Time to Get Serious About Public Health

In Sierra Leone, where recent public health campaigns are saving children’s (and parents’) lives.

by Richard Conniff

The PBS/Channel 13 show “The Open Mind” has just aired its interview with me about my book Ending Epidemics: A History of Escape from Contagion. You can take check out the interview here or if 28 minutes is too big a commitment, take a look at the transcript below

HEFFNER: I am Alexander Heffner, your host on The Open Mind, and I’m delighted to welcome our guest today, Richard Conniff. He’s author of Ending Epidemics, A History of Escape from Contagion. Richard, thank you so much for joining me today.

CONNIFF: Thanks. Good to be here.

HEFFNER: Richard, there’s some dispute about whether three years since COVID-19 struck we’re still in what you could call a pandemic. Where do you come out on that?

CONNIFF: Yeah, I think we’re still in a pandemic in the sense that it’s going to come back again seasonally. It’s going to be global, it’s evolving everywhere, and those who aren’t protected, who haven’t gotten vaccinated will be at risk.

HEFFNER: When you titled your book Ending Epidemics: A History of Escape from Contagion, and specifically you identify epidemic, as opposed to pandemic, that was intentional?

CONNIFF: Yeah, that’s intentional. Epidemics are a lot more common. They occur regionally or in individual nations, and pandemics, where it’s the entire world are relatively rare events.

People, especially in this country take for granted our current state of health
and have no conception of the frequency of epidemic disease in our past.

Richard Conniff

HEFFNER: Take us through, in your mind, whether or not the public sufficiently understands that what we encountered in this pandemic was something that for decades and centuries, many strata of society had suffered in what you call epidemics, as opposed to pandemics. Is that fully understood or was that one of the motivations in writing this book?

CONNIFF: Yeah, I don’t think it’s understood at all. It is the reason I wrote the book that is I think people, especially in this country take for granted our current state of health and have no conception of the frequency of epidemic disease in our past and not even in our distant past. So I think I wrote it partly because I’m old. I was born in the middle of the 20th Century, and my father and my uncle both had polio. When I was five, I was in kindergarten. The polio vaccine became available for the first time. And at that point you know, what had been polio season became summer again. And two years before I was born, there was still smallpox in this country. And whooping cough was quite common. It killed 4,000 people a year in the United States. Children. I shouldn’t just say people. It was children under the age of five for the most part. Diphtheria. I live in New England, and there was a massive epidemic of diphtheria in the middle of the 18th century. Okay, I’m going back ways now, but it’s interesting because entire families, 13 children in one family just gone over a period of days. So yeah, there’s a long history of highly infectious diseases. One other example I had measles. People think measles is a trivial disease now. Doctors don’t even see measles anymore, but measles was a brutal experience about 550,000 kids had it the year I had it. 550 died. And so yeah, these are things that people don’t even think about anymore and don’t think about why we are free of these diseases.

How We Lived (and Died) Before Vaccines

By Richard Conniff/National Geographic

This piece originally appeared in 2019. I’m republishing it now because it’s part of what motivated

my new book Ending Epidemics: A History of Escape from Contagion (MIT Press).

Like most American children of my generation, I lined up with my classmates in the mid-1950s to get the first vaccine for polio, then causing 15,000 cases of paralysis and 1,900 deaths a year in the United States, mostly in children.  Likewise, we lined up for the vaccine against smallpox, then still causing millions of deaths worldwide each year. I’ve continued to update my immunizations ever since, including a few exotic ones for National Geographic assignments abroad, among them vaccines for anthrax, rabies, Japanese encephalitis, typhoid, and yellow fever.

Having grown up in the shadow of polio (my uncle was on crutches for life), and having made first-hand acquaintance with measles (I was part of the pre-vaccine peak year of 1958, along with 763,093 other young Americans), I’ve happily rolled up my sleeve for any vaccine recommended by my doctor and the U.S. Centers for Disease Control and Prevention, with extra input for foreign travel from the CDC Yellow Book.  I am deeply grateful to vaccines for keeping me alive and well, and also for  helping me return from field trips as healthy as when I set out.

One result of this willingness, however, is that I suffer, like most people, from a notorious Catch-22: Vaccines save us from diseases, then cause us to forget the diseases from which they save us. Once the threat appears to be gone from our lives, we become lax. Or worse, we make up other things to worry about. Thus, some well-meaning parents avoid vaccinating their children out of misplaced fear that the MMR vaccine (for measles, mumps, and rubella) causes autism. Never mind that independent scientific studies have repeatedly demonstrated that no such link exists, most recently in a study of 657,000 children in Denmark.  This irrational fear is why the United States has experienced almost 1200 cases of measles so far this year, almost two decades after public health officials proudly declared it eliminated. About 124 of these measles victims, mostly children, have been hospitalized, 64 of them with complications including pneumonia and encephalitis, which can cause brain damage or death.

And yet autism can still seem like a bigger threat than measles, if only because it appears in countless television shows and movies such as “Rain Man” and “Gilbert Grape.” Meanwhile, you’re more likely to catch measles at a movie theater than see the disease featured onscreen.

And so, parents forget, or more likely never knew, that 33 of every 100,000 people who experienced actual measles ended up with mental retardation or central nervous system damage. (That’s in addition to those who died.)

They forget that an outbreak of rubella in the early 1960s resulted in 20,000 children being born with brain damage, including autism, and other congenital abnormalities.

They forget that, before it was eradicated by a vaccine in the 1970s, smallpox left many survivors

ENDING EPIDEMICS: Announcing My New Book

If you’re one of the good people who have enjoyed my previous books, you could be a great help with my new one, Ending Epidemics: A History of Escape from Contagion. Purchase the book with that link before April 11, using the code PREORDER15, and you’ll save 15%.

Here are few early notices for the book, to give you an idea why pre-ordering might be a good idea for you:

Richard Preston, author of The Hot Zone and The Demon in the Freezer, writes: “Ending Epidemics is an important book, deeply and lovingly researched, written with precision and elegance, a sweeping story of centuries of human battle with infectious disease. Conniff is a brilliant historian with a jeweler’s eye for detail.  I think the book is a masterpiece.”  —

Paul Offit, M.D., author of You Bet Your Life and other books on public health, calls it “A dramatic, page-turning account of the grim, never-ending war waged by infections on humankind.”

Pre-ordering sends a big message of reader support to bookstores & marketing folks. Please also spread the word with your friends, social media contacts, and your local bookstore. It can make or break this book.

You can read more about the book from the publisher MIT Press: “Ending Epidemics tells the story behind “the mortality revolution,” the dramatic transformation not just in our longevity, but in the character of childhood, family life, and human society. Richard Conniff recounts the moments of inspiration and innovation, decades of dogged persistence, and, of course, periods of terrible suffering that stir individuals, institutions, and governments to act in the name of public health.”

You can also read a sample chapter here, about two forgotten women whose work saves tens of thousands of small children every year from death by whooping cough.

The Unsung Heroes Who Ended a Deadly Plague

Grand Rapids, Michigan, shortly before the Depression. (Photo: Unknown)

by Richard Conniff

(excerpted from Ending Epidemics: A History of Escape from Contagion, MIT Press, April 11, 2023)

Late November 1932, the weather cold and windy, two women set out at the end of their normal working day into the streets of Grand Rapids, Michigan. The Great Depression was entering its fourth year. Banks had shut down, and the city’s dominant furniture industry had collapsed.  Pearl Kendrick and Grace Eldering both biologists for a state laboratory, were working on their own time to visit sick children and determine if they were infected with a potentially deadly disease.  Many of the families lived in “pitiful” conditions,” they later recalled. “We listened to sad stories told by desperate fathers who could find no work. We collected specimens by the light of kerosene lamps, from whooping, vomiting, strangling children. We saw what the disease could do.”

It could seem at first like nothing all, a runny nose and a mild cough. A missed diagnosis is common even now: Just a cold, nothing to worry about. After a week or two, though, the coughing can begin to come in violent spasms, too fast for breathing, until the sharp, strangled bark breaks through of the child desperately gasping to get air down her throat. That whooping sound makes the diagnosis unmistakable. 

Whooping cough, also known as pertussis, means nothing to most parents in the developed world today.  But the helpless feeling of watching a baby in the agonizing grip of a prolonged coughing spasm is unforgettable.  “It’s awful, it’s awful. You wonder how they can survive the crisis,” says a modern researcher who has seen it. “I mean, they’re suffocating. They’re choking. They become completely blue. They cannot overcome the cough, and you have the impression that the child is dying in your hands.” It can go on like that for weeks, or months.

Until the mid-twentieth century, there was also nothing anyone could do to prevent the disease.  It was so contagious that one child with whooping cough was likely to infect half his classmates, and all his siblings at home.  In the 1930s, it killed 4000 Americans on average every year, most of them still infants.  Survivors could suffer permanent physical and cognitive damage.

All that changed because of Kendrick and Eldering, now largely forgotten. They’d been hired to conduct routine daily testing of medical and environmental samples at a state laboratory.  But whooping cough became their obsession. They worked on it late into the night, without funding at first, in what a reporter later described it as a “dumpy broken down stucco” building.  They benefited from the work of their own hand-picked research team, which was remarkably diverse for that era in race, gender, and even sexual orientation. They also enlisted the trust and enthusiasm of their community.  

Medical men with better credentials were deeply skeptical.  But where other researchers had failed repeatedly over the previous 30 years, Kendrick, Eldering, and their team succeeded in developing the first reliably effective whooping cough vaccine.  Childhood deaths from whooping cough soon plummeted in the United States, and then the world. (To continue reading, click here)

Now Is Our Time to End Polio Forever

What it looks like when the vaccines don’t get there. (Photo: Unknown)

by Richard Conniff/Scientific American

In January 2014 an American public health worker was visiting northern Nigeria to observe a polio prevention campaign by local health workers. It was a big, festive event with a marching band to bring out parents and children for their immunizations. But the American visitor and the local program manager soon found themselves being drawn away from the action, down deserted streets to an area still under construction. They were being led by a young girl.

“And what was happening was that she was

The Single Best Thing You Can Do to Protect Your Child

by Richard Conniff/Patreon

Lately, I have been thinking about the changes in American health that have taken place in my lifetime, all of them explainable in one word. But before everybody shouts out the word, let’s look at a few of the changes, detailed in an article published in 2007 in the Journal of the American Medical Association, by Sandra W. Roush & Trudy V. Murphy, both then at the Centers for Disease Control and Prevention:

• Incidence of measles down 99.9%, deaths down 100%. (Peak year was 1958, when 763,094 cases occurred, my own among them.)
• Mumps cases down 95.9 %. (Peak was 212,932 in 1964.) Deaths down 100% from peak of 39.
• Polio cases and deaths both down by 100%. (Peak year was 1952, at 21,269 cases and 3145 deaths.)
• Rubella cases down 99.9%, deaths down 100%. Peak year was 1964 with 488,796 cases, but deaths were higher in 1968 at 24.
• Smallpox down 100%.  Peak of 110,672 cases occurred in 1920, and 2510 deaths in 1902. (OK, I wasn’t alive then. But the last major U.S. outbreak occurred in 1949, two years before I was born. And the disease was still causing 10-15 million

Endangered Species Now Need Vaccines, Too

(Photo: Julie Larsen Maher ©WCS)

One reason some modern parents persist in their delusional fear of vaccines is that they’ve forgotten the appalling reality of measles and other childhood diseases. But I remember, because measles was the closest I came to dying as a child, in the last gasp of the disease before widespread availability of a vaccine. It has left me with a feverish memory of feeling as if a suffocating pink graft of skin had been stretched across my face (probably because I couldn’t open my eyes) and of being unable to do much more than lie on my back struggling to breathe. Measles killed about 500 American children a year then. I got away cheap.

But this is a column about wildlife, and about a different virus—essentially measles for carnivores—that is causing an equally miserable sickness, often leading to death, in some of the world’s rarest species. Scientists are now proposing to use vaccines to save these animals from the brink of extinction. But figuring out how to vaccinate a scarce, shy, wide-ranging predator can be even more frustrating than trying to talk sense into recklessly misinformed human parents.

As the name suggests, canine distemper virus generally spreads among domestic dogs. In the United States, anybody who takes little Maggie or Jack to the vet for mandatory rabies shots typically gets the canine distemper vaccine too. But in parts of the world with feral dog problems or poor vaccine coverage of domestic dogs, the virus can readily jump to wildlife, and the victims aren’t just members of the canine family. In the mid-1990s, for example, canine distemper roared through the

Should We Test a Vaccine for Wild Chimps on Captive Ones?

(Photo: Guenter Guni/Getty Images)

My latest for Takepart:

Let’s say you have a technology that could save chimpanzee and gorilla species, our closest primate kin, from the almost certain prospect of extinction in the wild. But to make it work, you must first do biomedical testing on captive chimpanzees, a practice that has been denounced as cruel and largely unnecessary by the revered primatologist Jane Goodall and many others.

That’s the ethical dilemma posed by a study appearing today in the journal Proceedings of the National Academy of Sciences. It notes that outbreaks of the Ebola virus “have killed roughly one-third of the world gorilla population,” leading in 2007 to the listing of western gorillas as critically endangered. It also reports the results of the first experiment to vaccinate captive chimpanzees against this notorious disease.

While the immediate focus is on Ebola, the coauthors, led by University of Cambridge population biologist Peter D. Walsh, suggest that the study sets a precedent. Effective human vaccines often languish because drug companies cannot justify the huge expense of doing proper trials to bring them to market, especially when they treat conditions found only in impoverished regions. Hence the Ebola vaccine in the study remains unavailable for human use. But “our study demonstrates that it is feasible,” the coauthors write, “even for modestly funded ape conservationists to adapt such orphan vaccines as