Smallpox in Two Boys: How Vaccines Work to Help Keep Us All Alive?

These two boys had been exposed to the same smallpox source. One had been vaccinated, the other had not. This picture shows the real difference, and the enormous importance, vaccination makes. During 5,000 years of recorded human history, we have only eradicated one disease; Smallpox. In 1801, Edward Jenner hoped his discovery of vaccination would bring nothing less than the annihilation of smallpox. His hope was realized.

History of Smallpox

On December 9, 1979, a commission of scientists declare that smallpox has been eradicated. The disease, which carries around a 30 percent chance of death for those who contract it, is the only infectious disease afflicting humans that have officially been eradicated.

Something similar to smallpox had ravaged humanity for thousands of years, with the earliest known description appearing in Indian accounts from the 2 Century BCE. It was believed that the Egyptian Pharaoh Ramses V died of smallpox in 1145 BCE; however, recent research indicates that the actual smallpox virus may have evolved as late as 1580 CE. A type of inoculation—introducing a small amount of the disease to bring on a mild case that results in immunity—was widespread in China by the 16th century.

Smallpox was the leading cause of death in 18th century Europe, leading to many experiments with inoculation. In 1796 the English scientist Edward Jenner discovered a vaccine. Unlike other types of inoculation, Jenner’s vaccine, made from a closely related disease that affects cows, carried zero risk of transmission.

Many European countries and American states made the vaccination of infants mandatory, and incidents of smallpox declined over the 19th and early 20th centuries.

Compared to other epidemic diseases, such as polio or malaria, smallpox eradication was relatively simple because the disease lives only in humans, making human vaccination highly effective at stopping its spread, and its symptoms appear quickly, making it easy to identify and isolate outbreaks.

Starting in 1967, the World Health Organization undertook a worldwide effort to identify and stamp out the last remaining outbreaks of the disease. By the mid-70s, smallpox was only present in the Horn of Africa and parts of the Indian subcontinent.

The last naturally occurring case was diagnosed in Somalia in 1977. Two years later, doctors proclaimed its eradication. The elimination of smallpox is one of the major successes in the history of science and medicine.

Angel of Death: The Story of Smallpox

Angel of Death provides a very comprehensive history of smallpox and vaccine development, which has parallels with the current COVID-19 pandemic.

This book is written by a professor of medicine whose specialist expertise is in diabetes and obesity, though you would not know this from the detail and thoroughness of the contents. It is written for both medical and lay readership; for those interested in medical history and social history.

But equally the book will be enjoyed by someone who just likes to read a good story. The book not only covers the science but introduces the reader to the characters of the story and their relationships with their family and peers in considerable detail.

The book initially introduces the disease and epidemiology of smallpox and the variola virus. It leaves the reader in no doubt of the scourge that variola was to mankind over many generations; variola major killed about 30% (sometimes up to 50%) of those infected and left many survivors scarred for life. The pictures in the book also give testimony to the terrible nature of this disease.

In answer to this problem, vaccination was discovered in the late 18th century. In the Angel of Death, the next section is on variolation, the use of infected material from a patient with smallpox to inoculate and hopefully induce immunity in a non-immune person, which was still used in some parts of the world in the last century.

The reader is introduced to some powerful characters involved in the introduction of this technique including Lady Mary Wortley Montague whose drive and passion, having herself suffered and been scarred from smallpox, brought variolation into the UK from Turkey. The Reverend Cotton Mather was similarly a key person in promoting variolation in Boston. Variolation was not without its problems and had small but significant mortality.

The section on vaccination focuses on Edward Jenner who recognized the protection against smallpox by a person who had had cowpox. The author does mention others who may have used the technique, though from the balance of evidence presented it is appropriate that it is Jenner’s name that is associated with this intervention.

Alongside the birth of vaccination came the anti-vaxxer movement. The book offers a very detailed insight into how this movement gained momentum, and key issues which still hamper vaccination campaigns to this day e.g. unintended side effects, and compulsion to vaccinate versus the right to choose. In the early days, issues such as erysipelas and the spread of syphilis were rare side effects of smallpox vaccination.

In 1979, smallpox became the first (and only) disease to be successfully eliminated globally by vaccination. The book ends with a cautionary tale about how daily life could be seriously impacted if smallpox was to recur and cause a pandemic. Many of these fears have come to fruition with COVID-19, albeit thankfully with a far less deadly pathogen.

Primary References:

1. The picture was taken by Dr. Allan Warner in Leicester, 1892.
2. Angel of Death: The Story of Smallpox / Gareth Williams