What Can We Learn from Eradication of Smallpox?
The eradication of smallpox has been a great public health success over the last 30 or 40 years or so. Smallpox was responsible for 300 million–500 million deaths during the 20th century.
The eradication of smallpox has been a great public health success over the last 30 or 40 years or so. Smallpox was responsible for 300 million–500 million deaths during the 20th century. As recently as 1967, the World Health Organization (WHO) estimated that 15 million people contracted the disease, with 2 million dying that year.
After vaccination campaigns were conducted throughout the 19th and 20th centuries, smallpox was eradicated in the Americas in the 1950s but lingered in Africa and Asia until 1979. In 1966 an international team, the Smallpox Eradication Unit, was formed under the leadership of an American, Dr. Donald Henderson. The following year, the World Health Organization intensified the global smallpox eradication campaign by contributing $2.4 million annually to the effort, and adopted a new disease surveillance method.
Throughout the program, there were clear and stringent rules concerning vaccination, detection, and containment, matched by a fervent spirit of innovation and experimentation in the implementation of those procedures. I am told the program was run in an unusual, non-bureaucratic manner, quickly adapting new technology and lessons learned, cutting corners through the hierarchy and capitalizing on staff who were committed more than 100% to the program and its leadership.
I met the man behind this amazing success story, Dr. Henderson, at the Prince Mahidol Conference in January, were he was awarded with the Prince Mahidol Award, the most prestigious public health award in Asia Pacific.
Dr. Henderson described in his keynote speech how this endeavor to eradicate smallpox started and what the key factors for the success of the program were:
- Leadership: Involvement of government leaders at all levels, especially at the subnational level, and strong commitment at the program management level
- Strong workforce: Mobilization of more than 150,000 health workers, who administered the vaccine
- Quick adaptation of new technology: Countries developed capacity to mass produce high-quality freeze-dried vaccine and to administer the vaccine with a bifurcated needle and later jet injectors
- Quality control and standard operating procedures: Implementation of thorough quality control throughout the supply chain of the vaccine
- Monitoring and evaluation: Lessons learned from the field were quickly incorporated in the program design and local costumes and cultures were acknowledged.
- Intensified surveillance: Population in villages in which only one small pox case was reported, were immediately immunized and observed under a pending outbreak threat for several weeks.
- Easy access to the vaccination and other medicine: Vaccination campaigns were given at the point of care in the communities—the vaccine was brought to the people.
- Bear in mind also, this was back in 1970, when they were trying to coordinate this huge vaccination campaign operating from a small office of 10 staff at WHO in Geneva, without internet and fax, and dependent on unreliable phone lines.
When you listen to Dr. Henderson, you wonder why we struggle today in the times of instant messaging, emails, Skype, and social media to coordinate effectively and efficiently to eradicate, or at least control, other infectious diseases.
Maybe one answer is found in the statement by Halfdan Mahler, former WHO Director-General that the smallpox program was as “a triumph of management, not of medicine.”
It is said that at a meeting in Kenya in 1978 the then director-general, on announcing the end of smallpox, had turned to Dr. Henderson, and asked him which was the next disease to be eradicated. Henderson reached for the microphone and said that the next disease that needs to be eradicated is bad management.