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We Eradicated Smallpox. Why Do Other Preventable Diseases Persist?

When the World Health Organization (WHO) declared the eradication of smallpox on May 10, 1980, the power of vaccines in ensuring healthy lives came to the forefront of global health campaigns.

The eradication of smallpox was one of the greatest achievements in the history of public health. This devastating disease killed over 300 million people and lasted for over 3,000 years. Three out of 10 people who contracted the disease died. Survivors were often left with severe physical scars and met with stigmatization.

Immunization programs played a vital role in eliminating smallpox.

Its eradication is much more than a milestone for international medicine. It is a story of relentless innovation, resilience, and perseverance. It is a story that raised important questions about the means used to achieve an end. It is a story that needs to be remembered.

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At the start of its spread in the 6th century, smallpox moved rapidly to communities across the world and affected people from different walks of life.

The spread of this disease was amplified through global trade and colonization. Chinese and Korean trade was believed to have spread smallpox in Japan during the 6th century.

Similarly, in the 14th century, for example, Spanish and Portuguese conquerors carried the smallpox virus to the Aztec and Inca empires during colonial expansion.

Smallpox was initially addressed through a method called variolation. The Centers for Disease Control and Prevention (CDC) explains variolation as the process of putting people who were not yet affected by smallpox in contact with the variola virus that caused smallpox.

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Though variolation didn’t help prevent the contraction of smallpox, it reduced the number of deaths caused by the disease.

The origin of a preventative approach to smallpox can be traced back to Edward Jenner’s research from 1796-1801.

When Jenner noticed that milkmaids who had contracted cowpox did not show any symptoms of smallpox after variolation, he decided to further test this. This process eventually led to the development of the world’s first vaccine and paved the way for the eradication of smallpox.

However, the battle against smallpox was far from being won. The world still suffered from limited awareness and access to vaccines.

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The link between preventable diseases and poverty became clear through the journey to end smallpox.

Smallpox was completely eradicated in North America by 1952 and largely eradicated in Europe by 1953, owing to the availability of funding and personnel who were equipped and committed to ending smallpox.

On the contrary, countries across South America, Asia, and Africa that had recently gained independence from colonial rule lacked adequate healthcare resources and continued to suffer from the widespread impact of smallpox until 1966.

The WHO decided to change this.

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The first eradication plan in 1959 failed due to limited resources and global participation. The WHO learned from this failure and pushed for the end of this disease. They launched the Intensified Eradication Program in 1967.

Over the 10 years that followed, a collaborative approach that emphasized local action and global prioritization would lead to the elimination of smallpox.

Better-quality vaccines were made increasingly available in countries most affected by smallpox. Case histories were better recorded and mass vaccination campaigns were adopted.

The outcomes of the Intensified Eradication Program were phenomenal. Smallpox was completely eradicated from South America within four years, by 1971. Soon after that, Asia saw the end of smallpox in 1975 and one of the last cases was recorded in Somalia in 1977.

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Ali Maow Maalin, the last person to be infected by smallpox in Somalia, had not been vaccinated and was diagnosed with smallpox 18 days after coming in contact with infected patients. He was taken into isolation until he made a full recovery.

This method of isolation was also followed in Bangladesh, where a 3-year-old girl, Rahima Banu, was monitored at home until she was no longer infectious.

This prevention practice was also supplemented with a door-to-door vaccination campaign within a 1.5 mile radius of Banu’s house to ensure complete eradication.

Across the world, people adopted various strategies and worked together to fight against smallpox.

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Almost 38 years after its eradication in 1980, smallpox remains the only disease in the world to be completely eradicated. The challenge of increasing access and awareness of vaccines and their importance in global health security still needs to be addressed.

As we celebrate this landmark in human history, it is important to raise a difficult question: Why has the world not yet achieved success in eradicating other preventable diseases?

As the world continues to fight for the end of preventable diseases, it is pivotal to understand the smallpox story and to think about what was done right, and what can be done differently. It is most important to look back and realize that vaccines work, and that change is possible.