The Concept of Infectious Disease Eradication

Photo: Sari Dennise

There is a big difference between eradication and elimination when it comes to diseases. Disease eradication is when the global number of cases reaches zero. Even if there is a vaccine available for a specific disease, eradication means no one will ever be in need of using that vaccine again. Elimination is not as stringently defined – it can refer getting rid of the disease in specific regions or diminishing the cases to a negligible number of unlucky and impoverished people.

There have been a total of seven global attempts to eradicate human diseases. 4 failed (hookworm, malaria, yaws, and yellow fever), 2 are ongoing (polio and guinea worm), and only 1 was successful (smallpox).

Smallpox
In the early 1950s roughly 50 million people a year contracted smallpox with a mortality rate north of 10%. Shockingly, only 30 years later the disease was declared completely eradicated.

The first vaccine for smallpox was discovered in 1796. By giving someone the similar cowpox virus, they were then immune from contracting smallpox (fun fact: the word vaccine has the Latin root vaccinus meaning of or from cows). Unfortunately this was before the advent of FedEx so a timely delivery of the vaccine all over the world was not possible. Thus, the disease persisted for another 170 years.

In the 1950s and 60s a global initiative to eradicate smallpox began. Any outbreaks were immediately quarantined and everyone who lived close by received a vaccination (I imagine it was just like the movie “Outbreak”). Why did it take over 170 years from known vaccination to complete eradication? It was as much a communication and education initiative as a medical one. Any outbreaks of smallpox had to be immediately identified and a quick response was necessary to keep it from spreading. This was simply not possible in the 1800s.

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