What Neem Karoli Baba and Larry Brilliant taught us in their battle against smallpox

Neem Karoli Baba (left) and Larry Brilliant.

A badly botched up vaccination drive is a relevant moment to remember the two men, Neem Karoli Baba and Larry Brilliant, who are a part of the immunization canon of this country for their role in eradicating smallpox from India.

The first was no false baba of the kind that strut around today in fancy clothes or none at all. And the second was a disciple like no other.

Once the team doctor for the Grateful Dead, Brilliant was an American physician who arrived in the 1970s to meditate in a remote Himalayan ashram in Kainchi Dham near Nainital which was headed by Neem Karoli Baba. One day the baba gave the man he called Doctor America a mission: leave the meditation at the monastery, take the next bus to Delhi, and get to work with the World Health Organization (WHO) there to help eradicate smallpox from the country.

Brilliant was no epidemiologist nor was he even a particularly experienced doctor. So it was no surprise that WHO kicked him out when he went to their office seeking a job wearing pyjamas, sporting a long beard and with no knowledge of smallpox. Brilliant returned to the Baba’s ashram only to be sent right back. This went on several times till he told the folks at WHO that he would take up any job as long as he could get the baba off his back. Finally, he was hired though initially it was as an administrative assistant.

Efforts like mass vaccination that affect the lives of millions, or as in the present case billions, require a visionary and a proselytizer. The India of the 1970s when the guru and his shishya set out on their life-saving mission was desperately poor. Suspicion of the outsider, and the interventions they sought to bring in, were rife in the villages and towns where smallpox was rampant. Local people wouldn’t report the disease since it was seen as a visitation by the goddess, Sheetla ma. Education standards were low and what's worse, there was no mass media that could be used to spread the right message.

The disease that they had resolved to eradicate was ferocious and deadly. As Brilliant told Marketplace in a 2016 interview: “This is a disease which, in the 20th century, killed over 500 million people. …That’s more than all the people who died in that terrible century from all the two world wars and the Holocaust and all of the genocides.” Smallpox belonged to a class of diseases known as anthroponoses, which are only transmissible from human to human, unlike Covid 19, which is zoonotic, passed to humans from an animal host. Nor was it of recent vintage, being traced back to East Africa some 4,000 years ago.

On his first day in the field, Brilliant saw children afflicted by the dreaded disease, their eyes blinded, their bodies covered in terrible sores. A quarter of a million Indians were affected by it, and with no cure in sight, the only answer was to eradicate it. The disease was so contagious that every single patient infected seven others. Eliminating it meant tracking down each and every one of the victims. Even if one was left out, the disease would continue to spread.

Brilliant worked with thousands of people from 150 countries, including the US and Russia at the height of the cold war. For such a cause, everyone came together. This wasn’t vaccine diplomacy but plain simple humanity at work.

The team would go from village to village, often organizing some amusement in the market square to get people to come out of their houses. They would then show pictures of people affected by the disease and ask if anyone had seen someone like that. There were even cash rewards for informants. Since children tended to hide at home, Brilliant organized elephants to march through the area to coax them to come out. Over the next few years, under their supervision nearly a 100 million households were checked by the dedicated teams of healthcare workers.

On 16 October 1975, the last smallpox case in South-East Asia was reported from Bangladesh bringing to an end the Baba and Brilliant’s dogged pursuit.

Brilliant, who now heads Pandefense Advisory, still worries that the “tensions between politics and public health are still playing out” (interview with Scientific American interview last year). As for the baba, he passed away without seeing his vision realized. In a blurb for the book Walking Each Other Home: Conversations on Loving and Dying, authored by his friend Ram Dass, Brilliant wrote: “The night before our beloved Baba died, he remarked, ‘Tomorrow I will escape from Central Jail.’ He may have giggled as he casually predicted his own death."

Sheetla ma (Image via Wellcome Collection; public domain).