Taking Steps to Eradicate Smallpox: Historical Analysis

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Introduction:

Smallpox is a disease that attacks the skin cells, spleen, bone marrow, and lymph nodes and causes rashes, vomiting, and high fever. It is also an airborne disease which makes it especially dangerous because they tend to spread easily through coughing, sneezing, and other methods of contact with bodily fluids. 30% of infected people died within the first two weeks of having the infection. Smallpox is the only disease in the world that has been successfully eradicated. According to the online Smithsonian website “An estimated 300 million people died of smallpox in the 20th century alone”. In the 16th Century, the process of variolation was frequently used as a treatment for smallpox in China and India. Edward Jenner, an English doctor, displays the effectiveness of using the cowpox infection in protecting people from smallpox, forming the basis for vaccination.

Definition of Key Terms:

Britannica defines Smallpox as an acute infectious disease that begins with a high fever, headache, and back pain and then proceeds to an eruption on the skin that leaves the face and limbs covered with cratered pockmarks, or pox. Smallpox is also often referred to as variola due to the infection being caused by either variola major or variola minor.

Merriam Webster has defined Variolation as the deliberate inoculation of an uninfected person with the smallpox virus (as by contact with pustular matter) that was widely practiced before the era of vaccination as prophylaxis against the severe form of smallpox.

According to the Oxford dictionary, Epidemics are defined as the widespread occurrence of an infectious disease in a community at a particular time.

As per Merriam Webster Cowpox is defined as a mild eruptive disease of the cow that is caused by a poxvirus (species Cowpox virus of the genus Orthopoxvirus) and that when communicated to humans protects against smallpox.

Vocabulary.com defines Ring Vaccination as the act of administering vaccine only to people in close contact with an isolated infected patient; prevents the spread of a highly infectious disease by surrounding the patient with a ring of immunization.

Lexico defines Vaccines as a substance used to stimulate the production of antibodies and provide immunity against one or several diseases, prepared from the causative agent of a disease, its products, or a synthetic substitute, treated to act as an antigen without inducing the disease. Vaccination derives from the Latin word ‘Vacca’ which means cow, because of the early use of the cowpox virus against smallpox was very significant.

According to The Food and Drug Administration (FDA), Lyophilization is defined as a process in which water is removed from a product after it is frozen and placed under a vacuum, allowing the ice to change directly from solid to vapor without passing through a liquid phase (freeze-drying).

Description of Event:

1570-1085bc

The earliest traces of smallpox were believed to have appeared at around 10,000 BC, during the time of the first agricultural villages in northeastern Africa. It was most likely originated from such groupings to India and China through ancient Egyptian traders. The earliest evidence of skin lesions matching those of smallpox is found on faces of mummies from the time of “the 18th and 20th Egyptian Dynasties (1570–1085 bc). The embalmed head of the Egyptian pharaoh Ramses V (died 1156 bc) shows evidence of the disease. Around that time, smallpox was expressed in the ancient Sanskrit texts of India.

1800’s

In the 18th century in Europe it was estimated that around “400,000 people died yearly of smallpox”, and “one-third of the survivors went blind”. The signs of smallpox, or the “speckled monster” as it was known in 18th-century England, appeared abruptly and the consequences were disastrous. “The case-fatality rate varied from 20% to 60%, and in infants, it was even higher, approaching 80% in London.

May 1796

Edward Jenner was born on May 17, 1749, and over the course of many years, he had heard and understood folk tales that said dairymaids were immune to smallpox after naturally having suffered from cowpox. In May 1796, he began to take steps toward proving his theory. Jenner found a young dairymaid named Sarah Nelms, who had newly formed cowpox lesions on her body. He used scabs from the pustules and attempted to inoculate James Phipps. Following that he began to develop a fever which he eventually recovered from. A few months later, Jenner injected him with smallpox, and he was immune therefore proving Jenner’s theory.

1905

Jacobson vs Massachusetts was a legal case that was fought between Pastor Henning Jacobson and The Commonwealth of Massachusetts. Jacobson argued that it was a “invasion of his liberty” to force him to get his son vaccinated. He said that the vaccine caused him great pain and was reluctant to vaccinate his son. He lost the case and was fined.

1965

In 1965, the plan to eradicate smallpox globally were revitalized, with the establishment of the Intensified Smallpox Eradication Program.

Current Situation (1965)

In the 1960s, smallpox was still endemic. However, the practice of using vaccinations did not spread to the rest of the world, despite the vaccine’s success in Europe. There were an estimated 10 million cases of smallpox worldwide by the mid-1960s, specifically in South America, sub-Saharan Africa, India, Burma, Bangladesh, and Indonesia. The World Health Organisation (WHO) was working with countries in South America, Asia, and Africa to eradicate smallpox. The first attempt in 1958 to globally eradicate smallpox was not successful due to obstacles such as- lack of funds, commitments from countries, and a lack of vaccine donations.

Religious Barriers and Public Rejection

Religious groups were skeptical towards using the smallpox vaccine and truly believed that if God (or Gods) had chosen to give them smallpox, to interfere with his plans would be inappropriate. Some religions even had smallpox deities for example: shapona, sakpata, shitala, babalú- Ayé etc. People’s strong faith was a complicated obstacle which deterred them from accepting the vaccines. Another major problem was that this was the first time people were taking animal products and inoculating it into humans. Those who found it unnatural and revolting were hostile towards the inoculates. Early 19th-century illustrations showed cow parts growing out of the bodies of people who were vaccinated, this propaganda lead to the increased fear of vaccinations.

Bifurcated Needles

Dr. Benjamin Rubin created one of the most important tools used in mass vaccination campaigns in the year 1965, the Bifurcated Needle. The appropriate dosage of the reconstructed (freeze-dried) smallpox vaccine was held in the two prongs of the needle. The prongs were ideal as they would puncture into the skin easily to the essential depth. It was also much more cost effective, reliable and easy to transport and operate with.

Major Parties Involved and Their Views

Soviet Union

Viktor Zhdanov was a Soviet virologist who played a critical role in the movement to eradicate smallpox. He had seen smallpox contained in the Soviet Union in the 1930s and didn’t understand why the same methods couldn’t be used elsewhere. Zhdanov was not only experienced in running an eradication campaign, but he also believed in a technique known as lyophilization or freeze-drying. Evidence from the 1950s had shown that several medicinal products could be preserved in this way, the smallpox vaccine was one of them. The freeze-dried vaccine was easy to transport and can be reconstructed when needed. Zhdanov believed that freeze-dried vaccines would be an essential tool in the WHO’s smallpox eradication program, and said his government was ready to furnish WHO with supplies. Zhdanov convinced the WHO Member States to support his plan, and at the next World Health Assembly, in 1959, they voted in favor of starting an intensified global smallpox eradication campaign. If Zhadanov had not lobbied his idea to the UN it is likely that things would be very different.

UN Involvement, Relevant Resolutions, Treaties, and Events (before 1965)

The WHO came into existence in 1948. At that time the smallpox virus was killing hundreds of thousands of people worldwide. In many ways, it was exactly the kind of issue that the WHO was expected to take on, a disease that was beyond the scope of any individual nation to combat. In 1953 at the annual World Health Assembly, the topic of eradicating smallpox was discussed, but there wasn’t much enthusiasm towards the idea. In the 1950’s it seemed impossible that any disease could be eradicated globally, even though it was becoming more realistic because countries like the US had their last (natural) outbreak of smallpox in 1949.

Resolution: Regional Committee for the Western Pacific, 009. (‎1958)‎. Smallpox eradication (‎Resolution)‎. Manila: WHO Regional Office for the Western Pacific. WP/RC9.R9 – http://iris.wpro.who.int/handle/10665.1/8795

Possible Solutions

Emphasizes the importance of easy access to volunteers from the SEP to the public health officials of member nations through regular progress report to determine effective next steps.

SEP officials would be trained and experts in the effective techniques to contain and prevent the spread of diseases. The SEP should be able to effectively assign staff to where they need to be.

Urges member nations to negotiate the terms of variola virus stocks stock to prevent the weaponization of smallpox.

Merriam Webster defines bioterrorism as terrorism involving the use of biological weapons. Evidence shows that there is a possibility that smallpox has been used as a biological weapon during the colonization of North America. Were British colonialists in the 18th century gave smallpox-infected blankets to Native Americans.

Encourages the SEP to operate in smallpox-specific hospitals to prevent the further spread of diseases,

Though hospitals are thoroughly cleaned and extensive protocols are in place, it is impossible to ignore the fact that hospitals hold sick people in close proximity. Due to the easily contagious nature of smallpox, it would be safer to have separate hospitals/ camps for smallpox.

Hospital staff and volunteers should be aware of hospital protocols and should remain cautious.

Notes the benefits of Anti-vaccination fines.

In The United Kingdom, the Vaccination Act was implemented in 1853. Which made it compulsory for children to be vaccinated against smallpox in the first three months of their lives. Vaccinations from an early age which are provided by the hospital make it convenient for parents to vaccinate their children.

​Useful Links/Works Cited

  1. WHO. Bugs, Drugs and Smoke Stories from Public Health. World Health Organization, 2011.
  2. CDC. “The Spread and Eradication of Smallpox | Smallpox | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Aug. 2016, www.cdc.gov/smallpox/history/smallpox-origin.html.
  3. WHO. “Smallpox.” World Health Organization, World Health Organization, 2 May 2018, www.who.int/csr/disease/smallpox/en/.
  4. WHO. “The Smallpox Eradication Programme – SEP (1966-1980).” World Health Organization, World Health Organization, 22 May 2014, www.who.int/features/2010/smallpox/en/.
  5. CDC. “History of Smallpox | Smallpox | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Aug. 2016, www.cdc.gov/smallpox/history/history.html.
  6. CDC. “History of Smallpox | Smallpox | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Aug. 2016, www.cdc.gov/smallpox/history/history.html.
  7. TED-Ed, Simona Zompi. “How We Conquered the Deadly Smallpox Virus – Simona Zompi.” YouTube, YouTube, 28 Oct. 2013, www.youtube.com/watch?v=yqUFy-t4MlQ.
  8. Flight, Colette. “History – British History in Depth: Smallpox: Eradicating the Scourge.” BBC, BBC, 17 Feb. 2011, www.bbc.co.uk/history/british/empire_seapower/smallpox_01.shtml.
  9. Geographic, National. “Smallpox.” Information and Facts | National Geographic, 17 July 2019, www.nationalgeographic.com/science/health-and-human-body/human-diseases/smallpox/.
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  11. Discovery, DCODE by. “Can Smallpox Be Weaponised?” YouTube, YouTube, 10 Oct. 2018, www.youtube.com/watch?v=DgBQtrG_7EE.
  12. Garon, Julie, and Walter A. Orenstein. “Learning from Smallpox: How to Eradicate a Disease – Julie Garon and Walter A. Orenstein.” YouTube, YouTube, 10 Mar. 2015, www.youtube.com/watch?v=oBSandHijDc.
  13. Atkinson, Jason. “Small Pox │ Full Documentary.” YouTube, YouTube, 8 Sept. 2016, www.youtube.com/watch?v=d2rNvII842w.
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  18. Center for Global Development. “CASE 1: Eradicating Smallpox.” Center For Global Development, www.cgdev.org/page/case-1-eradicating-smallpox.
  19. Riedel, Stefan. “Edward Jenner and the History of Smallpox and Vaccination.” Proceedings (Baylor University. Medical Center), Baylor Health Care System, Jan. 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/.
  20. Gathany, James. “Bifurcated Needle.” Global Health NOW, www.globalhealthnow.org/object/bifurcated-needle.
  21. Rienzi, Greg. “18th-Century Cow Hair, a Two-Pronged Needle, and the Eventual End of Smallpox.” The Hub, 12 Jan. 2015, hub.jhu.edu/2015/01/12/smallpox-exhibit-welch-medical-library/.
  22. Milton, Donald K. “What Was the Primary Mode of Smallpox Transmission? Implications for Biodefense.” Frontiers in Cellular and Infection Microbiology, Frontiers Media S.A., 29 Nov. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3509329/.
  23. WHO. “Smallpox Eradication (‎Resolution)‎.” World Health Organization, World Health Organization, 2 Jan. 2014, apps.who.int/iris/handle/10665/141748.
  24. Regional Committee for the Western Pacific, 009. “Smallpox Eradication (Resolution).” World Health Organization, World Health Organization, 1 Jan. 1970, iris.wpro.who.int/handle/10665.1/8795.
  25. Thompson, Helen. “Should We Destroy Our Last Living Samples of the Virus That Causes Smallpox?” Smithsonian.com, Smithsonian Institution, 1 May 2014, www.smithsonianmag.com/science-nature/should-we-destroy-our-last-living-samples-virus-causes-smallpox-180951321/.
  26. Kiger, Patrick J. “Did Colonists Give Infected Blankets to Native Americans as Biological Warfare?” History.com, A&E Television Networks, 15 Nov. 2018, www.history.com/news/colonists-native-americans-smallpox-blankets.
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