The last outbreak of smallpox (variola) in Europe, the virus that has killed more people than any other disease, occurred in Yugoslavia in 1972; it was controlled fairly quickly, but there were 175 confirmed cases and thirty-five deaths. The Introduction to this study of that epidemic contains a concise account of the history of smallpox and of efforts to counter it, including a harrowing description of the increasingly ghastly stages of the progression of the disease. It also provides a brief history of efforts to control smallpox in Serbia and the Kingdom of Yugoslavia. Already in the 1830s, Serbia had rules governing quarantine and mandatory vaccinations, and the last case in Yugoslavia before the 1972 outbreak was in 1930.
The resulting lack of experience with smallpox was one reason why the initial cases were not immediately recognized as such, since in its early stages smallpox symptoms are not easily distinguished from those of other viral infections. The second chapter presents a chronology of the spread of the disease from Kosovo, where its first victims lived, to hospitals in Belgrade, where the disease was finally recognized and pre-established protocols for quarantine, treatment, and vaccination were immediately activated. Yugoslavia was prepared for smallpox. Connections with the Non-Aligned countries let Yugoslav doctors train with smallpox experts in India, Indonesia, Nigeria, and Brazil. Immunizations against smallpox were mandatory for most Yugoslavs, especially for medical personnel and for travelers to countries where smallpox was endemic.
In practice, however, these plans to treat a smallpox outbreak in Yugoslavia immediately showed flaws and required adjustment. In a chapter on “the State,” Radina Vučetić analyzes the reactions of political figures to the outbreak (which did not include President Josip Broz Tito, who stayed on the island of Brioni and never addressed the situation). Not surprisingly, their first impulse was to find scapegoats, and since the first cases were among Albanian Muslims who had been on the Haj, the usual “nesting Orientalist” stereotypes came into play, even though the Islamic Community of Yugoslavia required that Muslims undertaking the Haj be vaccinated.
Yet the politicians quickly followed the advice of the medical experts, as recounted in a chapter on “Expertise.” National and international agencies were notified and established protocols were followed, leading to massive international provision of medical expertise and equipment, and of vaccines, mainly from China, the US, the USSR, and Switzerland. The resulting vaccination campaign, recounted in a chapter on “Vaccination,” succeeded in vaccinating eighteen million of the population of 20 million. As a result, the Yugoslav handling of the 1972 smallpox outbreak is literally a textbook example of a successful reaction to a deadly contagious disease.
Vučetić's social history of these processes, however, and her penultimate chapter on “Life in the Time of Smallpox,” show how fear, greed, and other emotions led to efforts to avoid vaccination, or, alternatively, to be first to get it. Anti-vaxxers of 2020–21 and promoters of fake Covid remedies had their nearly exact counterparts in 1972 and earlier. The governments of the Yugoslav republics were no more unified in their approach in 1972 than were the states of the European Union in 2020–21. Vučetić notes that the smallpox outbreak revealed the “virus” of separatism in the various republics, with Slovenia and Croatia, which had no cases, trying to monopolize early access to scarce vaccines, and Kosovo, where the outbreak started and where there were most cases, being last in line for them.
The deeply disturbing final chapter looks forward. Smallpox was proclaimed eradicated in 1980, with routine vaccination ended worldwide, so humanity is now almost completely unprotected. Yet stocks of the virus remain in the US and Russia, neither of which was willing to destroy their last samples on the grounds that others might develop biological weapons from smallpox. Vučetić argues that smallpox is indeed a near-perfect biological weapon, since it is proven to be highly contagious, socially disruptive, and with a very high mortality rate among the unvaccinated, while the weaponizing state could easily protect its own population through sudden mass vaccination. She thus ends by imagining an all too plausible re-occurrence, somewhere else, of the arrival of smallpox in Yugoslavia in 1972, in which infected peoples’ symptoms are not quickly recognized because doctors have no experience with smallpox. Yugoslavia controlled the disease in 1972 because it was prepared, as were other countries and the World Health Organization, but no state is now prepared for such an event. Let us therefore hope that this history is not prophetic.
