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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)
Bulletin of the World Health Organization. 2007 Aug; 85(8):631-636.Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system. The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced. This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms. It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment. (author's)
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)
Bulletin of the World Health Organization. 2001; 79(1):69-70.This article reviews the 1991 paper by Arata Kochi on the strategy of WHO to control tuberculosis. It notes that Kochi's paper did not report a new scientific discovery, rather it depicted the devastating impact of tuberculosis around the world in a clear and forceful manner. Consequently, it changed the public health focus of WHO, national governments and leading voluntary organizations. Kochi's paper pinpointed three major programmatic deficiencies that had to be overcome: inadequate treatment services; high rates of failure to complete therapy; and the worldwide absence of adequate governmental surveillance and monitoring systems. Furthermore, the paper gave attention to the role of public health in addressing the tuberculosis issue. To address the problem, Kochi emphasized that it would take strong, directive leadership by national government to implement systems for an effective prevention and control program for tuberculosis.
WORLD HEALTH FORUM. 1998; 19(2):162-73.In 1796, English country doctor Edward Jenner demonstrated that scratching cowpox virus onto the skin produced immunity against smallpox. Following this scientific demonstration, the practice of vaccination gradually became widespread during the 19th century, and began to be applied to other infections. However, the use of vaccines was largely confined to the industrialized countries. Immunization played no significant role in the World Health Organization's (WHO) early activities. In 1974, however, WHO launched its Expanded Program on Immunization (EPI) with the goal of immunizing all of the world's children against diphtheria, pertussis, tetanus, measles, poliomyelitis, and tuberculosis. At that time, only less than 5% of all children had been immunized against the diseases. The word "expanded" referred to the addition of measles and poliomyelitis to the vaccines then being used in the immunization program. Now, 80% of the world's children receive such protection against childhood diseases during their first year of life, coverage could reach 90% by 2000, vaccines are becoming more effective, and vaccines against additional diseases are being added to the program.