A not so small-pox

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Small-pox had a high mortality, a third of all infected would die. Survivors would become blind, and carry a scarred face for life. Every infected person would have fever, followed by a typical skin-rash. Disease earned its name from the small-bumps that covered entire body. But, small it would not remain as it devastated entire communities, poor or rich. Many reigning monarchs and heirs succumbed to it.

The first vaccine – variolation

Lady Montagu, herself a small-pox surviver, and wife of a British ambassador to Turkey, came across a strange local practice. Turks would take pus from pox lesions and place this liquid in cut skin of healthy people. Those so “variolated” would mostly have a blunted disease with much lower death rate. By 1722, British royal family was using this protection. About seven decades later, Edward Jenner, an English physician further refined the process. He used cow-pox lymph instead. This helped retain the protection, while eliminating risks of variolation. Thus, in 1796 we had our first vaccine.

First mass-vaccinations: Balmis-Salvany expedition

King Charles IV of Spain had lost many of his family members to small-pox. In 1798, he “variolated” all his family members . He came across Jenner’s vaccine only two years later. In 1800 he ordered “vaccination” in all of Spain. At this time small-pox was devastating populations in South Americas. In 1803, Balmis-Salvany expedition had sailed, with an aim to vaccinate all of Spanish-Americas for free. In next three years, the expedition established vaccination boards in all Spanish territories. It was an enormous success. The expedition included 22 orphans from Spain, inoculated with cow-pox. This vaccine-production house kept their skin-lesions alive. Serum from their lesions would protect many others. Expedition sailed further west to Philippines and China. It returned back to Spain in 1806.

First, and only eradicated disease

After the Second World War, World Health Organization (WHO) embarked on a mission to eradicate diseases. WHO announced plans for malaria-eradication in 1955, and small-pox in 1959. As more resources were allocated to malaria, efforts for small pox were lagging. By 1965, scientists had realised that malaria eradication is tough, and small-pox may be a better bet. The latter disease only affected humans, and we already had an effective vaccine to inoculate. In 1966, WHO launched small-pox eradication program (SEP). By this time we had already eliminated the disease from North America and Europe. In 1969, we abandoned malaria eradication efforts.

Nations embarked on a mission to vaccinate entire populations. Unlike most modern vaccines, this did not require syringe-needle (or even gloves for the vaccinators). We used a bifid-needle, dipped into the vaccine, to make multiple skin-punctures. These techniques had evolved over the past 150 years. We used minimal accessories, except for sterilising the needle before next use. Remember – this was pre-HIV era and single use plastics were yet to come. Jet-injectors were also used in vaccination campaigns. This technology advance was to be abandoned later for fear of spreading person-to-person infections.

Small-pox: Target Zero

We made a steady progress to achieve zero-target. In 1971, we could eliminate human cases from South America. Rahima Banu, aged 3 years (Bangladesh), was last known person with the disease in Asia. She survived the illness in October 1975. Last case in Africa was Ali Maalin (Somalia), diagnosed on 30th October 1977. All his contacts were quarantined till 17th November 1977. Extensive surveillance followed till March of 1978. On 31st March 1978, United Nations declared that we had achieved a zero target.

As world was about to declare small-pox eradication in 1978, we saw a last mortality. She was Janet Parker, a British photographer in Birmingham Medical School. It was believed to be a lab-leak, but never proven. World waited longer, secured small-pox stockpiles from various labs. We would finally declare eradication on 8th May 1980.