On May 8, 1980, the world was officially declared free of smallpox. It is the first disease that has been eliminated, thanks to the first vaccine in history. The fight against this virus, which caused the death of 300 million people during the 20th century, shows that scientific development, international solidarity and cooperation are the keys to getting out of the Covid-19 pandemic.
The origin of the word “vaccine” contains one of the most momentous stories of modern science. In the late 18th century, smallpox was ravaging much of the world. In Europe it could kill more than a million people per year, an exorbitant figure for the population of the time. In the American continent, the disease had already devastated entire communities of native peoples.
It could be something similar to living in a Covid-19 pandemic, but constant.
It’s no wonder that the efforts of some of the brightest minds of the day were focused on avoiding the spread of smallpox, a disease caused by two viruses (variola majora and variola minora) that caused fever, tiredness, and then horrible sores and pustules. Three out of ten infected people died and those who survived were scarred for life, in the best of cases, and cases of blindness, in the worst.
Edward Jenner was an English scientist and naturalist who had heard of “virolization,” a smallpox prevention practice that would give the disease control centers the creeps today. First identified in 11th-century China, this practice involved exposing yourself to a smaller, controlled amount of the virus to develop immunity.
In China they inhaled the scabs from the sores of those who healed. When this practice spread, inoculation was chosen in Europe. Between 1 and 2% of those exposed died, a shocking figure but less than the 30% mortality rate of smallpox.
Something clicked in Jenner’s mind when she realized that many of the women milking the cows had never been infected. Instead, they had contracted a sister virus to smallpox that affected bovine animals. She decided to infect a child with this virus, the son of her family’s gardener. When she later exposed him to smallpox, she did not get sick.
The virus that protected him is called cowpox. This is how, in 1796, the world’s first vaccine was born.
The logistics of transporting a vaccine in the 19th century
Of course, it was a rudimentary vaccine: fluid from the sores of infected people was transported to later inoculate others and thus immunize them. This procedure could be done over short distances, so Europe soon began the first public vaccination campaigns. In fact, Sweden made vaccination compulsory in 1816 and the United Kingdom in 1853.
The problem arose when an attempt was made to export the proto-drug to the American continent. The original American population did not have any type of previous immunity against smallpox and, with the arrival of colonization, the virus dramatically decimated the indigenous peoples. Without going any further, he claimed the life of the Inca leader Huayna Capac, an indispensable ally for the victory of Western troops throughout the continent.
Centuries later, smallpox was still a health problem of even greater dimensions than in Europe. That is why Spain launched the Royal Philanthropic Vaccine Expedition to bring the immunization strategy to the colonies. In 1803, a ship sailed from A Coruña, on the Galician coast of Spain, with the doctor Francisco Xavier de Balmis… and 12 orphaned children.
The purpose of these children was to become a controlled chain of transmission to get the live cowpox virus across the Atlantic. When setting sail, two of the minors became infected; after ten days, they developed the pustules from which the liquid was extracted to inject the next two; thus, in the hope that the last two children in the chain would arrive with their sores ready to be used.
This method, so ethically questionable, was about to fail. The expedition arrived in Caracas in 1804 with only one child whose injuries were available. However, it was enough: Balmis and his team managed to immunize tens of thousands of children. Then they traveled to the Philippines, with the same strategy, and to China.
The fight to eradicate smallpox
This was the beginning of the end for smallpox, although it would still take more than a hundred years to consider it eradicated. First, it was eliminated in North America and within a few years in Europe. However, the disease remained a scourge in Latin America, Asia and Africa, in a global divide that resonates with the inequality in the current distribution of vaccines against Covid-19.
The World Health Organization (WHO), created in 1948, decided to get down to work. The first global eradication attempt failed, but in 1967 efforts were renewed, ones that meant high levels of epidemiological surveillance, unprecedented global cooperation, and a consensus to prioritize these campaigns in the most conflictive places in the world. The technological improvement of vaccines and needles to inject them, as well as transportation, also contributed.
South America said goodbye to smallpox in 1971; Asia in 1975 and Africa in 1977. Three years later, on May 8, 1980, 42 years ago, the WHO announced that the disease had been completely eradicated worldwide, a milestone that has never been achieved since.
On the 40th anniversary of the date, the director of the WHO, Tedros Adhanom Ghebreyesus, released this message: “Now that the world is facing the Covid-19 pandemic, humanity’s victory over smallpox is a reminder of what that is possible when countries come together to combat a common public health threat (…) This same solidarity, based on unity, is what we need more than ever to defeat Covid-19 “. It was May 2020 and the world was immersed in one of the toughest moments of the new pandemic.
Eradicating Covid-19 seems like a goal that, for now, is not worth pursuing. Smallpox was not present in animal reservoirs, while this coronavirus was; a single exposure to the disease or the vaccine protected for life, but reinfections of Covid-19 are common; the smallpox virus was not transmitted as long as the infected person did not present symptoms, something that happens with the current pandemic.
However, that does not mean that there are no lessons to be learned from the history of smallpox. To begin with, “no one is safe until everyone is safe”, that is, the vaccines have to reach everyone in order to say that we have come out of the pandemic. It is also clear that international cooperation must be firm and seamless, and there must be a consensus that controlling the crisis is a common priority.
If it was possible to do with smallpox with fewer scientific and technological tools and in the middle of the Cold War, why couldn’t it be done today with Covid-19?
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