Written by Leigh Henderson
One of the most significant anniversaries in human history passed recently with little fanfare. Forty years ago, on May 8, 1980, the World Health Assembly declared that smallpox had been eradicated.
Smallpox had been transmitted in an uninterrupted chain from person to person for at least 3,000 years. Unlike bubonic plague, it was endemic—always present—killing some 20-30% of those infected and leaving many of the survivors blind and most horribly scarred. Children bore the brunt of smallpox—many adults had survived the disease or been successfully vaccinated. Children under 15 could account for 75% of all deaths in an epidemic.
On January 1, 1967, the World Health Organization (WHO) started a global smallpox eradication program. Smallpox control efforts had ended endemic smallpox in much of the world, but epidemics introduced by travellers were rife. Smallpox was conservatively estimated to infect 10 million people annually, causing 2 million deaths.
On October 26, 1977, a Somali man became the last victim of smallpox in the world. Two years of exhaustive searches for any remaining smallpox reservoirs followed. A global commission reviewed the evidence and concluded that smallpox had indeed been eradicated.
And then on May 8, 1980, in moving language, the Thirty-Third World Health Assembly passed resolution WHA33.3:
Having considered the development and results of the global programme on smallpox eradication initiated by WHO in 1958 and intensified since 1967;
1. Declares solemnly that the world and all its peoples have won freedom from smallpox, which was a most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia and South America;
2. Expresses its deep gratitude to all nations and individuals who contributed to the success of this noble and historic endeavour;
3. Calls this unprecedented achievement in the history of public health to the attention of all nations, which by their collective action have freed mankind of this ancient scourge and, in so doing, have demonstrated how nations working together in a common cause may further human progress.
Many, including the Director of WHO, believed that smallpox eradication was impossible. Indeed, vanquishing smallpox was a formidable and daunting mission…
A small WHO headquarters unit had to coordinate and motivate WHO regional offices, national ministries, some 750 international workers, and hundreds of thousands of health staff in 50 countries.
Funding was a perpetual problem, as was getting sufficient supplies of vaccine.
Communication was limited—telephone service was rare, sporadic, and expensive.
The internet did not yet exist, and mail often went astray.
Field staff traveled to remote areas on near-impassable roads by Land Rover and jeep, motorcycle and bicycle, by boat, and on foot.
Floods, famine, and civil war threatened operations and generated massive movements of people.
Nevertheless, in just over 10 years, the 10 million annual smallpox cases were reduced to zero. Incredibly, a person-to-person chain of transmission that had endured for thousands of years was broken.
More than 700 international staff from 69 countries and 150,000 national staff served in the field during the smallpox program. Program chief Dr DA Henderson said, in 1982, “It is they who are now providing a new impetus to an international commitment to better health for peoples throughout the world.”
A Good War, in podcasts, articles, and interviews, will introduce the unsung heroes of smallpox eradication—”smallpox warriors,” as they call themselves. They include national staff, numerous volunteers, and senior professionals who came out of retirement and took sabbaticals to participate in this unique achievement.
Leadership, tenacity, dedication, and ingenuity were the hallmarks of the smallpox warriors. In addition to overcoming countless external challenges, the smallpox warriors also faced the inner challenges of isolation, self-doubt, and great personal risk including disease, kidnapping and death.
Many of the warriors recorded their personal thoughts in diaries, letters, and memoirs. This epic story is largely unknown outside the fields of public health and medicine. It is an inspiring story about a small group of selfless heroes. They came from a variety of countries and cultures. Most of them were young, dedicated, and idealistic.
They thought they could change the world—and they did.
Leigh A Henderson, Ph.D., is an epidemiologist and former director of the Behavioral Health Services Information System for the Substance Abuse and Mental Health Services Administration. She is the curator of Target Zero: The Smallpox Eradication Program Archives, which she started with her father, Dr. D.A. Henderson, Chief of WHO’s Smallpox Eradication Programme.