Community engagement, key to ending smallpox, will be essential now

The following is a guest post by Bertha Serwa Ayi, MD, FACP, FIDSA, MBA.

The World Health Organization has released measures that should be in place before we ease lockdowns with the goal to prevent resurgence of outbreaks. They include ensuring that community transmission is very minimal and the community can quickly detect new cases. One other criteria proposed by the World Health Organization for easing lockdowns is the issue of community engagement. This is when everyone understands the disease so well that they have a vested interest in the control. Citizens are not looking at what governments are doing to dole out praise or criticism, but they act based on a personal decision and collective community determination to end the pandemic.

On May 8, 2020 the world celebrated 40 years since the end of the smallpox, a disease caused by the variola virus. Smallpox had plagued the world for more than 3,000 years and killed an estimated 300 million people. Observations by scientists of the effect of fluid from the vesicles of the pox on non-infected persons (variolation) would herald the development of the world’s first vaccine. In 1796 Edward Jennings observations that patients who had recovered from cowpox did not develop a mild form of small pox, after variolation, led to the development of the cowpox vaccine and later vaccinia. It would take almost 200 years after the vaccine was developed before small pox was eradicated. It tells us a vaccine may not necessarily be the magic bullet for ending pandemics. A vaccine will artificially create a herd immunity to end transmission when there is a way of ensuring a successful vaccination campaign and the supply chain to produce enough for 7 billion people. We should be able to produce 14 billion vaccines to immunize everyone if two doses are needed.

In the case of smallpox, the missing piece needed to solve the pandemic in spite of discovering an effective vaccine was community engagement. In the 1960s as global leaders determined to work together, used various forms of public health measures, community engagement was paramount in detecting the every new case. Eradicating disease can be likened to the quiet of a dark night in a small town where neighbors can hear a pin drop or the stringing of any instrument. Citizens are trained to recognize every sound and observe the importation of instruments and are rewarded or encouraged to report any sound of a musical instrument. In 1975 it took an eight-year-old girl in Bangladesh who noticed smallpox on a three-year-old neighbor to report the last known case of smallpox major in the world to the local smallpox eradication team. The team is said to have confirmed the diagnosis made by the eight-year-old, placed security guards around the house, and vaccinated all neighbors within 5 miles. An eight-year- old engaged girl had saved the world from another cluster of smallpox cases. That is what community engagement looks like. We should find a way of engaging young people, children and teenagers in the fight against COVID-19. They will be key to ending the outbreak whether we find a vaccine soon or later.