The Day A God Died: How Humanity Eradicated Smallpox

Let me tell you a story of one single pathogen that redefined how humans lived alongside disease.

They called it… Smallpox.

Imagine if you will, an omnipotent tyrannical deity who ruled his land with a fist full of poison, deciding who gets to live, who gets to die, and who gets to be scarred for life.

For many centuries, the myth of this deity spread to all villages of Earth. Its stories were whispered in terror. Its victims — the scarred, the blinded, the dead — were proof of its vicious nature. It was not just tyrannical… it was something else… It was something even the abyss itself feared.

This deity… was a result of the Variola virus. The disease bearing the name Smallpox. Smallpox’s origins were unknown, experts had no data on when it actually began infecting humans. Some smallpox-like lesions found on Egyptian mummies suggested that this deity had ruled starting just about 3,000 years ago.

Hijacked!

Variola usually transmits through small droplets humans breathe in. When Variola enters your body, it would start killing the cells that line your throat. This attracts your defense forces, your immune cells. You see, a lot of unnatural death isn’t particularly… normal, so your immune cells would catch on and try to clear the infection.

Normally, this is really really bad, well for a normal pathogen at least. Unfortunately, it wasn’t bad for Variola, in fact, this is what Variola wants. The virus hijacks your Dendritic Cells, your body’s intelligence officer that finds evidence needed to activate your adaptive immune system. The Dendritic Cell unknowingly scours the battlefield, before returning to the Lymphatic system.

The lymphatic system has all the T cells your body has, these cells are the captains of your forces, composed of Helper T cells (commander of your immune forces and activator of B cells, your heavy weapons factory) and Killer T cells (specialized killers of a single type of pathogen, either that or cancer). Normally, this is super bad, but Variola doesn’t mind. For 12 days, it quietly infects civilian and immune cells, until a critical threshold is reached.

This time, Variola attacks for real. Suddenly, without warning, your brain receives millions of reports, all containing the same message.

“Infection detected. Recommend to deploy defense forces.”

Your innate immune system (first responders) jumps to action, but your adaptive immune system struggles to wake up as Variola deactivates your complement system (your body’s mobile minefield) and interferons (the chemical signal needed to activate your immune system, as well as interfere with the enemy).

Once you’re at this stage, you have a 3 in 10 chance of dying. There’s only 2 outcomes, either you survive as your adaptive immune system activates and B cells produce antibodies that take care of Variola. Or, you die. Simple right?

Well with that brief rundown out of the way, let’s focus on the blog’s main idea, the timeline of the eradication of Smallpox.

The Efforts of Eradication

Before modern medication existed, to prevent a disease is to quarantine it. Treating the infected is almost impossible, as you had no resources to help them win against the infection besides granting them rest and food.

1000 BCE — Terror We recall Variola has existed since 3,000 years ago. During those times until just recently, endemics were common across Asia, Europe, Africa, and later the Americas. In 18th century Europe, Smallpox took the lives of about 400,000 people annually.

1000 CE — Variolation (Inoculation) At around 1000 CE, variolation — also known as inoculation— surfaced as a reliable option to gain immunity from Variola. Doctors would take the scabs of Smallpox from an infected patient, dry them, and then grind them to a fine powder. This powder was then blown into the nose of a patient, or scratched on their surface. If everything went well the patient would only get a mild version of Smallpox and developed immunity.

This method probably worked as it introduced Variola into an area of the human body it wasn’t designed for, disabling almost all of its tricks. Other factors included the lower dosage and usage of Variola Minor, a significantly milder version of Variola. However, patients who took the treatment had a 1–2% chance of dying, either due to Variola itself or other diseases that took advantage of the distraction.

Still, Smallpox and Variola were such feared and by accounts unavoidable deities that many people took the risk and got variolation.

The first recorded use took place in China at around 1000 CE. Variolation may have also developed in India at the same time. Variolation would soon spread to other regions and nations, including the Ottoman Empire (around 1721), Boston (1717–1721), and later the treatment became widespread across Europe, American Colonies, and parts of Africa around 1720s onwards. Governments, Militaries, and Physicians started to accept variolation as a viable option to prevent Smallpox, with it being used in the American Revolutionary War (1776+) and the Russian Empire healthcare reforms (1760s).

1796 — The Beginning of Vaccination Edward Jenner — an English doctor — developed the world’s first ever vaccine, catered to preventing Smallpox by injecting the human body with Cowpox, a variant of Smallpox that infected cows. Cowpox was milder than Smallpox, but still granted immunity to Smallpox. It worked as both virus species were antigenically similar.

Alright so the story behind how Jenner did it was kind of weird so I’ll summarize my sources.

At 1796, Edward Jenner noticed that milkmaids who had gotten cowpox were protected from smallpox. He knew about Variolation and guessed that exposure to Cowpox could be used to grant humans immunity from Smallpox as well.

Testing his theory out, Jenner took some cowpox scabs from one of his milkmaids and inoculated it into the arm of James Phipps, the 8-year-old son of Jenner’s gardener. Months later, Jenner deliberately exposed Phipps to Variola multiple times, but Phipps never developed Smallpox.

Later, Jenner published his treatise “On the Origin of the Vaccine Inoculation.” which summarized his discoveries and called for humanity to annihilate Smallpox (yes! really! read my sources if you want more information).

This achievement is widely regarded as humanity’s greatest win in healthcare to date, as it paved the way for vaccination.

Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s, the virus used to make the smallpox vaccine changed from Cowpox to Vaccinia virus.

The change from Cowpox to Vaccinia was primarily due to the fact that there was no viral sequencing, no standard strain control, and no clear distinction between orthopoxviruses. As a result, the virus used gradually stopped being true Cowpox. By the mid-late 19th century, the virus used for the vaccine was clearly not Cowpox, it was renamed to Vaccinia.

Vaccinia is thought to have Horsepox as its ancestors. Either that or another closely related orthopoxvirus. Later, it was found out Vaccinia is better for vaccination than Cowpox, as it was more stable, easier to propagate, causes less severe reactions, and gave strong and lasting immunity. By the 20th century, all Smallpox vaccines were Vaccinia-based.

1959 — The War is Declared In 1959, the WHO started a plan to eradicate Smallpox. The plan execution failed to eradicate Smallpox due to a lack of funding, personnel, and surveillance. Despite the valiant efforts of the WHO, Smallpox was still widespread in South America, Asia, and Africa.

1967 — Retry? The WHO renewed their efforts in the 1967 Intensified Eradication Program. Laboratories in many countries where smallpox occurred regularly were able to produce more, higher-quality freeze-dried vaccine. Other factors accelerating the eradication included the development of the bifurcated needle, the establishment of a case surveillance system, and mass vaccination campaigns.

By the start of the 1967 program, Smallpox had already been declared eradicated in North America (1952) and Europe (1953). Australia was spared the deity as it never experienced sustained endemic transmission. The fight was still going on in South America, Asia, and Africa.

Late 1975 — Last Case of Variola Major In late 1975, three-year-old Rahima Banu from Bangladesh was the last person in the world to have naturally acquired Variola Major. She was also the last person in Asia to have active smallpox. She was isolated at home with house guards 24 hours a day until she was no longer infected. Immediately, the WHO conducted a 1.5 mile radius wide area of house vaccination, with teams checking every house, public area, school, and clinics within 5 miles to ensure no new cases are discovered.

Basically, they nuked the chance of the virus ever spreading again by containing the area Rahima Banu lived in and isolated, as well as vaccinating everyone in it.

October 1977 — Last Case of Smallpox In Somalia, Ali Maow Maalin was recorded as the last person to ever acquire Smallpox naturally (Variola Minor). He was taken in at a hospital in Merca, Somalia. At October 12, 1977, he and two other Smallpox patients were transported to the local Smallpox office. On October 22, he developed a fever. At first he was diagnosed with Malaria, then Chickenpox. The smallpox eradication staff then correctly diagnosed him with Smallpox on October 30. Maalin was isolated and made a full recovery.

Maalin lived a long life after his contact with Variola. He would die from Malaria in July 22, 2013 while working in the Polio eradication campaign.

Aug-Sep 1978 — The Last Victim Janet Parker was the last person to die of smallpox. In 1978, Parker was a medical photographer at England’s Birmingham University Medical School. She had worked one floor above the Medical Microbiology Department where staff and students conducted Smallpox research. Parker contracted Smallpox and was ill on August 11 and developed a rash on August 15. Unfortunately for her, she wasn’t diagnosed for Smallpox until 9 days later.

Parker would be Variola’s last victim, as she died in September 11, 1978. Her mother soon contracted Smallpox on September 7 despite being vaccinated.

Later on, an investigation concluded that Janet Parker had been infected either via an airborne route through the medical school building’s duct system or by direct contact while visiting the microbiology corridor.

Victory Recognized — May 8, 1980

Two centuries… two centuries it took for us to revolt against the deity ruling our lands… and in the end… we won.

At the 33rd World Health Assembly, we all declared a new era. An era free of Smallpox. This deity that hunted us mercilessly, vicious in its attacks, traumatizing in its memory, is finally gone.

Children could look forward to a life without threats, no scars to get, nothing to worry about…

The world has received the message: “Victory achieved!”

Remnants of the Past

Finally, let’s address the remnants. This is an extra section I wanted to include. Basically, where the heck is Smallpox now? Besides eradicated, we have two places that currently handle the Variola virus under WHO supervision, mainly for research. That being the Centers for Disease Control and Prevention in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology (VECTOR Institute) in Koltsovo, Russia.

Faded

It’s been quite a while since Smallpox and Variola existed on our planet, and we all can’t thank enough how valiantly the WHO, world governments, and we all contributed to the eradication of Smallpox. This achievement we have is a great reminder of how concentrated efforts allow all of humanity to triumph any problems we’d ever face. The god’s remnants are our trophy to be proud of.

However, remnants do fade. In the 21st century, we’re all forgetting the terrors our great grandparents had to undertake, just to live to see another day.

Most importantly, we forget the weapons we developed in spite of the god. We forget how important vaccines are, and are slowly building mistrust against it.

The threat of another god replacing Smallpox is never too small. Covid proved that any pathogen — even if unlike Smallpox — could rise up again and upend humanity when our trust, alertness, and coordination fail. Even though quarantine and worldwide efforts kept Covid from ever becoming an existential threat to humanity, we need to take precautions and solidify our fight against other tyrannical diseases.

We’ve killed one, let’s kill the others!

Thoughts

So… what are your thoughts? Do you think Smallpox will still pose a threat for humanity? What is your stance on vaccinations? Let me know in the comments!

**Sources:

• https://www.cdc.gov/smallpox/about/history.html
• https://historyofvaccines.org/blog/the-history-of-variolation**