Extract from ABC News
Doctors administering smallpox vaccination in 1946. (AFP: National Archives)
On December 9, 1979, a global commission of scientists certified that smallpox, one of the world's deadliest and oldest diseases to infect humans, had finally been eradicated.
Five months later, in May 1980, the 33rd World Health Assembly officially declared it from Geneva: "The world and all its people have won freedom from smallpox, which was the most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness and disfigurement in its wake."
The eradication of smallpox has been hailed as the greatest triumph of global public health — it is the only human disease to have been wiped from the world, thanks largely to a clever vaccination strategy.
It has also been held up as a model for global cooperation; the achievement hinged on rare collaboration between the United States and the Soviet Union, whose partnership was formalised under the World Health Organisation (WHO) in 1966.
As for whether such a feat could be accomplished today is up for debate. For one thing, the COVID-19 pandemic has exposed serious weaknesses in global health governance, with critics arguing that the WHO did not mount an effective enough response to the crisis.
Many countries are also recording concerning drops in vaccination coverage, with some recently losing elimination status for measles.
Still, the decades-long effort to stop smallpox paid off. The disease afflicted millions of people over at least 3,000 years, with historians estimating it killed as many as 300 million in the 20th century alone.
Its symptoms were gruesome: fever, vomiting, mouth sores, and a characteristic rash with pustules covering the face, hands and body. Roughly a third of patients died, while survivors were often left with permanent blindness or infertility.
The path to eradication
One of the earliest efforts to control the disease was variolation, a process named for the variola virus, which causes smallpox. With variolation, people who had never had smallpox were exposed to material from infected pustules, which was usually scratched into their arm — a primitive (if risky) kind of vaccination.
In the 1840s and 1850s, mandatory smallpox vaccination programs were established in the UK, US and other parts of the world, helping some European countries eliminate the disease by 1900 (and creating a new challenge from noisy anti-vaccination campaigns which sprang up in response.)
By the 1950s, heat-stable, freeze-dried vaccines had been developed, and smallpox was eliminated in Western Europe, North America and Japan.
It wasn't until 1958 that the World Health Assembly called for global eradication — the path to which was full of disasters, bureaucratic dilemmas and scepticism.
Not everyone believed it was possible, given the scale of the challenge, or that it was a worthy aim. Was the cost and effort worth it, given all the other diseases needing attention?
However, as the medical doctor Lawrence K. Altman wrote in the New York Times in 1979: "Smallpox eradication was undertaken as much for economic as altruistic reasons. In this era of cost‐benefit analysis, justification for wiping out smallpox comes from the savings of $1 billion that will be realised each year from reducing quarantine services, eliminating vaccinations and the treatment of smallpox cases and complications of vaccination."
'A minor surrogate for an alien invasion'
The Intensified Smallpox Eradication Program was launched in 1967. One pivotal strategy it relied on, particularly in Africa and India, was ring vaccination, which required health workers to quarantine and vaccinate people who had been exposed to smallpox and their close contacts — creating a protective "ring" around new cases and breaking chains of transmission without having to vaccinate everyone.
The architect of the surveillance-and-containment technique, William Foege, later said the international effort to stamp out smallpox had been one of the "greatest professional experiences" of his life. "Some things have to be believed to be seen," he said in 1994.
While Foege has previously said he didn't think any other human diseases could be eradicated (except maybe guinea worm), in recent years he has spoken about how the lessons of smallpox eradication could be applied to COVID, as well as other diseases and disciplines.
"There was a historian who said, 'You'll never really get the world to collaborate unless there's an alien invasion'. Smallpox turned out to be a minor surrogate for an alien invasion because we could all see ourselves at risk," Foege, a former CDC director, said in 2021.
"In our health programs we should deliberately ask: 'What could we use as a surrogate for an alien invasion?' We've done that with nuclear weapons. I think that we did that with HIV. That's one example of trying to get some equity globally because we saw ourselves at risk.
"I think COVID-19 is a great opportunity to say, 'We're all at risk, so what do we do as a world to make this truly a surrogate for an alien invasion?'"
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