Smallpox After Eradication: Black Pox, Ring Vaccination and Lab Freezers

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Smallpox killed an estimated 300 to 500 million people in the 20th century alone, and it remains the only human disease ever eradicated. This episode explains how the variola virus worked: a large, brick shaped DNA virus that copied itself in the cell's cytoplasm, followed by fever, mouth lesions, and pustules buried deep in the skin. Variola major killed about 30 percent of patients, the confluent form more than 60 percent, and hemorrhagic black pox nearly everyone. The disease left its mark on the mummy of Ramses V, devastated Indigenous populations in the Americas, and killed five reigning European monarchs in a single century.

Because it spread only between people and had no animal reservoir, it could be beaten. The story runs from powdered scabs blown into the nose in 1500s China to Edward Jenner's cowpox vaccine of 1796 and the World Health Organization campaign that ended with certification of eradication in May 1980. The episode then turns to why live samples remain in Atlanta and Koltsovo, Russia, the 2004 proposal to insert a glowing GFP gene into the virus, and the 2016 synthesis of horsepox from mail order DNA for about $100,000.

Why smallpox caused an estimated one third of blindness in 18th century Europe
How freeze dried vaccine and the two pronged bifurcated needle helped the campaign reach remote regions
Ring vaccination: isolating each case and vaccinating every contact, like a firebreak
The last naturally occurring case in October 1977
Why the FDA approved new smallpox drugs in 2018 and 2021 for a disease no longer found in nature

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