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Have you heard of a disease that killed more than 500 million people in its hundred years of existence? Its affected individuals experienced high fever, body pain, and skin rashes that developed into hard, pressurized blisters filled with pus. Welcome to the world of smallpox—the infection that threatened the human population but was eradicated through people’s solidified efforts.
The origin of smallpox, though unclear, was said to begin around 10,000 B.C., at the same time of the rise of the first agricultural settlements in Northeastern Africa. It was believed that smallpox had existed for at least 3,000 years. In 18th Century Europe, around 400,000 people died annually of smallpox wherein one-third of its survivors went blind. On average, three out of every 10 people who got infected, died.
One of the first methods for controlling smallpox was called variolation, a process named after the variola virus which was the causative agent of smallpox. It was also known as inoculation, and was used in China approximately a thousand years ago. There were two methods of variolation. First is to gather powdered smallpox scabs and let the person inhale them through the nose, and second is to expose the person by scratching the material into their arm.
In 18th Century Europe, inoculation was controversial. At that time, tuberculosis and syphilis were also rampant. Unfortunately, the use of variolation caused infection and transmission of the viruses to around 3% of healthy individuals. However, it is worth noting that the case-fatality rate associated with variolation was 10 times lower than that associated with naturally occurring smallpox. A malignant form of smallpox was fatal in 5-10% of adults and 72% in children. This statistic drove people to see the significance of inoculating the younger population.
Among those children who received the smallpox material was eight-year-old Edward Jenner who is now known as the Father of Immunology. During the smallpox epidemic in England, he became a doctor and observed that milkmaids who were infected with cowpox developed some form of protection against smallpox. With this, Jenner decided to study the concept of acquired immunity. His experiments included the injection of the material he obtained from the hand of a milkmaid named Sarah Nelms into the arm of a healthy young boy named James Phipps. James developed a scab and experienced soreness and mild fever for a day. Six weeks later, Jenner administered the legitimate smallpox-causing virus to Phipps but the boy surprisingly showed no signs of the disease.
This event, even though it was disapproved and criticized by other physicians, was one of the contributing factors to the birth of vaccination, leading to the gradual decrease in the prevalence of smallpox in Europe. Eventually, developments were made and a technique was done to produce a heat-stable, freeze-dried vaccine which has a longer shelf life. Soon after, North America and Europe were able to bring smallpox cases to zero. However, the disease remained endemic in 33 less-developed countries until 1966.
Years later, the global eradication effort led by D. A. Henderson planned to use mass vaccination campaigns to achieve 80% vaccine coverage in all countries but it appeared impossible in underdeveloped nations. Fortunately, Dr. William Foege devised a strategy known as the surveillance-containment or ring vaccination which led to the disappearance of smallpox in Nigeria despite the vaccine coverage of less than 50%. This involved aggressive case-finding, followed by vaccination of all known and possible contacts to seal off the outbreak.
By 1979, the world was officially smallpox-free with stringent efforts for vaccination and implementation of public health programs. At that time, people were aware that the benefits of vaccination outweigh its risks. In today’s battle against COVID-19, people have seemed to have forgotten the lessons from the past and many are swayed by the controversies on the newly developed vaccines. Vaccination has proven itself as a solution to epidemics countless times already. It ended smallpox, influenza, and other outbreaks that threatened the human population. With this, who is to say we cannot do it again, this time with COVID-19?
Written by Renz Ghester Ang
Art by: Neon Ross
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