Infectious Diseases: Two Faces of Smallpox

The English patients' faces were spotty, and the English health officers' faces were red. For in the industrial Midlands, less than a hundred miles from the birthplace of vaccination, no fewer than 24 Britons had come down with smallpox by last week. Both patients and health officers were lucky. They had no idea what traveler had carried the disease or where he had come from, but the smallpox proved to be the mild form, variola minor or alastrim. Only ten patients had to be hospitalized; the rest could be treated at home—with, so far, no deaths.

News of the outbreak had a particular significance for international health workers, 400 of whom were meeting in Geneva to discuss the World Health Organization's plans for a massive, ten-year effort to stamp out smallpox all around the globe. Western Europe and North America, WHO estimates, now spend $70 million a year on vaccinations to protect themselves against a disease that occurs nowhere within their borders. Why not allocate a fraction of this, $180 million over ten years, to exterminate the smallpox virus wherever it still flourishes? Then, the argument runs, many fewer vaccinations and revaccinations would be needed.

Jet-Borne Virus. The problem may be more difficult than the finances suggest. The world's greatest smallpox reservoir is the Indian subcontinent. In the 1950-51 winter epidemic season, the Republic of India recorded 225,000 cases and 57,000 deaths. By herculean efforts involving 420 million vaccinations, India has cut the toll, and the 1965-66 figures are expected to be closer to 10,000 cases and 2,500 deaths—an enormous achievement, even allowing for continued underreporting. The improvement has been made despite manpower shortages, and the fact that ordinary vaccine will not keep for more than a day in torrid India.

Pakistan reports a comparable success in reducing smallpox, especially in its detached eastern portion, even though vaccinations have reached only about 30% of the population. Yet it was from Pakistan that five jet-borne immigrants started Britain's 1962 epidemic of the more virulent and deadly form of the disease, variola major, that claimed 62 victims and caused 24 deaths. Suddenly, Britain, which had abolished compulsory vaccination in 1948, had to scrap its small annual vaccination budget of $650,000 and stage a $3,800,000 crash campaign. Since then, there have been half a dozen outbreaks in Europe. Today, although Britain has tightened its rules, there is still no universal vaccination. Traveling Britons find themselves in the embarrassing position of being required to get vaccinated before they can enter Spain or Cyprus or even their own colony of Gibraltar.