Case Study: Smallpox

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In this case study published in Milestones in Public Health, addresses the journey to the eradication of smallpox. It begins by explaining the origin of the illness, where measles was dated back as far as 1157 BC in Egypt then continues to explain the spread from Egypt to Asia, Europe, and eventually Latin America by Spanish conquerors. Smallpox was described as affecting humans only and being transmitted through the respiratory tract as well coming in contact with infected skin lesions. It was made apparent that individuals who survived gained lifelong immunity to the illness. That’s when experimentation with inoculation began in China and India. Despite this method being highly successful, two percent of cases would develop an aggressive form of the illness and result in death.

In 1796, Dr. Jenner created the vaccine for measles from a milkmaid’s cowpox infected pustule. He tried the vaccine on 24 children and though unethical, observed that the children were able to gain immunity. It is estimated that smallpox has killed 300 million people. The current issue today is outbreaks of smallpox for example, in 1947 a Mexican businessman was a carrier from the disease and unknowingly spread the disease in New York forcing residents to be vaccinated. Therefore efforts to eradicate smallpox worldwide were proposed by the World Health Organization.

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Analyze current situation

As of today in the United States there has been no smallpox outbreaks since 1947 New York, as said earlier in the introductory section1. Furthemore, smallpox was eradicated worldwide in 19801. A strength in this situation is that since the illness has been eradicated worldwide spread to the US from other countries is less possible. If smallpox wasn’t eradicated worldwide there would be a higher possibility of outbreaks. A weakness in our current situation is outbreak detection. What this means is that there is no effective set planned for our health care professionals and other institutions that successfully identifies an outbreak2. This is concerning since it doesn’t allow for fast and effective procedure to reduce the impact of an outbreak. An opportunity in this situation is to create effective protocol in outbreak detection for faster realization of an occurring outbreak to begin safety procedure2. A threat when it comes to smallpox today is since there is no cure to the illness just the vaccine, it could be used for bioterrorism3. Especially since vaccinations for the illness have not been routinely given since 1972 due to it being eradicated. The mission of the World Health Organization is to publish and spread important health information to enable policy makers, researchers, and practitioners to be more effective4. In the case of this article WHO’s goal was the eradication of smallpox worldwide1.

Prioritize Issues

The root cause of the problem in the case is lack of disease control methods that prioritized better communication of infectious diseases1. Without effective methods, despite having a vaccine, outbreaks could still occur. This was made apparent by an example given in the case, Bangladesh in 1972 after refugees were returning home from their war for independence1. This led to other outbreaks in many parts of the middle east and some parts of Asia. The core problem based on this case is still lack of effective detection of outbreaks/preparedness as well as lack of routine vaccinations for smallpox. These issues are of importance since they could lead to another outbreak. Lack of effective detention refers to hospitals not having enough supplies and space to handle an outbreak as well as healthcare professionals not detecting symptoms of an infectious disease. This also includes local governments not having effective protocol to control spread. As for lack of routine vaccinations, this makes us a target to another outbreak due to reintroduction or bioterrorism. Without the vaccine the illness has a fatality rate of 30% or higher.

Analyze alternatives

The solution in the case was developed by D.A. Henderson who was able to institute better methods for disease control. His methods were used by the World Health Organization as the main strategy for eradication. In short words, there was surveillance to quickly detect smallpox and then vaccination of all individuals who came in contact with the patient, led by specialized teams so that the illness would not spread1. This proved successful since smallpox was eradicated worldwide. A solution to reducing the possibility of a smallpox outbreak is routinely vaccinating our public once again5. The vaccine though not effective for a lifetime still is effective for many years giving immunity to the illness5. With vaccination there is not such a pressing worry for another outbreak since the population would be immune. The key health belief model messages to include perceived benefits, therefore marketing immunity to the illness thanks to vaccination would increase demand for the vaccine. Lastly, another solution is keeping a stockpile of drugs and vaccines in case of an outbreak5. Like mentioned earlier, lack of preparedness plays a big role in the spread of an outbreak. Therefore, having enough supplies/hospital space and implementing the correct protocol would greatly reduce the spread.

Provide Recommendations

The recommendations for keeping smallpox at bay and/or reducing the impact of an outbreak would be better reporting of infectious diseases since this would allow for control measures to start more quickly1. If exposure occurs, vaccination of all individuals that came in contact with the infected patient; vaccine is effective within 3-4 days of exposure5. This would reduce the amount of people that could potentially die from the illness as well as reducing spread. Lastly, developing a cure for the illness or more effective medication could be another route to take, though more aggressive strains of the disease could develop that could prove medication not effective5. Nonetheless, having somewhat effective medication could ease the strain on hospitals and allow time for a more effective response.

Establish Action Plan

The steps needed to achieve the recommendations would be creating an effective protocol for the reporting of infectious diseases. Healthcare institutions/staff from hospital to federal/political level must come together to create these protocols. Next, the protocols must be practiced in simulations to strengthen their effectiveness as well.

Following, to be able to vaccinate exposed individuals hospitals must have an ample supply of the vaccines. Therefore, hospitals or the government should request for the vaccines and then have them shipped to the medical institutions. After that, the vaccines must be kept in the right conditions so that they are effective when used. As for a cure to the illness, the steps needed to come close to this goal would require the government to invest in a program to do research on the illness and experiment with medications.


Overall I would say that effective measures were taken to eradicate the illness but it concerns me how preventative measures are not being taken anymore on the subject matter. What I’m referring to is vaccination. It concerns me since smallpox could be a great threat in an act of bioterrorism to our country. Still I do understand that the US does have a stockpile of vaccinations in case of an outbreak. Another illness with a similar story to smallpox eradication would be measles. Measles has the similar qualities as smallpox that could result in its eradication worldwide6. Measles is only transmitted in humans and has an effective vaccine6. Therefore if the right steps are taken then measles could be another illness that the world won’t have to worry about. Especially since this disease has become quite relevant in the past few years due to anti-vaccine parents.     


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