10. the intensified programme, 1967-1980 443 · tions. mindful of this experience and doubt-ful of...

Plate 10 .12 . A : Zdenek Jeiek (b . 1932) was attached to the WHO Regional Office for South-East Asia in1972, working for smallpox eradication in India . He later served in Somalia, before joining the Smallpox Eradi-cation unit at WHO Headquarters in 1980 and succeeding Arita as Chief of the unit in 1985 . B : Ehsan Shafa(b . 1927) was the smallpox eradication adviser in the Eastern Mediterranean Region of WHO, 1967-1971, andthen served with the Smallpox Eradication unit at WHO Headquarters until 1977 .

gists from a number of countries who wereinterested in the programme and aware of itsdemands and who screened and referredformer students and colleagues . Such epide-miologists included Dr Karel Raska, Czecho-slovakia ; Dr Jan Kostrzewski, Poland ; DrHolger Lundbeck, Sweden ; Dr ViktorZhdanov, USSR ; and Dr Paul Wehrle, USA .From early in 1972, when smallpox epidemicsunexpectedly occurred in Bangladesh, until1977, Dr David Sencer, then Director ofCDC, made available the services of 5 full-time CDC staff, and from 1974, the HighInstitute of Public Health in Alexandria,Egypt, provided a number of facultymembers and former students .

As the programme progressed, the numberof capable staff with field experience gradu-ally increased, and those who had successfullyworked in their own national programmesWere recruited for service in other countries .These included staff from Afghanistan,Bangladesh, Brazil, India, Indonesia, Nepal,Pakistan, the Sudan, Togo and Yemen .

International volunteers contributed sig-nificantly, both while serving as such andsubsequently when recruited as consultantsor staff. Arranging such volunteer supportwas difficult, however, because WHO policyuntil the mid-1970s was that volunteerassistance had to be arranged strictly betweenrecipient and donor governments, WHO staff

10. THE INTENSIFIED PROGRAMME, 1967-1980 443

not being allowed to assist in the process .Unofficial contacts and private correspon-dence, however, served to facilitate theassignment of United States Peace Corpsvolunteers in Afghanistan, Ethiopia andZaire ; volunteers from Japan and Austria,who served in Ethiopia ; and British volun-teers from OXFAM (a British private chari-table organization), who worked in India andBangladesh. Regrettably, an offer by Sweden,in 1970, to assign young medical officers atSwedish government expense to WHO itselfhad to be rejected by the Organization forpolicy reasons .

Until 1973, international staff assigned to acountry rarely numbered more than 1-4, withthe exception of large countries and thosewith an especially difficult terrain and ashortage of national personnel Afghani-stan, Bangladesh (from 1972), Ethiopia,Nigeria and Zaire. From 1973 onwards,increasingly large numbers of internationalstaff worked in Bangladesh and India andlater in Ethiopia and Somalia as more fundsbecame available and efforts were intensifiedto achieve eradication in the shortest possibletime. Throughout the course of the globalprogramme, however, international staff ofall types at any given time never numberedmore than 150. In all, 687 WHO staff andconsultants from 73 different countries even-tually served in the programme for periods

44 4

SMALLPOX AND ITS ERADICATION

ranging from 3 months to more than 10years ; approximately 125 others served withthe programme under bilateral agreements .Most of the staff were less than 40 years of ageand some less than 30, youth being anadvantage where living and travelling condi-tions were difficult .

Although international staff were few,they played an important role in sustainingnational government support, providing pro-gramme continuity where national leader-ship changed for political or other reasons,and expediting the transfer of new techniquesfrom one programme to another . In retro-spect, it may be said that few nationalprogrammes achieved much success whereinternational staff were of poor quality, butnational staff, given the necessary supportand encouragement, showed themselves topossess a skill and dedication which equalledand often exceeded those of the internationaladvisers .

OBTAINING NATIONAL AGREE-MENTS TO UNDERTAKE

PROGRAMMES

Although commitments assumed by gov-ernments by virtue of votes in favour ofresolutions at the World Health Assemblywere morally binding, WHO could not forcegovernments to undertake programmes .Thus, although the Intensified SmallpoxEradication Programme was unanimouslyapproved by the Health Assembly, onlycertain countries were, in fact, then preparedto undertake eradication programmes-much as had been the case during the period1959-1966. Some lacked resources, whileothers considered that other health problemswere of higher priority. Universal participa-tion was essential if the programme was tosucceed but, as described earlier, WHO's rolein actively promoting and advocating aparticular programme in all countries was anunaccustomed one. Malaria eradication wasthe only other programme in which this hadbeen attempted but, in that programme, thenecessary but substantial additional nationalcosts had distorted health allocations, and theextent to which its secondary objective, theimprovement of basic health services, hadbeen attained had fallen far short of expecta-tions. Mindful of this experience and doubt-ful of the feasibility of smallpox eradication,

the Director-General cautioned his regionaldirectors, at a meeting immediately after the1966 World Health Assembly, against ap-pearing to impose a smallpox eradicationprogramme on any country . Thus, in 2regions, Africa and South-East Asia (unfor-tunately also those most seriously affectedby smallpox), the regional directors did notinitially promote smallpox eradication pro-grammes, assistance being provided only tocountries specifically requesting it . In theRegion of the Americas and the EasternMediterranean Region, however, eradicationprogrammes were actively promoted fromthe beginning.

In the Americas, smallpox eradication wasnot a new objective, a regional eradicationprogramme having been in existence since1950 (see Chapter 9) . A Regional Adviser onSmallpox Eradication, Dr Bichat Rodrigues,was appointed in 1966 to coordinate theeffort, and Brazil, the only endemic country,committed itself to a national smallpoxeradication programme employing whatwere then the new jet injectors (see Chapter12). Vaccination campaigns in many othercountries in South America began soonthereafter . In the Eastern MediterraneanRegion, there were then 3 endemic coun-tries-Ethiopia, Pakistan and Yemen-andthere, also, an adviser on smallpox eradica-tion, Dr Shafa, was immediately appointed .He successfully promoted programmes inPakistan, Yemen and other countries of theregion although, for reasons beyond hiscontrol, he was unsuccessful in Ethiopia, inwhich a programme did not begin until 1971(see Chapter 21) .

In the South-East Asia Region, the Re-gional Director shared the Director-Gener-al's belief that eradication represented anunattainable goal, given the stage of develop-ment of national health services (see Chapter9). Responsibility for smallpox eradicationwas assigned to a 2-man intercountryadvisory team which dealt with other com-municable diseases as well and whose budgetfor travel was small . Little was done in theRegion until Dr Herat Gunaratne was electedRegional Director in 1968 ; coming from SriLanka, a country which had eliminatedendemic smallpox decades before, he saw noreason why this could not be achievedelsewhere. He therefore made the inter-country team, Dr Keja and Dr Louis Grem-liza, responsible solely for smallpox eradica-tion and, from the time of his election, played

"At a lime of pessimism and unease, when the very notion of medical progress isbeing increasingly questioned, it is heartening to know that we stand poised for atriumph as great as any in the entire history of medicine: the total global eradi-cation of smallpox" . British Journal of Hospital Medicine, September 1975 .

The triumph belongs to an exceptional group of national workers and to a dedicatedinternational staff from countries around the world who have shared privations

and problems in pursuit of the common goal

SMALLPOX TARGET ZERO

To

one of the international staff who assisted the World Health Organization in thishistoric venture - the ORDER OF THE BIFURCATED NEEDLE is given as

recognition of participation in this great achievement.

Geneva, 1976

an active role in encouraging national pro-grammes. The response was generally enthu-siastic and within a year effective pro-grammes were in progress in all endemiccountries of the region except India, wherethe programme started later (see Chapter 15) .

In the African Region, by late 1966, anumber of countries had already committedthemselves to national smallpox eradicationprogrammes . These included the 20 countriesof western and central Africa which wereparticipating in the smallpox eradication andmeasles control programme being carried outwith the assistance of the USA ; Zambia,which had begun a national vaccinationcampaign in 1966 because of epidemicsmallpox ; and Zaire, whose WHO-supportedactivities were then coordinated by GenevaHeadquarters. The other African countriesdid not officially express any interest in 1966and early in 1967 . This was disturbing to thestaff in Geneva, but also puzzling becausefunds were then available to meet all the costsof the programmes except salaries for thecomparatively small number of nationalpersonnel who would be required. Because


Plate 10 .13 . The contribution of the international staff who participated in the eradication of smallpox wasgiven sincere if informal recognition by their promotion to the mock "Order of the Bifurcated Needle",accompanied by an official-looking certificate and a hand-made lapel pin . The pins (inset) were fashioned frombifurcated needles in the form of an "0" to symbolize "Target Zero", the objective of the programme .

WHO was prepared to provide vaccine free ofcharge and because many countries alreadyemployed smallpox vaccinators, it was actual-ly cheaper for most of them to participate inthe eradication programme than to continuesmallpox control activities. They failed toexpress interest, as was later discovered,because no effort was made by the RegionalOffice to encourage programmes, acquaintnational authorities with the programme'sbudgetary implications, or indicate theamount of support which could be providedby WHO ; instead, the national authoritieswere expected to request WHO's assistanceon their own initiative . The WHO represen-tatives in the countries, as well as Ladnyi,then intercountry smallpox adviser for EastAfrica, were informed of this policy inSeptember 1966 . In the spring of 1967, theproblem was resolved fortuitously when amember of the Headquarters Smallpox Eradi-cation unit was given permission to visitseveral of the countries for the purpose ofgathering information for the Director-General's report to the 1967 World HealthAssembly. Although he was forbidden to

4 4 6


suggest to any country that a programmeshould be undertaken, he made the healthauthorities aware of the nature of theprogramme and the resources available and,within weeks, letters requesting WHO assis-tance were received from almost all of them .

By the summer of 1969, smallpox eradica-tion programmes had begun in all theendemic countries in Africa except SouthAfrica, Southern Rhodesia (now Zimbabwe)and Ethiopia. WHO then had no officialrelations with the first two of these, SouthAfrica having ceased to participate in theOrganization and Southern Rhodesia beingtechnically still a colony of the UnitedKingdom, although it had unilaterally de-clared independence. Visits by WHO staffwere not permitted and little informationcould be obtained about the status of small-pox or their programmes. However, neitherwas thought to represent a serious impedi-ment to eventual global eradication becauseneither officially reported many smallpoxcases and their health services were compara-tively well developed . Both began specialprogrammes in 1970 (see Chapter 20), stimu-lated largely by reports in the Weekly epidemi-ological record, which described excellent pro-gress in smallpox eradication elsewhere inAfrica but noted the lack of information fromSouth Africa and Southern Rhodesia . Thethird country, Ethiopia, although in Africa,was served (until late in 1977) by theRegional Office for the Eastern Mediterran-ean and presented quite a different problem .Smallpox was widely endemic and healthservices were few, but malaria eradicationstaff and their international advisers, fearingthat another programme would be a harmfuldistraction, persuaded government officialsto refuse to discuss with WHO the implica-tions of a smallpox eradication project . Notuntil late in 1969 did the government permitHenderson and Dr Shafa to visit the country .At that time, Ministry of Health officialsdeclined to participate but the Emperorhimself, who by chance had heard about theprogramme, intervened to commit thegovernment and, in 1971, the last of theprogrammes in the endemic countries began(see Chapter 21) .

Thus, although many countries needed tobe encouraged and persuaded to undertakesmallpox eradication programmes, these had,in fact, been initiated in all endemic countrieswithin 5 years of the 1966 decision . It wasquite another problem to ensure that the

various governments were sufficiently com-mitted for eradication of the disease to beachieved .

SUSTAINING GOVERNMENTINTEREST AND COMMITMENT

A continued high level of interest andsupport for the eradication programme wasdifficult to sustain in many countries, just asit was in WHO. Changes in governmentsand/or senior health personnel were oftenassociated with differences in priorities andin levels of commitment. Smallpox was butone of many problems competing for atten-tion and resources and, in countries in whichthe mild variola minor form was prevalent, itwas understandably not of high priority.After the last known cases had occurred,resources were particularly difficult to obtainfrom recently endemic and donor countries,as well as from WHO itself, in order tocontinue surveillance and thus permitcertification .

Role of the World Health Assembly

The World Health Assembly, convenedeach year for a period of several weeks, was aparticularly important opportunity for pro-moting and sustaining interest in the small-pox eradication programme. Senior healthofficials from all Member States attended and,in addition to reviewing the proposed WHObudget, discussed the Organization's overallprogramme of work as well as specificprogrammes, such as that for smallpoxeradication . During the debate, delegatesfrequently described what their own coun-tries were doing, some asked questions of atechnical nature and others took the opportu-nity to announce voluntary contributions .The Intensified Smallpox Eradication Pro-gramme, if included as an agenda item, mightbe discussed for 2-4 hours or more . Such adiscussion served to focus the attention ofhealth officials on the subject, and importantprinciplessuch as the role of surveillanceand the need to use only freeze-driedvaccine-could be emphasized by the Secre-tariat. It also enabled government officials tohear what were often heartening or optimis-tic reports of progress in other countries,causing them to reexamine their own pro-grammes. If, however, smallpox eradicationwas not included in the agenda as an item for

debate, it could still be discussed when theoverall programme of the Organization wasconsidered, but it was unusual for manydelegates to prepare themselves to speak onthe topic and the debate was usually brief .

Because the Health Assembly had identi-fied smallpox eradication as a priority pro-gramme of the Organization and it had beenon the agenda each year from 1959 to 1967,the Smallpox Eradication unit staff assumedthat the topic would continue to be an annualsubject for debate on which the Director-General would provide a special report to theHealth Assembly . From 1968 onwards, how-ever, it began to be omitted from the provi-sional agenda . The resolution on smallpoxeradication adopted by the Twentieth WorldHealth Assembly (1967), called only for theDirector-General "to report further" onsmallpox eradication to the Executive Boardand the Health Assembly . "Further" was inter-preted to mean at some time in the future andthe topic was omitted from the provisionalagenda of the Twenty-first World HealthAssembly (1968), an action which was re-versed at the request of the USSR . Resolu-tions adopted at the 1969, 1971, 1972, 1976and 1977 Health Assemblies called specifical-ly for special reports to each of the subsequentones and for smallpox eradication to beincluded in their agendas . In the other yearsuntil 1977, when transmission was interrupt-ed, smallpox eradication was the subject only


of a brief general discussion in the context ofthe overall WHO programme. A report bythe Director-General was nevertheless pre-pared and kept in readiness in case one wasrequested by delegates . To it was attached acomprehensive review of the programme'sprogress and status that was published twice ayear in the Weekly epidemiological record tocoincide with the January session of theExecutive Board and with the Health Assem-bly. Although the report was not to bedistributed unless requested by delegates, theinterest expressed, particularly by two dele-gates, one from the USSR and the other fromthe USA (Dr Dmitrij Venediktov and DrPaul Ehrlich, Jr, respectively), ensured that itwas distributed and the programme discussed .

Surveillance Reports

Regularly published surveillance reports,both international and national, were anessential component of the surveillance pro-cess and, as experience had demonstrated inother disease control programmes, were alsoimportant in stimulating and sustaining theinterest of those concerned with the pro-gramme . Such reports documented thenumbers of cases reported weekly by adminis-trative area, charted trends in incidence andin the progress of the programme, anddiscussed alternative strategies and tactics in

Plate 10 .14 . Two delegates to the World Health Assembly and members of the Executive Board of WHOwho were strong advocates of smallpox eradication . A: S . Paul Ehrlich Jr (b . 1932), Surgeon General of theUnited States Public Health Service . B : Dimitrij D . Venediktov (b . 1929), Deputy Minister of Health of the USSR .

4 4 8


different areas . The first WHO surveillancereports on smallpox eradication were issuedin September and December 1967, and fromMay 1968 onwards, they began to be pub-lished every 2-3 weeks in the Weekly epidemi-ological record, some 5000 copies being distrib-uted to health officials and others throughoutthe world . The system was not establishedwithout difficulty, however, as is discussedlater in this chapter in the section entitled"International surveillance reports". TheWHO Regional Office for South-East Asiaalso issued surveillance reports from 1974onwards, and national surveillance reportswere published monthly and sometimesweekly or every 2 weeks in a number ofcountries .

In addition to providing information towidely scattered health staff, the reports alsoserved to inform both public officials and thepress, sometimes with unexpected conse-quences. When, in Brazil, Ethiopia and India,for example, better surveillance and im-proved reporting were accompanied bymarked increases in the numbers of notifiedcases, national officials and the press ex-pressed concern, and even alarm, althoughthe increases were attributed, at least inpart, to better reporting . Greater politicalcommitment and increased resources soonfollowed . In other countries, interest in theprogramme grew significantly when nationalofficials read of more satisfactory progressbeing made in other countries, some of whichthey believed to have health services inferiorto their own .

Interregional and Intercountry Meetingsof Smallpox Eradication Staff

Meetings of senior staff from differentnational programmes also served to sustainand stimulate the interest of governmentsand staff while bringing to their notice thenew observations which were being made .The WHO Headquarters budget provided forat least one such meeting a year, the venuechanging from year to year, as did theparticipants (Table 10.2). In addition, overthe period 1967-1972, CDC supported ayearly conference for the countries of westernand central Africa .

The first of these meetings was held inThailand in 1967 for countries in easternAsia. At first they were largely devoted to thepresentation of reports on national pro-grammes by the respective national directors ;over time, their nature gradually changed andeach country was asked to present papersillustrating specific findings, the outcome ofparticular strategies and interesting newapproaches . The ensuing discussions made itpossible to determine whether the observa-tions made in a particular national smallpoxeradication programme were of relevance tothe others. Most of these reports weredistributed by WHO to all concerned withsmallpox eradication through the specialWHO/SE, SE and SME series of mimeo-graphed documents (see References : WHOdocuments) ; some were also published in themedical literature.

Table 10.2. WHO seminars and meetings on smallpox eradication, 1967- 1978 (excluding those associatedwith certification of eradication)

a Participants included national programme staff and WHO smallpox advisers and other smallpox eradication staff from the regionaloffices and WHO Headquarters. Advisers from the regional offices in the 4 endemic regions were invited to all meetings from 1967 to 1970and to the 1972 meeting in India .

Date Country inwhich held Participantsa

December 1967 Thailand 13 countries of South-East Asia, Eastern Mediterranean and Western Pacific RegionsNovember 1968 Zaire 1 1 countries of southern and eastern AfricaMay 1969 Nigeria 18 countries of western and central Africa (joint seminar with CDC)November 1969 Pakistan 1 I countries of Eastern Mediterranean and South-East Asia RegionsDecember 1970 India I I countries of South-East Asia, Eastern Mediterranean and African RegionsSeptember 1972 Ethiopia 4 countries of eastern AfricaNovember 1972 India 5 countries of South-East Asia RegionNovember 1972 Pakistan 4 countries of Eastern Mediterranean RegionSeptember 1973 Ethiopia Ethiopia and WHO Eastern Mediterranean Region smallpox eradication advisersNovember 1973 Pakistan Pakistan and WHO Eastern Mediterranean Region smallpox eradication advisersAugust 1974 India Bangladesh, India and NepalJanuary 1976 Nepal 6 countries of South-East Asia RegionMarch 1977 Kenya 4 countries of eastern AfricaSeptember 1977 Kenya 5 countries of eastern AfricaApril 1978 Kenya 5 countries of eastern Africa and the Eastern Mediterranean Region

Plate 10.15 . Participants in the first interregional seminar on smallpox eradication held in Bangkok, Thailand,11-16 December 1967 . Left to right, front row : A. M. Khan (Pakistan), A . R . Rao (India), M . K . Singh (India),S. A . Mallick (Pakistan), D . A. Henderson (WHO), E . Na Bangxang (Thailand), S. Falkland (WHO), J . J . Dizon(Philippines), I . F . Setiady (Indonesia), U Thaung (Burma) ; middle row: Z . Rahman (Pakistan), C . Rubinstein(WHO), C . H . James (United Kingdom), J . Singh (Malaysia), K . S . Ramakrishnan (India), G . P . Nikolaevskij(WHO), W . H . Foege (USA), J . Keja (WHO), B . Ignjatovic (WHO), F . G . L . Gremliza (WHO), B . Wirjodipoero(Indonesia), J . C . Pitkin (WHO), Khin Mu Aye (WHO), K . Chatiyanonda (Thailand), S . Somachai (Thailand) ;back row: C. Patanacharoen (Thailand), A . Prajapati (Nepal), J . S. Copland (WHO), T . M. Mack (USA),G. H. Waheed (Afghanistan), B . Chantasut (Thailand), E . Shafa (WHO), R. M . Lyonnet (WHO), Y . K . Subrah-manyam (India), S . Singh (WHO), P . Tuchinda (Thailand), T. Phetsiriseng (Lao People's Democratic Republic),N . D . Tiep (Viet Nam), P . Kunasol (Thailand), C . Debyasuvarn (Thailand) .

The meetings had both tangible andintangible benefits . Several specific changesin programmes can be associated with themIndonesia's full commitment to smallpoxeradication followed the 1967 meeting inThailand ; agreements to grant national sur-veillance and vaccination teams free passageacross specified international borders, a hith-erto unprecedented occurrence, followed the1968 conference sponsored by CDC in Coted'Ivoire and the 1973 meeting in Ethiopia ;and India's decision to adopt the surveil-lance-containment strategy and to undertakean intensified programme followed the 1972meeting in New Delhi .

Use of the Mass Media

The Smallpox Eradication unit staff ac-tively sought publicity for the programme innational and international media, believingthat it was important to make what washappening in the programme widely knownto potential donors and to those in theendemic countries. For many sectors of


government, this was a natural and logicalapproach but there was then, both in WHOand in many countries, a reluctance on thepart of physicians and other health personnelto meet representatives of the mass media orto use the media except to convey traditionalhealth education messages . The very smallstaff and limited programme of WHO'sDivision of Public Information at that timewas a reflection of this attitude .

The publication of the semi-annual sum-maries of progress in smallpox eradication inthe Weekly epidemiological record provided suit-able occasions for press conferences, as did theoccurrence of the last cases of smallpox inlarge countries and the certification oferadication in each of the countries andRegions. Efforts to obtain publicity were notwithout their embarrassing moments, how-ever, the most awkward occurring on 14October 1975, when Henderson, then on avisit to New York City, announced at a pressconference that 8 weeks had elapsed since thelast case of smallpox in Asia and, in view ofthe extent and effectiveness of surveillance,confidently stated that the last case of variola

4 5 0


major had been seen . Only 4 days later,however, another outbreak was found inBangladesh (see Chapter 16) .

As the programme progressed, increasingattention was given to contacts with themedia (see Plate 10 .16), particularly as theneed for voluntary contributions becamemore urgent . Geneva was not so important anews centre as New York, in which therewere more correspondents from many morecountries. Fortunately, WHO maintained asmall liaison office at the United Nations in

New York with two public informationofficers, Ms Joan Bush and Mr Peter Ozorio,who were particularly effective in interestingthe media in the programme. Among theunique ideas which they fostered were trans-atlantic press conferences, one in 1974, inwhich science writers and correspondents inNew York and Washington interviewedHenderson in Geneva, and a second, in 1975,in which science writers in London and DrNicole Grasset, the adviser on smallpoxeradication in the South-East Asia Region,

Plate 10 .16 . A : Lawrence K . Altman (b . 1937), correspondent for the New York Times, had been an epidemio-logist with the measles control programme in western Africa in 1964-1965 . B: James Magee (b . 1929) was thepublic information officer with the Smallpox Eradication unit, 1978-1980 . C and D : Joan Bush (b . 1928) andPeter Ozorio (b . 1928) served in New York as public information officers attached to the WHO Liaison Officewith the United Nations .

WWW" ,

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radtcalion of Smallpox Uaaiosinnosolo easode vlrueta en el mundo

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Erradicada la virue a

Smallpox virus escapes in England ;'extinct' disease rears its ugly head

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l a variole en Grande-Bretagne30$ do panique, recommande l'O .M.S .

10. THE INTENSIFIED PROGRAMME, 1967-1980

a bataillecontre la variolea ete gagnee

Plate 10.17. A montage of newspaper articles published in 1978 .

answered questions from New Delhi, India .

1974, the most critical year for smallpoxEspecially extensive and helpful press eradication in Asia (see Chapters 15 and 16) .

coverage was provided twice during the In that year, a large number of correspon-programmein 1974 and 1978. The first dents, who had come to India to report on therelated to epidemic smallpox in India during

detonation for the first time of an Indian

451

4 52

Publicizing the Programme

Special issues of the WHO magazine World health, stamps and medals served to publicizethe programme and its accomplishments . In addition to the special issues of World health in1965 on the theme "Smallpox : Constant Alert" and in 1975 on "Smallpox : Point of NoReturn", a third special issue was published in October 1972, with the slogan "Smallpox :Target Zero" (Plate 10 .18). It coincided with the launching of what was termed the "finalphase" which, at that time, was expected to result in eradication by the summer of 1974 . Asits introduction stated : "The global eradication programme this year, for the first time,extends into every state and province of every country where the disease exists . The finalphase of the campaign is beginning." Unforeseen problems, however, resulted in the finalphase lasting fully 3 years longer than had been optimistically envisaged .

World health featured the subject of smallpox on two other covers in October 1979, onthe occasion of certification of eradication in the last of the endemic countries, and in May1980 (see Chapter 24, Plate 24 .2), when the Thirty-third World Health Assembly acceptedthe recommendation of the Global Commission for the Certification of SmallpoxEradication that "smallpox eradication has been achieved throughout the world" and that"smallpox vaccination should be discontinued in every country except for investigators atspecial risk".

Postage stamps and cachets on the theme of smallpox eradication and vaccination wereissued by many different governments between 1965 and 1980, as illustrated in Plates10.19-10 .22. The largest number were produced in 1978, the year after the world's lastoutbreak, in response to a recommendation by the Universal Postal Union to its membergovernments that smallpox eradication should be a principal philatelic theme . In 1978,too, the United Nations issued special stamps and silver medals in recognition of theachievement (Plate 10 .23) .

In some countries, stamps echoed the 1965 World Health Day theme of "Smallpox :Constant Alert" ; several countries of western and central Africa issued stamps between1968 and 1972 during the course of the programme for smallpox eradication and measlescontrol, most of which featured pictures of the jet injector ; and Guinea, on completion ofits WHO-supported smallpox vaccine production laboratory, issued a full set of stampsdepicting various stages in the vaccine production process (see Chapter 11, Plate 11 .10) .

In commemoration of the declaration at the Thirty-third World Health Assembly ofthe global eradication of smallpox, all delegations were presented with a set of medals asmementos (Plate 10.23) ; these bore inscriptions in the six official languages of WHO-Arabic, Chinese, English, French, Russian and Spanish .

nuclear device, discovered that the recordedincidence of smallpox was the highest for 20years and reported this as well . Also in 1974, aseries of articles published in the New YorkTimes by Dr Lawrence Altman, who was onan extended tour of India and Bangladesh,vividly documented the magnitude of theeffort being made and, in turn, stimulated theinterest of other publications . The conse-quent international publicity brought greatlyincreased and badly needed support for theprogramme from senior government officialsand played an important role in obtainingadditional voluntary contributions. In 1978,world-wide press coverage followed the


occurrence of 2 laboratory-associated small-pox cases in Birmingham, England (seeChapter 23) at a time when the SmallpoxEradication unit was having difficulties inpersuading laboratories to destroy or transfertheir stocks of variola virus. As a result,national governments took a special interestin the matter and compliance followedrapidly throughout the world.

As the goal of global eradication wasapproached, it was important for a quitedifferent reason to publicize the status ofsmallpox and its anticipated demise . With theachievement of eradication, it would bepossible to discontinue routine smallpox

\'IORLD HEALTHWorldHealthDay1965

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10. THE INTENSIFIED PROGRAMME, 1967-1980

WORLD HEALTHnrs r

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453

Plate 10 .18 . The smallpox eradication programme was presented in several issues of World health,an illustrated magazine published in many languages by WHO and directed to the general public .

4 54 SMALLPOX AND ITS ERADICATION

Plate 10.19 . Postage stamps depicting smallpox eradication activities issued by western andnorthern African countries between 1968 and 1975 . The Libyan stamps at the lower right takeup the theme of World Health Day, 7 April 1975 : "Smallpox : Point of No Return" .


Brasil 784p 0 1,80

REPIJ UC oen o xp7}yftli .,, j, +.{41i

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l

Plate 10.20 . Postage stamps issued in 1978 by Brazil, Egypt, Iraq, Ireland, Kuwait and Lesotho tocelebrate the eradication of smallpox .


`

NIGERIA1101 .101. ~ 1 0 .1 IT IR 197-1

Plate 10.21 . Postage stamps issued in 1978 by Malaysia, Maldives, Mozambique and Nigeria tocelebrate the eradication of smallpox .


0,80E,. NATIONS UNIES

ERADICATION MONDIALE DE LA VARIOLE

1,10E, NATIONS UNIES

ERADICATIO,

O.NDI ALE DE LA VARIOLE

Plate 10.22 . Postage stamps issued in 1978 by the Philippines, Senegal, Togo, Tunisia and theUnited Nations to celebrate the eradication of smallpox .


Plate 10.23 . A: A proof set, presented to the Director-General of WHO by the UnitedNations, of sterling silver medals struck to celebrate the eradication of smallpox . The medalswere issued on 31 March 1978 in the 5 original official languages of the United Nations in conjunc-tion with the stamps shown in Plate 10.22 . B: In May 1980, when the Thirty-third World HealthAssembly had formally declared the global eradication of smallpox, each delegation to the HealthAssembly received a set of commemorative medals in the 6 official languages of WHO .

10. the intensified programme, 1967-1980 443 · tions. mindful of this experience and doubt-ful of...

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