Our Global Voices Posts

Celebrating the 40th Anniversary of Smallpox Eradication and Learning from its Success

Posted on by Inger Damon, MD, PhD, FIDSA, Director, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases and Rebecca Martin, PhD, Director, Center for Global Health
Dr. Inger Damon
Dr. Rebecca Martin
Dr. Rebecca Martin

This year, 2020, the world is commemorating the 40-year anniversary of the declaration of the eradication of smallpox. Considered to be the greatest achievement in international public health to date, we have many lessons learned from this monumental achievement that today’s public health professionals can apply to current and future disease outbreak efforts across the world. The eradication of smallpox showed us that with political commitment, targeted action, community engagement and quality operations, scientific advancements, continuous evaluation, and global partnerships, the world can eradicate a disease.

A map illustrating the timeline for global smallpox eradication. Share an animated version of this map on social media.
Source: U.S. Centers for Disease Control and Prevention (CDC)

Before it was eradicated, smallpox (caused by variola virus) was a contagious, deadly disease that affected global communities for thousands of years. Smallpox was spread mainly by direct and prolonged face-to-face contact between people through droplets from the nose and mouth when infected individuals coughed or sneezed –– similar to how many other infectious diseases are spread. People with smallpox developed skin sores and rashes, and about 3 of every 10 people with smallpox died.

Many countries attempted over centuries to control the spread of smallpox through various methods, such as variolation, the process of inoculating a person with material taken from the sores of a smallpox patient.  In the late 18th century, several medical practitioners, including Edward Jenner, experimented with inoculating people with cowpox virus to protect against smallpox. Although the precise origin of smallpox vaccine remains obscure, these early efforts using cowpox virus (called vaccinia virus by Jenner) led to broader use of the practice, forming the beginning of what we now know as vaccination.

A Global Program to Make a Difference

Following years of country-based efforts to combat and contain smallpox outbreaks, and after considerable contention, the World Health Organization (WHO) initiated a plan in 1959 to eradicate the disease. Despite many challenges, planners understood the eradication effort would be facilitated by the ease of disease recognition and absence of an animal reservoir. One of the first eradication-related initiatives was to develop methods to standardize the quality of vaccine. By 1967, the program intensified from a mass vaccination program to a targeted, community-focused approach that engaged local volunteers in the community in a collaborative strategy. Two public health pillars of the global eradication campaign became the mainstay of the efforts and still used today: disease surveillance and immunization. However, the campaign faced an uphill battle to successfully create a resourced global partnership with funding, personnel, commitment from countries, and sufficient vaccine supply and special needles needed to deliver the vaccine.  By 1971, smallpox was eradicated from South America, followed by Asia in 1975, and finally Africa in 1977 –– leading to the official declaration of global smallpox eradication in 1980.

South America

Ecuador, 1962: Last known case of variola major on the continent
Brazil, April 19, 1971: Last known case of variola minor on the continent

Africa

Somalia, October 12, 1977: Last known case of variola minor in the world

Asia

Bangladesh, October 16, 1975: Last known case of variola major in the world

Eradication Lessons Learned for Diseases Now and in the Future

The smallpox eradication program provides a roadmap for today’s public health professionals to guide them in addressing wide-scale public health crises and disease outbreaks. These lessons learned may now be applied to the goals of eradicating wild poliovirus and Guinea Worm. Not only can we learn from the measures taken prior to the eradication of smallpox, but we can also learn much from the ongoing work and research conducted to ensure the world is prepared for disease outbreaks in the future.

Today, public health professionals still employ two key strategies for eradication – immunization and disease surveillance – and regularly evaluate these efforts to strengthen programs addressing complex public health threats. We know that science is always evolving, but these lessons from the success of smallpox eradication should bring us confidence in our ability to improve disease-related global health outcomes, so long as we base our strategies in science and its advancements, engagement of communities, and secure political commitment.

In our disease surveillance efforts, we must be vigilant about timely collecting and reporting of relevant data. Focusing on these key areas will help public health programs be agile in response to potential changes that may occur in the planned response to an outbreak. We must also ensure that our public health campaigns are culturally relevant and engage communities. Global health requires the involvement and participation of people from many different ethnicities, religions, and countries.  To eradicate a disease, all citizens must feel respected and able to participate.

Much like the campaigns to eradicate smallpox, successfully combatting pandemic diseases like COVID-19 and others will require the commitment and collaboration from countries across the world. The vast amount of resources required to fight outbreaks will depend on a global coalition of leaders who are committed to protecting their citizens and the global community. This work goes beyond the science – it’s essential to helping improve people’s lives and bringing the world closer to global health equity and social justice because it will help protect groups that have been marginalized.

Therefore, we must use the lessons learned from smallpox and build on investments in global health security and the global COVID-19 response to respond to emerging threats effectively, including the current COVID-19 pandemic. The sooner we come together around the world to form a united front against infectious diseases, as we did in eradicating smallpox, the sooner we will move toward protecting all citizens of the world.

Posted on by Inger Damon, MD, PhD, FIDSA, Director, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases and Rebecca Martin, PhD, Director, Center for Global HealthLeave a commentTags ,

One Health – A Comprehensive Approach To Preventing Disease, Saving Lives

For as long as people have lived with – and in close proximity to – animals, the benefit of that reality has come with a serious trade-off… the potential for disease. That reality also explains why a One Health approach is used at the Centers for Disease Control and Prevention to identify and minimize the Read More >

Posted on by CAPT Casey Barton Behravesh MS, DVM, DrPH, DACVPM4 CommentsTags ,

CDC Tanzania and partners: Ensure HIV services amidst the COVID-19 pandemic

The COVID-19 pandemic has brought about a series of unique structural, logistical, and program challenges related to routine HIV prevention, testing, and treatment services in Tanzania. To better protect healthcare workers and people living with HIV (PLHIV), the U.S. Centers for Disease Control and Prevention (CDC), Government of Tanzania (GoT), non-governmental partners, and healthcare facilities Read More >

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Voices from the Field: An interview with Anita Beukes, Laboratory Advisor

How is COVID-19 testing conducted in Namibia? Namibia is using semi-automated and automated platforms to conduct viral tests for COVID-19 (molecular real time reverse transcriptase-polymerase chain reaction [RT-PCR]). Testing is conducted at the government laboratories (Namibia Institute of Pathology), as well as at the University of Namibia, and in the private sector (Pathcare and a Read More >

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Voices from the Field: Q&A with CDC Namibia Country Director Dr. Eric Dziuban

What is your role in the COVID-19 response for Namibia? As CDC Namibia Country Director, my role is to lead how this office responds to the COVID-19 pandemic. This includes how we support the Ministry of Health and Social Services, the U.S. Embassy in Namibia, and the public. I spend a lot of time working Read More >

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CDC Team Takes ME/CFS Around the World

Chronic fatigue syndrome, also known as myalgic encephalomyelitis and referred to as ME/CFS, is a debilitating illness that takes away the active lives of people who suffer from it. Between 17 – 24 million people worldwide are thought to have ME/CFS and, in the United States, this illness may affect up to 2.5 million Americans. Read More >

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World Meningitis Day 2020

She Knew Something Was Wrong Rahinatou Hamidou Amadou, an 18-year-old woman living in Niger, woke up one morning feeling fine, but by the afternoon knew that something was very wrong. She told her classmates she wasn’t feeling well, and a short time later could barely walk. She began suffering from an intense headache and a Read More >

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Safe Water Saves Lives- How We Can Combat Cholera

CDC public health engineer Andrea Martinsen works on the Global WASH team within the Division of Global Health Protection (DGHP), where she responds to international disasters, disease outbreaks, and humanitarian crises that threatened the supply and provision of safe drinking water. In September 2018, an outbreak of cholera was declared when 25 patients were first Read More >

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Ending the HIV/AIDS Epidemic: Community by Community

Prevention of Mother To Child Transmission Turns Around A Widow’s Life

The Centers for Disease Control and Prevention (CDC), a lead agency in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), works every day with partners to accelerate HIV epidemic control efforts. Communities play a vital role in controlling and ultimately ending the epidemic. A key part of CDC’s efforts in Tanzania includes working with Read More >

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CDC Responders talk about their experiences in Rwanda

Travelers get their temperature checked while crossing the DRC border into Rwanda.

Serving in Rwanda as an Assistant Ebola Coordinator CDC epidemiologist Shayne Gallaway served as Assistant Ebola Coordinator during multiple deployments to Rwanda for the 2018 Eastern DRC Ebola Response. Gallaway and team provided technical assistance to the Ministry of Health to prevent, detect, and respond to viral hemorrhagic fevers, including Ebola. He is a Lieutenant Read More >

Posted on by Shayne Gallaway / Dr. Kristie E. N. Clarke / Dr. Samira Sami / Todd Lucas, MD, MPHLeave a commentTags , ,