Smallpox: The Only Disease Humanity Has Erased

The dust came up under the Land Rover's tires long before the village showed itself, a red haze that clung to my clothes and got into my teeth, and I remember thinking, not for the first time, that Somalia in October felt like the inside of a kiln. Merca was still eleven kilometers off. Someone had radioed in a rash case, a young woman, fever three days before the spots came, and my job — my only job, week after week, for longer than I wanted to count — was to go and look at skin.

I had done this hundreds of times by then, in villages whose names I forgot as soon as I left them, kneeling by pallets and lifting sleeves, checking palms and soles because the rash liked to start there, on the face, on the hands, in the mouth. Most of the time it was chickenpox, or measles, or nothing at all, a fever that had already broken and left behind nothing but a frightened mother. I had learned not to hope for either outcome too hard. Hoping made you sloppy.

By 1977 we had already chased this virus across half the earth. It was strange to think that a disease which had, over the course of one century, taken three hundred million lives — more than every war of that century combined, though nobody ever put it that way in the villages — had been reduced to this: a handful of us in Land Rovers and on foot, following rumors of rash from town to town, closing in on it the way you close a door on a draft, inch by inch, until there was nowhere left for the air to move.

It had not always been this way. I remembered, from my training, being told how the campaigns of the sixties had leaned on mass vaccination alone — needle after needle, arm after arm, entire populations lined up under a hot sun — and how in the crowded places, the cities and river towns, the disease kept slipping through the gaps in a coverage that could never quite reach everyone in time. Somewhere around 1967 that changed. Surveillance and containment became the doctrine: find the case, ring it with vaccinated contacts before the virus could take its next step, starve it of new bodies to live in. It sounded almost gentle, put that way. In practice it meant miles of bad road and villages that did not always want to see us coming.

I had heard the older hands talk about Jenner, the way you hear men talk about a distant ancestor, with a kind of reverence that had nothing to do with knowing him. Seventeen ninety-six. Cowpox and milkmaids and a boy named Phipps, though none of us ever spoke his name; we spoke of Jenner's observation the way you'd speak of a match being struck in a dark room a very long time ago. Everything we did, every vial in the cold boxes strapped to the back of my vehicle, ran back to that one report, that one hunch turned into proof.

The card in my breast pocket — the WHO recognition card, we called it, with its careful drawings of the rash at each stage, papule to pustule to crust — had become something like a rosary to me. Fever, then two or three days of nothing, deceptively nothing, and then the bumps rising all together on the face and forearms, moving to the trunk last, unlike chickenpox's scatter. I had memorized the drawings before I ever saw the real thing, and when I finally did see it, months into the work, in another town, another year, I understood that no drawing prepares you for the smell of a room where a person is dying of it.

The disease moved slowly enough to be almost polite about it. Seven to seventeen days from exposure to fever, the manuals said, and no infectiousness until that fever broke the skin's calm. It gave us, if we were fast, if we were lucky, a window. Find the case. Vaccinate the household, the neighbors, anyone who had shared water or shade or a doorway with the sick person, in a ring wide enough that the virus, when it tried to jump, would land on ground already closed to it. We had done this in India, where the case counts had once run in the tens of thousands a year, and in Bangladesh, and in the Horn, walking sometimes because no vehicle could manage the terrain, carrying vaccine in boxes packed with ice that melted faster than we liked in that heat.

That October afternoon we reached the outskirts of Merca a little after two, and the woman I had come to see was sitting up on a straw mat inside a low mud-walled room, her mother beside her fanning flies from a bowl of water. I did not need long. The rash was on her face and hands, well advanced, the pustules distinct and deep-seated, the kind that when you rest a finger lightly against the skin you feel like a shot buried under it, a hard little pellet the drawings on my card had tried and failed to capture. I did not say anything to the mother right away. There is a particular kind of quiet that settles into a room once you know, before you've told anyone you know, and I sat in it for a moment before I spoke.

Her name, and I will not use it here, because it belongs to her and not to this story, was recorded that day as the last confirmed case of naturally occurring smallpox on earth. Nobody in that room understood the sentence I have just written. I am not sure I fully understood it myself, kneeling there with sweat running into my collar, filling out a form with a pen that kept skipping on the paper. I only knew that we needed a ring around this house, and around the next house, and around every house within reach, before the fever in her blood found somewhere new to go.