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Bulletin of the History of Medicine. 2007 Summer; 81(2):407-430.Between 1947 and 1951 the Scandinavian-led International Tuberculosis Campaign tested more than 37 million children and adolescents for tuberculosis, and vaccinated more than 16 million with BCG vaccine. The campaign was an early example of an international health program, and it was generally seen as the largest medical campaign to date. It was born, however, as a Danish effort to create goodwill in war-ravaged Europe, and was extended outside Europe only because UNICEF in 1948 unexpectedly donated US $2 million specifically for BCG vaccination in areas outside Europe. As the campaign transformed from postwar relief to an international health program it was forced to make adaptations to different demographic, social, and cultural contexts. This created a tension between a scientific ideal of uniformity, on the one hand, and pragmatic flexibility on the other. Looking at the campaign in India, which was the most important non-European country in the campaign, this article analyzes three issues in more detail: the development of a simplified vaccination technique; the employment of lay-vaccinators; and whether the campaign in India was conceived as a short-term demonstration or a more extensive mass-vaccination effort. (author's)
Jornal de Pediatria. 2006; 82 Suppl(3):S1-S3.In the last few decades, immunization -- one of the greatest breakthroughs in health sciences -- has increasingly gained significant ground all over the world. Advances in general sciences, microbiology, pharmacology and immunology have, together with results of epidemiology and sociology studies, demonstrated the remarkable impact of vaccines on society and the importance of vaccination in health promotion and disease prevention. In the beginning of the 17th century, smallpox was one of the most devastating communicable diseases in the world; it affected most individuals before they reached adulthood, and had high mortality rates. Lady Mary Montagu, wife of the British ambassador in Istanbul at the time, observed that the disease could be avoided by using a technique adopted by Muslims, who inoculated dried pus from smallpox pustules obtained from an infected patient into the skin of healthy individuals. This procedure, known as "variolation," probably originated in China; later, it was taken to Western Europe. Although it led to several cases of death due to smallpox, it was used in England and in the United States until the beginning of investigations by British physician Edward Jenner, whose research results were published in the study Variolae Vaccinae in 1798. Dr. Jenner studied peasants who developed a benign condition known as "vaccinia" due to their contact with cowpox, and his investigation resulted in the development of the first immunization techniques. (excerpt)
Journal of the Indian Medical Association. 2003 Mar; 101(3):142-143.The TB problem in India was first recognised through a resolution passed in the All India Sanitary Conference, held at Madras in 1912. The TB picture started becoming clear with the introduction of tuberculin testing. The Bhore committee report issued in 1946 estimated that about 2.5 million patients required treatment in the country with only 6,000 beds available. The first open air institution for isolation and treatment of TB patients was started in 1906 in Tilaunia near Ajmer and Almora in the Himalayas in 1908. The anti-TB movement in the country gained momentum with the TB Association of India was established in 1939. WHO and UNICEF took keen interest in providing assistance for introducing mass BCG vaccination with low cost in 1951. In the 1940s streptomycin and PAS were introduced in the west followed by thiocetazone and INH is 1950s. National Tuberculosis Control Programme (NTP) was formulated in 1962 which was implemented in phased manner. The deficiency in NTP was identified in 1963 and Revised National TB Control Programme (RNTCP) was developed. There is a commitment for Government of India to expand RNTCP to cover the entire country by 2005. (excerpt)
Intimidation, coercion and resistance in the final stages of the South Asian smallpox eradication campaign, 1973-1975.
Social Science and Medicine. 1995 Sep; 41(5):633-45.Occasions during 1973-75 are reviewed when physician-epidemiologists working under the auspices of the World Health Organization (WHO) in south Asia intimidated local health officials and resorted to coercive vaccination in the final stages of the Smallpox Eradication Program (SEP). The SEP was established inside this structure in 1962 with the goal of immunizing 80% of the population. By 1964, however, when 80% coverage had indeed been achieved in some states, outbreaks continued to occur because vaccination had been concentrated on the most accessible groups. From 1964 to 1967 a goal of 100% vaccination was set to include slum dwellers, migrant workers, and fishermen in less accessible regions. However, still numerous outbreaks occurred with more than 130,000 cases reported between 1970 and 1973. In mid-1973 an intensified campaign was launched in both India and Bangladesh under WHO guidance that appointed expatriate epidemiologists to work in cooperation with national SEP authorities. Surveillance teams were equipped with jeeps and motorcycles so they could search markets, schools, pilgrimage sites, tea-shops, and slums for cases. Repeated village-to-village and house-to-house searches were launched in both countries; cash awards were offered for hidden cases; rigorous containment measures were taken; and motorized teams rushed to the scene of outbreaks to backstop local vaccination personnel. Nonetheless, the SEP came close to a collapse in the first six months of 1974 with an explosion of outbreaks in Bihar and Madhya Pradesh. After June of 1974 the number of foreign epidemiologists doubled to about 100. Coercion was justified by containment, and in the last phase of the campaign, containment was defined to mean the vaccination of everyone living within a 1-1.5 km radius of an outbreak. Sustained resistance was infrequent, but there were a range of coercive encounters involving American WHO advisers during this period of time that were all documented by the advisors involved.
WORLD HEALTH FORUM. 1988; 9(1):7-23.To mark the 40th anniversary year of WHO, this article presents major events from WHO's life story, including episodes from its foundation in the aftermath of a world war, through the high hopes of the mass campaigns and the brilliant victory over smallpox, to the present great endeavour to achieve health for all. Between the world wars, international health work had been carried out by 3 separate organizations. Urgently needed was a new, truly global health organization to replace them. During the late 1950s, WHO was assisting yaws campaigns in 28 countries with a combined population of over 150 million. By 1960, in 64 countries or territories, 265 million children and adolescents had been tested with tuberculin and 106 million vaccinated with BCG. The technique of residual spraying with DDT held out the promise of conquering malaria by preventing the transmission of the malaria parasite. Within 12 years of its launch, the global malaria program had brought protection against the scourge of malaria to almost 1 billion people--more than 1/4 of the world's population. Smallpox victims were estimated at 10-15 million each year, of whom 1.5-2.0 million died. Through quiet advocacy backed up by solid research, WHO had helped to give family planning the international respectability it had so much needed. WHO increasingly urged governments to integrate disease control campaigns with the general health services and helped them to do so.