Mis­sion: Save the en­vi­ron­ment

Financial Mirror (Cyprus) - - FRONT PAGE -

It sounds like a scene from a Hol­ly­wood movie. And, in­deed, it mir­rors the open­ing scenes of the ‘Mis­sion: Im­pos­si­ble’ tele­vi­sion se­ries that pre­miered that year. But it re­ally hap­pened, if not in pre­cisely those words. The of­fi­cial was As­sis­tant Sur­geon Gen­eral James Watt; the man with the mis­sion was Com­mu­ni­ca­ble Dis­ease Cen­ter (CDC) sci­en­tist Don­ald Hen­der­son; and the en­emy was small­pox.

The mis­sion cer­tainly seemed im­pos­si­ble. At the time, small­pox was killing as many as two mil­lion peo­ple, and in­fect­ing another 15 mil­lion, each year. Yet, like in the se­ries, Hen­der­son and his team at the World Health Or­gan­i­sa­tion de­fied ex­pec­ta­tions. In just over a decade, small­pox be­came the first – and, so far, the only – in­fec­tious hu­man dis­ease ever to be fully erad­i­cated.

The key to this tremen­dous med­i­cal achieve­ment was not, as one might ex­pect, some ma­jor health break­through (the small­pox vac­cine had been around since the eigh­teenth cen­tury). It was di­plo­macy, flex­i­bil­ity, and co­op­er­a­tion.

From the be­gin­ning, the WHO lacked faith in a vac­ci­na­tion cam­paign. Many, in­clud­ing the WHO di­rec­tor­gen­eral, be­lieved that, to stop small­pox, all 1.1 bil­lion peo­ple in the 31 af­fected coun­tries, in­clud­ing those in re­mote vil­lages, would have to be in­oc­u­lated – a lo­gis­ti­cal night­mare.

That is why WHO del­e­gates de­bated for days be­fore agree­ing, by the slimmest mar­gin ever, to pro­vide a measly $2.4 mil­lion per year for the ef­fort – too lit­tle to cover the costs of what­ever vac­cine was not do­nated, let alone fund the nec­es­sary lo­gis­ti­cal sup­port. Many donors shared this pes­simism, be­liev­ing that their money would be bet­ter spent on, say, health-care in­fra­struc­ture. Even UNICEF de­cided against con­tribut­ing to the cam­paign.

In fact, the de­ci­sion to as­sign Hen­der­son to the un­en­vi­able job of spear­head­ing the cam­paign stemmed from the WHO di­rec­tor-gen­eral’s de­ci­sion to put an Amer­i­can in charge, so that the United States, not the WHO, would take the blame for the pro­gram’s fail­ure. (Hen­der­son tried to refuse the role, but there was no “should you choose to ac­cept it” in this episode.) Yet Hen­der­son man­aged to turn a bad hand into a win­ning one, with a key in­sight.

Hen­der­son recog­nised that the Soviet Union – which had been press­ing for an erad­i­ca­tion cam­paign for several years, and had al­ready pledged to donate 25 mil­lion doses of vac­cine an­nu­ally – would not be en­thu­si­as­tic about an Amer­i­can lead­ing the charge. So he reached out to the Soviet deputy health min­is­ter, Dim­itri Venedik­tov, with whom he es­tab­lished a rap­port that en­abled the two sides to work to­gether on strat­egy and lo­gis­tics, in ad­di­tion to their vac­cine do­na­tions (the US had agreed to pro­vide 50 mil­lion doses each year). The two most un­likely al­lies ended up lead­ing the fight to­gether.

Hen­der­son’s knack for di­plo­macy was matched by an eye for tal­ent and lead­er­ship. He in­sisted that all of his staff spend at least a third of their time in the field, work­ing with lo­cal of­fi­cials and vis­it­ing vil­lages, so that they could see first­hand the chal­lenges of mass vac­ci­na­tion.

Among those per­son­nel was Wil­liam Foege, a Lutheran mis­sion­ary doc­tor work­ing as a con­sul­tant for the CDC in Nige­ria. One day in De­cem­ber 1966, Foege got word of a small­pox case in another vil­lage and im­me­di­ately trav­elled there to vac­ci­nate the vic­tim’s fam­ily and other vil­lagers.

But Foege was wor­ried that a wider out­break might be un­fold­ing, and he did not have enough doses to vac­ci­nate ev­ery­one in the area. So he adopted a dif­fer­ent tac­tic: he sent run­ners into all vil­lages within 30 miles to check for more cases, and then vac­ci­nated peo­ple only in the four places where cases turned up. This cre­ated a “ring” of vac­ci­na­tion around in­fected peo­ple that broke the chain of in­fec­tion.

Foege’s strat­egy was ex­tended to eastern Nige­ria, then in­tro­duced to other parts of West Africa, and ul­ti­mately ap­plied to the most chal­leng­ing en­vi­ron­ment of all: In­dia, with its half-bil­lion peo­ple. It took 130,000 trained health work­ers 20 ex­haust­ing months, but they elim­i­nated the scourge of small­pox that had tor­mented In­dia for mil­len­nia. Then, in spite of nat­u­ral dis­as­ters, the kid­nap­ping of WHO per­son­nel, and civil war, health work­ers re­peated that suc­cess in Bangladesh, Ethiopia, and So­ma­lia. Fi­nally, in 1980, the world was of­fi­cially free of small­pox.

Fifty years af­ter the launch of this dar­ing mis­sion, the tremen­dous achieve­ment that emerged from it is fad­ing from mem­ory. But the lessons it car­ries for gal­vanis­ing a frac­tious in­ter­na­tional com­mu­nity to tackle a shared chal­lenge could not be more im­por­tant, es­pe­cially at a time when ur­gent prob­lems like en­vi­ron­men­tal degra­da­tion de­mand global so­lu­tions.

As Foege has pointed out, the erad­i­ca­tion of small­pox proves that “global ef­forts are pos­si­ble.” We do not “have to live in a world of plagues, dis­as­trous gov­ern­ments, con­flict, and un­con­trolled health risks.” In­stead, “the co­or­di­nated ac­tion of a group of ded­i­cated peo­ple” can “bring about a bet­ter fu­ture.”

Hu­man­ity can­not live in a world of pol­luted air and wa­ter, empty seas, van­ish­ing wildlife, and denuded lands. The eco­log­i­cal chal­lenges we now face are mat­ters of pub­lic health and wel­fare, just as small­pox was. Our mis­sion, whether we want to ac­cept it or not, is to sum­mon the col­lec­tive will to halt our self-destruc­tion.

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