Cookies?
Library Header Image
LSE Research Online LSE Library Services

What is the case fatality rate of smallpox?

Schneider, Eric B. ORCID: 0000-0001-7682-0126 and Davenport, Romola (2025) What is the case fatality rate of smallpox? Economic History Working Papers (377). London School of Economics and Political Science, London, UK.

[img] Text (WP-377) - Published Version
Download (1MB)

Abstract

This paper uses population smallpox mortality rates in eighteenth-century Sweden and the death toll from the 1707-9 smallpox epidemic in Iceland to estimate plausible ranges for the case fatality rate (CFR) of the deadly form of smallpox, Variola major, in both its endemic (Sweden) and epidemic (Iceland) form. We find that smallpox CFRs could be extremely high (40-53%) when smallpox was epidemic and attacked a population where both children and adults were susceptible as in Iceland. However, where smallpox was endemic and therefore a disease of childhood, as in Sweden, a better estimate of the CFR is 8-10%. This is far lower than the consensus CFR of 20% to 30%. Part of the differences between the CFRs studied here could be due to differences in the inherent virulence of smallpox in the two contexts. However, we argue that social factors are more likely to explain the differences. Where both adults and children were susceptible to smallpox, smallpox epidemics fundamentally disrupted household tasks such as fetching water and food preparation and prevented parents from nursing their sick children, dramatically increasing the CFR. Thus, when historians and epidemiologists give CFRs of smallpox, they should consider the population and context rather than relying on an implausible intrinsic CFR of 20% to 30%.

Item Type: Monograph (Working Paper)
Official URL: https://www.lse.ac.uk/Economic-History/Working-Pap...
Additional Information: © 2025 The Authors
Divisions: Economic History
Subjects: H Social Sciences > HC Economic History and Conditions
R Medicine > RA Public aspects of medicine
JEL classification: N - Economic History > N3 - Labor and Consumers, Demography, Education, Health, Income, and Wealth > N30 - Economic History: Labor and Consumers, Demography, Education, Health, Income and Wealth: General, International, or Comparative (Migration)
J - Labor and Demographic Economics > J1 - Demographic Economics > J10 - General
Date Deposited: 17 Jul 2025 09:09
Last Modified: 17 Jul 2025 09:09
URI: http://eprints.lse.ac.uk/id/eprint/128854

Actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics