Volume XXXVI Number 3 Immunize and Protect Your Family June 2014

Ciro de Quadros Honored as a PAHO Beloved Dr. Ciro de Hero of the Americas Quadros, 1940-2014 Dr. Ciro de Quadros, was honored on 25 April, 2014 as a “Public Health Hero of the Americas” by the Pan American Health Organization/World Health Organization (PAHO/WHO).

Ciro de Quadros accepted the award from PAHO/WHO Director Carissa F. Etienne during an international symposium marking the 20th anniversary of the Sabin Vaccine Institute, where Ciro de Quadros was Executive Vice President and Director of Vaccine Advocacy and Education until the day of his death.

“Ciro’s long and distinguished career in public health not only coincided with but indeed accelerated the growing use of to save lives and eliminate diseases in the Americas and beyond,” said Dr. Etienne in honoring Ciro de Quadros. “We at PAHO believe that no single person has done more to extend the benefits of immunization to people throughout the Americas.”

"I am deeply honored to be recognized by PAHO and to have been part of Latin America's immunization efforts,” said Ciro de Quadros.

In the late 1970s, Dr. de DR. CIRO DE QUADROS, 1940-2014 Quadros founded the Expanded Program on Immunization (EPI) at On 28 May this year, we lost a PAHO, which encour- visionary, a mentor, and a friend, aged and supported and one of the people that the countries of Latin contributed most extraordinarily America and the to the world of global immuniza- Caribbean in making tion. Dr. Ciro de Quadros made vaccines available for a tremendous difference in the populations that had previously been avail- lives of millions—not just in those able only in wealthier he saved through vaccination countries. efforts, but also in those of us who were lucky enough to learn from In the early 1980s, working with him. Ciro de Quadros PAHO’s Director, Dr. Carissa F. Etienne, with Dr. Ciro de Quadros after began advocating We have collected dedications, giving him the “Public Hero of the Americas” award, Washington DC, for the eradication memorials, and even some of his 25 April 2014. of from the own words to highlight who he See CIRO DE QUADROS HONORED on page 2 was, his accomplishments, and what he meant to us. In honor of his

In This Issue 4 In the Mood for Wiping out Vaccine-Preventable Diseases: memory and continuous legacy, 1 Ciro de Quadros Honored as a PAHO Public Health Interview with Dr. Ciro de Quadros we dedicate this special edition of Hero of the Americas 6 Remembering Ciro de Quadros the “Immunization Newsletter” to 1 Beloved Dr. Ciro de Quadros, 1940-2014 7 Obstacles Overcome: Excerpts from ‘Experiences with 2 Remembering a Hero Smallpox Eradication in Ethiopia’ by Dr. Ciro de Quadros its creator and first editor, Dr. Ciro 3 Dr. Jon K. Andrus Speaks at PAHO Memorial for 7 Selected Obituaries Commemorating Dr. Ciro de Quadros de Quadros. n Dr. Ciro de Quadros 8 In Memory of Dr. Ciro de Quadros 2 Immunization Newsletter Volume XXXVI Number 3 June 2014 Pan American Health Organization

Remembering a Hero Ciro Carlos Araujo de Quadros was born on January 30, 1940, in Rio Pardo, . He graduated from medical school in 1966 at the Pontifical Catholic University of Rio Grande do Sul in Porto Alegre, Brazil.

Dr. Ciro de Quadros, a central figure in the of the national immunization programs across polio and measles eradication efforts in the eradication of polio from Latin America and the Americas, the training and development Americas. the Caribbean and a Public Health Hero of of human resources, the overall strategy of In honoring Ciro de Quadros with this Public the Americas, passed away on May 28, 2014. the regular program, and the planning and Health Hero award in April 2014, Dr. Carissa His contributions and the impact he made on execution of vaccination campaigns. Under Etienne, Director of PAHO, stated “His [de the world will live on forever. his leadership, the Region of the Americas Quadro’s] leadership truly set the stage for became the first region of the world to In 1974 Ciro founded the Expanded Program PAHO’s continued strength in immunization on Immunization (EPI) at PAHO, which eradicate polio and to eliminate measles and, more important, for our Region's success encouraged and supported the countries of and . His influence expanded to in maintaining immunization coverage rates Latin America and the Caribbean in making other regions of the world as well. He was that are the envy of other regions of the world”. vaccines available that had previously been a visionary and a dreamer and has provided “We at PAHO believe that no single person has available only in wealthier countries. He was the Americas and the rest of the world with a done more to extend the benefits of immuniza- also the key figure behind the creation of the strong example of public health excellence. tion to people throughout the Americas.” PAHO Revolving Fund for Vaccine Procure- In addition to heading PAHO’s Immunization In addition to his work, Ciro also served as ment, established in 1979, which pools program, Ciro also served as WHO’s Chief Associate Adjunct Professor at the Johns demand for vaccines and other supplies, Epidemiologist for the Smallpox Eradication Hopkins School of Hygiene and Public achieving economies of scale that allow Program in Ethiopia from 1970 to 1976. He Health in Baltimore and Adjunct Professor participating PAHO member countries to was considered a leader in the develop- in the Department of Tropical Medicine purchase vaccines at low prices. ment of surveillance and containment strat- at The George Washington University In addition to founding the EPI program at egies that were used in the eradication of School of Medicine and Health Sciences in PAHO, Ciro was influential in the development smallpox worldwide, in addition to leading Washington, DC. n

CIRO DE QUADROS HONORED cont. from page 2

Members of PAHO’s Immunization Staff with Members of PAHO’s Immunization Staff with Members of PAHO’s Immunization Staff with Dr. Ciro de Quadros, 1993. Dr. Ciro de Quadros, 2002. Dr. Ciro de Quadros, 2014.

Americas, and in the next few years keenly aware that he has been a force for The Public Health Hero of the he successfully mobilized support from good in our Region and in the world.” Americas, PAHO’s highest distinction, other immunization experts, other was established for PAHO’s Centennial Ciro de Quadros acknowledged the impor- organizations and health authorities in celebration in 2002. It honors individ- tance of collaborative efforts to the success PAHO Member States. uals who have made extraordinary of immunization efforts in the Americas and contributions to improving the health “His leadership and vision were essen- worldwide. He also was clear that much and well-being of the peoples of the tial to our Region becoming the first remains to be done: “While we still have Western Hemisphere. Even though Dr. in the world to eradicate polio, a much to accomplish in global health, our Ciro de Quadros received numerous success story that inspired the global achievements to date would not have been awards during his public health career, campaign,” said Dr. possible without the leadership of govern- he considered the Public Health Hero of Etienne. “The list of his contributions ments and collaboration with development the Americas award one of the closest was much longer, but all of us here are partners," he said while accepting the Award. to his heart. n Immunization Newsletter Volume XXXVI Number 3 June 2014 Pan American Health Organization 3

Dr. Jon K. Andrus Speaks at PAHO Memorial for Dr. Ciro de Quadros We are here to celebrate the life of children and bring the diseases feared Shining Path guerrilla group Ciro de Quadros. As you know, he under control. He obtained invest- in Peru agreed to take part. passed away last week on 28 May at ments from UNICEF, USAID, 1:38pm. He was 74. We are honored CDC, Rotary International, the The last known case of polio in the to have his family here: Susanna, Inter-American Development Western Hemisphere occurred in Julia and Cristina. No one in the Bank and other organizations, and Peru in August 23rd, 1991. past 50 years did more than Dr. de established an international fund to Quadros to prevent the spread of help poorer countries buy vaccines While working for the Brazilian infectious diseases, particularly in at a discount. public health service, he developed the Americas. Begin- an interest in epide- ning in Brazil in the miology and infec- 1960’s, he helped tious diseases. He arrest smallpox in a received a master remote region of the of public health Amazon and then in degree in 1968 from Western Ethiopia. He the National School later led programs of Public Health in that brought an . end to polio and measles, sometimes Dr. de Quadros left brokering cease- the Pan American fires among warring Health Organiza- factions in order to tion in 2002, after vaccinate children in turning his atten- battle zones. Today tion to eradicating we have the oppor- measles from the tunity to celebrate Dr. Ciro de Quadros with Dr. Jon K. Andrus, 2004. Americas. his life. And live successes that are A year later, he also PAHO’s successes. He taught governmental health and joined the Sabin Vaccine Institute, finance ministers about the social where he was an executive vice After leading the eradication of benefits of preventive medicine. president. At the time of his death, smallpox in Ethiopia in 1977, Dr. de Even more remarkable was Dr. he was still seeking ways to elimi- Quadros moved to Washington, DC de Quadros’ diplomatic ability. In nate infectious diseases around to work for the Pan American Health several countries where there were the world. Organization, WHO’s regional wars or rebel insurgencies, he was branch for the Americas. He turned able to persuade the combatants to Dr. de Quadros kept working until his attention to polio, a disease that lay down their arms in the cause of the day before he died. He gave often causes paralysis. public health. hundreds of presentations around the world and was known to heads Since the discovery of a vaccine in Ciro met with rebel leaders from El of state, but he was also likely 1955, polio had been largely elimi- Salvador in a bar in Georgetown. to show up in remote locations, nated from the United States and He said "if you just stop fighting one talking with nurses about local other countries with advanced day, it will benefit everybody." Ciro health problems. medical care. But it remained a was a hero in that sense. scourge in many poorer nations, “My field experience has taught me where its victims were often He called the truce, “Days of to listen to fieldworkers,” he told the reduced to lives as beggars. Tranquility,” when public health Lancet in 2001. “You have to pay workers could go into the country- attention to everybody, because Dr. de Quadros adopted many side without fear and vaccinate you cannot predict who will come innovative methods to vaccinate children against polio. Even the up with the good idea.” n 4 Immunization Newsletter Volume XXXVI Number 3 June 2014 Pan American Health Organization

In the Mood for Wiping out Vaccine-Preventable Diseases: Interview with Dr. Ciro de Quadros Ciro de Quadros has led some of the most successful immunization campaigns in the history of public health. He tells WHO journalist Fiona Fleck why, in some ways, it’s harder to eliminate vaccine-preventable diseases today than it was in the past.

WHO: How did you become interested in you could stop the chain of immunization? transmission. That is how Ciro de Quadros: After I got my MD degree in surveillance and containment 1966, I worked at a health center in a small town works. In Brazil, surveillance in the Amazon region, then studied epidemi- and containment proved to ology and got involved in a new national center be a fantastic strategy and for epidemiology, a kind of “Brazilian CDC” it was tested in studies in (Centers for Disease Control and Prevention). West Africa and India with the But the center never took off because people same success. That’s why it working there were accused of being commu- became the final strategy of nists by the military dictatorship. Through the the global smallpox program. center, I got involved in the smallpox campaign WHO: Today Brazil is strug- which had started in Brazil. gling to fill physicians’ In 1969, three other colleagues and I did posts in remote areas. What motivated you to work in Dr. Ciro de Quadros with Dr. Albert B. Sabin, courtesy of the some of the first trials of the surveillance and Sabin Vaccine Institute. containment strategy. The smallpox program such places? in Brazil was based on mass vaccination Ciro de Quadros: When I applied to study WHO: This year marks 40 years of the but did not have enough resources to mass at the National School of Public Health, a Expanded Program on Immunization (EPI). vaccinate people in every state. So we chose professor there advised me to work in the field In 1977, you went to work at PAHO to four states where we set up surveillance and first. A foundation called the Special Service launch the program in the Americas, how containment units. I was in charge of the unit for Public Health (Serviço Especial de Saúde did you begin? in Paraná, a state of some eight million people Pública) was working in remote areas of Brazil Ciro de Quadros: When the program was and where in 7 or 8 months we identified over and needed doctors. They sent me to head approved by the World Health Assembly 1,000 smallpox cases and vaccinated their a health center in the Amazon Region, in a (WHA) in 1974, nothing happened for three contacts, about 30,000 people. As a result, town called Altamira of about 4,000 people in years. Vaccination coverage was very low, transmission was interrupted. We published the Pará state. All we had was a community below 10% in many parts of the developing the research in this journal. That was my first nurse, a laboratory technician, a sanitarian world and only three vaccines were in use experience with an immunization program. and an administrator to take care of the in most countries– DTP, tetanus toxoid and health of that community. Vaccine coverage WHO: What is surveillance and contain- BCG. Most countries in the region didn’t even rates were not very high; maybe about 50% ment and how did you help to develop this have an immunization program and were just or 60%, and we only had a few vaccines: approach? responding to outbreaks. My task was to get diphtheria–tetanus–pertussis (DTP), tetanus the countries to organize themselves. First, Ciro de Quadros: The smallpox program toxoid and bacille Calmette–Guérin (BCG) [for we asked them to appoint an immunization in Brazil started in 1966 with mass vacci- tuberculosis]. In the early 1970s, the picture manager to run their programs. Within a nation campaigns, which aim to vaccinate was similar all over the developing world. year they had done this. Then we trained the every single person. But when Donald A. Still, our small team managed to increase managers so that they could train their staff. Henderson came to Geneva to head the coverage to nearly 100% during my first year. WHO Smallpox Eradication Program – before We identified the traditional birth attendants WHO: The Americas was the first WHO I worked on smallpox – he and his team in the area, who would travel to the health Region to be certified polio-free in 1994, realized that some countries with high levels center and spend one day a week with us. and it has kept measles at bay since of vaccination coverage still had smallpox They reported the births in their areas and 2002. Why has the Expanded Program outbreaks and that mass vaccination was not we recorded close to 100% of these, then on Immunization been so successful in working everywhere. They knew that people gave the attendants sterilized materials to the Americas? with smallpox had pock marks on their faces use in their next deliveries. We had a good Ciro de Quadros: We had meetings to and that these people usually knew where system for recording and following up, and if introduce countries to the concept of the they got infected, because they had seen kids didn’t come for a second or third dose, Expanded Program on Immunization and someone else like that. They said that if you the nurse or sanitarian would visit the family soon all of them started moving in that direc- could trace the chain of transmission from to make sure they got it. We also sent the tion. We brought together all the country one patient to another over several genera- sanitarian to people’s homes to improve managers and everyone else from the govern- tions and vaccinate all of the people who had sanitation by building latrines and connecting ments working in epidemiology, primary come into contact with the smallpox patients, the water supply. health care, maternal and child health,

See INTERVIEW on page 5 Immunization Newsletter Volume XXXVI Number 3 June 2014 Pan American Health Organization 5

INTERVIEW continued from page 4 financing and so on, and we asked them: WHO: What challenges does the Expanded US$100 million, and they get reduced prices “What are the problems that you have when Program on Immunization face today? by purchasing in bulk. trying to implement immunization programs in Ciro de Quadros: We launched the polio WHO: You are on the Polio Independent your countries and what are the solutions?” campaign in 1985 and had the last case in Monitoring Board and have led the Global We listed the problems – how to improve 1991 in the Americas. The target was 1990 Vaccine Action Plan (GVAP) process in the coverage, do surveillance and organize the – we were eight months late. We didn’t cold chain – and analyzed them. Then we encourage independent program initiatives, past. Why is the Decade of Vaccines and produced a publication called Immuniza- like those you see today on the global level. the GVAP making slow progress? tion and Primary Health Care: Problems and For example, a Global Polio Eradication Initia- Ciro de Quadros: The GVAP represents a Solutions (PAHO Scientific Publication No. tive that is not part of the Expanded Program fantastic initiative, but follow-up has been 417) and started working on those problems on Immunization or a Measles & Rubella weak. WHO’s regional offices need to prepare and solutions. PAHO still does this today. Initiative that may work independently of or finalize their “regional vaccine action plans” this program. We integrated all programs WHO: You were criticized in the early years and countries need to be supported in the for vaccine-preventable diseases as far of the Expanded Program on Immuniza- preparation of their “national vaccine action as possible. So, national polio campaigns tion, how did you win over your detractors? plans.” Hurdles to implementation need to be included other vaccines, such as measles, Ciro de Quadros: At a cocktail party at DTP and tetanus toxoid. Many countries were overcome, such as insufficient budget alloca- PAHO in 1979, Dr. [Halfdan] Mahler, the Direc- so keen to wipe out measles they managed tion and lack of coordination among partners. tor-General of WHO at the time, told me that to control measles – and some even stopped he would never let a program like smallpox WHO: Why the delay? dominate WHO’s work so much again. But, Ciro de Quadros: First, you need to transform by the time we launched the program to the GVAP into regional and national vaccine wipe out polio in the Americas in 1985, he action plans. For example, at a recent meeting supported us. During the first three years, of the Expanded Program on Immunization we demonstrated that our strategies were managers from Africa, I asked how many of stopping polio transmission and that led to them had read the GVAP that was approved calls within WHO to eradicate polio globally. two years ago and that serves as a template At the meeting in 1988 in Talloires (France) for regions and countries. The answer was that led to the WHA resolution to eradicate polio, Mahler joined the heads of other inter- “none” because apparently they are not well national organizations and ministers of health briefed on the GVAP. It’s already four years into and was very supportive of polio eradication. Dr. Ciro de Quadros in Brazil, courtesy of the the decade: we need to accelerate progress. Sabin Vaccine Institute. WHO needs to be more forceful on that. WHO: In the 1980s, armed conflict threat- ened to undermine the Expanded Program WHO: Which experience in your career had measles transmission – during the polio of Immunization in the Americas. How did the most powerful effect on your work? campaign. We said: “Don’t do that now, finish you deal with this? polio first,” but some countries were just in Ciro de Quadros: Until today I bring with me Ciro de Quadros: We had lots of security the mood for wiping out measles. all the lessons of the smallpox eradication problems during the decade of the civil wars. program: that you must have a clear goal, WHO: What is your advice? We had lots of problems in Colombia, El everyone needs to understand that goal, every- Salvador, Peru and other countries and tried Ciro de Quadros: Avoid fragmentation. There body must work together to achieve that, you to work with UNICEF and other partners and are so many actors in the same field today: must have permanent research and feedback with conflict groups to find a resolution. We the GAVI Alliance, the [Bill & Melinda] Gates to the field, and you must have the resources were lucky that we could broker peace days Foundation, the nongovernmental organiza- and political support. Those are the principles between the warring factions. The first one tions and civil society – you need to coordi- was in El Salvador in 1985, when everybody nate them all. Also, with the advent of GAVI, we brought to the Expanded Program on participated in the National Immunization Day another major challenge is financing vaccines Immunization and that has been my experience – even the guerrillas – and that became known for the middle-income countries. They cannot throughout my public health career. as a “Day of Tranquility.” Dr. [Carlyle Guerra afford the expensive new vaccines, but there WHO: Is there anything you would have de] Macedo, who headed PAHO at the time, is nothing like GAVI to help them. The industry done differently? called this “a bridge for peace” because we is trying to divide the world and their tiered overcame problems through the discussion pricing strategy has been damaging because Ciro de Quadros: Nothing. I am so happy to of health issues. Today, the situation in Nigeria many middle-income countries cannot afford have participated in so many great initiatives and particularly in Afghanistan and Pakistan is these vaccines. They need new mechanisms with such fantastic people, it was a fantastic more complex than in Latin America. I know to make these vaccines available, such as ride that I had until now. n that the Global Polio Eradication Initiative is the PAHO Revolving Fund, created in 1979 Authorized by WHO (http://www.who.int/bulletin/volumes/ dealing with those issues, and it’s not easy. and that today has a capitalization of about 92/4/14-030414/en/, 19/09/2014) 6 Immunization Newsletter Volume XXXVI Number 3 June 2014 Pan American Health Organization

Remembering Ciro de Quadros Jon K. Andrus Speaks at PAHO’s 22nd TAG Meeting, 1 July 2014

On May 28th this year, the world lost I can say with the sincerest conviction a true public health hero. To many that Ciro embraced life like no one I of us in this room, we lost a tremen- have ever met, and I am sure the same dous mentor, an amazing colleague, is true for many of you too. Beyond and dear, dear brother and friend. his work, he loved jazz, art, science, Few people in the world of global and history. In many ways, Ciro was health have done more than Ciro de a modern Renaissance man. He Quadros to prevent the spread of loved to take friends and colleagues infectious diseases and save more to local jazz clubs to embrace the lives in some of the poorest parts beautiful music that made him so of the world. He was a compas- happy and joyful. But, profession- sionate champion of serving the ally, he possessed that extraordinary underserved, of smashing down the talent to turn what seemed as insur- barriers of inequities in health, and mountable challenges, into incred- Dr. Ciro de Quadros with Dr. Jon K. Andrus, 2014. of wielding the benefits of prevention ible opportunities groundbreaking and vaccines. He did so throughout for saving the lives of more people. his career spanning 4 decades. And, he some 8 million people, Ciro led local efforts When working with a particularly difficult did so until his last few final dying days. He to stop smallpox transmission in less than person or group, I once asked Ciro, “How taught many of us how to live and contribute a year. True to what would emerge as his do you work with such people?” He immedi- productively. And, in the end he in fact taught life-long commitment to excellence in epide- ately replied, “Make it fun.” Yes, indeed, he us how to die, with so much courage, honor, miologic surveillance, he kept meticulous made it fun, but in the end he also virtually and dignity. He recently said, “I cannot beat records on all the smallpox cases he and always made it great. this one. But, I am incredibly lucky. I lived his team encountered. He used the data to When it came to leadership and leading teams, far beyond my life expectancy that was target rapid vaccination of case contacts and Ciro truly broke the mold. As mentioned, he expected in the year I was born. For me, it quickly brought the end of transmission in exuded the vision, values, and courage that has been an incredible ride.” that part of his country. Ultimately, his efforts inspired people to work above and beyond contributed to a global strategy shift from Beginning in Brazil in the 1960s, Ciro de their natural human capacity. What made mass vaccination, to a strategy focusing on Quadros led efforts to arrest smallpox in him so unique is that all his leadership quali- surveillance and containment. a remote region in the Amazon, and then ties were grounded in his field experience, in Ethiopia, Africa. He later led programs D. A. Henderson definitely saw a good thing those early years of working in the field, that brought an end to polio and measles, when he visited Brazil in those early years. He listening and learning from the field workers sometimes brokering cease-fires among quickly hired Ciro to oversee smallpox eradi- who struggled with such challenging condi- warring factions in order to be able to vacci- cation efforts in Ethiopia, Africa. In fact, D.A. tions of poverty and inequities every day. Ciro nate children in battle zones. Few would would later say that the best thing he ever did was by no means perfect. He was incredibly argue that Ciro was one of the greatest public was hire Ciro de Quadros. Ciro would later demanding. He even admitted to me once health professionals we’ve ever had. become the grandfather of the Expanded that he was a slave driver! But, at the end of Program on Immunization in the Americas, the day, with who have you ever worked who Having the incredible opportunity to work and of polio eradication globally, and the rest was able to make such an incredible differ- with Ciro over the years has been an amazing is history. Ciro saved or improved the lives ence in the lives of so many people? experience, and indeed a most wonderful of millions of people around the world. He highlight of my career. I am sure many of you On this auspicious occasion of the 22nd worked tirelessly until his last final hours. The feel the same way. Most striking about Ciro’s meeting of PAHO’s Technical Advisory last communication I personally received from leadership style was the fact he never asked Group on Vaccine-preventable Diseases, Ciro was a text message 48 hours before his any one of his team members to do something let’s once again celebrate the life and times death. In response to an update over some that he would not do himself. Yes, he most of Dr. Ciro de Quadros. Let’s celebrate the issue he was concerned about, he simply definitely had all the other qualities of inspiring millions of lives he saved, and the many lives said, “Great.” That was the last I heard from leadership, including the vision, values, and he touched, including mine, and many of him. And, in the end for me that message valor, but just by the fact he would do most yours in this room. Let’s celebrate his legacy said it all. I would venture to say that many anything to save lives, including putting his through the work each of us has left to do, in this room have received similar messages own at risk, was truly inspiring for anyone in the remaining time we have. One of my from Ciro, with a simple but ever so powerful, who has ever worked with him. favorite quotes exudes Ciro in a nutshell. It “Great”. That message from Ciro was, is, was made by a South African boy dying of Ciro first left his mark on the global health and forever will be “Great.” Indeed, he taught AIDS. “Do what you can with what you have landscape in the early 1970s. Working as an us, and continues to teach us through his in the place you are in the time you have.” n epidemiologist in a rural Amazonia state of example of how to die. Immunization Newsletter Volume XXXVI Number 3 June 2014 Pan American Health Organization 7

Obstacles Overcome: Excerpts from ‘Experiences with Smallpox Eradication in Ethiopia’ by Dr. Ciro de Quadros

“[…] In 1974 we had a difficult transition already received additional when, a military revolution, overthrew resources, including aerial Emperor Haile Selassie. It was of course support with five helicop- a very difficult period in the country. All ters and a couple of fixed UN operations except our programme wing aircrafts. We also stopped. Stopping the programme at had the support of a C47 that time would have been disastrous. aircraft that carried jet fuel We received permission to stay in the to the helicopter bases. country but the US Peace Corps volun- These resources became teers were withdrawn. However, with available in part because additional WHO resources we were able the eradication of smallpox to deploy more nationals. We also hired in India and Bangladesh, local people in addition to the ones that released both financial the government had assigned to the and human resources to Dr. Ciro de Quadros working on smallpox eradication in programme. Many senior health staff areas were smallpox was Ethiopia, 1971, courtesy of the Sabin Vaccine Institute. from Ethiopia were hired, including a very still endemic. The govern- competent Ethiopian, to be the counter- ment allowed us to fly the helicopters and to the Ministry of Health, smallpox was all part of the director of the programme, aircrafts with the condition that we carry but ignored for a long time. With the hard and another to be my counterpart as the an army officer with us. This was agreed work of dedicated staff a successful surveil- chief epidemiologist. In each province to since the programme benefited from lance and containment strategy made great we started hiring more senior Ethiopians. their knowledge of the local language. strides toward the goal, but government The programme was “nationalised”. It The army officers could serve as inter- instability, harsh working conditions and was the best phase of the programme. preters between the staff and local nomadic populations continued to present During this transition period there were population. This arrangement satisfied all roadblocks. In the end the mission was many challenges. There was a time parties and we continued using helicop- accomplished through innovative interven- when the government decided that no ters and aircraft with no major difficulties. tions and continued persistence. Today, we private aircraft could fly in the country see similarities with the problems the polio because they wanted to prevent people Over the course of the seven year eradication initiative is having in the Ogaden from leaving the country. There were also campaign to eradicate smallpox in desert to those we faced thirty years ago. It issues related to currency flowing out of Ethiopia many challenges were overcome. is my hope that this supplement will assist the country. But again we came to an Beginning with the overall lack of medical those working in the field today to reflect agreement with the government to keep infrastructure and a variety of competing on the lessons learned from the smallpox our programme going. At this point we had interests for the limited resources available eradication campaign.” n With permission from Quadros, C: Experiences with smallpox eradication in Ethiopia, Vaccine, 29: D30-D35, Elsevier, 2011

Selected Obituaries Commemorating Dr. Ciro de Quadros: • “How Did This Man Rid Latin America of Polio?” (Global Citizen, USA) • “Ciro de Quadros, 74, Dies; Leader in Ridding Latin America of Polio”(The New York Times, USA) • “Doctor helped lead eradication of smallpox, measles, polio” (The Washington Post, USA) • “Ciro de Quadros” (The Lancet, UK) • “Remembering vaccines champion Dr. Ciro de Quadros” (One, USA) • “Remembering Ciro de Quadros, Global Health Hero” (Impatient Optimists, USA) • “Dr Ciro de Quadros, immunization champion, dies at age 74” (Global Polio Eradication Initiative, Switzerland) • “Ciro de Quadros – obituary” (The Telegraph, UK) • “Ciro A. de Quadros In memoriam” (Rota Council, USA) • “Remembering Ciro de Quadros, Global Health Hero” (Huffington Post,USA) • “Honoring the Life of Dr Ciro de Quadros” (Union of International Associations, Belgium) • “Ciro de Quadros” (The British Medical Journal, UK) • “Remembering Dr. Ciro de Quadros, advocate for vaccines” (The GAVI Alliance, Switzerland) • “Global Health Hero Ciro de Quadros Dies at 74” (IS Global, Spain) • “Remembering Dr. Ciro de Quadros” (ScienceDirect, The Netherlands) • “In Memoriam: Ciro de Quadros, MD” (Sabin Vaccine Institute, USA) The Immunization Newsletter is published every two months, in English, Spanish, and French by the Comprehensive Family Immunization Project of the Pan American Health Organization (PAHO), Regional Office for the Americas of the World Health Organization (WHO). The purpose of the Immunization Newsletter is to facilitate the exchange of ideas and information concerning immunization programs in the Region, in order to promote greater knowledge of the problems faced and possible solutions to those problems. Comprehensive Family Immunization Unit An electronic compilation of the Newsletter, “Thirty 525 Twenty-third Street, N.W. years of Immunization Newsletter: the History of Washington, D.C. 20037 U.S.A. the EPI in the Americas”, is now available at: http://www.paho.org/immunization www.paho.org/inb.

References to commercial products and the publication of signed articles in this Newsletter do not constitute endorsement by PAHO/WHO, nor do they necessarily represent the policy of the Organization.

ISSN 1814-6244 Volume XXXVI Number 3 • June 2014

Editor: Carolina Danovaro Associate Editors: Cuauhtémoc Ruiz Matus and Octavia Silva

©Pan-American Health Organization, 2014. All rights reserved.

Immunization Newsletter Volume XXXVI Number 3 June 2014 Pan American Health Organization 8