And still after coming back, we had probably some meal together, but then he was again sitting down to write his papers, books, and stuff like that. So there was not much opportunity to communicate with him unfortunately. This is I think a big thing that we all missed.

So that’s how it was in my childhood. But after then, the time came for me to choose the career. He was instrumental in deciding which school I should apply to. He helped me a lot with preparing for my exam to medical school, and it’s mostly because of him that I got into this medical school which I graduated from. He was really the key person who helped me with all my appointments, and a place to do my PhD studies. He actually advised me where to go because he knew all these paths and places. My mom also knew of course, but he had much more influence on me in terms of selecting the career path. And then the final input from him was choosing this HIV research as a career and that was exclusively due to him that I started this career path. Without him I probably would never do it.

Lucas Perry: This Institute of Virology, was it started by your stepfather, Michael?

Michael Burkinsky: Institute of Virology was the main virological research Institute in Moscow and in Russia in general. It was organized sometime before Viktor Zhdanov became the director, but it really flourished after he became the director. It became really a well-known place for research, not only in USSR, but all over the world. He was really instrumental in making this Institute well-recognized and known organization.

Lucas Perry: Right. So he later founded a Journal of Virology.

Michael Burkinsky: He founded it, yes.

Lucas Perry: Okay. So you say that he was extremely busy, which is quite easy to imagine. What is the home experience like for you then? You said you’re not interacting with him much. Do you guys have the occasional dinner together? Do you have meals together? What are most of your conversations like? What are some of your favorite memories with him in general?

Michael Burkinsky: Victor may say maybe his experience, but with me, he was not involved in my homework or stuff like that. What I remember very well was meals together because sometimes he came back from work when my mom was not home, and then we had a meal together and I was hungry of course. I remember that he comes and says, “Oh, you’re hungry. Let’s make some food,” and he started cooking. And this was really funny because his cooking was really a thing of, he could boil sausages, and then use the same water to make tea. He didn’t pay much attention to these kind of details and this was more of a formal thing. You need to eat, you need to drink and do we’ll do something, and that’s what it is. He just looked at it very utilitarian.

Lucas Perry: So what was it like eating that food?

Michael Burkinsky: Well, I ate sausages. I didn’t drink the tea that he-

Lucas Perry: You didn’t drink tea water?

Michael Burkinsky: Yeah. I thought that that’s really inappropriate. And I remember that sometimes funny things happened, like we had dogs at the country house and he sometimes cooked porridge for the dogs and then he could use the remaining of this porridge to eat himself. What he loved really was science and stamps. Those were his two hobbies, Science first and stamps second. And that’s what he loved. He had a great collection, one of the biggest in Moscow. All the other things were really kind of secondary.

Lucas Perry: So you didn’t think you would be doing HIV research if it weren’t for him. You’re currently at George Washington University, yes?

Michael Burkinsky: Yes.

Lucas Perry: And you’ve focused your career on HIV. You have many publications and many citations on that subject. What was his role in that decision, and what were his reasons, and what was his guidance?

Michael Burkinsky: Well, he was really instrumental here because at that time the epidemic had just started and it started in US, and in USSR, there were occasional cases, very few cases, but he envisioned that this would become a big problem for the world. And besides the virus itself was very interesting. It was a new virus that was discovered so he envisioned that this will be really a whole new area of science in a sense. And he told me that’s probably what you should try to do, and that’s extremely interesting and potentially very important. That’s what I did, and I started in 84.

Lucas Perry: Do you remember his reasons?

Michael Burkinsky: His reasons were that it is a disease that will really affect a lot of people, on all continents, in all countries, and will be potentially a very serious healthcare problem. That’s one thing. But second is that it’s a very interesting scientific problem also. So it has both things that are very attractive for a scientist, that you do interesting research, and you can discover a new biological phenomenon, and you are helping people.

Lucas Perry: All right. So Victor, what was your experience like?

Victor Zhdanov: Well, as Michael mentioned, my father was a high social position, but he never showed this. He really had his personal car, but he used it only on weekends to get to our country house. He act himself like a usual guy. He was fond of garden, and he was growing tomatoes, cucumbers, some fruits, some salads. That was his third hobby. Besides the science and postal stamps, the third hobby was the garden. All the weekend he spent in the garden. He did it himself. He didn’t hire anybody to develop, but he did it all by himself. During the weekdays, he was really busy and he really, like Michael said, came home very late, and when he came home, he continued working on his articles, and my mother too.

They had two tables standing one to each other, and they were sitting and writing, siting and writing. Articles, articles, scientific books. I felt lonely mostly because not father, not mother almost didn’t have any time to spend with me. The only time we spend together when my father and my mother, they took a break one month in the year and we went somewhere, Black Sea usually, two or three weeks. That was the time when we were together.

Lucas Perry: So you mentioned that your mother was also working on articles. Could you explain what your mother’s position and academic interests were, and what her science life was like?

Victor Zhdanov: Well, she was chief of laboratory in the same Institute where my father was director. She was also professor.

Michael Burkinsky: Yeah. She was teaching at the college for doctors. There was a college where practicing physicians could learn some science.

Victor Zhdanov: Yeah. Upgrade the skills and she was teaching there. That was her second job.

Lucas Perry: Okay. So I guess I’m a bit more interested also on what’s actually in your houses. Are there lots of books? In the diary it seemed like there was all this experiment stuff in the houses, and when it overflowed at one house, that the overflow got moved to the country home. What does the actual house look like?

Victor Zhdanov: We had an apartment in Moscow and the country house was also filled up with the books, with his articles, with the pictures of viruses. Viruses were everywhere, in Moscow apartment and in country house as well.

Lucas Perry: So I’m just imagining an apartment, there’s tons of papers and books stacked, and there are also prints of viruses from microscopes on the walls or.

Michael Burkinsky: There was this office where the tables stood side by side. On the wall near his desk where he was sitting and writing was a collection of his souvenirs that he brought from all over the world, from the countries that he visited at some point. So it was like 50, 60, 70 different souvenirs, just little things that he brought from foreign countries. And he hang them on the wall in two or three rows. This took a lot of wall space. Then there were shelves filled with books and that’s where all their writings went until they overflow and then it was taken to the country house.

Lucas Perry: So Victor continuing with a bit of your life experience there, so your parents are both incredibly busy, you’re going between the Moscow apartment and the country house, is there anything else you want to add about your life experience up until you’re about 18? How do you end up in America? And are there any other funny or interesting stories you have about growing up with your father or any other favorite moments?

Victor Zhdanov:  This lasted for, not 18, he passed when I was 16. I had just finished school when he passed. And then during when I was passing my exams, he died. And my mother and my brother, they didn’t tell me because they told me I need to pass my exams. I was in process of my exams in college. And so they considered that I need to concentrate on it, and only after I passed my last exam successfully, my brother Michael, he picked me up from my exam, and while he was driving me home, he told me this story that my father died and it was already a week or two ago, and so they didn’t tell me this.

Lucas Perry: Was his passing sudden?

Victor Zhdanov: To get the stroke, the stroke was sudden, yes. He had a bad heart. He was ill, but he was still working. And this attack, it came suddenly. He had couple of them before, but they were not that serious as the last one. The doctor was called and he was taken to hospital where he stayed like a week or two and then he died.

Lucas Perry: So as we kind of wrap up on this more personal side of your experience with your father, I guess I just want to offer a little bit of space in case anything else comes to your mind if either of you guys want to add anything before we move on.

Michael Burkinsky: Well, I just want to say that it sounds as if he didn’t pay much attention to us at home because he didn’t have time, or was too busy, and all these things, but he was extremely attentive in terms of if we needed something, he was always there to help. He could throw away his work, and make phone calls, and make arrangements, and things like that. Or whether we had a problem at school, or at the college, and in personal problems, probably not so much. We just didn’t, at least I didn’t really go to him with my personal things too much, but he was an extremely warm person, warm and kind, and tried to help. And I think that he was teared between his main interests, and his feeling of his obligations towards greater human, let’s put it this way, human need and his family interests.

He was an extremely kind, and warm, and helpful person. And maybe he didn’t express it too much but now I realize that he really was.

Victor Zhdanov: Michael mentioned that he was the higher social position, but he acted himself like a simple man. For example, he had government car with personal driver besides his own car, but he often went to work using just regular bus. He could eat in restaurants but he ate in the street dumplings place. He also had a lot of friends who visited us, and I and my mother, we were fond of mushroom hunting. In the United States it’s not popular, but in Russia, it’s very popular. Gathering mushrooms in the summer, and he also went with us. There’s some mushrooms, they are with worms. Well, we usually throw away these mushrooms, but he did say that they’re also edible. And he marinated, and then when his friends came, he put these mushrooms on the table, with some worms on the button.

Lucas Perry: Wait, what?

Katia Zhdanov: Because he was very high position, his friends or people visiting him, they couldn’t-

Victor Zhdanov: Refuse. They couldn’t refuse eating it.

Katia Zhdanov: They couldn’t refuse.

Lucas Perry: That’s hilarious.

Katia Zhdanov: So they would actually eat it. But that’s what he did.

Victor Zhdanov: He ate himself as well.

Lucas Perry: Did he remove the worms from the mushrooms?

Michael Burkinsky: No. The worms were there. People didn’t have to eat them of course. But they were there, and you could just put them aside.

Victor Zhdanov: His friends called it mushrooms with meat.

Lucas Perry: Okay. So they knew that it had worms in it?

Victor Zhdanov: Of course, of course. And he knew, but everything was marinated, and worms also. And he ate it himself. He didn’t eat the mushroom that we prepared with my mother, he prepared himself and ate his own mushrooms, and also his friends.

Lucas Perry: Oh, that’s hilarious. That’s a really good story. Thanks for sharing.

Between the mushroom worms and the sausage water, did you guys have anything else like that before we move on? These are pretty gold.

Katia Zhdanov: They keep saying that they didn’t spend much time with the father but Victor told me some stories, like his father bringing him some presents from different countries, which was very rare. Back in USSR bringing in something from out of the country, it was really exclusive. So, and also the car that your cousin?

Victor Zhdanov: I wouldn’t say cousin, Michael’s wife’s brother, we’re the same age approximately. My father was teaching me to drive the car when we were in our country house. Starting from, I think then he was teaching me to drive the car so I was driving. And once we took the key and stole this car.

Katia Zhdanov: They decided to go for a ride without [crosstalk 00:48:22].

Victor Zhdanov: Little bit, little ride like maybe 500 meters back and forth-

Katia Zhdanov: Without letting the adults know that they’re taking the car.

Victor Zhdanov: And then we got stuck in the woods for an hour and they were all searching for us. We were afraid to come back and say, “We’re stuck in the woods because we cannot move the car.” And finally a group of tourists helped us. They pushed the car out of the mud and then we decided, they’re already searching for us, they’re already angry with us, let’s go ride for the highway. And we went to highway and I remember I was spinning like 80 miles.

Katia Zhdanov: And you were 10?

Victor Zhdanov: I was I think 12.

Lucas Perry: Is that how fast you’re going, or how far you went?

Victor Zhdanov: How fast.

Katia Zhdanov: How fast.

Victor Zhdanov: It’s really fast for me, for a 12 year old boy.

Lucas Perry: Yeah.

Katia Zhdanov:And obviously when they came back, the parents already called the police so they were already searching for them. So you can imagine they got in big trouble.

Victor Zhdanov:Father didn’t talk to me for several days after that.

Lucas Perry:Wow. Yeah. Thank you for sharing all of these. Let’s pivot here into a bit of the more narrative story of the actual smallpox efforts. Where do those smallpox efforts start? And then it’d be great if you could take us through how Viktor Zhdanov was involved in the efforts for smallpox eradication and what his role there really was.

Michael Burkinsky:So smallpox eradication started in 68 so this was quite a long time before my mom married Viktor Zhdanov so this was a pretty long time before the things that we discussed so far. It started when Viktor Zhdanov was a Vice Secretary for Health Affairs in USSR. At that time, he was not really doing science. He was an administrator and he was a high level administrator. He introduced today’s program of eradicating smallpox using vaccines to the Assembly of World Health Organization in 68. And this was accepted and it took about 10 years, I believe to eradicate smallpox all over the world. So in 78, this program was completed. I only know about that from records and I didn’t have any personal experience with that part of his career. He spoke about it occasionally, with us, and with his guests, just remembering about these times, but he never put it as a front accomplishment of his life. And he always thought that he would do much more. Although in the hindsight, it is clear that this was his major contribution to humanity because it really saved in a measurable number of lives.

But after that, he contributed a lot to HIV prevention and the cure efforts to Influenza, pandemic, relief, and many other things which are related to those worldwide pandemics, epidemics, and I think that based on his initial experience during that time of smallpox, that helped him a lot in these future efforts.

Victor Zhdanov: Yes, of course. I cannot tell nothing about his role while I was not born, but I remember that once he returned, I think from Geneva, and he was awarded with the Bifurcated Needle award, he was very proud of it. He proudly put it on the wall or somewhere.

Lucas Perry: All right. So with regards to his actual efforts in relation to smallpox, the central contribution here is convincing the World Health Organization to take up this smallpox eradication program, which then effectively eliminated smallpox from the population. Do you guys have any insights into how he got interested in that or more of the details about his experience leading up to that presentation to the WHO about the need for smallpox eradication, or any of the details of him convincing members of the WHO to take it up?

Michael Burkinsky: Well, this program of smallpox vaccination was introduced in the USSR sometime before this session of the WHO. The program was extremely successful in USSR, and basically the number of infections dropped dramatically and eventually disappeared. So his idea was to expand this to the whole world basically. And what actually put him towards this idea, I cannot say, but he was a physician by training. He gradated from the medical school and was always interested in curing disease, so when he got to a position where he could influence world health, I think this was logical for him, natural for him to try to implement things like this program that would cure and eliminate the scourge, the smallpox, which was killing millions of people.

He was always, during his whole life as I remember, very interested in approaches to cure and eliminate infectious diseases, whether we talk about smallpox, polio, influenza, hepatitis, he was involved in many, many different diseases and infections, and specifically in viral infections, of course. And I think that that was very natural of him to propose this vaccination and a smallpox elimination program.

Lucas Perry: So something significant that you mentioned was that Russia already had a program for widely vaccinating the population against smallpox.

Michael Burkinsky: Correct.

Lucas Perry: And so perhaps that served as some kind of example of what should be done for the global community.

Michael Burkinsky: Absolutely, yes.

Lucas Perry: Okay.

Michael Burkinsky: His contribution was huge to many different elimination, or cure, or vaccination efforts. In some, he played the leading role like in HIV/AIDS efforts in USSR. In some, he was more in that secondary, like in polio vaccination, but he was actually a friend of Sabin, the author of the polio vaccine, and he invited Sabin to Moscow. Influenza vaccine for example program was one of his main interests because influenza studies were actually the main focus of the Institute of Virology for some time. So he was really instrumental in a number of vaccination, and cure, and other efforts. He was really a great virology figure, not only in Soviet Union, but I think worldwide.

Lucas Perry: All right. Finishing up here, could you expand a little bit on the specifics of what he exactly proposed at the WHO?

Michael Burkinsky: The vaccine scene was present. Scientifically everything was in place. So the only thing that was needed was a cooperation between the countries to implement the vaccination strategy around the world. And this required agreement between the health officials from all countries, and as we know, and we can see it now, with this Coronavirus vaccination, that’s not an easy task. It requires a lot of administrative and medical arrangements, and that requires commitment on the governmental and local levels. He was able to really put it together, basically, to convince all the people present at this meeting to sign the agreement and basically commit to implementing this vaccination in their respective countries.

Lucas Perry: So it’s this massive coordination effort to first of all, implement surveillance of where the virus is, and then containment. To some sense of there being a limited amount of vaccines, and so instead of just giving it to everyone in the world, you find where the smallpox is, and then identify everyone that’s interacted with that person and then vaccinate everyone around there. And so with a limited amount of vaccine, you can effectively stamp out the fire of smallpox by causing a cessation of the spread and so then it dies.

Michael Burkinsky: That’s correct, but it also requires production of the large number of vaccines. Ideally you want to really have total population being vaccinated rather than counting that maybe we will vaccinate half of the people and the virus will kind of disappear. At least in USSR, they vaccinated all children who were born. This was an obligatory vaccination strategy, and I believe this was an obligatory vaccination with a strategy and I believe it was accepted all over the world that that’s the way to do this. You need to vaccinate everybody at least only new born children. Not everybody agreed with this strategy because I mean it’s expensive of course, it’s difficult and it’s not a commonly accepted thing at least especially at that time.

Lucas Perry: All right. So, let’s talk a little bit about your mother and the book which she wrote titled, “From Viktor Zhdanov My husband, Elena Tatulova’s Diary,” sorry for butchering that, diary. You guys mentioned already that this is fictionalized to a certain extent. Can you explain why it’s fictionalized?

Michael Burkinsky: I don’t know. I guess that she didn’t want to put the real names there to avoid potential problems with people being in contempt with her recount and things like that. Although I should say that what is written in the book is pretty close to reality and I can recognize all the characters there. I suppose that that’s one reason and the second was that when she wrote it I think she saw it more as a love story if you want, rather than just a memoir or remembrance of Viktor. She thought that it would be more interesting for readers who do not know Viktor’s down to four people around him and maybe they will be just interested in reading a story in general about a scientist, his wife, and things like that.

Lucas Perry: So I’m going to share some extracts that I liked or found interesting and then you guys can react to them if you’d like, this is a translation from the Russian so it’s not totally perfect right now. Alyssa is mentioning that she found shortly after the death of your father in his journal, this kind of frustration around his work. She finds his journal entry in his office and it says, “I stopped working in the laboratories of course there is an excuse. I’m too busy working as the director but I don’t accept my own excuse. That is laziness inertia, how I hate myself for it. So much effort has been spent in vain and now I have no strength left no time for real science. I did not do what I should have and could have done with my life.” She then goes on to say, “He could have done a lot, move mountains, find a new code of life, invent a cure for all viral diseases but for that, the brash fearless and selfless person that Viktor Zhdanov was should have been born at a different time or place.”

Michael Burkinsky: He was always discontent with himself. He always felt that he should do more and that’s the reason why he was spending so much time at work and writing and he was always thinking that he did not do everything that he could, that’s his nature but he had a lot of obstacles and was always a target for all those people who tried to diminish him, tried to discredit him. The first year was very tough, it wasn’t competition. Competition might be healthy but this was not a healthy thing, it was more of an atmosphere where people used all the means to discredit him. Writing anonymous letters to those administrative organizations, making all this nasty phone calls and this was really unhealthy and difficult situation which definitely prevented him from being more productive and more purposeful.

Lucas Perry: What was the incentives or motivations for people to be disparaging?

Michael Burkinsky: Motivations were he usually either due to his ideas and that was on a kind of regulatory levels. For example, he wanted to establish close collaborations with the Western scientists and empower exchange of people, ideas and things like that and this was against the policy of the government.

Victor Zhdanov: KGB was everywhere at this time.

Michael Burkinsky: That was one of the things, another was his ideas of which people should actually be promoted and demoted and what should be the incentives and stuff like that. That always causes some tensions in particular for people who are in high positions. So if he wanted to promote somebody who was a Jew for example, this immediately caused tensions with the central communist party officials, things like that so there was a lot of regulations that he was fighting against.

Lucas Perry: Yeah. It seemed like somewhere in the journal he’s quoted as saying something like, “Science knows no borders.” So he’s having a conversation with someone who is kind of reacting to this call from him for this global interdisciplinary approach to science and virology specifically. So, here’s another one that I quite liked. It says, “Soon, his conflict with the minister worsened, Viktor with his big sense of humor celebrated our son’s first birthday with an article in an American magazine signed Zhdanov and Zhdanov Jr with thanks to Elena Tatulova for her technical assistance. When the minister found out about this he flew into a rage, can such a frivolous person be the director of a major scientific institute?” He asked. I thought that was quite funny and I think shows a bit of his humor and the juxtaposition between that and the overly strict ministers and bureaucratic figures that surrounded him.

Michael Burkinsky: Yeah he was extremely happy when Victor was born. Maybe a formulate was not the proper thing, but especially at that time, it was not a really big offense.

Lucas Perry: Yeah. I think I’ve got one more here for you it says, “The classification and evolution of viruses was a favorite problem of Viktor, a hobby that he devoted his evening hours to. He worked for many years on the fifth monograph evolution of viruses, which is one of the most voluminous and fundamental monographs on this problem. He believes that the evolution of the organic world and the evolution of viruses as one of the forms of life that went in parallel. Humanity would be different if the evolution of life took place apart from the evolution of viruses.” I thought this was interesting it shows that he’s thinking quite broadly and deeply, I think about the human condition and how it came to be.

Michael Burkinsky: This was his interest from the very early times in his career and he was a member for many years of this society devoted to classification of viruses and things like that. He wrote also several books about viral evolution and its evolution in the context of human evolution. So, he was very interested in this topic. Besides working on specific viruses he also was really thinking globally and widely about viruses. There was a long argument about whether viruses are alive or dead. He was always arguing that the viruses are a form of life, so they definitely are alive. So, that’s how it came up.

Lucas Perry: All right. Is there anything else that you guys would like to finish up on here?

Michael Burkinsky: The only thing that I want to finish up with is that I don’t think he is fully recognized for what he did to the world and to the Russian science and Russian virology in particular. I think that that’s a shame and I hope that this award that he is getting now would actually push people especially in Russia now to consider better his great accomplishments and contributions.

Lucas Perry: Yeah, totally agree. I mean, he played a necessary role in eliminating something which had taken hundreds of millions of lives. For that we’re eternally grateful and I do hope that the award helps to elevate awareness around his contribution and the history of smallpox and global health. So thank you guys so much for coming on and taking all this time to speak with me. It’s really been a pleasure and I’ve really loved hearing all of these fun little anecdotes. So yeah, thank you so much and I’m excited to see you guys at the award ceremony.

Michael Burkinsky: Thank you Lucas.

Victor Zhdanov: Thank you.

Katia Zhdanov: Thank you.

Lucas Perry: And with that, I’d like to reintroduce my conversation with Will Foege. Here we explore the history of smallpox as well as biology in the 21st century. So, I’m interested in getting into the lab side of things and why labs might be holding onto smallpox. I’m also interested here in a bit of the actual history of smallpox so going back maybe a few thousand years. I’m curious if you can give the estimated time at which we think that smallpox arose, how many lives we estimate that it’s taken over the 2000 years that it’s been around and if you could also introduce the concept of variolation and how variolation was discovered and implemented, and then how it led to a vaccine, I think that’d be interesting.

William Foege: Okay. The history of smallpox it goes back thousands of years, but we don’t know how it started or where it started. We do know that Ramesses V probably had smallpox because you can see there’s pock marks on his face and we actually attempted to get specimens to see if we could grow smallpox from the skin lesions that he had. So it goes back a long ways. It for some reason, did not come to the Americas though and so it was a disease of China and Asia and Africa and Europe. But you get some idea of how prevalent it was because Voltaire had smallpox and became interested in it and he estimated in his lifetime that about 60% of all children born in Europe would end up getting smallpox and he said of those 60%, a third of them will die, a third of them will be scarred for life and only a third will get away scot-free with this. So that’s how common it was and you look back and Mozart had smallpox, Mozart’s sister had smallpox.

You saw great changes in the Royal families because of this from smallpox, Louis XV died of smallpox. It was a very common disease. Then Europeans brought it to the Americas and in the Americas there was no immunity. Sometimes with a disease it’s dependent on the individual immunity. But sometimes as with smallpox you always have a bell-shaped curve if some people are more resistant to a disease than others and so if smallpox is killing a fair number of people early on, the survivors may well have some natural advantage and therefore over time you get an immunity in the population. There was none of that in the Americas and so when smallpox came through it was very devastating. We know that the Blackfeet got smallpox even before Lewis and Clark made their visit. So in about the 1790s, there was a severe outbreak that took many of the lives of the Blackfeet. The Blackfeet were the most resistant tribe to having Europeans overrun their territory.

They were great fighters and except for smallpox they might well have kept the United States at bay for a long time. Sometime in history and we don’t know when and we don’t even know how people came across the idea that if you actually took the smallpox virus from the pustule or the sore on a person with smallpox and injected it into the skin of a healthy person, that the death rate was much lower than if they got it through natural means which is through the respiratory tract. I cannot envision how that happened that someone came across that because you don’t know the exposure a person had whether it was through a skin lesion or inhaled you would need a number of people in each category to compare the risk of death. So I don’t know how this developed, but it did and it may have developed in three different places over time in China, in India and in Africa.

We found out about variolation in this country about 1720. It was about this time that Lady Montagu, the wife of the British Ambassador to Turkey, noticed that in Turkey they would take 20 or 30 school children at a time, take them to a remote farmhouse and they would variolate them. That is they would use smallpox virus to inject each child and over the next few weeks these children would get sick. Most of them would then recover without great damage and they could go back into their homes and be immune the rest of their life. The lady Montagu was intrigued by this and she wrote back to England about what she had observed. The Royal family in England then tried that on prisoners and they came to the conclusion that she was right, that you could spread smallpox and you would not have high mortality if you spread it skin to skin. So they tried that on prisoners it worked and they tried it then on their own children think of the leap of faith that they took there.

Well in England, it became an accepted thing to do and people were very elated by the tens of thousands and by the hundreds of thousands and their military was very elated. At just about the same time but by chance, the Boston area saw a smallpox outbreak. Boston only had about 10,000 people at the time but two or 3000 of them developed smallpox and Cotton Mather always a controversial figure, but a good scientist, a good observer noticed that the rate of smallpox was lower in African Americans than in whites. So he investigated, came to the conclusion that the African American slaves had brought variolation from Africa to America and when the first cases of smallpox appeared in Boston they started variolating in each other. So Cotton Mather wrote a pamphlet trying to get the U.S. to do this and it didn’t catch on in the U.S. and I think part of this may be that Cotton Mather was such a controversial figure.

But anyway, if you now go ahead maybe 55 years to the Battle of Quebec during the revolutionary war, the American troops outnumbered the British two to one, and it should have been an easy battle for the Americans. They invaded on December 31st 1775, but a smallpox outbreak decimated the American troops, but the British troops were immune. So the British won that battle handedly and captured a lot of American soldiers and I sometimes say Canadians can thank smallpox for being part of the Commonwealth rather than part of the United States. But George Washington understood what had just happened and so he with his advisors talked about, we need to variolate American troops in order to have equal immunity to this disease and they did it very secretly because they were afraid if the British knew they were doing this that’s when they would attack and he was successful in variolating the American troops and so as the revolutionary war headed south from New York down to Washington and down to Williamsburg and so forth, we now find that health-wise the British troops and the American troops were much more equal in their ability.

So I think this may have been the single most important tactical decision that George Washington made during the revolutionary war. So the idea of variolation, it comes from Variola which is the word for smallpox, vaccination comes from vaccinia the virus that’s used for vaccinating against smallpox and so you have all this variolation going on, but now in 1796, Edward Jenner is asked by his mentor Hunter to try to figure out what it is that is happening with the spread of smallpox. And we’re told that a milkmaid had mentioned to him, “I’ll never get smallpox because I’ve had cowpox.” And he decided to study what happens during outbreaks for milkmaids and he actually studied this for 12 years so it wasn’t something he did on the spur of the moment and he came to the conclusion that yes milkmaids were in fact immune, if they had ever had cowpox. Now cowpox is a self-limited disease of the hands of the milkmaids. It’s not something that they get systemically.

And so in 1796 in the spring, he finally did his big experiment where he made cowpox go from Sarah Nelms, a milkmaid to a boy James Phipps and then he later exposed James Phipps to smallpox, but James Phipps was immune. So that was the beginning of that structure. Now it took several years before he published for a number of reasons, but Thomas Jefferson was one of the first people to understand the significance of this and he was able to get smallpox vaccine through Benjamin Waterhouse in Boston and Thomas Jefferson went back to Monticello and vaccinated his household and his slaves and surrounding households so that they had immunity and then he wrote a letter to Edward Jenner and he said, “Future generations will know by history only that this lowsome disease has existed.” And of course he was right. It took a long time to reach that point but then vaccination took off around the world.

But even with it being used around the world there were plenty of people who didn’t get it, which explains why Abraham Lincoln got smallpox while he was president. So this is over 60 years after Edward Jenner had discovered the effect of cowpox and Abraham Lincoln had not had it. We only have one picture of him at the Gettysburg address and it’s at such a distance you can’t make out any real detail. But we’re told by reporters that he looked very haggard and he was because he was coming down with smallpox at that time. They put him on the train, he got back to Washington DC early next day, one or two in the morning, went to the white house and that’s where he stayed for two weeks. But the person taking care of him on the train developed smallpox from him and went on to die. So as late as the 1860s, it was still a major problem in this country and we had our last cases in 1949 due to an importation from Mexico.

Lucas Perry: So initially we’re variolating and then there’s this insight about the relationship between cowpox creating immunity to smallpox. Is that the vaccine or is that just a new kind of variolation?

William Foege: That is the vaccine.

Lucas Perry: Okay. That is the vaccine.

William Foege: That’s right and recently,and I’m talking about just the last year or so, the history of cowpox virus has been elucidated so that I think now it’s actually horsepox virus that we’re using and it was horsepox virus that went to cows and moved from cows to humans and then from humans became the vaccine. So that the vaccine we use today is not cowpox it’s something called vaccinia and it’s probably related to horsepox different than we expected at the beginning.

Lucas Perry: Okay. I see. And so, what is the difference in efficacy between variolation and the vaccine? and what are the risks?

William Foege: With vaccine it’s a very good immunizing agent and if you use potent vaccine, you should get a take rate or immune response in 95% plus of people so it’s very good but it was also a very unsafe vaccine in the sense that in this country we were losing seven or eight people a year dying because of the vaccine itself and so it’s the most dangerous vaccine that we’ve used. The vaccine was so dangerous that in the early 1970s, in this country we stopped using it routinely even though there was still smallpox in India, Bangladesh, Pakistan, East Africa, we stopped using it because we had come to the conclusion we were so good at containing outbreaks that even if we had importations we could contain them with fewer deaths than if we continued to vaccinate. With variolation, if you’re using a good virus and I’ll say in a minute why you might not be using good virus, it should have been about the same that you would get a take at most people, but it was dangerous, like maybe a one or 2% mortality, so much higher than the risk of vaccine itself.

But in West Africa we found a group of people called Feticheur . They made their living on consulting with people who had smallpox and this was basically in an area that is Western part of Nigeria in what is now Benin into the Eastern part of Togo and if people had smallpox they came to the Feticheur and the Feticheur would give recommendations to the patient on what to do. It was a thriving business because if the person died, all the Feticheur had to say is I told him what to do and he wouldn’t do it. But if the patient lived the family was so happy that they would give gifts to the Feticheur. But the Feticheur had learned that they could start outbreaks whenever they wanted to. They would take scabs from the people that they were seeing and they would keep these scabs in a bottle, in the coolest place they could. And those scabs would last for weeks or months.

And then if smallpox disappeared in the area they would make a paste with those scabs, put the paste on thorns and put the thorns on the inside of doorways and so that people going through some of them would inevitably get scratched and some of those would then get smallpox and that would start a new outbreak and continue their livelihood. In those cases, there was a point where you could not have viable virus anymore so that would be the equivalent of variolation but with low take rates. I should add that I spent a day with a Feticheur, I wanted to know what it is he knew about smallpox? What did he do in order to treat people? and why did they get smallpox? and his explanation was that they had all sinned, they’d done something wrong and this was the divine retribution for what they had done wrong. So I asked the question, “Well, what about children with smallpox at six months of age? What did they do wrong?” and they very quickly came back with the fact that the parents had done something wrong and so this was the equivalent of original sin.

Lucas Perry: Yeah. So what was the death rate of the actual vaccine? So you said seven people died from getting vaccine in one year. So it’s like one in a million or something.

William Foege: It was probably less than one in a million because we were probably vaccinating several million newborns at that time and also vaccinating a certain number of adults who had never been vaccinated before probably close to one in a million but very low compared to variolation and very low compared to what happened if people got natural smallpox.

Lucas Perry: Compared to the vaccines that are normally distributed today, how does that compare? What is the death rate of a random vaccine we’re given today?

William Foege: Smallpox was by far the most dangerous vaccine that we use. Vaccines have not only been quite safe, they’ve been getting safer all the time. For example, maybe the second most dangerous vaccine was for pertussis. Over the years you did not use pertussis vaccine in adults because they got such severe reactions. But now they have developed pertussis vaccine to a point where it does not have such severe reactions so most of the vaccines are just incredibly safe today and we have very few people who die from the routine vaccinations. You still have a few problems with encephalitis or other things, but they’re so safe it’s just unbelievable and compared to the disease, the vaccines are extremely safe.

Lucas Perry: Okay. And then you said that sometimes the virus might not be good or for example, in the case of those people in Africa who were intentionally infecting people to make money, maybe the virus wasn’t good for some reason.

William Foege: That’s correct because the virus dies over a period of time and the virus dies fastest with light and with heat and so in Africa you have trouble actually keeping it cold. If they kept it in a freezer it would last for years but they were finding the coolest place, a good underground as cool as it could be, but it would eventually go on to die so you can’t under those conditions keep a virus living for an extended period. With the last case of smallpox in that area, Feticheurs came from all over trying to get scabs and that poor person was just denuded of scabs, but they were not able to pass it on after that and so it died out and the Feticheurs in general went to chickenpox where the survival rate was so great that they’d look good, but they no longer had a business with smallpox.

Lucas Perry: And so when they took the thorns and put them on the inside of doors to scratch people, I mean the point is that that was basically variolation right. Why does that infect people?

William Foege: Because if enough people go through that doorway and enough people get scratched and if the virus is still viable, someone is going to end up getting smallpox and then that starts the chain again.

Lucas Perry: Oh. So variolated people can spread smallpox?

William Foege: Exactly and that’s why they would keep the 30 children at the farmhouse in Turkey until they’d all recovered.

Lucas Perry: Okay. That’s the missing link, obviously with the vaccine, you can’t spread it when you get vaccinated.

William Foege: That’s right. Now there are cases of people spreading the virus from the vaccine to someone else and you can see how that would happen with vaccinia that was on the arm of the person and they touch that and then they touch someone. Vacccinia is not good for people who have eczema. For instance, people with eczema were usually excluded for vaccination programs because the virus could then spread in the area of eczema and cause real problems. So you couldn’t get some spread of vaccinia virus but it was not that common.

A virus is a curious organism it cannot reproduce itself and so the only way it could reproduce is to get into the cell of a person or an animal or a plant and they’re all very much attuned to certain species in certain plants that the nice thing about smallpox is it does not infect other species and so that’s why it was possible to eradicate it. If had been a virus easily spread among other species as yellow fever was, there would have been no chance of doing eradication. The vaccine is made up of vaccinia virus and it is a little bit obscure what that virus really is but it appears it came from horsepox to cowpox into humans and mixtures along the way finally ended up with vaccinia which is the vaccine that’s used around the world.

Vaccinia, which is the vaccine that’s used around the world. Now, one of the things that they had done over the years, in India they used what was called a rotary lancet. And it was spikes around a central core. They would dip it in vaccine, put that on the skin and then spin it and you’d get a big sore because their feeling was it increased the chance that the virus would actually take. And just to be sure they would do this on three different places. So if they were using vaccine that was good, these people would end up with horrendous scars. If the vaccine was not good, they wouldn’t end up with anything. So the reason they were using it was because they were not getting a 100% take rates. And the reason for that was because the vaccine wasn’t good, not because they weren’t doing enough scarification of the skin.

Lucas Perry: Okay. And I guess one last question on this is, what makes a good vaccine?

William Foege: A good vaccine fools the immune system to think that it’s seen the disease itself. And so you give something to them that can not cause disease, but the immune system doesn’t know that. And so it develops antibodies against that disease. You also want to use something that does not end up causing encephalitis or causing other problems. And so it takes a lot of experimentation in the past to come up with the right kind of vaccine. They would actually put this virus through many, many passages in animals and each time try it out on someone to see how toxic it was before they could get a vaccine that would work. Unlike this year, where we see science just going ahead and inserting pieces of nucleic acid rather than a virus itself.

Lucas Perry: Right, so using CRISPR for example, to extract some smaller strands of information that would replicate some important feature of the virus?

William Foege: And what they’ve developed, and there are over a 100 vaccines under investigation some place in the world, just in the last year for this one coronavirus. And most of them are trying to put a cap on those spikes. Now, the virus itself, if you’ve seen pictures, those spikes are all around, which means if you want to put a cap on each one of those spikes, you have to ask how many viruses are in the body? And you know, it might be a million or more, how many caps do you need in order to protect against a million of these? So it’s quite a production that the vaccine is attempting to get the immune system to do, to provide enough of these caps to neutralize all of the virus coming in.

Lucas Perry: Yeah, wow. So let’s pivot into COVID-19 and the 21st century in the moment. Wrapping up here on your experience in this history, I want to ask you about any interesting personal stories that you’d like to share, anecdotes about your travels or important or beautiful or meaningful moments that you had, your adventures in global health. Anything you’d like to share?

William Foege: One of the things that comes back to me frequently is at the memorial service for Jonah Salk, which was held in San Diego at the Salk Institute. They invited a man by the name of Charles Meryon from France. And he had been a great friend of Jonah Salks, but he gave a talk about what has happened to vaccines over the years. And he said, “It’s a family, the vaccine family. And it started in 18th century with Edward Jenner in England. It went to France in the 19th century with Louis Pastore. And it went then to the United States with Jonah Salk in the 20th century.” And he talked about how this line continues on now with more vaccines.

But as he was talking, the thing that went through my mind is I had once been at his home in France. And he showed me a picture that he had on the wall, and he said, “This is my father working in the lab.” And he said, “You have any idea who the man is next to him?” And I said, “No.” He said, “That’s Louis Pastore.” Louis Pastore once made a trip to London and in a talk he suggested to honor Edward Jenner. “Why don’t we call all immunizations vaccinations?” Vaccination technically is giving vaccinia virus to someone, but he said, “Let’s honor him by calling all immunizations vaccinations.” And he said, “Why don’t we call all immunizing agents vaccines?” And so that’s why we use the words vaccination and vaccines. Well, as he said this, then I realized I was seeing right there the entire history of vaccines in this world, because it was Edward Jenner with that first vaccine that really started modern public health.

Up until that time, public health could make suggestions about what to eat and so forth. But now for the first time there was a tool that could be used to improve someone’s health. And it took some 60 years before we went from that tool with smallpox to Louis Pastore and his vaccines in the 1860s. And that’s about the same time we started to understand germ theory and the fact that there were bacteria, that there was a world we couldn’t see. But then in this country we saw a number of ships.

And I often tell students about Pearl Kendrick. She worked for the Michigan Health Department and in the 1930s with another woman, they developed pertussis vaccine. When she died, which was about 1980, the Dean of the School of Public Health at the University of Michigan, fellow by name of Bill Remington gave a talk and he said, “There are hundreds of thousands of people alive today because of Pearl Kendrick.” And he paused, and then he said, “Could you name one?” He said, “I can’t either.” And he said, “That’s why no one has thanked her.” But he said, “She was so secure in the knowledge of what she had done, that she didn’t need to be thanked.”

And that’s the story with vaccines. No one ever thanks the people who develop the vaccine because they didn’t know they were supposed to get the disease. The next big step was when Jonah Salk developed the polio vaccine, because the fear of polio was palpable around the country when I was growing up. And in April of 1955, there was a press conference at the University of Michigan, and his mentor, Tommy Francis was able to announce that the vaccine was safe, potent, and effective. And with that journalists poured out of the room, trying to fight a telephone and we had reached a new era of science.

A couple of weeks later we reached a new era in the social use of vaccines, because people started demanding the government do something with this new vaccine, the secretary of HEW, Mrs. Hobby, was against socialized medicine and so she had said, “There would be no increase in socialized medicine in her watch.” But now people were demanding something. And Eisenhower told her to come up with a plan. So she said she would seek an appropriation to buy polio vaccine for poor children. Senator Lister Hill then had a press conference. And he said, “No child in this country will have to declare themselves poor in order to be protected.” And he sought an Appropriations to buy vaccine for all children in this country, both citizens and non-citizens. And this was the beginning of the immunization program in this country that still goes on today with the federal government buying the vaccine saying, “This is both for personal protection and for social protection.”

But then after that came a fellow by the name of Maurice Hilleman. I gave two talks on Maurice Hilleman while he was still alive that he attended. The first one I introduced him to the audience and I said, “This is the Louis Pastore of our time.” The second one I introduced him. And I said, “Last time I said he was the Louis Pastore of our time, but I was wrong. He is the best vaccinologist the world has ever seen.” This man alone produced 30 vaccines for humans and for animals. And most of the children of the world now have his social DNA in their immune system, because they’re protected with vaccines that came out of his mind. And so that’s the history of vaccines. And that’s the foundation of public health today, the vaccines.

Lucas Perry: One person who I’m also interested in, if you could say a little bit about, would be Larry Brilliant and his role in the smallpox eradication?

William Foege: First of all, in India, India developed a team that was so incredibly good that I have said, “You could search the world and not find a better group of people.” Dr. Diesh, Dr. M. I. D. Sharma, Dr. Mahindra Dutta, Dr. Arora, Dr. C. K. Rao. I mean, these were exceptional people. And then we had a group of outsiders who became part of this internal click. And Larry was one of them, the real hero I think of the India program was Nicole Grasse from France who was just unstoppable. If she tried to get the ministry of health to do something and they ignored her, she simply wrote a letter to Indira Gandhi and they didn’t ignore her after that. She was such an important person, and so lively. She actually drove from New Delhi back to Paris at the end of the smallpox program.

And I like to tell the story about she and I went to a meeting one night with Dr. Diesh, the Indian who was head of all of this. And on the way back I said to her, “You are very quiet tonight. I don’t remember ever hearing you this quiet.” And she said, “I’m passing a kidney stone.” Well, if you’ve ever passed a kidney stone, you know it’s not possible to remain quiet. It’s not possible to stay in a meeting, but she did. I mean, she was one tough woman. So, there were a group of outsiders, but she was the person from the outside that is really credited with having made this program work.

Lucas Perry: So let’s pivot here into the present day. You’ve spoken publicly about COVID-19. Given all of your experience, especially in the 20th century with smallpox and global health. How do you reflect on the current COVID situation and the problem of disease, both artificial and natural in the 21st century?

William Foege: First, we have a new disease approximately once a year, whether it’s Lassa fever, Ebola, Zika. We’re faced with new diseases all the time. What’s interesting to me is that most of them, maybe three quarters of them involve an animal and some of them an animal and a vector. And yet we have not globally figured out how to really do surveillance on animals and humans simultaneously. We do it ad hoc with each new problem that involves an animal, but we have not progressed to the point where we have a true disease surveillance system that would include everything.

Another drawback is with each of these, we worry and figure out what’s going on. And some of them are big problems, like Ebola. Ebola was never a risk really to the United States, but it caused great fear in the United States. And we did have a few cases that came in from people who had worked in West Africa. But each time we have a problem like that, people say, “We need to improve the infrastructure of public health. States and counties need the resources to be able to continue looking for these things, doing surveillance and so forth.” Each time when the disease problem goes away, the funding goes away, and it happens with repetition. So I was asked yesterday, “Won’t this be different? That the coronavirus is so scary and it has taken such international attention. Won’t it be different this time?” And one can only hope it will be different, but based on history, I don’t think it will be. I think once this goes away, we’ll be back to doing things like we’re used to doing.

Now the other thing that bothers me considerably is that we have come up with a lot of lessons over the years on how to handle pandemics and outbreaks and epidemics and so forth. Almost every lesson that we’ve learned has been violated with coronavirus in the United States. It is so disheartening that the idea of knowing the truth, which is the basis for being able to do something about any of these problems was not followed. We didn’t know the truth. We had trouble finding the truth because the truth kept changing and people would undercut each other by saying things. It used to be you could go to CDC to get the truth. Now we found ourselves going to journalists and to Johns Hopkins to try to find the truth. We learned in the past that you need effective coalitions. And that these coalitions start with a federal coalition. You have to have a national plan.

And instead, in this country we have 50 states competing with each other for resources. For trying to figure out the best strategies. For coming up with, “When should we close things? When should we open things? When should we let children go to school?” So the whole idea of a national plan has not been used. The idea of coalitions and which ones actually work we’ve just ignored. The idea that the best results are found with the best management we haven’t used. The fact that we’ve learned from the past you have to do these things on a global basis. And instead we find the U.S. trying to pull out of WHO. So it’s been very disheartening to see the response that this country has made to coronavirus.

Lucas Perry: You talked a bit about human biases. And so there’s a bias for example with risk, that if a risk just happened, we’re unlikely to actually make the relevant changes and investment to mitigate that risk in the future. But there’s also this bias you’re talking about here, there’s this fracturing of American opinion on who counts as the experts, and also what should be done in relation to a virus of this type. In other pandemics in history, are there anti-mask people or anti-do something about the disease people? Or is this just a new thing?

William Foege: Is not a new thing. And incredibly it developed very fast after Edward Jenner published his paper on cowpox protecting against smallpox. Pretty soon there were cartoons showing cows coming out of the arms of people that had been vaccinated. So the anti-vaccination movement started just as soon as we had vaccines. The risk that you talk about is an interesting concept, because people will take great risks if they think that they are involved in some control of those risks. For example, we take great risks every day in cars, and we know what the risks are, but we feel in control. But we will not take great risks if we think that the government is imposing this on us. And so you have people arguing about fluoridation and that we shouldn’t be doing that.

With coronavirus people felt helpless at the beginning, which is part of why you saw toilet paper sales go up. It was one way of trying to get some control. We became very concerned when we would see a 1,000 deaths a day to coronavirus. For years we’ve had a 1,000 deaths a day in this country due to tobacco, but people have just accepted that as they’re in control, it’s a risk that they’re taking themselves and therefore they accept it. So the idea of risk is very important in this. And with coronavirus, we have so many people telling what the risk is in different ways that no one’s quite sure what the risk really is.

Lucas Perry: This particular bias is really, really, really, really important. And if humanity makes it through the 21st century, I think a lot of work has to be done to specify what the specific constellation of irrationality and biases here and how it is that you can remedy that. It’s some strange mixture of competing needs. Like human beings have a need for safety and also a need for autonomy, right? And so we have more than half of the country that feels that masks are a good thing and that some stuff should be shut down. And other people who think that that is some kind of unjust imposition on autonomy. And it also makes me reflect, I mean, imagine if this had been terrorism, how many Americans have died so far, like almost 200,000?

William Foege: Over that. It’s nearing 300,000.

Lucas Perry: Okay. So imagine that 300,000 people had just been killed in some kind of terrorist attack. People would be going absolutely crazy. We would have mobilized the entire army yesterday. But this bias is so strong that we’re taking all sorts of irrational risks all the time, because we feel like we have control over them. And it’s probably the definition of insanity. Do you have any more insight here about what this bias actually consists of? I mean, I really appreciate that you made this distinction here between risks we feel are controlled or in control and ones that are not?

William Foege: This is a little bit to the side of what you’re asking, but I often think about Will Durant saying, “The only way the world will get together is if we feel or fear alien invasion and then we’ll do something.” Well, I think coronavirus is a surrogate for an alien invasion. I think smallpox was a surrogate for an alien invasion and that we all felt at risk. Even if the United States had not had a case since 1949, we knew we could always have an importation. That’s why it was possible for the Soviets and the Americans to work together during the Cold War, because we saw this as a shared risk. And I think with coronavirus, if we saw this as a shared risk, instead of having competed, and instead of saying, “We’re going to leave the WHO,” we could still use this as a surrogate for an alien invasion.

I was on a committee with the National Academy of Science on vaccine allocation. And what we suggested is with the very first doses of vaccine produced in this country, we should be giving 10% to the global program to make it clear that we see ourselves as part of the global solution, not just that we’re going to take care of ourselves. And GAVI, which is the Global Alliance for Vaccines and Immunisation has more experience now in immunizing than any other group. And they have a good plan for how to do the world, but we have to from the beginning say that we’ll be part of this and give vaccine. But we should also be using global warming and all of the other problems we have as deliberate surrogates for an alien invasion so that we can say, “This is how we work together as a world.” That’s what happened with smallpox.

Lucas Perry: I mean, I think that the alien invasion thing really captures the imposition of an outside force, which is that difference between control and not control. Like if I want to take the risk of smoking cigarettes, which is far more dangerous to my health than something else more benign, but the other thing is being imposed upon me. That difference between the imposition and not kind of hacks our brains into doing things that are not in alignment with our values of health and longevity and well-being.

William Foege: And it’s incredible that this has become a political issue. That whether you would take public health actions or don’t depends on how you view things politically. What we should be thinking about is how public health and politics has always intertwined. So why did it get so separated here? I mean, I think of the fact that everything we do in public health, or most things we do in public health are actually funded by the government. And so by definition, they’re the ones that decide on the appropriations and there shouldn’t be this kind of separation between politicians and scientists. So something happened here that was not precedented. We have to be sure it doesn’t happen again, and we have to figure out how to heal it now.

Lucas Perry:If the United States and the global community were to take the appropriate reaction and to learn what we needed to learn from COVID-19 and were to begin implementing some solutions and safeguards and new programs, what would you suggest we do in the aftermath of COVID to make sure that global health is protected?

William Foege: There are two things that come to mind immediately. We now have 75 years of experience with UN agencies, WHO, UNICEF, World Bank, UNDP, and so forth. And I think we should have a look at how do we wish we had organized. We organized in a hurry without past experience, and now we see a lot of the problems because of that. So we should be asking first, how would we like to be organized in order to make sure things like this don’t happen and are fragmented and dysfunctional in the future? And then come back to a true group of people, elders, if you will, on both sides of every dispute that we’re talking about, asking that question, “How would we do this next time?” The problem with that is, we have no assurance that people will listen next time, just as people didn’t listen to the rules of the last 75 years on how to handle outbreaks. But at least it’s a start to look at this the way we would look at a autopsy of an airplane crash, what should be changed so that this does not happen again.

Lucas Perry: All right. So I think one last question for you here. Let’s talk a little bit about larger size risks. So COVID-19 was about as benign as a disease can be to make the world shut down in terms of its fatality rate. I mean, compared to something like smallpox, which was like 30%. Smallpox serves an example that there can be things that are much worse that might pose something like a global catastrophic risk, or it would kill some large fraction of the population, or potentially even synthetic bio agents, which could pose an existential risk to humanity. What is your thinking and perspective on bioterrorism and synthetic biology? The risk of weaponization of biology, like for example, smallpox hasn’t even been totally eradicated. And we discovered that they were part of biological weapons programs. So how do you view the synthetic side of this in the 21st century?

William Foege:Well, I think the place to start is, what are the things that could actually destroy humanity and make sure that we’re adequately addressing those. There aren’t a lot, but they’re big problems. Nuclear weapons turns out to be one. Global warming is a second one that could actually see the disappearance of the human race. I think synthetic biology is a third one. That people feel so secure in what they’re doing when they move nucleic acids around. But what’s the chance that someone’s going to create something that you can’t control. There are these things that we should be putting a lot of attention on, just because of how lethal they are. Okay, what about bioterrorism? Well, that’s something that’s actually worried me for years. In the 1970s and early 80s when I was director of CDC, we actually started a program where we took every disease and we asked ourselves the question, “What would be the counter to this if it was used as a biological agent?”

And so we came up with plans for every infectious disease. We did this with the FBI, we had secure phones, they had a secure room at CDC. We had people on 24-hour notice that could respond to requests. So we were doing the best we could to be able to respond to a bioterrorist problem. My successor, when briefed on this said, “Oh, this will never happen.” And he closed down the program. So at the time we had anthrax after 9/11, there was no program like that at CDC. I mean, it had to be started from scratch.

That’s the problem with this. You can see ahead of time what a problem might be and try to address it. But then you’re at the mercy of the people that follow whether they think this is a big enough problem to continue. I think it’s worth continuing and looking at what are the bio threats, because probably they’re not going to come from another country. They’re going to come from a terrorist group. It would not make a lot of sense for another country to use this, because how do they protect themselves? And so again, this could be seen as an alien threat, that we’re all at risk of it, and that we could figure out collectively how to counter this.

Lucas Perry: So do you see the proliferation of gene editing technology and the kind of democratization and how that becomes cheaper and more widespread as contributing to the risk likelihood of this over the rest of the century?

William Foege: All of this leads to what people call a cemetery. That you can get a small group of people, or even one person with enough power to hold off entire countries with a threat. And so, yes, I do see these risk and a problem to be addressed.

Lucas Perry: All right. Thank you so much for taking us through the tour of all of your efforts in smallpox and the history of it. It’s been a lot of fun and I really appreciate it. If you have anything else to say, I just like to give you a final space here. Any message for the audience about the future of life or global health or anything like this?

William Foege: The message I give students of public health and students of global health consistently now is, I didn’t understand this when I was young, but some of them should be preparing themselves to go into politics. It’s much more efficient to get public health people in politics then it is to train a number of politicians who will soon be out of office. So they should consider going into politics and bring their public health experience with them.

Lucas Perry: All right. And with that, thank you very much, Bill.

William Foege: Thank you. Appreciate it.

Lucas Perry:If you found this podcast interesting or useful, consider sharing it on social media, forums, with friends, or wherever you think it might be found valuable. We’ll be back again next month with another episode in the FLI Podcast.

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