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Smallpox: the First Eradicated Disease in History

Updated: Nov 10, 2022

Nashua, NH

Smallpox was a contagious disease caused by the variola virus. It spread through infectious droplets to uninfected people in close contact with those with the illness. Symptoms started with a fever, fatigue, vomiting, and pain in the back and stomach. After a couple of days, large rashes like blisters would form, filled with infective water and puss. Nearly 30% of those who were infected died, and this disease ravaged communities all over the world for nearly thousands of years. It seemed like a horrid plague that would torment humanity for many years to come, achieving status with other diseases such as Alzheimer’s, Ebola, and cancer, but you must be wondering “if this is such a horrible disease, how have I never heard of it recently?”. Answer: it’s no more. This disease has been declared eradicated since 1980, and the last known case of this infection was in 1977 in Somalia. It is the only disease as of August 2022 to have achieved this status and paves the way for more diseases to achieve this distinction. So, how was such an ancient and powerful disease eradicated?

Smallpox, vaccination, variolation, history of smallpox, eradication of smallpox, history of vaccination, Edward Jenner
Smallpox scars have been found on the Mummy of King Ramses V

The first evidence of smallpox is found during the New Kingdom period of Egypt, which lasted from 1570BCE to 1085BCE. Many mummies from that time period had been found with lesions on their bodies including The Pharoah Ramses V who was found with lesions on his face, showing that he had passed away from smallpox. During the Egyptian Hittite War in 1350BCE, smallpox spread to the Hittite population through enslaved Egyptians, which killed their king and destroyed their population, being the first smallpox epidemic. Soon, the virus spread Eastwards through trade routes, with records of its spread appearing in China, India, and Asia Minor through the 4th and 10th centuries CE. The virus reached Europe in the 6th century CE through the Crusades. The virus particularly devastated native populations in the New World, who had no prior exposure to the virus. It was believed that smallpox and other diseases from the Old World killed nearly 90% of the Native population.

But, the fight against smallpox started much before the 20th century, from all the way back in 1022CE in China, where a Buddhist nun practised variolation. After seeing that those who survived smallpox were never infected, she started to grind infected smallpox scabs and blow them up the nostril of those uninfected. This gave them a mild case, but they were soon cured, and they never got smallpox naturally after that. This method of intentional infection spread throughout Asia, Africa and the Middle East and was common practice there by 1700. Variolation was introduced into Europe and America in the 1700s, although they administered the infection by scratching the skin with a contaminated needle. This method was effective, but still, nearly 2% of those who underwent variolation died from the procedure, and the mild cases were still infectious, causing epidemics. The disease killed disregarding class and many royals killed themselves, such as Habsburg Emperor Joseph I, Queen Mary II of England, Czar Peter II of Russia and King Louis XV of France.

Smallpox, vaccination, variolation, history of smallpox, eradication of smallpox, history of vaccination, Edward Jenner
Edward Jenner

In 1796, Edward Jenner, an English doctor, decided to host an experiment. When 13-year-old Jenner was an apprentice to a physician in Sodbury, he met with a milkmaid who had claimed she cannot get smallpox, since she had caught cowpox. Cowpox is a disease from a virus in the same family as the variola virus and primarily infected cows. Later on, Jenner realized that the milkmaid was, in fact, correct. Those who caught cowpox never got smallpox, and since the cowpox virus only infects cows, when it does infect humans, which are an unfamiliar host, it is less severe. Jenner realized that cowpox could be used to give immunity, instead of smallpox, as it is a much safer alternative. To test his theory out, he took fluid from the scab of a cowpox-infected milkmaid named Sarah Nelmes and inoculated James Phipps, the son of his gardener. After a few days of ever, he got better. Jenner then repeatedly exposed him to smallpox, but Phipps never got infected. Later, Jenner tested this on many other subjects, all giving the same result. Soon, the medical community accepted this method of immunity and began practising it on the uninfected. This method, called vaccination, proved to be much more effective than variolation, and soon, variolation was banned in England in 1840.

Since vaccination was done by scratches, it was a slow process and was less effective in tropical countries, where the heat caused exposed cowpox viruses to deteriorate. Despite this, many countries managed to vaccinate and save many lives, with the last American case reported in 1949. Soon, the concept of injection for vaccination came to be with the invention of the bifurcated needle and the ability to freeze-dry a vaccine. This proved to be a much better method of vaccination, especially in those tropical areas where vaccination by scratches was less effective. Injecting the vaccine into the bloodstream allowed it to enter the body without being exposed to the tropical climate. In 1967, the World Health Organization started a campaign to immunize every person around the globe, in an effort to wipe out smallpox. With this campaign, the number of cases dropped from 15 million to nearly zero in a decade. After a thorough search for any more remnants of the disease, the WHO declared the disease eradicated on May 8, 1980.

Smallpox, vaccination, variolation, history of smallpox, eradication of smallpox, history of vaccination, Edward Jenner
The variola virus that causes smallpox is now only existent in 2 locations in the world

Even though smallpox is completely eradicated in the public setting, the virus itself still survives. After the announcement of its eradication, scientists and public health officials knew that smallpox was still needed, to conduct further research on it. In 1841, 4 countries, the USA, England, Russia, and South Africa were the only places where the virus was either stored or being tested on. In 1984, England and South Africa either destroyed their stock or shifted it to other locations. The only two places where the virus is stored are the State Research Center of Virology and Biotechnology (VECTOR Institute) in Koltsovo, Russia and the Centers for Disease Control and Prevention in Atlanta, Georgia.

The downfall of smallpox was a long process that took years of experiments, tests, and the loss of thousands of lives, but finally, the disease is not one that we have to worry about. Thanks to Jenner, we now have the vaccination, which has proved to be a very useful tool for immunization for thousands of other diseases. But, this is just the beginning of an age of medical discovery. There is a rise in many medical fields, including immunology, and we are on the brink of a new period of no disease and top-notch healthcare for all. But, we must not forget those in the past, such as the unnamed Buddhist nun, Sarah Nelmes and James Phipps, who played critical roles in eradicating smallpox and in the future wiping out many other dangerous diseases.

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