smallpox

Distress at the idea of inoculation is shown in this 19th-century caricature. The child is about to be infected with cowpox matter in order to protect him from smallpox. Smallpox epidemics killed thousands of people until English physician Edward Jenner established this successful source of immunity.

A protest envelope is shown, dated 1859, denouncing the introduction, in 1853, of compulsory vaccination against smallpox in Britain. Public outcry against the enforced governmental measure had remained vociferous for a number of years. Expressed pictorially on the front of the envelope, the protest continues as outraged text on the flap.

Acute, highly contagious viral disease, marked by aches, fever, vomiting, and skin eruptions leaving pitted scars. Widespread vaccination programmes have wiped out this often fatal disease.

Smallpox was probably first brought to Europe by the returning crusaders, and as sea travel developed it was carried to the New World by explorers and settlers. It was common in Europe until the development of vaccination by Edward Jenner about 1800, and remained so in Asia, where a virulent form of the disease (variola major) was fatal to 30% of victims until the World Health Organization (WHO) campaign from 1967, which resulted in its virtual disappearance by 1980. The campaign was estimated to have cost $300 million/£200 million, and is the organization's biggest health success to date.

In October 2001, US Health and Human Services Department announced a government order of 300 million doses of a new smallpox vaccine – seven times the original amount. Routine smallpox vaccinations ended in 1972 in the USA, but after the terrorist attacks on 11 September 2001 and the subsequent anthrax scare, smallpox was considered a possible bioterrorism threat.

In June 1996, the WHO agreed to wipe out all traces of the smallpox virus by the end of the century by destroying the 400 remaining samples of variola locked in special freezers at various research institutes. This agreement followed fears that if the virus escaped it could be lethal, as populations are no longer considered to have immunity. In 1999 WHO postponed the date for final destruction of the last remaining smallpox samples, promising to set a new deadline by 2002. Fears of the existence of unofficial stocks of smallpox and the possible use of the virus by bioterrorists were behind the postponement. However, in 2002 the date for final destruction was postponed indefinitely.