Ethiopia did not agree to participate in WHO's smallpox eradication programme until 1971, 4 years after the global eradication program began. Ethiopia was a member of the Eastern Mediterranean Region until 1977, when it joined the African Region. Eritrea was not an independent state during the ISEP.

Yemen and Democratic Yemen were delayed in beginning eradication activities by the North Yemen Civil War (~1962-70). Eradication programs began in 1969 and 1970, respectively. However, war has an aftermath and four vaccinators from Democratic Yemen were killed by a land mine in 1971.

Iran, Iraq, Sudan (which then included South Sudan), and the Syrian Arab Republic were not included in the ISEP in 1967, having halted transmission in 1963, 1959, 1962. and 1950, respectively. But an importation in 1967 reestablished smallpox in Sudan and importations in 1970-72 reestablished it in Irna, Iraq, and Syria. Transmission in all four countries was interrupted in 1972. Iran, Sudan, and the Syrian Arab Republic were certified smallpox-free by International Commissions, but political evens prohbited a visit by an International Commission to Iraq.

Djibouti (the French Territory of the Afars and Issas until 1977) had no endemic smallpox, but experienced periodic importations from Ethiopia. These were controlled by containment vaccination; mass vaccination was conducted every 3 years.

The Arab countries of the Gulf area (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) had interrupted transmission by the early 1960s, but were subject to importations from pilgrims and migrant labor. The United Arab Emirates were known as the Trucial Sheikhdoms or Trucial States until Dec 1971.

Somalia had reported its last endemic cases in 1962. However, importations from Ethiopia were frequent because of the shared border through the Ogaden Desert and its nomadic people. Reports of cases received in late September 1976, 7 weeks after the last outbreak in Ethiopia (potentially the last in the world), led to a declaration of a state of emergency by the government and a country-wide case search. Endemic smallpox was discovered throughout southern Somalia, and major epidemics followed. Somalia became the last country to be freed of smallpox.

Once in Afghanistan

An all-female Peace Corps team worked in Afghanistan during 1969-70, joining male Afghani vaccinators in the Hindu Kush mountains and the southern desert. Many Afghani women and girls were forbidden to be seen, much less vaccinated, by men not in their families. Their letters, diaries, and photos are archived in the Schlesinger Library of the Harvard Radcliffe Institute. Team member Jill Vickers and Jody Bergedick (Dirt Road Documentaries) produced the 2002 documentary Once in Afghanistan about the experience.