The fight against smallpox during the Savoy kingdom in Genoa between 1815 and 1859

Introduction: The article aims to outline the features of the efforts for smallpox eradication within the pre-unitary context of the Kingdom of Sardinia, characterized by a long tradition in medical-health prevention. This tradition is partly inherited from the health magistracies of the Italian states during the ancient regime and partly adopted from policies initially outlined by Napoleon and later by other European states. In addition to prevention activities, authorities also engage in a vigorous information and awareness campaign aimed at eliminating common prejudices and doubts about vaccination among the population. Methods: In analyzing the authorities' achievements in combating smallpox, this study examines the two epidemic waves (1829-30 and 1852-54), along with the legislative developments before, during, and after these periods. It also compares these regulatory changes with those in other European contexts. Discussion: The epidemiological situation turned out to be more complex to manage than the authorities had anticipated, as evidenced by the increasing controls imposed. Scientific and political communities, both in the Kingdom of Sardinia and in other European nations, found themselves divided on the legitimacy of proposing restrictive measures by the state. Some advocated for restricted access to public places and imposed mandatory vaccination for vulnerable individuals. Conclusions: The comparison with smallpox resulted in a gradual improvement in of health security levels, although vaccination coverage did not reach the desired targets. Several factors contributed to this failure, including the limited expertise and reluctance of medical personnel, who were burdened with much of the operation's costs. Additionally, particularly in rural areas, there was widespread mistrust among the population towards doctors. Despite these challenges, the fight against smallpox enabled authorities to develop population control tools in the name of public health protection. However, it was not until 1888 that mandatory vaccination was introduced.