Picture of a group of French models in line to be vaccinated against smallpox.

Why smallpox vaccines fell out of use—and what that means for monkeypox

Smallpox vaccines have been approved for monkeypox. But experts warn that many questions remain about the protection they provide and how to best administer them.

Members of the Association of French Models line up for their smallpox vaccinations, October 2, 1955. A mass vaccination campaign led to the eradication of smallpox in 1980. Although the vaccine is no longer routine, it's in demand once again during the monkeypox outbreak.
Photograph by FPG, Hulton Archive/Getty Images

Gregory Poland has been vaccinated against smallpox three times—a necessary precaution as a member of a bioterrorism response team—and he has unpleasant memories of each one. Unlike typical modern vaccines, the smallpox vaccine he received contained live virus applied directly to the skin on his arm, which was then punctured 15 times with a bifurcated needle.

Poland, a vaccine researcher at the Mayo Clinic, says the scar left by the process “itched like mad.” Worse, the live virus it contained meant the scar would remain infectious for a month, during which time Poland had to keep his distance from others—even sleeping in a separate room from his wife.

Poland is part of a shrinking population who have been vaccinated against smallpox. Thanks to an historic global vaccination campaign, the disease was eradicated in 1980, meaning the young adults of today weren’t alive when smallpox vaccines were routine. Now, however, monkeypox is driving new demand for the smallpox vaccine. Although monkeypox is far less dangerous than smallpox, the two viruses are related—and there is some evidence that the smallpox vaccine provides protection from monkeypox.

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