April 2010

Meet Our Featured Guest Columnist:
D. A. Henderson

led the World Health Organization’s global campaign to eradicate smallpox. In November 1979 an international commission declared the campaign a success.

Q: How/why did you become involved in global health issues?

A: My career in global health really began when I had to serve time in the Uniform Service at the end of internship and a man came through and talked with me about the Center for Disease Control in Atlanta, which I had never heard of; it was very small at the time, and it sounded very interesting. It was the Epidemic Intelligence Service in which you would go to various epidemics on 24 hour call. And so, I went there for two years.

When I was completing my internship, the question was, what was I going to do about specializing? And I'd decided I was going to be a cardiologist, and so that was the training I was preparing to take up and which I did for two years after I did my introduction in the Epidemic Intelligence Service and what I found was that end of a day and I'm seeing patient after patient, I thought to myself, am I really making a difference? At the end of the day, you've got congestive heart failure, maybe a little constipation, maybe a little upset tummy, that sort of thing. At the end of the day, you say, "Would it had made any difference if I hadn't been here at all?" And I contrasted that with my experience while I was working out of Atlanta at the Epidemic Intelligence Service, we were constantly involved in major problems. You've got a big outbreak here, you're looking at trends of disease hoping to pick up let's say an unknown outbreak of food borne disease or what have you. It was an adventure every day. It was an adventure.

Q: Describe some of the successes you have seen in your work.

A: Well, every country in the world belongs to the World Health Organization and in the World Health Organization, they have quite a number of people, some tens of thousands who work to get various programs started in countries, to do training, to convene meetings, that sort of thing. The small pox eradication program was under the World Health Organization. Complementing this program were various donations that countries would make. So, for example, we had Peace Corps people coming from the U.S., from Japan, from Austria to work on it in addition to the local people. We had donations of money which came in, not very often, a number of donations of vaccine; Soviet Union was really critical here, and the U.S. played a big role in deciding very early on to undertake to eradicate small pox and control measles in 20 countries of Western Central Africa. These countries were among the poorest, countries of highest incidence of small pox and that program gave a big boost because within four years we'd stopped small pox throughout that whole area. It was a very dramatic change.

Q: What were some of the challenges?

A: We continually faced major challenges whenever there was a movement of refugees, whether we had civil war or floods or whatever, once you got a whole lot of people coming together in any sort of large group and there were small pox brought in, it was spread very rapidly and you're very often having to work in areas where the health services are not well organized and where the circumstances are very difficult. So that was a continuing problem throughout and there were a number of countries with civil war, and how do you deal with areas where you've got rebel bands working? And that was always a puzzle and we were able to do it but it took a lot of imagination and courage to get in there. We had problems because not all countries decided that they would go on with small pox eradication. In Ethiopia, Stott would not permit me to visit even to discuss with the minister some sort of a program so that they could get started until late 1971, so took me four years before I could get in there. Finally got there and the minister at that point said, "We're not putting anything into this. We have no resources. We have no people." So I presented him finally with a plan on a Friday and he said, "I'll see you on Monday and I'll study it," and we came back into the office on Monday and much to my surprise, he said, "We accept this plan and we're ready to move ahead," and I couldn't imagine what had happened. Well, what had happened was that I was talking at a small dinner on Saturday night with a man who was an Austrian physician who happened to be the physician to the Imperial Guard. He was also the physician to Haile Selassie. He saw Haile Selassie, thought the program was pretty good and the word went from Haile Selassie to the minister that this was a good idea and we will do the program.

Q: How can young people make a difference?

A: I believe that the next 20-30 years are probably the most exciting and productive years we're going to have in improving health globally. I've been in international health for 50 years and I have never witnessed so much that is in the research pipeline, of new vaccines, of new treatments, of new ways of approach problems as I have today and more can be expected ahead. We're also I think beginning to realize that we really can and to work together different countries in achieving some of the possible achievements of disease control and eradication and it's a different attitude today then we had 20 years ago and I think as time goes on, we realize that this is a small world and that we can. It's one small planet and we - - the problem now today in China or Kenya can very well be a problem in the United States or anywhere else within 24 hours and that is happening today. So we need to be and from our own country we need to be as concerned about the disease problems in other countries as in our own country and I think we're now beginning to realize this. The next generation will benefit from this enormously. It will be an exciting time to be in international health.