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How We Got Rid of Smallpox, Why It Matters

Ghanaian Boy with Smallpox

Ghanaian Boy with Smallpox


Ghanaian Boy with Smallpox

This was a horrible, terrifying disease.


It’s hard for many of us to appreciate now what an awful scourge this viral infection once was, in the mid-1960s still causing 15 million cases a year and killing nearly as many as AIDS today.

And now it’s gone, eradicated. The only disease, so far, wiped off the face of the planet.

Some of those who helped rid the world of this disease are meeting in Rio de Janeiro, Brazil, this week. The Smallpox 2010 conference is being held to celebrate the 30th anniversary of the official declaration that “smallpox is dead” — and to apply what was learned to assist other efforts aimed at eradicating diseases like polio, measles and even perhaps malaria.

Some say it was the global campaign to eradicate smallpox that paved the way for today’s concept of global health.

One of those attending the Rio meeting is Dr. Bill Foege, who I can say (because he won’t) was the guy who figured out how to finally beat smallpox.

Foege, who grew up in Colville, went to Pacific Lutheran University and then to the University of Washington to become a doctor, arguably came up with the strategy that turned the tide in the smallpox campaign.

Bill Foege

by Tom Paulson

Bill Foege

Called “surveillance and containment,” it was a strategy borne out of necessity. In 1967, when the World Health Organization launched the campaign to eradicate smallpox the goal was mass vaccination — vaccinate everyone.

It was a globally coordinated attempt, some 150 years after the smallpox vaccine was discovered, to simply make sure everyone got immunized.

Foege was a medical missionary working in Nigeria when he was drafted to assist with the global smallpox campaign. At one point, he and his colleagues ran short on vaccines and could not possibly vaccinate everyone.

So Foege “started thinking like the virus” and devised a more targeted method, of asking the community to help identify smallpox cases so that health workers could encircle the virus and vaccinate everyone around the person infected.

This “surveillance and containment” approach proved so effective, it was eventually adopted globally as a means to finally rid the world of this terrible disease.

Polio could be next on the list of eradicated diseases. Foege, now a senior adviser to the Gates Foundation, has been an advocate for that cause as well.

But polio is not smallpox and measles is not malaria. What does Foege think we learned from the successful effort to eradicate smallpox that applies to these other efforts fighting different diseases?

“We learned to adapt,” Foege said to me recently at his home on Vashon Island, before he left for Brazil. “Nobody thought we could ever drop mass vaccination, but we were forced to come up with a different strategy.”

In the end, it was the better strategy.

Ridding the world of smallpox was an immense achievement, so far unprecedented. We are frustratingly close to beating polio, but the global health community has had to keep pushing back the goalposts as cases continue to pop up here and there. Measles is another candidate for eradication, but will there be support for starting another eradication effort with polio persisting?

Don’t ignore the evidence if your strategy isn’t working, Foege says. And don’t give up. Adapt.


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.