Interview Transcript
REVISITED:
The Smallpox Eradication/Measles Control Program
in West and Central A"frica
By
J. Donald Millar, M.D., D.T.P.H. (Lond.)
Director Emeritus
National Institute for Occupational Safety and Health (NIOSH)
Centers for Disease Control and Prevention, Atlanta, GA
Formerly Director (1967-1970)
Smallpox Eradication Program (SEP)
Centers for Disease Control, Atlanta, GA
and currently
President
DON MILLAR & Associates, Inc.
AHanover "Hanover Hall@ "
6320 Brady Road
Murrayville, GA 30564
tel: 770-983-5705
fax: 770-983-0822
An address at the Centers for Disease Control and Prevention (CDC)
for the 40th Anniversary of ASmallpox "Smallpox Pioneers@"
July 15, 2006
AAtlanta, Georgia, USA
Introduction:
On the day after its sixtieth birthday, I publicly thank CDC for greatly
enriching my life. Forty five years ago I came to CDC as a member of the
EIS Class of 1961. I intended to serve two years and return to academic
medicine. Instead, 32 years later - reluctantly - I retired. In the
interim CDC='s magnificent leaders provided me a career far more
interesting and compelling than anything I could have conceived on my own.
And, all I had to do was A"report for duty.@"
One of the greatest experiences CDC provided is the subject of our
discussions today, The Smallpox Eradication/Measles Control Program in West
and Central Africa. This program, funded by the U.S. Agency for
International Development (USAID) and directed by CDC, covered 20
contiguous countries from Mauritania to the Congo River.
Forty years ago this month some 50 smallpox fighters and their families
came to CDC to train for combat against disease in Africa. After an
intense A"boot camp@" in epidemiology, strategy and tactics of disease
eradication, logistics of supply and transport, truck and jet-gun
maintenance, and not least, conversational French, they began to leave for
Africa in October, 1966. It was not an orderly embarkation; they left in
abrupt jolts and starts over four months, in a pattern dictated by unsigned
international agreements, unfinished housing arrangements, incomplete
security clearances, maybe even unwritten travel orders! .... Fifty
families lived through an abundant expression of Murphy='s Law. But, they
got there.
They went with the din of the >"nay sayers=' in their ears. The text book
writers, the international experts, the ex-colonialists - they said it
couldn='t be done. A"What is this CDC? Who do you think you are? You='ve
never worked in Africa. You can='t get those countries together to do
anything.@" They even had a slogan to express the futility,@">"WAWA - West
Africa Wins Again!@"
Together with their African and French counterparts these CDC upstarts
forged an achievement which was unprecedented in human history and which
will bless all future generations. They were the first phalanx of the
worldwide conquest of smallpox.
They went to a Region where over half the countries had smallpox. Of the
five countries with the highest incidence of smallpox in the world, four
were in West and Central Africa.[i] The host countries were the youngest
of newly independent states. They had the least sophisticated health
services in the world, the worst communications, virtually non-existent
roads, and even fetisheurs who ritually infected people with smallpox
virus!
In the next three and a half years, CDC='s smallpox fighters overcame all
these barriers and a thousand more. They convincingly won the first and
arguably most difficult campaign of the war on smallpox. They did what
they set out to do and did it a year and a half sooner than expected!
Their creativity changed the strategy for the rest of the war; their
success strengthened the resolve of the World Health Organization and the
other smallpox-endemic countries, and their enthusiasm inspired a
generation of health workers all over this jaded world.[ii]
A number of these CDC A"smallpox pioneers@" are here today for a 40th
anniversary party. Of them and their colleagues, it is legitimate to say
they caused the eradication of smallpox from the world.
It was my great good fortune to serve as their leader.
Twenty years ago in the Seventh Annual Joseph W. Mountin Lecture at CDC, I
summarized the strategy, tactics, innovations, and results of their
magnificent achievement. Time does not permit that today. Instead, I
recommend two later books: A"CDC and the Smallpox Crusade,@" by the late
Horace G. Ogden,[iii] and A"Sentinel for Health@" by Elizabeth W.
Etheridge.[iv] Both describe CDC='s African smallpox/measles program
accurately and in detail. The CDC African program is also discussed in
Chapter 17 of A"Smallpox and its Eradication,@" edited by Fenner and
others, the World Health Organization='s massive official account of the
global campaign.[v] Unfortunately, this book is not organized
chronologically and hence blurs the crucial role of CDC='s African program
as both spearhead of the global campaign and as winner of the early
victories which inspired and influenced the rest of the global smallpox
eradication campaign.
For today, from the perspective of forty years, I will be content to make
just two points, and then tell a true story.
Two Points:
Point One:
Had CDC failed to eradicate smallpox in West and Central Africa, there
would be endemic smallpox in the world today.
Despite the fact that West and Central Africa contained eleven smallpox-
endemic countries, African health officials considered measles immunization
a higher priority than smallpox eradication. This was because, in Africa
, measles caused a devastating loss of life among African infants. The
African ministers of health agreed to do smallpox eradication as the price
of access to measles vaccine! Had we failed in Africa and those 11
endemic countries not been removed from the list at that time, the
likelihood of any second attempts to eradicate smallpox, is nil. For the
smallpox-endemic countries in rest of the world, CDC='s failure in Africa -
in the first offensive of the war - would have killed any enthusiasm for
global smallpox eradication. Without global smallpox eradication, we would
still have endemic smallpox.
Point Two:
From the perspective of our national history, the U.S. fought two wars in
the 1970s, the War in Viet Nam and the War Against Smallpox. No one
seriously claims that the U.S. won the Viet Nam war. However, the war on
smallpox was an unequivocal triumph. Smallpox eradication is the A"War We
Won in the 1970s.@" One may ask A"why?@"
Against smallpox the U.S. did not A"cut and run,@" but A"stayed the
courseA" until smallpox was totally eradicated. We finished smallpox in
West and Central Africa a full seven years before the rest of the world
reached zero-pox. However, the U.S. continued to support the WHO smallpox
eradication program until well beyond the world='s last case of smallpox in
Somalia in October, 1977. For this tenacious persistence we are indebted
to one particular American.
As Director of CDC, he simply would not permit the global smallpox
eradication program to fail. When the WHO needed a capable American to
lead its Smallpox Eradication Unit, D.A. Henderson was dispatched from CDC
to Geneva for the duration. When the WHO program faced its greatest
challenge, India, the CDC Director sent not one but two of his ablest
lieutenants, Bill Foege and Bill Watson. When they, in turn, said A"we
need experienced hands for field work in India,@" he emptied CDC of every
experienced smallpox fighter and sent them to India. Then just to make
sure, he came to India himself! CDC='s personnel contributions to the
Indian Smallpox Eradication Program exceeded the contributions of any other
nation by four times![vi] With similar intensity, he committed CDC
personnel to Afghanistan, Brazil, Bangladesh, Indonesia, Nepal, Sudan,
Ethiopia, and finally Somalia.
Once the CDC program in Africa accomplished its goal in 1970, there were no
U.S. foreign aid funds for CDC='s extra efforts in support of the WHO
global program. Nonetheless, there was no resting on laurels, no pulling
back, so long as smallpox transmission persisted anywhere. The CDC
Director scrimped and scratched and somehow found the money to keep on
sending CDC people until smallpox reached zero throughout the world. If
any single man deserves credit for winning the world war on smallpox, that
man is David J. Sencer, CDC='s A"wartime@" Director from 1966-1977.
A True Story:
Shakespeare wrote, A"The evil that men do lives after them; the good is
oft interred with the bones.@"[vii] In hopes that you will remember the
good done in Africa by one of the A"smallpox pioneers,@" I close with this
true story:
In July, 1993, during my last week on active duty, I was in Washington
speaking at a big construction safety meeting at the Shoreham Hotel. My
spouse, Joan, was also there as we planned to drive to West Virginia right
as soon as I finished my speech. NIOSH folk in Morgantown were hosting a
retirement A"do@" for us. While I was speaking, Joan went to the hotel
lobby to get a bell hop to load our luggage into the car. Joan is very
gregarious and her attention was drawn to a particular bell hop - a short
black man - who had an unusual English accent.
A"Are you from Jamaica?@" Joan asked.
A"No, madam,@" he replied, @"I='m from Africa.@"
A"Africa,@" said Joan, A"my husband worked there twenty years ago.@"
A"A"nd what work did your husband do, madam?@"
AHe directed the smallpox/measles program in West and Central Africa@"
With visible excitement, the man asked, A"What is your husband='s name?@"
A"Dr. Millar. He='s the man in there speaking.@"
The bell hop grew reflective
A"Madam,@" he said, A"I owe my life to your husband.@"
Joan assumed he meant he had avoided death from smallpox or measles because
of the vaccination program, but she asked anyway:
A"How is that?@"
He replied, A"My name is Ogunbi.[viii] I am an Ibo from Eastern Nigeria.
We became Biafra and fought against the federal government of
Nigeria.@"
Joan knew about the Nigerian Civil War which began in June 1967 and ended
in January 1970, when Biafra surrendered. She also knew that, amazingly,
the CDC smallpox/measles program operated on both sides, throughout the
war.
Ogunbi continued, A"Dr. Millar='s program had a smallpox vaccine production
lab near Lagos, a place called Yaba. I worked in that Lab. I
remember when your husband visited us.@"
Joan knew about the Yaba Lab because we had entertained Nat Rothstien and
his spouse in our home before they left for Africa. Nat was the virologist
assigned to Yaba. Joan recalled that the Rothstiens Rothsteins lived in
nearby Silver Spring, Maryland.
Ogunbi continued, A"the war came so quickly, I could not go home. I was
trapped in Yaba. I knew that if the Federal soldiers found me - an Ibo -
they would kill me. But, Dr. and Mrs. Rothstien did not let that happen.
They hid me in their house. The Nigerian soldiers searched the Lab but
they dared not search the home of a prominent American scientist.
So, madam, because of your husband='s lab in Yaba, Dr. and Mrs. Rothstien
were there to save my life. Because of them, I survived, and when the war
ended, they helped me come to Washington. I have worked in this hotel ever
since.@"
To say I was startled by this encounter with Ogunbi, on the very eve of my
retirement, is a huge understatement. I was flabbergasted. I believe in
a Higher Power who works in my life but have rarely seen such striking
evidence. Given all the factors that had to come together to arrange this
meeting, I consider it an act of Providence.
I do not fully grasp the implications of Ogunbi's dramatic re-entry into my
life. But, I think there is a lesson here that may be useful to you in the
EIS class of 2006 who are at the beginning of your CDC career:
When we do our best in any assignment, as the Rothstiens did in Yaba, we
will have opportunities to bless people in ways we cannot imagine!
Thank you.
References:
-----------------------
[i].Millar, JD and WH Foege. Status of eradication of smallpox (and
control of measles) in West and Central Africa. J. Inf. Dis. 120:725-732.
1969.
[ii].Millar, JD. Extensively quoted from the introduction of ASeasons in
the Sun.@" The Seventh Annual Joseph W. Mountin Lecture. Centers for
Disease Control (CDC), October 27, 1986.
[iii].Ogden, HG., CDC and the Smallpox Crusade, US Dept of Health and Human
Services, Centers for Disease Control, HHS publication No. (CDC) 87-8400,
Atlanta, GA, 1987, 141 p.
[iv].Etheridge, Elizabeth W., Sentinel for Health: A History of the Centers
for Disease Control., University of California Press, Berkeley, CA, 1992,
414 p.
[v].World Health Organization. Smallpox and its Eradication. Eds.,
Fenner, F., Henderson, D. A., Arita, I., Jezek, Z., and I. D. Ladnyi.
WHO, Geneva, Switzerland, 1988, 1460 p.
[vi].World Health Organization, South-East Asia Regional Office. The
Eradication of Smallpox from India. Basu, RN, Jezek, Z and NA Ward, eds.
WHO Regional Publication, South-East Asia Series No. 5. New Delhi, 1979,
346 p..
[vii].Shakespeare, W. Julius Caesar, Act III, Sc. 2. Shakespeare: The
Complete Works.
Ed., St. J. Irving, Collins Clear-Type Press. London, UK, 1923. Page
876, spoken by Antony.
[viii].The name AOgunbi@" is fictitious, chosen to protect the privacy of
the person described. Otherwise persons, places and events reported are
authentic.
"REVISITED: The Smallpox Eradication/Measles Control Program in West and Central Africa" by Don Millar
July 15, 2006
Presentation at seminar at time of West Africa Reunion by Don Millar, who was Director of the Smallpox Eradication Program from 1966-1970. History of the program. A classic presentation.
