Dr. Henderson shared his expertise and opinions on smallpox-related issues in the interview below.
Thank you, Dr. Henderson for your kindness and willingness to share your expertise on smallpox with "Humans and Viruses" students!
"A critical issue for any program is that of mustering sufficient resources. However enthusiastic countries were for the goal of eradication to be achieved and however great the cost-benefit ratios, there was reluctance by all to provide resources in any way commensurate with the benefits they themselves would gain. Thus, the total of all international contributions, in cash and in kind, amounted to just under $100 million over the 14 years 1967 through 1980 when eradication was declared. Even as we struggled with the last cases in Ethiopia and then Somalia, funds seriously restricted activities. The principal donor was the US with about $26 million, an amount that the country saves every 27 days as a result of no longer conducting routine vaccination programs and review of vaccination certificates of visitors.
A no less difficult problem was that of trying to sustain an effective program that was responsive to new developments. With programs in 50 countries, with the WHO comprised of 6 only loosely affiliated Regional offices, with international staff comprised of some 73 different nationalities, this proved to be a complex task. I gained great respect for General Dwight Eisenhower's WW II leadership.
Perhaps the easiest task was that of finding enthusiastic young recruits, mostly from the health care sector, who were willing to work incredibly long hours under the most difficult conditions in common pursuit of a goal."
2. What is an adequate public health approach to an imminent smallpox threat?"There are several key elements. First is early detection and key to this are alert physicians and nurses in Emergency Rooms where the patients are likely to be referred from soon after onset of symptoms. Second, is a 24/7 communication system linking the ERs with on-call public health staff who, in turn, can alert needed consultants, the laboratory, and state and federal officials to confirm the diagnosis in the shortest possible time. Third is a stock of smallpox vaccine that can reach the site within 12 hours so that health staff and patient contacts can be vaccinated within a matter of 24-36 hours. Fourth is the availability of isolation facilities both for examining suspect cases in the ER and for caring for cases. Fifth is a plan for distributing vaccine widely throughout a community as needed and for communicating authoritative information widely to the public and professional community. For most areas in the US, all or most of these provisions have been put in place or are rapidly nearing that point."
3. At this time, is it appropriate to implement a policy for mass vaccination?"Given the generally held belief that the risk of smallpox being released is small, a mass vaccination program is not warranted. While the risk of a release may be small, it could result in a catastrophe, given the low levels of population immunity. Thus, the need to respond rapidly to control an outbreak at the earliest time."
4. What is your opinion of the decision to keep stocks of smallpox in the CDC's laboratory in Atlanta and in Russia?"The initial decision to retain stocks of smallpox was premised on the belief that some day virus strains might be needed for presently undefined research purposes. Later, it was argued that the strains were needed to develop a new vaccine and new antiviral agents. Many prominent virologists, especially those most knowledgeable of the Orthopoxviruses, believed that retention of the strains was unnecessary given the fact that smallpox does not infect animals other than man (thus limiting its use in laboratories) and the fact that representative strains had been sequenced and cloned fragment libraries created. Moreover, both monkeypox and camelpox have a homology of more than 95% with smallpox and monkeypox, in man and monkeys, produces a disease very similar to that of smallpox. It is now approaching 10 years since the decision was made not to destroy the strains; little of value has yet to emerge from the two laboratories still engaged in working with smallpox -- certainly, from their work, we are no closer today to a new drug or vaccine that we were a decade ago.
Those favoring destruction of the known stocks of virus believed that destruction should be accompanied by a resolution of the World Health Assembly, as well as the United Nations General Assembly, to the effect that as of "x" date, any individual, any laboratory, any country found to be in possession of variola virus would be, de facto, "guilty of crimes against humanity". Although there was no way to verify compliance, it seemed to many of us that such a resolution would serve as a deterrent. It also seemed logical to believe that if the nations were not prepared to take this rather straightforward step, there was little hope for any more serious bioweapons control measures being implemented.
The principal objectors to the proposal for variola virus destruction were the US Department of Defence, the British Ministry of Defence and the Russian government. Eventually, they succeeded in postponing the decision to destroy the known stocks of virus and that is the status today."