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By LAWRENCE K. ALTMAN, M.D.
NEW YORK TIMES, OCT. 3, 2016
Dr. Donald A. Henderson receiving a smallpox vaccine. Dr. Henderson, who led the effort to eradicate the disease, died in August. Credit Reuters
When I worked at what is now the Centers for Disease Control and Prevention in Atlanta in 1964, my boss, Dr. Donald A. Henderson, sent me to West Africa to help with an immunization program aimed at eradicating measles in eight countries.
The Agency for International Development, which sponsored the program, had grievously erred in designing it and carrying it out, making it impossible to accomplish the mission. But Dr. Henderson, who died in August, saw a way to turn the fiasco into a victory. He forced AID to add smallpox vaccination to the immunization program.
That small achievement led to an even greater one. Eventually, from a small office at the World Health Organization, Dr. Henderson oversaw an army of thousands of lieutenants who wiped smallpox first from West Africa and then, in 1980, from the world.
His legions did what no other group of doctors has ever done: rid the world of a naturally occurring human disease. He was the overseer of what is perhaps medicine´s greatest triumph.
The vaccine prevented hundreds of millions of smallpox cases, although it sometimes caused fatal encephalitis and other serious complications. Now, with the disease gone, no one faces such risks, or bears scars from the smallpox vaccinations that were once required to enter grade school.
The path to this monumental public health victory was tortuous, full of mini disasters, bureaucratic quagmires, rivalries, skepticism and dissension. Dr. Henderson met it all with diplomacy, old-school epidemiology and cutting-edge technology.
His team freeze-dried a vaccine that Edward Jenner developed in England in 1796, so it no longer needed refrigeration, and adapted a two-pronged needle to simplify its application. The team also adopted a strategy of “ring vaccination” — identifying and isolating each case and vaccinating only those exposed to the infected individual, instead of immunizing the entire population.
I first met D.A. — everyone called him D.A. — in 1963, when I joined the epidemic intelligence service program at the C.D.C. As we chatted in a cafeteria line, D.A. raised the theoretical possibility of eradicating smallpox, a preventable but incurable scourge.
In medical school, none of my professors had ever broached the possibility of disease eradication. They rarely even spoke of smallpox, even though the disease has altered the course of history, killing hundreds of millions of people and blinding and scarring even more.
Before I left for West Africa on my measles mission, D.A. told me to learn about smallpox — a hint, I realized only later, that he planned to take on this fiend.
The measles vaccine was effective. But, as was all too evident after I arrived in West Africa, the number of children who received it was vastly reduced by various logistical problems, like limited communications and difficult travel.
The vaccine had to be kept cold and away from ultraviolet light, for instance. To deliver it to remote areas in the savanna and the Sahara, AID purchased huge trucks designed for American highways.
The trucks were too large to maneuver through ruts in the dirt roads and too heavy for the wooden planks that served as bridges. The agency also bought refrigerators that operated only in temperatures below 90 degrees and ran on butane. They were placed near the gasoline tanks on the trucks.
The only time one of those refrigerators was actually operating, it set off an explosion just after I exited a truck cab, injuring the driver. Had those refrigerators worked, we´d have had many blasts.
I cabled AID about the problems. The reply: Park the trucks in the shade to lower the temperature below 90. In the savanna, alas, the tallest trees were shrubs.
Exasperated, I wrote a cable requesting 10,000 trees. The language recalled something I might have written back when I was at The Harvard Lampoon. D.A. appreciated the humor; AID officials did not, but they needed C.D.C. support.
D.A. eventually goaded them into adding smallpox to the flailing measles program in West Africa. It would soon turn the tide against the disease, and in 1966, the World Health Organization approved its own global smallpox eradication program and appointed D.A. its director.
Soviet officials and the first director of the W.H.O. had long advocated a smallpox vaccination program, but the United States and many other countries opposed it, favoring malaria as the target. D.A.´s success in West Africa had a critical domino effect, however, convincing many skeptics that smallpox could be eradicated worldwide.
Since then, health workers have come close to ridding the world of just two other diseases: polio and Guinea worm (dracunculiasis). But after a two-year absence from Africa, polio has re-emerged in Nigeria, which joins Afghanistan and Pakistan as the only countries where the virus is spreading.
And the recent discovery of Guinea worm among many domestic dogs suggests the possibility it has found a new host, delaying the goal of making it the first parasitic disease to be eradicated worldwide. (One animal disease, rinderpest, caused by a viral cousin of measles, was eradicated in 2011.)
Many experts have wondered why the spectacular success with smallpox did not earn D.A.´s vaccinators, or the W.H.O., a Nobel Prize. One reason, a member of the committee that chooses recipients in the medicine category told me several years ago, is that the prize honors scientists for recent discoveries.
The smallpox eradication program did not qualify, then, because Jenner´s vaccine came 184 years earlier.
Over the years, D.A. and I sparred over the fate of the remaining stocks of smallpox virus in high-security laboratories in Russia and the United States. He ardently favored destroying them, in keeping with the original plan.
I favored keeping them, in case scientists someday needed to test a novel and presently unfathomable finding. D.A. and I traded our last emails in June, after he had reread several of my articles from India and elsewhere about the final efforts to eradicate smallpox.
He recalled the time I was trapped on a rooftop as the Ganges overflowed, and “the all but impossible problems of working in the summer heat of India, in the middle of floods while battling armies of mosquitoes.”
It may have been all but impossible, as he said. But it was also an era of great possibilities.
A version of this article appears in print on October 4, 2016, on page D3 of the New York edition with the headline: Comrades in the Smallpox Fight.