66 12 2286 https://www.globalhealthchronicles.org/files/original/9c4eb38b7b33579782dddfac3c43af2f.jpg e2940ab5a27ebff907d52ec979490dd1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Malaria Control: CDC Beginnings Description An account of the resource <div class="landing"> <p>In 1942, when the U.S. was mobilizing for the Second World War, the U. S. Public Health Service set up a program to protect the personnel of military bases in the Southeastern states from malaria. This disease had long been rampant in the area, and posed serious threats to the health of the military and civilian populations. The program known as Malaria Control in War Areas (MCWA) was created to carry out the work. The lack of space in Washington due to the war effort allowed the program to base its headquarters in Atlanta, Georgia, and closer to the work at hand. During the war years, the program was expanded to include the control of other communicable diseases. Because its work was so successful, a new organization was created around the nucleus of MCWA, the Communicable Disease Center (CDC). The date was July 1, 1946. This archive chronicles the agency’s early history from 1941-1951, including the contributions of local businessmen and Emory University. The buttons to the right will connect you to a searchable database of documents, oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used.</p> </div> Media Powerpoints, Recorded lectures, movies, training films, and interviews Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/gWi6YSPzO70" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HEALTH EDUCATION MALARIA CONTROL Description An account of the resource Health Education Against Malaria. A teacher learns the facts about malaria control and mosquito elimination in a health education course sponsored by local, state, and federal public health officials, and later imparts her knowledge to home town groups by lectures, field trips, and individual instruction. Black and White TRT :06:11 Produced by the United States Public Health Service Source A related resource from which the described resource is derived U. S. National Library of Medicine, History of Medicine Division, Images and Archives Section at the National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894 www.collections.nlm.nih.gov Date A point or period of time associated with an event in the lifecycle of the resource 1944 https://www.globalhealthchronicles.org/files/original/03152ec869a41504ee22052dd47e4897.pdf 4089f6b8d98aace678e8491a1c22976e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HIV/AIDS Documents Government Records Keywords March 29, 1985, Darrow, AIDS, homophobia, care, inadequate, insensitive, education, need, empathy, sensitivity, CDC, training experiences, channels, topics, language, skills, nurturing, support, scientifically credible, standardized message, policy, technical assistance, evaluation Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HEALTH EDUCATION: Issue of Homohobia Description An account of the resource Discussions on homophobia, health-workers need to enhance their understanding, empathy, and sensitivity towards high-risk groups. Source A related resource from which the described resource is derived Bill Darrow Collection Date A point or period of time associated with an event in the lifecycle of the resource March 29, 1985 https://www.globalhealthchronicles.org/files/original/fc977aaa4af0379ecde5363ab37bbe57.pdf 67284144332dff24e4958a5ed48ac54c Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HIV/AIDS Documents Government Records Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HEALTH WORKER PRECAUTIONS Description An account of the resource A collection of 5 memos regarding risks to Health-care workers and exposure to blood from AIDS patients and precautions to take. One manuscript on precautions for personnel taking care of patients with AIDS. Source A related resource from which the described resource is derived The U. S. National Archives and Records Administration at Atlanta, 5780 Jonesboro Road, Morrow, GA 30260 www.archives.gov/atlanta Date A point or period of time associated with an event in the lifecycle of the resource 1982-1984 https://www.globalhealthchronicles.org/files/original/849aab2bcd50143f027792248f1a8022.JPG e5de2775973929cb628fe608de7802a9 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HIV/AIDS Media Powerpoints, Recorded lectures, movies, training films, and interviews Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HEARD MUCH ABOUT AIDS LATELY? Date A point or period of time associated with an event in the lifecycle of the resource 1991 Description An account of the resource America Responds to AIDS [ARTA] "Heard much about AIDS lately?" "Barbara: Ask me if I've heard about anything else. Really? So your friends talk about AIDS? Barbara: No, no one does. But, you said you haven't heard anything else. Barbara: I guess they're embarrassed. Are you embarrassed? Barbara: AIDS isn't exactly what you'd call party conversation. No, it's not party. But how are we ever going to prevent AIDS if we can't even talk about it? Barbara: But, how do you talk to someone about AIDS? Just like this." Prevention; Education; Women; Advocacy; Source A related resource from which the described resource is derived United States Department of Health and Human Services, Centers for Disease Control and Prevention, America Responds To AIDS https://www.globalhealthchronicles.org/files/original/ea4d91d4e47689bbe084c65887cc294c.pdf d4a451b3cfb67b633452862f07ace1e2 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HIV/AIDS Documents Government Records Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HEARING REQUEST Description An account of the resource LETTER TO: Dr. Mason FROM: G. V. (Sonny) Montgomery, Chairman of the Subcommittee on Hospitals and Health Care Asking Dr. Mason to testify on AIDS policy regarding the Veterans Administration medical system. Attached are budget documents and a Q&A about AIDS programs. Source A related resource from which the described resource is derived The U. S. National Archives and Records Administration at Atlanta, 5780 Jonesboro Road, Morrow, GA 30260 www.archives.gov/atlanta Date A point or period of time associated with an event in the lifecycle of the resource May 29, 1987 https://www.globalhealthchronicles.org/files/original/6c05648fe0f26c77059d17827e217d2d.JPG 358e2e12533f32430aa346434291156e https://www.globalhealthchronicles.org/files/original/f8a83df4dab3a4469049b40b976cfc06.JPG ee20bee70b9fcdc07126a16e368d7aaf Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Ebola Media Powerpoints, Recorded lectures, movies, training films, and interviews Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HELMET – Liberia Description An account of the resource A motorcycle helmet worn by Riders for Health couriers traveling by motorcycle throughout 15 districts for specimen transport during the 2014 – 2016 Ebola response in Liberia. Riders for Health specializes in supplying, managing, and maintaining vehicles for health-focused organizations in African countries. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Riders for Health Date A point or period of time associated with an event in the lifecycle of the resource 2014 – 2016 Identifier An unambiguous reference to the resource within a given context 2016.106.008 https://www.globalhealthchronicles.org/files/original/bf42be937ce9eae9cb9b19cbb7de99f9.pdf 96dd5c27e1ada97265aa001cbc1ba59a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HIV/AIDS Documents Government Records Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HEMOPHILIAC RISKS Description An account of the resource LETTER TO: Dr. Jeffery A. Koplan FROM: Dr. Leon W. Hoyer Regarding the risks associated to hemophiliacs. Source A related resource from which the described resource is derived January 6, 1983 Date A point or period of time associated with an event in the lifecycle of the resource The U. S. National Archives and Records Administration at Atlanta, 5780 Jonesboro Road, Morrow, GA 30260 www.archives.gov/atlanta https://www.globalhealthchronicles.org/files/original/ee0ead593395bd00bb0f24999ae89aac.jpg 9feba0e305076cbf28b12294cf45b79e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview D.A. Henderson with Paul O'Grady Transcribed: February 2009 Paul O'Grady: This is an interview with D. A. Henderson on July 12, 2008 at the Center for Disease Control and Prevention in Atlanta, Georgia about his involvement with the smallpox eradication program. The interview is being conducted as a part of a reunion marking the 40th anniversary of the program in Asia and East Africa. The interviewer is Paul O'Grady. Can you state your name? D.A. Henderson: D. A. Henderson Paul O'Grady: And you understand that this oral history is being recorded? D.A. Henderson: Yes, I do. Paul O'Grady: Thank you. I would like to start off by having you give us a little bit about your background, what lead you to a career in public health and how you started working for the CDC? D.A. Henderson: Well, I was born and brought up in Lakewood, Ohio near Cleveland. Went to Oberlin College and then to the University of Rochester School of Medicine. After internship at the Mary Imogene Bassett Hospital in Cooperstown, I was told that my deferment from the draft was at an end and I had my choice either to voluntarily enlist in which case I would be a first lieutenant, or be drafted in which case I would be a private. So, like many of my colleagues who had been deferred since, in my case 1946, and this is 1955, I decided I could volunteer. I was having difficulty making up my mind whether it was army, navy or air force. I figured I am just an intern, all I am going to do are boring draft and do physical of new recruits. So about this time somebody shows up from something called the Communicable Disease Center, which I had never heard of. They are from the public health service which I knew nothing about, but they talked about working on infectious diseases which I didn't really much care for. As I thought about it, well it might be two years and I'd learn something, and as they pointed out we don't wear uniforms, we don't salute, you don't do basic training. I go, well, okay, doesn't sound too bad. So I enlisted, in the public health service. Now, this was the Epidemic Intelligence Service which at that time was only four years old. That created by Alex Langmere at the CDC. There were, however, quite a number of applicants every year who were anxious to do their required time and service at CDC would be challenging, interesting, so forth. Well, fortunately I had done a history of medicine paper in my last year of medical school. Why had a done the history of medicine paper? Because they offered $200 and a handy subject was something about cholera in upstate New York in 1834 and there was material available in the newspapers and so forth. So I spent time creating this paper, going through the newspapers, plotting cases, doing curves. I didn't know what I was doing in terms of training but it really was epidemiology and in fact it turned out to be rather fun. I had to see what the responses of the health department were, to the various challenges. Seeing how it spread through the city and so forth. So in advertently I'd become interested in a subject which we had no courses in at all and I got drafted to the public health service. That's where I got into public health and I had no interest in public health either at that time. I was going to be in my mind a cardiologist and this would be two years out and then I go back to my residency in cardiology. Paul O'Grady: What were the major public health concerns at that time? D.A. Henderson: There was one dominant major public health problem at that time or challenge and that was polio myelitis. There had been significant cases, significant outbreaks of polio myelitis. In the 1950s, there was a great deal of fear at that time about polio. In the summers there was - they closed swimming pools, parents kept their children away from other children. If there were outbreaks there was a great deal of anxiety in the community. The National Foundation for Infantile Paralysis was a very major foundation. It was the only categorical foundation at all that time. It had been started because of President Roosevelt's, Franklin D. Roosevelt's polio myelitis and they had raised for Warm Springs, Georgia rehabilitation center. They had been extremely successful and they took some of this money and they put it into some basic research of very good quality and development of the vaccine. There was great anticipation in 1954 because they began the first major study of the Salk vaccine and there was school children across the country. I forget how many were involved. As I recall it's 100,000 plus. The results were coming up in April of that year that I was doing my internship. Very soon thereafter they began to, in April, I guess they announced the results and they began vaccination around the country with the vaccine. About this time they found that some of the lots of vaccine were not quite - the virus was not quite as dead as it should be. They began to get cases of polio myelitis, paralytic disease caused by the vaccine. So I was being inducted into the Center for Disease Control. The epidemic intelligence service Alex Langmere's group were doing the work of compiling information on the cases in trying to find out which lots of vaccine were involved and trying to determine the magnitude of the problem and then what to do about it. So we were totally immersed, as I came into the service on the 1st of July with what was an ongoing investigation into what really was the end of the largest field trial ever conducted on a vaccine and the introduction of the polio myelitis vaccine which was - had been awaited for so long. At the same time we had what was amounted to a vaccine incident which was serious with a number of paralytic cases associated with the vaccine. The question was, was it the vaccine of all companies or was it maybe one company and only some lots of the vaccine or what was it. So this was all absorbing for many of those who came aboard at that time. Paul O'Grady: And how many years were you at CDC after your - so you got a two year government required service and then you stayed on? D.A. Henderson: Well it turned out be rather more exciting than I had thought. They had a matching program. So, that those who are recruited you then submitted your preferences on a list of different positions you could have. They in turn would look at the people who are coming in, about 30-35 of us and decide which ones they wanted and they would list their priorities and then they match them up. I matched up with a position which was called assistant chief of the epidemic intelligence service which would be as they called it a go-for job kind of putting things together, helping organize a course and doing things of this sort. Well, we would have a course to a one month at that time where they taught us epidemiology and bio statistics. Basically how to investigate an outbreak and at the end of the one month you are then a qualified epidemiologist in our terms and at the end of that course I had to go off the epidemic intelligence service did to an epidemic. We were constantly being called for various epidemics. There was a big epidemic of diphtheria in Phoenix City, Alabama. I went down, I spent three weeks down there and giving vaccine, taking cultures. The patients were housed in a big Red Cross tent. I came back and here was the chief epidemic intelligence service officer packing his bags. I said, "Where are you going?" He said, "I have another job. I am going to be a state health commissioner." I said, "Well, what do I do?" He said, "I guess you are the Chief EIS officer." I said, "I have no idea what to do?" He said, "You will learn." Sure enough, then I began working in a job that certainly I was not qualified for but plunged in. With the mentorship of this Alex Langmere who was a legendary epidemiologist, a rather difficult person but demanding and just a wonderful teacher, just an extraordinary teacher. At the end of two years of this, I finished my duty. I proposed to him, you know, we are not keeping many people on. The people were getting, so many people apply. They are well qualified. All of them wanted to do academic medicine or pediatrics. Just about nobody wants public health. Now, if we offered a 5-year training program in which you do two years of training, like a residency in cardiology that I was thinking for myself, and maybe then three years with the public health service. Maybe that would be a way to attract people, then by then you will have, say then, seven years and we might get people staying longer. Well, he liked the idea and then well, he submitted it up-line to the surgeon general. He liked the idea. So, I applied for a five year training program and went back to get my residency. At the end of the - well, during the course of the residency, I found this to be frankly rather boring. I was seeing patients and some of them had some heart disease and heart failure, a little diabetes, a little gastroenteritis. A little constipation and sort of the end of the day I felt, you know, if I really hadn't been there, I wonder if it would have made any difference and was I making any difference. Am I going to be doing this for my next 40 years? Well, meanwhile I had been two years in the epidemic intelligence service which some exciting outbreaks here and there including one which was an interesting one in Argentina. There was a big outbreak of food borne disease. They were stoning the restaurant, the Argentine government was upset. They thought it was a type of food poisoning due to the Botulinum toxin. They wanted our, what we had in the way of antitoxin to treat them. So I took off for Argentina with such supplies as we had. Paul O'Grady: When was this? D.A. Henderson: That was 1957. At the end of this I saw the secretary of health. He sort of offered "Well, let's go on a hunting trip or a shooting trip with me at my lodge." I said, "You know, I hear you have got an outbreak of smallpox." He said, "Yes." I said, "I would like to go see it." So he said, "Fine." We took off on an old Pan-Am clipper off the waters and the river on La Plata. On up to another place and we got in a two passenger piper cub and flew into a smallpox - the area where they had the smallpox and they had an outbreak of smallpox. The people were in tents in the field and so, about 30 different patients. We looked at the patients one by one, it was fascinating. And at that point, I had never seen a case of smallpox, really didn't know what it looked like. But it was my first contact with smallpox. Paul O'Grady: Was there at that point any national or international interest in trying to organize the fight for smallpox? D.A. Henderson: The international concerns about smallpox were there very, very strongly because all travelers were obliged to carry certificates indicating they've been successfully vaccinated within the preceding three years. Just about every country including our own enforced this. If you weren't vaccinated you wouldn't get admitted or they might vaccinate you on the spot. There was a great concern about importations of smallpox. It was in 1958, just about a year later after I had seen the cases that the vice-minister of the Soviet Union proposed to the World Health Assembly that they undertake a program to eradicate smallpox. That was the year the Soviets came back in to the UN family. They'd withdrawn because of the Korean War and they were - they just come back. So the proposal, they looked at this, delegates at the assembly looked at this and they really wanted to be helpful and encouraged the Soviets this time. So a year later they approved a program to eradicate smallpox. The only thing was that at - that same time the World Health Organization was deeply involved in a program to eradicate malaria. And fully a third of all staff were involved in that and all the spare money they could get together because it was very expensive, very costly. The idea of undertaking another eradication program was really not the intent of the director general. In fact the only thing he could do is say, "Fine." He really gave it very little money and a few countries then did some vaccinating and tried to get rid of smallpox. They did make some progress in this but it basically was going anywhere. That was the beginning. It was 1959 when they decided that they would undertake a global program but it really was not anything that was happening. It was seriously, it was not until 1966 that they really took it seriously. Paul O'Grady: What was the attitude of the United States government towards this program that it seemed to have gotten some impetus from the Soviet Union? Was there any political peculiarities about that? D.A. Henderson: There, clearly was an element of Cold War competition. The US was heavily supporting the malaria eradication program, both through the organization very heavily and through direct bilateral donations to the countries. So the US, you could almost say, owned the malaria eradication program. The Russians had no program at that point that they could say the same thing about. So, in a way they came in with this smallpox and said look, we got rid of it in the Soviet Union back in the 1930s when our vaccine wasn't so good, when health conditions were poor, where personnel were not well trained and we got rid of it. So, why can't the rest of the world get rid of it? So that's where they came in and then put after 1959, every year at the World Health Assembly they would really give the director general a very hard time. Why aren't you putting more money into the smallpox program? Why do you favor the malaria program? And so that went on as a continuing piece. The US really took no notice of it. It's really what it amounted to until really it came up to 1965 when a change came for the US. Paul O'Grady: Which was? D.A. Henderson: Well, in 1965 - I'll go back a little bit, 1961, Merck Sharp &amp; Dome, at that time, was introducing a new measles vaccine. It caused a lot of fever in children. So in the US, they were using it giving the measles vaccine and they gave them some immune globulin at the same time so that they wouldn't have so many reactions to the measles vaccine illness, if you will. This made little practical sense if you went to Africa. The idea of doing these two together and made life a lot more complicated. You really could not do large scale vaccination and try to preserve the immune globulin and deal with two shots to get this. So they undertook studies in Upper Volta, Benin. I am sorry Upper Volta is the place where they were doing the country. They did x number of children, 150 -200, kids reacted very well. They were no complications. Then they asked - the country minister said, could you give - do it for all kids under six years of age. So they gave them a vaccine enough for that. Then there was an organization, French organization that had a number of countries and he said, could we do it for six countries now. USAID said, "Okay, we will do it for six countries." Well, things couldn't go very well with six. I won't go into all of the complications but we got drawn in at that time to evaluating it. I sent one person over to evaluate. It was a disaster. Well, not to be deterred they decided we are now going to do 11 countries. We need from you, 11 people for six months each to help get the program started in each country. I thought, we can't do that. Really, it's - a good segment of my staff and signing people over for 6 months at a stretch is, without families and what have you, this is tough. So I thought, you know, I really have to work with AID, we really got to be responsive to them. I didn't know what to do. So I decided, all right, let's put together a proposal that we would say is sound from this public health standpoint. Why was the measles proposal bad? Well, they were going to give it for just four years and then stop. In other words AID would support it for four years and they expected the countries to continue. It cost a $1.75 a dose. The countries couldn't afford $0.10 a dose for yellow fever vaccine. So this is not good public health practice. To start a program, get the hopes of the public up and then drop it. This is terrible way to do it. Smallpox had vaccine however, cost a penny a dose. So they proposed the idea, well, suppose you take this whole block of countries, 18 countries and suppose you give, do smallpox vaccination - Paul O'Grady: And you talk about West Africa? D.A. Henderson: This is west, West and Central Africa as well called it. And so we do 18 countries. You give smallpox and develop a smallpox program there. We could get rid of smallpox in that whole area, they could then - would have as an established program for vaccination. They could continue it easily when that only cost them a cent a dose in vaccinating newborns and so forth. Then if they want to have measles vaccine added and the ministers think this is a good idea, we would be happy to give measles vaccine at the same time, but we can't eradicate it because measles spreads too easily. We couldn't get rid of it, but at least the countries would have to think through was this a good idea to do this with measles vaccine as well. Well, I think the cost - what USAID expected to spend was about five or $6 million. The proposal we submitted was about $35 million. So, I knew it can be turned down. But on the other hand I thought it was going to be a point of departure for discussion. I didn't know where we were going to find any sort of compromise on this. They just, their demands were so great that it was impossible. So I set it up through channels, through the surgeon general and very shortly USAID turned it down. We were just debating along about autumn what we would do subsequently on this. Paul O'Grady: And we are still in 1965? D.A. Henderson: This is 1965, when all of a sudden we got information that the president had decided to approve the program, the whole program. This shook everybody. My boss Alex Langmere was absolutely beside of himself. As I told him they were not supposed to accept it, that was - but the president was looking for an initiative which would be something that he could publicize that the US was contributing to a UN International Cooperation Year. There were several proposals that went forward. This I had no idea was even being considered and suddenly AID was told by the White House, fund it. All of a sudden, we are told, all of a sudden we have got 18 programs to set up in the West and Central Africa. We had never run a program outside the United States at all. Paul O'Grady: So you guys have been faced with a tremendous manpower problem? D.A. Henderson: Well, we would need about 54 people. That we are going to have to recruit. AID said that it probably would be - you can't do this under three years. They agreed finally to fund it then on November. They felt we could get it in three years. I said, no. This is wrong. It's just got too much of a delay. How about 13 months? We will have the people over there in January of 1967. They thought it was almost impossible. You've got individual agreements what every country. You have got to order the vaccine, you have got to put on training programs, you've got to recruit all the people. We did. Recruited the people, we got the vaccine ordered. We got vehicles. We had to use US American vehicles. There weren't any in all of these countries. No maintenance, no repair, so we had to set up workshops and everything else, to train our people to be mechanics. We had to lay out plans for all of the countries to get everything signed and we did. Paul O'Grady: Let's talk of, just for a second, about the attitudes of the countries involved. What was the interaction with the governments like? D.A. Henderson: Well, in November as soon as this was approved, I went over with a consultant that I had who, Warren Winkelstein, who was a good epidemiologist and spoke French, another person by the name of Dr. Henry Gelfand. The three of us went and visited each of the different countries. Fortunately a number of them were having a meeting, so we could present it to all of them at one time. They were enthusiastic. Why were they enthusiastic? More - most of them, more because of the measles vaccine because this is a very - in Africa, this is a very deadly disease. It's 10-15% death rate. The French speaking countries by and large had done some pretty good vaccination with pretty good vaccine. The English speaking countries had a lot of smallpox. They were more enthusiastic about the smallpox. But they were getting both and they were really very enthusiastic. We were coming up with vehicles. We were coming up with vaccines and consultant help but not a lot of people. It was by and large one or two people or advisors to be assigned to most of the countries with a few more in Nigeria. Paul O'Grady: And how about the Americans that were going to go over there as part of this program? Let's talk a little bit about their attitude? D.A. Henderson: Well, the Americans who were going over there, a number of the people I - some of them I had known. Basically called up and said, we have got this coming up, are you free, or would you be interested, people, contemporaries and so forth. I had a couple of people who are already serving in CDC and took them. Basically it was almost word of mouth advertising because there just wasn't very much time, and contact with people at schools of medicine and other places, infectious disease people that might know of people interested in this. People - the word of mouth, by word of mouth they learned about this and my goodness, we were able to recruit enough, so that we were able to begin the training program in July of 1966. Paul O'Grady: And people were on the ground? D.A. Henderson: Well, they had to finish up the training. We had to get all the agreements signed. I think we got all of them in to 16 of the 18 countries. We managed to put two, postpone two, but we had 16 of them by January of 1967. Meanwhile, there is a little problem. There was a debate coming up in the Assembly in May of 1966. So this is only like about 6-7 months after this approval for the whole West African program had come through. Paul O'Grady: Debate in the United Nations Assembly? D.A. Henderson: Debate in the World Health Assembly? Paul O'Grady: Okay. D.A. Henderson: Every year the ministers of health convene in May, in Geneva to look at issues of health. So they were debating the question of going with an intensified program of smallpox eradication with a budget of $2.4 million a year and an objective to complete that within 10 years. The director general Marcelino Candau, a very capable Brazilian knew that it was impossible to eradicate it. He felt you had to vaccinate everybody in the world and he was a Brazilian and he knew that there were tribes in the Amazon that hadn't been found. Or were just recently found or that sort of thing. So he knew it couldn't be done. There were a number of countries that were very doubtful of the concept of eradication at all because they were having so much trouble in malaria eradication. There were others who thought this was far too ambitious for an organization like WHO which is, where it's not, except for the malaria really it hadn't run programs or really coordinated that way operationally health programs. So it came to a debate in the assembly. The US had, as I said, been very quiet before this really in taking a position but at this assembly they were going to take a vote finally because it was very controversial, whether they went ahead or didn't go ahead. One of the strong arguments was well, the US is already committed, funds and personnel for - to take care of 18 countries. So that's a big start on this whole thing and after two o three days, three days debate, they did vote. They had about 58 votes to start the program and it passed by just two votes. It was the closest vote they have ever had in the World Health Assembly. The director general was furious and felt that the assembly had committed the World Health Organization to a program which is going to fail. It would bring the organization into disrepute and question the credibility of public health and the World Health Organization. He blamed the US for this. Well, in a way, it was true. If the US had not done this crazy thing in West and Central Africa that almost certainly the voting would not have gone as it did. So he was blaming the US. He, then, called the surgeon general in the US and said I want an American to run the program because when it goes down, when it fails, I want it to be seen that there is an American there and the US is really responsible for this dreadful thing that you have launched the World Health Organization into and the person I want is Henderson. Well, I was associated, of course, with the West African program of having gotten involved with starting it and so forth. So I got called to Washington and I was told I was being assigned to be head of the World Health Organization's Global Smallpox Program. I declined. I said, we are just starting this West African program. We have just - there is a huge amount of work and we have just barely started. The $2.4 million we got to go, we had programs in 50 countries. We don't even have enough money, $2.4 million won't even buy the vaccine we need. Trying, I had some experience in working with the World Health Organization and they really were not working well together. Each of the six regional offices were sort of wholly independent and trying to coordinate them was a terribly job. So I said, I really can't do it. I, you know, I think this is a very difficult task. I really, I think if we do a good job in West Africa, we are going to show what can be done. Maybe that will encourage the other countries but that's, I think, where I ought to stay. Paul O'Grady: Was this conversation going on between you and the surgeon general? D.A. Henderson: Yes. So I declined. He said - I said, you do not - we don't order people in the public health service to go from place to place. That we - we talk about career opportunities, and so forth and so on. It's not like the military services. He said, "Well, this is your career opportunity." I said, "And suppose I decline." He said, "You are fired." I said, "You are serious." He said, "I am very serious. I will tell you what, make a deal. You go for 18 months and if at any time during that 18 months you really feel it won't go, just send me a telegram, just put now and I will pull you out." So, I headed for Geneva to head up the Global Program. We left in October to go to Geneva, get a house. Wife and three kids, plus left half of our household goods in the storage because we knew we would be back pretty soon. Took over a program, which was a global program. This provided for headquarter staff eventually of nine of us. It never got bigger than that. So there were five medical officers, two admin officers and a couple of secretaries. That was our total staff. Paul O'Grady: Let me ask you about your own mindset at this point. You had mentioned the problems with the measles program and that malaria eradication had been problematic. Were you optimistic at this point about - at least with respect to the West African piece of the puzzle? You were optimistic about eradication's success? D.A. Henderson: This is a good question as to whether you would characterize what I felt is optimistic. My feeling was it was doable but without a full appreciation of everything, all the problems we would encounter. I must say because as I thought back on it, had I any idea of all the problems that we would face, I would have not been optimistic. You can't anticipate civil wars, floods, masses of refugees, one thing after another and bureaucratic blockage of things, countries refusing to participate. All of the difficulties you can have with this, but fortunately I was innocent of the problems, these problems that you would encounter or we couldn't anticipate, obviously, most of these. It was the fact we had a good vaccine and the vaccine we knew and I'd worked, we had done some studies at CDC while I was in charge of the surveillance program, showing the vaccine was very good. You could get virtually a 100 percent takes, using a proper technique. We had jet injectors that we had worked with and perfected these with the inventor in the US Army so that we could add jet injectors that could vaccinate a 1000 people an hour. They looked - we looked optimistic that we could do a lot of vaccination with them. So that, we had a good vaccine, we knew something about smallpox. You know that - we knew that there were a number of countries, developing countries who didn't seem to have any cases but the reporting was so bad that, little did we know that many of them just weren't reporting it. But we just - we really didn't have an idea but we thought there were large countries, free of the disease, certainly the US was and Canada was. Certainly there must be others that were involved too. So it was a feeling of technically this was doable but without an appreciation that experience would provide as to just how difficult the problem would be. Paul O'Grady: Let's take you to - take you back to Geneva. You have arrived, you had your family there and when did you start to realize that these challenges were going to present themselves? D.A. Henderson: We quickly found that we had problems. Within just the first couple of years, we ran into a number of problems. Paul O'Grady: Can you - ? D.A. Henderson: The West African program basically, Don Millar who took over from me, who had been my chief of my smallpox unit before. He was running it and he had a good administrative officer and he had some very good people in the field. My feeling was that they had to run that themselves and the only thing we could help them with, which they needed was some local costs. I think we gave them a couple of $100,000 a year to permit in some countries, purchase a vaccine, gasoline and a few other things, they couldn't get it, legally with their USAID funds. Other than that, they were on their own. So we worked at the world and saw well, we got, two countries are sitting rather at the far end. One is Indonesia, the other is Brazil. Now at that time, South America appeared to be free of smallpox except for Brazil. They had done vaccination programs in the other countries and one way or another, with their infrastructure, not perfect but they managed to get rid of smallpox. That of course was encouraging. But if we got rid of it in Brazil then they would be far away from endemic areas and indeed they could be basically the funds that we are putting into a Brazilian program could be withdrawn and we put it in other areas like Asia or Africa. Similarly with Indonesia, Indonesia sitting off where we are here and the countries nearby are free of smallpox. So the chances of smallpox being imported into Indonesia, if we got that free would be small and therefore the limited amount of funds we could use have, we could then transfer that to other countries and at least make a start in trying to get rid of the smallpox with the limited funds we had. So, that was the strategy. We almost immediately found we had a vaccine problem. The Russians had pledged 25 million doses a year and we had no idea how much vaccine we would really need. Most of the countries were doing some vaccination. The disease was so severe, it was such a problem that at least they had to vaccinate in the big cities simply because of civil disorder, with too much of this epidemic smallpox, it is destabilizing. So in all countries we are doing some vaccination and what we had - we made the assumption that most of them, already have vaccine and we have got 25 million from the Soviet Union. US is covering all the vaccine needs in their 18 countries, later 20 countries. So we got to be alright, but we - I thought we need to have some way to determine whether the vaccine is really, really potent, really good. So, I went to the Netherlands and asked if they would help in doing testing the vaccine, vaccine quality of the production that was there and then we went to Connaught Laboratories in Canada and they agreed to do that as well. So we began getting samples of vaccine from the different countries and they began testing it. Five percent of it was potent and stable. Five percent met the international standards. So we had a problem almost immediately. We couldn't afford to buy the vaccine. So I made a decision, we won't buy any vaccine. We are going to have to develop - improve the vaccine production facilities that are out there. We called a meeting of the vaccine producers from several major laboratories. From Wyeth Laboratories in the US, they were the producer here, they had one Lister Institute in London, where Netherlands were there, Soviet Union were there. I think that was it. We brought them together and we talked about vaccination and developing a standard manual. Every country was using where they were making a vaccine they were using all sorts of different techniques. So let's get what we think is the best way to do it in a simple manual that I can understand. Then let us then help these countries improve their vaccine. We will, then work with UNICEF to try to get them to provide some machines so that they could freeze dry the vaccine and we would use some of the people from these consultant laboratories that we had brought together to go out and train and help develop the vaccine. That's what we did. The vaccine quality began to pickup. It was by about 1972, we had more than 80 percent of the vaccine was being produced in the endemic countries themselves and it was good quality. So we were immediately involved in trying to solve just the vaccine problem. How to administer the vaccine was the second problem. The problem was this. You have a vaccine which is a very, has a vial, it's in a vial with about 0.25 milliliters of fluid. That is reconstituted. You have one vial that has dried powder of the vaccine, another which has a quarter of a milliliter of fluid which is a very small amount. To use a vaccine, you have to put the liquid into the dry powder and mix it up. Then you had to put it on the arm. The way they did this in most of the developing countries was take like a glass rod, dip it in and then put it on the - dip the rod against the arm, tip it against the arm and a little drop would be there. Then by and large what they did was scratch through the vaccine. They had a number of scratches through the vaccine, it was an old technique which goes back more than a 100 years. In the US we did a little bit differently but it was the same principle but it was important that the US did it this way. They took and took a needle and they put the drop back on the arm and then they gently pushed the virus through the skin and the idea was that if you got it just through the skin it will grow and produce something. If you push too hard you will get bleeding. If the bleeding occurs then it washes out the virus. You don't push hard enough, it doesn't go into the skin, and so the vaccination fails. Wyeth laboratories was developing a new device which I visited Wyeth laboratories because it was the question of improving our vaccine production capabilities in the other countries and they showed me this wonderful device which they developed. A little needle about - well, tube about so long. There are two little prongs on the end. They called it a bifurcated or sort of two fork needle. The idea was you put the needle into the vaccine and you just withdrew it. Between those two prong, the little bit of vaccine would be held and then they thought you press it through the skin. In this way the amount of vaccine you could get from a vial was 100 doses rather than 25 doses. Well, I looked at it and I know how much trouble we had had in trying to teach them to medical students how to vaccinate because they were forever not getting it quite - not enough pressure to break the skin. So it wasn't growing and then a number of them are getting a little bit of drop of blood and that was thought to be bad. So I raised the question of well, suppose that we take a needle and just hold it like this and poke it like this, we called it multiple puncture. Instead of scratching or pressing it through, do multiple puncture. You are going to get bleeding. So let's see what happens. So we tried a few of these, they all got very successful takes. We took it to the field into Kenya and Egypt and did several 100 children and we did it very vigorously. There was a little drop of blood on everyone. Every single one of them was successful. So this was incredible. All of a sudden we were going to have four times as much vaccine than we thought we had or we are getting, with these wonderful needles. The needles cost us, we shortened them up a little bit and make them cheaper than we made them out of a stainless steel virtually. We could get a thousand of them for $5. You could boil them and reuse them and we ran through about a 120 vaccinations perfectly good. So we had needles very inexpensively. We had a vaccine and suddenly we had four times as much vaccine as we thought we had. Then it was a matter of bringing those into play in the different countries and this went very rapidly. So it was another development, right at the beginning which made a huge difference. It was a crazy little thing. Now the important thing, I think was is that the - the inventor of this, a man by the name of Ben Rubin received a one time, to tell you, what's called the John Scott Medal of the City of Philadelphia for the best, most important invention of a particular year. Here he was getting this and it had gone back - the award goes back to the 1700s. Marconi has received it, Edison has received it so forth. He said, "This is the most insignificant patent or invention I have ever made," and he said, "And here I am receiving the John Scott medal." And it was - it just was like inventing the safety pin. It was so incredible. So we began using that, we had - introduced the jet injector for West Africa but very soon we said, for this price we don't have problems in mechanic to repair or what have you. It's very inexpensive, much less expensive than a bio - than jet injector. So pretty soon the bifurcated needles took over the whole of the world in terms of vaccination. Well, we had a couple of the very early problems that we had. There were many more. Paul O'Grady: So tell me how the smallpox program moved into Asia and East Africa? D.A. Henderson: Well, West Africa, I want to go back to the West African program which began in '67 and they managed to record their last case in 1971. Well, ahead of schedule and under budget. Not too many programs come through like that. Meanwhile, I had a man in East Africa and he was working with the people in the different countries and helping them and strengthening what they were doing, a Russian, Ivan Ladnyi and they began to make very good progress. We, from WHO, began supporting Central Africa, not Central Africa, but Sudan and Zaire are two huge countries across the middle. This was frightfully difficult but we had some very good people, incredible people. Some national, some internationals and they began to make a good deal of progress. Brazil, I got back to say Brazil became free in '71. We had, Indonesia was a bit of struggle but they became free by 1972. In fact the whole of Africa, was free of smallpox except for Ethiopia. The whole of Africa was free of smallpox by the summer of 1973. We were only six years into the program and here we were with a good piece of the world free now of smallpox. So, in the summer of 1973, we were down to - just five countries that had smallpox, just five. It was India, Pakistan, Nepal, Bangladesh in Asia and Ethiopia. When you looked at India and that group - that bunch of countries, I think the population then was maybe about 700 million. So you look at it and you say, only four countries in Asia but 700 million people is, at that time, almost three times the size of United States. So it was not a small undertaking to deal with that. Meanwhile in Ethiopia, they were doing a malaria program. They did not want to see a smallpox program. So, the Minister of Health refused to even have me go and talk with him about starting a program. So nothing had happened in Ethiopia at all on smallpox, up until late 1970 before I managed to get into Ethiopia and lay out a plan and by various devices working through the emperor to get approval to get started in Ethiopia. So we came in the summer of '73. We had programs in all the countries and we were very optimistic that now we are on our way. The big problem, frankly, at that time was India. Huge country, a number of people talked about India being like the native, like we talk about cholera being the home or India being the home of cholera. There are some who said, well, India with very dense population, particular climate and so forth. They must have something special here that maybe is the home for smallpox. Very difficult, you will never get rid of it there. That was the general discussion that was going on. We weren't making much progress. India had started a program back in 1962, not so long after the first World Health Assembly heads said, well, let's do an eradication program. By the time they got to 1973 it really, they'd made progress some of the southern states of India but most of India, they were still recording as much smallpox as they've had 11 years before. They were discouraged and really, not sure they would continue. There was a lot of discussion about it. It was a problem saying we really have to keep going. They agreed to do so and this was the earlier 70s. They agreed to keep on going but then we met and sort of the late spring of '73 and we said, we have got to do something different. Paul O'Grady: Who's meeting? D.A. Henderson: In India, well the strategy that we had had was not working. They had done a lot of vaccinating. They were doing mass vaccination all the time, they were then beginning to do what we called surveillance and containment. Really getting much better reporting and when a report came from a village, they would go out, send a team out. Try to vaccinate and control the outbreak. It didn't seem to be working and there was a still a lot of cases and we were - they were not making progress. So that spring we decided what we needed to do was find the cases more quickly. Find them before they became outbreaks. So the decision was made that we try to undertake a village by village search throughout the whole of India in 10 days time. Mobilize the health services for an intensive 10 day search. With this we were - would employ about a 120,000 people. And the idea initially was to go to selected parts of the village in a particular pattern to try and find cases and see what you could turn up. There was a lot of planning. A lot of organization went on. We got Bill Foege from CDC, was sent over. I had asked for more help. They sent over a couple of people but India is a big place and we have a very cracked team of international from France, from Czechoslovakia, from Soviet Union, but not a lot, we were very few. So the first search was completed in October in this one state of India. We were normally getting about 500 cases a week. That first search was completed and they recorded 10000 new cases found, 10000 new cases. This wasn't even the high point of the season. This was really at the - almost the beginning of when the seasonal increase occurred. Oh my gosh! This is far, far worse than we had ever imagined. Well, it was even worse than that, because it wasn't several weeks later I found that the search teams had not done a great job and they really reached only half of the villages. So it was probably twice as bad as bad as I thought it was. They repeated the search in another two months and they got better. By about the third search they got into the point where they would do house to house. We actually had a team following and doing a sample number of the villages to make sure that they had really reached at least 80 percent of the houses. So we began gradually to mobilize this tremendous force. It took 8 tons of paper for one search. We began getting more cases. The cases were increasing. The problems were that of mobilizing the staff, of supervision, quality control. It was a really tough job. We went on and through the summer of 1974, when at that time the smallpox goes down to its low as points. Some of - smallpox transmits best like measles in the winter. Measles is a winter disease, smallpox is the same. Whatever it is, whether it's being dryer air and cooler air that does it we don't really know all the answers. But certainly the summer months are where it gets to the lowest point. So the summers and the states, northern states where this almost all the smallpox was, the summers are terrible, 120 degrees. There is not - limited amount of electricity and there is certainly no air conditioning. We were bringing in a lot of people who are on 3-month volunteer stints with their Indian colleagues. That summer it was murder. We brought them together, once a month, looked at what they had done. Reports, we viewed all of these. We had no cell phones, we had no telephones. There were no computers. I mean, this was all done by hand. They'd come in for a weekend. We'd come in for work for a day and then they had one day of rest. Paul O'Grady: Can you identify a turning point in the Indian experience? D.A. Henderson: Yeah, I will come to that. At the moment, there was a turning point but a strange one. We worked through '74 but we got started going into late '74. The seasonal pick up, picked up. There were more cases than ever, it was really a going and there were several longer term trends in the disease in India and this was a little [1:03:18 inaudible] with a longer term trend. It was on its way up and we were not having that much of an effect. However, by the time we got to around February, we realized that the search system was in place. That we had some very good people supervising this and in fact I even remember the time it was with, Bill Foege, the two of us were looking at this and wondering now, where were we at this point in time and that - but as Bill said, I am not sure I am going to put out a weekly - putting out, I guess a bi-weekly report and the curve was going up and he said, the only thing I can do that's optimistic is turn it upside down. But we felt at that time, secretly that we are on our way and they got worse. It got worse for the bad time in a way and a good time in others. India detonated a nuclear device. They had people, press coming from all over. The theme of all of the coverage, news coverage was India detonates nuclear device, smallpox - their health system is so bad that they are the world's primary country for smallpox. So here is this advanced country with such primitive health facilities that it's epidemic for smallpox. This got a lot of interest. The Indian government was not pleased. They were very upset and they began making more resources available. Higher levels in government began paying attention to it and they assigned to the program, from the Indian side, four of their very best people to work with four of our central people. We call it the central appraisal team. Well, we got over that and for India at least, when we came to the end of the last cases in May of 1975, we thought we had the last case. There was a beggar woman out on a railway platform in the far eastern part of India going into a whole area and she had infected a bunch of people going after. We had no idea what was going on. By that time by October, the Minister of Health and the Prime Minister were very excited about this. We were not confident that we got rid of smallpox. October 5 - August 15th is India's Independence Day. They were determined to announce that this was India's Independence Day and it's freedom from smallpox for its first time in history. I would say we were chewing nails at that time, thinking, oh my gosh! If they have more cases, you know, the press coverage and these people don't know what they are doing, oh god. It would have been awful, that was the last case. Meanwhile, Bangladesh was going through tragedy after tragedy of flood and famine and we had an exhausted group of really fighting to get rid of it in Bangladesh which is a story unto itself. So, on August 15th, the Director General and I, headed for Bangladesh. They only had I don't know, something like maybe 80 villages infected at that point. It was just really coming way down and we felt, my gosh! I think we are going to have - be rid of this bad disease for all the world. It was a very severe time for smallpox. That would have been in. So we are on our way to the airport and got the word, all flights are canceled. The President of the country, the really the founding father of the country, Mujibur Rahman, had been assassinated along with his entire family. Martial law had been declared. Troops were moving to the border. Floods of refugees were expected. We thought, oh my god, once more, but for some reason, the international group, was laid low. They worked locally, they kept out of the way and the expected civil war that was expected to erupt immediately did not. They went back to work and finally in October of '75 it was all done in Asia. Then we were left with Ethiopia and Somalia, subsequently Somalia. Well, if you like to hear the rest of the story I can go on Ethiopia but Ethiopia is a huge country. People look at the map and they say oh, it's about the same size as Georgia, but not so. It's equivalent to all of the states on the eastern seaboard of the United States in area. It's huge. There are very few roads or where there are roads or even roads you can drive on. It's estimated I think that, two-thirds of the population lived more than one day's walk from any accessible road, at least one day. We had just - the government had only, I think, 2000 health workers in the whole country. For a while we were working with 20 Ethiopian sanitarians, 14 US peace corps, about six Japanese peace corps and some Austrian peace corps and some volunteers who kind of wandered in. Anybody who wanted to work, we put them to work and paid them the Ethiopian per diem which if you didn't [1:09:59 inaudible] high on the hog on that one, I can tell you. Then as they were making progress, slowly but it was difficult. Some of the - first time we ran into a huge area where the people fought against vaccination. They didn't want it. Trying to solve that problem, took us some doing but finally they wanted malaria drugs and we could give them malaria drugs. We got malaria drugs to give them, provided they got vaccinated first. So they got vaccinated first and then got the drugs. Not the way you like to run a program but that was the only way we were going to stop the disease. It was a less severe decision than let's say in Asia. So there is less motivation, less concern on the part of government. Well, we got all of a sudden the emperor Haile Selassie was in charge and had been there you know, as emperor for a long time. They had a coup, military coup. Marxist military group took over. Civil war broke out, so there was fighting in different parts of the country. The emperor was, I don't really know what happened to him. I think he was killed. Then it was the US Peace Corps had to pull out as did the other groups. A number of the embassy people pulled out and for a quite a period of time the only people allowed by the military to go outside of Addis Ababa were the smallpox group. We had some pretty very good people, particularly our person who was the real leader of the program, he was a Brazilian fellow by the name of Ciro de Quadros. He had a charm and an ability to persuade that was legendary. That's why we had permission to go outside the country but that wasn't much fun because they were - we had to go to many of the provinces with military escort because it was too dangerous. So they fought through all of that. It was really horrendous and then they came to a point. Finally we got additional people in, and then finally the surgeon general of the United States came up with a contribution of a million dollars for us to get three helicopters to transport people. It was so big. That made a huge difference. Well, one of them was shot down, one of them getting up there - I don't know, we don't know what reason went into like Kenya. Another one was hit with - they threw a hand grenade at it. They were a pair of those, of those and they took one for the - we had to get at one of them with a hostage and they were captured and we had ransom notes which I've still got a copy of the request for ransom from the people dictated by the rebels, written by the helicopter pilot. While he was captured took the vaccine and got all the rebels vaccinated, so took care of that, he was thinking all the time. Finally we got to this place in Dimo, a little village way down in the desert, last case. I flew down. We thought we got a television crew down there, film this and we did and got a lot of footage of Dimo, crazy little village sitting in the middle of a desert. We had a hard time even finding it with the - by helicopter, you couldn't spot at great distance. We went back and we waited and they searched. Nothing, nothing. It went on for eight weeks. We were about ready to make a statement at the press, we are done. There was a report came in of two cases in Somalia right next door. Well to make a long story short, the Somali government, even for the all the discussions we had had with them, had been hiding cases. They knew they had smallpox. They were admitting them to a hospital in a sort of secret ward, nobody knew about. They were trying to stop it but because they were embarrassed, the only country with smallpox. They hated the Ethiopians and they hated the thought that Ethiopia was free of smallpox. They refused to believe that they were free. This went on and as they would let our people come in but they would let them go out beyond the main city of Mogadishu. The cases kept occurring but they are having trouble finding out where were they coming from, in other words, who was infecting them. Finally, there was a great discussion about this and one of them, the turning points, I think it was that a couple of turning points had happened. One being they captured a Dutch adviser who we had working with Ethiopians. He was kidnapped, if you will, with his team and vehicle and taken to Mogadishu. I think we had eight or nine of these and then the UN commissioner would intervene and talk to president and minister. This fellow Bert van Ramshorst, finally they took him. He has to see the minister. So he spent, sat down with the minister and pretty well, persuaded him that Ethiopia was free of smallpox and that there was a problem and that the - WHO would be willing to help and so forth and so on. He made a quite a persuasive pitch here. Meanwhile, Assistant Director General, Ivon Lodney indicated he would want to come down and visit the city of Mogadishu at the capital and meet with the Minister. The Director General was threatening to do the same and I think the pressure was on. Then they began to loosen up. So from then until this was about March of '77 and the number of cases, I recall are about 3000 cases finally that they had troubles because they had nomad groups moving all over the desert area, couldn't find them. Smallpox kept spreading and you couldn't vaccinate them. It wasn't that they would resist vaccination, you couldn't find them. Then the great problem was, come November, was the Hajj. Somalia is right near Saudi Arabia. Many people come from Somalia to Mecca. All we could imagine were people and they would come from through Somalia from other countries, all we could imagine was can we possibly have at this time, one of these groups infected going into Mecca and spreading it among hundreds of thousands of people and watching smallpox go like this. So there was a frantic effort in terms of - they flew in vehicles, so we had more mobility and flew in all sorts of people and the government declared a national emergency and it went all out. On October 26, 1977, Ali Maow Maalin, a cook 23-year-old was the last case of smallpox. That was the end of the smallpox. We had to spend two more years working in the countries to make sure it was really the last one. Paul O'Grady: How did you find out about that last case, do you remember? D.A. Henderson: Oh, yeah. They had brought in some people at this point in time. They were moving people to an isolation camp to make sure that they would be held. There was two kids who were brought in by a vehicle from outside one of the program vehicles and they brought them in and they stopped at the hospital to inquire about where the camp was. Ali Maalin was a cook at the hospital. He was supposed to have been vaccinated but he wasn't. He had been a vaccinator, in fact but he hadn't been vaccinated. How we went wrong, - he got in the vehicle, rode for about 10 minutes till they got to the isolation camp. He got out and he came down with smallpox. Well, he came down with a rash, and as often the case the last is the worst. He was admitted in a hospital and diagnosed as chicken pox. Finally, they had discharged him with a mild case of chicken pox and it was one of the other people, friends of his, who said, I don't think this is chicken pox. It wasn't, smallpox. He was a very popular guy and he had contact with all sorts of people. So, there were everything from roadblocks to all night searches throughout Mogadishu to goodness knows what, trying to find possible other cases, but it was the last. Paul O'Grady: So do you have any final thoughts, anything you want to share about your experience with over the course of the years in the program? D.A. Henderson: Well, I think there were several things about the program that were very special and that is that we came together, people from across the world worked together very well. I worked very closely with the Russians. It was during the darkest days of the Cold War. Totally cooperative, we shared all sort of problems and they had some things that needed to be corrected and I flew to Moscow. We talked it over, they corrected them. We had people working across borders from one country to another. We had mix of nationalities out there. What was perfectly clear was that if we had a goal, we had leadership at all these levels that it became a very unique situation. Bridges were built such as you can't imagine. It formed the basis for going on from smallpox and we really convened a meeting and before the program was over, to say, the vaccination has been so inexpensive. We can vaccinate so many people in a day, so effectively so efficiently. We should be doing more of the smallpox vaccine. This was an international meeting we held and from that came recommendations for an expanded program for immunization, which was finally accepted by the World Health Assembly in 1974, even before the end of smallpox. The idea was to add other vaccines, diphtheria, whooping cough, tetanus, the DPT vaccine, measles and polio and add this to smallpox. That was adopted and then UNICEF got behind it and rotary got behind the polio side and the goal was at that time to reach 80 percent of the world's children by 1990 with these six vaccines. At the beginning, we estimated that at best about 10 percent were receiving these vaccines. So we had cases of tetanus and diphtheria. Totally preventable diseases, whole wards full of whooping cough and so forth and good vaccines out there, well, made it. So by 1990, 80 percent of the world's children had been vaccinated against these six diseases. So this was the expanded program in immunization which is going on, became in due course the eradication of polio. It served to eradicate measles throughout the western hemisphere. Measles was gone. We had so few cases of tetanus and diphtheria that it was a amazing, they were exceptionally, just throughout the whole of the Americas, they developed reporting system which I think, at the beginning we had 500 hospitals reporting once a month. The last count I looked at the reporting, they had weekly reporting from 42000 sites in Latin America. People just - it's better reporting for these diseases than it is in the United States of America. This is going on to develop the group that has convened here, have done all sorts of marvelous things and out of this came a feeling of we've done this, why can't we take on something else. They have done that with great success. So, if there is a real need for an international organization WHO, even though there is some of those like our President Bush who have not felt the need to work with other countries, this could never have been done in the United States, it could never have done by a few countries, it had to have an international organization. It showed also how much you can do if we have preventive medicine and public health vaccines. We were dealing with 10 to 15 million cases of smallpox a year, 2 million deaths a year and 10 years later we have zero cases, and zero deaths. This is pretty dramatic. Now you are seeing similar things happening with measles. Very dramatic changes and now we are talking about with the Gates Foundation supporting a lot of things, why can't we go and tackle malaria in a different way. Why aren't we doing research to get better vaccine for tuberculosis, why don't we have a vaccine against malaria? It's opened up, it's begun a whole revolution in prevention which is really something to see. Today or last couple of days, we have been hearing reports of, now, how many different fronts it's moving on very rapidly and really rethinking all of this. It has, I think, built bridges in the international field that you can't build in agriculture or education. Those are political. Agriculture, for obvious reasons, even education, it becomes quite political. With the health side, you really just don't get into political issues. It's amazing, you don't and thus it has built relationships in ways that are really quite unique across the Americas which I have spent more time with recently. There have been in other areas as well. They had days of tranquility in the Americas, where in the fighting in Nicaragua. The agreement was they would stop fighting for two days and they would and the vaccination team to go out. This has happened in Afghanistan, days of tranquility. So that even the rebel groups could be approached and could be helpful. So we got to Peru in the end of polio in the Americas, the last cases were in the area called the Shining Path, where the Shining Path was. They destroyed hospitals, they destroyed schools what have you. What the people really behind the scenes, Ciro de Quadros who was the head of immunization for the Americas had met with the commanders of the Shining Path and talked it through and got commitments from them, not to harm the health workers. Well, they went through and this is what the health workers are doing. Guess what, they searched this whole area which was so dangerous, it was a problem for the military to go into. So there, it's something that I think is unique about health here and something which gives you great encouragement for the future. Thus, I really feel quite, I feel like we have a made a difference well beyond smallpox eradication. I think, well smallpox eradication, I think has been the first step. We are now moving on well beyond that into many more exciting things. Paul O'Grady: Great. DA Henderson, thank you very much for this interview. D.A. Henderson: Yeah, you are very welcome. [End of audio 1:29:16] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/qbfMSB8kwAs" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rdc emory:16rdc Format The file format, physical medium, or dimensions of the resource 19266000000 bytes video/x-dv Creator An entity primarily responsible for making the resource O'Grady, Paul (Interviewer) Henderson, Donald (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, D. A. Description An account of the resource Donald Ainslie Henderson, MD, MPH, was seconded by Centers for Disease Control and Prevention to the World Health Organization in 1966 and served as the Director of the Smallpox Eradication Program until 1977. Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO Language A language of the resource English https://www.globalhealthchronicles.org/files/original/cb7475e7a333797eee0784fa07df81a1.jpg 6b06d68571895aea924311292d8aaa65 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 386 Width 300 https://www.globalhealthchronicles.org/files/original/f80aca498bb46502cb0bc096b7ee57ec.pdf a468e39de2d04039f2903843eb74dacf Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Malaria Control: CDC Beginnings Description An account of the resource <div class="landing"> <p>In 1942, when the U.S. was mobilizing for the Second World War, the U. S. Public Health Service set up a program to protect the personnel of military bases in the Southeastern states from malaria. This disease had long been rampant in the area, and posed serious threats to the health of the military and civilian populations. The program known as Malaria Control in War Areas (MCWA) was created to carry out the work. The lack of space in Washington due to the war effort allowed the program to base its headquarters in Atlanta, Georgia, and closer to the work at hand. During the war years, the program was expanded to include the control of other communicable diseases. Because its work was so successful, a new organization was created around the nucleus of MCWA, the Communicable Disease Center (CDC). The date was July 1, 1946. This archive chronicles the agency’s early history from 1941-1951, including the contributions of local businessmen and Emory University. The buttons to the right will connect you to a searchable database of documents, oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used.</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Duration Length of time involved (seconds, minutes, hours, days, class periods, etc.) 1:55:20 Player html for embedded player to stream video content <div style="padding:100% 0 0 0;width:100%;"><iframe style="width:100%;height:1500px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2843/collection_resources/132665?embed=true" frameborder="0"></iframe></div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HENDERSON, DONALD "D.A." Description An account of the resource Dr. D.A. Henderson, EIS Class of 1955 describes his roles in the early days of CDC and his relationship with Alex Langmuir. Interviewed by Karen Torghele Source A related resource from which the described resource is derived The David J. Sencer CDC Museum at the U. S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 www.cdc.gov/museum Date A point or period of time associated with an event in the lifecycle of the resource April 12, 2012 Identifier An unambiguous reference to the resource within a given context HendersonDA(After combining)(1).mp3 https://www.globalhealthchronicles.org/files/original/856ae8e9debcf0a0fb88fad7eec1217f.jpg c4496bf89f802d44f19921c5977ef646 https://www.globalhealthchronicles.org/files/original/84ddaacdfd3a2e0353d387af7eea8d34.mp3 3ace9d384155207cd1d834f6b9c8e3ea https://www.globalhealthchronicles.org/files/original/62c38e3955439f427d51ca7b3a2385ff.pdf 1279ef2ab906908d12145d08f49aad64 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Ilze Henderson on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Project. The interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Alicia Decker. Decker: What I thought would be an interesting way to begin is for you to just briefly describe your early life, some of the major factors or influences that affected you as you were growing up. Henderson: That's a question that's hard for me to answer. I was born in Riga, Latvia, and my life was very normal until age 7. Then the world fell apart. Now we call it genetic cleansing. It was Soviets shipping out people to Siberia. They just missed my family, so we had to flee to my grandparents, to the country. But that was the first time I realized that you can't depend on anyone. Then the war started. Finally, we fled to Germany and we stayed there, in southern Germany, until the war ended, and then spent 5 years in displaced persons camps. We came to the United States. Immigrants are sponsored. Well, our sponsor had become a drug addict, and he was losing his own job. So we managed. Finally, my father got a job in Milledgeville State Hospital, the largest hospital in Georgia, if not anywhere else, and,despite being a surgeon, he became a psychiatrist. Then I went to the University of Georgia, degree in pharmacy, and worked here in 1965, met Rafe Henderson [Ralph H. Henderson]. And he went off to Africa for a while and came back, and we got married in May of '66. In October, we went off to Lagos, in Nigeria. Decker: Wow! So you were married in May 1966, and then in October 1966, you moved to Africa. Henderson: Yes, yes, we did. Decker: Wow! Henderson: And I started a journal. Decker: Oh, wow. Henderson: And I can't stop it, so I've been doing it ever since then. Decker: Forty years. Henderson: Yes. An interesting part is that we left Atlanta October 13, 1966, and then we had the weekend off because the plane to Lagos left from New York. So we did this wonderful trip, well, Pan Am to Dakar, Roberts Field, stopping every few places, and we arrived on October 19 in Lagos. It was hot, humid, colorful, smelly, I'm saying. We got there at 2:00 pm, and we were very tired. The weather was hot. We were provided with USAID [U.S. Agency for International Development] houses, which was like living in Florida, and we had a cook and a small boy and a gardener, a night watchman, and day watchman. So that's where it started. Decker: Wow! Did you write in your journal every day? Henderson: Yes. And this is 4 years on 1 page. Now I have 1 year on 1 page. Decker: Wow! So, as newlyweds, what was the motivation for you and Rafe to pack up and to move to Lagos? Henderson: Well, he was an EIS [Epidemic Intelligence Service] Officer, and he came to Atlanta in July '65, and he did the usual EIS things. And then there were a couple of people, Mike Lane [J. Michael Lane] and Larry Altman [Lawrence K. Altman], who were already in West Africa, and I guess Larry was coming back. And they needed somebody else. So they said, "Do you want to go on this smallpox-measles thing?" And so Rafe did. He came back and married me. Decker: And when you got married, did you know that you were going to be going off to Africa, or was it a surprise? Henderson: Oh, yes. No, it wasn't a surprise.. Decker: Was this your first time to Africa? Henderson: Yes. Decker: How much notice did you have between finding out that he wanted to go to Africa and your actually leaving? Did you have a lot of time to prepare mentally, physically, emotionally? Or was it a very quick transition? Henderson: At that age, you don't care about those things. You know, "Let's just go." Decker: Just do it. Henderson: Yeah. Decker: That's great. Henderson: I have a scrapbook in the meeting room where we got briefed. And we got French lessons, of course-we were going to Lagos, which is English-speaking. We got lists of things as to what we were supposed to take that's supposed to last us 3 years, as if we were going to the end of the world. Anything and everything. That was a summer of preparation. Decker: Okay. So it's just a few months. Henderson: Yes, July to October. Decker: So, then, what were some of the greatest challenges you faced upon arriving in Lagos? Henderson: The heat. Humidity. Not knowing where anything was; different money; the new languages being spoken around you. Oh, and also, looking back, one flies a lot and one has colds in Lagos, and we had colds, and we had viruses, and we had diarrhea, and we had trots. In the 30, 40 years, I've only had 3 bad attacks of diarrhea, whereas my husband had a lot more. And other people. I mean, in this group . . . Decker: Healthy bunch? Henderson: No, no. We had to take what we called Sunday-to-Sunday medicine, which is chloroquine every Sunday. One of our group said one of the side effects is going deaf, and Margaret Grigsby [Margaret E. Grigsby] did. Of course, now we don't take it anymore because it's not good. I mean, they said it developed resistance, so you had to take other things. It wasn't ever a normal life for me. We started the morning with salt pills, vitamins, and aspirin (because we rode around in trucks a lot and we got shook up). The program covered 25 countries in West Africa, and everybody did not start work at the same time. There was a lot of travel for the regional office and people coming in and going out to the bush. So, we lived in Lagos, but it was mostly to regroup and wash up and then go out again. What was real different with me was that we didn't have-we don't have-children, so if we had enough money, I could go with Rafe, and that was fantastic. That s ort of subnormal life lasted until the end of April of '67, when Don Millar [J. Donald Millar] sent a cable saying, "You're supposed to be in Delhi with Dr.Lyle Conrad and Dr. Gordon Reid to put out the smallpox epidemic in India, like yesterday." (We called Conrad "Conree" because we combined the 2 names.) Decker: So this was in May of 1967. Henderson: Yes. Decker: So you had been in Nigeria for less than a year. Right? Henderson: Yes. Decker: From October '66 through May '67. And then you went to New Delhi? Henderson: Yes, because, seemingly, India was out of smallpox vaccine, and theirs was the kind that you apply with a rotary lancet, which is really an instrument of torture. But D. A. Henderson [Donald A. Henderson] from Geneva had said that "we will give you all the vaccine you want, but you have to use the Ped-O-Jet." So he said, "We're going to send 3 people from CDC-Atlanta to vaccinate India." Well, it turned out that that was the sort of demonstration project, vaccinating a whole lot of people like the police and the school kids. They were all already vaccinated, and that was what we did. When they sent the vaccine, they forgot to include the diluent, and the first demonstration project too! Many of the public health people had been saying, "This is a test and it doesn't hurt." Well, the vaccinees were all cringing and grabbing their arms because the vaccine was reconstituted with water and not saline. Decker: Oh, because it was freeze-dried, and so you had to reconstitute it with saline. Henderson: So they had to make their own saline, and from then it went a little better. And it was pre-monsoon. It was very hot and dry. . Whereever we went, we were given tea or Orange Spot or Pop Cola or Pee Cola, which tasted not so good, but, you know, it was liquid. India had thrown out Coca-Cola . So I think we survived that and came back to Atlanta for debriefing, and that was one of those wonderful flights, like New Delhi, Tehran, Ankara, Istanbul, Rome, New York. And we rushed from 1 plane to another and got back to what was the Sheraton Emery back then. I think it was like a 33- hour flight or something, so exciting. Decker: And when was this? Henderson: It was June 4, 1967. The next day, we had breakfast in the CDC cafeteria and lunch at CDC, and we slept a lot, and we're awake at 3:00 in the morning. And the war in the Middle East was starting, and RFK [Robert Kennedy] was shot in L.A. And I guess we had a little vacation for some reason. Then, on June 23, Rafe went to Lagos, and I stayed here for some reason. And then, in July, I went back to Africa. And then the Biafran War started. Decker: So July 1967, you returned to Lagos. Henderson: Well, no, to Accra. Decker: To Accra first, and then Lagos? Henderson: No. I can't remember the date of the start of the Biafran War, but it looks like that was a time when dependents could not go back into Lagos because it was too dangerous. Although there was only 1 small plane that tried to bomb Lagos, and that didn't work too well. So then Rafe was given or asked for a job to do assessments of the different programs in West Africa program. So I don't think I got back to Lagos. .. This was really wonderful. This was sort of like camping out forever. But I didn't get back to Lagos for a long, long time, to the point where it was becoming financially difficult because we had to pay for my tickets, and Rafe was sort of at wit's end and saying, "I'm just going to quit because this can't go on." And then they said, "Well, do some more assessments," and that worked out okay, and that was really a lot of fun in Niger and northern Nigeria and western Nigeria. And the trucks breaking down. The Dodge trucks were guzzling gas and were not made for the roads that were there. There was a trip from Niamey to Kaduna on which I think we broke like 5 things on the truck. Usually it was just washboard roads, you know, so you were really shook up all the time. But near Kaduna, there was a paved road or asphalt. But the truck was so bad that we couldn't hold it on the road, so we had to drive 2 tires off the asphalt and 2 on. And by the time we got to Kaduna,, we drove up to Hogan's house and they couldn't recognize us because we had red dust all over. Really fun. Decker: How exciting! Henderson: Yes. In western Nigeria, the assessment was during rainy season, so we got stuck coming and going. There's a picture downstairs where Rafe is crawling into the Dodge truck through the window. We went to a village-this famous survey where you pick out the village and you check people in their houses for vaccination scars. So there was this nice road, and then we got to what looked like a puddle, but it was big ruts, so we got stuck. And the villagers came and looked, and they said, "For 2 pounds, we'll pull you out," and they did, and we were very thankful. We came back, and we got stuck again in the same place. Decker: Fifty pounds. Henderson: No, five. Decker: Oh, my. Henderson: And just some fantastic meetings of the emir of Yelwa, which is on the western part of the country. People were fighting over their land or their churches or whatever, like last year. But the emir back then, I guess he was 40, had been to Oxford, but he still wore his robes. In Yelwa, there were these fantastic markets, where all kinds of people gathered and we did market surveys. I helped a little bit, to look at arms. And the first group was usually the butchers because they were the first ones in the market. The meat was all raw, and ever since then, I really like it well done. And they were very accommodating. It was a cold early morning, so the people wore many layers, and you had to stand there, and the aroma of the meat was overwhelming, until till they took off all the layers of clothing so we could see their arm with the vaccination scar. But other people then started coming. The busiest time, I guess, was between 11:00 and 2:00, when the sun is at the hottest. And most of the different groups didn't mind showing their arms. Except we met some ladies. Now we'd say they were dressed in leather miniskirts with cowry shells. I don't think they had spears, but they had some kind of a weapon. And, of course, they wouldn't, certainly, let us look at their children. And they didn't talk to us, and we knew not to ask if we could take their photo because they were really tough. Decker: Was this in Yelwa? Henderson: Yes, the Yelwa market. Decker: So you were really on the front lines with Rafe the whole time? Henderson: Yes, I guess partially because of the Biafran War. Decker: So you got to see everything that he got to see? Henderson: Yes. Decker: Instead of staying isolated in a compound somewhere. Henderson: With air-conditioning. Decker: How interesting. You're my kind of woman. I like that; I definitely like that. So, some of the challenges. . . Did you have to learn how to fix the Dodge trucks yourselves? Henderson: No. They did. Decker: They being the men? Henderson: Well, you finally had to rely on the driver because the driver was the most competent. I mean, some of the people who went, like Rafe, could kick the tire and look under the hood. Although once we broke down in a rubber plantation in Sierra Leone or Liberia. There was this feeling that we'd been losing brake fluid, and eventually the brakes didn't work. So what they discovered was that the Dodge was designed where the brake-fluid line was right next to the engine block, so of course when you shook on the washboard roads, it eventually would rub a hole in there. So, what do you do? Well, we had a first-aid kit which had cotton, and we found some thin rope somewhere, and we said, "Well, that won't do. But, look, there's a rubber tree, with rubber." So they got some rubber and cotton, and then they wound the twine or the rope around the line, and it held for some time. Decker: So you bit off part of the rubber tree, chewed it off? Henderson: No. The rubber itself, because they tapped the rubber tree. Decker: Oh, and it's like syrup, it's sap. Henderson: It's like chewing gum, almost. Decker: That's right. That's a great story, that's a great story. Henderson: All true. Decker: So, when you went back in '67, back to Lagos finally, that's when you started traveling around the region? Henderson: No, it was before that. It was from the time after India, after Atlanta, and then we started traveling. Decker: Okay. And then, after the travels around the region, you came back to Lagos? Henderson: Yes. And it was nice to meet all the MOs [medical officers] and the OOs [operations officers] everywhere. There was something about Jay Friedman [Jay S. Friedman] bellowing for his driver named Benson , who was supposed to come pick him up. The driver finally showed up and he said, "Well, my watch didn't work," which was not exactly right. . . And in western Nigeria, I think we did part of the assessment iduring the war with Biafra, so there were roadblocks everywhere, every few miles, manned by the local police and usually drunk soldiers. And they didn't get along among themselves very well. And there was, of course, a curfew. Wherever you were going, you had to be there by 7 pm. So when you get stuck in mud on the road and you can't quite get out . . . We had 1 very uncomfortable checkpoint stop where the police and army were arguing with each other. We had to take everything out of the truck, and they went through everything. And I think one probably wanted a little gift, and they couldn't agree, until Rafe finally said, "This is an American Embassy vehicle, and I need your names because I have to make a report," so that sort of stopped them. And they thought a bit and they said, "Look, just go on." Decker: Oh, so you were in an embassy vehicle, or did you just make it up? Henderson: No. Well, I guess, you know, USAID is part of the government. Decker: That's true. Henderson: And the embassy is our thing in the country, so, yeah. Decker: Clever, very clever. So, what were some of the challenges of working with your local country counterparts? I mean, you talked about some of the physical challenges of living in Africa. What about the interpersonal relationships with the Nigerians? Henderson: The regional office was regional, so the Nigeria program was a country program. Decker: Oh, okay. Henderson: Dr. Foster [Stanley O. Foster] and Dottie [Dorothy Foster] were working with the Nigerians, so we really didn't interact with the Nigeria program. Decker: Oh, you didn't. Okay. Henderson: Well, at dinners and receptions. And I'm sure Rafe had some interaction, but that was a big program. Nigeria is a big country, so it was Dr. Foster who did it. Well, whenever we went to a country, we'd stay with either the MO or the OO. It was just wonderful: an exhausting day and a delicious dinner and fall in bed. Decker: So your husband was the regional epidemiologist? Is that correct? Henderson: He was Deputy Director of the regional office. And George Lythcott was the Director. And Don Millar was the counterpart here in Atlanta, and then D. A. Henderson in Geneva. Decker: Okay. Were you and your husband actually administering vaccinations yourselves, or were you supervising teams that were doing that? Henderson: I didn't. I took pictures and observed the ambiance. Decker: Have you written a book, published a book? Henderson: No. This "Any Year Diary" I am holding, is my book. Decker: It sounds like you have amazing memories.. . . Henderson: The OOs and the MOs were all epidemiologists. So when Rafe went to a country, he'd make a checklist as to whatever was going on and the problems, the accomplishments, the unsolvables, all that. And , we all would volunteer , sometimes, to be vaccinated. I've been vaccinated so much. So that was my only involvement. Decker: Okay. Can you describe a typical day, or was every day different? Henderson: Every day is different. Decker: Every day is different. So you were always moving around? Henderson: Yes. Decker: So, then, was it difficult, I suppose, to form attachments with local friends? Henderson: Well, not in those years in West Africa because we were all friends. We were all like a big team. No, that was no problem. It was a unique experience and situation. Decker: What are some of the things that you or your husband would have done differently, looking back on the program today? I mean, obviously, it was a great success. But are there any elements that you would have changed if you could do it again? Henderson: Probably the orientation wasn't that realistic. But in any travel, they give you a sheet of things that are supposed to go on, I mean, and it doesn't really. And I don't think anyone can really know, unless they send someone to do exactly what you're going to do and they come back and they report. But their report sometimes is very different from what really goes on on the ground. Back then there were no emails. Phones didn't work very well. I think if you'd called from Lagos to Cotonou-which is like, what? an hour away or so?-the call went from Lagos to London to Paris to Cotonou because the French had their system and the British had their system. And there were no satellite phones, of course. The mails were not reliable. So communication is always a problem. And when there's that breakdown, people in Atlanta had a different idea of what was going on in West Africa. And, of course, we thought the Atlanta people really didn't care much about us. That's putting it politely. Decker: Yeah. Henderson: And we had broken equipment. I mean, the trucks just weren't meant for West Africa. There were many times the Land Rover had to pull us out. Just to get spare parts . . . And there was a time we broke an axle-I mean, everybody was breaking axles, and it happens on a washboard road out in the middle of nowhere. And finally somebody comes by and pulls you into a town, and then you get a cable from Atlanta saying, "Well, 3 months to get a new axle." Decker: And what do you do? Henderson: Well, you can raid another truck, that kind of thing. And, when Atlanta came to West Africa, but it was rather ceremonial. I mean, they came for, I guess, the ten-millionth vaccination and the twenty-fifth million. Decker: I read about the ceremony that they had, Henderson: That was very good. Decker: They had a big observance: they vaccinated a young girl. Henderson: Yes. I was there. Decker: Could you describe that day or the event? Henderson: Oh, it was fantastic! Other than hot. It was a little bit up from Accra, so maybe it was higher, so it wasn't so humid. But all the chiefs were coming in. Each chief was under a ceremonial umbrella, of course, just red and gold-I guess Ghana used to be called the Gold Coast. These umbrellas were like what we have on our patios. And, of course, the chiefs were preceeded by the bearer and the person who carried the paramount chief's insignia and all that, and then probably a praise singer. Finally they got seated, and somebody had to hold the chief's arms because they were so weighed down in gold. And then we all sort of filed by and shook hands. And that's when the visiting cards were exchanged. And the drumming and the dancing! There was a group of women who pulled my husband into their midst and formed a sort of a circle, and I think they took turns dancing with him. I'd better not describe them, but they liked my husband. Decker: So it was a big event. Henderson: Yes. Decker: And the folks from Atlanta, like Dr. Sencer [David J. Sencer], flew in. Henderson: Millar, Dr. William Stewart, the Surgeon General of the United States, then. Decker: Oh, right. Henderson: And here are just wonderful pictures. [she is showingpictures] Decker: That's the Ogden book that you're showing me? Henderson: Yes, it is. It's the 10th anniversary. Decker: Okay. I just got done reading that book. Henderson: A letter from Billy Griggs is saying, "Sorry that you couldn't be with us," December 2, '87. And then James Mason, the CDC Director, was talking about the smallpox warriors in a special exhibit. Decker: Wow! Is this a letter that you would be willing to photocopy and give to the museum? Henderson: Sure. Decker: Okay. Henderson: And this mentions, in the first paragraph, the people who came. And here is a picture of the 3 instruments for vaccinating- the rotary lancet, jet gun, and the bifurcated needle. And this is where they're learning to repair Dodge trucks. Decker: So your husband was in one of photos? Henderson: Right there. And Bill Foege [William H. Foege]. Decker: So you're all just young-young, fresh, energetic. That's great. What an experience. How many years total were you in Nigeria and the region? Henderson: Three. Decker: Three. So you came back in . . . Henderson: July of '69. Decker: '69, okay. So I read that Nigeria was smallpox-free by May 1970. So you came back before it was completely eradicated. Henderson: Yes, because things were slowing down. Decker: Okay. It was just that final little pocket in Nigeria. Henderson: Yes. Decker: Okay. So, at what point did you actually think or believe that the smallpox would be eradicated? Henderson: Day 1. Decker: Day 1! So you were an optimist from the get-go. Henderson: Well, I think everybody thought that, except for maybe Millar, and, D.A. I don't know. Decker: Did you recognize the magnitude of what you were trying to accomplish at the time, or only years later? Henderson: Well, it's a horrible disease, and to see what it was doing to the villagers. There was one village that we went to, with either Jean Roy [Jeannel A. Roy] or Andy Agle, that had a smallpox epidemic. I don't know how many died. And the chief felt so responsible for it, felt that the smallpox was his fault, that he burned down his house. And he didn't have very much to start with. And in India we saw hemorrhagic smallpox, which is just on the skin. It's like having very thin skin. All the capillaries are just about to burst. The hospital in Delhi had a special ward for the people. It's an awful, awful disease. Decker: Was there an understanding among the folks on the ground of how smallpox was transmitted? Henderson: Well, not in those words, no. Decker: What was the local understanding of the disease? Henderson: If you go to the village level, it's just something that comes every year or every so many years. That's just part of life. Decker: Was it attributed to a particular god or act or witchcraft? Is there a way that people explained the disease? Henderson: Well, we really never got into it too much because you had to have several interpreters. And by the time the answer came back, it probably is not what was said at the end of the line. So I don't know. Decker: That's the anthropological side of me probing you here. Henderson: Well, Nigeria, or the Yorubas - Lagos, in Aboekuta, , Ibadan, had a smallpox cult that had been going for several hundred years probably. And maybe the priests or the Fetisheurs had been using variolation because they didn't get smallpox. So they could say, "Well, I'm the special person, and the chief of smallpox, but if you give me some gifts, maybe smallpox will not attack you. There are 2 kinds of smallpox; with one, your skin will break out; with the other, your mind is affected. So a little gift would help. And if it doesn't, then I'll just take care of you after you're dead. But I will need to be paid with your possessions." The British finally outlawed the cult, I guess, in 1905, but they had some outbreaks after that. Shapona is supposedly the smallpox god. The Fetisheur has a little sort of a shrine where he has the god, a special smallpox pot, and bottles of gin and vodka and things like that. I have a history of the Yorubas that I bought in a market. We all loved markets. Other than checking for vaccination coverage, I mean, they're just vibrant places and had wonderful stuff. There's the medicine and the Juju [phonetic] part of it, and all of the different things you can eat from these huge snails that must weigh 3 or 4 pounds, dried rats, and all the delicacies. Decker: Were you able to partake in eating all of the delicacies? Did you tend to live an American lifestyle in terms of diet, or did you jump into the culture with both feet? Henderson: Well, what is that thing that CDC travel book says, unless you cook it, peel it, or -you know, the 3 things-you don't touch. And, well, it's not comfortable to have a lot of diarrhea attacks, so one sort of watched. But we also went to the restaurants. The dishes I cook with ground nuts, too, they're just wonderful. Curries, West African curry, just different from Indian curry, somewhat. Brochettes of things, frog's legs, shrimp, barbeques. In northern Nigeria, they had too many peanuts, so the hogs were fed on peanuts, so that was a very good. Decker: You can tell it's close to lunchtime now. I'm talking about the food. Henderson: Well, yes, the food. And then, of course, there was English food, which wasn't so great. But the French, Lebanese, was just wonderful stuff. I was going to say that we should have tried more-well, we did, we did, but we didn't eat things off the street. I didn't think that was the best. And even then, I got diarrhea. My first diarrhea attack occurred in Accra, between the jet-gun demonstration in January and the 25th millionth vaccination. It was bad, and I took too many Lomotils, and I think I slept probably a whole day. Decker: Did you have major illnesses while you were there or just mostly routine diarrheas? Henderson: Diarrheas, colds, feeling, I guess Brits say, seedy, lousy. I think my husband probably had typhoid fever between Lome and Niamey. Maybe that's why he left me somewhere, and he went off to Lagos. But, well, I guess it was Niamey where the Peace Corps doctor had this big book of tropical diseases. I went down to look in it to see what he could have because he'd been treating himself, thinking he had malaria and he didn't. So he'd be okay one day, and the next day he would be just shaking. There was a nurse who said, "Well, I've met some typhoid people, and sometimes they just jump out the window, it's so bad." But, luckily, the Peace Corps doctor had Chloromycetin, so Rafe got a dose of that, and I think I got some, and he recovered. Well, at that age, you don't think that health is that important. I think it's only after retirement, that that sort of hits people, things that should have been looked at before, like prostate cancer, colon cancer. I don't know if anyone had lung cancer in the group. But back then, we were invincible. Decker: During the time that you were actually in the field, were there moments that you had regrets or feelings such as, "What am I doing here? Why did we do this?" Henderson: No. Decker: No regrets. That's fabulous, that's fabulous. So, it seems like such a silly follow-up question, but in what ways did this experience as part of the project for these 3 years change your life? Henderson: We got sent to Geneva, Switzerland, to WHO [World Health Organization]. Decker: Oh, okay. Henderson: So we got back here in '69. Then Rafe got 2 more degrees, an MPH and an MPP [Master of Public Policy] from the JFK School. And then he came back to Atlanta, and he was given several projects. One involved blood in labs, I think; I can't remember. There's some blood network. It's not the Red Cross. And then Dr. Sencer thought that we should get some taste for how Washington is run, so we spent the summer there. And then we came back and Rafe started supervising the Venereal Disease Division. Eventually, the name was changed to Sexually Transmitted Diseases, and the list of diseases enlarged from just 2- gonorrhea, syphilis-to all the others, ending with unwanted pregnancy. Guess one shouldn't talk about that. And that lasted from '72 to '77. And in January of '77, Dr. Sencer said, "WHO needs an American to create the Expanded Program on Immunization for WHO, so do you want to go?" So Rafe said, "Oh, yes," and he spent the month of January in Geneva justifying why he was capable of doing it and why he would want to do it because WHO had many experts, over 50 or so, because they'd done everything and they knew everything, and then this young American comes. Decker: And Rafe was in his 30s, right? Henderson: Yes. And so, finally, they said, "Well, okay." I think D. A. Henderson was coming back, and that created the slot. And Rafe came back, I think, the end of January of-this is not the book; I have another book. Decker: You must have a line of books in your house. Henderson: I do, yes. I think I'll have a bonfire or something. Decker: No. You should donate them. Henderson: Yes, well. Decker: It depends on your secrets. Henderson: No. Most of them are in a code. Decker: Oh, that's good. Henderson: But it was a Saturday, and, Rafe was in Geneva. Back then CDC was smaller. . Jane and Dave Sencer were really taking care of everybody and supervising and giving wonderful dinners. Dr. Sencer came back from Washington. And this was after the swine flu problem. He'd been up there to brief Hale Champion, who was Undersecretary of Health and Human Services, Health, Education and Welfare, I guess. Dr. Sencer had been briefing him, and he was about to go out the door, and Hale Champion said, "By the way, you're fired." Decker: Wow! Henderson: So Dr. Sencer came back, and there we were all going to have a nice, joyful party, and that certainly put a damper on things. A few days later, Rafe came back, and CDC decided he could still go to Geneva, and they gave us a month to pack up and go, and we did. We went for 2 years, and the contract was renewable every 2 years, so if WHO and CDC were happy with Rafe, and Rafe was happy, it was renewed. So we stayed for 23 years. Decker: Oh, my. Are you still there? No. Henderson: No. We came back October 1, 1999. Decker: Wow! What an exciting life! Henderson: And the interesting thing is that, after the smallpox program, there were all these - in the states and other places. WHO turned out to be a place that had abbreviations for everything and they called the Expanded Program on Immunization EPI. , The old smallpox people were very valuable, so they were coming through EPI all the time. So smallpox and EPI sort of runs together to me, and I can't tell sometimes who's who. Decker: They view your experience in one, not into the next experience. Henderson: Well, the OOs and the MOs, that's what they did. They were valuable in running vaccination programs. So they had this expertise that WHO didn't have. Decker: So WHO needed them for their next thing? Henderson: And, well, Jean Roy is still running around doing that, and he works for the Red Cross and Red Crescent Societies, whose headquarters are in Geneva. Decker: I understand that you're trained as a pharmacist? Henderson: Yes. Decker: Do you practice as a pharmacist? Henderson: No. I retired in July of '66. Decker: Good for you! Had you practiced before you retired? Henderson: Yes. I was a pharmacist at Emory University Hospital pharmacy, and I should have worked about 4 more months so I would get full Social Security, but I didn't, so mine is half of what my husband is. Decker: Wow. Did you ever feel that because you were going where your husband was going, you missed out on your own career? Henderson: No, because the West Africa experience was so unique. Who wants to have a 9-to-5 job if you can do that? Decker: That's true. Henderson: And then coming back here for a few years was very nice. And then the EPI experience. I think I said before that I don't want to travel. I've had it. And I don't want to go camping. The only places I haven't been, I guess, are South America and China, Mongolia. We had a big network of friends; some of them, as I said, were from the Smallpox Program and some new ones. I went to so many meetings. And I wasn't welcomed everywhere at the meetings. Finally, we hit upon Rafe's introducing me as his personal assistant, instead of as his wife. There was no problem with that because there were other people who took people along who weren't exactly their wives. But, no, that was fantastic. Decker: Wow. So you were definitely a member of the team. Henderson: Yes, in a sense as being a personal assistant, taking photographs. Well, I'm also sort of a people watcher, and it's wonderful to see the people, what they say and what they do and how they perform. Decker: Did you have an opportunity to learn any local dialects? Henderson: No. We weren't there long enough. Decker: You were moving around too much. Well, you've done amazing things. Henderson: I wonder if I've forgotten something I wrote down but no, probably not. Decker: One of my last questions was actually going to be whether or not you would like to add anything that we haven't discussed? Henderson: I think the EPI experience is interesting. Decker: The EPI is the one in Switzerland? Henderson: No, global. Decker: Oh, the global, okay. You'll have to forgive me with the acronyms because I'm on the academic side over here with historians. But what incredible opportunities you've had. Is there a particular story that you can conclude with, of like the greatest challenge or the toughest moment or the most exciting moment? Henderson: All of those! Decker: And it all happened on 1 day. Henderson: Just about. Decker: Were you able to stay in contact with your family back in the United States? Henderson: Yes. At first it was just postcards. I have them on the desk.downstairs. And then I took home leave every 2 years. I would visit everybody for 2 weeks, and then collapse, emotionally, psychologically, and physically. And airplane travel isn't that great. But then it used to be better. But 1 thing I forgot: Rafe and I developed a hobby that we both participate in. The thing is that it's a hobby that you have to do together. It's bird watching. It started in Lagos. In Lagos, it would be dark and all of a sudden it would be sunny. And then in the evening, 6:00 sunset. Decker: Yes, the 12-hour days. Henderson: So we would be woken up to this bird outside our window-well, our windows were closed, but it was loud enough. And the bird was saying, "Quick, doctor, quick!" and it kept on and on and on. And Rafe said, "What in the world?" Well, it was a bird. Luckily, there was a little book that we found, The Birds of West Africa, I think, and it had that bird in it. It was a common bulbul, and it's the Omar Khayyam's nightingale. It's a nondescript bird, and it's not like the European nightingale. And then we saw all these other birds out there in the garden, and sure enough, they were in the book. They were all colorful and loud and great. And from then on, we started birding, and now we do that. We always had been members of the Georgia Ornithological Society. They have a spring meeting and a fall meeting and a winter meeting in different places in Georgia. So now that we're back here, we're going bird watching and we meet these unbelievable people who just know what's what and hear a sound, and they say, "No, that's not it. That's what that is." Decker: So you traveled the world and found . Henderson: Yes, but this is just in Georgia. In August, we're going to Jekyll, Tallahassee, Kennesaw, Columbus. We don't do all the canoeing and kayaking, and we're not that good, because each continent has different birds, but we're learning. Decker: What a fun hobby. Henderson: Yes. Oh, the thing is that if you see a bird and you say that's what it is, well, someone has to agree with you, so that's the hobby that we can do. Decker: And do you ever fight over it? Henderson: Yes. Decker: And who's right? Henderson: This spring, he was. He saw an orange-crowned warbler, and you can't see a crown and it's not orange, but that's what it was. Decker: That's great. So Africa comes back to you again. Well, thank you so much. Henderson: Well, thank you. Decker: Thank you for your stories, thank you for your time. You're just a firecracker. Henderson: Yeah, on vacation. Decker: Yeah, well, that's great. So thank you for your time. # # # </pre> Player html for embedded player to stream video content <iframe width="100%" height="166" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310125697&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource text interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158jd emory:158jd Subject The topic of the resource WHO Biafra War Life as expatriate wife CDC USAID Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 699002640 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Decker, Alicia (Interviewer); Emory University; Graduate Student Henderson, Ilze (Interviewee); CDC; Wife of Deputy Director of Regional Office Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HENDERSON, ILZE Description An account of the resource Ilze Henderson, wife of Rafe Henderson who served as Deputy Director of Regional Office, in Nigeria. Ilze tells of immigrating from Latvia to the United States and meeting her husband, Rafe, during college and moving to Lagos, Nigeria shortly after they married. Ilze went with Rafe on assignment to India, and then back to Nigeria. Ilze speaks of the Biafra War in Nigeria, traveling with her husband on assessment surveys, adjusting to life as an expatriate, Rafe's later career with CDC and WHO, and life and hobbies since the years spent working on smallpox eradication. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/f2f26a6dd20ab344b90031f2ab88d350.jpg f2ba8e7c3ea456bfd6f16ff1ca4dca2b https://www.globalhealthchronicles.org/files/original/35e4e0cbe1eb945418410dfb4594ca53.pdf 0633e9098537d49867bb7050d97e1576 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Duration Length of time involved (seconds, minutes, hours, days, class periods, etc.) 1:37:40 Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310213455&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HENDERSON, RAFE & ILZE Description An account of the resource Dr. Ralph "Rafe" Henderson talks about his public health career at CDC and the World Health Organization. He and his wife, Ilze, who was a tremendous help to him and kept a journal of their travels and work, were primarily stationed in the field working on infectious diseases, especially smallpox eradication. Interviewed by Karen Torghele Source A related resource from which the described resource is derived The David J. Sencer CDC Museum at the U. S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 www.cdc.gov/museum Date A point or period of time associated with an event in the lifecycle of the resource February 3, 2012 https://www.globalhealthchronicles.org/files/original/e7e81b68fcf0968506a76bad6f69091e.jpg 0929000669383a01f855c8d9ec805ee0 https://www.globalhealthchronicles.org/files/original/20bde83a0bf8cc195ef1f2909f16b36f.pdf dde2403f413cec4e8af73567f2080cec Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. Ralph H. "Rafe" Henderson, about his role in the West African Smallpox Eradication Project of the Centers for Disease Control. Today is July 7, 2006, and this interview is being conducted as a part of the 40th anniversary reunion of the launching of the Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Dr. Henderson, I want to begin by setting the stage for who you were in the smallpox project, and I'd like to start at the beginning. If I am correct, you were born in New York City, on March 5, 1937. Would you give me a brief account of your childhood and education, who your parents were, and whether any of these early experiences nudged you towards medicine or public health? Henderson: Yes. My father was born in Burma, which is the explanation for my nickname, Rafe. The British soldiers in Burma, who were then in charge, used Rafe as a nickname for Ralph. My father's name was also Ralph, and when he named me Ralph, then they called me Rafe as a nickname. So that explains that. But it also explains my orientation for international health. My grandparents were medical missionaries; their grandparents were also medical missionaries in Jamaica. My uncle was a medical missionary in China. My father was the black sheep of the family: he went into publishing with the Reader's Digest. But my brother and I became physicians. When I was doing my internship at Boston City Hospital, I was contacted by somebody from CDC, who told me about the Epidemic Intelligence Service (EIS). And that, combined with a lot of my other interests in the international sphere and missionary work- although my father was not religious and I'm not particularly either-seemed to be a very good next step for my career in public health. Harden: Let's drop back a little bit and ask you to talk about your years at Harvard. You were at Harvard for both your undergraduate education and medical school. Was there anybody on the faculty who was particularly important to your career? Henderson: Yes, obviously in college, one always has heroes. Mine was a psychologist named Jerry Bruner [Jerome S. Bruner], who was dealing with cognitive psychology, and I found that very interesting. I won't tell you the funny things we did, but in any case, it was an interesting time at Harvard. I was there only 3 years because I had spent the year before going to Harvard as an exchange student for the English-Speaking Union. So I was in the U.K. for a year, in what was a public school, before coming to Harvard, so I was only at Harvard for 3 years. Then I went on to medical school. In medical school, many of us were very, very influenced by Professor Thomas Weller, who had worked with Enders [John Franklin Enders] and Robbins [Frederick C. Robbins] in developing the polio vaccine and later on the measles vaccine. Weller was very eloquent about tropical public health and the challenges and the needs that were going on. As I say, a whole bunch of us came out from under his tutelage very interested (well, let's say interested because we were too young to be career-committed at that point). I think he was a strong influence. Harden: You joined CDC immediately after your internship and residency in Boston City Hospital. Were you one of the folks joining initially to avoid-pardon me, to discharge-your military obligation? Henderson: Well, I think "avoid" is a very good term because I think for many of us, that was 1965, '64, '65, when the Vietnam War, was just starting. And how does one want to spend one's military career? Well, it was certainly a very easy choicevivid one for us. I would like to think that my own reflexes-both seeing the difficulties of practicing in a city hospital, where you're seeing end-stage disease and not being able to do very much about it, and my interest in international health-made CDC a choice whether or not there had been a military draft. But it was clear that that served the best of all purposes as far as I was concerned. I was not interested in serving in other areas of the military. I was very interested in serving in what I knew, at that point, CDC was doing. Harden: In public health service. Henderson: Right. Harden: So in 1965 and '66, you were an EIS Officer. Would you talk a little bit about your EIS training and assignments? Henderson: Well, it was incredible. In those days, they used to call the interns "the iron men" because we didn't get salaries, we ate at the hospital, we often slept at the hospital, we had 1 set of clothes. But we came to Atlanta and we're presented with a slide rule; we got a salary; we were treated like important individuals. It was incredible. Absolutely incredible. And we had a very exciting 6-week EIS course, training us in shoe- leather epidemiology. Because of my interest in international health, I applied to the smallpox unit. I was lucky enough to be selected. And then, lo and behold, I was sent off, very shortly after the training, to West Africa as a technical advisor to the French public health organization in the western part of West Africa, called the OCCGE [Organization de Coordination et de Cooperation pour la Lutte contre Grandes Endemies]. That's a very long name, but part of it, the Grands Endemies, translates into the "great endemic diseases." I have to back up a couple of steps to explain why I was going over there. In about 1963, roughly, the NIH [National Institutes of Health] conducted a major field trial of measles vaccine in West Africa, beginning in Upper Volta, as it was called. And it was an astounding success. They covered most of Upper Volta in a few months, with mobile teams, and did it very well. They had high vaccination coverage, and measles pretty well disappeared. Now, that was a self-serving exercise, in that we, the United States, wanted to test the measles vaccine on a large scale. Here was an area where this could be done, where it was desperately needed, where kids were dying of this disease, and you would have had to have a very, very bad vaccine indeed, not to be ethically justified in doing a combined trial of the immunization and of the vaccine itself and seeing what impact you would have on public health. Well, the impact was absolutely astounding. One of the reasons that USAID [US Agency for International Development] was willing to go along with D.A. Henderson [Donald A. Henderson] and others at CDC in joining a smallpox eradication program, which USAID wasn't interested in, with the measles program, which USAID was interested in, was that they knew that they couldn't do much with the measles program unless they had some good technical support. USAID had some disastrous experiences without technical support, before they funded the full program in '66. Because the United States had the measles vaccine and no other nation did, it was perceived that a measles immunization program allowed the United States an entryway into West Africa, where the French culture was dominant, one that did not compete with the French either on educational or economic grounds. But here was a neutral health ground-very popular concept. All the countries desperately wanted the measles vaccine because measles was such a bad disease. And so I went over as one of the people to help out in the stages before the full program got going. I was advising OCCGE in running these mass immunization campaigns with measles vaccines. Now, the French were very good at doing mass campaigns; there was no problem with that. The problem was that they were not very good at dealing with this funny, electrical jet injector, which we were using to administer the vaccine. And they were not very good at dealing with the many, many difficulties in supply and logistics posed by our USAID and U.S. Government contributions to the programs. And so, when I arrived, or at least one of my interviews was with the Ministry of Health in Upper Volta and with the Chef des Grands Endemies, the French advisor who was running the Grands Endemies. The Minister was furious because our 5 Dodge trucks that had been given to help administer the vaccines were consuming his entire budget of gasoline for his entire Grands Endemies. And the USAID deal was, "We give you the trucks, but you run them. You pay for the gasoline." And of course, that just wiped out the budget for the Ministry of Health for gas. All of these enormous trucks were consuming all the gasoline. And so he was not a happy person. Harden: Was there any solution to this problem? Henderson: They did the best they could. They were unhappy, but they did not do a bad job with the things. One of my problems as advisor was firing off cables about getting spare parts for the jet injectors. They kept running out of some tiny points-I didn't know what they were, but I think that on a regular engine they'd be called the points. They relate to the electrical system. Forget it. But that's all I knew. And I knew that they were burning out, and they couldn't get spare parts. So one of my jobs as a technical advisor, very technical, was to send cables back saying, "Send more of these things because they can't run the injectors." Nor did CDC send enough diluent, so we were often using Evian, one of the French bottled waters, as diluent for the measles vaccine. I was overseas for about 6 months, traveled widely in those countries. I was treated extremely well by the French advisors, even though they knew I didn't speak very good French and they knew a lot more than I did about anything they cared to ask me about. But they were very gracious, very good about teaching me and helping me learn about things. I think I saw in those 6 months enough problems to last me the rest of my life about what can go wrong with an immunization program and with other kinds of public health programs that you're running. It was extremely valuable. Harden: One of the points that has been made over and over here is that medical knowledge about smallpox was really only the first step to eradicating it. The logistical problems, and the personnel problems, and the diplomatic problems, all of these things were key to eradicating the disease. So you were seeing this in advance of the project. Henderson: Yes, I think that's very true. I think the CDC tradition, though, is an important one to emphasize. We medical people went over with public health advisors, who joined us as nonmedical people, who were there exactly for the management issues. CDC had had a long tradition of this in the venereal disease control program, as it was called in the old days, and the advisors then branched out into tuberculosis and many other programs. There were always public health advisors who were trying to get the logistics and the management right. And so I think the CDC position was, "We've got to have some medical expertise to be credible, but we really need the management to be sure that we can be effective." And I think that was really the key to the success of much of what we did. We didn't have such great medical knowledge of smallpox, if I can say that. The program was designed to immunize everybody in West Africa against smallpox, sort of a 100% vaccination coverage. And we didn't find out until a couple of years into the program that we didn't need to do that. That was one of the really startling breakthroughs in the program-the ring vaccination strategy of simply immunizing around active smallpox cases, breaking the cycle of transmission, and not going all-out to maintain high levels of immunity in all sectors of the population. We learned that relatively rapidly, I must say, within a year or so of the program. But it was a major conceptual breakthrough for us. Harden: Would you walk me through setting up the regional office in Lagos? You were the Deputy Director and the epidemiologist. I know that the Director, Dr. Lythcott [George I. Lythcott], is no longer alive. So will you tell me about how it was formed and how it functioned? Henderson: Well, it's a funny thing. I have very little idea about that. I knew that there was to be a regional office and that George was the Director. When I was in West Africa, and the full program came into being, I was then recruited from my role as an EIS Officer to join as the Deputy Chief of the regional office. George had worked in Ghana, and was a senior person, very well respected. It was perceived that if we were going to have a regional office, we should have a good regional office. And in the early days, as I understand it, the idea was that this would be the first regional office. Then, as the program expanded worldwide, as we got rid of smallpox in West Africa and then moved to other regions, there would be other regional offices in other regions, which were similarly constituted. In any event, we never did that. Ours turned out to be the only regional office. I was there as an epidemiologist, but I was one of the few people who spoke French. So even though I didn't speak French very well, my responsibilities were mainly for looking after the francophone countries. My role as deputy was sort of doing all- hands work. We had an equipment specialist with us, a very good health educator, a statistician, and a secretary who was knowledgeable about local and embassy issues having worked in West Africa before. And we also had Jim Hicks [James W. Hicks], our Senior Administrative Officer, who was very effective. George, as the Director, dealt with all the terrible, terrible political problems that were really insolvable, and he managed to solve most of them. Jim Hicks dealt with equally difficult administrative problems, like who had furniture in their houses just in Lagos; could we get transport from the embassy in the early days; what was going on with the financing of things. He had all sorts of fights with the embassy and the USAID mission, who didn't really have the resources to give the support that they were supposed to to our group in the regional office. Harden: Now you, as I understand, wrote most of the E-1s, the programs for each of the countries, in the francophone countries. Is this correct? Henderson: I don't remember that. At my age, I'm finding that happens more and more often. I do know that I spent some time going around with George Lythcott and Henry Gelfand trying to finalize and write what we called pro-ags, project agreements. Harden: Yes, that's what I meant. Henderson: That's right. I recently got a communication from a colleague who was working with us in West Africa. He sent me some of the letters he had sent me then. And he quoted me asking if we could give some of the cars that had been assigned to us, as advisors, to our national counterparts? And he said in the letter to me, "Rafe, you had already anticipated this and put the request in for these cars. You knew that they would be needed by the ministry, and that you couldn't justify it just for the ministry, but you would justify it by giving it to the advisors who were there, anticipating that they would then be shifted back." I have no recollection of that at all. Harden: There was, at this point, however, some tension between CDC personnel and USAID as to whom the CDC reported to-whether they reported to USAID, or reported to CDC through the regional office . And I think it fell on you to clear the air about this, if my reading is correct. Henderson: Boy, I don't remember that either, very much. I do remember going to a couple of countries; my wife and I were talking about that. I remember being in Chad, and I was trying to recall, 40 years later, why was I in Chad? And then it occurred to me, there was something going on with USAID and our staff there that I apparently was trying to mediate. Again, I don't remember the details of that. I do remember that there was a general problem when we from CDC came into the West African countries, and we felt we were masters of the universe, and there was nobody about to tell us what to do, certainly neither USAID nor the embassy. We had a mission. We were going to get our stuff done. And so that was a general tension that I do recall. I don't remember my role exactly, and what I did about it. Harden: You started to tell me about developing the cluster sampling system and the instruments we adhered to, to do the sampling. Would you explain, for the record, what cluster sampling is, and how you developed it? Henderson: I can, but I would also like to go back at some stage, to lead up as to why I ever got into that. Harden: Okay, let's go back. Tell me how you got into cluster sampling. Henderson: I had come back from India in the spring of 1967, when there was a smallpox outbreak. We had been expected to eradicate smallpox in India in a very short period of time. We did not succeed in doing that. My wife and I came back to CDC, and found that, in the interim, the Biafran War had broken out. She was then not allowed to go back to Lagos as a dependent. I would not go back to Lagos without her, and we arranged a compromise, as my range of responsibilities was the francophone countries anyhow. I did a whole series, 6 months or so, of continuous consultancies, firefighting, and all sorts of stuff in West Africa. And then the Biafran War settled down, and we were able to go back to Lagos. I got back to my regular job, as Deputy Chief of the regional office. And I promptly got myself into trouble with headquarters because I kept feeling that the policies that we were being asked to follow by headquarters were not the best ones for us in the field and that there was not a very good understanding of what was needed in the field. Harden: And when you say headquarters, you mean here in Atlanta? Henderson: In Atlanta. So I became a very shrill voice, I'm afraid, demanding and troublesome. And I don't remember whether I was called back, or whether I had to come back on for another occasion, but when I did get back here at CDC, I was pretty well told, "Enough of this nonsense. We need some assessments done. Go do them." Again, my memory is foggy, and it may be that there was a lot of help, but I don't remember. What I remember was going off and saying, "Oh yeah. Okay. We need to do assessments." And it turned out to be 3 major assessments, one in northern Nigeria, one in western Nigeria, one in Niger. And I brought some reports that I'd been looking at recently, and trying to scratch my head, and yeah, the cluster sample survey was part of that assessment or evaluation. There were also aspects of the assessments where we reviewed records, interviewed people, looked at the health centers, inspected vaccination teams, and the rest of it. So it was a very extensive project. Now on cluster sampling: if you do a random sample, if it was the Gallup polls that we do in the United States, you can get away with sampling a relatively tiny fraction of the population. But you have to do it in a very meticulous, random manner, so that the individual that you select is not selected with any bias that you can imagine. This is very intensive, very expensive, and very difficult to do. A compromise that was developed by CDC staff, Serfling and Sherman (Robert Serfling and Ida Sherman of CDC), here in the United States, was a cluster technique. And that meant that, rather than taking a single individual and asking questions, you could take a group of individuals. But if you did that, you had to compensate for the fact that they were a group and no longer independent. So one of the group had more similarities to the other members of the group than if you'd taken a totally different person from a different area because the cluster was a geographic cluster. So you would get households that were all together, or members of a household that were all together-that was the "cluster" part of the cluster . Rather than sampling as individual people, you sampled them in groups. I had learned the Serfling-Sherman technique as an EIS Officer. We had done a sample in Atlanta. Bill Foege [William H. Foege] did a modification of that in The Gambia early on. I knew about that. So when I was asked to run these surveys, run these evaluations, and do a cluster survey as part of that, I further adapted that survey. To look back on that, it was incredible. How am I going to do a survey in a huge area of the country? What kind of a sample do I select? How do I get the records done? How do I collate them? I taught myself to type; I didn't know how to. I realized I was going to have to write these long reports, so I was going to have to type. I realized I was going to need some way of recording the data. So I had worked on my own files with McBee cards-strange animals. I'm just going to hold up one. It's a strange card with a lot of holes on the sides of it. And you punch a notch in a hole. Each hole corresponds to something you've written on the card. So, for example, is this person who you're sampling a male or a female? Male, 1; female, 2. If they check 1, I punch 1, which is numbered on the edge of the card. At the end of the day, I get a hundred cards together, and with a sort of knitting needle, I run through the hundred cards, at the number 1. And lo and behold, all the cards that have this number punched fall out, if I shake them vigorously enough. These cards were fascinating to use-difficult to use, but a godsend because I could then train teams, who would go out with these cards and then, while they were in the field, simply mark a number for each of the data points I had. Then at the end of the day at their leisure, they would take a paper punch and punch out the holes that corresponded to what they had found during the survey. Then I collected all the cards from all the teams at the end of the survey, went home, and spent a long time shaking knitting needles and having the cards fall out. And I'm sure there were a lot of errors involved with the things. But it was absolutely an incredible exercise, and I can't believe, even to this day, that I was able to do that, with very short notice, to go in, to design the cards, to decide on the sample surveys. But I want to talk a little bit about the actual sample survey design because that was fascinating. What are you going to do with a population that is as varied as you have in West Africa? Yes, you've got some people in cities, but you've got people in villages. You've got people that don't particularly go to a village; they're nomads; they're all over the place. And, again, I'm just impressed with ourselves, myself, in that time. We designed the sample surveys to try to get if not a valid sample, at least an idea of these various groups. So, for example, we could have a sample survey that said, let's take a valid statistical survey of all the villages in a catchment area, or a state, or a country, that are under 5,000 population. Perhaps we thought under 5,000 would be a high-risk group for smallpox. We'd get all the villages. So you select, say, 30 villages out of those. And then we said, "You get your sample from that village but then leaving the village, for the next 10 kilometers, you stop every person you see, and you interview them-no matter who they are, or what they're doing." And then we said, "In addition to that, you go to some of the local markets, and you do a market survey and find out who's there. And within the market, sometimes you can select individual groups." We knew there were nomadic tribes, and we could recognize them because they wore distinctive things. So we could say, "Survey 10 of the nomads from this area, and 10 from that area." In western Nigeria, we had an area of the state that was very heavily influenced by fetisheurs, by the traditional healers. And we knew that they had a cult, the Shapona or smallpox cult, that did not appreciate being vaccinated against smallpox. They were against vaccination. And we knew that vaccination coverage was lower in that area than in other areas. So we did a separate sample of the fetish area and the nonfetish area. We did all sorts of tricks to try to probe where we were weak. It wasn't so much that the sample was going to give us a wonderful average of what was going on in the country, but my idea was, let's point the finger at where we think we're doing least well. Let's find out what's going on there; that's where we need to make the changes. It was just a fascinating experience. As I said earlier, the survey was only part of the full assessments we did. We also looked at records, we interviewed people, we inspected vaccination teams. We found faults everywhere. There were problems everywhere. And that was one of the great lessons that I learned in my life-despite all the problems that you find every day, and despite the fact that you think nothing's going well, that isn't always the case. You can have some success despite it. The other thing that was impressive looking back now on this, is that there was no stopping us. I mean, getting a sample survey, doing these assessments, that's no problem. We'll just do it. And I think it was the attitude of the entire program. We had a goal; we were going to do it; nothing was going to stop us. I'll tell you 1 other anecdote that illustrates that. We got stuck in western Nigeria during one of these assessments. We got often stuck in western Nigeria. It was during the rainy season, and we spent more times pulling ourselves out of mud holes than anything else. But we were in a rubber plantation, for reasons I don't understand, but we were doing a survey there. And it turned out that the vehicle was running down on hydraulic brake fluid. The brake pedal kept getting weaker and weaker. And we knew when we left in the morning that we needed some extra fluid. We had some, but by the middle of the day, it was getting low, and we were running out. And we finally looked under the hood and found that the brake line was rubbing against the engine, and it had cut a little hole in the hydraulic line. And I said, "Right, okay. I know how to do that from an intern in Boston City Hospital. Give me some tape, and I'll tape it up." I taped it up. But each time I did it, because the brake line has a lot of pressure it just blew the tape away. It didn't work at all. We were down to our very last little bit of hydraulic fluid, and I said, "Right. What am I going to do?" And we got some cotton that we had for first aid. I took some sap out of a rubber tree, chewed the sap into the cotton to make it a solid compress, and tied a whole series of very tight suture knots around the hydraulic line. Amazingly, the thing held 'til we got back at the end of the day. But that was the attitude: "This isn't going to stop us. We can fix this. Nothing is going to stop us." And that happened over and over and over again, to everybody in the program. It was incredible. And I think it was one of the things that made the program just such a success. People would not be stopped. Harden: Now, do a little analysis here. Was it just because these particular people were so special? Was it an American thing? Was it inspiration from above? What do you think made this group? Obviously, it's a very special group. Do you have any opinions on this? Henderson: I hesitate to say it, but I'll say it anyhow. It's not a very special group. And I think that's the magic of it. Special in that the challenge was there, yes. Good leadership. Good support. A strong image of what needed to be done. But by God, when you do that, and you give people responsibility and things that they've never met before, most times, most people will rise to that challenge. And I say that because I then had experiences later in life, in the World Health Organization (WHO), or other programs, where we had the same sort of thing. We had specific goals to achieve and people from many cultures, many different backgrounds, still rising to that challenge in an extraordinary way. And don't forget, as I'm sure that nobody will, that we were a tiny fraction of those who did the work. Most were the nationals - the vaccination teams, the staff, the people living in the endemic villages. So let's be clear that we were helpers in a project that was done largely by national staff. Harden: Were there any particular problems in dealing with the national staff that you recall or were there good relations from start to finish? Henderson: I would have to say mixed. I think the relationship got better as we all got more familiar with the environment and the cultures with which we were dealing. When we arrived, we, the CDC people, fresh out of the U.S., were impatient. We didn't understand why something couldn't be done yesterday; what was the problem? And of course, the folks we were dealing with- whether it were the national ministries of health, the French or English advisors who were there, the other expatriates-they thought we were nuts when we first arrived. They couldn't understand why we were having these expectations. Many of the French thought that the word "eradication" should be eradicated. They had very little little time for this eradication concept. And so, yes, there were a lot of tensions with that. But I would have to say, again, that the experience of the public health advisors-who had dealt with those kinds of issues in the United States with state and local health departments and recalcitrant public officials at all levels and learned to find ways of getting things done so that everybody went along with it- these types of situations are where they really shone. We in the medical officer field were often not so good at that, and I think we were very well served by having the public health advisors with us. Harden: In December 1969, there was an observance of the hundred millionth vaccination in Niger. Were you involved in that at all, and do you have any special memories of that event? Henderson: That was in Ghana, and I have some memories of it. I wasn't involved with the organization of the event, thank goodness, because it was a massive affair. But I do remember going and giving an interview to the Ghanaian newspaper about things. The report of the interview in the press talked about our work in eradicating rabies or malaria, or something totally not having anything to do with what I had said or what the program was about. One of the reasons I was doing that interview was that, I think the Minister of Health and George, the Director of the program, were off doing the hundred millionth observance, and they needed somebody to satisfy the local news media who could speak about the program. So my role was a very minor one. But it was a grand affair. Harden: If you were going to do the program all over again, would you change anything about the way it was run? Henderson: Given that it worked, I think not. Harden: How did the smallpox eradication program change your life and career, or did it? Henderson: Oh, very much. When I came to CDC, my idea was to work in public health for a while, go back to internal medicine, and maybe get a joint accreditation in public health and internal medicine, as many of my colleagues were doing. But when I got to West Africa and had a little bit of experience there, 2 things happened. One, I was addicted to public health. Two, I knew I had to go back and get some management training. So I applied to the Director of CDC, Dave Sencer, and asked him for a career development extension to go back and get a degree in public health at Harvard Medical School. And I said, "I know Harvard. I will look during that first year at the School of Public Health and I will find some management training I can do during the second year." I was sitting in Lagos, so I couldn't tell Sencer exactly what that second year was about, but I said it would be management. And, in fact, I tried to get into the Harvard business school, but they had a very rigid program that I thought was very unhelpful. The Kennedy School was just starting a program of Master of Public Policy. They wouldn't let me into it because they said I was too old. I think I was 28 or 29. I insisted that I was just the right person and talked my way into it. So that was my second year of training. So it did change my life in a radical way. Harden: What impact do you think the program had? What impression did it leave in Africa about the United States, about CDC? Do you think it had an impact on the end? Henderson: I think it was good. I mean, it may have been astounding. When you're working down in the guts of an organization, one doesn't see the perspective of what others have about the whole range of things. I don't think we left a bad impression, by any means. But that was nothing I was aware of, or got feedback on. Harden: You said your wife was traveling with you. What impact did the smallpox eradication effort have on your marriage, in terms of anything? Traveling? Henderson: Well, we were unusual. We had just gotten married. My wife is a pharmacist, and we didn't have kids. And I thought that she could be extremely helpful in what I was doing. Sample surveys are not difficult to do. Keeping the records, drawing maps, things of that sort, she does very well, and so we worked as a team. And we continued to travel wherever we could as a team, together. Now, she wasn't paid by anybody. I paid for whatever travel was going on, but we worked together all the time. And in fact, when I think about it now, it set an unusual precedent. We kept running into problems later in life, when she would sit in on staff meetings, or go to meetings with other organizations, and they would say, "What's your wife doing here?" Well, there would be administrative assistants, other people who would not be contributing from a professional perspective but would be sitting and listening in. But the fact that she was a wife alienated a lot of people. Eventually, she began introducing herself as my personal assistant. That seemed to work a lot better. But it had a very strong bonding affect on our marriage and lasted throughout our professional lives and through the present.. Harden: Before we stop, is there anything else about the Smallpox Eradication Program that you think of, that we should discuss? Henderson: I think that one of the extraordinarily important legacies was the group of people. Now, I have just told you that the group of people was not extraordinary, that they were ordinary people. But having gone through that experience, many of them continued on working together as colleagues throughout their careers. And the smallpox program in West Africa morphed into the larger global program, with many of our staff from West Africa joining the global smallpox eradication program and having major roles in that. After spending some time at Harvard and back at CDC, I went back to WHO in 1977. I had left West Africa in '69. So almost a decade later, I came back to international health at the recommendation of Dave Sencer, to go and replace D.A. Henderson at WHO and to run what was then a new program, the Expanded Program on Immunization, which was a child of the smallpox program. Even in the smallpox days, we were looking at how to use other vaccines with smallpox vaccine, how to do combined immunizations. So a lot of the science had already been done by us in West Africa, plus other colleagues elsewhere that were working on the same issue. When smallpox success seemed assured in 1974, the Expanded Program on Immunization was adopted by WHO. The idea was to take what we knew about the smallpox experience, providing immunizations for a disease, and do a childhood immunization program. The program faltered for a couple of years, and I was called in both because the program was faltering and D.A. who everyone assumed would take over the program decided to leave WHO. There was a desire on the part of the U.S. to have a CDC US person replace D.A. and I went back to do that. Now, when I went back, a lot of the "mafia" I worked with were the smallpox mafia-both the smallpox mafia that we had in West Africa and the larger mafia that was then created when the global program was created because the global smallpox program was just phasing out. So suddenly I had a whole large staff of people who had that same motivation, who had that same perspective, coming into my program now, into the Expanded Program on Immunization. They continued on to do polio eradication, the diarrheal disease program, a whole slew of very, very important public health initiatives. And that came, I think, directly from this initiative in West Africa, the smallpox group, then going to the larger, international group, and then the international group coalescing around several extremely important public health programs. Harden: Do you think there will be another disease we can eradicate? Henderson: Well, we're certainly trying with polio. Harden: And having some very difficult problems, I think, and discussions about whether it will be done. Henderson: Yes. It's a very interesting quandary in public health because you don't know, when you're beginning, if you're going to succeed. If you knew that, it wouldn't be a problem. You'd just get it done. We didn't know when we did smallpox in the beginning that we would succeed. In fact, we had to change the program radically in order to succeed. The same is happening with polio-major, major technical breakthroughs, change your philosophy, change of the way we approach things-learning as we go, and having a lot of problems on the way. But that's the way you make progress in science. That's the way you get better. Now, there may come a day when we say, "Okay, enough is enough. We've got to call it quits." But until that very end, I think it's absolutely well worth giving it the best shot that we can. Malaria was a situation where we tried and tried, and then it became increasingly apparent that this was not going to work. We didn't have the science. We didn't have the technical skills or the technical equipment to do the job. We had to change the goal of the program. That's not happened with polio, yet. We have a lot of good irons in the fire, and I don't think we should be anywhere near giving up at this time. But there will also be interest in eradicating measles; there will be interest in eradicating other diseases. When I did the Expanded Program on Immunization, coming in in '77, people in WHO said, "OK Rafe, we know who you are. You're one of these eradication people. You are just interested in the short term." And I said, "Not on your life. I'm not interested in eradication. I'm interested in long-term childhood immunization." But I was interested in eradication. And I came back to that in the late 1980s, when our routine immunization had more or less done what it could do. It was reaching levels that were not too bad but were also not too good. And at that point, we adopted polio eradication, not only because we thought we were ready for it but also because the polio eradication effort was 1 thing that stiffened us up in the other efforts. Because we were dealing with a specific disease, that helped us do the rest of the things, gave us more enthusiasm for doing those other things, as well. And I do think that the occasional disease- specific initiative, whether it's eradication or radical control of a disease, can help strengthen a larger health initiative, or set of initiatives, and will remain a useful public health strategy as long as we have both the combination of large, integrated services that we're doing and some specific things that are within those integrated services. I think that combination remains extraordinarily important in public health and probably in other enterprises as well. Harden: Thank you so much for speaking with me. I think we've got some fine footage here. I am delighted about the details on the cluster sampling system. Nobody else has provided anything on that for me, so I'm very pleased to have that. Henderson: Good. ### </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/FlQOn2USRvU" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-07 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15ncv emory:15ncv Subject The topic of the resource Smallpox Eradication Survey Cluster sampling Surveillance USAID WHO CDC Expanded Programme on Immunization Format The file format, physical medium, or dimensions of the resource 10852080000 bytes video/x-dv Creator An entity primarily responsible for making the resource Henderson, Ralph (Interviewee); CDC Harden, Victoria (Interviewer) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, RALPH "RAFE" Description An account of the resource Dr. Henderson was Deputy Director of the West African Smallpox Program, stationed in Lagos in the Regional Office. He was responsible for the on the ground epidemiologic aspects of the program and developed methods of evaluation that have served in a multitude of other programs. He was subsequently assigned to WHO to initiate and direct the Expanded Immunization Program, and was an Assistant Director General of WHO. Language A language of the resource English