Why can’t we eradicate other diseases, as we did with smallpox?

Why can’t we eradicate other diseases, as we did with smallpox?

In theory, nearly any infectious disease for which an effective vaccine exists should be eradicable. With sufficient vaccination levels and coordination between public health organizations, a disease can be prevented from gaining a foothold anywhere; eventually, without anyone to infect, it must die off. (A notable exception is tetanus, which is infectious but not contagious: it’s caused by a bacterium commonly found in animal feces, among other places. Thus, tetanus could not be eradicated without completely removing the Clostridium tetani bacterium from the planet.)

Smallpox is unusual, however, in the set of characteristics that made it susceptible to eradication. Unlike many other infectious diseases, smallpox has no animal reservoir. That is, it can’t “hide” in an animal population and re-emerge to infect humans, while some diseases can do just that (yellow fever, for example, can infect some primates; if a mosquito then bites an infected primate, it can transmit the virus back to humans).

Another obstacle to eradication for many infectious diseases is visibility. People with smallpox were highly visible: the smallpox rash was easily recognizable, so that new cases could be detected quickly. Vaccination efforts could be focused based on the location of the cases and potential exposure to other individuals. Polio, by contrast, causes no visible symptoms in about 90% of the people it infects. As a result, tracking the spread of the polio virus is extremely difficult, which makes it a difficult eradication target.

Perhaps most importantly, smallpox patients generally did not reach their highest level of infectivity (that is, their ability to infect others) until after the appearance of the smallpox rash. As a result, quick action to quarantine infected individuals upon the eruption of the rash usually left enough time to vaccinate anyone who had already been exposed, and prevent additional exposures. Many infectious diseases do not allow for this kind of reaction time. Measles patients, for example, can become infectious up to four days before the appearance of the measles rash. As a result, they can pass the virus on to many, many other people before anyone even knows that they are infected.

Many people still think eradication is possible for certain diseases. Efforts are ongoing to eradicate polio and Guinea worm disease (Dracunculiasis), with both having been eliminated in many regions, but remaining endemic in several countries. Meanwhile, the Carter Center International Task Force for Disease Eradication has declared additional diseases as potentially eradicable: lymphatic filariasis (Elephantiasis), mumps, pork tapeworm, and yaws.


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May 27, 2021 3:34 PM

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