2 the Jacqueline Kennedy-Onassis Reservoir The Central Park Reservoir was renamed the Jacqueline Kennedy-Onassis Reservoir in 1994 in recognition of the former First Lady’s contributions to the city. Jacqueline Kennedy-Onassis could often be seen jogging the Bridle Path around the lake.
19 | For the rest of our lives
1 Drink ORS like Toby drinks Scotch Oral Rehydration Salts is the term used for an inexpensive mixture of salts and sugar that, dissolved in water, can prevent the dehydration caused by diarrhoeal disease. In the early 1980s, diarrhoeal dehydration was responsible for approximately five million child deaths a year. ORS, along with immunization, was a key component of the child survival revolution inspired by UNICEF Executive Director James P Grant in the 1980s and early 1990s (see Postscript).
24 | The sender of this letter
1 pull-out list of random numbers A means of selecting a random sample of a given population is a critical tool in epidemiology. Various methods have been improvised in the field. For example, spinning a bottle in the centre of a village or neighbourhood is a way of deciding on a random direction for survey workers. Following this line (tossing a coin should a crossroads be encountered), households must then also be chosen at random – perhaps by using the serial numbers from a banknote. Whatever the method, the golden rule is that every household in the community being surveyed must have an equal chance of being selected.
25 | The presence in the shadows
1 UNICEF’s headquarters in the old ALCOA building The former New York offices of the Aluminum Company of America.
26 | Let’s do it
1 crowded with Amtrak commuters Amtrak carried its New York passengers in and out of Grand Central Terminal until the late 1980s when it switched operations to Penn Station.
29 | Take this cup from me
1 HEPA filters High Efficiency Particulate Air filters used to help ensure the safe recirculation of air.
30 | The girl next door
1 can-do generation of global public-health pioneers that has become legendary A group of international public-health pioneers who made an enormous contribution to global health in the 1970s and 1980s. Their characteristic ‘can-do’ attitude was commented on by former US Surgeon-General Julius B Richmond who said, for example, that ‘the reason the global smallpox eradication programme worked at all, at a time when not even WHO fully believed in it, was that the people involved were “too young to know that it couldn’t work”.’ Another example of the ‘can-do’ mentality of those times is the effort mounted by the much-maligned bureaucrats of the Indian Civil Service who in 1974 organized a smallpox search that reached into every house in India (over a hundred million homes) in the space of just six days and succeeded in repeating this feat every three months.
31 | That can’t happen
1 We’ll need a HazMat team Abbreviation of Hazardous Materials, commonly used by emergency services.
2 misdiagnosed as chickenpox or EM Erythema Multiforme, a skin condition producing lesions.
3 We don’t have enough vaccine Until 2001, US reserves of smallpox vaccine totalled no more than fifteen million shots. In November 2001, the US Department of Health and Human Services contracted biotech firm Acambis to bring the stockpile up to two hundred and eighty-six million doses.
32 | Ours not to reason why
1 We’ll need to get someone from Detrick to take a look at it and maybe someone from NIH Fort Detrick, Maryland, is the home of the US Army Medical Research Institute of Infectious Diseases (AMRIID). NIH is the US National Institutes of Health, based in Bethesda, Maryland.
34 | To satisfy our masters
1 a DVE under an electron microscope Direct Viral Examination.
35 | Common ground
1 Onesimus Onesimus was a slave owned by the New England Puritan preacher Cotton Mather. He eventually bought his freedom and earned a living of sorts sweeping the streets of Boston. His name may be translated as ‘useful’.
2 Thomas Jefferson’s letters to Jenner In 1806, President Thomas Jefferson wrote Edward Jenner, ‘Future nations will know by history only that the loathsome smallpox has existed and by you has been extirpated.’
36 | It’s Harvey
1 It’s Harvey Harvey is the name that was given to the strain of variola major, originally from India, that was first isolated by Professor Allan Downie of Liverpool University in the United Kingdom. It was distributed by the World Health Organization to registered smallpox research centres around the world so that all collaborating research laboratories could work on the same reference material. ‘Harvey’ was also the strain of variola major that escaped from the Birmingham Medical School laboratory in 1978, leading to the death of Janet Parker, a medical photographer in the same building.
2 CAM results Chorio-allantoic membranes from developing chicken eggs are used to culture viruses.
3 certify destruction of stocks World Health Assembly resolution 29.54 (1976) requested all institutions no longer involved in smallpox research to destroy any remaining stocks of variola.
4 came in from California about a year ago In 1979, health officials in California found twelve unrecorded vials which turned out to contain smallpox virus. This led to all laboratories being asked to conduct new checks. In July 2014, six more glass vials of small pox virus were found in an unlocked storeroom on the campus of the National Institutes for Health in Bethesda, Maryland.
40 | The words he knew by heart
1 mutually verified destruction of stocks The Biological Weapons Convention of 1972 agreed on the destruction of any existing biological weapons and cessation of further research. Through the 1970s and 1980s, suspicions grew that the Soviet Union was continuing research into the weaponizing of smallpox and other pathogens. Following the collapse of the Soviet Union in 1990/91, a series of defectors confirmed the existence of Biopreparat, a large-scale programme for the development of biological weapons with smallpox as a top priority. One such defector, former Biopreparat chief scientist Dr Kanatjan Alibekov, revealed that the Soviet Vector programme, based in Koltsovo, Western Siberia, had been attempting to produce weaponized liquid smallpox in quantities of between fifty and one hundred tons a year. Vector had also been attempting to develop a more lethal and more easily transmissible version of smallpox by combining it with a haemorrhagic virus. Kanatjan Alibekov became Ken Alibek after his defection to the United States in 1992.
41 | The cards face up
1 Universal Childhood Immunization One hundred per cent immunization is rarely achievable, and the term ‘universal immunization’ is used by the World Health Organization to indicate a coverage level of eighty per cent of children under the age of one – the level at which ‘herd immunity’ offers a significant level of protection even to unimmunized children.
43 | A little bit of your heart
1 a group of citizens decided to employ distinctly illegal means See first note on Chapter 15.
44 | Competing with James Dean
1 that underarm delivery at the MCG On February 1st, 1981, at the end of a One Day International between Australia and New Zealand at the Melbourne Cricket Ground, the Australian captain Greg Chappell instructed his brother, Trevor, to bowl the last ball of the game underarm, rolling it down the pitch to the batsman. This ensured victory by preventing a six being struck (because the ball could not be hit over the boundary without touching the ground). Though technically not illegal, bowling underarm is considered a violation of the spirit of cricket and the incident has since lived in infamy among lovers of the game.
Epilogue
1 in response to an actual rather than a theoretical threat In March 1988 a role-playing exercise conducted in California found that senior officials in the Clinton administration would almost certainly not be capable of an adequate response to a sophisticated smallpox attack.
Acknowledgements
The Kennedy Moment is dedicated to the memory of UNICEF Executive Director James P Grant, who led the campaign to immunize the v
ast majority of the world’s children in the 1980s and 1990s (see Postscript: The real story).
This book also owes a very special debt to two other great names in the field of international public health – Dr Stephen Joseph and Dr Jon Rohde. Steve Joseph’s encouragement and expertise have been invaluable throughout, and I have also drawn freely on his brilliant memoir River of Stone, River of Sand: A Story of Medicine and Adventure (available on Amazon Kindle). Jon Rohde, who first proposed a ‘child survival revolution’ and convinced Jim Grant that it was possible, has also been an inspirational collaborator in this as in many other ventures.
I would also like to thank my editor, Chris Brazier of New Internationalist Publications, and Candida Lacey, Linda McQueen and all at Myriad Editions for the professionalism, talent and enthusiasm they have brought to publishing The Kennedy Moment – and for being a pleasure to work with.
As always, no thanks are enough for my partner Lesley Adamson who has been colleague, enthusiast, critic and tolerator-in-chief of all that goes into writing a novel. My children, Naomi and Daniel, have also given the unstinting praise and encouragement I have always demanded of them. Naomi’s suggested title for the book – Say it with smallpox – did not make the final cut.
Many former UNICEF colleagues have also contributed, knowingly or not, but I would especially like to thank two outstanding servants of that organization – Mehr Khan and John Williams – not only for their help and encouragement with The Kennedy Moment but also for their support and friendship with almost everything else I have undertaken in my career.
Adam Fifield’s advice and support has also been very much appreciated and I would again like to recommend his exceptional biography of James P Grant – A Mighty Purpose: How UNICEF’s James P Grant Sold the World on Saving Its Children (Other Press, New York, October 2015).
Special thanks are also due to the group of writers and friends in Oxford who share comments on each other’s work-in-progress: John Marzillier, Anne MacFarlane, Jenny Stanton and Gabrielle Townsend. For their suggestions and encouragement I would also like to thank Tariq Ali, Peter Cotton, Alastair Hay, Rafe Henderson, Tony Hewett, Gareth Jones, Eve Leckey, Richard Lee, Sandy Loffler, Neil MacFarlane, Sarah Metcalf and Jean Wood.
About the author
Peter Adamson is the author of two previous novels, Facing out to Sea (1997) and The Tuscan Master (2000). His short story ‘Sahel’ was awarded the Royal Society of Literature VS Pritchett Memorial Prize in 2013.
For sixteen years Adamson was Senior Adviser to the Executive Director of UNICEF in New York, with responsibility for the annual State of the World’s Children report. In the 1970s he founded New Internationalist magazine.
Copyright
First published in 2018 by
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Copyright © Peter Adamson 2018
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Thanks to Chandos Music for kind permission to quote from
‘To Bobby’ by Joan Baez. Copyright © Joan Baez, 1972
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ISBN (hardback): 978–0–9955900–4–5
ISBN (trade paperback): 978–0–9955900–5–2
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The Kennedy Moment Page 32