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This was primarily driven by incidence in India: in , for instance, in a state that had reported approximately cases a week, the WHO search team found 10, cases. The last variola major infection was recorded in Bangladesh in October , and the last variola minor infection occurred two years later in Merka, Somalia, on October 26th, During the following two years, WHO teams searched the African continent for further smallpox cases among those rash-like symptoms which is a symptom of numerous other diseases. They found no further cases.

The world map below shows the year in which each country recorded the last endemic case of smallpox. Countries across Sub-Saharan Africa, Latin America and Asia eliminated smallpox several decades later in the s and 70s. In May , the World Health Assembly, the governing body of the World Health Organization, officially certified the global elimination of smallpox, the first ever eradication of a disease in human history.

Before the year , Indians and the Chinese had already observed that contraction of smallpox protected children against any future outbreaks of the disease. This would usually result in a milder infection of smallpox after which the person was immune against the disease. Both practices became known as variolation inoculation techniques. The disadvantage of variolation, however, was that during the course of the mild infection the person became a carrier of the disease and could infect other people.

If anything, it helped to spread the virus in a population even further and thereby encouraged its survival. She herself had suffered a smallpox infection and lost her younger brother to the disease at the age of She first learned about variolation when she arrived in Istanbul in , where variolation was commonly practiced. She later had the embassy inoculate her two children. News spread among the royal family and after following trials Maitland successfully inoculated the two daughters of the Princess of Wales in Thereafter, variolation became a common practice in Great Britain and became known in other European countries.

It became an even more established practice when the French King Louis XV died of smallpox in May of and his successor and grandson Louis XVI was inoculated with the variola virus one month later.

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At the end of the 18th century British surgeon and physician Edward Jenner pioneered the first ever vaccination against an infectious disease. He himself had been inoculated with smallpox at the age of 8 and later as a surgeon, variolation was part of his work. At the time unknowingly, he had discovered that the cowpox and variola viruses were members of the same orthopoxvirus family. He hypothesized that variolation using the cowpox virus would protect children against smallpox as well.

Since cowpox infections were much milder and never fatal, this would eliminate the problem of variolated children being carriers of smallpox and sometimes dying of the virus developing into a full-blown infection. On top of protection against the symptoms, it could reduce the stock of humans that the variola virus needed for survival and brought elimination and eventually eradication of smallpox into the realm of possibility.

In May , Jenner inoculated a boy with cowpox, and then a few months later with the smallpox virus. When the boy did not develop any smallpox symptoms in response to being variolated, his hypothesis of the cowpox offering protection from smallpox was confirmed motivating his further research trials. Initially, Jenner faced major barriers to spreading the word about his discovery. They even advised him not to pursue his ideas any further, pointing to the detrimental impact on his career and reputation. Undeterred, he published his work with an increased number of trials at his own expense two years later in He also went on to convince colleagues and supply them with vaccines in other British cities of his new procedure that became known as vaccination derived from the Latin word for cow, vacca.

Meanwhile, vaccination had spread to most of Europe and New England. Before the introduction of a smallpox vaccine in , on average 7.

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Following introduction of the vaccine, we see a clear decline in smallpox deaths. It was only with the establishment of the World Health Organization WHO in the aftermath of World War II that international quality standards for the production of smallpox vaccines were introduced. This shifted the fight against smallpox from a national to international agenda.

It was also the first time that global data collection on the prevalence of smallpox was undertaken. Nonetheless, skepticism about the feasibility of eradication prevailed and the WHO lacked experience in administering projects that required both technical and material support, as well as coordination across countries. Furthermore, the funding provided to the Intensified Smallpox Eradication Programme was insufficient to meet global needs, resulting mostly in vaccine shortages.

Further still, continued globalization and growth of international air travel resulted in the continual re-introduction of the disease into countries that had previously managed to eliminate smallpox. Initially, the WHO had pursued a strategy of mass vaccination which attempted to vaccinate as many people as possible, hoping that herd immunity explained in our vaccine entry would protect the whole population. This is known as the ring vaccination principle. People who had been in direct contact with a smallpox patient over the last two weeks were quarantined and vaccinated.

The downside of such an approach was that the virus could spread easily if it was re-introduced from overseas. Despite the risk of re-introductions, ring vaccination greatly reduced the cost of the eradication campaign. The number of administered vaccines dropped and smallpox was increasingly brought under control. Regional elimination came within reach. While Did smallpox variolation and vaccination against smallpox have a notable impact on life expectancy? Many have made the claim that inoculation against smallpox was one of the first measures that had a positive effect on life expectancy.

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Angus Deaton 28 makes this claim based on a book by Razzell 29 which reviews existing birth, baptism and burial records in various counties of 18th century Britain. Furthermore, the local communities for which records were available may not have been representative of Great Britain as a whole. Such evidence therefore seems insufficient to show a causation relationship between inoculation and increases in life expectancy.

When comparing these charts on London smallpox deaths and British life expectancy we see that neither smallpox deaths or life expectancy dramatically deviated from their averages following the wider adoption of variolation in The high case fatality rate of approximately 30 percent for the variola major virus strand meant that smallpox shortened the lives of many.

Since the virus predominantly affected children during endemic periods, smallpox deaths are likely to have had a disproportionate impact on average life expectancy. Large-scale smallpox outbreaks were documented for the years , , , and These years exactly coincide with sharp declines in life expectancy, implying that smallpox endemicity did have a substantial effect on life expectancy. Furthermore, while the available data did not show a clear decline in smallpox deaths after the introduction of inoculation in Britain, they do show dramatic declines in mortality in London as well as in Sweden below from onwards.

Once smallpox mortality fell at the turn of the eighteenth to nineteenth century, life expectancy in Sweden for the first time was put on an upwards trending trajectory. Overall, the impact of inoculation on life expectancy remains uncertain. By the time the World Health Organization launched the Intensified Smallpox Eradication Program in many countries, most of them high income countries, had already eliminated smallpox.

Therefore, the true cost of eradicating smallpox will never be known as individual country programs reach back to before records of public health expenditure existed. Beyond direct program costs, smallpox incurred much higher indirect costs in the form of foregone economic performance. Following its eradication, countries now do not have to spend money on vaccine development and administration. Estimates on the savings from forgone costs thanks to the eradication of smallpox exist, but we are not aware of estimates that we would consider reliable.

To date the eradication of smallpox saved millions of lives. It is impossible to know very exactly how many people would have died of smallpox since if scientists had not developed the vaccine, but reasonable estimates are in the range of around 5 million lives per year, or between and million lives saved between and The name of smallpox originates from a common confusion with syphilis in 15th century France. The diseases shared similar symptoms rashes even though syphilis was caused by spirochaete bacteria and smallpox by the variola virus.

Petite is French for small so the disease became known as smallpox in English. When he took office, nearly a third of America's workforce was unemployed. Many banks were closed and tottering on the brink of collapse. Business confidence was broken, the nation was rudderless. At his death, the US was the richest and most powerful nation on Earth, the position it has held ever since.

Few historians doubt that Roosevelt deserves a large part of the credit for this achievement. Although some of his policies remain shrouded in controversy, he mobilised the American genius in a way few of its leaders have matched, either in peace or war. Franklin Delano Roosevelt was born into the hereditary aristocracy of upstate New York, the inheritor of 17th-century Dutch immigrants whose descendants had ever since been growing a fortune based upon land speculation. His father, James, was a year-old widower with one son when he married year-old Sara Delano, whose family had made their own pile in the China trade.

He became his mother's adored only child. The family lived the lives of country gentry, surrounded by servants and estate workers.

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James repeatedly declined offers of public office, or indeed of any employment. He took his son on long summer trips to Europe and at home trained him to inspect herds, cherish trees and confine social exchanges to his own kind. The Roosevelts were famously snobbish. Franklin was tutored at home until he was 14, then taken in his father's private railroad car to enrol at the exclusive Groton school, before moving on to Harvard. The boy had no contact with mainstream America, very little with its cities, and none with hardship.

He sailed his own 21ft boat, collected stamps, shot birds that were then stuffed and mounted by a local taxidermist, and read voraciously and retentively. His social life was restricted to a tiny circle of those whom Sara deemed acceptable. In a letter home, he offered consolation for James's distress at losing his butler: "Don't let Papa worry about it, after all there are plenty of good butlers in the world.

He loved school, became a star debater, and displayed an early inclination towards a political life. He showed a hostility towards imperialism that would stick: "Hurrah for the Boers! I entirely sympathise with them. Though his parents were committed Democrats, as was Franklin himself, his role model was his Republican cousin, Theodore, who became President in The young student's unfailing geniality made him popular enough, but there were those who found him, in the words of one classmate, "bumptious, cocky, conceited".

How could a young man gifted with good looks, wealth and high intelligence be anything else? On a trip to England in , he flirted enthusiastically with every pretty girl he met at country house parties. Soon after his return to New York, he fell in love with his cousin Eleanor, the orphan niece of Theodore. The couple were married in March , the bride being given away by the President. On his graduation, he became a clerk with a New York law firm, though it was already plain that his ambitions were focused on political office.

Sara, who had become a widow when James died in , still dominated her son's life and controlled the purse strings, to the deep and enduring resentment of Eleanor. When an upstate Democrat power-broker offered to help the gilded youth to a state senate seat in , the man paused outside the local bank, where the party faithful were gathered to meet him, and said: "The men looking out of that window are waiting for your answer. They won't like to hear that you had to ask your mother. For the first time in his life, on the campaign stump he began to encounter ordinary Americans.

He met a house painter working at his half-brother's house who doffed his cap and said: "How do you do, Mr Roosevelt. The candidate said: "No, call me Franklin. I'm going to call you Tom. This masked a dislike for showing his hand, or revealing his real thoughts or intentions. Roosevelt was always a plausible liar, especially about his own and his family's achievements. In this first election, he stormed home in a traditionally Republican area.

As a freshman senator up at the state capital, Albany, instead of learning the ropes he plunged into hostilities with the New York City bosses of Tammany Hall. He lost his first battle with Tammany, as a would-be reformer. Yet some of his contemporaries thought him a prig and hypocrite. He showed little interest when Frances Perkins, the pioneer campaigner for workers' rights, sought to enlist his aid. As a state senator, the only pitch for which he was later remembered was his fight against logging in local forests — he had a lifelong passion for trees.

Always vulnerable to infections, he was suffering from typhoid when he came up for re-election in He enlisted the aid of a tough political fixer, Louis Howe, to run his campaign — and won again. A few months later, to the anger of some of his constituents, he abandoned Albany for Washington. At the age of 30, he was offered the plum post of assistant secretary of the US Navy.

He held the post for seven years, among the happiest of his life. His superior, Josephus Daniels, was an ineffectual figure who proved happy to let Roosevelt have his head. His young assistant proved a whirlwind of energy and enthusiasm. His growing reputation survived such embarrassments as an interview given by the incorrigibly grand Eleanor to The New York Times about her contribution to the national food economy campaign, in which she said: "Making the 10 servants help me do my saving has not only been possible, but highly profitable.

When the nation at last entered the conflict in April , he threw himself into enlarging the navy from ships to the 2, in commission at the Armistice. Visiting Europe and its battlefields in the summer of , he became so excited by the prospect of martial glory that he returned to Washington bent upon becoming a naval officer.

Yet, once again, he succumbed to illness — this time, double pneumonia. He was still ailing when the war ended. Thereafter, he found himself plunged into a succession of domestic and political crises. First, Eleanor discovered that he was having an affair with her year-old social secretary, Lucy Mercer.

Eleanor had never been enthusiastic about sex. Franklin indulged himself wherever he could, though his attachment to Mercer ran deeper than any other. After the revelation of his infidelity, Eleanor plunged herself into social causes and passionate friendships — perhaps unconsummated — with lesbians. He resigned his office at the Department of the Navy in August , to take another political leap, standing as vice-presidential candidate in the campaign of James M Cox. The Democratic Party was divided, demoralised and unpopular amid the failure of Woodrow Wilson's presidency.

Republican Warren Harding romped to the White House. Roosevelt was deemed to have performed poorly on the campaign trail, appearing to be a lofty, conceited East Coast elitist. His political career was further damaged by revelations the following year about the so-called Newport Navy Scandal. In , after reports of a homosexual ring at the Newport navy base, an officer appointed to investigate took the extraordinary step of ordering undercover enlisted men to offer their sexual services.

If Roosevelt did not authorise this action, he certainly knew of it. When the scandal broke in and Congress investigated, anger focused less upon the accused than on those who subjected sailors to such experiences in order to expose them. Some of the mud stuck. All this paled into insignificance, however, beside the blow which struck Roosevelt in August. Suddenly feeling ill, within days he found himself paralysed. Infantile paralysis polio , a viral condition affecting the spinal cord that baffled medical science at the time, was diagnosed. This intensely energetic, chronically restless man succumbed to deep depression amid the horror of finding himself immobilised.

The power of his legs was gone forever. He could stumble a few steps only with heavy steel braces and so he believed that his political career was over. The years that followed were dominated by a struggle to come to terms with his condition. He founded a medical resort for polio sufferers at Warm Springs, Georgia, and began a business career on Wall Street, specialising in high-risk investments. He made occasional political speeches, the first in Roosevelt's closer friends saw a gradual change in his personality.

He seemed cooler, more patient, but above all resolute. Once at Hyde Park, a visiting clergyman watched him crawl from his desk across the floor to a shelf, then crawl back, clutching a book in his teeth. Asked why he had subjected himself to such an ordeal, Roosevelt answered: "I felt I had to do it to show that I could. He seemed more serious. His famous charm was succeeded by a more powerful magnetism. In , he delivered the nominating speech for Al Smith's presidential candidature at the Democratic convention, to thunderous acclaim.

He deliberately addressed himself to a national radio and newspaper-reading audience, rather than to delegates in the hall. He began to believe that his own political life need not be over. That autumn, he allowed himself to be persuaded to run for the governorship of New York. The Evening Post dismissed his candidature as "pathetic and pitiless".

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Yet he fought a fiercely determined campaign and won, by a majority of just 25, out of 4. Roosevelt was a natural ruler, born to authority and wholly unafraid of its responsibilities. He took office as governor in , the year of the Great Crash, and astonished many people by the populist, anti-capitalist spirit that he swiftly displayed. After 47 years spent assuming that bankers and business bosses knew what they were doing, he came to realise that they didn't.

The great American myth of self-reliance, a Darwinian faith in allowing the strong to prevail and the weak to go to the wall, was tested to destruction by the crash. Roosevelt's tenure at Albany was characterised by a commitment to show that, contrary to deep-rooted national belief in personal endeavour, only government could solve the greatest problems that afflicted society. He undertook the regulation of utilities and embarked upon public projects designed to help New Yorkers help themselves through bitterly hard times. Hoover's Republican Party's failure was terribly apparent.

When people talked of Roosevelt as a possible Democratic candidate in , he said dismissively: "I have seen so many presidents at close hand in the White House that I have come more and more to the conclusion that the task is the most trying and most ungrateful of any in America.

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Roosevelt's conviction that a vigorous government could lift the nation from the slough of despondency found growing support. The senator Henry Ashurst said: "Roosevelt is a man of destiny He will lead this country out of the Depression and go down in history as one of our greatest Americans. But plenty of sceptics remained. Some cited his physical infirmity, while others considered him an arrogant, privileged dilettante. The columnist Walter Lippmann wrote that Roosevelt was "without any important qualification for office". He knew nothing of economics and, by March , had yet to devise a plausible platform for his own candidacy.

But by the time of the Chicago convention in June, he had recruited a panel of economists to create a programme. He spoke of mobilising money, stopping mortgage foreclosures, making the banking system once more put its faith in "the forgotten man at the bottom of the economic pyramid". During the convention's fourth ballot, the California delegation suddenly renounced its earlier support for rival John Nance Garner, and declared for Roosevelt.

The switch was decisive. Roosevelt became presidential candidate, amid wild enthusiasm. He was now 50 and a chain-smoker with a huge number of acquaintances, but few people who knew him intimately. For all his irrepressible cheerfulness and bonhomie, scarcely anyone who knew him claimed to know his real thoughts; such was his intense self-control. His family existence was a charade: his children grew up to lead uniformly unsuccessful lives.

After years of cherishing hopes that he might recover use of his legs, now he knew that he could never do more than pose standing for pictures and shuffle a few steps before reverting to his wheelchair. But he possessed a genius for reaching out to millions of people whose circumstances were utterly remote from his own experience. He conveyed a serenity, optimism and strength that touched hearts. It seemed entirely appropriate that a suffering nation should entrust its fortunes to a man who had also known suffering.

The Republicans made the election campaign easy for him, by adopting a platform based on laissez-faire capitalism. Roosevelt travelled 9, miles across the country on his personal train, preaching a gospel of salvation by government action — though he also sought to calm affrighted businessmen by promising to cut government spending.

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On election day, Roosevelt carried the country by 23 million popular votes to 16 million for the Republican candidate, taking 42 states. It was widely said that he won simply because he was not Herbert Hoover, but such sentiments decide many elections. A fortnight before taking office, he gained a stark insight into the hazards of his new job. Landing in Miami after a yachting holiday, he was approached by the mayor of Chicago, Anton Cernak, who had come to seek a political reconciliation. An Italian bricklayer, Joseph Zangara, fired five pistol shots from a range of 10 yards, intended for Roosevelt.

Yet it was Cernak who fell dying. Roosevelt was not only untouched but, to the amazement of his entourage, almost preternaturally calm in the face of an experience that might have terrified him. Zangara went to the electric chair, Roosevelt to the White House. His first months of office were characterised by a display of presidential activity unmatched in US history.

With his overwhelming national mandate and control of both houses of Congress, he thrust through a stream of revolutionary legislation that was rubber-stamped with scarcely a delay or voice of dissent. Roosevelt had declared in his inauguration speech his commitment to lead the nation out of its valley of woe, in such terms that many of his audience wept, and his aide Ray Moley said to the new labour secretary, Frances Perkins: "Well, he's taken the ship of state and turned it right around.

At the heart of the "New Deal", the phrase inseparably identified with his presidency, was a commitment to use government as an engine of economic recovery. He created an Emergency Banking Act, which within weeks enabled the struggling bank system to function again. One of his first projects was the Civilian Conservation Corps, which put unemployed men to work in forestry under army supervision for a dollar a day — , people had enrolled by June To the fury of the army chief of staff, Douglas MacArthur, he slashed defence spending.

He took America off the gold standard, and provided relief to struggling farmers. He created the Tennessee Valley Authority to generate cheap electricity and assist a large poverty-stricken region to regain its feet. He sought to curb insider share trading by his Securities Act. The administration bore down upon the steel industry, business cartels and Wall Street's fat cats, notably JPMorgan, in a fashion hitherto unknown.

This storm of activity gave Roosevelt extraordinary popularity among the nation's "have-nots". Poor families set his photograph on their living room walls, and revered it as an icon. At the mid-term elections, the Democrats bucked every historic trend by increasing their support.

Yet business leaders were increasingly hostile. They perceived his policies as socialistic, even fascistic. Through his time of office, Roosevelt polarised opinion. Scarcely anyone seemed indifferent to him. He was loved, or hated. Nor were all his policies successful. For all his claims to represent clean politics, he trafficked as much as any predecessor with the city bosses who controlled local party machines.

A high-handed attempt to undercut US aviation companies' mail-carrying rates by using US Army Air Corps planes foundered when 12 crashed within a matter of weeks. He dismayed the Europeans by refusing to join them in pursuing stabilisation measures by pegging currencies. And though Roosevelt was from the outset an opponent of Hitler — he had spent some months in Germany in his boyhood and formed an abiding dislike of German militarism — he showed a weakness for Mussolini, "the admirable Italian gentleman".

The President remained impenitent. To do something, he believed, even if imperfect, was always preferable to doing nothing. He conducted business with a country gentleman's informality. No minutes were taken even of cabinet meetings. Little was decided in writing. Roosevelt talked, decided, invited one or other trusted aide to implement his wishes, and moved on. Far from pursuing unity of purpose among the members of his administration, he kept every department and its chief in its own box. Each was told no more than they needed to know for their own part in the business of government and quite literally worked to death in a startling number of cases.

Roosevelt raised to an art form the ability to allow any visitor to leave his office feeling warmed, flattered, assured of satisfaction; only to discover later that the President's intentions were quite different from those that they supposed. More than a few close associates deeply admired Roosevelt the President but deplored Roosevelt the man, evasive and often deceitful.

Marguerite LeHand, the secretary who became a mistress and adoring confidante, said later that it was impossible for anyone to get close to Franklin Roosevelt. Yet this is, in some degree, true of all great men. And by , many Americans were convinced that their President was a very great man indeed. He had given them hope. Roosevelt was re-elected in by the largest popular majority in US history, almost 28 million votes to Yet his second term was notably less successful than his first.

He was frustrated by the resistance of conservatives on the US Supreme Court to his policies. Four judges were ex-corporate lawyers, and struck down his legislation to curb big business as if they themselves were still on company payrolls. The President moved to get rid of them with unaccustomed clumsiness, introducing a bill enabling them to receive full salaries for life in exchange for resignation.

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The measure rang every alarm bell in a nation deeply wedded to the separation of powers. Roosevelt was successful in that the court became more tractable to his wishes, and he was later able to appoint liberal nominees to the bench, but he forfeited much goodwill, and exhausted himself, in the protracted battle with Congress and his political opponents. The Supreme Court fight was the worst blunder of his peacetime presidency. He felt bitter that the great efforts and achievements of his first term were so poorly rewarded.

Attacks on him became increasingly personal and virulent. It was claimed that he was syphilitic, that he played the dictator and abused US Navy warships for fishing trips. Fighting back, he displayed astonishing vindictiveness to political and media foes, mobilising against them the tax authorities, FBI and even the Secret Service. His deep-rooted faith in alumni of Groton and Harvard was damaged by a scandal when a former classmate, Richard Whitney, was found to have abused his position as president of the New York Stock Exchange to embezzle its pension fund.

He was sometimes embarrassed by Eleanor Roosevelt's increasingly strident social campaigning for liberal causes — and by her indifferent housekeeping at the White House. The New Deal was still forging ahead, with huge programmes of public works, minimum wage and union rights legislation. But in , when he launched an attempt to balance the budget, the economy tipped into recession, the stock market fell and two million people lost their jobs.

Roosevelt himself joined speculation that he might not run again in and that maybe Harry Hopkins could take over his job. He feared that at the next election, a conservative might carry the White House, calling a closure on his great project. It was the mounting crisis in Europe that revived Roosevelt's flagging energy and enthusiasm for office.