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The Inside Story of Smallpox Eradication

From Smallpox—The Death of a Disease: The Inside Story of Eradicating a Worldwide Killer (Prometheus Books, 2009). Reprinted by permission of the publisher.


Few believed it was possible. For millennia, the smallpox virus visited misery and death upon humanity, claiming hundreds of millions of lives.Then, in 1966, the World Health Assembly launched the smallpox eradication campaign. D.A. Henderson led the successful global effort, which enlisted more than 100,000 people and demanded extraordinary tenacity, creativity, organizational skills and a willingness to break bureaucratic rules. In the following excerpts from his new book, Smallpox—The Death of a Disease, Henderson, MD, MPH ’60, dean emeritus of the Bloomberg School, shares his insider stories from the consummate public health triumph.

Preface

Smallpox has played a pivotal role in every era of human history. No disease has been so greatly feared or worshipped—no disease has killed so many hundreds of millions of people nor so frequently altered the course of history itself. As I was growing up, however, I knew smallpox only as a name, a disease against which all children had to be vaccinated. That abruptly changed in 1947.

Smallpox suddenly appeared in New York City—two smallpox patients were discovered, but no one knew how or where they had acquired the infection. Their movements were traced, and more smallpox patients were discovered.Emergency vaccination programs began—first for the hospital staff and the patients where the cases were isolated and then for residents of the apartments where they had lived. As more smallpox patients were found, the vaccination program extended to other hospitals and to other parts of the city. Eventually, the source was discovered: a visitor from Mexico who had become ill and died five days after his arrival. During his stay in a hotel, 3,000 people from twenty-eight states had booked rooms. Health staff sought to trace and vaccinate all of them. The city was in turmoil. A decision was finally made to vaccinate the entire urban population. Six million people were vaccinated during a four-week period. This massive effort was the response to an outbreak that consisted of only twelve patients, two of whom died.

Berton Roueché, the respected New Yorker medical writer, vividly described the evolving events, the threat, and the terror in an article “The Man from Mexico.” He quoted from a doctor’s description: “The patient often becomes a dripping, unrecognizable mass of pus by the seventh or eighth day of the eruption. The putrid odor is stifling, the temperature often high (107) has been authoritatively reported), and the patient frequently in a wild state of delirium.” For me, the pervasive concern and fear of smallpox was startling and yet I had known nothing of this disease until its unexpected appearance in New York.

Fourteen years later, in 1961, I would be assigned national responsibility for dealing with smallpox, should it be imported into the United States. My position was chief of the surveillance section at the U.S. Communicable Disease Center (CDC).

It was a time of high anxiety. Major smallpox epidemics were then erupting across India and Pakistan. Travelers flying by jet aircraft were rapidly increasing in number, and some were infected with the smallpox virus.

From 1958 through 1960, the disease had been imported into Europe from Asia six times; eleven more importations occurred in 1961. By the end of 1963, twenty-three importations had resulted in nearly 400 cases. Not surprisingly, we had a number of false alarms in the United States—primarily patients with chicken pox. I assumed that it was only a matter of time before we would have to cope with smallpox.

A Program in Its Infancy

On October 26, 1966, I arrived in Geneva to face stark realities inherent in assuming the position of chief of the Smallpox Eradication Unit—to direct a global program intended to reach more than 1 billion people in fifty countries. I was thirty-eight years old and had a mere ten years of public health experience. Many thought I looked considerably younger than thirty-eight; certainly I lacked the maturity and gravitas expected of a WHO unit chief, few of whom were then under fifty.

Countries, Fiefdoms, and Short-Circuiting the Bureaucracy

The regional offices of WHO were important components of the administrative structure. For smallpox eradication, they were more a hindrance than a help. All WHO member countries belonged to one of the organization’s six regions. In 1967, four of the regions included countries with known endemic smallpox. One regional smallpox eradication program adviser was allotted for each of three—Southeast Asia (SEARO), Eastern Mediterranean (EMRO), and the Americas (PAHO). Two advisers were allotted for the African Region (AFRO)—one for eastern Africa, based in Kenya, and one for western Africa, based in Liberia. The advisers were selected and appointed by each regional director without reference to our unit at headquarters.The regional directors considered themselves all but autonomous. After Dr. Halfdan Mahler became director-general in 1973, he often said to me, “You have to remember that WHO is, in fact, an Association of Regional Offices, not a World Health Organization.”

The regional directors were each elected for four-year terms by a majority vote of that region’s member countries. Gaining or retaining a country’s vote required skillful politics, and such factors inevitably played a role in important decisions such as the selection of qualified staff and allocating of budget funds.

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  • Joan Levin

    Chicago 03/27/2010 01:17:14 PM

    Sadly the important pioneering role of Dr. Karel Raska was overlooked in this article. You may read Dr. Alex Langmuir's appreciation of Dr. Raska and Dr. Henderson's addendum originally printed in 17 Intl. J. Epid. 491 (1988) at http://ije.oxfordjournals.org/cgi/reprint/17/3/491.pdf

  • Joan Levin

    Chicago 03/27/2010 01:25:33 PM

    Sadly the pioneering role of Dr. Karel Raska was overlooked in this article. Interested readers may learn more about this in Dr. Alex Langmuir's Appreciation and the Addendum by Dr. D. A. Henderson published in 17 Int. J. Epid. 491 (1988) and found online at http://ije.oxfordjournals.org/cgi/reprint/17/3/491.pdf .

  • JustinBeersons

    USA 04/13/2011 06:07:08 AM

    Hi - I am definitely glad to discover this. cool job!

  • zeroxtrpo

    england 05/04/2011 10:50:23 PM

    Wow this information is great! Thanks this has helped me a lot! I'm sure your posts are one of the best out there! Always so accurate!

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