We attach great importance to building a community of health for all

Smallpox was the world's first infectious disease to be permanently eradicated. It has plagued humanity for at least 3,000 years before it is completely wiped out. In the 17th and 18th centuries, smallpox was the world's most devastating infectious disease. In the 20th century alone, it caused 300 million deaths. Infectious diseases are like natural disasters that destroy, erode and endanger human health and life. Beginning in January 1974, India experienced another severe smallpox epidemic, with 187967 cases reported nationwide, accounting for 86% of the total number of cases reported worldwide that year. The smallpox virus was so raging that it can be said that everyone was shrouded in the shadow of the smallpox virus at that time, and the smallpox virus has been called "the largest genocide in human history" by historians. Although the smallpox virus has been eradicated, it is still difficult to forget the suffering it caused.

Smallpox, also known as the measles virus, is a highly contagious disease that often causes serious complications and even death, claiming hundreds of millions of lives in the 20th century alone. There is no specific medicine to treat people after being infected, showing severe symptoms of poisoning blood, the typical smallpox mortality rate is as high as about 30%, even if the infected people who survive by luck will have a rash for life, and their pustules will leave dense acne scars after rupture, which is very affecting the appearance, hence the name smallpox. Smallpox is mainly transmitted through droplets and direct contact, and when a sick person coughs, sneezes or talks, the virus can be transmitted to those around them. At the same time, a person can also become infected if they come into contact with clothing, bed sheets, or other items of a person who has the smallpox virus. Due to the highly contagious nature of the smallpox virus, it is difficult to control its spread in a short period of time in the event of an outbreak.

In January 1974, the smallpox virus quietly invaded the Indian states of Bihar, Odisha and West Bengal. These areas have the worst sanitation and high population densities, and holiday gatherings and markets provide an excellent environment for the spread of the virus. At the same time, poor transportation and communication infrastructure in these areas hindered the delivery of vaccines, causing more than 60,000 infections and more than 15,000 deaths in a short period of time, making it one of the worst smallpox epidemics of the 20th century and the largest since World War II. The number of cases reached record levels in May of that year, with 11,000 new cases and 8,600 impending outbreaks in a week in Bihar alone, which equates to one new case every minute. In the face of the escalating outbreak, the Indian government and the World Health Organization (WHO) have been stepping up their anti-epidemic measures, including mobilizing more health workers and increasing vaccine supply. Despite these measures, the outbreak persists in the worst areas, and while the onset of the rainy season has somewhat restricted movement and effectively reduced the spread of the virus, a human tragedy continues to unfold due to India's religious and backward public health awareness. It was not until May 24, 1975, when the last case of smallpox was cured in India, that the epidemic finally subsided after more than a year of rage.

It is gratifying that in May 1980, the World Health Organization General Assembly made a historic announcement of victory over the smallpox virus, which had spanned 3,000 years and became the first infectious disease to be completely defeated by mankind. The symbol of the victory over smallpox is the small pit on each person's arm, which is a permanent mark of vaccination. Although the smallpox virus has a high tolerance to the external environment, its most Achilles' heel is that it is essentially a DNA virus, and compared with RNA viruses, DNA viruses have a low probability of mutation, so even if they are passed for thousands of years, their pathogenic characteristics remain unchanged, which gives us enough time to study countermeasures.

After long-term observation, once infected with the smallpox virus and recovered, it was not possible to get the disease again. At that time, the British physician Edward Jenner observed that the milkmaid had no symptoms after being infected with smallpox, and found that cowpox and human pox (smallpox) are close relatives, and the fatality rate of cowpox is very low, so he can try to use the cowpox virus to gain immunity to smallpox. However, this idea did not go well in the early days, and it was thought that cow horns and body hair would grow after vaccinia, so it was very repulsive. Through the continuous publication of papers and vaccination trials, Dr. Edward Jenner gradually gained recognition from the whole society with his facts.

In the 1950s, as scientists found a way to prepare a lyophilized vaccine, mankind really saw the possibility of eradicating the smallpox virus. Since lyophilized vaccines no longer require harsh cold chain environments, this has made vaccines accessible to remote and backward areas. In 1959, when the WHO officially began its smallpox eradication programme, one of the most challenging locations in the world was India, and vaccinating the 609 million Indian population at the time was a daunting task. Mass immunization campaigns can be relied upon in industrialized countries, but less effective in poor countries where health infrastructure is lacking. India's National Smallpox Eradication Programme began in 1962 with the goal of vaccinating the whole country within three years. However, the initiative failed due to a lack of funding, personnel, and access to vaccines. In the meantime, India is still using liquid vaccines that have been phased out in other countries, and inadequate cold chain facilities have hampered the plan. When smallpox hit in 1974, the Indian government stepped up its support to deal with the smallpox epidemic and increased donations of lyophilized vaccines from other countries, which greatly facilitated the spread of the vaccine in India.

Looking at the historical context of the smallpox virus, we can see the process of human beings from timidity and fear to helplessness and then to fight back, and finally took up the weapon of science to completely eradicate the smallpox virus. The large-scale outbreak of smallpox in India has exposed the fact that the government has not taken effective measures to control the spread of the epidemic, the public health awareness is weak, and the concept of social coordination and co-governance to deal with major public health emergencies has not yet been formed, coupled with the lack of objective conditions, which leads to slow action. The outbreak has highlighted the challenges of controlling infectious diseases in a densely populated and resource-limited scenario, and India's successful smallpox eradication is an important milestone for global health and a testament to the effectiveness of a coordinated public health intervention. The decisive factor in this protracted fight against smallpox was a series of international initiatives and donations of anti-epidemic supplies. It can be seen that a single country cannot deal with the global threat of infectious diseases alone, and only through global cooperation can the spread of infectious diseases be effectively contained.

At the same time, the outbreak has made it clear that strong public health infrastructure and preparedness are critical to effective management and containment of outbreaks, including having trained care and adequate supplies before emergencies occur. Vaccination is one of the most economical and effective ways to prevent infectious diseases, and vaccines are decisive for the prevention and control of infectious diseases. In addition, epidemics of infectious diseases are often closely related to public perception and behavior, which is why the epidemic in India mainly occurs in areas with poor sanitary conditions, and it is even more necessary to strengthen public health publicity and education in poor areas to improve public health awareness and self-protection ability. The rapid spread of smallpox in densely populated areas such as Bihar reminds us of the importance of a rapid and coordinated response in the face of an outbreak. In this case, we have seen the importance of the international community in strengthening cooperation in information sharing, technical exchanges, and mutual assistance of resources, and promoting the building of a global community of health for all is an important principle for global public health governance. Therefore, reflecting on public health emergencies requires in-depth thinking from the perspectives of prevention and response strategies, public health publicity and education, international cooperation and exchanges, scientific and technological innovation and R&D, etc., and continuously strengthen and improve the public health system and rapid emergency response mechanism, so as to improve the response capacity and effectiveness.