For over 3,000 years, a deadly virus wreaked havoc on Earth. The disease caused by this virus was excruciating and perilous, with a mortality rate of 30%. In other words, one out of every three infected individuals succumbed to its effects. Those who survived were left with permanent scars, particularly on their faces, which bore large blemishes. Tragically, many also suffered permanent blindness.
The devastating impact of this disease was seen when it swept through Japan in 1735, claiming the lives of a third of the population. When European colonizers introduced it to Mexico and America in the 1500s, it decimated 90% of the Native Tribal population. In the 18th century, one in every seven children born in Russia met their end due to this disease. It obliterated entire empires and civilizations from the annals of history. It’s estimated that this virus claimed five million lives each year, totaling 500 million deaths in a century – half a billion people perished. In comparison, the recent Covid-19 pandemic pales in comparison.
Throughout history, this virus went by various names, including “Speckled Monster,” “the Red Plague,” and “Pox.” In India, it was known as “Mata Lagna,” meaning “Being afflicted by the Goddess.” However, the most common name for this scourge was “Smallpox.”
Interestingly, during the 1700s, a peculiar village in England appeared to be immune to this disease. The farmers living there seemed to possess an extraordinary defense against this deadly virus.
Smallpox is a viral disease caused by the Variola virus, classified as an Orthopox virus. Within the same category, one can find viruses like Monkeypox and Cowpox. Smallpox was exceptionally contagious, spreading readily through respiratory droplets from sneezes and coughs, saliva, and even contaminated surfaces, like towels and clothes used by infected individuals. Once infected, initial symptoms resembled a common cold, but soon, rashes would appear on the body, eventually turning into unsightly boils.
Around eight to sixteen days after infection, characterized by headaches, vomiting, rashes, and fever, death would occur. As previously mentioned, the mortality rate was 30%, significantly higher than that of Covid-19, which has a death rate of less than 1%.
One of the most disturbing aspects was its increased impact on children, who faced an even higher risk of death. The origins of this disease remain a mystery. It is believed to have emerged around 10,000 BC when humans transitioned to agriculture, coming into contact with animals such as cattle and poultry. These Orthopox viruses are naturally found in these animals, making zoonotic transmission a possible source. Some scientists even speculate that rodents could have played a role in the virus’s spread.
The first recorded evidence of smallpox dates back to 1156 BC when an ancient Egyptian mummy was embalmed, displaying the characteristic facial scarring associated with smallpox. Ancient texts from India and China also make reference to the disease. In the Sanskrit text “Susruta Samhita,” written around the 6th century BC, smallpox is described. Despite centuries of observation, modern medicine has yet to find a cure for this lethal disease.
Over time, people came to understand the concept of immunity through survival. Those who had previously battled the disease were less likely to be infected a second time. This led to the development of a practice known as inoculation, believed to have originated in India or China. In the 18th century, a group of Brahmins, called Tikadaar, would carry out inoculations, transferring scabs from infected individuals to healthy individuals via pricked skin. This method was a significant advancement in combating the disease.
However, there were drawbacks to this procedure. There was no guarantee that the small dose of the virus used for inoculation wouldn’t be fatal. A 1%-2% death rate was associated with this method, yet it was still a more favorable option compared to the disease’s 30% mortality rate. Additionally, those who were inoculated were left with permanent scars.
The third drawback was that the inoculated individuals could still spread the virus. Inoculation was indeed a double-edged sword.
In the 18th century, a peculiar event unfolded in the English village of Gloucestershire, where farmers, cattle breeders, and milkmaids seemed to possess immunity to smallpox. This phenomenon intrigued Dr. Edward Jenner, who embarked on an investigation to uncover the truth.
He discovered that those who had contracted Cowpox, a less severe disease, did not succumb to smallpox. This sparked a groundbreaking hypothesis – Cowpox might offer protection against smallpox. To test this theory, Dr. Jenner collected pus from a woman infected with Cowpox in 1796. This marked the beginning of his experiment, which would alter the course of medical history.
However, the pressing question was, on whom could he test this groundbreaking discovery? Someone had to serve as the host for this groundbreaking experiment. Dr. Jenner found a willing participant in his gardener’s 8-year-old son, James. Without the ethical constraints and legal regulations of modern times, Dr. Jenner proceeded to intentionally infect young James with Cowpox. After a few days, the child developed a fever due to the Cowpox infection but, fortunately, he eventually recovered.
Dr. Jenner’s next step was crucial. Six weeks later, he took lesions from a smallpox patient and intentionally infected young James with the smallpox virus. In contemporary society, conducting experiments on children in this manner is considered both morally reprehensible and illegal. However, the absence of such moral and legal standards during that era allowed Dr. Jenner to proceed. The intentional infection of a child with smallpox was a highly perilous endeavor, with a high likelihood of fatality. Nevertheless, young James emerged unscathed and had developed immunity against smallpox.
This groundbreaking experiment not only demonstrated the protective potential of cowpox against smallpox but also laid the foundation for the world’s first vaccine. Dr. Jenner is credited with coining the term “vaccination,” derived from the Latin word “Vacca,” meaning cow. This term, originally associated with cowpox, has evolved to encompass a wide array of vaccines used today.
Vaccination was an immense leap forward in terms of safety compared to the earlier method of inoculation, which carried a 1%-2% risk of fatality. Cowpox, on the other hand, presented almost negligible risks of death. Today, the principles underlying this process are well-understood. Both cowpox and smallpox belong to the Orthopox virus family, and they are so similar that when a person’s immune system is exposed to cowpox, it can effectively combat other similar viruses like smallpox, using the antibodies developed during the previous infection.
Recently, another orthopox virus, Monkeypox, has gained global attention. While it belongs to the same viral family, it is less severe than smallpox and less contagious. The death rate for Monkeypox is estimated to be around 3%-6%. Some studies suggest that the smallpox vaccine offers approximately 85% protection against Monkeypox. However, the emergence of a new disease always exerts a significant impact on society, particularly in terms of medical costs and expenses.
Returning to Dr. Jenner’s remarkable contribution, one might assume that the world would have celebrated his groundbreaking discovery, recognizing that millions of lives could be saved. However, the reality was quite the opposite. Dr. Jenner faced severe backlash and widespread mockery. When he presented his findings to the Royal Society of London, his report was summarily rejected, with the President of the Royal Society advising him to abandon his research.
Nonetheless, Dr. Jenner persisted, conducting further research and collecting additional data. He published his book, titled “Enquiry Into The Causes And Effects of the Variolae Vaccinae.” Over time, his work gradually gained acceptance among medical professionals and scientists, although convincing the general population proved to be an arduous task.
Many religious organizations opposed vaccination, contending that it defied God’s plan and was unnatural. Some individuals were repulsed by the idea of their bodies being exposed to animal matter. Particularly in various European regions, there was a prevailing fear that vaccination would lead to individuals gradually transforming into cows. Painters and artists humorously depicted the emergence of bovine features from human bodies, contributing to the public’s misconceptions.
Those who carried out inoculations were fervent opponents of vaccinations since it adversely affected their livelihoods. Over time, governments began to recognize the efficacy of vaccines, leading to mandatory vaccination policies. In 1853, England became the first country to enforce compulsory smallpox vaccination for children. This marked the beginning of the first Anti-Vax movements.
Despite these challenges, Dr. Jenner faced yet another formidable task – expanding the reach of vaccinations to the rest of the world. The key question was how to transport the vaccines, especially to countries where cowpox was not prevalent. Dr. Jenner devised three main methods to address this challenge.
The first method involved saturating a long string with pus from the vaccine and allowing it to dry before transporting it on ships. Healthy individuals would then make a small cut on themselves, ensuring it bled, and place the dried string on the bleeding wound. This method was instrumental in delivering the vaccine to Canada in 1800. However, it was not practical for long distances, as the strings became ineffective over time.
The second method entailed transporting the vaccine in glass tubes, sealed with wax. This approach enabled the delivery of the vaccine to other European countries and cities.
The third method, and perhaps the most unusual but successful, involved using children. Youngsters who were infected with cowpox were placed on ships and transported to distant locations. Their purpose was to infect more people in those areas with cowpox. The same ships also carried healthy individuals and doctors who would intentionally infect the unvaccinated population. By the time the ships reached their destination, a growing number of people had been vaccinated, ensuring that someone who had recently received the cowpox vaccine was always on hand.
The first cowpox vaccine in India arrived via the Middle East in 1802. Unfortunately, due to India’s vast size and limited resources, the vaccine did not reach the masses, leading to a devastating smallpox outbreak in 1974. By 1977, the World Health Organization launched a global campaign to eradicate smallpox worldwide, championed by the Health Minister of the Soviet Union in 1958.
In the same year, the global program aimed at disseminating this vaccine worldwide was officially initiated. However, India posed a significant challenge in this endeavor. In 1962, the Indian government launched the National Smallpox Eradication Programme, investing substantial resources in vaccine manufacturing and health worker training. By 1966, approximately 60 million individuals had been vaccinated. Unfortunately, these efforts were insufficient, as the number of smallpox cases was steadily rising.
The most devastating smallpox epidemic in India occurred in 1974, claiming over 15,000 lives in just five months. At the time, India accounted for 86% of all smallpox cases worldwide. Several factors contributed to this alarming situation. India’s vast population, characterized by constant migration for political, economic, and educational reasons, made it exceedingly challenging to reach every individual with vaccination information. Limited media penetration compounded the problem.
Furthermore, opposition to vaccination was fueled by superstition, as some believed that smallpox was a result of the goddess Shitala’s anger. Instead of opting for vaccination, people chose to visit temples to appease the goddess. Religious beliefs and a widespread misconception that the vaccines were derived from cows led many to reject vaccination.
The vaccination process in the 1970s was notably painful, and the vaccines often spoiled due to India’s hot climate. In 1970, the World Health Organization and the Indian government joined forces to develop a new plan for eradicating smallpox in India. This collaborative effort introduced freeze-dried vaccines that were easier to store and transport. Moreover, less painful vaccination techniques were introduced.
To educate and convince the population, a team of four WHO medical officers arrived in India in 1971, and an agreement was signed to acquire the new vaccines. These officers were deployed across the country to ensure that people, especially children, received this crucial vaccine. An extensive campaign was conducted, featuring posters and the active engagement of Prime Minister Indira Gandhi. Citizens were even offered a reward of ₹100 for reporting smallpox cases.
Radio broadcasts played a pivotal role in explaining the importance of vaccination to the public. Thanks to these combined efforts, in 1975, the last case of smallpox was reported in India. The disease was effectively eradicated from the country. Those born in or after 1975, their parents, or grandparents bear a round scar on their upper arm—a remnant of the smallpox vaccine.
The World Health Organization launched similar campaigns in Africa and South America, resulting in the last instance of natural smallpox infection in 1977 in Somalia. The last person to succumb to this disease was an English woman who was accidentally exposed to the virus in a laboratory in 1978. In 1979, the World Health Organization officially declared the global eradication of smallpox.
Since then, there has been no recorded case of smallpox in the world. If you are of my generation or were born after 1980, there’s no need for a smallpox vaccine, as this virus has been eradicated worldwide. It’s incredible to imagine that a small discovery by Dr. Jenner resulted in such profound positive changes. Each year, an estimated five million lives are saved due to the existence of this vaccine and the eradication of smallpox.
Regrettably, we still do not have a cure for this disease, although the need for one has ceased to exist. Instead, we prevented its spread through vaccination and ultimately eradicated it. Only two samples of the smallpox virus remain in the world, carefully stored in highly secure laboratories: one at the US Centre for Disease Control and Prevention and the other at the Russian State Research Center of Virology and Biotechnology. These samples are retained for the purpose of further research, with an underlying fear that genetic engineering could potentially revive this virus. Such an event could have devastating consequences if the virus were to escape from these laboratories and lead to another outbreak.
