Prime Time Replay:
Dr. Donald Henderson
on the World Health Organization
and disease eradication
MsgId: *breakthrough(1)
Date: Wed Aug 6 20:43:32 EDT 1997
From: moderator At: 152.163.206.33
Hi, I'm Madeleine Lebwohl, moderator of Breakthrough Medicine. Tonight I'll be speaking with Dr. Donald Henderson, who directed the World Health Organization's global campaign which successfully eradicated smallpox.Tonight Dr. Henderson will be joining me for an in-studio interview. Welcome, Dr. Henderson!
MsgId: *breakthrough(3)
Date: Wed Aug 6 20:57:07 EDT 1997
From: moderator At: 152.163.206.33
Dr. Henderson: Happy to say hello. I'm D.A. Henderson, I'm returning to Johns Hopkins from service in Washington for the last five years, and look forward to tenure as a professor concerned with vaccination issues and international health.
MsgId: *breakthrough(4)
Date: Wed Aug 6 20:58:03 EDT 1997
From: moderator At: 152.163.206.33
What projects are you working on right now?
MsgId: *breakthrough(5)
Date: Wed Aug 6 20:59:24 EDT 1997
From: moderator At: 152.163.206.33
Dr. Henderson: I chair the technical advisory group on immunization for the Pan American Health Organization. So we've been very much concerned, firstly, with the eradication of poliomyelitis in the western hemisphere, and we're very much the eradication of measles from the western hemisphere.In a meeting coming up in Guatemala next month, we will be discussing the question of adding other vaccines to the broader immunization program in the Americas, specifically the rubella vaccine (german measles vaccine), and the HiB (hemophilus) and influenzae vaccines.
The countries of the Americas have been extremely active and very progressive in implementing the immunization programs and this has been with the advice and support of the Pan American Health Organization, and the director of the immunization program, Dr. Ciro De Quadros. The countries meet on a periodic basis to look at what has been accomplished, and to decide on future activities that they may wish to undertake conjointly. These meetings have taken place for now twelve years, beginning in 1985 when the group decided to endeavor to eradicate poliomyelitis from the western hemisphere.
MsgId: *breakthrough(9)
Date: Wed Aug 6 21:05:23 EDT 1997
From: moderator At: 152.163.206.33
Is the population more educated now, and will that help your effort?
MsgId: *breakthrough(10)
Date: Wed Aug 6 21:07:00 EDT 1997
From: moderator At: 152.163.206.33
DAH: First of all, the governments themselves are more knowledgeable about vaccines and their advantages and are better able to undertake large scale programs than they have ever been, and at the same time they have done a good job educating their own populations about the advantages of the vaccines, and so the peoples in their own countries are far more receptive than they have ever been. Thus, at this time, it is much easier for them to look at the question of the addition of other possible vaccines than it has ever been before.
MsgId: *breakthrough(12)
Date: Wed Aug 6 21:09:30 EDT 1997
From: moderator At: 152.163.206.33
Is the prospect of increased health an obvious motivator no matter where these programs are presented, or do you need other motivations?
MsgId: *breakthrough(13)
Date: Wed Aug 6 21:11:02 EDT 1997
From: moderator At: 152.163.206.33
DAH: The vaccines are enormously powerful in preventing abnormalities and death, and in the case of the german measles vaccine, the objective is to prevent the mother from developing the disease, because the pregnant woman who contracts the disease may have a baby who has many abnormalities, including deafness and problems with sight, and many other problems.So this is a vaccine which is more important than preventing long term serious illness in children than preventing death. The HiB vaccine prevents middle ear infections, it prevents meningitis, it prevents pneumonia. Many of these diseases causing permanent abnormalities, if not death. Thus, the addition of these two vaccines to the others that are being given, could result in many children living healthier lives.
MsgId: *breakthrough(15)
Date: Wed Aug 6 21:14:16 EDT 1997
From: moderator At: 152.163.206.33
If we can look on the your landmark work with eradicating smallox, can we hope for any disease being similarly wiped out?
MsgId: *breakthrough(16)
Date: Wed Aug 6 21:16:12 EDT 1997
From: moderator At: 152.163.206.33
DAH: We are coming up to the twentieth anniversary since the last case of smallpox occurred. There were many people when that program began who doubted very much that it was possible to eradicate that disease, or, in fact, any disease. There was the belief that microorganisms have become so ingrained in nature in such a complex manner, that it would be impossible to eradicate the organism from its niche in nature.Fortunately, through a truly heroic team effort involving professionals from countries around the world, we succeeded in eradicating smallpox. It was an extremely difficult task, and looking back over that time I know there were a number of occasions in which we came very close to failing for a variety of reasons. On some occasions it was because of civil strife in a country, and when peace was made it was then possible to work. On some occasions resources were so meager that the program had to be slowed substantially, to the point that we wondered if it would succeed eventually. But eventually the many hurdles, the many problems, were overcome.
MsgId: *breakthrough(19)
Date: Wed Aug 6 21:20:23 EDT 1997
From: moderator At: 152.163.206.33
What was the worst hurdle in your effort -- the civil conflict that almost got in the way?
MsgId: *breakthrough(20)
Date: Wed Aug 6 21:22:21 EDT 1997
From: moderator At: 152.163.206.33
DAH: One of the most difficult periods in 1974, in Northern India. At that time we were experiencing some of the most serious epidemics that we had ever experienced. During that period the airlines went on strike, and then the railroads went on strike. The price of gasoline went very high, and then the health staff went on strike. We wondered if, as a result of this, smallpox was suddenly going to spin out of control. But fortunately, almost at the last moment, the health staff strike was settled, the program then began again, and one way or another they managed to find petrol, and vehicles, and kept things going. And by May of 1975, we found our last case in India.After India, the next major hurdle was Bangladesh, the country in Asia with smallpox. In India, in August of 1975, there was a major celebration which was India's independence day, and was also celebrated as the first day of independence of India from smallpox. The director general of the World Health Organization was with me at the celebration and we were on our way to the airport to fly to Bangladesh when we learned that the prime minister of Bangladesh, the father of independence of Bangladesh, had been assasinated with his family. The airport was closed, and so we could not fly to Bangladesh, and we were profoundly afraid that this would mean civil war in Bangladesh, and of course with that health activities would be seriously disrupted and we would see major epidemics of smallpox again. Miraculously, this did not happen. And after about two to three weeks, the staff was able to go back to the field and continue the eradication effort. And by October the last case was found and contained.
MsgId: *breakthrough(24)
Date: Wed Aug 6 21:30:29 EDT 1997
From: moderator At: 152.163.206.33
Did you have a lot of help from the Bangladesh people, that is, they were willing to bring sick children for treatment?
MsgId: *breakthrough(25)
Date: Wed Aug 6 21:33:05 EDT 1997
From: moderator At: 152.163.206.33
DAH: The Bangladesh people were most helpful, as people were in all countries. This was, after all, a disease which killed twenty percent of those who got the disease. There is no other disease which kills this high a percentage. In Bangladesh and in other countries, as we came toward the end, that is, when numbers of cases became very few, we began to offer a reward for reporting cases. This is an added encouragement because we knew that if we could find the cases quickly, we could vaccinate around the case, vaccinate the contacts of the case, and stop the spread of infection.
MsgId: *breakthrough(26)
Date: Wed Aug 6 21:35:59 EDT 1997
From: moderator At: 152.163.206.33
So what other diseases are being targeted for eradication now? Are there different diseases in different parts of the world?
MsgId: *breakthrough(27)
Date: Wed Aug 6 21:38:35 EDT 1997
From: moderator At: 152.163.206.33
DAH: There are two diseases targeted for global eradication at the present moment. One of these is called guinea worm, which properly is known as dracunculiasis. And the second is poliomyelitis. Let me talk about poliomyelitis first. In 1985, the countries of the Americas, decided to undertake poliomyelitis eradication, with a hope for a target date of December 1990. Under the guidance of the Pan American Health Organization, they did an outstanding job. And in August, 1991, the last case of poliomyelitis occurred. For three additional years the countries searched for cases and tried to find evidence of the wild polio virus, but they could find no trace of it.Meanwhile, in 1988, the World Health Assembly proposed a global program for poliomyelitis eradication, utilizing the strategy that was used in the western hemisphere, and that was accepted. That program has made very good progress in eliminating polio in many of the countries of the western pacific area, in northern Africa, in southern Africa, and of course in Europe. The hope is that eradication will be achieved by 2005. However, a very difficult task lies ahead because of the problems of civil disorder in a number of countries making it difficult to undertake vaccination or surveillance or any other operations.
MsgId: *breakthrough(32)
Date: Wed Aug 6 21:47:36 EDT 1997
From: moderator At: 152.163.206.33
What exactly is guinea worm, and why is it worthy of being targeted for eradication?
MsgId: *breakthrough(33)
Date: Wed Aug 6 21:50:40 EDT 1997
From: moderator At: 152.163.206.33
DAH: Guinea worm is a parasitic infection, which afflicts people through tropical Africa and parts of south Asia, specifically Pakistan and India. The parasite is acquired from drinking infected water. The organism makes its way down to the legs and becomes a very long worm and produced infections as it comes out of the skin and many peole will recall from reading the National Geographic, seeing pictures of villagers with a stick with they wind up a worm and sort of gradually pull it out from the skin. This is guinea worm.For people in the rural areas, the infection is painful, it is disabling, it prevents them from doing their farming and other chores. But by several mechanisms, one can do away with this problem. Specifically, by using a chemical to destroy basically the parasite in the ponds, by filtering the water before its consumed, and by treating those who have the infection. And in many cases, by providing the people wells, so they don't have the open ponds of water. And this is a program which has gone very well, and it is expected that this infection will be eradicated by the year 2000.
MsgId: *breakthrough(37)
Date: Wed Aug 6 21:55:47 EDT 1997
From: moderator At: 152.163.206.33
Were there any compliance issues as the vaccine campaign progressed?
MsgId: *breakthrough(38)
Date: Wed Aug 6 21:58:00 EDT 1997
From: moderator At: 152.163.206.33
DAH: Many people told us that there were large groups in different countries who would be resistant to vaccination, or who would refuse vaccination. In fact, however, we discovered that if we got the support of the village leaders, the school teachers, the religious leaders, there was a ready acceptance almost everywhere on the part of villagers. Originally we had hoped that the teams would be able to reach 80% of the people. But in fact we discovered that 90% acceptance was very common. The lesson is that if people are appropriately approached and it is explained to them, what you propose to do, that they are remarkably receptive.
MsgId: *breakthrough(40)
Date: Wed Aug 6 22:00:57 EDT 1997
From: moderator At: 152.163.206.33
Is vaccination going to continue to be the method for eradicating many diseases?
MsgId: *breakthrough(41)
Date: Wed Aug 6 22:02:43 EDT 1997
From: moderator At: 152.163.206.33
DAH: Vaccination is clearly the most cost effective procedure that we have in medicine for disease prevention and for eradication. We foresee over the next twenty-five years many more vaccines becoming available, and miracles being achieved far beyond even those which we have achieved to date.
MsgId: *breakthrough(42)
Date: Wed Aug 6 22:04:05 EDT 1997
From: moderator At: 152.163.206.33
Dr. Henderson, I wish you luck with these crucial projects that have saved so many lives.
MsgId: *breakthrough(43)
Date: Wed Aug 6 22:04:47 EDT 1997
From: moderator At: 152.163.206.33
DAH: Thank you for a pleasant hour.
MsgId: *breakthrough(44)
Date: Wed Aug 6 22:06:42 EDT 1997
From: moderator At: 152.163.206.33
Goodnight, from Breakthrough Medicine. Please join me next week when I speak with Shane Murphy, Ph.D., author of the book, "The Achievement Zone: 8 Skills for Winning All the Time from the Playing Field to the Boardroom." Dr. Murphy has served as sport psychologist for the U.S. Olympic Committee.
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