Conquering Smallpox

J. Donald Millar, left, with two other physicians in 1980 (Wikimedia) ( )
Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.

The New York Times reports that J. Donald Millar, a former assistant surgeon general during the 1960s and 1970s at what would become the U.S. Centers of Disease Control and Prevention, died on August 30. He was 81.

I would wager that most people have never heard of him or his work. But Millar, alongside other physicians and public-health officials around the world, helped lead one of the greatest achievements in the history of science.

Although he held a variety of public-health positions throughout his career, Millar’s most significant work took place as the first director of the CDC’s smallpox-eradication program from 1966 to 1970. He worked in concert with the World Health Organization and public-health agencies in the newly post-colonial world to develop mass-vaccination campaigns.

The Times notes in Millar’s obituary that smallpox killed half a billion people in the century preceding its eradication. But this is only a fraction of its toll throughout human history. Smallpox epidemics periodically ravaged Africa, Mesopotamia, and Eurasia from the time of the ancient Egyptians to World War II. When Europeans landed in the New World in the 15th century, the virus played a central role in the depopulation of the Americas. Those who did not die were often left disfigured by its characteristic pockmark scars.

Smallpox had one fatal weakness: us. Only humans can carry the virus; it doesn’t spread naturally through animals, stagnant water, or other typical infectious-disease vectors. This made smallpox highly susceptible to vaccination campaigns after Edward Jenner developed the first inoculation in 1798. Eradication also became a theoretical possibility, but the logistical challenges were insurmountable until the mid-20th century. When the international public-health community declared war on smallpox in the late 1960s, Millar helmed the U.S. program, as the Times noted:

From the center’s offices in Atlanta, Dr. Millar oversaw the training, deployment and support of dozens of health workers in some 20 countries there. Many, like Sierra Leone, Guinea, Niger and Togo, then had some of the highest rates of smallpox in the world.

Operating under the aegis of the World Health Organization, Dr. Millar’s program focused on locations, like marketplaces and festival sites, where inhabitants of remote rural settlements came together in large numbers. There, local workers trained by his staff gave smallpox vaccinations to as many people as possible.

Eventually, some 4,000 Africans were trained to administer the vaccine. By 1969, The New York Times reported, Dr. Millar’s program had vaccinated 100 million people in the region.

The last naturally occurring case occurred in Ethiopia in 1977. On May 8, 1980, the WHO formally certified that smallpox had been eradicated worldwide—the first disease to be completely eliminated in human history.

Millar, it must be emphasized, did not work alone. Other major figures include Viktor Zhdanov, who pioneered eradication in the Soviet Union, and Donald Henderson, who led the WHO’s overall smallpox-eradication efforts. Countless virologists, epidemiologists, physicians, nurses, and public-health workers on five continents also worked toward eradication.

It’s hard to understate the significance of their efforts. The global eradication of smallpox easily ranks alongside the Manhattan Project, the Apollo landings, and the development of the Internet as one of the great scientific accomplishments of the 20th century. It saved countless lives worldwide, perhaps including your own, and set the template for eradication campaigns against polio, hookworm, and malaria.

Smallpox eradication remains a largely untold story, with few books and no films about the men and women who organized it. But our ignorance is their victory: We are the first generations in recorded history to live without fear of smallpox. To Millar, and to those who worked alongside him, nothing less is owed than the gratitude of all mankind.