Smallpox and its Eradication, 1969 to 1980

Table of Contents

Introduction
Smallpox: the Disease
Clinical Features
Epidemiology
The History of Smallpox
Immunization
Early Attempts to Eradicate Smallpox
The Intensified Smallpox Eradication Program, 1967 to 1977
The Extent of the Problem
The Vaccine
Priorities
Strategies for Eradication
Certification of Eradication
Informal Consultations on Monkeypox and Related Viruses
First Meeting, Moscow, 26–31 March 1969
Fourth Meeting, Geneva, 10–13 February 1976
Fifth Meeting, Geneva, 9–10 November 1978
Study Group on Orthopoxviruses
First Meeting, Atlanta, USA, 26–28 June 1979.
Certification of Smallpox Eradication
India, 4–23 April 1977
Malawi, Mozambique, Tanzania and Zambia, 6–29 March 1978
South Africa, 23 January to 18 February 1978
South Africa, Second Visit, 11–12 October 1978
People's Republic of China, 14–31 July 1979
Eradication from Africa, 16 October to 6 November 1979
Consultation on the Worldwide Certification of Smallpox Eradication, 11–13 October 1977
First Meeting of the Global Commission for the Certification of Smallpox Eradication, 4–7 December 1978.
Second and Final Meeting of the Global Commission for the Certification of Smallpox Eradication, 6–9 December 1979.
Smallpox Eradication Program, Meeting of the World Health Assembly, May 8, 1980

Introduction

Why have a whole chapter on smallpox? The reader will know when he reads this chapter and portion of the next. For almost the whole of my career at the laboratory bench—excepting my time as a pathologist during my army service—I worked on poxviruses. Initially, with Macfarlane Burnet at the Walter and Eliza Hall Institute, I worked on infectious ectromelia, which we were able to rename ‘mousepox’. From 1950 until 1965, I spent most of my time working and writing about myxomatosis, and have written and lectured about it, off and on, ever since. In 1957, I began work on the genetics of vaccinia virus as a simpler laboratory model, with the ultimate goal of studying the genetics of virulence in myxoma virus. This gave some very interesting results, but the problem was much too complex to be solved by the techniques then available. In 1967, I was appointed Director of the John Curtin School of Medical Research and gave up research at the bench and the supervision of research students.

The World Health Organization (WHO) Intensified Smallpox Eradication Program was initiated in 1967, and in 1969 WHO set up a small committee of scientists expert in the laboratory study of poxviruses, called the ‘Informal Group on Monkeypox and Related Viruses’. I was appointed a member of that committee and served as rapporteur at its first meeting in Moscow in 1969 and Chairman for the meetings in 1976, 1978 and 1979. I missed the meetings in 1971 and 1973.

Clearly, as countries appeared to have succeeded in stopping transmission of smallpox within their jurisdictions, there needed to be an independent assessment of these claims, and International Commissions for the Certification of Smallpox Eradication were established. In April 1977, I served on the International Commission for the Certification of Smallpox Eradication in India, where I was appointed rapporteur for the final meeting. In March 1978 I was a member of the International Commission for Certification in several African countries, including Malawi. There were 23 such International Commissions and a few less formal investigations that needed to be consolidated; in October 1977 a large ‘Consultation on the Worldwide Certification of Smallpox Eradication’ was established, and I was appointed Chairman of the Consultation and later, in December 1978 and December 1979, of its successor, the Global Commission for the Certification of the Smallpox Eradication. At its second and final meeting, the Global Commission affirmed that smallpox had indeed been eradicated and produced a substantial report which contained 19 recommendations for WHO responsibilities post-eradication. As Chairman of the Commission, I presented the report and its recommendations to the 33rd World Health Assembly in May 1980, where it was approved unanimously. To put this work into context, I set out below a brief account of the disease and efforts to control it before describing my own involvement in this program.