ARTICLES / ARTÍCULOS SALUD COLEC T Chronicle of a consolidated success: smallpox IVA. 2019;15:e2167. doi: 10.18294/sc.2019.2167 eradication policies in Brazil (1962-1973) Crónica de un éxito consolidado: las políticas de erradicación de la viruela en Brasil (1962-1973) Jonatan Sacramento1 1PhD Student, Social ABSTRACT The aim of this article is to understand actions taken towards smallpox eradica- Sciences Postgraduation Program, Philosophy and tion in Brazil, in the framework of the Smallpox Eradication campaign that took place in the Human Sciences Research 1960s and 1970s. The article argues that, in addition to the bifurcated needle and the lyo- Institute, Universidade philized vaccine, epidemiological surveillance – based on the construction of instruments Estadual de Campinas, São Paulo, Brazil. * and protocols for health surveillance – was the third key element that guaranteed the eradi- cation of the disease. The hypothesis is that the actions taken towards the control and erad- ication of smallpox contributed to the construction of new health institutions within Brazil. As an exercise of socio-historical analysis, this research was based on documentary sources (reports, newsletters and legislation), interviews with professionals directly involved in the eradication of smallpox, and part of the intellectual production on the subject. KEY WORDS Smallpox; Eradication; Epidemiological Surveillance; Health Policy; Brazil. RESUMEN El objetivo de este artículo es comprender las acciones del combate contra la viruela en Brasil en el marco de la Campaña de Erradicación de la Viruela, que tuvo lugar entre las décadas de 1960 y 1970. A partir de la construcción de instrumentos y protocolos de vigilancia en salud, se intenta argumentar que, además de la aguja bifurcada y de la vacuna liofilizada, la vigilancia epidemiológica fue el tercer elemento clave que garantizó la erradicación de la enfermedad. La hipótesis que se pretende sustentar es que las acciones de control y erradicación de la viruela contribuyeron a la construcción de nuevas instituciones de salud en el interior de Brasil. Como un ejercicio de análisis sociohistórico, la investigación se basó en fuentes documentales (informes, boletines y legislaciones), en entrevistas con profesionales directamente involucrados con la erradicación de la viruela y en parte de la producción intelectual de estos respecto del tema. PALABRAS CLAVES Viruela; Erradicación; Vigilancia Epidemiológica; Políticas de Salud; Brasil. Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2019.2167 2 SACRAMENTO J. INTRODUCTION with power and as an object of knowledge through the control of smallpox in the 18th century.(9) As a chronicle of a consolidated success, If taking actions to combat smallpox in smallpox eradication occupies a unique place that century helped to constitute the new in the history of international public health. form of the State and the State power, in Bra- However, research studies on this subject zil, at the beginning of the 20th century, the seem to have a marginal place in the historiog- fight against smallpox had the same role in . 2019;15:e2167. doi: 10.18294/sc.2019.2167 A raphy of public health in Brazil, only dealing promoting the creation of scientific institu- IV with analyses that emphasize a major episode tions to produce the vaccine and generating ECT L known as the “The Vaccine Revolt,” which oc- the need to maintain a team of civil servants CO curred in the year 1904, when the population to fight epidemics. As shown by Hochman,(10) LUD A of Rio de Janeiro of the newly-born republic the “sanitation of Brazil” enabled not only S rose in rebellion against the mandatory vac- the fight against the main diseases that dev- cination measures imposed by the municipal- astated the inner territories of Brazil, but also ity of Rio de Janeiro.(1,2,3) Interest in discussing the construction of the whole State public smallpox eradication is recent and, until now, health bureaucracy in the 1920s and 1930s, there have been few research studies seeking which would be consolidated in the insti- to recover the history of the Smallpox Eradica- tutions that even today, one hundred years tion Campaign in Brazil.(4,5,6,7,8) later, are still active in the country. Keeping However, observing smallpox and its in mind the relative importance and the his- eradication campaign helps us to understand torical context, something similar seemed to the relations between health, society, the have happened with smallpox eradication. State, and its institutions, as well as the actors As I will show throughout this article, the that were involved in such experiences. As fight against smallpox, starting in 1965, made shown by Foucault,(9) the response adopted possible the redefinition of health institutions by the State to smallpox epidemics in Europe at a national scale, the production of immu- in the 18th century led to one of the most sig- nological materials, and the creation of pub- nificant political and organizational changes lic health statistics, apart from organizing a in terms of the conception of power and its new public health routine for reporting and connection with the people. controlling diseases. The emergence of the idea of population, The Brazilian production on smallpox as an entity that should be managed through eradication has shown how this action was in- a security apparatus as a new technique of tegrated into a broader scenario of discussion power, brought along the need to combat within the international public health sphere smallpox in order to control death rates, as a regarding eradication of diseases,(4,5,6,7,8) in result of the disease outbreaks. Furthermore, which epidemiological surveillance became, this safety device enabled, after establishing at least in terms of smallpox eradication, a vital statistics records and probability calcu- methodology applied to control diseases.(4) In lations for life expectancy, not only a direct this sense, Gazeta(5) affirms that the Smallpox control of the population health, but also the Eradication Campaign in 1966 was used as a protection of health and a less dangerous public health policy in a context of interna- type of the disease. tional articulation and efforts to control and According to Foucault, smallpox started eradicate the disease, subject to the coordi- to be understood as a collective phenome- nation by the World Health Organization non, and as a result it was included in the (WHO). In this way, according to the author,(6) social dynamics of a safety device that was the structure within which the Campaign was born at that time, focused on the demogra- established was inversely proportional to the phy of the disease and its control. Hence, the seriousness of the disease in Brazil, where the concept of population was born as a correlate “benign” version was already predominant as CHRONICLE OF A CONSOLIDATED SUCCESS: SMALLPOX ERADICATION POLICIES IN BRAZIL (1962-1973) 3 SALUD COLECTIVA. 2019;15:e2167. doi: 10.18294/sc.2019.2167 a consequence of the control measures im- process, the aim was to understand the intel- plemented in the 1962-1965 period. lectual trajectories of the participants in erad- It is along those lines that Hochman(7) icating the disease as well as the international shows how such changes within the national public health context in which such actions and international context of disease eradi- were taken. cation and control policy referred not only to public health, but also to issues linked to economic development and international re- METHODOLOGY lations between the main political and eco- nomic powers of that time, mainly the USA and the Soviet Union, and other countries. Using a qualitative approach, the research In the case of Brazil, even without a consen- was based on three procedures: a review sus between physicians and national author- of national and international literature deal- ities on the health significance of eradicating ing with smallpox eradication in Brazil and smallpox, control of the disease materialized worldwide; documentary analysis of epi- as an opportunity to create a good image of demiological newsletters published by the the military regime at that time, apart from Smallpox Eradication Campaign between having been a contribution to the construc- 1967 and 1974, of federal and state legis- tion of an “immunization culture” in Brazil.(8) lation relating to smallpox eradication, and In this context, this article seeks to under- of statements made by physicians and other stand the process of eradication of smallpox health care professionals working in the in Brazil, based on the construction of epide- Campaign; and an interview with one of the miological knowledge and the institutional- Campaign coordinators. ization of a public health apparatus within the policies to combat smallpox in the national territory. In order to discuss the dynamics of From center stage to backstage: the production of epidemiologic knowledge smallpox as a national public health and public health policies, the goal is to priority show how the combat against smallpox and, mainly, the rediscovery of smallpox as a pub- In the history of Brazilian public health, lic health problem enabled the consolidation smallpox followed a priority, invisibility and of the bureaucratic and intellectual apparatus eradication triad.(7,8) It was a priority at the of Brazilian public health, through the insti- beginning of the 20th century, along with tutionalization of protocols and public health yellow fever, as it was the target of the man- practices. The hypothesis presented here is datory vaccination campaign imposed by the that, in addition to the bifurcated needle and federal government in the actions directed by the lyophilized vaccine, indicated in the Bra- public health officer Oswaldo Cruz (1872- zilian literature as being essential for eradi- 1917), in the transformation process under- cation, epidemiological surveillance was the taken in the city of Rio de Janeiro during the third key element for its consolidation.