On 8 May, 1980, less than two months after I was born, the World Health Assembly declared the world was free of smallpox. (Those two events are completely coincidental, by the way, but it was great timing on my mother’s behalf.)
Smallpox was a devastating disease. It killed three of every 10 people who contracted it and left those who survived with terrible scars. Eradicating it is the world’s greatest achievement in international public health. But it did not happen by accident, and it did not happen quickly.
It was in 1796 that an English doctor, Edward Jenner, first came up with the idea for a smallpox vaccine. He’d noticed that milkmaids who’d had cowpox (a related disease) didn’t show any symptoms of smallpox when later exposed to it. He did some experiments and by 1801 believed inoculation could lead to the “annihilation” of the “dreadful scourge of a disease”.
You’ll notice from the dates it took nearly 200 years for that to happen. During that time, smallpox killed millions of people. Experts estimate that, in just the first 75 years of the twentieth century, somewhere between 300 million and half a billion people died of smallpox. There was no cure. There was no treatment. Annihilation was the only option.
But why did eradication take so long? The problem wasn’t anti-vaxxers (in case you’re worried you’re in for some kind of lecture). The problem was strategy.
In 1959, the World Health Organisation set about trying to eradicate smallpox completely. Over the next decade progress was slow, particularly in Asia, South America and Africa. Funds were low, donations of vaccines woefully insufficient, and available medical staff precious few. This meant a mass vaccination program, like countries are now planning to roll out for coronavirus, simply wasn’t an option.
So, they changed strategy. Instead of vaccinating everyone, they decided to seek out and vaccinate only the people who were at immediate risk from smallpox, because someone in their household or living nearby had the disease. The strategy was called ring vaccination. And it worked. The last person to die of smallpox died in 1978, less than a decade after the strategy was introduced.
We’d had the vaccine for nearly two centuries, but it took a change of strategy to get the result the world was waiting for.
There are a few really valuable lessons here we should all keep in mind:
After a year of living with coronavirus and its chaos, I hope the story of how we eradicated smallpox has been just the shot in the arm you need to get you through. At least until you get that other shot in the arm you need to get you through.
20 January 2021
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