"Vision Zero" -- no more deaths from highway accidents.

The idea was born in Sweden, where it's had spectacular success in reducing traffic fatalities. Now zeroing out all traffic fatalities must become an explicit U.S. and worldwide goal. Otherwise we have no prospect of taming the appalling roadway death toll -- 42,000 lives lost yearly in the United States, close to 1.2 million worldwide.

That's the message of Mark Rosenberg, founder and former director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention.

My first reaction was skepticism when I heard Rosenberg argue the case at a Global Urban Summit in Italy this summer. But he makes a compelling comparison to global eradication of smallpox -- a stunning public health success. The know-how for a cure -- the vaccine -- had been known for decades, but it took a worldwide commitment to finally control the disease.

Traffic deaths, Rosenberg insists, constitute an epidemic we can prevent. Sweden has succeeded, driving its yearly toll down to 440, lowest since World War II. Annual traffic-related deaths of children, once 118, sank to 11 at last count.

How did the Swedes do it? Tough seat belt and helmet laws, to be sure. But they've also begun to remake their roadways. Red lights at intersections (which encourage drivers to accelerate dangerously to "beat the light") are being replaced with traffic circles. Four-foot high barriers of lightweight but tough Mylar are being installed down the center of roadways to prevent head-on collisions. On local streets, narrowed roadways and speed bumps, plus raised pedestrian crosswalks, limit speeds to a generally non-lethal 20 miles an hour.

Britain, New Zealand and the Netherlands are also registering major success with safety redesign and tough roadway rules. New Zealand cut its death rate by 50 percent in 10 years. But in the United States, we're "stuck," notes Rosenberg, at 42,000 to 43,000 deaths a year, adding:

"If those 42,000 deaths came from air accidents, air traffic would come to a screaming halt, all airports closed until we fixed the problem. But because our staggering numbers of road deaths come in ones and twos, they don't get attention. Fatalism is our biggest enemy."

Across the world, says Rosenberg, road injuries are likely to double by 2020 and could well total 100 million by 2050. The big reason: rapid motorization of India and China, indeed the entire developing world (the capitalistic dream of every automaker from General Motors to Toyota).

Cars and trucks are especially lethal in developing countries as they accelerate on roadways filled with pedestrians, cyclists, jitneys and sometimes farm animals and hand-drawn wagons.

Without the protection of riding in one's own vehicle (our "steel cages," Rosenberg notes), vast majorities of children and adults in such countries face a high danger of direct and deadly vehicle impact. In Vietnam, for example, there are almost 3,000 fatalities for every 10,000 crashes.

Indeed, the World Health Organization (WHO) projects that highway deaths may well pass global death tolls from HIV-AIDS in the next two decades. And the death toll doesn't include serious injuries, which WHO estimates as high as 50 million annually, many resulting in lifelong paralysis and permanent disability.

I asked Rosenberg if Americans have any stake in the developing world's traffic dangers. A "big one," he replied, noting that U.S. business people (engineers and CEOs), soldiers and students all travel there. Plus, he insists, we could play a huge humanitarian role with our resources and knowledge.

Some developing world cities -- Bogota, Colombia, for example -- have shown it is possible to cut roadway accidents dramatically by rigorous crackdowns on reckless or drunk driving and improved street layouts.

But if developing nations were helped to build their new roads, and remade old ones using technologies such as Sweden's traffic dividers, literally millions of lives could be saved, tens of millions of frightening injuries avoided.

Rosenberg, a former U.S. assistant surgeon general and now executive director of the Task Force for Child Survival and Development, is making a life cause, helping create a world network to spread the "Vision Zero" concept.

And, he notes, there's been lots of international action since the United Nations General Assembly first debated the issue in 2004. A U.N. Road Safety Collaboration was brought together by WHO. The World Bank is mobilizing resources to help developing countries in particular. George Robertson of Britain, a former secretary-general of NATO, chairs a new Commission for Global Road Safety. There's now a push for a 2009 U.N. Ministerial Conference on road safety -- a first-ever meeting of Cabinet-level officials from both developing and developed countries to set a global strategy.

"A hundred million lives are at stake," says Rosenberg. "With ‘Vision Zero' we have a chance to avoid an unimaginable disaster. It's hard to walk away from it."