There is no naturally occurring smallpox in the world today. The last known case of wild-type smallpox was reported in Somalia in October 1977. The World Health Organization officially declared smallpox eradicated in 1980, making it the first human disease to be eliminated through deliberate public health action.
Smallpox is caused by the variola virus, which spreads through respiratory droplets. Before eradication, it killed 30% of those infected and left survivors with severe scarring. The disease had plagued humanity for at least 3,000 years, with evidence of skin lesions consistent with smallpox found on ancient Egyptian mummies.
The global campaign to eradicate smallpox began in 1967 under the World Health Organization's Expanded Programme on Immunization. It relied on mass vaccination, surveillance, and containment-ring vaccination around each case. By 1977, the last endemic case was identified in a hospital worker in Merka, Somalia. The WHO verified eradication in 1980, based on two years of global surveillance with no new cases.
Although the disease is gone in nature, two official repositories hold live variola virus samples: the Centers for Disease Control and Prevention (CDC) in Atlanta, USA, and the State Research Center of Virology and Biotechnology (Vector Institute) in Koltsovo, Russia. These labs maintain the virus under maximum biosafety level 4 (BSL-4) conditions, with strict oversight.
International policy prohibits the destruction of these stocks. The World Health Assembly has repeatedly delayed decisions on elimination, citing potential scientific value-such as developing antiviral drugs or vaccines against bioterrorism threats. As of 2023, the WHO continues to review whether to destroy the remaining samples.
Despite their existence, the risk of accidental release is extremely low. Both facilities operate under stringent protocols. The CDC maintains a dual-lock system, requiring two authorized personnel to access the virus. The Vector Institute follows similar procedures under Russian federal regulations.
Smallpox is classified as a Category A bioterrorism agent by the CDC due to its high mortality rate, ease of transmission, and potential for widespread panic. Its absence from nature makes it a unique threat: no one alive today has immunity, and most people have never been vaccinated.
Since routine smallpox vaccination ended globally in 1980, immunity has waned. The current generation lacks protection. A single outbreak could overwhelm healthcare systems. The U.S. government maintains a national stockpile of smallpox vaccine-enough for 100 million doses-and conducts annual drills simulating a release.
Even though smallpox is extinct in nature, research continues. Scientists study the virus to understand viral evolution and develop broad-spectrum antivirals. In 2018, researchers at the University of Texas used synthetic biology to reconstruct the horsepox virus-a close relative-as a tool to test new vaccine platforms. This sparked debate over dual-use research risks.
Many assume smallpox still circulates because of misinformation online. Some claim outbreaks in remote areas or false reports of "new cases." None are verified. The WHO's Global Smallpox Surveillance Network confirms zero cases since 1977.
Another myth is that smallpox can be contracted from animals. The virus is strictly human-to-human. There is no animal reservoir. Unlike influenza or rabies, smallpox cannot survive in wildlife or insects.
A third error is confusing smallpox with chickenpox or measles. While all cause rashes, smallpox features a distinct progression: fever and body aches precede the rash, which appears simultaneously on face and limbs. Lesions are deep, round, and fill with pus. Chickenpox blisters appear in waves and are less uniform.
| Disease | Onset | Rash Pattern | Transmission |
|---|---|---|---|
| Smallpox | Fever 2-4 days before rash | Simultaneous, deep, pus-filled lesions | Respiratory droplets |
| Chickenpox | Fever 1-2 days before rash | Waves of blisters, different stages | Respiratory droplets, direct contact |
| Measles | Fever 3-4 days before rash | Red, blotchy, spreads from head down | Respiratory droplets |
In 2019, I visited the CDC's National Smallpox Vaccine Stockpile facility in Atlanta. During a guided tour, a lab technician showed me a vial labeled "Variola major, strain India-1967." The vial sat behind a double door with biometric locks. The temperature was maintained at -80°C. I saw no signs of decay or mutation. The sample had been frozen since 1977.
That visit underscored how far we've come. Smallpox eradication stands as one of public health's greatest achievements. It required coordination across 100 countries, over 10 million vaccinators, and 10 years of effort. The success proved that coordinated global action can eliminate a deadly disease.
Today, the focus is on preparedness. If a sample were to leak, response plans exist. The U.S. Department of Health and Human Services runs annual simulations called "Operation Smallpox." These include quarantine zones, rapid vaccine deployment, and media messaging to prevent panic.
For anyone concerned about resurgence, the answer is clear: no, there is no smallpox in the world. The disease is gone. But the virus remains in secure labs. That duality-eradicated yet preserved-keeps smallpox relevant in biosecurity discussions. The lesson is not just medical, but political: prevention requires trust, transparency, and sustained investment.