The smallpox chronicles

Trying to eradicate smallpox worldwide

On December 4, 1966, William Foege was in Nigeria working on smallpox eradication in eastern Nigeria as an Epidemic Intelligence Service officer for the CDC.

A missionary asked if he could come to a remote area to look at what he thought might be smallpox. Traveling seven miles off-road on French Solex power bicycles, Foege confirmed smallpox cases when he arrived with his CDC team.

“It was so early in the program, we didn’t have much in the way of supplies, and then I learned we wouldn’t get any more supplies,” says the Emory professor emeritus of global health. “We were faced with the questionof how to use our small amount of smallpox vaccine most effectively under these

Foege’s story from the history pages of smallpox eradication is just one covered in an online global health archive hosted by the Emory University Libraries. The Global Health Chronicles launched last October to coincide with the 30th anniversary of worldwide smallpox eradication.

What Foege did in the face of limited supplies of vaccine changed the course of the smallpox eradication effort. He learned that each night at 7, the missionaries in eastern Nigeria would radio each other to make sure no one was having a medical emergency. Spreading out maps, he assigned each missionary a geographic area to send runners to every village to locate any smallpox cases. Twenty-four hours later, at the next nightly radio time, he had his answers. 

“That night we knew exactly where smallpox was,” Foege says. “Our strategy was to use most of the vaccine in the villages where we knew that smallpox existed.”  

The EIS officers also tried to outsmart the smallpox virus. They believed the virus would need susceptible hosts to continue spreading, so they began to track where people were likely to go based on market and family patterns. They chose the three areas that seemed the most susceptible and used the rest of their vaccine supply in those areas. The smallpox outbreak came to a full halt in four weeks, even though only a small portion of the population had been vaccinated. 

Ring vaccination was a key strategy in turning around the epidemic. In this approach, direct contacts of diagnosed cases were identified and vaccinated. 

“We began to wonder if this new strategy might be worth trying in larger areas,” Foege remembers. “We talked to the Ministry of Health. It was a very crucial time, because war was being talked about every day. The Ministry of Health said that in the eastern region, they were willing to change the whole strategy against smallpox. We could put all of our attention on finding smallpox and containing each outbreak. Five months later, when war fever was at a peak, we were working on the last known outbreak in that entire region of 12 million people. In five months, we’d cleared out every outbreak.” 

The Global Health Chronicles gives an overview of the smallpox eradication effort through video, interviews, previously unpublished field reports, and digitized books. Compiled by staff at the Emory Libraries, Emory’s Global Health Institute, the Rollins School of Public Health, and colleagues from CDC, the project features oral histories of the people who played a significant role to stop the spread of smallpox in 22 countries in Africa, as well as in India, Bangladesh, and Nepal. —Rhonda Mullen

Table of Contents

Bookmark and Share

spring cover