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The Greatest Killer: Smallpox In History
22 Aug 2002


A Q&A session with Carter Center's Dr. Donald Hopkins on the eradication of smallpox

What does eradication mean?
Eradication means that the disease is gone "forever," and control measures are no longer necessary. That is why there is this current uncertainty about reintroducing smallpox again in the form of vaccinations. We are losing a small part of the benefit of having eradicated smallpox in the first place.

Survivors of smallpox, particularly women, were routinely ostracized because of the scarring and blindness inflicted by the disease. Smallpox was eradicated in 1977

What are the pros and cons of the recent decision to vaccinate against smallpox again?

The intent of resuming vaccinations of the general public is to reduce the potential value of smallpox as a biological weapon and to have a head start on any epidemic if the disease were re-introduced. A few researchers have continued to be vaccinated since smallpox was eradicated in 1977. The general public is not privy to specific intelligence information about the potential risk of smallpox being used as a biological weapon. The main risk of vaccinating many more people for an epidemic that may not come is that some of those vaccinated will have severe reactions to the vaccine, including some deaths, and those will be at higher rates than when the vaccine was given routinely to infants before 1971, because adults have higher reaction rates than infants. Some believe there would be sufficient time to vaccinate persons at risk after any epidemic appears, if ever.

How much impact did smallpox have in the past?

Smallpox caused an immense suffering through the ages, since before ancient Egypt. About one-third or more of victims died, and many of the survivors were blinded or were ostracized, especially women, because of severe scarring of their faces by pockmarks. Everyone was susceptible, unless they previously had smallpox or had been immunized. Smallpox is contagious from when patients first begin to feel ill, about 10 - 14 days after they were exposed to infection, until the last scab falls off, about three weeks after they become ill. In the days before vaccination, it was said that smallpox was "a river that everyone had to cross".

How was smallpox eradicated?
Smallpox could spread by air, by face-to-face contact, or by contaminated clothing, blankets, etc. The challenge was to find every case quickly and prevent each patient from infecting others. Prevention was achieved by isolating patients and by immunizing persons who were in contact with them, and sometimes by mass vaccination. The smallpox patients often were very poor and located in very remote villages or in densely populated urban areas.

Why is the history of smallpox relevant to The Carter Center's work now?
The Smallpox Eradication Program proved for the first time that a disease of humans could be completely eradicated. The Carter Center's international health programs are using lessons learned in the smallpox campaign in our current efforts to eradicate Guinea worm disease (dracunculiasis), and to control river blindness (onchocerciasis), schistosomiasis, lymphatic filariasis, and trachoma. The historical experiences also show how individual and national efforts were inadequate; smallpox could only be eradicated when the entire world resolved to join together to do so.

How does your book inform this debate today?
"The Greatest Killer" signifies how devastating and important smallpox was. This disease deserves as much respect as the plague, if not more; and it spreads much more easily than AIDS/HIV infection.


Learn more about Donald Hopkins, M.D., M.P.H., associate executive director for health programs.

Find more information on The Carter Center's International Task Force for Disease Eradication.

For information on how to order a copy of Dr. Hopkins' book, The Greatest Killer: Smallpox in History, please contact

University of Chicago Press.
The University of Chicago Press
1427 East 60th Street
Chicago, IL 60637 U.S.A.
General telephone: (773) 702-7700

Hopkins, Donald R. The Greatest Killer: Smallpox in History. With a new introduction. 400 p. (est.), 36 halftones, 15 line drawings.
1983, 2002
Cloth $55.00tx 0-226-35166-1 Fall 2002 Available 07/02.
Paper $18.00 0-226-35168-8 Fall 2002 Available 07/02.



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