These facts offer more than just a walk down memory lane for anyone old enough to remember smallpox terror. Together they tell a “then and now” story about how difficult it is to eradicate a disease, how vaccines work, and how devastating a virus left unchecked can be.
1. As horrific as Covid-19 is, it’s nowhere near as deadly as smallpox. With a fatality rate of 30%, smallpox decimated populations from the third century BC until 1977. Even though it was eradicated well before the 20th century was over, it killed roughly 500 million people in that century alone.
2. SARS-CoV-2 (a/k/a “the coronavirus”) causes Covid-19. It is a more dangerous cousin of the SARS coronavirus that killed nearly 800 people in 2003 and 2004. The current fatality rate for COVID-19’s coronavirus varies by country, from 0.2% in Germany to 7.7% in Italy. The World Health Organization estimates that Covid-19 has killed 1.324 million people so far.
3. “The cavalry is coming.” Or so Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease, has declared. By this he meant that vaccines are almost ready for approval, with distribution expected to begin in April. However, he also suggested that COVID-19 will ever be entirely eradicated.
4. This may be because SARS-CoV-2, like most viruses, has animal “reservoirs.” If public health efforts succeed at pushing it out of human populations, it will likely live on in fruit bats and ferret populations (at least), only to return to infect humans again.
5. Smallpox, on the other hand, does not have any animal reservoirs. No longer living in human hosts, it is completely defeated — at least in the wild, at least for now.
6. A common fear people have about vaccines is that they can cause the very sicknesses they are supposed to prevent. This may be part of what’s driving a single frightening number in the latest Gallup poll: about 42% of Americans say they will not get a coronavirus vaccine.
7. This is in spite of the fact that neither the Pfizer nor the Moderna vaccines can cause COVID-19. That’s because they are not made from whole DNA. Instead they are made from synthetic messenger RNA (“mRNA”), which does not contain the complete genetic information for SARS-CoV-2.
8. While it can’t create cases of Covid-19, synthetic mRNA can direct the body to produce the coronavirus’s signature spike proteins. The body’s immune system identifies those spike proteins as invaders and prepares a full defense — against not only the mRNA-produced spike proteins but against all spike proteins on any SARS-CoV-2 virus cell. With their spike proteins thwarted, SARS-CoV-2 virus cells cannot invade human cells.
9. Like the Moderna and Pfizer coronavirus vaccines, the vaccine that was deployed worldwide against smallpox was incapable of causing the disease it was meant to prevent. During the 1967-1977 push that eradicated smallpox worldwide and in the years before that decade, the vaccine was made from a virus very similar but not identical to smallpox.
10. It was a pox-type virus seen in cows.
11. The cowpox was first used as a vaccine in 18th century England. Back then, most people in the rural parts of the country knew that touching the open pustules on sick cows often created minor outbreaks of pustules on the hands of milkmaids. With those pustules, milkmaids seemed to acquire an immunity to smallpox.
12. Scientists and physicians at the time were not surprised at the idea that a mild pox infection could prevent serious disease. For decades, doctors around the world had been successfully inoculating perfectly healthy people with tiny bits of smallpox pus taken from the open sores on sick people. Royalty in England, Austria, France, and Prussia had been inoculated that way. George Washington had his whole army roll up their sleeves for the lancet that would bring material from other people’s wet sores directly to their arms. In the harems of the Turkish sultan, young girls were inoculated in places where, once they were grown, the scars would be difficult to see.
13. As an eight-year-old orphan, an English boy named Edward Jenner was successfully inoculated. Only a mild disease resulted.
14. Young Jenner’s relatively minor reaction was typical. Even so, sometimes people died — either from a full-blown case of smallpox (this happened .5% – 2% of the time), or as a result of other germs like syphilis that hitched rides on the lancets.
15. Because inoculation from human pustules came with such heavy-duty risks, in 1796 Edward Jenner (now grown and a practicing doctor in rural England) took pus from a cowpox pustule on a milkmaid’s hand and injected it directly into a little boy to see what would happen.
16. Six weeks later he injected the boy with actual smallpox.
17. There is no record of how the little boy’s mother felt about all of this. And, yes, this was long before regulations governing the ethics of medical testing were in place.
18. Fortunately, the boy was fine. The cowpox indeed conferred immunity from smallpox.
19. Jenner began harvesting cowpox pus directly from cows. But it was hard to keep the pus fresh, so he started a routine of bringing the cows themselves door to door to vaccinate people.
20. Jenner was not able to vaccinate nearly as far and wide as he would have liked. Even so, his cowpox vaccinations marked the beginning of the end of the horrible plague that left many survivors blind and that scarred bodies and faces so hideously that the English nicknamed it “the speckled monster.”
21. Smallpox scars are even apparent on the faces of Egyptian mummies. Perhaps if today’s coronavirus caused the same degree of indelible cosmetic damage that yesterday’s smallpox did, people who can’t be bothered with social distancing, hand washing, and masks would take precautions more seriously. Unfortunately, today’s public health messages aren’t motivating enough behavior change. They might if, instead of communicating, “You might not die, but your grandmother might” they said, “You might not die, but your face will be heavily pitted for life.”
22. The industrial-scale development and worldwide dissemination of vaccine is what finally eradicated smallpox. According to Donald Ainslie (D. A.) Henderson, who led the eradication effort for the World Health Organization, ridding the world of smallpox took ten years and the labor of 150,000 people.
23. Americans have not been exhibiting extraordinary patience regarding Covid-19. Pandemic-related civil unrest and discord may make ten years feel like a lifetime.
24. Without universal respect for public health measures, even ten years might not bring the coronavirus under control. Like Dr. Fauci said, SARS-CoV-2 may be impossible to eradicate.
25. Smallpox is the only disease known to have been fully expunged from the human population. The last person to acquire smallpox “in the wild” was Ali Maow Maalin, a young man who was exposed to it in 1977 while tending young children who had smallpox. He recovered, after which he worked for years in polio eradication programs in Somalia, where he caught malaria on the job and died.
26. One person has died since. She was Janet Parker, a 40-year-old medical photographer who worked in a school one floor up from a medical lab freezer in which smallpox vials were being stored for research purposes. She may have been infected through the building’s air ducts. She died in 1978.
28. That is especially worrisome because no one in the world is currently immune to smallpox. Booster shots need to be given every three years to maintain immunity. No one has been vaccinated since 1980.
29. The SARS-CoV-2 virus is far easier to obtain than the smallpox virus. You don’t have to know anyone in Russia. You don’t even need a United States security clearance or a key to a secret freezer.
30. Pretty much all you have to do is refuse to socially distance, wash your hands, or wear a mask. Then see what happens.