Here's the WSJ article from yesterday:
October 24, 2001
Marketplace
Leader of Efforts to Eradicate Smallpox
Is Called on to Assess New Threat in U.S.
By YOCHI J. DREAZEN
Staff Reporter of THE WALL STREET JOURNAL
WASHINGTON -- Five days after the terrorists struck, even before the first case of anthrax, Health and Human Services Secretary Tommy Thompson summoned Donald Henderson, a 73-year-old semiretired infectious-disease specialist, from his home in suburban Baltimore for an urgent conversation about bioterrorism.
For Dr. Henderson, a tall man with a reedy voice who is known by his initials, D.A., the encounter marked an unpleasant reunion with a foe he had long thought vanquished: smallpox.
In the most successful public health effort in history, Dr. Henderson led the team that eradicated smallpox by 1980, saving tens of millions of lives. Now, the old warrior has been brought out of near-retirement to head a federal advisory committee that will help the U.S. government decide whether the threat of a terrorist attack involving smallpox is grave enough to vaccinate the entire country against it.
The U.S. abandoned smallpox vaccination in 1971 because side effects produced complications ranging from severe rashes to brain inflammation in roughly one out of every 1,000 people, and killed about one of every million. Since the disease hadn't been seen in the U.S. since the early 1950s, experts at the time said the risks from vaccination outweighed the risks of the disease.
That calculus may be changing. Smallpox is highly contagious and fairly easy, in theory, to disperse. In June, a group of academics and former government officials gathered at Andrews Air Force Base for a war game, code-named Dark Winter, that began with reports of a single case of smallpox in Oklahoma. By the time it ended, the mock epidemic had spread to 25 states and 10 foreign countries, killing millions and creating chaos.
With concern over bioterrorism mounting over the past month, the U.S. government has decided to buy 300 million doses of vaccine, enough for everyone in the country. Now comes the tough question that Dr. Henderson's committee is struggling with: whether to use them or hold them in case smallpox reappears.
Dr. Henderson's own beliefs illustrate the complexity of the question. On one hand, he doesn't think the country should be vaccinated unless there is an outbreak of the disease. Too many Americans, including cancer patients undergoing chemotherapy, people who are HIV-positive and small children, have weak immune systems that might not be able to withstand the vaccine. After all, he stresses, the vaccine is effective even after a person shows signs of infection.
But he also talks of the devastation an outbreak would cause. "The risk of it being used as a weapon is not very high, but it's there," he says. "And if you got an outbreak, it would be a terrible global catastrophe."
0See a timeline of Dr. Henderson's fight against smallpox
Even discussing the possible need to vaccinate against smallpox is an intensely personal blow to Dr. Henderson. "It's tragic that he may be seeing his life's work unravel," says Elizabeth Fenn, a historian of smallpox at George Washington University.
For centuries, smallpox ravaged the world, killing hundreds of millions of people. In 1796, a British physician developed a method of infecting patients with a generally harmless virus that also provided immunity from the much-more serious disease. But many doctors didn't trust the vaccine method, and it was hard to create mass quantities of it and difficult to ship and store it. So it wasn't until the 20th century that developed countries began broad vaccination programs.
Dr. Henderson began his career amid earlier fears of biological attack. In 1955, just after completing his medical internship, he joined a unit of the federal Centers for Disease Control charged with detecting and identifying possible biological warfare attacks by communist saboteurs, and quickly assumed its top job. A decade later, the World Health Organization asked the U.S. government to send him to Geneva to resuscitate its languishing effort to eradicate smallpox.
At the time, the disease was still killing nearly five million people a year, most in developing countries. Dr. Henderson managed the effort from Geneva, traveling frequently to remote parts of the world to boost morale.
He was known for innovation -- when supplies of vaccines ran short, he was able to stretch existing stocks by using a two-pronged syringe that required less vaccine because it allowed for stronger, more effective punctures -- and bluntness. In 1971, he visited Iran, where the government sought to suppress word of a smallpox outbreak because it was gearing up to celebrate the 2,500th anniversary of the Persian empire. Everywhere he went, he was told that there were no deaths from the disease, an obvious lie. Finally, in a Tehran hospital, he lost his temper. "I said how wonderful it was that they had found a way to treat such a horrible disease with no deaths," he recalls. "I said they should write it up for a medical journal. It took them a few minutes to realize that I was taunting them, but I was just so angry at the dishonesty."
Gradually, countries, and then continents, were declared smallpox-free. In 1971, smallpox was eradicated in Brazil, eliminating it from the Americas for the first time since the early 1500s, when the Spanish conqueror Hernando Cortes accidentally brought the disease to Mexico.
In 1974, 150,000 workers visited more than 100 million households in India during a yearlong effort that eliminated the disease there. An outbreak in Somalia in 1977 sparked fears of resurgence, but Dr. Henderson and his team brought it under control by targeting their vaccination efforts to people in places where the disease was likely to spread. In 1980, the WHO formally declared that smallpox had been eradicated, the only infectious disease humanity has ever fully vanquished.
At first, the WHO kept 200 million doses of smallpox vaccine in Switzerland. Then a false sense of security set in. During the Reagan administration, Dr. Henderson says, the White House decided to slash support for the WHO, including the smallpox storage and testing programs. Stores of vaccine dwindled to 500,000 doses.
After leaving the WHO, Dr. Henderson became the dean of the Johns Hopkins School of Public Health and then spent four years working for the Clinton administration, first at the White House and then at HHS, where he urged the U.S. to destroy its last stores of smallpox, which it was keeping for research. He lost the argument. Samples are still kept in secured facilities in Atlanta and Siberia for research.
In 1996, Dr. Henderson was devastated to learn that the Soviet Union -- which had been among the earliest and most loyal supporters of the eradication program -- had produced tons of smallpox as part of a covert bioweapons program.
Horrified by the possibility that terrorists might obtain smallpox, Dr. Henderson created the Johns Hopkins Center for Civilian Biodefense Studies in 1999, and spent two years traveling the country to warn state and federal officials about the threat of bioterrorism. His admonitions fell largely on deaf ears. "I was a voice in the wilderness," he says.
That has changed now. Dr. Henderson meets with Mr. Thompson almost every day, either alone or with other members of the advisory council, who are charged with identifying and quantifying the threat from biological weapons like anthrax, smallpox and Ebola, and making policy recommendations on how to prepare or respond. He recently appeared at a press conference beside Thomas Ridge, the new chief of homeland security.
The recognition is cold comfort to a man whose house in Baltimore is full of relics from countries he visited during the campaign against smallpox. "I feel no pleasure or vindication," he says. "I wish I was still out there warning people that there might be a problem rather than figuring out how to deal with it. I really thought we'd never have to worry about any of this again."
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A Timeline of Dr. Henderson's Fight Against Smallpox
1959 World Health Organization resolves to eradicate smallpox; U.S. sees last case of smallpox
1966 Dr. Henderson moves to Geneva to lead effort. Plans to stay 18 months, stays 11 years. Smallpox infects 15 million a year, and kills 2 million..
1971 U.S. Public Health Service seeks end to mandatory smallpox vaccination
1975 Henderson-led team eliminates smallpox in India.
1975 Dr. Henderson leaves WHO for Johns Hopkins.
1977 Somalia has last recorded smallpox epidemic.
1980 WHO certifies that smallpox is eradicated, calls for end to mass vaccination.
1984 France becomes last country to end mass vaccinations.
1990 U.S. unveils plans to sequence smallpox DNA, destroy remaining Russian and American stores of disease by 1993.
1990 Dr. Henderson joins White House science office staff
1993 Dr. Henderson joins Dept. of Health and Human Services staff.
1996 Dr. Henderson learns of covert Soviet effort to turn smallpox into a weapon.
1998 Extent of Soviet effort becomes public when USSR bioweapons chief Ken Alibek defects.
1998 Clinton postpones destruction of last smallpox.
2001 Dr. Henderson chairs U.S. advisory council on bioterrorism. U.S. plans to obtain 300 million doses of smallpox vaccine. |
