Today’s Moment of science continues about where we left off yesterday, with part two of how we yeeted smallpox the fuck out of existence.
Smallpox eradication was not our first rodeo. We’d gone to war with several diseases, including malaria and yellow fever. Both are spread through mosquitoes, and a large part of the program for eradication in each case was to give the bloodsuckers a miserable mother of a day. However, they’ve survived 210 million years for good reason, and they have continued to prove stubborn to kill off. These and other eradication efforts have brought diseases better under control, but ending another disease entirely had never been within grasp.
When World War II ended, major superpowers started reconfiguring who the baddies were. The US immediately was like “fuck the commies,” dove into a space race, McCarthyism, and blacklisting screenwriters to save free speech. Or something. On account that Russia had just done a lot of heavy lifting in wrecking the Nazis, the only polite thing was to make this war a cold one.
So when, at the 1958 World Health Assembly, USSR virologist Viktor Mikhailovich Zhdanov suggested “to the workers of the world, no more smallpox,” there were a few reactions. One was that they were thrilled to have the USSR at the assembly and wanted to keep up the uneasy peace. The other was ‘Jesus Christ how the fuck are we going to do this?’
Zhdanov was like “the USSR can make all these smallpox vaccines. idk you can just have them because smallpox super fucking blows.”
The WHO was like “let’s fuck up some viruses.”
Soviet scientists were partnered with Americans. Because of course they wanted it to work but also wouldn’t a handy “we tried to make it work but those darn Murkans and Ruskies, y’know?”
No notable tension arose, because these were scientists with a bigger dicknozzle to do battle with: fucking smallpox.
Some groups were opposed to it because they saw eradication efforts as something that would potentially take money away from other essential health programs, and still possibly fail in the process. Nevertheless, the Intensified Smallpox Eradication Programme eventually launched at the beginning of 1967, with smallpox still endemic in thirty-one countries. The strategy was simple: you get immunity! And you get immunity! Immunity for everyone was the goal.
They started with nearly 7,000 outbreaks to manage. Though many countries contributed to the effort, support came heavily from the US providing funding and the USSR providing 450 million doses of smallpox vaccine.
By 1970 smallpox had receded from thirty-one countries down to eighteen. In 1974, it was isolated to five countries, one of which was India. With 600 million people representing 100 million households, the task was monumental. Every year, 20 million babies were born in the country, highly susceptible to the virus.
Constant surveillance to contain and end the spread was needed. How do you conduct this task on that many people in the era before computers and smartphones? How do you get around the need to just vaccinate everyone?
In an outbreak in eastern Nigeria earlier in the initiative, doctors from the WHO found themselves low on vaccines.
This fortuitously led them to the way that they would defeat this; ring vaccination. Instead of vaccinating everyone without aim, they vaccinated everyone in and surrounding an outbreak, bringing the infections to a screeching halt. If you could break the chain of transmission between humans, without another host animal eventually the disease would burn itself out.
Now let’s elucidate what a Herculean effort ‘constant surveillance’ entails is in this case.
Send a small army of doctors to every household, every month, until there’s not a case of smallpox left to be found. When I say a ‘small army,’ I mean about 135,000 doctors from 170 countries combining forces to spit in nature’s face.
Presenting a picture of someone with smallpox at home after home, they would ask “does anybody you know look like this?” When outbreaks were located, walls of herd immunity were shot into the arms of everyone around the infected, cutting off every path the virus had.
Over a billion house calls later, and smallpox was eliminated from India in 1975. Two years later, Ali Maow Maalin was the last smallpox patient. It was declared eradicated in 1980.
Smallpox likely killed half a billion people in the last century of its existence, the last victims of an unbroken chain of human hosts passed on for thousands of years. It now only exists in samples in a few labs hidden away behind lock and key, hopefully only to be discussed as history.
This has been your daily Moment of Science, unsure of the future for covid, but grateful to the army of scientists that made my vaccine possible.
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