Dr. Ciro De Quadros describes here the challenges faced in mapping the incidence of smallpox in Ethiopia, the hostility of the managers of the malaria eradication programmes in the country, the role of the American ‘Peace Core’ corps in developing a better idea of the source of outbreaks and, not least, the WHO administrators’ role in developing a national chapter of a global smallpox eradication programme.
03. 1974, Selassie overthrown, involvement of locals
Dr. Ciro De Quadros tells us about 1974, which brought on what he terms a ‘period of transition’, as well as the important and careful negotiations with the Ethiopian government. He describes how an expansion of WHO assistance to the Ethiopian smallpox eradication programme allowed for the employment of large numbers of local workers, who filled the gaps left by departing American ‘Peace Corps’ members.
04. Epidemiological data
Dr. Ciro De Quadros describes the ways in which cases were identified and reported in Ethiopia, and how the target of surveillance changed over time.
05. Geo-political concerns
Dr. Ciro De Quadros tells us here of political difficulties in specific localities in Ethiopia, which made fieldwork very difficult – he underlines here the importance of developing a better understanding of local political and cultural factors. De Quadros also talks about the last Ethiopian case in the Ogaden desert region, which was largely populated by nomadic communities that did not respect national borders as they were drawn on official maps; this, he argues, caused difficulties in investigating – and reporting on – trans-national importations.
06. Regional difficulties, violence
Dr. Ciro De Quadros describes here the difficulties of working in the highlands of Ethiopia, as well as the form of civilian resistance to smallpox eradicators. He also tells us how WHO teams worked closely with all parties in localities, including Eritrean guerrillas who were fighting for the formation of an independent country.
07. Resource conflicts with other programmes
Dr. Ciro De Quadros describes here the gradual expansion of the Ethiopian smallpox eradication programme, which was developed on a surveillance-containment-vaccination model. He also talks about the malaria eradication programme’s unwillingness to assist anti-smallpox work.
Dr. Ciro De Quadros tells us how an outbreak area would be identified, how members of local communities would be employed by the WHO to keep up effective isolation by guarding houses where smallpox cases were confined and how efforts were made to control travel from affected areas.
09. Religious, cultural and language issues
Dr. Ciro De Quadros tells us here about the fears surrounding the use of smallpox – and polio – vaccines. Religiously informed resistance was localised in specific regions and communities, and was not over-arching in character; De Quadros highlights the importance of accessing interpreters fluent in local languages.
10. Lessons of the smallpox programme
Dr. Ciro De Quadros tells us here about the lessons that the global smallpox eradication programme can provide to the present-day global polio eradication initiative. In this regard, De Quadros underlines the importance of using information coming in from the field in order to re-organize local projects; operational adaptability was crucial to success and this is a lesson that managers of all public health projects should keep in mind.
Ciro de Quadros, M.D., M.P.H., is the Executive Vice-President of the Albert B. Sabin Vaccine Institute. A Brazilian national, he has dedicated his career to freeing the world of infectious diseases, especially those that disproportionately affect the health and social development of the world's poorer countries. A pioneer in developing effective strategies for smallpox surveillance and containment, de Quadros served as the World Health Organization's chief epidemiologist for smallpox eradication on Ethiopia in the 1970's. Following the global eradication of smallpox, he became the regional immunization advisor and then the director of the Division of Vaccines and Immunization for the Pan American Health Organization, for whom he successfully directed efforts to eradicate poliomyelitis and measles from the Western Hemisphere, and established innovative planning and managerial processes that helped countries improve their immunization programs. These processes became the model for the recently established Global Alliance for Vaccines and Immunization (GAVI).