A Further Look Into… A Milestone In Modern Medicine

By Michelle L. Warmath

“Liberty cannot be preserved without a general knowledge among the people, who have a right … and a desire to know.”
— John Adams, 1765

Forty-one years ago, on May 8, 1980, the World Health Organization officially certified that smallpox had been eradicated completely.

Smallpox was a scourge of Biblical proportions. Its known existence goes as far back as Ancient Egypt, as scars left from smallpox have been found on Egyptian mummies. It caused thousands of painful blisters that spread all over the body and in the mouth and left extensive and disfiguring scarring in most cases. Its severest cases left one-third of survivors blind. There are traders’ and whalers’ accounts of people in agony from the fever and blisters going to lie in a river, a lake or in the sea surf to try to find relief and refusing to come out until they died. People perished of smallpox in the hundreds of thousands every year in medieval Europe and an estimated 500,000,000 people worldwide – especially infants and children – lost their lives to smallpox in the final century before its eradication alone.

Smallpox is transmitted essentially through inhalation of the airborne virus but also from exposure to contaminated objects. There are two smallpox variants, variola major and a milder form, variola minor. However, as the milder form was less debilitating and less deadly, this often meant that people frequently continued to go about their lives as usual, thus exposing many other people and causing the disease to spread exponentially, which led to recurring outbreaks and epidemics.

Like all contagious diseases, smallpox was spread around the globe through travel, trade and conquest, particularly after the 6th century CE. Indigenous populations, which had no immunity against the foreign diseases introduced by European traders, whalers and colonizers, were decimated by it. This fact is well-documented in the Americas and Africa, and while smallpox was not endemic in Australia to the extent it was in Europe, it ravaged the Aboriginal peoples.

In the latter part of the 18th century, several investigators in England and Germany who had observed that people who were exposed to cowpox did not catch smallpox began using a vaccine made from cowpox, or milk from cows affected by cowpox, to inoculate others against smallpox. Edward Jenner is credited with initiating, in 1796, the development of the modern smallpox vaccine. But “inoculations” had already been carried out in China, where the first published reference, dating to 1549 (Wan Quan), was found. These early methods usually involved placing the person in contact with the virus through inhalation of dried smallpox blisters or by “variolation”, which involved cutting the skin and placing fluid from smallpox blisters on the cut. Vice-President John Adams and his family were inoculated in this latter way. Those inoculated became sick with the disease but as the symptoms were generally far milder, they usually did not die from it as they would have if they had caught the disease spontaneously, and they developed lifelong immunity to it.

In case you were wondering: Cowpox is caused by the vaccina virus which is similar to the variola virus. Vaccina, and thus “vaccination”, comes from the Latin word for “cow”, “vacca”. Smallpox and cowpox are poxviruses. Chickenpox is caused by the varicella zoster virus and is not the same thing; it’s a herpesvirus and catching chickenpox doesn’t make you immune to smallpox like catching cowpox does.

The first international campaign to eradicate smallpox was begun by the Pan-American Health Organization in 1950 and led to its eradication in most of the Americas (United States in 1952) and in Europe (1953). In 1959, the World Health Organization launched a global eradication campaign. This was slow to get off the ground due to lack of funds, lack of commitment and lack of vaccine donations, but the WHO persisted. The last recorded naturally-acquired case of smallpox was that of Mr. Ali Malow in Somalia, who fell ill with the milder form in 1977 and survived. Mr. Malow went on to advocate for the eradication of polio; sadly, he died of malaria in 2013 while working on one such campaign. The last recorded death from smallpox was that of a medical photographer in England in 1978, Ms. Janet Parker, who may have been accidentally exposed to the smallpox virus while visiting the microbiology department at the Birmingham Medical School.

Today, only two laboratories, the CDC in the United States and the Vector Institute in Russia, keep strains of the smallpox virus for research purposes, under WHO supervision.

We are very fortunate that we no longer have to fear this dreadful disease. The eradication of smallpox is one of the significant medical and scientific accomplishments of the 20th century. Similar campaigns to eradicate polio and other major diseases are ongoing today, and vaccination against childhood diseases and other illnesses is either required or at least strongly recommended in Western countries while in Africa and other developing countries child vaccination campaigns are held on a yearly basis with support from international NGOs and global corporations. It should be noted that recently, significant progress has been made in developing a vaccine against malaria, which is still endemic in tropical and subtropical regions and causes hundreds of thousands of deaths every year, with well over half being children.

The fact that last year’s 40th anniversary of the eradication of smallpox coincided with the onset of COVID-19 should be food for thought. We are not as “fortunate” with COVID-19 as we were with smallpox, because once you have been vaccinated against smallpox (or if you got sick with it and survived) you are sure to never catch it (or never catch it again). Smallpox didn’t mutate to any extent, either. It’s still unsure, at least at this time, whether COVID-19 vaccination or survival offers the luxury of permanent immunity, and COVID-19 mutates like wildfire in a dry pine forest and science simply must be able to keep ahead of that.

Does that mean we can’t eradicate COVID-19? Of course not. We have seen that we as a world community have the science and the technology to develop and manufacture COVID-19 vaccines at breathtaking speed (in terms of scientific achievement, anyway) and mRNA technology may also provide avenues of hope against many other cruel maladies – perhaps even cancer, who knows? But because COVID-19 mutates so easily – and because it CAN’T mutate if it has NO host – in other words, if it can’t infect people – it will require the worldwide village to be strictly disciplined and commit wholly to doing what it takes: vaccinating, boosters if necessary, testing, preventive measures and masks – and yes, in that case, and in that case only, we can eradicate COVID-19.

How many of you have the scar that shows you were vaccinated against smallpox? Be proud of it. You were part of a truly historical medical and humanitarian undertaking. And your COVID-19 vaccination card makes you part of another momentous moment in human history.

Let’s be strong, keep doing our part, mask up and keep encouraging others.

Stay safe and till next time.

Michelle L.W.