Academic journal article Bulletin of the World Health Organization

Smallpox Eradication in West and Central Africa(*)

Academic journal article Bulletin of the World Health Organization

Smallpox Eradication in West and Central Africa(*)

Article excerpt

In May 1970, the last cases of smallpox were reported in West and Central Africa, 3 1/2 years after the start of a coordinated regional programme to eradicate smallpox from the 20-country area. This report describes the development and results of the West and Central African regional smallpox eradication programme.


History of the programme

Since Jenner introduced vaccination in 1796, smallpox has been gradually eliminated from the industrialized world. However, the thermolability of glycerinated lymph vaccine posed a severe logistical barrier to widespread mass vaccination, especially in the tropics and in areas with limited medical services. Moreover, the efficacy of vaccination was compromised by vaccinators using suboptimum multiple pressure and scarification techniques. Global eradication of smallpox under such conditions was a fantasy. The years after the Second World War witnessed a revolutionary change--the large-scale production of thermostable lyophilized smallpox vaccine (1). Teams of vaccinators could now range far from refrigeration facilities and yet administer a highly potent vaccine. The later introduction of the bifurcated needle[a] and intradermal jet injector largely eliminated the problem of variability of vaccination technique while reducing the quantity of vaccine needed to achieve good results.

In 1950, a regional smallpox eradication programme began in the Americas under the leadership of the Pan American Health Organization (PAHO) (2). By 1958, this programme had achieved significant success; several previously endemic countries had eliminated the disease by mass vaccination campaigns. In addition, PAHO's support stimulated the establishment of large-scale freeze-dried vaccine production centres in several of the countries.

In 1958, the USSR proposed that a programme of global eradication be undertaken under the auspices of the World Health Organization (3), with primary responsibility for implementation of the programme to be left to the countries concerned. India, on the advice of an expert committee of the Indian Council of Medical Research, decided to undertake a programme of total smallpox eradication; pilot projects started in 1960 and 1961 (4). A number of other smallpox-endemic countries also began eradication campaigns.

Following the introduction of a measles vaccine by Enders (5), a trial of immunization against measles was held in Upper Volta in 1961 (6). Its success led the Ministry of Health of Upper Volta to conduct a nationwide programme of immunization in 1963 with the assistance of the United States Agency for International Development (USAID) (7). Six additional countries received assistance from the USA to conduct nationwide measles immunization programmes in 1965, and further requests soon brought the number of countries conducting mass immunization against measles to 11. Medical epidemiologists from the Center for Disease Control (CDC), Atlanta, GA, USA, provided part-time technical assistance for these programmes.

During the years 1961-66 CDC investigated mass vaccination techniques, especially the use of jet injection in smallpox vaccination. Beginning in 1963, with the support of PAHO and WHO, a series of trials was conducted in Brazil (11), Jamaica, Tonga (R. R. Roberto, unpublished observations, 1964), and the USA (8-10) to test techniques of mass vaccination, principally jet injection, under a variety of circumstances.

During 1965, a series of discussions and planning meetings, held principally between Dr A. C. Curtis, Chief, Public Health Division, Office of Institutional Development, USAID, and one of us (D.A.H.), then on the CDC staff, laid the financial and technical groundwork for regional assistance to eliminate smallpox and control measles in the 20-country area of West and Central Africa within 5 years. In January 1966, an interagency agreement was signed and the "West and Central African Smallpox and Measles Control Programme" came into being. …

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