October 26, 1977: In Merca, a Somali cook becomes the last smallpox patient in the world

On October 26, 1977, in Merca, a port in southern Somalia, the WHO recorded the skin rash of a 23-year-old hospital cook. Ali Maow Maalin became the last human in the world to have naturally contracted smallpox, a scourge that had been killing for millennia. The final chain of transmission stopped in Africa, and African teams broke it.

Fifteen minutes in a Land Cruiser

Born in Merca in 1954, Maalin sometimes lent a hand to WHO vaccinators. In October 1977, he guided a vehicle taking two nomadic children suffering from smallpox to an isolation camp: a journey of five to fifteen minutes, according to Wikipedia, was enough to infect him. He was not vaccinated: "I was afraid of the vaccine," he would explain in 2007, as reported by the Vaccine Alliance (Gavi).

Sources differ on the timeline: fever on October 22, initially treated as malaria; rash on October 26, the date adopted by the WHO; isolation on October 30, after being reported by a nurse. Maalin had variola minor, the milder form, which is fatal in about 1% of cases. He survived.

54,777 people vaccinated in fifteen days

The response was remarkably precise: 161 contacts were identified, including 41 who were unvaccinated, some 120 kilometers away, and monitored for six weeks. Around Maalin's home, 54,777 people were vaccinated in fifteen days, according to the Global Polio Eradication Initiative. No other cases appeared.

Eradication was therefore not achieved solely in laboratories in the North, but in the Horn of Africa, house by house, with Somali health workers. The World Health Assembly proclaimed on May 8, 1980, that "all peoples of the world are now free from smallpox," recalls Le Quotidien du Médecin. The final death due to the virus was not African: Janet Parker, who was contaminated in 1978 by a laboratory in Birmingham.

From the last patient to a vaccinator

Maalin turned his story into a career. In the 2000s, he traveled across Somalia going door-to-door against polio and helped extinguish the 2005 epidemic. To reluctant parents, "I tell them not to make a mistake like I did," he confided in 2006. His country had been the last affected by smallpox; he did not want it to be the last affected by polio.

He died on July 22, 2013, in Merca, at the age of 59, in the middle of a vaccination campaign, from complications of malaria according to Gavi—a disease that has still not been defeated.

Key takeaways

The last natural case of smallpox in history was recorded on October 26, 1977, in Merca, Somalia. African health workers closed the door on the disease, and Ali Maow Maalin spent the rest of his life vaccinating the children of his country.