CHAPTER 9 DEVELOPMENT OF THE GLOBAL SMALLPOX ERADICATION PROGRAMME, 1958-1966 Con tents Page The commitment to global smallpox eradication, 1958- 1959 366 History of the concept of eradication 37 1 Introduction 371 Eradication of animal diseases 372 The first eradication programmes for human diseases- hookworm and yellow fever 373 Aedes aegvptz eradication 377 Eradication of another mosquito vector-Anopheles gambiae 377 Programmes for the eradication of malaria, yaws and other human diseases 379 WHO smallpox control and eradication activities, 1946- 1958 388 Introduction 388 Smallpox eradication in the Region of the Americas 389 An abortive attempt to launch a global smallpox eradication programme, 1953 391 The smallpox eradication programme, 1959-1 966 393 Introduction 393 Status of smallpox, 1959 393 The global eradication programme begins, 1959 394 Budgetary provision for the programme 395 Programme activities, 1959-1 962 395 Proposed provision of support through the WHO regular budget, 1963 399 Voluntary contributions 400 The first WHO Expert Committee on Smallpox, 1964 402 The Seventeenth World Health Assembly, 1964 403 A retrospective view of progress in smallpox eradica- tion, 1959-1964 403 Events leading to the introduction of an intensified global programme, 1965 405 The Eighteenth World Health Assembly, 1965 408 A special budget for smallpox eradication, 1966 409 The Director-General’s report to the Nineteenth World Health Assembly 41 0 365 366 SMALLPOX AND ITS ERADICATION Page The smallpox eradication programme, 1959-1 966 (cont.) The discussions at the Executive Board Uanuary 1966) and at the Nineteenth World Health Assembly (May 1966) 414 Preparations for initiating the Intensified Programme, 1966 416 Summary 41 8 THE COMMITMENT TO GLOBAL complete eradication throughout the world, SMALLPOX ERADICATION, we think that this can be achieved within the 1958-1959 next ten years.” No reference was made to an 8-year-old regional programme for smallpox The decision by the Twelfth World Health eradication in the Americas nor to the Health Assembly, in May 1959, to undertake the Assembly’s earlier discussions on smallpox. global eradication of smallpox marked the The USSR had not participated in those beginning of a programme which, some 18 discussions, however, having withdrawn years later, would witness the last naturally from active participation in WHO from 1948 occurring case. The Health Assembly’s policy, to 1957. which made the global eradication of a disease The new initiative originated with Profes- one of WHO’S goals, was not without prece- sor Zhdanov himself. From 1951, when he dent, a similar decision with regard to malaria had first assumed responsibility for communi- having been taken 4 years before. cable disease control in the USSR, as Chief of The commitment to smallpox eradication the Department of Sanitary and Epidemi- in 1959 represented, for the Health Assembly, ological Services, he had taken an active an abrupt reversal of its views regarding the interest in the concept of disease eradication. disease. The problem of smallpox and its His interest was stimulated, in part, by the control had been the subject of discussions in successful interruption of smallpox trans- the Health Assembly in 1950,1953,1954 and mission throughout the USSR in 1936, and by 1955. An eradication programme had been the elimination of dracunculiasis from the proposed, in fact, by the first Director- Central Asian republics of the USSR follow- General, Dr Brock Chisholm, to the Sixth ing a 10-year campaign that ended in 1932 World Health Assembly in 1953. However, (Isaev, 1956 ;Litvinov, 1970). These successes after 2 years of study and debate, the Eighth led him to initiate a study of infectious World Health Assembly, in May 1955, re- diseases in the Soviet Union for the purpose of jected the concept as unrealistic, and the terse identifying others which might similarly be resolution which was adopted (WHA8.38) eliminated (Zhdanov & Timakov, 1952). By simply urged “that health administrations assigning more resources in the short term to conduct, wherever necessary, campaigns disease elimination, longer-term savings against smallpox as an integral part of their could be anticipated. Smallpox remained a public-health programmes” (World Health problem, however, particularly in the Central Organization, 1973a). Asian republics, because of importations from From 1955 to 1958, the issue of smallpox Afghanistan and Iran, 537 cases being record- eradication lay dormant but, at the Eleventh ed between 1950 and 1957 (Burgasov, 1968). World Health Assembly, Professor Viktor Professor Zhdanov’s report to the Health Zhdanov, Deputy Minister of Health of the Assembly pointed out that the danger which USSR and a delegate to the Health Assembly, endemic countries posed to others caused “the presented a formal, lengthy report which countries which are free from smallpox.. to argued that the problem of smallpox was an make considerable efforts and spend large important one for endemic and non-endemic sums on vaccinating and revaccinating the countries alike, that eradication was theoreti- population in order to provide constant cally feasible and that national programmes strong immunity against this disease”. Small- had demonstrated it to be a practicable pox, as he saw it, would be much easier to possibility (World Health Organization, eradicate than any of the other infectious 1958a). The report concluded: “AS regards its diseases, as indicated by the success of the 9. DEVELOPMENT OF THE GLOBAL PROGRAMME, 1958-1966 367 programme in the USSR. Despite the diverse the world will learn about this disgusting problems presented by a country so large and smallpox disease only from ancient tradi- abundantly populated, transmission had been tions’.’’ The Zhdanov report proposed that stopped by means of a programme of compul- vaccination and revaccination campaigns sory vaccination (Vasil’ev & Vasil’ev, 1982). should be conducted throughout the endemic For other countries to do likewise seemed areas of the world, commencing in 1959. It both logical and feasible and the USSR was recommended that vaccination should be willing to offer its assistance to support such made compulsory and that freeze-dried vac- efforts. In addition to offering 25 million cine should be used. It also suggested that the doses of vaccine to WHO, it informed the programme could be accelerated if the Leices- Director-General at the twenty-third session ter system were introduced as well. This of the Executive Board that it had sent offers system, as noted in the report, was used for of assistance to Burma, Cambodia (later De- outbreak control, mainly in England (see mocratic Kampuchea), Ghana, Guinea, India, Chapter 6), and resembled what eventually Indonesia, Iraq and Pakistan (World Health came to be called surveillanceecontainment Organization, 1959a). activities-namely, “prompt identification The Eleventh World Health Assembly was of the disease, special notification, isola- held in Minneapolis, Minnesota (USA), and, tion, quarantine, disinfection measures”- with this venue in mind, Professor Zhdanov although it included the “eradication of flies” introduced his report with a quotation : “AS as well (Fraser, 1980). early as 1806, the President of the United The draft resolution introduced by the States of America Thomas Jefferson. said in USSR in 1958 for consideration by the Health his letter to Jennet: ‘It is owing to your Assembly differed from the report in suggest- discovery.. that in the future the peoples of ing that eradication in 4-5 years was possible in accordance with the following timetable: (1) preparation of the necessary amount of vaccine in 1958-1960 and the training of vaccinators; (2) vaccination during 1959- 1960 of the populations in which principal endemic foci existed; and (3) completion of eradication in 1961-1 962 by additional vacci- nation and revaccination. Nothing was said of the Leicester system in the resolution. The concept of global eradication was broadly endorsed by virtually all the delegates who spoke, although a number believed that the timetable was too optimistic and some wondered whether there might not be in- superable technical and administrative prob- lems. Accordingly, the resolution was altered to request “the Director-General to study and report to the Executive Board ... on the financial, administrative and technical impli- cations of a programme having as its objective the eradication of smallpox” (see box). Immediately after the Health Assembly, the Executive Board met and formally ac- cepted the gift of freeze-dried vaccine from the USSR, as well as 2 million doses of glycerolated vaccine offered by Cuba. The Plate 9.1. Viktor M. Zhdanov (b. 1914). Academ- Board noted in resolution EB22.Rl2 that the ician and Deputy Minister of Health of the USSR, Director-General would establish a special 1955-1960, proposed to the World Health Assembly account for smallpox eradication, which in 1958 that WHO should undertake the global would “be credited with the value, as reported eradication of smallpox. Many epidemiologists whom he trained while Director of the lvanovsky Institute by the governments concerned, of these gifts served as WHO staff and consultants for the eradi- of vaccine and of any gifts for the same cation of smallpox. purpose which may be accepted by the Board 368 SMALLPOX AND ITS ERADICATION - \ Resolution WHA11.54, adopted at the Eleventh World Health Assembly in 1958 “Noting that smallpox still remains a very