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An 1802 cartoon by James Gillray of the early controversy surrounding Edward Jenner's vaccination procedure, showing using his cowpox-derived smallpox vaccine causing cattle to emerge from patients.

Smallpox was an infectious disease caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names variola or variola vera, derived from varius ("spotted") or varus ("pimple"). The disease was originally known in English as the "pox" or "red plague".


  • Its decline in the later decades of the nineteenth century was at one time almost universally attributed to vaccination, but it is doubtful how true this is. Vaccination was never carried out with any degree of completeness, even among infants, and was maintained at a high level for a few decades only. There was therefore always a large proportion of the population unaffected by the vaccination laws. Revaccination affected only a fraction. At present the population is largely entirely unvaccinated. Members of the public health service now flatter themselves that the cessation of such outbreaks as do occur is due to their efforts. But is this so? The history of the rise, the change in age incidence, and the decline of smallpox rather lead to the conclusion that we may here have to do with a natural cycle of disease like plague, and that smallpox is no longer a natural disease for this country.
    • G.K. Bowes, “Epidemic Disease: Past, Present and Future,” Journal of the Royal Sanitary Institute 66, no. 3 (1946): 174–79
  • One of the most significant and serious current examples of the harm that can be set into motion by eliminating a disease-bearing pathogen from the human environment is associated with the present status of smallpox. The 23 year-long, global eradication of smallpox that has been achieved is a public health and medical triumph of the late twentieth century. However, the freedom attained from this infectious and contagious disease, and the suspension of smallpox vaccination that it has made possible, have rendered the world population highly vulnerable to the intentional or unintentional release of the variola virus that causes smallpox. This has heightened the anxiety that now exists about the threat of biological warfare and terrorism, and the possibility that the smallpox variola might be used as a weapon. In the United States, the government has responded with a plan to reintroduce smallpox vaccination, beginning with the vaccination of members of the military, hospital workers and health professionals, and firefighters and police who, in the instance of a biological warfare attack, would be most likely to have “front-line” contact with the persons who have diagnosed or undiagnosed smallpox. This plan has ignited debate about how many and which persons to vaccinate, about the risk of the adverse effects that will result from vaccination (ranging in gravity from diffuse skin eruptions to brain damage and death), and about how to monitor and minimize them.
  • Public health and vaccination programs rest on one central story: that they were crucial to the elimination of one of history’s greatest killers, smallpox. As we’ve seen, this is not true.

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