Here, D.A. Henderson tells us about the remarkable impact, on the global stage, of the multi-faceted West African immunization programme against smallpox and measles from the mid-1960s onwards. He describes the role played by the USAID and the CDC in this region, especially the programme that was extended across Anglo- and Franco-phone countries in the region.
03. 1965-66: Henderson appointed
In 1965, the World Health Assembly asked for the development of plan for global smallpox eradication. D.A. Henderson describes this, as well as the budgetary challenges facing the managers of the programme; problems that were heightened by debates within national governments about who would contribute what. Strikingly, Henderson informs us about the WHO DG’s predictions of failure of the programme.
04. Dissenting voices
D.A Henderson describes here other critiques of the global smallpox eradication programme
05. Fred Soper & PAHO
D.A. Henderson tells us here about the role played by Fred Soper, of the Pan American Health Organization, also the WHO Regional Office for the Americas, in popularizing the idea of disease eradication. He mentions how the mass production of freeze dried smallpox vaccine helped eliminate the disease in the Americas.
06. Geneva & structure of WHO
D.A. Henderson tell us here about the complex structure of the WHO, and how this impacted on the design and running of the global smallpox eradication unit. The WHO had 6 regional offices, which could be regarded, according to Henderson, an association of regional offices, whose Directors were elected locally. He reminds us that the number of international staff was always relatively low and that this was not a grandly, centralized campaign, run by armies of foreign workers; he highlights the important role played by staff provided by the host countries, who did the bulk of the day to day work.
07. The strategy & vaccine production
D.A. Henderson tells us how the primary goal was to immunize 80 per cent of the population; he refers also to the importance of the initiation of a quality control programme, both for work carried out in the field and vaccine quality. He also talks about the so-called surveillance-containment strategy, which resulted in surprisingly effective results in relation to driving down smallpox prevalence. Henderson refers also to the importance of vaccine production in the developing world.
08. Surveillance, reporting & data
D.A. Henderson describes the importance of preparing - and investigating information provided by – surveillance reports.
09. Local knowledge, beurocracy & communications
D.A. Henderson refers here to the importance accorded to service in the field. He also describes the challenges of dealing with the Regional Offices, as well as national governments and local administrative bureaucracies.
10. Innovation & Ruben
D.A. Henderson refers to the use of the jet injector and its main problem, that is, the high level of technical support needed. He goes on to describe the bifurcated needle and its great importance to the global smallpox eradication programme.
11. Sub-clinical infection & re-vaccination
D.A. Henderson refers here to the assumptions about re-vaccination, and the immunological boost received by many of those vaccinated when they were in contact with smallpox cases.
12. Critical final challenges
D.A. Henderson describes here the critical challenges at the end – India, Bangladesh and Somalia. He describes, in some detail, the problems caused by the political instability in Bangladesh; this was the last location in which variola major, the more infective form of the disease, was eradicated.
13. Final words
D.A. Henderson reminds us here that smallpox eradication just barely succeeded.
D. A. Henderson, is a Distinguished Scholar at the Center for Biosecurity of UPMC and a Professor of Public Health and Medicine at the University of Pittsburgh. He is Dean Emeritus and Professor of the Johns Hopkins School of Public Health and a Founding Director (1998) of the Johns Hopkins Center for Civilian Biodefense Strategies. Dr. Henderson’s previous positions include: Associate Director of the Office of Science and Technology Policy, Executive Office of the President (1990-93); Dean of the Faculty of the Johns Hopkins School of Public Health (1977-90); and Director of the World Health Organization’s global smallpox eradication campaign (1966-77).