Disease emergence , the
Yoruba god thought to cause the disease The earliest credible clinical evidence of smallpox is found in the descriptions of smallpox-like disease in medical writings from ancient India (as early as 1500 BCE), and China (1122 BCE), as well as a study of the
Egyptian mummy of
Ramses V (died 1145 BCE). It has been speculated that Egyptian traders brought smallpox to India during the 1st millennium BCE, where it remained as an
endemic human disease for at least 2000 years. Smallpox was probably introduced into China during the 1st century CE from the southwest, and in the 6th century was carried from China to Japan. At least seven religious deities have been specifically dedicated to smallpox, such as the god
Sopona in the
Yoruba religion in West Africa. In India, the Hindu goddess of smallpox,
Shitala, was worshipped in temples throughout the country. A different viewpoint is that smallpox emerged 1588 CE and the earlier reported cases were incorrectly identified as smallpox. While the
Antonine Plague that swept through the
Roman Empire in 165180 CE may have been caused by smallpox, Saint
Nicasius of Rheims became the patron saint of smallpox victims for having supposedly survived a bout in 450, During the
Middle Ages several smallpox outbreaks occurred in Europe. However, smallpox had not become established there until the population growth and mobility marked by the
Crusades allowed it to do so. By the 16th century, smallpox had become entrenched across most of Europe, and subsequently among the native-born colonists. Case fatality rates during outbreaks in Native American populations were as high as 90%. Smallpox was introduced into
Australia in 1789 and again in 1829, Although smallpox was never endemic on the continent, By the mid-18th century, smallpox was a major
endemic disease everywhere in the world except in Australia and small islands untouched by outside exploration. In 18th century Europe, smallpox was a leading cause of death, killing an estimated 400,000 Europeans each year. Up to 10 percent of
Swedish infants died of smallpox each year, with earliest hints of the practice in China during the 10th century. In China, powdered smallpox scabs were blown up the noses of the healthy. People would then develop a mild case of the disease and from then on were immune to it. The technique did have a 0.5–2.0% mortality rate, but that was considerably less than the 20–30% mortality rate of the disease itself. Two reports on the Chinese practice of
inoculation were received by the
Royal Society in London in 1700: one by Dr.
Martin Lister who received a report by an employee of the
East India Company stationed in China and another by
Clopton Havers.
Voltaire (1742) reports that the Chinese had practiced smallpox inoculation "these hundred years". by country An early mention of the possibility of smallpox's eradication was made in reference to the work of
Johnnie Notions, a self-taught inoculator from
Shetland, Scotland. Notions found success in treating people from at least the late 1780s through a method devised by himself despite having no formal medical background. His method involved exposing smallpox pus to
peat smoke, burying it in the ground with
camphor for up to 8 years, and then inserting the matter into a person's skin using a knife, and covering the incision with a cabbage leaf. He was reputed not to have lost a single patient. , 1969 The English physician
Edward Jenner demonstrated the effectiveness of cowpox to protect humans from smallpox in 1796, after which various attempts were made to eliminate smallpox on a regional scale. In Russia in 1796, the first child to receive this treatment was bestowed the name "Vaktsinov" by
Catherine the Great, and was educated at the expense of the nation. The introduction of the vaccine to the New World took place in
Trinity, Newfoundland in 1800 by
Dr. John Clinch, boyhood friend and medical colleague of Jenner. As early as 1803, the Spanish Crown organized the
Balmis expedition to transport the vaccine to the
Spanish colonies in the Americas and the Philippines, and establish mass vaccination programs there. The
U.S. Congress passed the
Vaccine Act of 1813 to ensure that safe smallpox vaccine would be available to the American public. By about 1817, a robust state vaccination program existed in the
Dutch East Indies. On March 26, 1806, the
Swiss canton Thurgau became the first state in the world to introduce compulsory smallpox vaccinations, by order of the cantonal councillor
Jakob Christoph Scherb. Half a year later,
Elisa Bonaparte issued a corresponding order for her
Principality of Lucca and Piombino.
Baden followed in 1809,
Prussia in 1815,
Württemberg in 1818,
Sweden in 1816 and the
German Empire in 1874 through the Reichs Vaccination Act. In Lutheran Sweden, the Protestant clergy played a pioneering role in voluntary smallpox vaccination as early as 1800. The first vaccination was carried out in Liechtenstein in 1801, and from 1812 it was mandatory to vaccinate. In
British India a program was launched to propagate smallpox vaccination, through Indian vaccinators, under the supervision of European officials. Nevertheless, British vaccination efforts in India, and in
Burma in particular, were hampered by indigenous preference for inoculation and distrust of vaccination, despite tough legislation, improvements in the local efficacy of the vaccine and vaccine preservative, and education efforts. By 1832, the federal government of the United States established a smallpox vaccination program for
Native Americans. In 1842, the United Kingdom banned inoculation (variolation), later progressing to
mandatory vaccination. The British government introduced compulsory smallpox vaccination by an Act of Parliament in 1853. An epidemic in Sheffield in 1887/88 demonstrated that, in addition to the vaccine, several other factors such as extensive isolation measures contributed to the control of the disease. In the United States, from 1843 to 1855, first
Massachusetts and then other states required smallpox vaccination. Although some disliked these measures, The first
hemisphere-wide effort to eradicate smallpox was made in 1950 by the
Pan American Health Organization. The campaign was successful in eliminating smallpox from all countries of the Americas except Argentina, Brazil, Colombia, and Ecuador.. At this point, 2 million people were dying from smallpox every year. Progress towards eradication during this time was disappointing, especially in Africa and in the
Indian subcontinent. The Soviet Union continued to advocate for greater support of the smallpox eradication effort. In 1966 an international team, the Smallpox Eradication Unit, was formed under the leadership of an American physician,
Donald Henderson. In 1967, the World Health Organization intensified the global smallpox eradication by contributing $2.4 million annually to the effort, and adopted the new
disease surveillance method promoted by Czech epidemiologist
Karel Raška. of Bangladesh
(pictured) was the last person infected with naturally occurring variola major, in 1975. In the early 1950s, an estimated 50 million cases of smallpox occurred in the world each year. This process is known as "ring vaccination". The key to this strategy was the monitoring of cases in a community (known as surveillance) and containment. The initial problem the WHO team faced was inadequate reporting of smallpox cases, as many cases did not come to the attention of the authorities. The fact that humans are the only reservoir for smallpox infection (the virus only infected humans and not other animals) and that
carriers did not exist played a significant role in the eradication of smallpox. The WHO established a network of consultants who assisted countries in setting up surveillance and containment activities. Early on, donations of vaccine were provided primarily by the Soviet Union and the United States, but by 1973, more than 80 percent of all vaccines were produced in developing countries. The last major European outbreak of smallpox was in
1972 in Yugoslavia, after a pilgrim from
Kosovo returned from the Middle East, where he had contracted the virus. The epidemic infected 175 people, causing 35 deaths. Authorities declared
martial law, enforced quarantine, and undertook widespread re-vaccination of the population, enlisting the help of the WHO. In two months, the outbreak was over. Prior to this, there had been a smallpox outbreak in May–July 1963 in
Stockholm, Sweden, brought from the
Far East by a Swedish sailor; this had been dealt with by quarantine measures and vaccination of the local population. By the end of 1975, smallpox persisted only in the
Horn of Africa. Conditions were very difficult in
Ethiopia and
Somalia, where there were few roads. Civil war, famine, and refugees made the task even more difficult. An intensive surveillance, containment, and vaccination program was undertaken in these countries in early and mid-1977, under the direction of Australian microbiologist
Frank Fenner. As the campaign neared its goal, Fenner and his team played an important role in verifying eradication. The last naturally occurring case of indigenous smallpox (
Variola minor) was diagnosed in
Ali Maow Maalin, a hospital cook in Merca,
Somalia, on 26 October 1977. The global eradication of smallpox was certified, based on intense verification activities, by a commission of eminent scientists on 9 December 1979 and subsequently endorsed by the World Health Assembly on 8 May 1980. The first two sentences of the resolution read: The World Health Organization records of the smallpox eradication programme, from 1948 to 1987, were added to the UNESCO Memory of the World register in 2017.
Costs and benefits The WHO smallpox eradication program ultimately involved hundreds of thousands of people, from senior WHO leadership to local village health workers. The cost of the eradication effort, from 1967 to 1979, was roughly US$300 million. Roughly a third came from the developed world, which had largely eradicated smallpox decades earlier. The United States, the largest contributor to the program, has reportedly recouped that investment every 26 days since in money not spent on vaccinations and the costs of incidence. The eradication of smallpox has been called "one of the noblest and best things that we have ever done, as a species". In the last 100 years of its existence, smallpox was thought to have killed at least 500 million people; by comparison, all wars on the planet during that time killed an estimated 150 million.
Since eradication The last case of smallpox in the world occurred in
an outbreak in the United Kingdom in 1978. A medical photographer, Janet Parker, contracted the disease at the
University of Birmingham Medical School and died on 11 September 1978. Although it has remained unclear how Parker became infected, the source of the infection was established to be the variola virus grown for research purposes at the Medical School laboratory. All known stocks of smallpox worldwide were subsequently destroyed or transferred to two WHO-designated reference laboratories with
BSL-4 facilities – the United States'
Centers for Disease Control and Prevention (CDC) and the Soviet Union's (now Russia's)
State Research Center of Virology and Biotechnology VECTOR. WHO first recommended destruction of the virus in 1986 and later set the date of destruction to be 30 December 1993. This was postponed to 30 June 1999. Due to resistance from the U.S. and Russia, in 2002 the World Health Assembly agreed to permit the temporary retention of the virus stocks for specific research purposes. Destroying existing stocks would reduce the risk involved with ongoing smallpox research; the stocks are not needed to respond to a smallpox outbreak. Some scientists have argued that the stocks may be useful in developing new vaccines, antiviral drugs, and diagnostic tests; a 2010 review by a team of public health experts appointed by WHO concluded that no essential public health purpose is served by the U.S. and Russia continuing to retain virus stocks. The latter view is frequently supported in the scientific community, particularly among veterans of the WHO Smallpox Eradication Program. On March 31, 2003, smallpox
scabs were found inside an envelope in an 1888 book on
Civil War medicine in
Santa Fe, New Mexico. The envelope was labeled as containing scabs from a vaccination and gave scientists at the CDC an opportunity to study the history of smallpox vaccination in the United States. On July 1, 2014, six sealed glass vials of smallpox dated 1954, along with sample vials of other pathogens, were discovered in a cold storage room in an FDA laboratory at the
National Institutes of Health location in
Bethesda, Maryland. The smallpox vials were subsequently transferred to the custody of the CDC in Atlanta, where virus taken from at least two vials proved viable in culture. After studies were conducted, the CDC destroyed the virus under WHO observation on February 24, 2015. In 2017, scientists at the
University of Alberta recreated an extinct
horse pox virus to demonstrate that the variola virus can be recreated in a small lab at a cost of about $100,000, by a team of scientists without specialist knowledge. Although the scientists performed the research to help development of new vaccines as well as trace smallpox's history, the possibility of the techniques being used for nefarious purposes was immediately recognized, raising questions on
dual use research and regulations. In September 2019, the Russian lab housing smallpox samples experienced a gas explosion that injured one worker. It did not occur near the virus storage area, and no samples were compromised, but the incident prompted a review of risks to containment. == Society and culture ==