Bill Griggs Oral History

Interview Transcript
	   
This is an interview with Mr. Billy G. Griggs, who was Deputy Director for
the Smallpox Eradication Program in West Africa. This interview is being
conducted on July 7, 2006, at the Centers for Disease Control and
Prevention as a part of the 40th anniversary reunion for the launching of
the program. The interviewer is Victoria Harden.

Harden:     Mr. Griggs, I would like to get a little background, to set the
           stage for your role in the smallpox program. I know you were
           born in Ripley, Tennessee, on November 20, 1933. Could you, just
           briefly, give me a little indication about your growing-up
           years, your pre-college education, who influenced you, how you
           grew up?
Griggs:     Well, Ripley is the county seat. Actually, I was born in
           Ashport, a port on the Mississippi River, 15 miles west of
           Ripley. And in 1933, this was boondocksville. In every way. Most
           of the things that came into Ashport came in by river boat. I
           went to school in Ripley-was bused 15 miles to school. I lived
           on a farm, of course. I had a rather uneventful, typical farm
           boy's life. I did all sorts of activities going on with farming.
           I went to high school at Ripley High School and graduated in
           1951.
                 I started to college my freshman year at Union University,
           which was a Baptist college in Jackson, Tennessee, about 45
           miles east of Ripley. I was influenced largely by the pastor at
           the church, which happened to be located on the farm. He kept
           pestering me to come to Union. So I went to Union freshman year
           and met a senior girl, who I was infatuated with. She finished
           that year and was teaching in Memphis, so I decided Memphis
           State was probably better than Union. We got married Christmas
           my sophomore year. I was self-supporting, and I worked my way
           through college, working all sorts of jobs and I graduated in 4
           ½ years. I came out of school with a house, 2 kids, a wife, and
           no debt, I might add, which is very good for college years.
Harden:     It certainly is.
Griggs:     I finished up the undergraduate work in January and decided to
           go on and do a master's in geography at Memphis State. I did the
           first semester but I was working, at that point, 48 hours a week
           at a soybean/cottonseed-oil mill at night. I decided that maybe
           I'd better slow down just a little bit. I knew there was a job
           opening down at the Shelby County Health Department for a VD
           [veneral diseases] investigator. On arrival down at the health
           department, I found out that not only was there the state job
           but there was also a federal co-op job vacancy. Tom Davis (from
           Atlanta) and Press Fish from the Nashville state office were
           there interviewing for the co-op job. The jobs were virtually
           the same, in terms of interviewing VD patients, locating their
           contacts, and referring them in for treatment for VD. The only
           difference in the state and federal jobs was that the federal
           job paid $500 a year more than the state job, and at the end of
           the year you were subject to transfer throughout the United
           States. This was a cooperative appointment between the State of
           Tennessee and the federal government. The feds paid the
           salaries, and you worked literally as a state employee on a
           local level there, at the City of Memphis.
                 Keep in mind that my motivation for coming down was going
           through school, working full-time, and making a living. And it
           was beginning to get a little tiring. I decided that I probably
           ought to slow down a little bit and finish this master's degree.
           So I applied for the federal job, thinking that I would just do
           a year at it, and I'll have my master's, and I'll get on with
           what I was planning on doing.
Harden:     Which was?
Griggs:     At that point I was still thinking possibly about law school.
           But some things had happened while I was working in a real
           estate company. I was manager of a rental department at one of
           the oldest and largest realty companies in Memphis and going to
           school at night. We had several young lawyers on retainer who
           were very smart, but they were having a tough time making a
           living. So I wasn't sure that I wanted to do another 4 years of
           law school after the master's.
                 So I applied, got the co-op job, and went to work. Two co-
           ops were hired, I might add. This was mid-June of '56. In early
           August, late July, Carl Hookings, who was the director of VD
           there, got a call that l of the co-ops was needed to go to the
           Mexican border to work with the Bracero Program. There was a
           pilot project being run to see if Braceros, who were Mexican
           agricultural workers, could be blood-tested for syphilis at the
           border. Then you could only have to follow up those scattered
           throughout the states when they went out from the border.
           Syphilis was the only blood test they were doing at that time.
           The Braceros were visually checked for syphilis and gonorrhea by
           a male nurse coming through.
                 I was married with 2 children. The other young co-op was
           married with no children, and he made a long pitch to Hookings
           why it really wasn't in his best interest to go to the border. I
           didn't have any strong feelings, and I thought the program was
           going to be over with by the time school started back. So I went
           out to El Paso. The 2 kids stayed with their grandparents. My
           wife went with me. She was going to stay 2 weeks and then fly
           back and take care of the kids. She was a teacher in Memphis.
           Well, we got to El Paso, and she decided that she didn't really
           like the idea because the program was going to take longer than
           we thought. So we made a hurried trip back to Tennessee, got the
           kids, rented an efficiency apartment, and started work.
                 And, believe me, in those days, things were a little
           different than working now-a-days. The Braceros came across the
           border at 6:00 in the morning, went out to the reception center,
           and we started work. They were processed through, and that meant
           a complete physical (in terms of looking at them, a chest x-ray,
           a blood test since we were there to do that), and then they were
           checked and recruited by the farmers, processed, and then went
           to the farm that afternoon.
                 The Braceros were all young, male agricultural workers,
           who were coming in for limited farm work. So our day started at
           6:00; usually we were through about midnight. The largest day of
           processing workers was 4,500 people who came through that kind
           of process all in one 24-hour period. We finished up in late
           September or October. And I returned to Memphis.
                 The good thing about the Bracero Program was that Bill
           Watson [William Watson], who was then the Program Management
           Officer of the VD program, and I became quite good friends. In
           the spring, I had taken the federal service entrance exam and
           made fairly high marks on it. I had gotten a lot of job offers
           from other agencies, at a considerably higher grade than the VD
           program co-op salary. Bill and I talked about this, and then
           Bill had a long conversation with Johannes Stuart, who was in
           Washington then, and then Stu and I had a long conversation. The
           sum total of it was, by the time I got back to Memphis, I was
           converted from being a coop appointment to a regular appointment
           career status as a GS-5, as opposed to the normal GS-7. I used
           to kid Bill that at that time he was the longest co-op that had
           ever been, and I was the shortest co-op. I was converted in
           about 5 months.
                 So I returned to Memphis. By the second year on the job, I
           was, as a GS-7, the federal city rep in Memphis for the VD
           program. I recruited all over west Tennessee and eastern
           Arkansas. I gave the people we brought into Memphis a rapid
           training program on how to draw blood. Then they went to the
           interviewing school in Atlanta, and then they were transferred
           throughout the United States. We hired some 50 people that
           second year in Memphis.
Harden:     How did you decide who was going to work out and who wasn't?
           Did you talk to each person?
Griggs:     I interviewed them all. I was the major interviewer at that
           point. There was not a central interviewing team; it developed
           later within VD for the large-scale interviewing. But we visited
           colleges, had an ad in the paper, and interviewed people. We
           tried to pick people who were resourceful, self-starting,
           understood kind of what they were getting into.
                 Then in the summer of the second year, because the pilot
           project had been very successful on the border, I went back to
           El Paso, which was the headquarters of the program. Five
           reception centers along the border, El Centro, AA, Nogales, AZ,
           El Paso, TX, Eagle Pass and Hidalgo, TX processed the Braceros
           who were initially screened at three centers in Mexico.  We had
           1 assignee in southern California, 1 assignee in Hidalgo, Texas,
           and me. I covered the Nogales, Arizona, and the El Paso station
           out of El Paso. That was my first real exposure to international
           work. We visited down in Mexico at the reception centers. Mexico
           had 3 such places, where the overall health of the workers was
           checked before they came to the border.
Harden:     And this experience is what made you the logical person, I
           suppose, to be coordinator for the International Symposium on
           Syphilis and Treponematoses in 1960-1961.
Griggs:     Right.
Harden:     This symposium was bringing together people from all over the
           world, then, or the Western Hemisphere?
Griggs:     It was worldwide. There were about 1,500 people at the
           symposium, held in Washington, D.C., at the Sheraton Park, from
           some 65 or 70 countries. It was a large meeting, probably a
           first-class meeting, with translation in French and Spanish.
           There were lots of papers, a lot of coordination in terms of
           getting the people together, letters out for the invited
           speakers, establishing everything that goes along with a meeting
           of that size. I had left El Paso and gone to Houston as the city
           rep. Then I went from Houston to Atlanta, when I was interviewed
           for this job as the coordinator of the symposium. I was offered
           the opportunity to live in Washington and commute to Atlanta.
           The VD program had moved from Washington to Atlanta in '57. Or I
           could live in Atlanta and spend a lot of time commuting to
           Washington and New York. The other sponsor of the program was
           the American Social Health Association in New York City. And
           with Atlanta being a much better place to live than Washington,
           that wasn't much of a problem. That was a supposedly temporary
           assignment for 22 months to hold that symposium.
                 At the end of that particular assignment, I went back into
           the VD program at headquarters as the Assistant Chief of
           Operations and Development. I had responsibility for the grant
           program, in terms of working with the states and the major
           cities in submitting and approving VD control grants. By now
           it's late '64. I got a call from Bill Watson 1 day, and he said,
           "There's going to be a program for smallpox and measles control,
           with USAID [US Agency for International Development] sponsorship
           and funding, that D.A. Henderson [Donald A. Henderson] is
           starting to get together, or and I'd like for you to go over and
           talk to D.A. about being the Program Management Officer and
           deputy of that program." So I went over and talked to D.A.
Harden:     And I understand that you had to do some selling about how to
           structure the personnel for this program.
Griggs:     D.A. had come out of the Epi program, and while he had had some
           exposure to Public Health Advisors, he had not really worked
           very closely with them at that time. I had to sell the idea of a
           joint effort with an M.D. epidemiologist and an Operations
           Officer. It clearly was going to be a program of operations, not
           just one of technical expertise.
Harden:     This is very important. Would you talk a little more and define
           what a Public Health Advisor did, how he was trained, and then
           explain if Operations Officers did the same thing or were
           slightly different?
Griggs:     The title "Operations Officer" was created for Africa, but they
           would actually have been civil service Public Health Advisors in
           the United States. The Operations Officer title was more
           descriptive for the African people than the title "Public Health
           Advisor" because we wanted it clearly understood that these guys
           were operationally involved. Just like in the Public Health
           Advisors in the United States, they worked with local health or
           state health departments or regional offices. But they pretty
           much had the understanding and expectation that they were
           responsible for getting the job done. Generally speaking, it was
           a situation in which, not that we can't do it, but how can we do
           it? In other words, if it needs something else, what do you need
           to get it done?
                 Public health advisors started out just interviewing and
           running down contacts, and then moved up to supervisory
           positions, grant writing. In some instances, they were literally
           functioning as VD control officers. So it was a multitask,
           multifaceted background and job. I might add that growing up on
           a farm didn't hurt any, either, because it was all of the kinds
           of things that you have to do in getting jobs done.
                 And if I may digress for one second, we had a problem out
           in El Paso, in terms of who was running the public health
           aspects of the bracero program. When we got there with 4 people,
           the quarantine people asked where the other 20 people were. But
           we couldn't slow down. We had to run these people through at
           that speed. So we had to work out a system that would let us,
           with 4 federal employees and a couple of local hires, handle
           that-drawing bloods and processing them; getting the results
           shipped to Austin and back again. So there was a lot of that
           kind of thing that came along. So I was used to multitasking and
           making do with what we had.
Harden:     So after you convinced Dr. Henderson to have Operations
           Officers in the smallpox program, what was the next step? Did
           you have to go out and hire people? How?
Griggs:     When I started with D.A., probably in November, there was an
           expectation that there was going to be a program, but there was
           a daunting list of things that had to be done before July 1966.
           When we started, no project agreements had been signed with any
           country in Africa, and there was no project proposal. We had to
           recruit personnel. We had to negotiate a PASA (Participating
           Agency Service Agreement), which would provide the funding for
           the program. We had to negotiate project agreements with Country-
           Specific Plans for each country in Africa. This would require an
           agreement between the US Government and each of the Ministers of
           Health of those countries to do the program. We had to develop a
           training program for the new employees to begin in July; it had
           to include language training as well as epidemiology and
           technical matters. We had to develop needs and specifications
           for all materials that would include quantity and quality and
           develop the Requests for Proposals (bids) for the equipment. We
           had to develop a comprehensive Manual of Operations, both
           technical and operational (which WHO latter took and issued it
           as though they had written it!). We had to develop the knowledge
           required to write individual country agreements that would be
           negotiated and signed by the host countries. All of this went on
           simultaneously. And we did it!
                 I think D.A. came around relatively quickly to
           understanding the need for the Operations Officers. He and Henry
           Gelfand, who was one of the other physicians in the office then,
           did a fair amount of interviewing physicians. Not only were we
           looking within the current EIS class, since we had the
           opportunity to get the young docs who came to CDC as an
           alternative to serving their draft time, but we were also
           looking outside of the Commission Corps. I might add that we got
           some very outstanding physicians that way. Don Hopkins [Donald
           R. Hopkins] was an individual who was hired as a physician from
           outside of the EIS, a direct hire. We also hired several more
           experienced physicians who went overseas. In most countries, the
           model was to have a physician epidemiologist and an Operations
           Officer. In a few of the smaller countries, the physician
           epidemiologist served 2 countries with an Operations Officer in
           each country. In Nigeria, because of its size and complexity, in
           addition to the headquarters office in Lagos we had multiple
           docs and OOs.
Harden:     My understanding is that there were an awful lot of details
           regarding the equipment that had to be used in the project. You
           had to deal with trucks, with doing procurements for trucks that
           were U.S.-made, getting them rigged up to have refrigerators for
           measles vaccine. Can you tell me about what all you had to do at
           this time from that standpoint?
Griggs:          Well, we had the benefit of a little bit of history of
           this. To backtrack 1 second . . .When measles vaccine was first
           in the process of development at NIH [National Institutes of
           Health], the Minister of Health from Upper Volta came over on a
           leadership grant visit. He was being shown the measles vaccine,
           and he said, "Measles is a major killer of children in my
           country, and I would like to offer my country as a place to
           field test the measles vaccine for you."
                 So in '63 or thereabouts, the USAID signed a project
           agreement with Upper Volta to go out and do several hundred
           thousand measles immunizations. CDC was asked to provide an EIS
           Officer to work with Hank Meyer of NIH as an advisor in the
           field for this team. USAID provided some trucks and the Ped-O-
           Jets (foot-operated hydraulic instruments that give an injection
           of the vaccine) to use the vaccine with; Merck, which had the
           measles vaccine, provided the unlicensed vaccine. And the
           program went to Upper Volta.
                 The first year, it was more successful than expected. I
           think they did about 700,000 vaccinations, and the next year the
           measles incidence in Upper Volta just dropped off to practically
           nothing. So the surrounding countries said that they would like
           to have a measles program, and USAID was negotiating to do that.
           They asked for 3 or 4 EIS Officers, and the program was expanded
           to 2 or 3 countries. The second year, they did not do the
           program in Upper Volta; they did the surrounding countries. The
           third year, Upper Volta got measles back-right back where it was
           to start with. So it was known early that in order to be
           successful in measles, it was going to require a fast-hitting,
           multiple repeat because the birth rate was so high that you
           built a new supply of susceptibles each year.
                 So the reason the smallpox program actually came into
           existence was that USAID come back to CDC and said, "We would
           like to have a major measles program, and we need 20 EIS
           Officers to be assignees to work with these countries on doing
           this." And D.A. picked up on this and said, "Measles is going to
           be a never-ending problem." So D.A. proposed the business of
           adding smallpox eradication to this measles program for West and
           Central Africa. The idea of pushing for a global smallpox
           eradication program had come up in WHO [the World Health
           Organization]. And this part of the world was probably going to
           be the toughest to try to do it in.
                 So it was proposed as a 19-country program, starting in
           Congo, and over to Chad, and Central African Republic, the whole
           West and Central Africa. That, USAID would consider doing.  We
           were putting together this proposal as to what it was going to
           cost for such a program-this was the project agreement proposal
           that I was talking about earlier. For that proposal, based on
           what information was available from the old measles program, we
           had to determine what kinds of vehicles were going to be
           required for each country, what kinds of vaccine, how much
           refrigeration space, the whole bit. This was all calculated into
           this project agreement for each individual country. It totaled
           up to a $46 million, 5-year eradication program for smallpox and
           control of measles in the 19 West and Central African countries.
           Subsequently, the other, 20th country was added, which was
           Fernando Po, which became Equatorial Guinea So we did our best
           guess as to needs on the basis of the life expectancy of the
           trucks, in terms of replacement on a 2-year basis; the life
           expectancy of the Ped-O-Jets; etc. All of this was listed by
           country. We started with 16 countries the first year. The second
           year we added 3 countries, Sierra Leone, Guinea, and Liberia.
           The third year, the 20th country was added.
Harden:     When you had to estimate the life expectancy and plan for the
           budget, were you correct? Did the items last that long, or
           longer, or not as long?
Griggs:     Well, we had some problems with vehicles that had not been
           expected. The Dodge truck was the vehicle that was chosen by
           bid. Bids were requested from Dodge, GMC, and Ford, and Dodge
           won the bid. And it was an eminently suitable vehicle. I was
           familiar with Dodge and was pleased that they won the bid. But
           we ran into the difficulties with the roads. This truck, being a
           long-bed crew-cab, had a lot of weight on the 2 axles, so a lot
           of axles were broken in Africa. And while we sent over with each
           truck each year a best guess as to what was going to be needed
           for repair, replacements to keep the vehicles running, it soon
           became apparent that we needed a system that would provide rapid
           turnaround in emergencies because if a vehicle was down,
           everything came to a stop. So we negotiated with an Atlanta
           Dodge dealer, a parts replacement general contractor, on a task
           order. We could just order what we needed, and it would be air-
           freighted to Africa. We would get a cable saying, "Gotta have
           this," and that day it was ordered and put on an air freight
           shipment. And it was usually in Africa in about a week, 10 days.
Harden:     And who actually did the replacement of the part? The
           Operations Officer?
Griggs:     Yes. But I'm getting ahead of myself a little bit. Going back
           to the spring, when we were writing these agreements, we
           actually had people start in late spring-Henry Gelfand, for
           example. And George Lythcott, who was a doctor working on a
           program in Ghana from NIH, was selected as the director for the
           regional office to be established in Lagos. Mike Lane [J.
           Michael Lane] and a couple other people were visiting the
           countries, negotiating project agreements, explaining the
           program, moving towards getting signatures.
                 After the participating agency service agreement had been
           signed with USAID and it was a pretty sure bet that we were
           going forward with this, we started recruiting people and
           started security clearances on doctors and Operations Officers.
           They were to report to Atlanta the first of July to go through
           the EIS course, which was normal training for that period. And
           then these recruits were to stay on for an additional training
           course in smallpox activities, in which there was a mechanic's
           course. It was lengthier for the Operations Officers, with a
           shorter version for the Medical Officers, to learn all about
           these Dodge vehicles and how to repair them. Now, keep in mind
           that the repair of the trucks was the responsibility of the host
           country. I mean, their facilities, their mechanics, supposedly.
           And they had had some exposure to Dodges, but not a lot.
                 But the Dodge turned out to be a very good vehicle. I was
           last in Africa shortly after retirement in 1989, in Togo, and I
           saw 2 of the Dodge trucks that had been there. The last one was
           probably sent to Africa in '70 or '71. And in '89, 2 of them
           that I saw out in the field were still running.
Harden:     Let's talk about going to Africa. Being the headquarters
           operation, you had to help all these people get settled in all
           these different countries. How did that work?
Griggs:     After the decision was made to have a regional office in Lagos,
           we were going to send 9 people there. We had a young, not brand-
           new EIS officer who was going to be the epidemiologist. George
           Lythcott was going to be the director. Jim Hicks [James W.
           Hicks], a senior Public Health Advisor, was going over as the
           administrative officer. Bill Despres [William Despres] was the
           assistant administrative officer. We also had a Muriel Roy, a US
           secretary, Gordon Robbins, as a health educator and Nat
           Rothstein [Nathaniel Rothstein] as a virologist. We were going
           to be there primarily to work with the vaccine production
           facility, to develop a creditable one there in Lagos to make
           smallpox vaccine. We also had a statistician, Davis [Hillard
           Davis] and Bill Shoemaker as an equipment specialist. So 9
           people were sent there. And they were to provide a nucleus of
           expertise. They could rapidly get from Lagos to the surrounding
           countries in those various areas statistics, senior
           epidemiologic skills, or an administrative function, or whatnot,
           rather than trying to have all that kind of expertise in each
           country or from CDC.
                 I first went to Africa in the summer of '66, with
           responsibility for working with the Department of State,
           embassy, and USAID, in terms of lining up office and housing
           space for the regional office people. We located offices,
           prevailed upon USAID to sign the contracts for the offices and
           houses. An activity out of Washington, called the regional
           office, had the responsibility for several of the smaller
           countries. So really all of the administrative sorts of
           activities were handled by the embassy, on agreement between
           USAID and the embassy and those countries. Providing office
           space was the responsibility of the host country, and they
           actually had an office in the Ministry of Health, or in an
           appropriate health building with the Ministry of Health. And the
           housing was provided by the US Embassy on a contract basis.
Harden:     And that worked out okay?
Griggs:     Worked out fine.
Harden:     In 1966, D.A. Henderson moved to Geneva, with WHO, and Don
           Millar [J. Donald Millar] came back from London to take over, is
           that correct?.
Griggs:     Don had been at the London School of Tropical Medicine, getting
           a degree, and he came home in the summer of '66. Don was missing
           during most of the preparation for the smallpox program. He got
           back just as we were getting folks to start.
Harden:     And I have a quote here that you said to him, "Welcome to the
           NFL." You want to explain that, and talk about how it was to
           shift from 1 leader to the other leader?
Griggs:     Well, Don and D.A. had a considerably different management
           philosophy, I guess you would say. I didn't know Don. I may have
           met him, but I had not remembered meeting Don until he showed up
           at the office coming back from England. We hit it off quite
           well. Don was completely unexposed to the operations office or
           the Public Health Advisors, but he quickly saw their value and
           was a champion of the Public Health Advisor throughout the
           remainder of his career, even after he became Director of NIOSH.
                 So after Don came in, the program was moving right along,
           in terms of the training activities; project agreement signings
           were slow. We had planned on sending the first people to Africa
           in September to get things kind of on the road at the end of the
           rainy season and be ready to start at the beginning of the dry
           season. The last pro-ag [USAID term for a project agreement] was
           signed, I think, in March of '67. There were considerable delays
           in getting all of these, and there was some very fancy footwork
           involved in getting pro-ags signed. It's too bad that George
           Lythcott's not here. George was a master at getting things done
           in Africa. I won't say how, but he wound up getting an
           appointment with the head of the government of Nigeria at the
           time after the coup. And he got a commitment that the pro-ag
           would be signed, and it was signed. That was the big one, with
           the regional office going into Nigeria and the 3 or 4 regional
           assignments within Nigeria. And because of its size and
           complexity, northern Nigeria had a Medical Officer and 2
           Operations Officers. It had a male and a female Operations
           Officer, the only female Operations Officer we had, because of
           the expected difficulty of working with purdah, in terms of
           getting the women vaccinated. And it worked out quite well.
Harden:     What was her name?
Griggs:     Vicky Jones [Clara Jones].
Harden:     Were there any unusual occurrences that you can think of that
           you can tell me about?
Griggs:     There were so many things that were happening. We had some
           problems with 1 individual, I recall, who had difficulty with a
           security clearance. He never got it cleared, so he was very
           unhappy. The people who were sitting in Atlanta with families,
           living in temporary quarters, and being delayed about going
           overseas, were considerably unhappy.
Harden:     And this was all coming back to your desk?
Griggs:     Mine and Don's. For the docs, it would go to Don, and Don would
           come to me. If it was the Operations Officer, he'd come to me,
           and then we'd try to get it resolved.
            Don and I went to Nigeria, for a meeting-it was after the
           program had started. The folks who were in Africa came to it,
           and they were less than happy campers, I guess is a good way to
           describe it. For a variety of reasons.
                 During the training session, because of the cross-cultural
           problems they were going to be facing, we tried to give some
           insight into the things, the do's and don'ts, or at least,
           "Think twice before you do it" type things. And I remember very
           vividly, one of the wives who had been aghast at the thought of
           having a cook, a nanny for the kids, a gardener, and a night-
           watch person, and maybe a small boy for the kitchen, depending
           on how many kids they had. This was the typical number of
           servants a family would have. She didn't want that.
                 But when she got to Africa, she was very unhappy because
           she was in an apartment. (We lived by the ground rules that the
           American embassy had, that folks with no children and single
           people were usually put in flats and apartments. If possible,
           families with children were given a house with a yard.) So when
           Don and I got to Yaounde, this woman was very unhappy because
           she was in an apartment when other folks had houses. So the
           uptightness about the ugly American with hiring the people and
           going to the market and sending the local hire to the market to
           buy food and whatnot, and not shopping for themselves, soon
           became a thing of the past. People realized that they just
           couldn't cope with that kind of activity.
Harden:     Very interesting. What was the toughest problem that you recall
           in this whole endeavor?
Griggs:     Oh. I hadn't even thought about that. I guess what caused the
           most consternation were the delays in getting project agreements
           and getting people out there, ready to go.
Harden:     So the beginning was [the hardest?] Once it was going, it was
           [ok]?
Griggs:     As you can imagine, people have a tendency, if a program says
           they're going to do 300,000 vaccinations, to want 400,000 doses
           of vaccine because they're going to have some loss at the end of
           the day. (Vaccine that is opened is discarded at the end of the
           day.) So they ordered more vaccine than they needed. Or some
           didn't order enough vaccine. It was a problem trying to second-
           guess people in the field, or respond back and forth to people
           in the field about what the realities of the program are. For
           example, you've got to have the vaccine, you have to discard it
           if it's at the end of the day, but if there are only 2 people
           left and you're going to be there in the morning, you don't
           necessarily open a large vial of vaccine to throw away-that type
           deal.
                 And the business of getting the parts. Having been in the
           field myself, I know it's never fast enough. "How come I didn't
           get it yesterday?" is the attitude.
                 So there was a certain amount of confusion and
           consternation constantly. But the program had a budgeted cost of
           $46 million. It was completed at a cost of just over US $30
           million-largely through some good work on the contract officer's
           part, being innovative and looking at alternative sources for
           things. So it was $16 million under cost, and it was completed
           in West and Central Africa a year ahead of schedule in terms of
           smallpox eradication.
Harden:     That is an amazing story. Tell me about the bureaucratic
           relations between headquarters in Atlanta and the regional
           office in Nigeria, in Lagos.
Griggs:     Sore point. The regional office was designed to start with as a
           resource of experts to be available for the countries. I wasn't
           involved in recruiting George Latchet, so I don't know what was
           said to him. George felt that the regional office was the
           director and that Atlanta was to provide support to the staff in
           the Regional Office. This misunderstanding was resolved, I think
           amicably, and George stayed through to the end of the program,
           and I think he was satisfied. He would have much preferred to
           have been running the program, but I don't know how to say much
           more about it than that.
                 Copies of memos and reports went to the regional office so
           that they were aware of what was going on, but things did not go
           through the regional office to be signed off on. Dave [David
           Sencer] just walked in, and I 'm sure that he may have a
           different story about this regional office conflict, but it was
           resolved. People were not ecstatic over the way it resolved, but
           the program operated.
Harden:     If you were going to undertake the program again, would you do
           anything differently?
Griggs:     Knowing what I know right now, I might do something
           differently. Not a lot. This doesn't sound right coming from me,
           but we didn't make a lot of mistakes in the smallpox program.
           Things were thought out, were worked out. We had a couple of
           people who I might not have recruited, but we didn't bring
           anybody home for improper action, or for not doing their job.
           And to have had 46 people in the field at 1 time-and overall,
           I've not even looked at the number, but probably with
           replacements, probably 60 or 70-people overseas-and not to have
           had somebody that didn't work out? We had a medical evac
           [evacuation] or 2, now. But I 'm talking about bringing somebody
           home for either being unable to carry out their work or the host
           country's saying, "Get this guy out of here"-that just didn't
           happen.
Harden:     That's also very impressive, is it not? Did you ever have any
           doubts that the program was going to be a success?
Griggs      :    No, none, after it got off the ground, in terms of
           smallpox eradication. Success in terms of measles control? An
           awful lot of people thought it couldn't be done. It was proven
           that it could be done with the right kind of input. Bob
           Helmholtz [Robert C. Helmholtz] ran the program in Gambia out of
           Senegal, and Tom Leonard [Thomas A. Leonard] doubled with Bob in
           Senegal for a short period of time. Tom was in Mauritania, when
           the '68 conflict occurred there, and the US Government left. Tom
           went and finished his tour in Senegal, but The Gambia had a good
           person who was in charge of the program, had a Minister of
           Health who was very much in favor of this. It was a small enough
           country, and while it was had poor roads, it had a river that
           ran through the middle of it, and you could get up and down the
           river. And The Gambia interrupted measles transmission and kept
           the country measles free for a couple of years. So it could be
           done. But it required an awful lot of effort, and I don't think
           Africa was ready for that effort. But smallpox was a success.
Harden:     How did you all, in headquarters, deal with the feedback you
           were getting, in terms of your conversations? The feedback from
           the people on the ground, and what you then said back to them?
Griggs:     There was a weekly newsletter that went out to all the field
           staff, which was kind of folksy. It originated in Atlanta. Don
           dictated material for it, and I added to it. It covered what was
           going on, what the problems were, what some solutions to
           problems were.
                 There were lots of phone conversations. In those days, you
           connected to French West Africa through Paris, and English West
           Africa through London, with a radio call from there on down. So
           you started out with a voice that they could hear at least 2
           floors above you, to build up impetus on the radio, and after a
           long conversation you almost lost your voice sometimes.
Harden:     What do you think that the Africans learned about CDC and about
           America from this program?
Griggs:     Some of them already had exposure to CDC. They had been CDC EIS
           officers in with the measles program a little bit earlier. The
           Operations Officers were told that their responsibility was to
           get the job done, but not to do it. If you do it, if you're out
           on vacation or out sick, things are going to go to hell in a
           hand basket quickly. So while it's much more difficult to train
           your counterpart to do the work, it's worth the effort if you
           want something left when you are not there. And you could very
           quickly see the difference when this philosophy was accepted and
           followed through on, as opposed to when work was done directly
           by the Operations Officer.
Harden:     So that was a legacy, then, that was left from the program?
Griggs:     That was a legacy that was left. To each of the training
           programs each year, we brought a cadre of docs and nurses. Now,
           Africa had a few docs, but most of the actual field activities
           of the program were carried out by nurses or kind of an African
           Operations Officer, if you want to call them that. A group of
           those came to Atlanta each summer-probably at least 100 people
           over the 5 years.
                 The last year of the smallpox program in Africa, when the
           CDC people were brought home, was '71. USAID wanted to follow up
           with a program for childhood immunizable diseases. Such a
           program subsequently came to CDC, through a participating agency
           service agreement. And the activities, the countries that were
           involved in this were virtually the same as those involved in
           the smallpox program, with some expansion into eastern and
           southern Africa.
                 So, all in all, I would think that from the standpoint of
           foreign relations-forget about the health aspects of it-the
           money spent on the smallpox program was probably better or equal
           to anything that was spent otherwise. In the 20 countries, there
           were a lot of coups and counter-coups, changes of government,
           and a civil war in Nigeria right in the middle of starting the
           program. And no one was evacuated except the team that was in
           eastern Nigeria. But in terms of a coup and a change of
           government, the smallpox and measles program proceeded as if
           nothing had happened.
Harden:     What impact did the program have on your career?
Griggs:     Hard to say. I guess it was probably good. Dave Sencer came in
           as the Director of CDC during the program, and I could have said
           this better if he wasn't in here, but I'm going to say it
           anyway. The smallpox program was accused of being Dave Sencer's
           pets, the fair-haired boys, but I might add that when Don and I,
           or subsequently after Don, when Bill Foege [William Foege] and I
           went to Dave and laid out what we needed, Dave bent over
           backwards and gave us what we needed, to the extent possible,
           and it was sufficient.
Harden:     Did this program have any impact on your family? Now, you were
           here in Atlanta primarily; you visited Africa but you weren't
           living there. But how did your family think about it?
Griggs:     I had a good wife, who understood being gone 3 weeks at a time.
           George Lythcott tried his damnedest to recruit me to go to
           Africa, to the regional office. And I turned him down. And
           obviously he had talked to D.A., and maybe to Dave, and I think
           they turned him down. Other than being away from home a short
           period of time, while I was in VD, I was home on weekends. But I
           traveled more days when I was working the 50 states than I did
           when I was working Africa.
Harden:     Did any of your children go into health-related work?
Griggs:     No.
Harden:     Not a one?
Griggs:     Not a one. As a matter of fact, my son may have had a negative
           impact from this. He was, I think, pleased with the work that I
           was doing, but he was adamant that he did not want to work for
           the government. I don't know who brainwashed him.
Harden:     Very interesting. Is there anything else you can think of about
           the program that we should capture in this interview, before we
           stop?
Griggs:     Well, I'm sure that Don Millar and others will say it better
           than I would, but the things that were really learned about
           doing immunization work from the smallpox program, in this
           country as well as other countries, have made a big impact on US
           activities, as well as on international activities in other
           countries. Obviously, D.A. was head of the smallpox program in
           Geneva. West and Central Africa cleared up right quickly. It was
           obvious that some problems were occurring in India, Bangladesh,
           and other places. CDC people from the West Africa program went
           overseas into many of those countries, to either get them kick-
           started or to stay there and wind up. In Bangladesh, India, Andy
           Agle was in Afghanistan, so it was a maturing of CDC's
           international venture, I think. While CDC is a domestic
           organization, when I left CDC we had people assigned in probably
           25 or 30 countries around the world, through WHO or through
           other avenues-the World Bank, UNICEF, etc. And this has
           contributed, in my estimation immeasurably, to other health
           activities. I think the Gates Foundation's work in international
           health goes back to the smallpox program. Bill Foege was a
           missionary in eastern Nigeria, and I guess was happy when we
           recruited him to be a contract doc for eastern Nigeria for us.
           And when he was evacuated, we brought him back here, and he
           became one of the lead people in smallpox. When Don left, Bill
           of course became the director. Went back to India for the wipe-
           up on that. I'm sure, no question in my mind, that the Bill
           Gates Foundation would not be doing what it's doing, if it were
           not for Bill Foege.
Harden:     Thank you so much for speaking with me.
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