SEC 2010 Symposium on Smallpox Eradication

24 – 27 August 2010 | Rio de Janeiro, Brazil

What is Smallpox?

A little girl being vaccinated in Colombia – now the need is no longer there. ©WHO/Almasy
Smallpox vaccination in a school in Colombia. ©WHO/Almasy
"VACCINE AGAINST SMALLPOX: PROTECT ALL YOUR FAMILY" said the poster displayed by a health worker in Colombia. He and his colleagues got the message across. ©WHO/Almasy
In smallpox outbreaks, the brunt of the disease invariably falls on young children. ©WHO/Wilkie
A curious boy looks at the arm of a little girl who has just been vaccinated. ©WHO/Satyan
Ciro de Quadros worked in the smallpox eradication program in Brazil before joining WHO and the program in Ethiopia, 1970-1976. ©WHO/Shafa
Freeze-dried smallpox vaccine ready for use. ©WHO/Sharma
A vaccinator at work in Dacca. ©WHO
Educational leaflets on smallpox, India. ©WHO/Mohr
A modern vaccine jet injector. ©WHO
A gun designed to save lives. The injector gun can safely vaccinate as many as 1000 people in an hour. ©WHO
Vaccination of a nomad girl. ©WHO
Vaccination techniques have been refined considerably during the last 10 year. Most recent is the bifurcated needle, first employed in 1968. ©WHO
Bifurcated needle became the principal instrument for vaccination in the campaign. One drop of vaccine clings between the two prongs and is sufficient for immunization. Actual size of needle is 2 inches (about 5 centimeters) long. ©WHO
Declaration smallpox eradication scroll. ©WHO
Smallpox is dead, 1980. ©WHO

Smallpox is an acute contagious disease caused by variola virus, a member of the orthopoxvirus family. From the time it was first recognized as a distinct disease until the late 19th century, smallpox was universally associated with a high fatality rate. Smallpox is classified into two strains, “variola minor” and “virola major” or classic smallpox. During the first half of the 20th century, nearly all cases of smallpox in Asia and most parts of Africa were of the variola major strain while variola minor was endemic to certain countries in Europe and the Americas.

Smallpox Eradication Historical Milestones

570 CE - The word variola used for first time by Bishop Marius of Avenches, Switzerland.

910 CE - First medical report on smallpox, Treatise on Smallpox and Measles, published by Persian scholar Rhazes.

1721 - Lady Mary Wortley Montague, wife of British ambassador to Turkey, learns about variolation in Turkey and introduces it to England.

1763 - Allegedly the first instance of biological warfare when Lord Jeffrey Amherst approves distributing blankets from smallpox patients to Native Americans.

1796 - Dr. Edward Jenner uses cowpox to vaccinate a human for the first time.

1798 - Dr. Jenner publishes his findings on vaccination.

1800s - Increasingly widespread use of vaccine in Europe and U.S. reduces smallpox threat.

1923 - The Russian government makes smallpox vaccination mandatory.

1950 - PAHO approves smallpox eradication plan for the Americas.

1950s - Freeze-dried vaccine developed by Lister Institute in England.

1958 - Soviet Epidemiologist Viktor Zhdanov proposes global eradication of smallpox to the 11th World Health Assembly (WHA).

1959 - 12th WHA approves a USSR resolution to eradicate smallpox.

1965 - President Lyndon Johnson (USA) endorses smallpox eradication.

1966 - WHA approves annual budget to support 10-year smallpox eradication and creates Smallpox Eradication Unit in Geneva with Dr. D.A. Henderson as chief.

1967 - 20th WHA adopts resolution for global eradication of smallpox.

1967 - Ben Rubin from Wyeth Laboratories (USA) invents the bifurcated needle.

1970 - Last case of smallpox occurs in West Africa.

1971 - Last case of smallpox occurs in Brazil.

1975 - Last case of variola major in the world - 3-year-old girl, Rahima Banu, from Bhola Island in Bangladesh.

1977 - Last case of variola minor in the world - Ali Maow Maalin in Merka, Somalia.

1978 - A laboratory-associated case of smallpox occurs in Birmingham, England with one death. The last non-naturally acquired case of smallpox in the world.

1980 - The 33rd WHA formally declares smallpox eradicated globally.

1988 - WHO's Smallpox Eradication Unit is closed.

1991 - Smallpox virus DNA is mapped containing 186,000 pairs of DNA with 187 genes.

2010 - 30th Anniversary of the WHA Declaration of the Eradication of Smallpox with the unveiling of Smallpox Eradication Commemorative statue on the grounds of the WHO, Geneva, Switzerland.

Dr. Ciro de Quadros’ Story – The Smallpox Eradication Program in Ethiopia

Now and Then Sabin Executive Vice President Dr. Ciro de Quadros served as the World Health Organization (WHO) Chief Epidemiologist for the Smallpox Eradication Program in Ethiopia from 1970 to 1976.

Dr. de Quadros arrived in Addis Ababa, Ethiopia in 1970, when the nation, under the monarchy of Emperor Haile Selassie, had a population of 25 million people primarily residing in the rural countryside. In 1970, Ethiopia had 84 hospitals, 64 health centers, less than 400 physicians and approximately 2,800 other health staff to serve the entire population.

At the start of the program, smallpox vaccination was essentially unknown by Ethiopians. Most of the resources of the Ethiopian Ministry of Health were dedicated to malaria eradication, and the government did not believe that Ethiopia had a smallpox problem.

As a result, when a WHO team went to Addis Ababa to plan the smallpox eradication program they estimated that very few cases would be found. In fact, by the end of 1971, when the first year of the program was completed, Dr. de Quadros and his colleagues had reported over 26,000 cases.

By 1972 that number had been reduced to 16,000 and to approximately 5,400 in 1973. In 1974 and 1975 cases remained relatively stable at around 4,000, diminishing to 915 cases in 1976 with the last case in August of that year.

Ethiopia was the first country in the world to start the smallpox program using a strategy of “surveillance and containment,” and not mass vaccination which was never used. The operational plan that was put together consisted of the search for cases and outbreaks (surveillance), followed by the vaccination of all contacts of the cases (containment).

“The paramount factor that made the program successful was the incredibly high quality and dedication of the people assigned to the program,” said Dr. de Quadros in a presentation to the The Wellcome Trust Centre for the History of Medicine at University College London. “They were trained in basic epidemiological principles for the eradication of smallpox and disease control and were integrated with the rudimentary primary health care infrastructure existent in the country, which received support from the program.”

Selected Speakers

Program Committee

Ciro de Quadros, M.D., M.P.H (Co-chair)
Executive Vice President
Albert B. Sabin Vaccine Institute (SVI)
Washington, D.C. USA

Donald P. Francis, M.D., D.Sc
Executive Director
Global Solutions for Infectious Diseases
San Francisco, CA USA

Joel G. Breman, M.D., D.T.P.H. (Co-chair)
Senior Scientific Advisor
Fogarty International Center
Bethesda, M.D. USA
D.A. Henderson, M.D., M.P.H.

Distinguished Scholar
University of Pittsburgh Medical Center
University of Pittsburgh
Baltimore, M.D. USA

Paulo Gadelha, M.D.
President
Fundação Oswaldo Cruz

David Heymann, M.D.
Chairman of the Board
Health Protection Agency
London, United Kingdom

Jon Andrus, M.D.
Pan American Health Organization
Washington, DC USA
Gilberto Hochman, Ph.D.

Pesquisador (Investigator/Researcher)
Fundação Oswaldo Cruz
Rio de Janeiro, Brazil

Isao Arita, M.D.
Kumamoto City, Japan

Zdeněk Ježek, M.D.
Prague, Czech Republic

Ravinder Nath Basu, M.D.
New Delhi, India

T. Stephen Jones, M.D., M.P.H.
Florence, MA USA

Sanjoy Bhattacharya, M.D.
The Wellcome Trust Centre for the History of Medicine
University College of London
London, UK

Jeffrey P. Koplan, M.D., M.P.H.
Vice President for Global Health
Director, Emory Global Health Institute
Emory University
Atlanta, GA USA

Paulo Buss, M.D., M.P.H.
Center for International Relations
Fundação Oswaldo Cruz
Rio de Janeiro, Brazil

Svetlana Marennikova, Ph.D.
Professor of Virology, Honored Scientist of Russia,
Member of WHO AD Hoc Committee on Orthopoxviruses
Moscow Russia

Daniel J. Carucci, M.D.
Vice President for Global Health
United Nations Foundation
Washington, DC USA

Jean Jacques Muyembe-Tamfun, Ph.D.
Director of the Institut National de Recherche Biomédicale
Kinshasa, Democratic Republic of Congo

Peter Carrasco
Policy Advisor - Vaccine Security
Department of Immunization, Vaccines & Biologicals
World Health Organization
Geneva, Switzerland

Jean Roy
Emory Global Health Institute
Emory University
Atlanta, GA USA

Rodrigo Corrêa, Ph.D.
Director
Fundação Oswaldo Cruz
Bela Horizonte, Brazil

Sergei Shchelkunov, Ph.D.
State Research Center of Virology and Biotechnology “Vector”
Koltsovo, Russia

Mahendra Dutta M.D.,D.P.H.,Dip.Epid.
Haryana, India

Professor Emeritus Umaru Shehu CON, CFR, FAS
Chairman, Governing Board
National Agency for the Control of AIDS (NACA)
Abuja, NIGERIA

Joseph J. Esposito, Ph.D.
President, JGL Tech-consult
Atlanta, GA USA

Gassan D. Suleimanov, M.D.
Moscow, Russia

Frank Fenner, M.D.
The John Curtin School of Medical Research
Acton, Australia

Daniel Tarantola, M.D.
Professor of Health and Human Rights
School of Public Health and Community Medicine
The University of New South Wales
Sydney, Australia

Stanley O. Foster M.D., M.P.H.
Professor of Global Health
Rollins School of Public Health
Emory University
Atlanta GA USA

Oyewale Tomori, Ph.D.
Redeemer's University
Ikeja, Lagos State