Throughout most of human history, one of its greatest single killers was not a creature nor an army but a single disease that accounted for the deaths of 300m people.
It killed 30 per cent of the people it infected, and survivors were left scarred and sometimes even went blind.
For as long as there were civilisations and towns smallpox had existed, and whilst some countries in southwest Asia, as well as China, had developed ways to combat and reduce the risk of death, until 1796 it was a disease that was widely feared, even more so than the bubonic plague.
In 2023, it has been over 40 years since the last reported death, the disease being the first and only major infectious disease to have been eradicated completely.
The story of how it happened is also one that affects how prescription ordering services and public health prepare humanity for epidemics ever since.
The Concerted Effort
The story of the first ever vaccination programme, created by Edward Jenner in 1796 after seeing how milkmaids who had previously had cowpox never caught smallpox, was the beginning of the end for the deadly disease but it would take centuries for the disease to stop killing millions.
In 1801, Mr Jenner published a treatise that called for the “annihilation” of what he described as the scourge of the human race. Even centuries later, we had fallen short of this.
By the 1950s, 50m cases were estimated to occur every year, and whilst many major nations had wiped it out, international travel mean that there was always a risk of it spreading through international flights and causing a major epidemic.
As such, in 1959, the World Health Organisation started a plan to eradicate smallpox from the entire world, which for any other disease would be seen as impossibly audacious but was made possible by the fact that smallpox only spreads through humans and not through animals.
The programme was intensified in 1967, aided by technological advances and a greater commitment of resources by countries in North America and Europe, both free of smallpox since 1952 and 1953 respectively.
This involved the development of a freeze-dried vaccine that could be stored in the countries where smallpox was still found, the safer bifurcated needle, and a case surveillance system that found outbreaks quickly and targeted contact tracing and vaccination efforts around them,
It was finally working, and in 1971 they reached their first breakthrough by eliminating smallpox from South America. Asia followed in 1975 and finally Africa in 1977.
The Last Three Cases
The last person to naturally catch the deadlier variety of smallpox was Rahima Banu, a three-year-old girl from Bangladesh. After several days where she was isolated at home, she was no longer infectious. She still lives in Bangladesh to this day.
Ali Maow Maalin was the last person to have been infected with naturally occurring smallpox. Another aggressive containment campaign prevented its spread and he became a lifelong advocate for vaccination until he tragically died in 2013 after contracting malaria.
The final person to die of smallpox was Janet Parker, a medical photographer who was accidentally exposed to smallpox at the University of Birmingham Medical School with the details as to how still a debate to this very day.