28 January 2009
Pearls from the WHO&#=
8217;s
“Smallpox and its Eradication”:
Lessons and Benefits,=
but
no Template for other Disease Control Campaigns
This third (3rd) in a series of pearls (insig=
hts)
from the 1988 World Health Organization (WHO)’s Red Book on “Sm=
allpox
and its Eradication” is taken from Chapter 31 “Lessons and
Benefits”.
=
<=
span
class=3DGramE>“The rapidity with which smallpox was finally eradicated
after so long a history of persistent transmission suggests that lessons ma=
y be
derived from the experience of the Intensified Programme to benefit other
initiatives in health and development. Most significant is the
extraordinary achievement which was possible when countries throughout the
world collaborated in the pursuit of a common aim, making use of the struct=
ures
of an international organization and acting under its auspices. This made it
possible for the necessary resources to be mobilized and applied to better
effect, for improved methods of management and epidemiology to be introduced
and widely applied, for vital modifications in strategy to be communicated
quickly, and for new and often very simple techniques suited to a
country’s capacities and characteristics to be introduced promptly. In
consequence, international confidence and accord were strengthened and a
foundation was laid for other community-wide health programmes.
=
T=
he
smallpox eradication programme, however, cannot serve as a template for oth=
er
disease control or eradication campaigns. Every disease has its own
epidemiological characteristics and methods for its control which require
strategies and tactics specific to it. Also, the approach taken to the
eradication of smallpox differed considerably from country to country and w=
as
continually modified to capitalize on an evolving understanding of smallpox
epidemiology and to deal with different local conditions. It is important a=
lso
to note that smallpox had a number of features which greatly facilitated
eradication. Most important is the fact that its severity and ability to sp=
read
in any part of the world commanded both the attention and the concern of he=
alth
authorities everywhere. It had no known animal reservoir; there were no
long-term carriers of the virus; and a single attack of the disease conferr=
ed
life-long immunity. The detection of cases was comparatively simple because=
the
rash was so characteristic and the persons with subclinical infections did =
not
transmit the disease. Finally=
, a
highly effective, easily administered and surprisingly heat-stable vaccine,
conferring long-term protection, was available by the time the Intensified
Programme started. Taken together, these characteristics are unique in rela=
tion
to human infections. Indeed, =
when
the goal of eradication from all countries of the world was decided upon, i=
ts
feasibility in most of the industrialized countries and some of the develop=
ing
ones had already been demonstrated.” (page
1346).
Daniel R. Lucey. MD.
EROne Institutes,
Adjunct Professor of Microbiology and Immunology
Website for this posting (requires Internet Explorer): www.BePast.org
e-mail DRL23@Georgetown.edu