Summary of Chapter 10:
The Intensified Smallpox Eradication Programme (1967-1980)

The Intensified Smallpox Eradication Programme, launched in 1967, was a globally coordinated effort led by the World Health Organization (WHO) to eliminate smallpox. The disease was well-suited for eradication due to the highly effective and stable vaccine, clear identification of cases through the distinctive rash, and the slow transmission rate that allowed for targeted containment. However, achieving eradication required global cooperation, sustained funding, and strong surveillance measures.

Strategic plan and WHO's role

WHO was instrumental in coordinating the eradication programme, though it had no direct authority to compel countries to participate. Instead, it relied on moral persuasion and global consensus-building. The strategy involved:

  1. Mass vaccination campaigns aimed at reaching at least 80% of the population.
  2. Surveillance and containment to rapidly detect and isolate cases, preventing outbreaks.
  3. Flexible implementation, allowing adjustments based on country-specific challenges.
  4. Continuous research and improvement of vaccines, surveillance methods, and case detection.

Challenges in global coordination

Despite WHO’s leadership, the programme faced significant challenges:

  • Limited funding: WHO had difficulty securing voluntary contributions, and resources often fell short.
  • Vaccine shortages: Despite appeals, donated vaccine supplies were often insufficient.
  • Political instability: Civil wars, famines, and frequent government changes disrupted eradication efforts in several regions, including Ethiopia, Nigeria, Pakistan, and Uganda.
  • Regional disparities: WHO’s ability to communicate and coordinate efforts varied, with some regional offices being slow to prioritize smallpox eradication.

Surveillance, research, and vaccine improvements

WHO established a robust global surveillance system, tracking cases and identifying high-risk areas. Research focused on:

  • Improving vaccine production and distribution.
  • Developing new vaccination devices, such as the bifurcated needle, which simplified vaccine delivery.
  • Distinguishing orthopoxviruses, ensuring that cases were properly identified.

Final eradication efforts (1970-1980)

By the early 1970s, India, Bangladesh, and Ethiopia were among the last strongholds of smallpox. Intensive search-and-containment strategies were deployed, involving cash rewards for case reporting and door-to-door vaccination campaigns. By 1977, the last endemic case was recorded in Somalia, marking the end of naturally occurring smallpox.

Global certification and legacy

Following a three-year global monitoring process, WHO certified smallpox eradication in 1980, making it the first disease eradicated by human effort. The success of this programme set a precedent for future disease eradication efforts, such as polio and measles.

Conclusion

The Intensified Smallpox Eradication Programme was a landmark achievement in global health. Despite funding shortages, political instability, and logistical hurdles, WHO’s leadership, scientific advancements, and international collaboration led to the complete eradication of smallpox, proving that large-scale disease elimination is possible through coordinated global action.