OBITUARIES

Ciro de Quadros Epidemiologist who was a driving force behind eradication

Ciro de Quadros (b 1940; q Pontifical De Quadros Catholic University of Rio Grande do Sul, believed that Porto Allegre, , 1966), died from all people, pancreatic cancer on 28 May 2014. particularly the world’s In the 1960s and 1970s, throughout Latin Amer- poorest, had ica, only 5-15% of children were vaccinated, usu- ally only if they lived near a health centre (vast as much right areas did not have one) and only when that health to centre was not too busy. as to water, When an outbreak of smallpox erupted in a sanitation, remote area of the Amazon, a young doctor, Ciro and nutrition de Quadros, on his first tour of duty after qualify- ing, decided to try to contain the outbreak himself, without waiting for the government to organise a vaccination campaign. With a car, a driver, and a vaccinator, he con- vinced local communities to work with him to spot new cases quickly, track down everyone who Child deaths in the Americas went from 12 million De Quadros believed that all people, particularly might have had contact with the patient, and vac- to six million between 1990 and 2010 (while they the world’s poorest, had as much right to vaccines cinate these people. In less than a year, smallpox fell by only a third globally). as to water, sanitation, and nutrition. To this end, was no longer present in an area inhabited by “We believe that no single person has done he convinced the governments of developing coun- eight million people. more to extend the benefits of immunisation to tries to invest in vaccines for the entire population, De Quadros ultimately showed the Brazilian people throughout the Americas,” said Carissa rather than seeing them as a bonus if richer coun- authorities that vaccinating in this way, nation- Etienne, director of PAHO, in a tribute statement. tries donated them. He also devised mechanisms wide, was possible and worth while. Until then, it De Quadros is considered to have saved thou- such as PAHO’s revolving fund for procure- had been considered an impossible task. sands, if not millions, of lives. Yet he is virtually ment (established in 1979), which allowed poor “His greatest achievement was show- unheard of outside his field. countries to pool demand for vaccines to achieve ing that you could mobilise a country,” said “Ciro was not a vaccine developer, he was one lower prices through economies of scale. From D A Henderson, former dean of the Johns Hop- of the world’s greatest vaccinators,” says Peter 2002 he worked for the Sabin Institute and con- kins School of and director of the Hotez of the Sabin Institute in Washington, DC, tinued to travel and advocate for global vaccination World Health Organization’s global project to where de Quadros was executive vice president. efforts as executive vice president of the institute eliminate smallpox.­ Ciro Carlos Araujo de Quadros was born into a until weeks before his death. In the 1980s, working for WHO’s branch for the middle class family in Rio Pardo, Brazil. He stud- He travelled constantly, said Hotez. “I never Americas, the Pan American Health Organization ied medicine in Porto Allegre and developed an knew where he was and was always afraid of wak- (PAHO), de Quadros mobilised the whole region interest in epidemiology while completing a mas- ing him up, but he didn’t mind,” he said. into embracing the concept that national vac- ters at the National School of Public Health in Rio De Quadros is perhaps best remembered for his cination programmes against preventable com- de Janeiro. After he had worked on smallpox in belief that it was possible to eradicate polio world- municable diseases from smallpox and polio to the Amazon, Henderson hired him to apply his wide—although it is a far less visible disease than , aiming for at least 90% coverage, should leadership and negotiation skills to the smallpox smallpox or measles. His work for PAHO on this in be a fundamental part of primary care. problem in war torn Ethiopia. the 1980s led to the western hemisphere becoming It was “a transition of major proportions which After “learning English on the flight,” according the first part of the world to be polio free. He was a has yet to be repeated in other parts of the world,” to Henderson, de Quadros talked fighting Ethio- driving force behind the Global says Professor Henderson. pian factions into holding immunisation cease- Initiative, which almost achieved its goal in 1999. De Quadros did this despite much of Latin Amer- fires and inspired such dedication in his team Colleagues said he was “in deep distress” over ica being at war, by negotiating ceasefires (known that, when a helicopter was hijacked by rebels, the recent return of polio to several countries in as tranquillity days) between guerilla fighters and the pilot—who had vaccines aboard—made the which conflict had interrupted vaccination pro- government forces in El Salvador and Guatemala. most of the “access” to vaccinate his captors. De grammes. Ironically, just weeks after his death, a He also won over sceptics (from the head of WHO to Quadros worked for Henderson’s smallpox cam- strain of polio, thought to have come from Equato- overworked health workers) and organised festival-­ paign from 1970 to 1977 before taking up a series rial Guinea, was found in Brazil. like immunisation days with music and sport to of roles in immunisation with PAHO. Sophie Arie, London [email protected] encourage the public to turn out. “He achieved things despite the problems of Competing interests: None declared. Largely as a result of his work, the Americas war. He could get things done,” says Henderson, Provenance and peer review: Commissioned; not became the first region to eradicate smallpox, then describing de Quadros as a natural leader who externally peer reviewed. polio (1991), measles (1992), and rubella (2009). had a talent for motivating people. Cite this as: BMJ 2014;349:g4853

26 27 September 2014 | the bmj