The Smallpox Pandemic: How Vaccination Eradicated One of the Deadliest Diseases in Human History

For over 3,000 years, a deadly virus known as smallpox ravaged the Earth, causing immense suffering and death. The Variola virus, responsible for smallpox, left a profound mark on human history. Characterized by painful symptoms, high mortality, and long-lasting effects, smallpox was one of the most dangerous diseases ever to infect humankind. With a fatality rate of 30%, 1 in every 3 individuals infected with the virus died, while many survivors were left with permanent scars and blindness.

This devastating virus wreaked havoc across nations, wiping out civilizations and killing millions. In 1735, smallpox claimed one-third of Japan's population. In the 1500s, when European colonizers brought the disease to the Americas, it decimated 90% of the Native American population. In Russia during the 18th century, one out of every seven children was killed by the virus. Smallpox is estimated to have taken five million lives each year, accounting for a staggering 500 million deaths over the span of a century.

Comparatively, the recent COVID-19 pandemic, which disrupted the world, seems much less severe. COVID-19’s mortality rate is less than 1%, whereas smallpox had a death rate of 30%, and its long-term impact on survivors was much worse. Smallpox was not only a pandemic but also a tragic historical event that scarred human civilization.

The Origins of Smallpox: A 3,000-Year-Old Disease

Smallpox emerged thousands of years ago, making its first known appearance around 10,000 BC, during the advent of agriculture in Africa. As humans began domesticating cattle and other animals, they unknowingly came into contact with orthopoxviruses like smallpox. These viruses are naturally found in mammals and were transmitted to humans due to prolonged exposure to these animals.

While the exact origin of smallpox remains unknown, the first evidence of the disease was discovered in 1156 BC when an Egyptian mummy was found with facial scars resembling those caused by the virus. Ancient texts from India and China also reference smallpox. In the 6th century BC, the Sushruta Samhita, an ancient Indian medical text, mentions the disease, highlighting its long-standing presence in human history.

The Horrors of Smallpox

Smallpox spread easily, primarily through respiratory droplets. Infected individuals could transmit the virus by sneezing, coughing, or through their saliva, skin rashes, and contaminated objects. Once someone was infected, the symptoms initially resembled those of a common cold, but soon painful rashes and boils, known in Hindi as fafole, would cover the person’s face and body. These boils were disfiguring, and in severe cases, could lead to death within 8-16 days of infection.

Smallpox particularly affected children, with a higher death rate among them. The disease’s relentless spread and its impact on young lives made it one of the most feared illnesses of the time.

Early Attempts at Prevention: Inoculation

For centuries, humanity had no cure for smallpox. However, people did understand that survivors of the disease developed immunity. This led to the development of a procedure called inoculation. Inoculation involved deliberately infecting a person with a small dose of the virus to prevent a more severe infection later on.

The practice is believed to have originated in India or China, where Brahmins called Tikadaar carried out inoculations by pricking a person’s skin with needles coated in the virus from smallpox scabs. In China, Buddhist monks used a similar technique, turning smallpox scabs into powder and blowing it into a healthy person's nose. These methods spread across the world and eventually reached Europe.

However, inoculation had significant risks. The dose of the virus used in inoculation could sometimes kill the recipient. While the death rate from inoculation was lower than the 30% mortality rate of smallpox, it still caused 1%-2% of recipients to die. In addition, inoculated individuals could spread the virus to others, prolonging outbreaks.

A Breakthrough: Edward Jenner’s Vaccine

In the late 18th century, a significant discovery in England led to the eventual eradication of smallpox. Dr. Edward Jenner, a physician, noticed that milkmaids who had contracted cowpox, a less severe virus from the orthopox family, never caught smallpox. Intrigued, Jenner theorized that cowpox could provide immunity against smallpox.

In May 1796, Jenner conducted a groundbreaking experiment. He extracted pus from the cowpox boils of a milkmaid named Sarah and infected an 8-year-old boy named James Phipps, the son of Jenner’s gardener, with cowpox. The boy developed mild symptoms but recovered. Six weeks later, Jenner deliberately exposed the boy to smallpox, but to his relief, the boy did not contract the disease. Jenner had proven that cowpox could prevent smallpox and developed the world’s first successful vaccine.

The term "vaccination" itself comes from the Latin word vacca, meaning cow, in reference to the use of cowpox to immunize people. Jenner’s discovery marked the birth of modern vaccination, a safer alternative to inoculation, with much lower risks of death or severe side effects.

Challenges and Opposition to Vaccination

Despite the potential to save millions of lives, Jenner’s vaccine was met with resistance. When Jenner presented his findings to the Royal Society of London, they rejected his research, and he faced mockery from many of his peers. Religious organizations opposed vaccination, claiming it went against God’s will. Some people were disgusted by the idea of injecting "animal matter" into their bodies, and rumors spread that vaccinated individuals would develop bovine features, with some artists even depicting people turning into cows.

Inoculators, whose livelihoods depended on the practice, also opposed the vaccine. Despite these challenges, governments recognized the efficacy of Jenner’s vaccine and began mandating its use. In 1853, England became the first country to make smallpox vaccination compulsory for children, sparking the first anti-vaccination movements.

Eradication of Smallpox: A Global Effort

Once the efficacy of Jenner’s vaccine was widely accepted, the challenge shifted to distributing the vaccine across the world. In an era without modern transportation or preservation techniques, transporting cowpox posed significant challenges. Jenner developed several methods to transport the vaccine. One method involved soaking strings in cowpox pus and sending them to other countries, where individuals would cut themselves and apply the dried string to the wound. Another method used glass tubes sealed with wax to transport cowpox fluids.

However, the most effective method involved using infected children as live carriers of the virus. Children who had been vaccinated with cowpox were transported on ships, and as they traveled, they would infect other individuals, ensuring that cowpox was continually available for vaccination upon arrival in distant lands.

The Legacy of Smallpox Vaccination

Dr. Edward Jenner’s work laid the foundation for the modern field of immunology. His invention of the smallpox vaccine saved millions of lives and eventually led to the complete eradication of the disease. In 1980, the World Health Organization declared smallpox eradicated, marking the first and only human disease to be completely wiped out.

Today, vaccination continues to play a vital role in preventing and controlling infectious diseases. The success of smallpox vaccination demonstrates the power of scientific discovery and the profound impact it can have on global public health.

Keywords: smallpox, Variola virus, smallpox vaccine, Edward Jenner, cowpox, inoculation, orthopoxvirus, vaccination history, smallpox eradication, infectious diseases, public health, immunity, anti-vaccination movement.