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Smallpox Eradicated - History

Smallpox Eradicated - History

The smallpox disease was completely eradicated from the Earth, thanks to a worldwide prevention program, combined with wide distribution of a vaccine.

Smallpox: How the Deadliest Disease in History Was Eradicated

If you were to watch a split-screen broadcast with global weather on one side and world politics on the other, you could easily conclude that we are doomed. Prodigious storms and killer heat waves announce the arrival of human-induced climate change, with more disasters to come as the planet warms and ecosystems collapse.

But right-wing populism is rising faster than the oceans, sinking efforts to combat this and other global crises. Meanwhile, President Donald Trump keeps tweeting that climate change is fake news. Very bad!

And yet we humans have also shown that we can overcome even our most daunting problems. Exhibit A is our victory over smallpox, perhaps the most feared pathogen of all time.

Ancient scourge

The smallpox virus probably "jumped" from camels or other domesticated animals to people some 3,000 years ago, striking everyone from Chinese peasants to Egyptian pharaohs.

The highly contagious disease caused fever and tremors in infants, killing them even before the tell-tale rash broke out. Thousands of tiny pox appeared on the faces and hands of older victims, leaving many dead and many more disfigured.

By the medieval period, healers across Asia had learned to insert pus from a victim's pox into the shoulder or thigh of a healthy but at-risk person. Known as inoculation, this procedure carried a two to five percent death rate&mdashmuch lower than full-blown smallpox&mdashand usually brought on a mild case that still conferred lifelong immunity.

Europeans unwittingly gave the virus new life by delivering infected African slaves to hellish mines near Columbus's landing spot on Hispaniola (Haiti and Dominican Republic) in 1518. From the islands, smallpox spread to the mainland, enabling the ruthless conquistadors to topple vast civilizations who had no natural immunity to "spotted death."

The apocalypse that followed has no parallel in recorded history. In repeated outbreaks all over the Americas, smallpox killed up to 90 percent of some Indigenous peoples. Among the worst hit were the Salish of Vancouver&mdashtheir traditions speak of a "fearful dragon" whose hot breath fell upon the children, burning their skin into sores.

From inoculation to vaccination

But people fought back. Around 1720, Europeans and colonial Americans learned about inoculation from Ottoman and West African sources. During an outbreak in Boston, the Rev. Cotton Mather urged everyone to embrace this new method&mdashand to ignore the bigots who dismissed it as "negro" or "Mahometan" (Islamic) sorcery.

Many used this technique for darker purposes. Wealthy planters on the British island of Barbados imposed near-universal inoculation by 1750 because they wanted to keep their slaves in the sugar fields. In the 1760s, British commanders protected their own troops and then spread the monster disease to native enemies. They probably did the same to rebel colonists in Boston a decade later.

Nonetheless, men and women with open minds worked to combat smallpox, the common enemy. They shared ideas with researchers from enemy nations and insisted that medical progress in service to humanity had no price and no borders.

The big breakthrough came in 1796, when Dr. Edward Jenner observed that English milkmaids never caught smallpox. He scraped the "milker's nodules" on their hands and applied the infected material&mdasha related virus known as cowpox or vaccinia&mdashto his patients. Vaccination was born.

Despite his fear and loathing of England, U.S. President Thomas Jefferson wrote to Jenner with thanks on behalf of "the whole human family."

Throughout the 19th and 20th centuries, wealthy countries vaccinated their people with increasing regularity. The U.S. even had a National Vaccine Institute until parsimonious congressmen killed it in 1822. Poorer countries in Africa and the Caribbean suffered longer, even though they had pioneered inoculation.

The lingering threat

In 1966, four years after the last case in Canada, the WHO resolved to wipe smallpox off the Earth. This remarkable project succeeded in large part because of the close co-operation of the U.S. and the Soviet Union&mdashdespite the Cold War. Humanity has now been smallpox-free for more than 40 years. We no longer live in fear of another outbreak, nor recall the ghastly sight of a child in its clutches.

The downside is that most of us no longer have any immunity against this cruel foe, making us just as vulnerable as the first Americans were five centuries ago.

Officially, the virus only exists in two high-security laboratories in the U.S. and Russia. Because smallpox is stable in laboratory environments, however, old stocks from the days of inoculation may be hiding. Bioterrorists could weaponize such active matter.

If that were to happen, we would need new drugs such as tecovirimat, just approved by the U.S. government. We'd also require the intelligent use of vaccine stocks and a massive international effort to contain the outbreaks and the panic they'd spread. We'd need to overcome the inevitable resistance of anti-government and anti-science reactionaries.

All of that may seem impossible in 2018.

That's why we need to remember our first triumph over smallpox as proof of our ingenuity and resilience, not to mention our capacity to work together for the health and happiness of our species.

Steven M Opal is a Research Scientist and Clinical Professor of Medicine at the Alpert Medical School, Brown University and J.M. Opal is Associate Professor of History and Chair, History and Classical Studies at McGill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.


Contents

Henderson was born in Lakewood, Ohio on September 7, 1928, of Scots-Canadian immigrant parents. [7] His father, David Henderson, was an engineer his mother, Eleanor McMillan, was a nurse. His interest in medicine was inspired by a Canadian uncle, William McMillan, who was a general practitioner and senior member of the Canadian House of Commons. [8]

Henderson graduated from Oberlin College in 1950 and received his MD from the University of Rochester School of Medicine in 1954. He was a resident physician in medicine at the Mary Imogene Bassett Hospital in Cooperstown, New York, and, later, a Public Health Service Officer in the Epidemic Intelligence Service of the Communicable Disease Center (now the Centers for Disease Control and Prevention—CDC). He earned an MPH degree in 1960 from the Johns Hopkins School of Hygiene and Public Health (now the Johns Hopkins Bloomberg School of Public Health). [8]

Eradication of smallpox Edit

Henderson served as Chief of the CDC virus disease surveillance programs from 1960 to 1965, working closely with epidemiologist Alexander Langmuir. During this period, he and his unit developed a proposal for a United States Agency for International Development (USAID) program to eliminate smallpox and control measles during a 5-year period in 18 contiguous countries in western and central Africa. [9] This project was funded by USAID, with field operations beginning in 1967. [8]

The USAID initiative provided an important impetus to a World Health Organization (WHO) program to eradicate smallpox throughout the world within a 10-year period. In 1966, Henderson moved to Geneva to become director of the campaign. At that time, smallpox was occurring widely throughout Brazil and in 30 countries in Africa and South Asia. More than 10 million cases and 2 million deaths were occurring annually. Vaccination brought some control, but the key strategy was "surveillance-containment". This technique entailed rapid reporting of cases from all health units and prompt vaccination of household members and close contacts of confirmed cases. WHO staff and advisors from some 73 countries worked closely with national staff. The last case occurred in Somalia on October 26, 1977, only 10 years after the program began. [8] Three years later, the World Health Assembly recommended that smallpox vaccination could cease. Smallpox is the first human disease ever to be eradicated. [10] This success gave impetus to WHO's global Expanded Program on Immunization, which targeted other vaccine-preventable diseases, including poliomyelitis, measles, tetanus, diphtheria, and whooping cough. [11] Now targeted for eradication are poliomyelitis and Guinea Worm disease after 25 years, this objective is close to being achieved. [6] [12]

Later work Edit

From 1977 through August 1990, Henderson was Dean of the Johns Hopkins School of Public Health. After being awarded the 1986 National Medal of Science by Ronald Reagan for his work leading the World Health Organization (WHO) smallpox eradication campaign, Henderson launched a public struggle to reverse the Reagan administration’s decision to default on WHO payments. [13] In 1991, he was appointed associate director for life sciences, Office of Science and Technology Policy, Executive Office of the President (1991–93) and, later, deputy assistant secretary and senior science advisor in the Department of Health and Human Services (HHS). [8] In 1998, he became the founding director of the Johns Hopkins Center for Civilian Biodefense Strategies, now the Johns Hopkins Center for Health Security. [4]

Following the September 11, 2001, attack on the World Trade Center, HHS Secretary Tommy G. Thompson asked Henderson to assume responsibility for the Office of Public Health Preparedness (later the Office of the Assistant Secretary for Preparedness and Response). [14] [15] [16] For this purpose, $3 billion was appropriated by Congress. [8]

At the time of his death, he served as the Editor Emeritus of the academic journal Health Security (formerly Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science). [17]

Honors and awards Edit

  • 1975 – George McDonald Medal, London School of Tropical Medicine[18]
  • 1978 – Public Welfare Medal, National Academy of Sciences[19]
  • 1985 – Albert Schweitzer International Prize for Medicine [20]
  • 1986 – National Medal of Science in Biology [21]
  • 1988 – The Japan Prize, shared with Drs. Isao Arita and Frank Fenner[22]
  • 1990 – Health for All Medal, World Health Organization [citation needed]
  • 1994 – Albert B. Sabin Gold Medal, Sabin Foundation [23]
  • 1995 – John Stearns Medal, New York Academy of Medicine [24]
  • 1996 – Edward Jenner Medal, Royal Society of Medicine [25]
  • 2001 – Clan Henderson Society, Chiefs Order [26]
  • 2002 – Presidential Medal of Freedom [27][28]
  • 2013 – Order of Brilliant Star, with Grand Cordon, Republic of China [29][30]
  • 2014 – Prince Mahidol Award, Thailand [31][32]
  • 2015 – Charles Merieux Award, National Foundation for Infectious Diseases[33]

Seventeen universities conferred honorary degrees on Henderson. [34]

Selected publications Edit

    , Henderson DA, Arita I, Jezek Z, Ladnyi. (1988) Smallpox and Its Eradication (ISBN92-41-56110-6), Geneva, World Health Organization. The definitive archival history of smallpox.
  • Henderson DA. (2009) Smallpox, the Death of a Disease ( 978-1591027225) New York: Prometheus Books
  • Henderson DA (1993) Surveillance systems and intergovernmental cooperation. In: Morse SS, ed. Emerging Viruses. New York: Oxford University Press: 283–289.
  • Henderson DA, Borio LL (2005) Bioterrorism: an overview. In Principles and Practice of Infectious Diseases (Eds. Mandell MD, Bennett JE, Dolin R) Phil, Churchill Livingstone, 3591–3601.
  • Henderson DA (2010) The global eradication of smallpox: Historical Perspective and Future Prospects in The Global Eradication of Smallpox (Ed: Bhattacharya S, Messenger S) Orient Black Swan, London. 7–35
  • Henderson DA, Shelokov A (1959). "Medical progress: Epidemic neuromyasthenia—clinical syndrome". The New England Journal of Medicine. 260 (15): 757–764, 814–818. doi:10.1056/NEJM195904092601506. PMID13644582.
  • Langmuir AD, Henderson DA, Serfling RE (1964). "The epidemiological basis for the control of influenza". American Journal of Public Health and the Nation's Health. 54 (4): 563–571. doi:10.2105/ajph.54.4.563. PMC1254817 . PMID14136320.
  • Neff JM, Lane JM, Pert JH, Moore R, Millar JD, Henderson DA (1967). "Complications of smallpox vaccination: I. National survey in the United States, 1963". The New England Journal of Medicine. 276 (3): 125–132. doi:10.1056/nejm196701192760301. PMID4381041.
  • Henderson DA. (1967) Smallpox eradication and measles-control programs in West and Central Africa: Theoretical and practical approaches and problems. Industry and Trop Health VI, 112–120, Harvard School of Public Health, Boston.
  • Henderson DA (1972). "Epidemiology in the global eradication of smallpox". International Journal of Epidemiology. 1 (1): 25–30. doi:10.1093/ije/1.1.25. PMID4669176.
  • Henderson DA (1975). "Smallpox eradication—the final battle (Jenner Lecture)". Journal of Clinical Pathology. 28 (11): 843–849. doi:10.1136/jcp.28.11.843. PMC475879 . PMID802231.
  • Henderson DA (1976). "The eradication of smallpox". Scientific American. 235 (4): 25–33. Bibcode:1976SciAm.235d..25H. doi:10.1038/scientificamerican1076-25. PMID788150.
  • Henderson DA (1998). "The challenge of eradication: lessons from past eradication campaigns (The Pittsfield Lecture)". The International Journal of Tuberculosis and Lung Disease. 2: 54–58.
  • Henderson, DA (1998), "The siren song of eradication", Journal of the Royal College of Physicians of London, 32 (6): 580–84, PMID9881317 .
  • Henderson, DA (1999). "The looming threat of bioterrorism". Science. 283 (5406): 1279–82. Bibcode:1999Sci. 283.1279.. doi:10.1126/science.283.5406.1279. PMID10037590.
  • Henderson, DA Inglesby, TV Barlett, JG et al. (1999). "Smallpox as a biological weapon: medical and public health management". JAMA. 281 (22): 2127–37. doi:10.1001/jama.281.22.2127. PMID10367824.
  • O'Toole, T Henderson, DA (2001). "A clearly present danger: confronting the threat of bioterrorism". Harvard International Forum. 23: 49–53.

Henderson married Nana Irene Bragg in 1951. [7] [20] The couple had a daughter and two sons. [20] [34] He died at Gilchrist Hospice, Towson, Maryland, at the age of 87, after fracturing his hip. [7] [34] [35]


Smallpox: emergence, global spread, and eradication

Speculatively, it is suggested that variola virus, the cause of smallpox, evolved from an orthopoxvirus of animals of the central African rain forests (possibly now represented by Tatera poxvirus), some thousands of years ago, and first became established as a virus specific for human beings in the dense populations of the Nile valley perhaps five thousand years ago. By the end of the first millennium of the Christian era, it had spread to all the densely populated parts of the Eurasian continent and along the Mediterranean fringe of north Africa. It became established in Europe during the times of the Crusades. The great voyages of European colonization carried smallpox to the Americas and to Africa south of the Sahara. Transported across the Atlantic by Europeans and their African slaves, it played a major role in the conquest of Mexico and Peru and the European settlement of north America. Variolation, an effective preventive inoculation, was devised as early as the tenth century. In 1798 this practice was supplanted by Jenner's cowpox vaccine. In 1967, when the disease was still endemic in 31 countries and caused ten to fifteen million cases and about two million deaths annually, the World Health Organization embarked on a programme that was to see the disease eradicated globally just over ten years later, and the world was formally declared to be free of smallpox in May 1980. Smallpox is unique--a specifically human disease that emerged from some animal reservoir, spread to become a worldwide, severe and almost universal affliction, and finally underwent the reverse process to emergence, namely global eradication.


3. Polio

Jimmy Nickle gazes at the adornments on his iron lung, at Hillcrest Hospital, Tulsa, Oklahoma, where he was recovering from polio, 1945.

Bettmann Archive/Getty Images

Polio was once one of the most feared childhood diseases in the U.S. The viral infection can cause temporary or permanent paralysis, as it did with wheelchair-user Franklin D. Roosevelt. This paralysis could stop a person’s body from breathing on its own, which is why so many infected people had to be placed in an “iron lung.” By the late 1940s, it was disabling more than 35,000 Americans򠺬h year. The number of U.S. polio cases peaked in 1952, when it caused 57,879 infections and 3,145 deaths.

During the 1954 trials for Jonas Salk’s polio vaccine, parents flocked to sign their children up to get the shot. As a result, 623,972 children received the vaccine or a placebo. The trials showed the vaccine was 80 to 90 percent effective at preventing polio. Thanks to the continued vaccination of children through today, no polio cases have originated in the United States since 1979. However, polio has not been eradicated, and remains a health threat in Afghanistan and Pakistan.


The Rise and Fall of Smallpox

Smallpox is believed to have first infected humans around the time of the earliest agricultural settlements some 12,000 years ago. No surviving evidence of it, however, predates the so-called New Kingdom of Egypt, which lasted from about 1570 B.C. to 1085 B.C. 

A few mummies from that era contain familiar-looking skin lesions. Ramses V, for example, who ruled for roughly four years in the 12th century B.C., looks to have had the raised bumps on his face and body for which smallpox is named (it’s derived from the Latin word for “spotted”). 

Moreover, an ancient Egyptian papyrus scroll briefly describes what could be smallpox, as do Hittite clay tablets. The Hittites, who lived in the Middle East, even accused the Egyptians of infecting them during a war between the two empires.

Many historians speculate that smallpox likewise brought about the devastating Plague of Athens in 430 B.C. and the Antonine Plague of A.D. 165 to 180, the later of which killed an estimated 3.5 million to 7 million people, including Emperor Marcus Aurelius, and hastened the decline of the Roman Empire. 

At any rate, it reached Europe no later than the 6th century, when a bishop in France unmistakably described its symptoms𠅊 violent fever followed by the appearance of pustules, which, if the patient survived, eventually scabbed over and broke off. By that time, the contagious disease, caused by the variola virus, had spread all across Africa and Asia as well, prompting some cultures to worship special smallpox deities.

In the Old World, the most common form of smallpox killed perhaps 30 percent of its victims while blinding and disfiguring many others. But the effects were even worse in the Americas, which had no exposure to the virus prior to the arrival of Spanish and Portuguese conquistadors. 

Tearing through the Incas before Francisco Pizarro even got there, it made the empire unstable and ripe for conquest. It also devastated the Aztecs, killing, among others, the second-to-last of their rulers. In fact, historians believe that smallpox and other European diseases reduced the indigenous population of North and South America by up to 90 percent, a blow far greater than any defeat in battle. 

Recognizing its potency as a biological weapon, Lord Jeffrey Amherst, the commander-in-chief of British forces in North America during the French and Indian War, even advocated handing out smallpox-infected blankets to his Native American foes in 1763.

English doctor Edward Jennerꃞveloped the first smallpox vaccine in 1796.

DEA Picture Library/Getty Images

Knowing that no one can contract smallpox twice, survivors of the disease were often called upon to try and nurse victims back to health. Throughout much of the last millennium, this involved herbal remedies, bloodletting and exposing them to red objects. 

One prominent 17th-century English doctor realized that those who could afford care actually seemed to be dying at a higher rate than those who couldn’t. Yet that didn’t stop him from telling a smallpox-infected pupil to leave the windows open, to draw the bed sheets no higher than his waist and to drink profuse quantities of beer.

Far more effective was inoculation, also called variolation, which involved taking pus or powdered scabs from patients with a mild case of the disease and inserting them into the skin or nose of susceptible, healthy people. Ideally, the healthy people would suffer only a slight infection this way and, in so doing, would develop immunity to future outbreaks. 

Some people did die, but at a much lower rate than those who contracted smallpox naturally. Practiced first in Asia and Africa, variolation spread to the Ottoman Empire around 1670 and then to the rest of Europe within a few decades. Its first proponent in the present-day United States was Cotton Mather, a Puritan minister best known for vigorously supporting the Salem witch trials. Benjamin Franklin, who lost a son to smallpox, was another early American supporter.

Variolation notwithstanding, smallpox continued wreaking havoc on princes and paupers alike. In the 17th and 18th centuries, it killed several reigning European monarchs, including Habsburg Emperor Joseph I, Queen Mary II of England, Czar Peter II of Russia and King Louis XV of France, as well as an Ethiopian king, a Chinese emperor and two Japanese emperors. 

Queen Elizabeth I of England and U.S. President Abraham Lincoln also apparently contracted smallpox during their time in office, though they fortuitously lived to tell the tale. Meanwhile, in Europe alone, an estimated 400,000 commoners were succumbing to smallpox annually.

Finally, in 1796, English doctor Edward Jenner performed an experiment that would, in good time, cause the virus’ downfall. By inserting pus from a milkmaid with cowpox, a disease closely related to smallpox, into the arms of a healthy 8-year-old boy and then variolating him to no effect, Jenner was able to conclude that a person could be protected from smallpox without having to be directly exposed to it. This was the world’s first successful vaccine, a term that Jenner himself coined. He tried to get his results published by the prestigious Royal Society, only to be told not to “promulgate such a wild idea if he valued his reputation.” 

A free smallpox vaccination clinic in France, circa 1905.

Ann Ronan Pictures/Print Collector/Getty Images

Persisting anyway, his vaccine gradually started catching on. The advantages over variolation were many. Unlike a variolated person, a vaccinated person could not spread smallpox to others. Moreover, the vaccine seldom left a rash and proved fatal in only the rarest of circumstances. 

𠇏uture generations will know by history only that the loathsome smallpox existed and by you has been extirpated,” U.S. President Thomas Jefferson wrote to Jenner in 1806. The following year, Bavaria declared vaccination mandatory, and Denmark did the same in 1810.

Because the vaccine originally had to be transferred from arm to arm, its use spread slowly. It was also much less effective in tropical countries, where the heat caused it to quickly deteriorate. Nonetheless, one country after another managed to rid itself of the disease. The last reported U.S. case came in 1949. 

Spurred by two new technological advances𠅊 heat-stable, freeze-dried vaccine and the bifurcated needle—the World Health Organization then launched a global immunization campaign in 1967 with the goal of wiping out smallpox once and for all. That year, there were 10 million to 15 million cases of smallpox and 2 million deaths, according to WHO estimates. Yet just a decade later, the number was down to zero. No one has naturally contracted the virus since a Somali hospital worker in 1977 (though a laboratory accident in England did kill someone in 1978).

After searching far and wide for any remaining trace of smallpox, the WHO’s member states passed a resolution on May 8, 1980, declaring it eradicated. “The world and all its peoples have won freedom from smallpox,” the resolution stated, adding that this “unprecedented achievement in the history of public health … demonstrated how nations working together in a common cause may further human progress.” 

Today, guarded laboratories in Atlanta and Moscow hold the only known stores of the virus. Some experts say these should be destroyed, whereas others believe they should be kept around for research purposes just in case smallpox somehow remerges.


The Antibody Initiative -- Eradicating Smallpox

A viral infection, smallpox spread along trade routes in Africa, Asia, and Europe, reaching the Americas in the 16th century. Because smallpox requires a human host to survive, it smoldered in densely populated areas, erupting in a full-blown epidemic every ten years or so. Wherever it appeared, smallpox caused blindness, sterility, scarring, and death.

In Africa and Asia, smallpox was traditionally contained through variolation—deliberately infecting an individual with a controllable case of smallpox to confer lifelong immunity. Variolation spread from Asia and Africa into Europe and the Americas during the 18th century. This practice had its dangers, as recipients of variolation could develop a full-blown case of smallpox.

In 1798, the English physician Edward Jenner developed a safer technique: vaccination with cowpox (vacca is the Latin word for cow). He based his “discovery” on existing folk knowledge but provided scientific proof of its veracity by testing the vaccine on a young child.

In 1809, following Jenner’s published account of his success in using vaccination to prevent smallpox, the town of Milton, Massachusetts, offered free vaccination to all its inhabitants. Over three hundred persons were inoculated during a three-day campaign in July. The town leaders then took the daring step of holding a public demonstration to prove without a doubt that cowpox vaccine offered protection from smallpox. In October, twelve children, selected from those vaccinated in July, were inoculated with fresh, virulent smallpox matter. Fifteen days later, they were discharged with no sign of smallpox infection. The experiment’s success led Miltonians to declare “He is Slain,” presaging the idea of “slaying” smallpox permanently.


Early Victims

Smallpox is thought to have originated in India or Egypt at least 3,000 years ago. The earliest evidence for the disease comes from the Egyptian Pharaoh Ramses V, who died in 1157 B.C. His mummified remains show telltale pockmarks on his skin.

The disease later spread along trade routes in Asia, Africa, and Europe, eventually reaching the Americas in the 1500s. Indigenous peoples there had no natural immunity. An estimated 90 percent of indigenous casualties during European colonization were caused by disease rather than military conquest.

Smallpox contributed to the decline of the Aztec Empire, in what is now Mexico, following the virus's arrival with Spanish conquerors in 1519. More than three million Aztec succumbed to the disease. Severely weakened, the Aztec were easily defeated. Likewise, smallpox claimed the life of an Inca emperor and wiped out much of the Inca population in western South America.

In Europe, smallpox is estimated to have claimed 60 million lives in the 18th century alone. In the 20th century, it killed some 300 million people globally.


The history of vaccinations and how smallpox was eradicated

It was called the "most dreadful scourge of the human species." It killed at least one-third of the people it infected. It decimated entire populations, striking old and young, rich and poor alike.

"It" is smallpox, a horrifying, deadly, and disfiguring disease caused by the variola virus. Early symptoms include high fever and fatigue, followed by a characteristic pus-filled rash, particularly on the face, arms, and legs. Smallpox is spread primarily through airborne respiratory droplets or saliva. Because the contagious period starts before symptoms begin and lasts until the last blister scab falls off, the disease spread easily from person to person. If it did not kill you, it often left disfiguring and tell-tale deep pockmarks on the skin. (Readers who have strong stomachs can view images of smallpox here.)

Smallpox was one of the most terrifying diseases in history. Today, however, we do not live in fear of it because smallpox no longer exists in the wild. That's right. In 1979, after an intensive and very effective worldwide vaccination campaign, smallpox was declared eradicated. This means that the smallpox virus is no longer circulating anywhere in the world. Let me repeat. Smallpox, which once killed millions of people and left thousands disfigured, no longer exists in the wild. It might show up in a forgotten government storage fridge, but that is not the point. The point is, it doesn't exist naturally in the population.

From milkmaids to mass vaccination

The amazing story of how this terrible disease was eradicated cannot be told without giving credit to a British physician and scientist named Edward Jenner. Dr. Jenner, like many others, had long heard that milkmaids who were infected with a bovine disease called cowpox were later protected against smallpox infection. In 1796, Jenner decided to test this theory. With permission, he took matter from a fresh cowpox lesion on the hand of a young dairymaid named Sarah Nelms and rubbed it into a cut on the hand of a healthy young boy (the gardener's son) named James Phipps. While Phipps did report a loss of appetite and fever, he recovered within a week. Sometime later, Dr. Jenner took matter from a fresh smallpox lesion and again rubbed it into a cut on James Phipps' hand. Young James did not become ill, proving to Jenner that the "inoculation" worked. A few years later, Jenner referred to the process as "vaccination" from the word "vaca," which means cow in Latin.

Dr. Jenner's theory was viewed with skepticism at first. But over time, it took hold in the medical community. Only four years later, in 1800, most of England had been vaccinated as well as vast swaths of Europe. Jenner's vaccine was eventually brought to America. Thomas Jefferson was vaccinated and became a swift proponent of the vaccine. In the early 20th century, following a smallpox outbreak, the town of Cambridge, Mass., mandated that all residents be vaccinated against smallpox. In what has become one of the key public health cases in American history, the Supreme Court held that the compulsory vaccination law was constitutional under the state's "police powers."

Even today, despite the obvious success of the vaccine, some people argue that smallpox was eradicated not by the vaccine but as a result of better hygiene or medical treatment. While improved hygiene and sanitation have improved public health in some aspects, cleanliness alone cannot prevent the spread of an infectious disease like smallpox. This disease spreads through droplets in the air and in saliva, not through dirt on the floor or because of unsanitary conditions. This is why even in industrialized, wealthy nations, smallpox continued to be a serious threat until the vaccine. And likewise, if cleanliness were the reason smallpox was conquered, then it would not have disappeared from the developing world, where poor hygiene and medical treatment remain realities.


Global Smallpox Eradication

1980 witnessed the fulfilment of a goal that many had considered impossible. At the recommendation of an independent commission of experts, the World Health Organization&rsquos (WHO) Health Assembly announced the global eradication of smallpox. It was a momentous occasion. In the view of many, with good reason, this was the greatest achievement of global public health in the twentieth century.

However, the passage of time seems to have taken some shine off the accomplishment in some quarters. Speeches and writings dealing with problems faced with current immunisation programmes argue, all too often, that smallpox eradication was easily achieved. According to this interpretation of events, the problems faced by the &lsquosmallpox warriors&rsquo were relatively straightforward as the disease did not have animal hosts.

For further information, please contact Professor Sanjoy Bhattacharya, Director of the Centre for Global Health Histories at the University of York.

Some commentators also argue, quite simplistically, that the work was based merely a strategy of searching for cases, containing infective individuals and vaccinating their immediate contacts with efficacious vaccines. These arguments are becoming increasingly commonplace as a series of subjective histories are beginning to be used by global funding agencies and scientists in their employ to justify dramatic increases in funding for new immunisation programmes targeted at specific disease.

These trends make it all the more important to come up with a rounded history of smallpox eradication that does not reduce the success of a complex global programme to the ideas and actions of a handful of individuals, and the impact of a supposedly uniform and stable vaccine technology.

A diversity of challenges

&zwnjThe situation was always more complicated throughout the course of a long-drawn out global smallpox eradication programme. Although it was announced in the late 1950s, the programme really only took off a decade later (after the completion of a series of successful campaigns across West Africa). Notably, its constituent activities took a further ten years to complete in a situation where the South Asian sub-continent and the Horn of Africa threw up a series of unexpected challenges. The mere presence of technological developments &mdash such as the introduction of heat stable freeze dried vaccines, and the so-called bifurcated needle that contributed to vaccinal economy and safety&mdash did not guarantee smallpox eradication. Human agency was an important determinant. Indeed, significant efforts had to be made by programme managers within the WHO and national governments to convince field officials to embrace new ideas and technologies. Notably, despite these efforts at persuasion, some people remained indifferent to the calls for the introductions of new operational methods and vaccinal products, choosing to stick to older procedures that they were more comfortable with and often regarded as being more reliable.

&zwnjOther challenges continued to afflict the campaign as well. Some sections of the target population opposed vaccination, which led to delays in projects in some areas and introduced time-consuming negotiations in others. There were, after all, limits to how much pressure the &lsquosmallpox warriors&rsquo could impose on local politicians, junior governmental officials and civilians diplomatic niceties could not be dispensed with altogether and international workers remained wary about stoking violent civilian resistance. Force, when it was used, could create lasting resentment, which was recognised as being strategically unhelpful in the longer term.

Other factors also created difficulties for the global effort at smallpox eradication. Support from within the WHO frameworks in Geneva and the Regional Offices remained inconstant, and often caused serious financial difficulties for those working in the field. These challenges were only overcome in the 1970s with the assistance provided by a range of donors. Help was provided by sources as diverse as the Swedish and Danish International Development Agencies, the Indian and Bangladeshi governments, and, not least, the Tata industrial consortium in India. To make matters worse &mdash and these trends remained visible right till the end of the campaign &mdash some officials associated to national and local governments continued to oppose the eradication goal, often simply because they considered it misguided and damaging to the vitality of general healthcare facilities. In addition, competing health and financial priorities, alternative epidemiological understandings of smallpox causation and control, and a variety of professional and personal jealousies proved damaging. This stoked doubts amongst bureaucratic and civilian constituencies, which translated into episodes where assistance was refused to teams of &lsquosmallpox warriors&rsquo.

Celebrating diversity and variation in practice

There were many positive aspects to the global smallpox eradication programme as well. A large number of participants cherish the internationalism that characterised it. For many, the campaign allowed a context in which cold war rivalries gradually dissipated, as several officials from the USA, the erstwhile USSR and countries allied to each of these countries learnt to trust each other. It is also worth remembering that many national workers regarded their participation in the project as a career highlight, allowing an intense and productive association with WHO frameworks. This attitude is well represented by the care and pride with which many officials have preserved certificates thanking them for their involvement in the eradication programme. There can be little doubt that there was goodwill amongst many &lsquosmallpox warriors&rsquo, despite differences in nationality, education, race, gender and age. For many young officials, participation in such a global programme led to new career paths, with international and government agencies, non-government organisations, universities and charities. A shared goal of saving lives drew many people together in the 1970s and ultimately gave rise to projects such as the Expanded Programme on Immunisation, whose components are credited for reducing levels of infantile mortality around the world by many observers.

However, all these positives should not be allowed to cloak important intricacies in operational strategy, especially as these are sometimes downplayed or ignored in celebratory treatises. The global smallpox eradication programme, which was composed of several national chapters linked by a series of international accords, was always marked by variations in official and civilian attitudes. Participants had differing visions about the efficacy of plans, and teams were composed of workers with dissimilar levels of ability and commitment. The contours of these attitudinal variations changed over time and place, as there were shifts in the composition of teams and their interactions with various constituencies in national territories and their locales.

Significantly, the transfer of ideas about the best means of eradicating smallpox did not flow in one direction. Indeed, the most effective campaigns were generally those that were based on a proactive exchange of ideas between field personnel of different ranks and backgrounds. For this reason, regular meetings between international workers and national counterparts were regarded as being a crucial component of the programme in the 1970s. Many international workers were also able to play another important role &mdashconduits for locally garnered information, which would otherwise have been ignored by those at the apex of national governing structures. Notably, WHO representatives were often able to put forward ideas presented by junior medical and paramedical staff who were in touch with the social, political and economic realities of specific regions this frequently ensured that such input was not summarily rejected. The multi-directional flow of ideas &mdash and the resulting impact on field policies &mdash is not always recognised or analysed by chroniclers of smallpox eradication. These trends are worthy of sensitive and in-depth study so that we are better able to present the many complexities characterising international, national and local vaccination campaigns.

A spirit of collaboration, in the widest sense, allowed the achievement of the impossible. So, as a magnificent achievement in public health co-operation is celebrated, care should be taken to avoid reducing all successes to the contributions made by a few individuals associated to specific institutions. These people and organisations could not, on their own, have stamped out smallpox all over the world. Different health agencies worked with each other, with one stepping up to fill the breach whenever another&rsquos strength was denuded by constant toil and required time to recover its vitality. Seen from this perspective, a complex association of institutions and people led to the stamping out of variola in its natural form it is of paramount importance that we do not forget the contributions of the many people who contributed to the triumph. As Donald A. Henderson and others deeply involved in running this most remarkable and complicated public health programme remind us in a series of lectures and interviews, smallpox eradication would have been impossible without the dedication of a huge number of individuals. It is imperative that we do not forget that a vast majority of these people were drawn from the countries where the final battles against the variola virus were concluded. Many more voices need to be remembered and recorded, before they are lost to posterity. But, that is a job for future historians, for whom there remains a lot to study and better understand, not least as efforts continue to be made to learn from past experiences.


Watch the video: Η μυστική επιδημία της Μαύρης Ευλογιάς στη Μόσχα το 1960 - ντοκιμαντέρ Ελληνικοί υπότιτλοι (December 2021).

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