The Cold War is normally recalled as an age of caustic hostility, ideological confrontations, and a worldwide competition in arms buildup that brought humanity to the nuclear precipice. In the midst of this long period of tension between the United States and the Soviet Union, a remarkable tale of cooperation between the two giants occurred, one that involved not guns or politics but health. Health diplomacy became an unexpected linkage between the two adversaries, demonstrating that even when nations were irreconcilably at odds, there was hope for them to unite for the benefit of humankind. Perhaps the best demonstration of such unity was the fight against smallpox, a plague that had plagued humanity for centuries. This success is of considerable interest and is significant in its lesson concerning the potential for health diplomacy to address global challenges in the contemporary world in a world increasingly divided. The Cold War (1947–1991) was a period during which the United States and Soviet Union were locked in a bitter struggle between communism and capitalism. Their competition extended to virtually all areas of military strategy, economic strength, cultural dominance, and even scientific advancement. However, there were some matters that transcended such rivalries, one of which was health crises. Pandemics such as smallpox menaced all individuals irrespective of political or ideological variations. Both superpowers understood that pandemics had the capability of destabilizing economies and societies all over the world, including their own. This shared vulnerability created a singular opportunity for cooperation in an otherwise polarized time. Both nations, in spite of their distrust of each other, understood that no single nation could combat international health threats unilaterally. This reality provided the foundation for one of the greatest instances of Cold War health diplomacy: smallpox eradication.
Smallpox was the deadliest disease ever known to have existed, causing millions of fatalities each year and leaving survivors either deeply scarred or blind. Smallpox became eradicable in the mid-20th century as improvements in vaccine technology allowed eradication to be considered. It was in 1967 that the World Health Organization (WHO) launched its Intensified Smallpox Eradication Program, one that would require an unprecedented effort by the whole world to reach fruition. Both the United States and the Soviet Union, despite political differences, had significant roles in this campaign. The Soviet Union contributed millions of doses of freeze-dried smallpox vaccine to countries all over Asia and Africa, using its technical experience in vaccine production to enable mass immunization programs. The United States provided substantial financial support, logistical support, and public health experience. American and Soviet epidemiologists worked together to conduct vaccination campaigns in the most inaccessible and remote parts of the globe. The collaboration was not without hitches. Political tensions at times threatened to sabotage efforts, but the two nations remained committed to their shared goal, eliminating smallpox from the face of the Earth. Their efforts eventually bore fruit, by 1980 smallpox was officially eradicated the first disease in history to be wiped out by human intervention. This success is recorded in history as a beacon of what can be achieved if nations set aside their differences to work for a shared objective. There are lessons that current health diplomacy may benefit from learning from the success of US-Soviet cooperation in eradicating smallpox. Mostly, it demonstrates that health can be the one thing that holds back even in the midst of full-scale war. Health issues are universal; they transcend nationality as well as ideology. Both the superpowers were aware that pandemics like smallpox targeted their interests at par during the Cold War era and that an action required must be shared. This testifies to how diplomacy of health is a bridge for unison between adversaries of modern conflicts.
The smallpox campaign also demonstrates the power of multilateralism. While U.S.-Soviet cooperation was significant, it was one component of a worldwide international campaign led by WHO. The campaign succeeded because it brought governments, international organizations, scientists, and health professionals together worldwide. This same framework applies today as we contend with global health challenges such as pandemics, climate-related health crises, and antimicrobial resistance. A second valuable lesson is that cooperation is possible even between adversaries due to common vulnerabilities. During the Cold War era, both sides understood that infectious diseases do not heed borders or ideologies. Similarly, contemporary threats like COVID-19 and emerging zoonotic diseases remind us that no state can remain immune from global health crises. Such shared vulnerabilities are pathways to discussion and cooperation between states otherwise in conflict. Health diplomacy during the Cold War shows us the wisdom of prioritizing science over politics. The U.S.-Soviet cooperation succeeded because both countries were committed to generating public health outcomes more than pursuing ideological ambitions. In an era where science becomes more politicized either in terms of vaccine nationalism or propaganda campaigns this lesson rings truer than ever.
Although the Cold War is a relic of the past, its lessons remain profoundly relevant to the world’s fractured geopolitics today. The wars today between or among nation-states pose enormous threats to global health security. For example, the Syria, Yemen, and Ukraine wars have devastated health systems and left millions without access to basic healthcare. Health diplomacy may be vital in facilitating humanitarian access and rehabilitating these systems. Similarly, pandemics like COVID-19 have also highlighted the necessity and frailty of worldwide collaboration on issues of health. Early COVID-19 response was dominated by competition rather than collaboration; countries hoarded medical gear and vaccines rather than sharing them in equal amounts. Yet there were examples of cooperation like collaborative research or vaccine donation that showed the potential achievable through good health diplomacy. Emerging threats in the guise of bioterrorism or pandemics like Ebola further underscore the need for robust international cooperation on health security. As much as smallpox eradication required collaboration between Cold War rivals, addressing these challenges will necessitate similar partnerships today. There are significant obstacles to realizing this vision. Trust between major powers has waned in the past few years due to geopolitical conflict over issues such as trade wars or border clashes. Health issues themselves have become politicized; vaccine roll-out during the COVID-19 pandemic was often used as a tool of soft power rather than solely humanitarian reasons. Multilateral bodies like WHO fall victim to financing shortages and political interference blocking effective mediation functions.
There are certainly tough times ahead, but there is hope if we learn from history’s successes, like Cold War health diplomacy. The U.S.-Soviet collaboration in eradicating smallpox is a very strong testament that even in bitter rivalries, nations can be brought together in the greater good. By placing human interest ahead of politics and applying the use of science as a cementing factor bringing us together, rather than estranging us from each other, we can bridge walls with where there are none. When addressing upcoming global public health threats, from pandemics to global climate change, the time has come to reignite the Cold War-era health diplomacy spirit. The risks are too high for any one nation to take action on its own; it is only through cooperation that we can ensure a healthier future for all.