Donald Henderson and the Smallpox Eradication Programme
Donald “D.A.” Henderson passed away earlier this year. Visitors to the School can see his name on the plaque in the reception area of the Keppel Street building. Often historians of medicine would be wary of claims of “Great Men” who were ‘largely responsible for the success of the World Health Organisation’s Smallpox Eradication Programme’. But in the case of D.A. Henderson, such a reading is probably justified.
As students on our History and Health module are no doubt aware, the World Health Organisation has a mixed record in the post-war era with regard to disease eradication. While smallpox was an undoubted success – the last wild case was recorded in 1977 – and poliomyelitis is slowly but surely going the same way, the Malaria Eradication Programme was abandoned in the 1960s. One of the reasons why smallpox succeeded where malaria failed was a more determined effort from international governments and transnational organisations to root out and contain the disease. The key player in ensuring such cooperation was D.A. Henderson.
For those interested in a technical history of smallpox eradication and Henderson’s role in the programme, the WHO produced a comprehensive review of the disease from antiquity to the (then) present in 1988. Henderson was one of the co-authors. You can download it for free from their website.
For an analysis of the geopolitics and the role of American epidemiologists like Henderson, however, you may be interested in Bob H. Reinhardt’s book The End of a Global Pox (released in 2015). It includes interviews with Henderson, and shows how smallpox eradication – like the malaria programme before it – was a product of the Cold War. Unlike with malaria, both the Soviet Union and the United States had common goals. Perhaps crucially, smallpox was only carried by humans and there was an effective vaccine against it.
Henderson was an expert at getting governments to prioritise smallpox eradication. Working with the CDC in the United States, he was able to convince the American government that their geopolitical interests would be served by providing vaccine and technical assistance to West African governments, as it would lessen the influence of Soviet overtures in these newly-independent, post-colonial states. At the same time, he ensured that the USSR was given full credit for producing and supplying vast quantities of vaccine to the programme. Both sides of the Iron Curtain were also convinced of the self-interested argument that eliminating wild smallpox would reduce to zero the risk of world travel and immigration resulting in outbreaks of the disease at home and in countries in which the two super powers had economic and political interests.
Sometimes this required politics that may seem counterproductive. For instance, in the 1970s Henderson opposed research into new smallpox vaccines, arguing the testing and development of such prophylaxes would divert funds and energy away from targeting the final remaining cases. This was despite the known risks of adverse reactions to the vaccine, including encephalitis. Questions can also be raised as to whether or not the recipients of vaccine and quarantine were able to give what we today would call “informed consent”. Clearly some individuals and post-colonial governments were forced to comply with public health measures imposed by the West. Such ethical concerns are explored in Reinhardt’s book, but Henderson – like many others – saw that the benefits of eradication far outweighed the damage that would be caused by allowing smallpox to remain.
After the eradication programme was complete, Henderson became an advisor to governments concerned with bioterrorism. For the irony of smallpox’s death in the wild was that the disease remained in laboratories across the world, with the potential that it could be weaponised in a planet in which nobody retained natural immunity.
If the polio eradication programme is to succeed, it learnt the lessons from Henderson and the smallpox programme. International cooperation is key to such measures, as is the existence of a reliable and easy-to-administer vaccine. As historians continue to look back on post-war global health programmes, D.A. Henderson will remain one of the key figures.