Smallpox Is Dead I Cover Design a Victory for All Mankind by Peter Davtes
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M!ft^?;?:-.: --^-Vk^y^)^ S?-^ii!-'?:^^v.,-- WORLD HEAUH THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION • MAY 1980 w . ft.^-*^- tl^-fk'^'-Zt >:^ 1!M^v. Smallpox is dead i Cover design A victory for all mankind by Peter Davtes Brought about by hundreds of thousands of health workers from all over the world, eradication is a triunnph of IX ISSN 0043-8502 international cooperation and of preventive medicine Vl/orld Healtb is the officia! illustraled magazine of tfie World Healtfi Organization, by D.A. Henderson Editor: ^H—1^^ For centuries, variola virus population within a period of four to five John Bland ^^ stalked the world with im- years", smallpox could be eradicated Deputy Editor: ^^^ punity causing unmeasured from endemie areas. Christiane Viedma ^Q suffering, death and blind- During the following eight years, WHO Art Editor: —m.^£i ness. Today it is conlined encouraged governments lo undertake Peter Davies to glass vials kept under high security in programmes, solicited contributions of News Page Editor: Lalit Thapalyal six laboratories. To those who vividly vaccine, encouraged and coordinated recall the suffering of its victims, to studies of vaccine strains, and assisted health staff who so diligently conducted laboratories in starting vaccine produc World Healtb appears in Arabic, Englisfi. vaccination programmes, to quarantine tion. Many countries started pro French, German, Italian. Persian, Portuguese, inspectors who carefully examined vacci grammes and some succeeded in inter Russian and Spanish, nalion certificates, it is difficult to believe rupting transmission. But not all did or Articles and photographs not copyrighted that "sporadic" cases are nol still occur could embark on eradication with their may be reproduced provided credit is given own limited resources. Contributions to the World Health Organization, Signed ring somewhere. However, convincing articles do not necessarily reflect WHO's dala, diligently assembled by tens of were far less than the funds required and views thousands of health staff, now demon many countries which interrupted trans World Health. VJHO. strate that smallpox is a disease which mission were reinfected by their neigh Av, Appia. 1211 Geneva 27, Switzerland can be consigned to history—the first bours. Of greater concern was the dis disease ever eradicated by man. covery that, even when vaccinations were administered to 80 per cent of a popula It was little more than two decades Contents tion, smallpox often persisted. Health ago, in 1958, that the Soviet Union pro authorities became discouraged and pes A victory for all mankind posed to the Eleventh World Health As simistic. It was one thing to eliminate the by DA, Henderson 3 sembly that the countries of the world disease from countries with a developed cooperate in a globally coordinated ef A windfall for development health infrastructure, but eould this be by James Magee 5 fort to eradicate smallpox. In thai year, done in the numerous countries, so 6.'t countries reported 280,000 cases. This A job well done recently independent, whose limited is ilself a substantial number of cases by Marcella Davies 6 health services scarcely extended beyond bul, because of incomplete reporting, it their urban centres'? And eould these An effort of will would need to be multiplied by 100 or by V.T. Herat Gunaratne 11 many countries coordinate their efforts more to describe the true magnitude of sufficiently for smallpox to be eliminated India's "war plan" lhe problem. Data regarding deaths are from large geographical areas? by Jilendra Tuli 12 likewise incomplete, but it is reasonable A goddess defied to assume that al least 20 per cent of It was a concerned and less confident those infected died and tens of thousands World Heallh Assembly which in 1966 by Arun M, Chacko 15 were permanently blinded. There was, decided that WHO should undertake an How much did it cost? 18 and is, no treatment for smallpox; pre intensified eradication programme. Ap Towards the year 2000 vention through vaccination was the proximately US $2.5 million was in only way to cope with this disease. by Halfdan Mahler 19 cluded in the Organization's regular bud Ramses V: earliest known victim? After further study of the Soviet pro get to provide for overall programme by Donald R. Hopkins 22 coordination and for assistance lo those posal, the Assembly in 1959 agreed that a Decline and Fall global smallpox eradication programme countries requiring it. This was a small of the Smallpox Empire 24 should be undertaken as a matter of sum indeed to provide support in some 50 countries with a population of more Can we stop smallpox vaccination ? urgency. Il was thought that, by "vacci by Isao Arita 27 nating or revaccinating 80 per cent of the than one Ihousand million persons. But it represented almost five per cent of The closing stages WHO'S total budget that year. Hopes by Svetlana Marennikova , , , , 30 This was .smallpox. The world will never again were expressed thai more sutistantial vol witness the suffering that was caused by the How can we be sure? variola virus. (Photo WHO I untary contributions would be made and by Frank Fenner 35 that all countries would give the pro bifurcated needle soon became the stan 77?(' end of smidlpox tn Asia meant that more gramme a high priority. Some delegates dard method for vaccination. resources could be made available in Ethiopia. optimistically proposed setting a 10 years A second concern from the start was The net was closing on the last places on earth goal for eradication, but most believed the question of an appropriate strategy. where the disease lurked. ( WHOIE. Shafa realistically that better conlrol of small Mass vaccination designed to reach 80 or pox was the best thai could be expected. even 100 per cent of a population had rumours of smallpox. A special "WHO The intensified programine began in succeeded only in some smaller countries Recognition Card" showing a picture of January 1967. That year. 46 countries and those with more developed health a smallpox patient was printed and dis recorded 131,697 cases, a number repre services. For most of the still endemic tributcd to help them in their search. senting perhaps one per cent of the true countries, a different strategy was The first campaigns started in 1967 number of cases. Four endemic areas required. The decision to emphasize and, by 1969, all countries except Ethio were present. A major reservoir was surveillance as an important component pia had started eradication programines. Africa where virtually all countries south of the strategy proved to be the much- Ethiopia's programme began in 1971. In of the Sahara were infected. A second needed critical breakthrough. The new 20 countries of western and central Afri important reservoir of smallpox was strategy called for a systematic two- to ca, a USA-assisted programme of small in Asia, extending from Bangladesh three-year vaccination campaign de pox eradication and measles control suc Ihrough India, Nepal, Pakistan and Af signed to reach 80 per cent of the popu ceeded in eliminating smallpox in jusl ghanistan. The third was the Indonesian lation in each country. During this time, three and a half years. Brazil's last case archipelago and the fourth was Brazil, it it was planned for a nationwide reporting was detected in 1971 and Indonesia's self comprising half a continent. system to be developed which would be in 1972. By the summer of 1973, small Of primary concern as the programme sensitive enough to detect such smallpox pox transmission had been interrupted began was the need for sufficient vacci foci as remained and to eliminate them. throughout the whole of Africa, except nation devices and vaccine—the guns Soon after the programme began, it in Ethiopia. That country plus five coun and bullets of the campaign. Large con was discovered first in Nigeria, then in tries in Asia remained as the only small tributions were made initially by the Indonesia and Brazil, that effective pox infected countries. Soviet Union and the L'SA: eventually reporting systems could be developed in However, India, Pakistan and Ban 26 countries became contributors. A de months rather than years. By isolating gladesh, with a population of more than tailed manual on vaccine production was the patients and vaccinating their con 700 million persons, presented a special produced and vaccine batches were rou tacts, outbreaks could be rapidly con problem. Surveillance-containment mea tinely tested to ensure that they met in tained. Even in areas where vaccination sures such as had been successful in Afri ternational standards. By 1971, all vaccine coverage was poor, smallpox transmis ca and South America proved far less ef in use in the programme met accepted sion could often be stopped quickly. So fective in these densely populated areas standards and by I97jt, fully 80 per cent now increasing emphasis was placed on where people travel frequently and far. A was being produced in the endemic coun the surveillance-containment component different approach was required. During tries, some of which supplied vaccine lo of the strategy. Special surveillance the summer of 1973, Indian health au others. In 1967, the jet injector was intro teams were recruited and trained. They thorities with WHO stafT planned a dif duced in programmes throughout the visited each health unit in an area to en ferent surveillance strategy. All heallh countries of western and central Africa sure that each week it submitted a report personnel were asked to undertake an in and Brazil. In 1968. field studies conduc indicating the number of cases seen. tensive search of each village, and later ted by WHO showed that the newly devel When cases were reported, the teams each house, to detect smallpox cases.