DEFENDING THE BODY FROM WITHIN

The Worldwide Eradication of Smallpox

The havoc of the Plague...visited our shores only once or twice within living memory; [but] the small pox was always present, filling the churchyards with corpses... .
- Thomas Macaulay, History of England, 1848

For 32 centuries, smallpox virus existed as a disfiguring and often fatal pathogen, taking an unrelenting toll on human populations. Today, smallpox is an historical footnote, the first global infectious disease to have been eradicated completely by vaccination. The absence of smallpox has made vaccination of new generations unnecessary, but has left them vulnerable if exposed to smallpox virus. So this triumph over infectious disease must now be tempered by concern over the possible misuse of smallpox virus as a potential biological weapon.

The story of smallpox eradication in Europe goes back at least two or three centuries to the use of smallpox variola or "crusts" (containing the smallpox virus) to induce immunity. In 1796, an English doctor named Edward Jenner substituted the less virulent cowpox for smallpox, thus prototyping what became a widely used vaccine. Following Jenner's momentous achievement, Thomas Jefferson wrote to him from America. "Future generations," Jefferson said, "will know by history only that loathsome smallpox has existed." Jefferson was correct, but premature.

Smallpox continued to ravage large parts of the world — with sporadic outbreaks occurring well into the century in this country and more sustained outbreaks in developing countries. In 1966, the World Health Organization (WHO) announced a 10-year global smallpox eradication program. Headed by Dr. Donald A. Henderson, the program was successful — with Africa the final battlefront. The disease has effectively been eradicated, but known stocks of the smallpox virus still exist as medical resources. Secret stocks, held for potential use as pathogenic agents in bioterrorism or biological warfare, may also exist.

Vaccination equipment and paraphernalia. The bifurcated needle was invented by Benjamin Rubin specifically for smallpox vaccine. The space between the tines holds exactly the right amount to vaccinate a single individual. Other items include smallpox vaccine, a horn for holding smallpox crusts, a needle holder, and a rotary lancet.

The last campaign(s)
The last campaigns in the war on smallpox were waged in developing countries. They entailed the widespread vaccination of populations living in places where smallpox was endemic and the use of community leaders and others to track the disease. There have been no known cases of smallpox since 1978. In addition, the success of the Smallpox Eradication Program suggested that other infectious diseases might be similarly eradicated or at least reduced. In the mid-1970s, the World Health Organization launched an Extended Program of Immunization to protect children and others from polio, tetanus, measles, and other infectious diseases. Those programs are now ongoing.

Left: Booklet designed to help people recognize smallpox, 1970s.

Upper right: Dr. Henderson, chief medical officer of the Smallpox Eradication Program, (at left), in Afghanistan, 1976.

Lower right: WHO physician vaccinating a West African child, c. 1970. The physician is using a jet injector, which uses a bulky compressed air tank to force small quantities of vaccine through the skin. This high-technology device proved less useful for global eradication because of its energy requirements, cost, and need for a skilled operator.

Left: Story board depicting the 1970's eradication of smallpox in Ethiopia.
This story board, painted by a native African who followed Dr. Henderson, documents the progress of the World Health Organization campaign.

Right: WHO magazine cover, announcing the end of smallpox.

Figures from Africa and elsewhere. These figures — all having some connection to smallpox — were collected by Dr. Henderson during the World Health Organization's eradication campaign.

Left: "World's Last Case of Smallpox Waiting for the Helicopter," 1976 carving. This titled and signed carving by Massengo, an artist from Zaire, shows one of the last African cases of smallpox.

Right: Sopona, the smallpox god of the West African Yoruba people. Among the Yoruba, Sopona is known as a powerful warrior who waged many wars, often resorting to the use of medicinal brooms to spread smallpox (sopona). Worshipers use figures such as these to repel and divert epidemic diseases.

Left: Sitala Mata, the Hindu goddess of smallpox, from India. Sitala is a Hindu goddess, whose help is sought in combating smallpox.

Right: Omolu, a Brazilian version of Sopona. The mythology of Sopona was transported to Brazil by Yoruba slaves, and became known as Omolu.

United Nations coins and pins commemorating the eradication of smallpox.

Medals awarded to Dr. Henderson in recognition of his work in world health care.