Interview Transcript
This is an interview with Leo Morris about his activities in the West
Africa Smallpox Eradication Program. His wife, Jane Morris, is also
present. The interview is being conducted at the Centers for Disease
Control and Prevention, on July 14, 2006. This is during the 40th
anniversary celebration of the launching of the Smallpox Eradication
Program. The interviewer is Kata Chillag.
Chillag: How did you come to choose public health as a career?
Morris: It was a bit serendipitous. My background is statistics, and I
was studying statistics at the University of Florida. Usually
every summer, I went home to Miami to work, usually in the
hotels, to get money to go back to school the next fall. But
during my junior and senior year, I thought I'd better get some
experience. The Public Health Service had a traineeship program
for statisticians, and 1 other person and I were selected from
the University of Florida. Our assignments were just random. He
got assigned to the Department of Agriculture, which turned out
to be pretty boring, he tells me; and I got assigned to the
Tuberculosis Program, Public Health Service, before it was
transferred to CDC.
After that summer, they asked if I'd consider coming back
after graduation. And I might add, in those days-'59, late '50s-
a statistician, even one with just a bachelor's degree, was in
great demand. There just weren't many around. And I said, "Well,
you know, I'd like to stay closer to Florida," and they told me
about CDC. The Serfling-Sherman Polio Immunization Surveys were
being conducted then, so CDC was looking for statisticians. So
they recommended me to CDC, and there I was.
Chillag: And so, how did you get tracked into smallpox eradication?
Morris: I started out in the Polio Surveillance Unit, when we had cases
of polio in the United States. I worked in that unit for 3 years
in the EIS [Epidemic Intelligence Service]. Then Dr. Langmuir
[Alexander Langmuir] supported me for employee development, and
I left and got my Ph.D. at Michigan, where our first child was
born. (The first was born in Michigan where I got an MPH in
biostatistics in biostatistics, the 2nd in Atlanta, and the 3rd
in Brazil,.) Then I worked with D. A. Henderson [Donald A.
Henderson], mostly on viral diseases in the Surveillance
Section. The Investigations Unit was devoted to bacterial
diseases back in those days, with Phil Brachman. I also worked a
lot in reviewing material for the MMWR [Morbidity and Mortality
Weekly Report]. That was '63. I worked on a big St. Louis
encephalitis outbreak that year in Houston, Texas.
In '65, I worked with Larry Altman. He became the first
person to go to West Africa in the measles program in West
Africa on a TDY [tour of duty].
We were getting involved in some smallpox work, and I was
chosen to be part of it. We had a 5-person team in '65,
including Don Millar [J. Donald Millar], who later became head
of the Smallpox Unit at CDC, to evaluate the vaccine produced in
Brazil. Basically, we were comparing the Wyeth freeze-dried
vaccine with the freeze-dried vaccine produced in Brazil. We
worked in the Amazon territory of Amapa, which is now a state.
We were gone about 5 weeks. When we left here, it was winter. In
fact, we had a snow storm, and that day we didn't know whether
we were going to get to the airport or not. And there, of
course, it was summertime and 100° in Rio de Janeiro before we
went up to the Amazon. That was my first trip to Brazil.
I did some polio work in Chile and Puerto Rico in 1960 and
1961. I really sort of fell in love with the culture in Brazil,
and the people and so forth. That was '65.
Then '66 was the start of the smallpox program, so I stood
up with D. A. Henderson and others in the original group that
started the Smallpox Eradication Program. I was in charge of the
statistical end and evaluation. In '66, we trained the first
group that went to West and Central Africa. I had interviewed
many of the nonphysicians who had applied.
Then the Pan American Health Organization (PAHO) came to
CDC. At that time, Brazil was the only country with endemic
smallpox in the Americas. There were some overflow cases into
neighboring countries. It was variola minor, not variola major,
so it didn't get the publicity of some areas. But PAHO, which is
part of WHO [World Health Organization], said they were going to
put advisors into Brazil. They had a newly created Smallpox
Eradication Program, and they needed a statistician, an
evaluation person. They had 3 physicians, 1 from Paraguay, 1
from Peru, who was the team leader, and 1 from Colombia. So I
was asked if I might want to go to Brazil. I said, "Where do I
sign up?" I was very eager for that. In February of '67, we left
for Brazil. And that's how I got to Brazil. I was there 3 years
as advisor to the Smallpox Eradication Program after I had
participated in sending the first trained group over to West
Africa.
Chillag: And, Mrs., Morris, how did you feel about that?
Mrs. Morris: I loved it. When Leo asked me, "What do you think about
going to Brazil?" I said, "When?"
Morris: We both learned how to samba.
Chillag: Yeah, there you go.
So, you mentioned that before the actual smallpox
eradication, you did the trial between the 2 vaccines, correct?
Morris: In '65.
Chillag: In '65. And then, after that, was there a typical day for you
as a statistician working on this in Brazil?
Morris: Well, we had several primary objectives. I spoke Spanish
reasonably well, but I took some Portuguese courses so I could
forget my Spanish because it's hard to combine the 2 languages.
The director of the program in Brazil was a man named
Silva. He had recently retired from being the head of malaria
control in all of the Americas at PAHO in Washington and
returned back to Brazil. Because of his vast experience, they
talked him into taking over this new Smallpox Eradication
Program. He was the only one in the office who spoke English.
Now if you went up to the Ministry of Health in Brazil, a good
percentage of the people spoke English. But he was the only one
who spoke it in this office back then in 1967. So on my first
day there, we conversed in English, about the surveillance we
needed, reporting, and so forth, and then he said to me, "This
is the last day I'm going to speak to you in English," and he
never spoke to me in English again. So in that environment, it
was easy to really improve my Portuguese.
We had 3 primary objectives. First was to develop a
reporting system, which they didn't have. There were 22 states
at that time, and I think only 6 or 7 were reporting cases of
smallpox . Sao Paulo, the biggest state, with the most cases,
never reported. Starting a surveillance report based on the
reporting was the 2nd goal. And the 3rd was to start thinking
about evaluation. I had worked on the system that they were
going to use in West Africa for evaluating the vaccination
program. We wanted to extend it to Brazil, although in Brazil we
could be a little more sophisticated because they had better
census data to use as a sampling frame.
Chillag: When you talk about evaluation of vaccination, what all does
that entail?
Morris: Two primary things. One would be a sample of villages or towns,
sometimes big cities in Brazil, to look at 2 things: 1) asking
everybody in the sample households if they had been vaccinated
in the campaign; and 2) checking everybody <5 years of age for a
vaccination take on their arm. Since this was a mass vaccination
campaign, the take would be visible at 7-10 days. So little kids
should have had a nice smallpox vaccination take on their arm by
that time.
Chillag: And you mentioned that the reporting was all new. What were
some of the challenges of starting up a reporting system in this
context?
Morris: Well, slowly but surely, we got most states to start reporting.
What we had to do was go to some of the biggest states and talk
to them.
Brazil is different from the rest of Latin America in that
it has independent state health departments like in the United
States. In all the rest of Latin America, it's all federal
system down to the county employee. Mexico has states that are
not as independent as in Brazil.
So it was important to go visit states. One of the first
challenges occurred as we were improving reporting. In '67 and
'68, a total of 4,500 cases were reported; by that time, a
vaccination program had been started in northeast Brazil, a poor
area. In '69, when we had reporting really going strong, 7,500
cases were reported. So explaining to newspapers how cases
almost doubled while we were vaccinating was challenging, but I
think they finally got that the increase in cases was due to
better reporting.
Chillag: Was there misinformation in the newspapers?
Morris: Several times.
Chillag: Like what?
Morris: Some areas, there were rumors, "The vaccine must be causing the
disease." I remember also, in 1 state, there were some tetanus
cases, and they were blaming that on the vaccine. But I left
those kinds of public relations problems up to my Brazilian
counterparts to handle. I didn't want to be the middle. So they
handled that.
But also, we came up with data showing that from '68 to
'69, in places where the campaign had been completed, there was
an 80% decline in cases. There was 100% increase in the states
without vaccination, but it was mostly better reporting.
Chillag: So, how much were you at headquarters versus out in the field?
Morris: Well, Jane thinks I was in the field 100% of the time, but it
was probably half of my time, about 40%-50%.
I was training teams to do evaluation (that's another
story), visiting states to get better reporting, and so forth.
And once the reporting was starting to be established, we talked
about evaluation using surveys. That didn't get off very well.
It was not traditional in Brazil. They were worried about
improving the reporting, getting out the surveillance report,
the politics of a new program, and so forth.
In March of '67, one of the first states to be vaccinated
was a little state called Alagoas. It's right below where Recife
is in Pernambuco State, which was vaccinated in late June of
'67. And a report of an outbreak came in from a county called
Branquinhas. So the first thing we did was to check the
vaccination records, and according to the number of vaccinations
given in that county versus the estimated population, 104% of
the estimated population was vaccinated.
Well, first the diagnosis had to be confirmed in a
laboratory. It was confirmed that it was smallpox, not
chickenpox or anything else. So we mounted a team, and we looked
at several factors. We did a survey to look at the take rates on
vaccination scars of little kids, and the survey showed that
there were satisfactory take rates in those who had been
vaccinated. But the survey showed only 49% of residents had been
vaccinated, not 100%. We checked if there was any significant
migration of people into the area since. That had not happened.
And all of the smallpox patients were long-term residents. They
were living there during the campaign. So it turned out it was
just plain old falsification of the records. They vaccinated
half, they said, "All right, let's put down 100% and go on."
Chillag: And so how was that handled?
Morris: The main result for me was that we implemented routine
evaluations by center surveys in all the states.
Chillag: What happened to the officials who falsified records?
Morris: All of the ones involved in that state were dismissed-the
chiefs were dismissed, and the supervisors. The campaign had
been finished, but we revaccinated in that area. And state by
state, we trained the teams that would do the evaluations 7-10
days after vaccination. They would follow the vaccinators by 1
week to 10 days to do a survey of random villages and towns.
Chillag: You mentioned that training was another story. So what is the
other story?
Morris: Oh, just that there was strong resistance to putting resources
into evaluation. But after that incident, they had egg on their
face and they said, "Okay, let's do it."
Chillag: One of the things that we are supposed to ask you about is
collaborating with locals and some of the challenges and
successes with that. Maybe you can comment a bit more on that.
Morris: You know, maybe I'm biased after being there. And also, in
addition to the 3 years I was in residence, later I went back
and got a PhD in population studies to join the new Family
Planning and Evaluation Division., with Dr. Langmuir's support-
and I'd like to thank him for it. So between '78 and '95, I was
in Brazil, involved with a lot of family planning and maternal-
child health surveys. Although these trips were just TDYs; I
spent a lot of time there.
Brazilians are very nice people. They're very different
from people in the Spanish-speaking countries. Although a lot of
people think Latin Americans are all alike, their history is
different. The Portuguese colonization was different than the
Spanish colonization. I learned about soccer. They didn't have
any baseball.
Although just to digress for a minute, when we were
training, the state health department in Sao Paulo-the richest
state in Brazil, at that time composed of about 20 million
people-took jet injectors and vaccine from the federal
government but would not let the federal government pay their
state employees. They had their own money, and they wanted to
control their own employees.
I went down there to train their statistician in
evaluation and in field and training techniques. And we were out
in the field, in a county, a municipio, in northeast Sao Paulo
State called Araçatuba. It was a big agricultural area with a
lot of Japanese Brazilians. Brazil has the largest population of
Japanese immigrants in the world, even more than the United
States.
On Saturday morning, we were coming into Araçatuba to meet
with the evaluation crew and check their work. And we saw a
sign: "Saturday morning, 10 AM, baseball game between a visiting
team from Japan and the local team of Japanese Brazilians." So I
said to my counterpart, "Have you ever seen a baseball game?"
"No. I don't know what it is." So I said, "How about if we work
tomorrow afternoon?. We'll go to the game at 10 AM." It was a
little stadium, about 5,000 people. And it was me, him, and
4,998 Japanese Brazilians. They were selling rice cakes.
But that was a very unusual situation. As you know, soccer
is the sport there. So I got into soccer with many of my
colleagues and that was part of an entry with them, to be able
to talk day to day like we may be talking about the Braves here
this weekend. That was an important way to connect.
But I got along very well with my colleagues, and in some
ways they appreciated working or advice from a North American
more than from people from Spanish-speaking countries.. I still
have very good friends from those days. And I just want to
mention how the epidemiologists that we trained in Brazil might
have had the biggest impact of any country in terms of going to
other countries after that and working in smallpox; they worked
in Ethiopia, Bangladesh, and India.
We lived in a 10-story apartment house, 2 apartments per
floor for 20 apartments. And except for a woman from North
Carolina married to a Brazilian, and 2 other Americans (he was
with some shipping company.), everybody was Brazilian. So we
were intimately involved with Brazilians. So we had very, very
few problems with relationship with our counterparts there.
Chillag: You know, it's a little different than the West African
situation. One thing that we were supposed to talk to you about
was how you reacted to challenges in the living situation. Were
there any?
Mrs. Morris: To me, living there was wonderful. We hadn't been in our
apartment 3 days, and my first visitors were 3 Brazilian
neighbors who didn't speak English. We had coffee. And we
communicated, even though I didn't speak Portuguese.
Chillag: Were there any really striking cultural differences for you
that caused you pause?
Mrs. Morris: Well, their driving was a challenge, and walking my
children across the street. I had to hold their hands because
when the drivers turned the corner, they didn't look. But, no. I
didn't speak the language, but I learned what they would call
kitchen Portuguese, and I did very well with that. So my
communication with the locals was very good.
Morris: Since she could pass for a Brazilian, they thought she was
Brazilian.
Mrs. Morris: We went to the first dinner party when . . .
Morris: Oh, that's a colorful story. So, 8:00 PM, we invited some
people from the PAHO office and a few other Brazilians. So we
thought people would arrive at 8 o'clock. At 8:45, nobody was
there, so, "My God, what happened? Did we give them the wrong
address?" But people started to arrive. So we quickly learned .
. .
Mrs. Morris: Always late.
Chillag: Was that true in the work, too?
Morris: Not really, somewhat, you know. A 9:00 meeting might start at
9:20. But for social events, it was more-
Mrs. Morris: But usually someone would say, "What time?" "Eight
o'clock." "Is that Brazilian time or American time?"
Chillag: This was your first trip to Brazil. How was it different from
your expectations, both the work and the living?
Morris: In '65 or later?
Chillag: Either.
Morris: In '65, I was just surprised at the openness of the people. Now
I've worked in every Latin American country except, I think,
Suriname and Haiti. But at that time, I think it was just Chile
and Puerto Rico. But the openness of the people was a surprise.
PAHO had scheduled the vaccine trials in the Amazon just
before Carnivale, and after the vaccine trials, we had to come
back to Rio to report to PAHO and the Ministry of Health. Of
course, we stayed over for Carnivale, and that was quite
impressive.
I think there were probably 2 things we couldn't get in
local markets. One was cranberry sauce. And they didn't have
peanut butter.
Mrs. Morris: But they had Hellmann's mayonnaise.
Morris: She likes Hellmann's mayonnaise. The first time she went to the
supermarket, she said, "Oh, there's Hellmann's mayonnaise!"
Mrs. Morris: Yeah. They did have Hellmann's. And I thought, "Okay, I'll
be fine here."
Morris: So compared to the situation for people who went to West
Africa, culturally different but not extreme different living
conditions?
Mrs. Morris: The people were very, very warm, and they had a very nice
warmth for children, and that was nice.
Chillag: Well, this may not be true for you, but in my experience,
sometimes it's not your actual discipline or training, those
skills or experiences that are most relevant for doing good
work. What about your skills and your past experience were most
relevant to doing good work in Brazil and in smallpox in
general?
Morris: Well, I think my training in EIS and my work with reporting
polio. It was almost an easy transition into another disease.
I think to this day that it was very important being able
to talk to colleagues about nonwork things, like who won the
soccer game this weekend, what singer was going to be at a club
that weekend. I think that helped a great deal. In fact, on that
kind of a personal basis, I think I was much closer to the
counterparts than the 3 epidemiologists in the Latin American
countries were. In fact, our leader of the group from Peru never
learned Portuguese. He just kept talking in Spanish for 3 years.
The Colombian spoke Portuguese or learned Portuguese. And
Brazilians would always appreciate that. ( DELETE - Three years
he kept talking Spanish). So I think those things were very
important and translated from a personal basis to the work
environment.
Chillag: What do you wish you had known before doing this work that you
didn't know?
Morris: Well, I wish I had arrived there speaking better Portuguese.
But then I had the help of the director, we never spoke English
again. And when we were up in the northeast with the vaccination
campaign, very few people spoke English. So if I wanted to eat,
I had to learn how to speak Portuguese.
Other than that, it was a pretty seamless transition,
actually, and I was very impressed. They picked up on the
reporting, and after the 3 years, expanded it to other
communicable diseases for the first time: measles and polio and
other diseases.
Chillag: And did they in any way translate what you taught them
technically into local terms, or did they implement it, as you
said, directly? It sounds like you were already very aware of
local constraints.
Morris: I had a counterpart for the surveillance report and the
reporting system. He was a physician without a lot of
statistical background, but he was eager to learn. He was sort
of at the end of his career, eager to learn. He was from Bahia
State, which is the most interesting Afro-Brazilian Brazilian
state.
I remember 1 time I was invited to his house for dinner.
They had a great mokaka [phonetic], which is a Brazilian dish
using palm oil, and it's very similar to West African food,
actually. It was very good.
I would work with him on what to put in the surveillance
report. We worked on the tables together. We would put a graph
or something in very rough Portuguese, which he would change.
And sometimes I would wonder why some of my words didn't work.
One time, I was trying to describe the peak of the outbreak for
a histogram. And I looked up peak in the dictionary, and he
looked at the Portuguese word I was going to use, and evidently
it was their word for orgasm. He looked at it, and he said, "We
can't use that word," and so we had to use another word. But
there were little subtleties like that I had to learn.
Chillag: You've gone back to Brazil for reproductive health. Have you
seen any of the communicable disease contributions that you
made?
Morris: Like I mentioned, the last case of smallpox was in '71. We left
there in '70. They then expanded our surveillance report to 6
major communicable diseases, calling it the BBoletim oletim
epidemiológicoBoletim Epidemiologico instead of just a report
covering smallpox.
You can see our influence in the current surveillance at
the Ministry of Health even today and in the fact that they have
an epidemiology training program now in Brazil. The rationale
for doing surveys, to evaluate, is now incorporated into their
AIDS program and also in the maternal-child health area. So I
always thought of that as a big success that that stuff
continued after I left.
Chillag: That's amazing. I mean, it's not just the smallpox, which is
just so amazing in and of itself, but this kind of effect. I
mean, what an impact for a career.
So, what do you think was the biggest challenge of the smallpox
work in Brazil?
Morris: The first was getting them to accept the evaluation of the
vaccination program to avoid more outbreaks in areas where
supposedly everybody was vaccinated.
The second area was the switch-over from mass vaccination
to surveillance-containment, which was started in, I guess,
Nigeria, West Africa, with Bill Foege [William H. Foege] and the
support of Don Millar [J. Donald Millar] and D. A. Henderson
[Donald A. Henderson]. Part of that strategy was that the other
consultants and I, along with internal help from people we knew
better in the program, finally convinced the Brazilian health
officials that this new strategy was coming down. In '69, all
the big states in the south were just starting mass vaccination.
So we discussed-and they accepted-their having EIS type Officers
work in the 4 of the biggest states: Bahia, Minas Gerais,
Paraná, and Rio Grande do Sul. Sao Paulo, the biggest state,
went its own way.
And to introduce the new strategy, we had a big training
course for these people. There were some state coordinators,
plus they brought in about 6 or 7 young physicians working in
the special public health service. They were not more than a
couple of years out of medical school, enthusiastic, ready to be
assigned to these big states and to improve reporting and
introduce surveillance-containment. And we had a 2-week training
program at the Hospital Emilio Ribas in Sao Paulo, which at
that time was the smallpox hospital. In the '80s, it became the
AIDS hospital.
Chillag: Interesting.
Morris: The course covered general epidemiology and survey techniques,
but it also introduced the surveillance-containment methodology.
And I remember that we had a paper published by 3 of the
trainees from 3 states Bahia, Minas Gerais and Parana). In 1969,
they investigated 33 outbreaks in the surveillance-containment
situations. There were originally 27 cases reported, and they
found an additional 1,500 cases. So it suggested that reporting
was only about 2% in these big states. These were all part of
surveillance-containment investigations.
So I think introducing surveillance-containment in those
big states helped shorten the campaign, although mass
vaccination in the school populations, things like that,
continued. But switching to surveillance-containment-getting it
going and functioning-was the challenge.
Chillag: Yes, I know. I understand the magnitude of what you just
described to me. But could you speak a little more about this
for the lay person? You know, it sounds so matter-of-fact if you
don't fully know about this.
Morris: Well, Brazil had better communication systems than West Africa,
but you have to remember Brazil at that time was a country of
120 million people; the whole Amazon area was without roads. The
poverty in the northeast was quite real. It was really 3
different countries. The southern part, the industrial part, was
much more developed. Then you had the northeast, really
agricultural, lot of poverty. Then the Amazon was different.
People get around by rivers and stuff like that.
So in a country with very few good Federal-State
relationships, training the federal Ministry of Health and the
state health departments was in the mix of trying to get this
whole thing going and accomplished.
Chillag: Yes. That's amazing.
So what do you think were the biggest rewards for you of
participating in smallpox eradication?
Morris: We had our third girl down there, and Jane was mentioning how
they love kids there. In many of the Spanish-speaking countries
of Latin America, you could be a 4th-generation person, but
you're still not really a Venezuelan or a Mexican or something.
But in Brazil, they said about our daughter, "She was born in
Brazil, she's a Brazilian." And she even got a Brazilian
passport later on. So we loved the people.
There were some rough areas. I remember in northeast
Brazil, the first couple of trips reminded me of how the West in
the United States might have been, you know, guys with guns and
horses, riding around and things like that, and not having
bathrooms.
But I must admit, living in Rio was not a hardship. We
happened to live 3 blocks this way from Copacabana Beach and 4
blocks the other way from Ipanema Beach, so we can't say that
Rio was a hardship.
Chillag: Did the West African guys tease you any for all your hardships?
Morris: The other thing that helped push surveillance-containment
was that D. A. Henderson held a big meeting of smallpox
laboratories in Brazil the 2nd year,'68, to talk about
surveillance-containment in West Africa. One of the attendees
was a person from the smallpox lab in Moscow. And the Brazilians
had prepared a field trip to get participants out of the meeting
room and into the next state, where they were vaccinating. But
she was very concerned. She came up to me and said, in English,
"How can I go on this trip?" I said, "Well, they're going to
have a bus to take everybody there," and so forth. And she said,
"But isn't my visa only good for Rio de Janeiro?" At that time,
if you got a visa for Russia, you could just be in Moscow unless
you had a special permit. She was very surprised that it was
different in Rio. Plus, I guess she had the impression, from
whatever education she had growing up, that in Latin America,
everybody was poor, the capitalists are killing them, yet she
saw people going to the beach, every restaurant full. She was
surprised at all this.
But D. A. having that meeting there was also helpful to
us, continued stimulation of the Brazilian program.
Chillag: Do your kids remember Brazil?
Mrs. Morris: A little bit. The 2 older ones do remember. The young one,
she was only 2 when we came back to the States. My oldest
daughter was in a Spanish class in the United States, and the
teacher asked her to count to 10 in Spanish, and she immediately
rattled off in Portuguese. The 2 older girls spoke fluent
Portuguese but then totally forgot everything they knew. Our
oldest daughter lived in Miami, and she understands and speaks
pretty good Spanish.
Morris: She was at Miami Children's Hospital for about 10 years, and a
lot of the patients were from Latin America.
Mrs. Morris: But our 2nd child, she doesn't remember really much at
all.
Morris: They were 7, 5, and 2 years old then. Now when we left,, the 2-
year-old didn't speak much, but she understand Portuguese
because she was with the maid a lot. But although she doesn't
remember much, she feels a great affinity for Brazil. After she
graduated college and was working on a federal grant doing
social work in Athens, Georgia, we fixed up a trip to Brazil for
her to stay with colleagues of mine in 3 different states, and
that really turned her on. And, as I mentioned, because she was
born in Brazil, they issued her a Brazilian passport. So she can
work there, and she got some job offers in teaching. She had 1
more year on this grant she was working on, and she was thinking
about going down there. She met a guy that year, so she never
went down. But she feels a strong affinity, just that she was
born there and that we gave her a Brazilian first name, Eliana.
Mrs. Morris: And her middle name is Iraci, who was "An Indian princess
from the northeast state of Ceara. [Chillag: So now I'll ask you
to sort of step back from Brazil and think about the program as
a whole. At what point did you think smallpox could actually be
eradicated?
Morris: This was doubtful to some people because they claimed there
could be hidden cases in the Amazon region...
In '69, we expanded to the south, the populous states,
where we introduced surveillance-containment. I went down for 2
years, then extended for a third year because I didn't think it
was over. I think I thought that I had to see it through another
year anyway. This is from '69 to '70; but the full year of '69;
I came back in February of '70. And towards the end of '69, a
lot of progress was made in the southern part of Brazil, and the
surveillance systems were stronger. And at that time, Dr.
Langmuir offered me more career development in demography and
population studies. So I think we left in February of '70. The
last case was in early '71. So I think it was towards the second
half of the 3rd year.
Chillag: So, how did that feel when you heard it was the last case?
Morris: In Brazil, it wasn't as famous as the last case in Somalia,
but, man, it was great!
Chillag: Yes. Has anything in your career compared that that? I'm just
curious.
Morris: Reproductive health has been a different kind of challenge.
It's not as easy to eradicate unintended pregnancies and women
dying of illegal abortion. Reproductive health is a different
kind of challenge, more long-term, but it has been a good
challenge and a very important one for women's health.
Chillag: Which sort of brings me to another question. How has your
participation in smallpox eradication influenced the choices you
made in your career afterwards?
Morris: I think the biggest thing that transferred over was the
importance of good survey techniques and evaluation using sample
surveys. This is especially true in reproductive health, where
things aren't reported like a disease and you have to use sample
surveys. That fit in with my statistical background and so
forth. So I think that was the biggest transfer of skills, from
smallpox to reproductive health.
Chillag: And how would you [Mrs. Morris} say that your being there
affected your life afterwards?
Mrs. Morris: Well, it made me appreciate help because I had 3 children.
I learned to see how other people live, and that was good, and
to appreciate how much we do have right here.
Chillag: So, do either of you have anything else to add that you think
it's important for people to know about this experience as a
whole?
Morris: First, it was wonderful to be part of the esprit de corps in
the Smallpox Eradication Program, to be part of eradicating the
disease. Later on, of course, I was well out of infectious
disease into reproductive health, but then came polio control
and eradication. We continued some of our reproductive health
work in Brazil as well as other parts of Latin America, and also
Portuguese-speaking Africa, Guinea-Bissau, and Mozambique.
I was able to really maintain friendships with people. One
of the persons we trained for surveillance-containment became
the head of all vaccine preventable diseases in the Ministry of
Health in Brasil. Now he's an advisor at PAHO in Brasilia, and I
had lunch with him. So maintaining friendships was important.
Some of the people I worked with went to PAHO, one went to
Ethiopia for WHO and then became head of immunization for PAHO
for Latin America. So I've been able to maintain friendships and
continue following Brazilian soccer.
Also, over the years, I've met most of the Brazilians
who've come to CDC for training, and I followed the World Cup. I
was over at the home of some Brazilians' who were working at CDC
in 2006, and, of course, it was disappointing to lose that year.
But the other thing that carried over was from FETP
[Foreign Epidemiology Training Program], the idea of trying to
expand somewhat into noninfectious diseases. Three years ago, we
(myself and a colleague from Brazil) conducted a 2-week course
on basic epidemiology for reproductive health; that helped me
translate the manual into Portuguese for the FETP program in
Brazil. And a heavy content of that 2-week training was the
importance of surveys.
And I guess that CDC has FETP in around 12 or 13 countries now,
some of it paid for by the countries themselves. World Bank
loans also come into play, sometimes even paying the salary of
the CDC person.
Chillag: Do you have anything else you want to add?
Morris: No, no, thank you.
Chillag: Well, it was really an honor, and I thank you very much.
# # #
Leo and Jane Morris Oral History
Leo Morris interviewed by
Kata Chillag
January 13, 2006
Leo Morris describes the smallpox program in Brazil and the eradication of the disease. Jane Morris relates some of the challenges of life abroad. Leo, was already employed with CDC, and helped interview and train the initial group that went to West Africa. He served as a statistician for the Smallpox Eradication Program in Brazil, which was the only endemic area for smallpox in the Americas. Leo helped develop a smallpox reporting system and surveillance, as well as an evaluation program for the smallpox vaccination campaign. After his time in Brazil, Leo continued his work with surveys and evaluation techniques in the area of reproductive health.
