The last days of smallpox: tragedy in Birmingham

Abstract

‘One host, one virus, one vaccine: so it was a simple matter, the eradication of smallpox’ [ [1] Christie A.B. Smallpox: obituary and caution. 4th ed. Infectious disease. Vol. 1. Churchill Livingstone, Edinburgh1987: 347-350 Google Scholar ]. Barnett Christie's irony in the opening words of his obituary to smallpox is betrayed by his later description of its eradication as mankind's greatest achievement. The devil, of course, is in the detail, and Pallen's account of the 1978 Birmingham outbreak provides us with plenty of that. The book is divided into seven sections, the first three of which summarize what is known of the origins of smallpox, its historical impact, the development of vaccination and the eradication programme. Pallen clearly has a journalistic flair for bringing history to life with human interest stories, including victims of the disease as well as key protagonists. Chief among the latter are Viktor Zhdanov, the Soviet Union's energetic and visionary Chief Medical Officer, whose leadership of the Soviet delegation to the World Health Assembly (WHA) in 1958 marks the end of the Soviet boycott. In promoting his vision of global eradication, Zhdanov cunningly quotes Thomas Jefferson who, in a letter to Edward Jenner in 1806, wrote ‘future generations will know by history only that the loathsome smallpox has existed’. The WHA subsequently agreed on a global eradication programme in 1959, but it was another five years before the USA was fully engaged. In 1966, Donald ‘DA’ Henderson was appointed Director of the World Health Organization Smallpox Eradication Office, with a budget so small that it did not even cover the cost of the vaccine. His leadership was pivotal, but we should also acknowledge the role of the thousands of field workers, like the young Alasdair Geddes, who is pictured carrying his bicycle across a footbridge in Bangladesh, and William Foege, whose development of the Leicester system for surveillance-containment in Nigeria quickly replaced the early policy of mass vaccination. Surveillance-containment, initially forced on Foege by shortage of vaccine, proved to be outstandingly effective, and enabled smallpox to be eradicated from Nigeria's 12 million inhabitants with just 750,000 vaccinations [ [2] World Health Organization Bugs, drugs & smoke: stories from public health. WHO, Geneva2011 Google Scholar ]. Technological developments also contributed, including the freeze-dried vaccine developed in the USSR, and the bifurcated needle that made effective inoculation easy and used less vaccine.