Summary of Chapter 12-22:
The global Smallpox Eradication effort in the final stages
Chapters 12 to 22 detail the final phases of the global smallpox eradication campaign, focusing on regional eradication efforts across South America, Asia, Africa, and the Middle East. The program’s success relied on country-specific strategies, including mass vaccination, surveillance, containment, and public health mobilization. Despite significant challenges such as civil wars, political instability, difficult terrain, and vaccine shortages, each region played a crucial role in achieving the ultimate goal: the complete eradication of smallpox by 1980.
Chapter 12: South America
By 1967, Brazil accounted for almost all smallpox cases in the Americas. A regional eradication strategy was implemented under the Pan American Health Organization (PAHO), prioritizing mass vaccination, outbreak containment, and improved reporting systems. The last known cases in Brazil occurred in 1971, marking the continent’s successful elimination of smallpox.
Chapter 13: Indonesia
Indonesia was one of the five Asian countries still experiencing endemic smallpox in 1967. Given its geographic isolation, it was a high-priority target for eradication efforts. Despite initial resistance from the WHO regional office, a nationwide program launched in 1968. Indonesia achieved eradication by 1972, introducing innovative strategies like village-to-village searches, reward systems for case reporting, and visual recognition cards for smallpox identification.
Chapter 14: Afghanistan and Pakistan
Both countries were high-risk zones due to their shared border, nomadic populations, and the persistence of variolation practices. Afghanistan’s rugged terrain and lack of infrastructure made vaccination campaigns difficult. However, an intensive surveillance program and containment strategies helped eradicate smallpox by 1972.
Pakistan, despite having a better healthcare system, was slower to adopt surveillance-based strategies. It continued mass vaccination until 1973, delaying full eradication. The last case occurred in 1974, making it one of the last countries in Asia to eliminate smallpox.
Chapter 15: India and the Himalayan Region Afghanistan and Pakistan
India was the largest remaining smallpox reservoir in the world in the 1960s. Early eradication efforts struggled due to population density, religious beliefs, and poor reporting systems. However, a shift from mass vaccination to surveillance and containment led to the launch of “Operation Smallpox Zero” in 1974. This campaign, mobilizing 100,000 health workers, successfully eradicated smallpox by May 1975.
Nepal, Bhutan, and Sikkim followed similar approaches. By 1975, the entire Himalayan region was smallpox-free.
Chapter 16: Bangladesh
Bangladesh successfully interrupted transmission in 1970, but the 1971 civil war caused massive refugee movements, reintroducing smallpox. Poor vaccination coverage in refugee camps led to a severe outbreak, requiring a renewed eradication effort post-independence. The last case in Asia occurred in Bangladesh in October 1975.
Chapter 17: Western and Central Africa
This region had some of the world’s most challenging conditions for smallpox eradication, including remote villages, poor transportation, and political instability. The US Centers for Disease Control (CDC) led efforts, implementing mass vaccination campaigns supported by USAID. By 1970, smallpox had been eliminated from 21 countries in just 3.5 years, demonstrating that eradication was achievable even in resource-limited settings.
Chapter 18: Zaire and Sudan
Zaire (now Democratic Republic of the Congo) had the highest smallpox burden in central Africa. A national vaccination campaign began in 1968, but surveillance remained weak. In 1971, the first human case of monkeypox was detected, leading to increased monitoring of orthopoxviruses.
Sudan faced multiple smallpox reintroductions due to population displacement and war. By 1971, intensified containment strategies led to eradication.
Chapter 19: Eastern Africa
Countries including Kenya, Uganda, Tanzania, Rwanda, and Burundi had relatively strong health infrastructures, making eradication more straightforward than in central Africa. By 1970, smallpox was eliminated from the region, though occasional imported cases from Ethiopia and Sudan required rapid containment.
Chapter 20: Southern Africa
In Angola, Mozambique, South Africa, and surrounding countries, smallpox was not a major problem, but political challenges complicated WHO’s ability to coordinate efforts. Civil wars in Angola and Mozambique limited eradication campaigns, requiring indirect interventions through Portugal. By 1973, all cases had been eliminated from the region.
Chapter 21: Ethiopia, Yemen, and Democratic Yemen
Ethiopia was the last African country to eradicate smallpox, facing extreme challenges like civil war, famine, and rugged terrain. Initial efforts were underfunded and poorly supported, but a final intensified effort in 1975-1976 succeeded.
Yemen’s smallpox eradication efforts began in 1969, but poor infrastructure led to delays. Democratic Yemen had fewer reported cases and was considered non-endemic by 1973.
Chapter 22: Final Eradication and Certification
By 1977, the last naturally occurring smallpox case was recorded in Somalia. WHO then launched a global surveillance effort to confirm eradication, monitoring suspected cases until 1980, when smallpox was officially declared eradicated.
Conclusion
The eradication of smallpox was one of the greatest achievements in public health history, requiring global coordination, innovative surveillance strategies, and rapid containment of outbreaks. Despite geopolitical challenges, war, and infrastructure limitations, smallpox was eliminated through persistent scientific effort and international cooperation. The campaign set the foundation for future disease eradication programs, proving that global public health interventions can succeed even in the most difficult conditions.
