WHO against smallpox
Work on the WHO Global Smallpox Eradication Programme. A Niger resident is given a vaccine using a needle-free injector, 1969.
Over the past 21 years, doctors from 73 countries have jointly rid humanity of a viral infection that has killed millions of people.
The idea of the program was simple: by mass vaccination, to block the spread of the smallpox virus until there was only one patient left on Earth. Find him and put him in quarantine. When the chief sanitary inspector of the USSR Ministry of Health, Viktor Mikhailovich Zhdanov, proposed such an idea at a WHO session, this unknown person was only 4 years old. When he was finally found, the boy grew up to become a skilled chef.
Why didn't the milkmaids get sick?
The man destined to find a safer and more effective way to prevent smallpox was named Edward Jenner. He was born near Bristol, in the town of Berkeley (Gloucestershire) on May 17, 1749. His father Stephen was a Church of England minister.
When Edward was eight years old, they decided to send him to a free boarding school, and soon the school was engulfed by a terrible smallpox epidemic. All students who had not undergone it previously, including Edward, were hastily subjected to variolation. The boy, already at a loss in an unfamiliar environment, had to endure a futile and potentially dangerous training with inevitable bloodletting, fasting and enemas. After six weeks, the weakened, exhausted, frightened and unhappy child was vaccinated, and then he was placed in the infirmary along with children who had already contracted smallpox and were for the most part in a serious and sometimes hopeless condition. This frightening experience had serious psychological consequences for Edward.
At school, Edward was interested in biology and decided to become a doctor. He did not achieve any particular academic success, but his knowledge was enough to become a student of junior surgeon John Ludlow at the age of thirteen and study with him for six years. Working under Ludlow, he listened with interest to what the villagers were telling their doctor. In particular, in 1768, already at the end of his studies, he heard talk that milkmaids who were infected with cowpox never subsequently became ill with human smallpox. It was this story that led Jenner to the idea that deliberately infecting people with cowpox could protect them in the future from contracting the terrible disease.
Before Jenner had the opportunity to test the validity of his idea, he moved to London, where he began studying at St. George's Hospital. Its chief surgeon, John Gunther, was soon to gain a reputation as England's most distinguished surgeon. And Jenner, while working in the hospital, gained considerable experience in using the latest surgical techniques.
But after spending two years in London, Jenner dreamed of a quiet and peaceful life in the English countryside, he desperately wanted to return to Berkeley.
In Berkeley, Jenner's activities were not limited to his duties as a country doctor. He found time to play the violin and flute, and also composed ballads and songs. Having heard that two French brothers had built a balloon to transport passengers and, having filled it with hydrogen, had flown a considerable distance, he himself made a huge balloon out of silk and also filled it with hydrogen. Edward Jenner became the first Englishman to build a hot air balloon.
Jenner was also interested in a mysterious disease first described in 1772 by William Heberden. Geberden called this disease angina pectoris, now we call it angina pectoris. Jenner performed an autopsy on a patient who died after an attack of angina pectoris. Having examined the heart and not finding, by the means on which he could count, any cause of the sudden death of the patient or the symptoms preceding it, he proceeded to make a transverse section of the heart very close to its base, and suddenly the scalpel rested on something very hard and hard. Further study allowed us to establish the truth: the coronary arteries turned into ossified canals.
The calcification of the coronary arteries discovered by Jenner first led him to the idea that it was the obstructive lesion of these arteries that was the cause of angina pectoris and sudden death, which so often overtook people suffering from this disease. This suspicion turned into certainty after subsequent autopsies of those who died of angina confirmed the indispensable presence of one or more blocked coronary arteries.
But the question of a possible connection between cow, horse and natural smallpox still occupied him. At a medical conference, he met with a certain Mr. Frewster and learned that in 1765 he presented a report to the London Medical Society on cowpox and its ability to prevent smallpox. (The report was never published.) Jenner found Fruster's story about the possible interdependence between the two diseases extremely interesting. As a result, he and Früster devoted almost all of their time at the conference to discussing various types of smallpox, although members of the Society believed that the problem was of no medical importance.
Today we know that smallpox, cowpox, pigpox, horsepox and a great many other types of animal pox are caused by viruses of the Orthopox family and that all of these diseases can also be infected by humans. Infection with one type of disease creates immunity in a person against all other diseases in the group. Jenner did not know this, but in December 1789 events occurred whose enduring historical significance he immediately appreciated.
The anti-vaccination movement began shortly after Edward Jenner developed the first smallpox vaccine. James Gillray. “Cowpox, or the miraculous effect of a new vaccination!” (1802)
Wikipedia
How the USSR interfered with the fight against smallpox
On June 12, 1958, no one yet knew where this last patient would be found. There were 63 states in the world with smallpox outbreaks. All these countries were developing. And although the idea of helping them was expressed by the not very popular delegation of the Soviet Union, which was at odds with half the world, the resolution was adopted unanimously. There were two reasons for the consensus: financial and medical. Firstly, smallpox was regularly imported from the colonies to first world countries, so it was necessary to spend a billion dollars a year on prevention. It’s easier to just vaccinate all of humanity, it will cost a hundred million, and it will only be needed once. Secondly, more people began to die from complications as a result of vaccination than from imported smallpox.
The Soviet Union was one of the founding states of the World Health Organization, but until 1958 it demonstratively did not participate in its work. Now that relations with the outside world were improving, a program was needed that would attract universal approval. The political situation and the dreams of Soviet doctors coincided for a while. The USSR generously donated millions of doses of smallpox vaccine to WHO, and WHO called on world governments to vaccinate their populations with this drug.
Development in Russia
Vaccination also came to our country from England. Not the first, but the most famous to be vaccinated were Empress Catherine the Great and her son Paul. The vaccination was carried out by an English doctor who took biomaterial from the boy Sasha Markov - he later began to bear the double surname Markov-Ospenny. Half a century later, in 1801, with the light hand of Empress Maria Feodorovna, the surname Vaktsinov appeared, which was given to the boy Anton Petrov, the first to be vaccinated in Russia using Dr. Jenner’s method.
In general, the history of smallpox in our country can be studied by last name. Thus, until the beginning of the 18th century, there were no written references to smallpox in our country, but the names Ryabykh, Ryabtsev, Shchedrin (“pockmarked”) indicate that the disease existed, as elsewhere, since ancient times.
After Catherine II, vaccination became fashionable, thanks to the example of the august person. Even those who had already been ill and acquired immunity from this disease were vaccinated against smallpox. Since then, vaccinations against smallpox have been carried out everywhere, but only became mandatory in 1919. It was then that the number of cases dropped from 186,000 to 25,000. And in 1958, at the World Health Assembly, the Soviet Union proposed a program to completely eliminate smallpox from the world. As a result of this initiative, no cases of smallpox have been reported since 1977.
Iraq's successes
The first country where smallpox was eradicated in this way was Iraq. The local prime minister, Abdel-Kerim Qassem, sought Khrushchev's friendship. In August 1959, a detachment of Soviet doctors arrived in Baghdad. For two months, they traveled all over Iraq on UAZ sanitary loaves, distributing the vaccine and teaching local doctors how to use it. There were many women in the detachment, because in a Muslim country male doctors were not allowed to vaccinate women and girls. Every now and then we had to wear hijabs, but in general the attitude was favorable. Until October 7, 1959, when young Saddam Hussein shot at the prime minister's car and wounded him. At that time, Kassem remained alive, but unrest began, and epidemiologists were called home. Iraqi doctors independently brought the matter to complete victory - later there was only one outbreak of the disease, and that was an imported one.
The program had such success where there was its own intelligentsia. Doctors enthusiastically accepted help, explained to the population the importance of vaccination and made sure that there were no foci of infection. This came out in Iraq and Colombia, but there were only two dozen such states. After 10 years, WHO admitted that in 43 countries there was no progress: officially there were 200 thousand sick people, but in reality there were probably 10 times more. We adopted a new, intensive program - WHO specialists went to developing countries to organize on the spot what local authorities were unable to do. And events began in the spirit of the Strugatsky novels.
The director of the program was the American epidemiologist Daniel Henderson, who successfully fought smallpox brought to the United States. At 38 years old, he was able to understand a stranger in five minutes of conversation and accurately determine whether he should be accepted into the team, and for what place. Henderson, based in Geneva, conducted the work around the world. He turned to new technologies, without which mass vaccination was too slow.
Early in the morning at the very end of December 1959, a plane carrying the famous artist Alexei Kokorekin landed at Vnukovo airport. The artist arrived from India a day earlier than planned, went through border and customs control and went home to his mistress. He coughed a little, but who would be surprised by a cough in December Moscow?
Having presented his passion with gifts from warm exotic countries, the next day he finally got to his family, hugged his relatives, celebrated his arrival and distributed gifts in the same way. The cough got worse, the temperature rose and he went to the doctors.
He was hospitalized almost immediately - he was getting worse literally before our eyes. And by evening he died. The pathologist who performed the autopsy invited the head of the department, Academician N.A. Kraevsky, to the dissection room. By a lucky coincidence, an old pathologist from Leningrad came to visit Nikolai Alexandrovich and was invited to the dissecting table. The old man looked at the corpse and said, “Yes, my friend, this is variola vera - black smallpox”...
By that time, even doctors in our country had almost forgotten about the existence of a terrible disease that devastated cities and countries in the Middle Ages. In the USSR, the disease was overcome through universal vaccination back in 1936. The doctors didn’t even think that it could come back and stopped taking it into account.
But not in India, where the famous Soviet artist, two-time Stalin Prize winner Alexei Kokorekin visited. It was there, in one of the Indian provinces, at the burning ceremony of a Brahman who died of smallpox, that the artist contracted a terrible infection.
The full seriousness of the events became clear already on the second day: the virus was diagnosed in the hospital receptionist who received the artist, the doctor examining him, and even a teenager who was in the same hospital on the floor below, right next to the ventilation hole from Kokorekin’s room. A hospital stoker caught smallpox just by walking past the ward.
Two weeks later in 1960, some patients at the Botkin Hospital developed the same symptoms as Kokorekin: fever, cough and rash. Material taken from the skin of one of the patients was sent to the Research Institute of Vaccines and Serums. On January 15, 1960, Academician Morozov identified particles of the smallpox virus in the material. The news was promptly reported to the country's top leadership. It became clear that Moscow and the entire Soviet Union were one step away from an epidemic of a disease that was not being treated.
By the afternoon, at a meeting with Khrushchev, a set of urgent measures was adopted to prevent a smallpox epidemic. The capital's police and KGB personnel were tasked with identifying as quickly as possible everyone with whom the artist had contact, starting from the moment he boarded the plane to India. The risk group includes the plane's passengers, its crew, customs officers, colleagues, friends, and relatives.
The investigation even established that before returning home, Kokorekin spent a day with his mistress. The scale of the work was enormous. They found out that over the course of several weeks the patient had contact with several thousand people. It was almost impossible to identify everyone.
The KGB of the USSR, the Ministry of Internal Affairs and the Ministry of Health identified and isolated absolutely everyone who in any way came into contact with the infected person. One of those who spent the evening with the patient was a teacher at the institute, where she administered exams to numerous students—hundreds of people were immediately sent into quarantine from the university. Gifts brought from India for his wife and mistress through second-hand stores on Shabolovka and Leninsky spread throughout the city, but within a day all the store visitors were identified, quarantined, and the items themselves made from Indian fabrics were burned.
The Central Botkin Hospital found itself in a state of siege. Thousands of patients and staff could not leave its walls. Trucks with everything necessary are leaving the mobilization storage facilities of the State Reserve towards Moscow. They managed to turn around the plane over Europe, which took one of the passengers of the Kokorekin flight from Moscow to Paris.
Moscow, which had just celebrated the New Year, was virtually completely closed under martial law. It was impossible to enter or leave it: flights were cancelled, railway communications were interrupted, and roads were blocked. Medical teams traveled to addresses around the clock, hospitalizing more and more potential carriers of the infection.
In infectious diseases hospitals, more and more new beds were installed for quarantine patients, and a week later about 10 thousand people were already under the supervision of doctors. The thread to which began with just one passenger on the Delhi-Moscow flight.
The American Conservative 03/14/2020 Foreign Media 03/13/2020 Paris Match 03/13/2020
At the same time, the second phase of the operation to combat a possible epidemic was launched - urgent vaccination of the population. Within 3 days, 10 million doses of smallpox vaccine were delivered by plane to the Moscow City Sanitary and Epidemiological Station from the Tomsk and Tashkent Institutes of Vaccines and Serums and the Krasnodar Regional Sanitary and Epidemiological Station. And medical workers of absolutely all enterprises and institutions of the city injected it to Muscovites and guests of the capital.
Results: In total, during this outbreak in Moscow, 19 people became infected from Kokorekin (7 relatives, 9 staff and 3 patients of the hospital where he was hospitalized with unrecognized smallpox). Another 23 people became infected from them, and three more from the latter. Three of the 46 infected people died.
In 1960, all 7 million residents of Moscow were vaccinated. The dying were also vaccinated. Every week, 1.5 million people were given an injection, and 10 thousand vaccination teams were vaccinated, which, in addition to doctors and paramedics, included medical students. A month later, the smallpox outbreak was extinguished.
PS But all this happened a long time ago, in another country that we lost.
Alena Degrik (Shevtsova), founder and CEO of FC LeoGaming Pay (CEO LeoGaming)
InoSMI materials contain assessments exclusively of foreign media and do not reflect the position of the InoSMI editorial staff.
Military at the forefront of the fight
The US military provided WHO with needleless injectors - pneumatic devices with a pedal that injected the vaccine under the skin. The idea came from a grease gun. Workers in French shipyards complained that they sometimes accidentally injected themselves with lubricant. If such a gun is loaded with vaccine, one person per shift can easily vaccinate a thousand. No electricity required - just compressed air.
A device like this cost the same as a Volkswagen Beetle, but it worked wonders. He cleared smallpox from Brazil, West and South Africa - places where the population could easily gather at the call of Catholic missionaries, who also served as epidemiological surveillance. It was enough to promise the distribution of food, and nomadic Indians from the Amazon jungle and cannibalistic pygmies from the Zairean rainforest appeared in response to the cry.
Dr. Ben Rubin came up with an even more powerful tool - the bifurcation needle. Its forked sting held a drop of the drug, only 0.0025 milliliters. For reliable vaccination, it is enough to slightly prick the shoulder 10-12 times. The developer donated the rights to his needle to WHO. This saved millions and made it possible to recruit volunteers without any medical training.
Ivan Okay's needle
Soviet scientist Ivan Ladny in Zambia destroyed one outbreak after another until he found a person who was spreading the smallpox virus to the entire country. It turned out to be a shaman who did variolation. His bamboo tube contained material from the purulent scabs of a mild case of smallpox. For a fee, this rubbish was injected into an incision in the skin. It could induce immunity for many years, or it could provoke a fatal disease. What to do with this shaman? Ladny suggested that he change - a set of variolator for a bifurcation needle. The deal took place, and the shaman turned from an enemy into an assistant.
In 1970, Central Africa was considered free of infection, when suddenly this diagnosis was made to a 9-year-old boy in a remote village. Where could smallpox come from if it is transmitted only from one person to another? A sample of material from the vesicles on the boy’s body was sent to the WHO Collaborating Center in Moscow, where Svetlana Marennikova examined it under an electron microscope and determined that it was a smallpox virus, not natural, but monkeypox, known since 1959. This is how we learned that people can get this infection from animals. Moreover, monkeypox was found in animals in the Moscow Zoo. Marennikova had to vaccinate the animals, including stabbing the ear of a huge Amur tiger in a special pressure cage. But the most important thing about this discovery is that the smallpox virus has no host other than humans, which means the virus can be isolated and left without prey.
Smallpox vaccinations: the main thing that still distinguishes older people
Daria Yudkevich, October 26, 2021, 00:05 — REGNUM Smallpox is one of the oldest infectious diseases that has literally decimated the inhabitants of different countries and continents for many centuries. According to ancient Egyptian manuscripts, smallpox originated in Central Africa. Egyptian mummies with traces of smallpox prove its existence in Egypt in the third millennium BC. Chinese sources mention smallpox as early as the 12th century BC; a smallpox-like disease is described in Indian documents from the 9th century BC. Much later, only in the 4th century after the birth of Christ, smallpox spread from Northeast Africa to Arabia, and two centuries later to Europe, where it literally scourged countries for two centuries: epidemics were noted in France, Italy, and Spain. Smallpox was introduced to Russia, as it was to Germany, in the 15th century. A hundred years later, Spanish colonialists brought smallpox to America, where they also used it as a bacteriological weapon to destroy the indigenous population of Mexican lands - through contaminated clothing that was hung in the forest (a method they tested during the Reconquista against the inhabitants of the Cordoba Caliphate). In the mid-16th century in Brazil, smallpox killed about 100,000 people in one province alone. But the British brought this disease to North America, and in 1616-1617, the largest epidemic among Indians was recorded on the East Coast, including the almost complete extermination of the tribe living in what is now the state of Massachusetts.
Accompanying drawings to the text from the Florentine Codex (1540-1585) A Nahua Indian suffers from smallpox (the era of the Spanish conquest of central Mexico)
Smallpox became most widespread in the world in the 18th century. In some years in Europe, up to 10-12 million people fell ill with it, of whom from 25 to 40% died. Smallpox not only killed, it left many blind, and in the vast majority of cases it literally disfigured people:
“The pestilence or plague was more deadly, but it visited our shores only once or twice in people’s memory, while smallpox remained persistently among us, filling the cemeteries with the dead, tormenting with constant fear all those who had not yet suffered from it, leaving the people whose lives she spared are ugly signs, like a mark of her power, making the child unrecognizable to her own mother, turning the beautiful bride into an object of disgust in the eyes of the groom,” wrote the English historian Thomas Macaulay (19th century).
Smallpox Quarantine Warning, California, circa 1910
The source of infection is the sick person throughout the illness, regardless of what form of smallpox he has, with or without a rash (although the severe form with profuse rashes is especially contagious). The virus is found in large quantities in smallpox crusts, but the main route of transmission is airborne droplets, as well as airborne dust (transmission by shaking infected clothing, which was what the Spanish colonialists used). The disease can take a mild form or extremely severe, with the addition of secondary infections and complications (encephalitis, meningitis, myocarditis, tracheitis, otitis media, blindness). In various forms of smallpox, not only the skin is affected, internal organs also undergo changes, necrosis and hemorrhages occur in the bone marrow, necrotizing tonsillitis, and sometimes damage to the lungs. The kidneys, liver, and heart undergo dystrophic changes. Rashes form not only on the skin, but also on the mucous membranes of the nasopharynx, trachea, esophagus, intestines, and stomach; in such cases, the vesicle quickly breaks through and erosion forms. A typical case of the onset of smallpox is a temperature of up to 40 degrees, severe weakness, headache and muscle pain, anxiety, insomnia, pain in the lumbar and sacral area, tachycardia, cough, runny nose. The rash appears on the 2nd–3rd day of the onset of the disease, localizing on the neck, chest and thighs. This rash disappears on average within a day, and on the 3rd-4th day a smallpox rash proper appears, quickly spreading throughout the body. At the same time, the temperature drops - until the 9-10th day, when it rises again to 39-40 degrees, and the so-called. "suppurative fever" The patient's condition is especially difficult during this period. Improvement occurs on the 11th-12th day. From the 16th to 17th day, brown crusts form, which fall off on the 30th to 40th day, leaving behind gradually fading spots and scars.
The famous Arab physician Ibn Sina , better known to us as Avicenna, became the first doctor to describe smallpox as a contagious disease. The causative agent of smallpox - variola virus - was first discovered by Bust (1886), but what about the discovery of the vaccine? The first vaccinations against smallpox existed in the Middle Ages in the East, in the 8th century in India, in the 10th century in China, they were known in Siberia and the Urals, in Africa and Scandinavia. T.N. variolation was an inoculation of smallpox pus from a mature pustule of a smallpox patient. In 1718, this method of vaccination was brought to Europe by the wife of the British ambassador in Constantinople, who vaccinated her little son. In England, this vaccination was given to the family of the British King George the First. Variolation gave a 2% mortality rate, but they abandoned it not only and not so much for this reason: it did not provide a guarantee and itself often caused epidemics. In France, variolation was prohibited by law in 1762; England abandoned it in 1840.
In 1767, 11-year-old composer Wolfgang Amadeus Mozart survived a smallpox outbreak in Austria.
The discovery of an effective smallpox vaccine belongs to the English doctor Edward Jenner, who in 1796 inoculated an eight-year-old boy with cowpox (the word “vaccine” itself comes from the Latin vaca - cow): the disease took hold, developed only in two vaccinated areas, proceeded normally, after a month and a half Jenner inoculated with natural human smallpox, which did not take off. It was concluded that exposure to cowpox imparts immunity to smallpox. A few years later, smallpox vaccination became mandatory in the English army, and in 1807 in Bavaria it was declared mandatory for the population. Catherine the Second vaccinated herself (the boy from whom the material was taken received nobility, the surname Markov-Ospenny and a coat of arms depicting a hand with a vaccination).
Jenner's discovery reduced the incidence of smallpox, but since only part of the population was vaccinated, epidemics continued into the next two centuries. At the beginning of the 20th century before World War I, there were large outbreaks of this disease in Europe, but after the war the situation became significantly worse - not only in Europe (where 167,300 cases were reported in 1920 alone), but also in the United States. In the 30s, the incidence was reduced, mainly due to high-quality and widespread vaccination. The weakening of preventive measures led to the fact that since 1943, large epidemics again engulfed some European countries (but not the USSR, which eliminated smallpox by 1936). Statistics from the third quarter of the 20th century show that the number of countries where cases of smallpox were recorded gradually decreased, as did the number of cases - although very unstable. So, if in 1950 cases were recorded in 82 countries of the world (216,555 diseases), then the next year - in 80 countries, but with a much larger number of patients (486,508) - the epidemic was in Asia; in 1952 - 69 countries (154,734 patients), then a decrease, again an outbreak in 1958 (again in Asia) - a year that became special for the world fight against smallpox, to which we will return. The real difference only becomes noticeable in the 70s, when the statistics began to decline sharply and steadily.
Statue of Sopona, a Yoruba god believed by local tribes to cause disease
However, before that time, the world's fight against smallpox still had a very long way to go. The existence of the vaccine discovered by Jenner did not help defeat the disease on a global scale; even at the beginning of the 20th century, smallpox continued to be the most common viral infection. The most striking thing is that, despite this fact, since the mid-19th century, neither the agenda of international conferences nor the summary of international sanitary rules included smallpox. Only in 1926, at the XIII International Sanitary Conference, after a heated discussion, smallpox was included in the list of especially dangerous diseases, albeit with the amendment that mandatory declaration was required only in the case of epidemics, but not individual cases of the disease.
Meanwhile, the development of international communications, increasing the mobility of people and at the same time complicating the implementation of quarantine measures in such conditions, made itself felt: smallpox foci existed in Asia, Africa and South America, posing a possible threat of epidemics if preventive measures were weakened. Smallpox appeared in new countries every year, and it became obvious that no country was immune from its importation.
In 1958, at the XIth session of the World Health Assembly, a proposal made by the Soviet delegation to eradicate smallpox throughout the world was adopted. The historic resolution established a global program, as a result of which, through joint efforts, it was possible to gradually overcome this disease. In 1971, smallpox was eradicated in South America, four years later in Asia, and two years later in Africa, where the last case of smallpox in the world was recorded on October 26, 1977. Exactly one year later, to the day, WHO declared the smallpox virus destroyed in nature. Now it exists only in laboratory conditions (which, by the way, leaves the potential for infection, as happened in England in 1973 and 1978).
Cartoon created in 1802, when Edward Jenner proposed vaccinating animals with smallpox to protect humans
The World Smallpox Eradication Program was made effective by a combination of factors: clear coordination through a single center (WHO) and effective management of actions, supply of high-quality vaccine, vaccination using methods that eliminate errors in vaccination techniques, and the creation of an epidemiological control service. At the WHO session, where victory over smallpox was officially declared, the role of the USSR in this achievement was noted as a country that not only initiated the smallpox eradication program, but also actively participated in its implementation. In the history of world medicine, this is the first case of a global victory over one of the deadliest infections.
Indian nursery
The main breeding ground for smallpox in its deadliest form remained the Indian subcontinent - India, Pakistan, Bangladesh, Nepal. WHO Director General Marcolin Candau did not believe that anything could be eradicated in India at all and promised to eat a jeep tire if he was wrong. The fact is that the reporting in those parts was extremely bogus. Local epidemiologists quickly found their bearings: they signed up for the WHO program, received good salaries in foreign currency, dismantled the jeeps allocated to them as personal vehicles, and sent Henderson reports on 100% vaccination of their regions. And thousands of cases of smallpox were attributed to the poor quality of vaccines, primarily Soviet ones. Like, it’s hot here, the Russian drug is decomposing. Only the bosses were distinguished by such meanness. Among the rank and file there were always enthusiastic doctors who were able to go on call all night to a mountain village with a torch in hand, removing earth leeches from their feet. Walking side by side with them were staff from the global program.
Soviet doctors, who understood the false statistics, began to go to every outbreak. They came up with the idea of mobilizing all the district’s health workers for this purpose for a week - the authorities allowed it, and Indira Gandhi directly called on the population to help WHO staff. Canadian student volunteer Beverly Spring first thought of sending volunteers to the market to ask if there was smallpox in these places. The information received was always accurate. Next, vaccinators moved to the site, and after vaccination, a watchman, usually a relative, was assigned to the patient’s house, who recorded everyone who came. In 1975, smallpox was no longer endemic in India, and Henderson sent Kandau an old Jeep tire. But he did not eat it, because by that time he had retired.
Victory over smallpox
On October 23, 1768, Empress Catherine II of All Russia was vaccinated against smallpox, setting an example for her subjects who were afraid of vaccination. This fear was not without foundation: the vaccination was made with the patient’s pus and could be fatal. However, it was a life-saving practice when looking at the statistics.
Killer of Millions
Until recently, smallpox killed millions of people, blinding and disfiguring survivors. The Germans came up with a saying: “Love and smallpox are inevitable,” and the French police indicated a special sign in the descriptions of people: “No scars from smallpox.”
Naturally, people have been looking for a way to protect themselves from this highly contagious viral infection since ancient times. The Hindus came up with the goddess of smallpox, Mariatale, and tried to appease her; the Koreans brought gifts to the “respected guest of smallpox,” but this did not help. The first epidemics were registered in China in the 4th century, in Korea in the 6th century, in Japan in the 8th century: in 737, 30% of the Japanese died from smallpox. The first method of protection through vaccination was invented in the East during the early Middle Ages. They began to introduce the patient's pus to healthy people, extracting it from a ripened vesicle on the skin. This method was called “variolation”; it was practiced in India in the 8th century, in China in the 10th century, and reached Europe only in the first half of the 18th century.
The first European woman to decide on variolation was the English writer and traveler Mary Wortley-Montagu. As the wife of the British ambassador to Ottoman Constantinople, she learned of the Turkish mass practice of vaccinating girls destined for harems: variolation protected them from epidemics and prevented the appearance of unsightly pockmarks on the face. The determined Englishwoman vaccinated her five-year-old son in 1718, and then her three-year-old daughter in 1721, at the height of the smallpox epidemic. Returning to Europe, she began to actively promote variolation - and not without success. In England, experiments began on criminals and children from church orphanages. It turned out that the mortality rate from such a vaccination is 2%, which is 10–20 times less than the chances of dying from a smallpox epidemic. Variolation has become a popular method of vaccination, despite the risks. Even the family of the British King George I was vaccinated.
The philosopher Voltaire spoke about the struggle of the British against anti-vaxxers in Philosophical Letters: “They usually say in Europe that the English are a crazy and exalted people; crazy, because they vaccinate their children with smallpox to prevent it from appearing in them; exalted, as they joyfully inform their children of this terrible disease in order to prevent an as yet unknown evil. The British, for their part, say: other Europeans are cowards and degenerate people. Cowards because they are afraid of causing minor pain to their children; degenerate people because they expose their children to the danger of dying from smallpox.”
Yet it was a very dangerous method. Many have died from human smallpox inoculation, including theologian Jonathan Edwards in 1758. The English physician Geberden calculated that over 40 years of variolation in London, 25,000 more people died than before the introduction of this vaccination. France officially banned this method of vaccination in 1762.
Smallpox vaccination in Russia
However, Catherine II was determined to introduce smallpox vaccination in Russia and believed in the power of vaccination. Smallpox seriously threatened the imperial court: it disfigured the face of her husband Peter III, who was ill at a young age, and their one-year-old daughter Anna Petrovna died from smallpox in 1759. When deciding on variolation, Catherine wanted to protect not only herself, but also her son Paul, the heir to the court: in 1768 he was 14 years old. Just this year, the wife of the Tsarevich’s mentor, Countess Sheremeteva, died of smallpox, and death was about to come to the Empress’s chambers.
In October, the experienced doctor Dimmesdale was urgently transported from London to St. Petersburg. The pus for vaccination was taken from a six-year-old peasant boy, Alexander Markov - after the recovery of Catherine II, he received a noble rank, the surname Ospenny and a coat of arms, which depicts a hand with a visible mature pockmark.
History is silent about how the court empresses felt, forced to serve and care for her in the days after the vaccination - they were probably mentally preparing to die from smallpox. Only on the sixth day did Catherine II develop symptoms of the disease and she retired to Tsarskoe Selo. The patient herself was preparing for death: she ordered to keep a team of horses ready for the doctor in case she died. Dimmesdale had to urgently leave Russia to escape reprisals. While the empress was recovering, her son Pavel fell ill with chickenpox. He received the smallpox vaccination when he recovered, on November 10th. By that time, it became obvious that Catherine II had tolerated variolation well and her courtiers also hastened to receive “the pockmark from the empress.” The doctor was awarded a baronetcy and a lifelong pension. Later, he returned to Russia again to vaccinate Paul's wife Maria Fedorovna and their children, the grandchildren of Catherine II, against smallpox. Contemporaries glorified the empress’s initiative in odes, minted a commemorative medal “She set an example,” and even staged the ballet “Defeated Prejudice.”
When the French king Louis XV died of smallpox in 1774, contracted from his mistress, Catherine exclaimed: “What barbarity!” Smallpox vaccination in Russia by that time had become a mandatory, albeit risky, event.
Final victory
In 1765, three years before Catherine II was vaccinated, the London scientific community learned of a safer way to protect against smallpox. Physician John Fewster and his colleague Sutton reported that patients who had cowpox did not develop severe smallpox, even during epidemics. But this observation of rural doctors seemed to London scientists to be a mere coincidence and they did not pay due attention to it.
Only one person who was present at this report, Edward Jenner, remembered this message and began to make observations. He tracked cases of cowpox for 30 years and became convinced that, having become infected from a cow, a person acquires lasting immunity to smallpox. His guesses were confirmed by the fact that milkmaids suffered from human smallpox much less often than other people. Years passed, and the first daredevils appeared - vaccine testers: in 1774, during a smallpox epidemic, the English farmer Benjamin Jesty vaccinated his two children and his wife with a “cow vaccine”, and in 1791, the German teacher Peter Plett vaccinated his entire family in the same way.
On May 14, 1796, Edward Jenner conducted the first public vaccination against smallpox. In the presence of spectators, he took liquid from the pustule of a milkmaid infected with cowpox and introduced it into small cuts on the hand of an eight-year-old boy, James Phipps, the son of his gardener. The child fell a little ill and a week later was healthy, after which he was vaccinated with human smallpox - without any consequences. Subsequently, they tried to infect Phipps with smallpox 20 more times, but he remained healthy, demonstrating enviable immunity to the disease and the high effectiveness of the vaccine. Since 1800, vaccination against smallpox has become mandatory in the English army and navy.
In 1803, the vaccine was delivered to the New World using an interesting method. The doctor Francis Javier de Balmy, who received this task from the Spanish king, took 22 healthy boys aged three to nine years old from shelters and sequentially vaccinated them during the journey: the first two children were infected with cowpox before leaving, from them the following received a portion of pus in pairs . Thus, thanks to the “human chain”, vaccination of people in North and South America became possible.
The last case of smallpox infection was reported on October 26, 1977 in the Somali city of Marka. Since then, the disease has been considered completely defeated thanks to mass vaccination.
Ethiopia is the last country to defeat smallpox
The jeeps and people liberated in Asia were thrown into the last bastion of smallpox - Ethiopia. There, doctors did not keep fake statistics, because healthcare did not exist at all. The Muslim part of the country turned out to be more enlightened and loyal to vaccination - scattered pockets of the disease were quickly eliminated there. The situation was worse in the Orthodox regions, where the clergy was engaged in variolation, saw it as a source of income, and therefore opposed the eradication of smallpox. Two local vaccinators were even killed in the line of duty. But when Emperor Haile Selassie was overthrown and then strangled to death with a pillow, the new government needed international recognition and began helping the WHO. It couldn't just close the border with Somalia. In the Ogaden Desert, Somali guerrillas captured a Brazilian smallpox specialist and released him only after the personal intervention of the UN Secretary General. Traces of smallpox led to Somalia. Despite the war that this quasi-state waged with Ethiopia, employees of the Global Program identified all the sick people among the nomads. They were taken to the hospital in Marka. On the way, I met a friendly guy named Ali Mayau Mullin, who not only knew the way, but even got into the jeep and showed me how to get there, because he worked as a cook in that very hospital. In a few minutes in the car, Ali contracted smallpox and went down in history, because he was the very last person to become infected on Earth. When he recovered, the WHO waited some time and announced a reward of a thousand dollars to anyone who would find a smallpox patient. This money never went to anyone.
Mikhail Shifrin
Mikhail Shifrin
Smallpox Experience – On May 14, 1796, Edward Jenner successfully inoculated with the cowpox virus.
Edward Anthony Jenner
Wikipedia
Cavalrymen and milkmaids were less likely to suffer from smallpox - this was noticed at the end of the 18th century. The people knew that cowpox was not dangerous to humans - only minor traces of blisters remained, and the risk of getting sick again was reduced to a minimum. This was also noticed by the English doctor Edward Jenner, who proved that vaccinating people with cowpox is effective and safe - on May 14, 1796, he inoculated eight-year-old James Phipps against smallpox.
Jenner took the contents of several pustules that appeared on the hands of peasant Sarah Nelms and rubbed them into James Phipps's scratch. The child felt slightly unwell, but after a few days it went away, and the smallpox vaccinated after a month and a half did not take root. The following vaccinations also gave negative results: after a few months and after a few years.
Edward Jenner is thanked for the fact that it was through his efforts that it was possible to defeat a disease from which 10 to 20 people out of a hundred died, and 15% of those who survived remained disfigured with marks for life. But Edward Jenner was not the first to inoculate humans with cowpox. He conducted the experiment in 1796 and was 22 years behind farmer Benjamin Jesty and 5 years behind German teacher Peter Plett in vaccinating their families.
But it was Jenner who was able to prove that vaccination with the cowpox virus could solve the problem with the disease - two years after the experiment, he announced his research: in 1798, the Royal Society of London doubted the results and refused to publish his work. The doctor printed the brochure “Investigation of the Causes and Effects of Cowpox” at his own expense.
“Man’s retreat from the way of life destined for him by nature was the cause of many illnesses for him. Admiring brilliance, indulging his desire for luxury, and loving entertainment, he surrounded himself with a great number of animals that, perhaps, were not originally intended to be his companions... The cow, the pig, the sheep and the horse are all, for various purposes, under his care and patronage... Is it not reasonable to assume that the source of smallpox is a special kind of infectious matter, derived from a horse disease, and that random circumstances, which arose again and again, changed this disease so that it acquired that infectious and malignant form that we usually see the devastation among us?” - from a pamphlet by Edward Jenner.
Only two years later, in 1800, Jenner’s results were widely adopted: vaccination was recognized as mandatory in the English army and navy. Later it spread to the English colonies, North America and further to Europe. In 1802, the British Parliament recognized Jenner's merits and awarded him a prize of 10,000 pounds sterling, and in 1807 appointed a second prize of 20,000 pounds.
Before Jenner's research, people were vaccinated with the smallpox virus in various forms: Jenner himself, like his patient, was vaccinated at age eight. But many of those vaccinated with smallpox fell ill not with a mild form, but with a dangerous one, which left them disfigured or could kill them: two percent of those vaccinated died.
The disease was finally defeated in 1978, and today there is no compulsory vaccination against smallpox.
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Based on Wikipedia materials
