Towards Eradication

Is your child vaccinated?

Poster created by the Work Project Administration for the Chicago Department of Health between 1936 and 1941 promoting smallpox vaccination

Vial of Dryvax

2002 photo by James Gathany showing a vial of Dryvax-- a freeze-dried version of the smallpox vaccine-- alongside a diluent and a bifurcated needle

Turkmen poster promoting smallpox vaccination

Turkmen poster contrasting a vaccinated young Turkmen and an elderly Turkmen disfigured and blinded by smallpox; Turkmen text reads "If you don't want to be blind and miserable, give yourself a shot"

Fleet of vehicles in Burkina Faso

1969 photo of a "Truck Ceremony", when transportation vehicles officially entered the service of the Republic of Upper Volta (now Burkina Faso); many such vehicles were used by vaccinators in the country

By the 1950s, smallpox had been eradicated from North America and Europe and was becoming a third-world disease. In the interest of global safety, and because eradication efforts for other diseases already existed, the World Health Organization (WHO) started a plan to eradicate smallpox. Unfortunately, due to a lack of personnel, funds, commitment from countries, and a shortage of donations for vaccines, by 1966 smallpox was still widespread and endemic in many countries in South America, Africa, and Asia. (History of Smallpox, CDC)

In 1967, the WHO started the Intensified Eradication Program which was meant to strengthen efforts and rejuvenate the campaign for eradication. Advancements in vaccines, like the bifurcated needle (a two-pronged needle that made vaccinating easier and used the same dosage every time) and freeze-dried vaccine solution (it was easier to transport, as it no longer needed refrigeration), and the establishment of mass vaccination campaigns and a case surveillance system, made the feat of eradication more achievable. (History of Smallpox, CDC)

Eradication plans started with a goal of vaccinating 80% of the people in a country, and once that threshold was reached, increasing the goal to 100%, if smallpox infections were still occurring. This was difficult to achieve, and efforts made to increase vaccination measures-- like vaccinating schoolchildren-- did not end up reaching the communities underserved by the program and sometimes caused ethical concerns due to forced vaccinations in some areas. (Cohen, 2019)

In 1974, after struggling to mass vaccinate populations for years with less progress than hoped, the IEP moved toward the surveillance and containment method (Okwo-Bele & Cherian, 2011). Cases of smallpox were identified either by members of the public or health officials, and the infected person was isolated until they recovered or died. During their isolation, anyone they had come into contact with, those living nearby, and contacts of their contacts were vaccinated - this technique is now known as ring vaccination (Ring Vaccination, CDC). This method was much more efficient and achievable than the goal of 100% vaccination. (Cohen, 2019)

Even with this new method for vaccination, natural disasters, wars, bureaucratic obstacles, breaks in communication with locals, and many other difficulties posed challenges in the fight for eradication. Nevertheless, as the years moved on, the number of cases continued to shrink. The last naturally occurring infection of smallpox was in 1977, and the eradication effort was certified by the WHO in 1979. The eradication of smallpox marked a monumental achievement for public health and for the hope of eradicating other deadly, vaccine-preventable diseases. (History of Smallpox, CDC)