advanced search

<< Back To Home

The Role of Chance in Smallpox Eradication

Saturday, 1st of October 2016

The Role of Chance in Smallpox Eradication: A Personal View

Does chance favor the prepared mind, as Louis Pasteur said? The example of smallpox eradication casts some light on the answer to this question

There would have been no Jennerian vaccine had it not been for the chance observation by Jenner that English milkmaids previously infected with cowpox did not contract smallpox. That simple clinical observation by a country doctor led, finally, to the development of the first smallpox vaccine (http://www.sciencemuseum.org.uk/broughttolife/people/edwardjenner)

Fast forward to the multicountry measles/smallpox campaign launched in Nigeria and neighboring countries in the 1960s. All countries have agreed to participate except Nigeria. CDC sends Dr. George Lythcott to Lagos to negotiate Nigerian agreement. He goes from the health ministry to the foreign ministry, back and forth for a week. He is ready to give up and go back to Atlanta when he happens to meet the fiancée of General Gowon at a diplomatic reception. She invites him to her apartment to discuss smallpox. The following morning, the signature of the Nigerian president is on the agreement between CDC and the Nigerian government. (F. Fenner et al., Smallpox and its Eradication. Geneva: W.H.O., 1988, page 864).

Fast forward to the Nigerian civil war. In Biafra, logistics and transport are a mess. It is not possible to do mass campaigns of the entire population, so the smallpox teams identify the foci of active transmission and do ring vaccination around the cases. Thus, the birth of ring vaccination (surveillance and containment), which replaces mass vaccination as the winning strategy against smallpox (F. Fenner et al., op. cit., page 877).

Fast forward to Indonesia, which is making slow progress in identifying smallpox cases. Here is the W.H.O. account of development of the smallpox recognition card.

“Events which led to the development of the WHO smallpox recognition card and the use of schools in the search for cases in Indonesia occurred in Bandung. Among the many vaccinators engaged in search activities, there was one who recorded exceptional success in detecting outbreaks. Supervisors noted that, paradoxically, the vaccinator was considered to be one of the laziest workers – the last to leave for the field and the first to return home. When asked why he was so successful, he admitted that instead of visiting all the houses in a village, as instructed, he was visiting only the schools. There he showed children and teachers pictures of smallpox cases which appeared in a WHO teaching folder on smallpox diagnosis that had been prepared for Africa. Numerous case notifications were obtained with the minimum effort. . . . Programme staff suggested preparation of a single large picture of an Asian child with smallpox for use as a recognition card. Thus, the WHO smallpox recognition card was first prepared, encased in plastic for durability, and widely distributed around the world.” (F. Fenner et al., op. cit., page 651)

Fast forward to nomadic Somalia, where cultural reticence prevents full transparency between the community and W.H.O. Here is what happened in one nomadic community in Somalia.

“In March 1977, the suppression of information and concealment of cases continued to be widespread despite the new instructions of the Ministry of Health. One of the first to break this barrier was an ingenious Sudanese sanitarian, Mr. Abdul Gadir El Sid, who was serving as a WHO consultant. On entering a village for the purpose of investigating suspected cases, he saw several persons with facial pockmarks suggestive of recent smallpox but was confronted with unanimous denial by the villagers that cases had recently occurred. Taking over the vehicle from his driver, he deliberately drove it into deep mud. A large crowd came from the village to help to extricate the car, and among them were 4 persons with active smallpox.” (F. Fenner et al., op. cit., page 1052)

Chance favors the prepared mind. Chance favors the prepared program. Under the late, great D. A. Henderson, the global smallpox program looked for innovations and ramped them up worldwide through its tight network of national and international eradication experts.