The eradication of smallpox

La vaccination gratuite contre la variole dans le grand hall du Petit Journal, Le Petit Journal. Supplément illustré du 20 août 1905. BIU Santé.

The eradication of smallpox illustrates the success of a proactive worldwide policy.

   In Octobre 1977, Somali Ali Maow Maalin recovered from smallpox; he is the last recorded case of the disease. Three years later, in 1980, the WHO officially declared smallpox eradicated, notably thanks to the campaign it launched in 1967.

   Smallpox (variola) is a highly contagious disease the presence of which goes back to the remotest past. Early writings refer to it in Hippocratic times. In Europe, the disease does not appear in texts before the 15th century, at the very time it became widespread. Smallpox spreads through human transmission and early symptoms, typified by the emergence of blisters only appear twelve days after the infection started. This endemic disease follows two patterns variola major is the severe and most common form, (some 90%of cases) and variola minor.

   Long before the 18th century, many physicians set about to find methods and remedies to counter the disease, such as varied draughts, or else bloodletting. In 1721, Mary Wortley Montagu imported a new method in the West: variolation. This new approach, which consisted in voluntarily inoculating (or introducing into the organism of a healthy subject) in this instance smallpox, antedated vaccination but its results were unreliable and risky as the human to human procedure could spread other diseases, notably syphilis.  The English physician Edward Jenner ‘s 1796 thesis according to which cowpox protected from the disease was vindicated and its  results would get broadly disseminated from 1798 on. Concerns about contamination through human vaccine persisted however leading to the manufacture of animal-sourced vaccines (sometimes known as retro-vaccines) based on Jenner’s prevention model.

   At the end of the 19th century, thanks to the progress of vaccination, smallpox grew selective in its targets, and varied in its intensity: much depended on the place, the level of distribution of the retro-vaccine, health practices or even of the good working order of the vaccination service. It came under different guises, hitting the poorest as a result of their job in street industries (shopkeeper, dressmaker), their proximity with many people, as day labourer, or indeed home-helps and housewives. The most effective way to curtail the disease remained vaccination, the isolation of the sick and the disinfection of the sites. Countries diverged in their approach to tackling smallpox: in Germany children had to be compulsorily vaccinated in their first year unlike in Austria which made vaccination compulsory only in free public education institutions as well as orphanages asylums and the army.

   After the First world War, mortality had fallen so low that it could no longer be entered in statistical data. Smallpox reappeared only sporadically, creating clusters here and there, in geographic zones affected by migratory fluxes or vaccine hesitancy.

However, this decline did not apply to developing countries who remained severely hit by the disease and where close on two million people died every year.

   In 1948 the World Health Organisation was created in the wake of the San Francisco Conference. Founded for the purpose of improving the global population’s health level, the Organisation seeks to find solutions to diverse health problems; it focussed on a range of diseases such as poliomyelitis and malaria but did not straightway tackle smallpox. Hard-headed initiatives aimed at countering the disease were set up in the late 50s-early 60s.

One such is the massive vaccination programme initiated by doctor Fred Lowe Soper, an epistemologist working for the Pan American Sanitary Bureau (PASB). This initiative resulted in the massive extinction of smallpox in Central America and the Caribbeans. Similar results were obtained In Ivory Coast thanks to the health policy set in place by Félix Houphouët-Boigny, its president.

   Faced with the difficulties developing countries experienced in eradicating the disease, the WHO increased its effort. In parallel with individual initiatives, the WHO launched a massive campaign of smallpox eradication in 1959 thanks to a call from the Soviet Union’s Deputy Minister of Health  Viktor Zhdanov. In 1969 the first International Health Regulations were adopted to ensure the surveillance of six diseases, smallpox a key indicator among them. The eradication campaign had sped up and reached a high watermark in 1967 when the initiative was taken up by other Organisation member-states who helped the eradication by setting up health policies in their respective countries. A strategy of “ring vaccination” was followed. It consisted in pinpointing epidemy clusters, keeping records, isolating cases, vaccinating. The vaccinators were nevertheless faced with numerous difficulties: nomadism, political instability and religious issues hindered vaccination efficacy. Still, thanks to the diverse countries’ joint action, the WHO could declare smallpox officially eradicated in 1980 thus putting an end to anti-smallpox vaccination.

   Bereft of its human support, the smallpox virus has theoretically disappeared outside the laboratories where virus strains are kept. This rises much questioning as does the total vaccination cessation recommended by the WHO three years only after the last case. Fears of the disease’s return or of its use as a biological weapon is at the heart of those anxieties, even though research on the disease is ongoing.

Read more in the dictionary : Epilepsy

Read the paper in French : Éradication de la variole