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The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.
Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
Report of the first meeting of the Scientific Working Group on Viral Diarrhoeas: microbiology, epidemiology, immunology, and vaccine development, Geneva, 1980.
Geneva, Switzerland, WHO, 1980. 11 p.The main function of the Scientific Working Group was to review existing knowledge, designate areas where research was needed, recommended approaches for such research; and prepare a research plan. The Group's five year work plan for research is described, consisting of 3 priority topics: investigations related to viral diarrheas in general, studies of rotavirus diarrhea (recognized by the Group as the most important public health problem among the viral diarrheas at present), and research to determine the possible role as a cause of diarrhea of other viral agents (Norwalk and Norwalk-like agents, adenoviruses, calcivirus, coronavirus, axtrovirus, and other small round viruses). Needed epidemiological studies, clinical studies, and studies of disease resistance and vaccine development are identified. Identification of institutions to undertake research was discussed; priority was given to locating institutions and individuals within the developing world, or those in developed countries which work closely with developing world groups. An application form was reviewed and approved, and some general principles established. A list of participants in the meeting, and the 1st report of the Rotavirus reagents subgroup are appended.
Report of the First Meeting of the Scientific Working Group on Bacterial Enteric Infections: Microbiology, Epidemiology, Immunology, and Vaccine Development, Geneva, April 1980.
Geneva, Switzerland, WHO, 1980. 17 p.The group developed a five year research plan (1980-84). Topics were given priority based on the following group-established criteria: 1) the extent of the problem to be studied; 2) the chance of its early success given the limited funds available; and 3) the availability of good research workers with an interest in the problem. The epidemiology and microbiology of Vibrio cholerae 01 and Enterotoxigenic Escherichia coli (ETEC) are given first priority for study, as are immunology and vaccine development against cholera and ETEC diarrhoea. The immunology study will involve: 1) identification of protective antigens, 2) tests for antibody measurement and 3) measurement of acquired immunity. Methods of stimulating mucosal immunity are given first priority, as is the testing of existing candidate cholera vaccines such as B-subunit cholera vaccine and living vaccines made from non-toxigenic V. cholerae. Other organisms which will be studied are Campylobaster jejuni (which can account for up to 15% of acute diarrhoea cases in some settings), Salmonella, (including S. typhi), Shigella and Yersinia enterocolitica. Once there is a better understanding of the modes of transmission of the bacterial enteric pathogens, a study of specific cost effective methods of interrupting their transmission through environmental intervention is suggested, with emphasis on modifications in water supply and water usage, defecation practices, and personal and domestic hygiene. Identification of institutions to undertake research, and funding distribution, were also considered.
PUBLIC HEALTH REPORTS. 1980 Sep-Oct; 95(5):422-6.The implications of the eradication of smallpox in the context of epidemiology are presented. Eradication of disease has been conceived since the 1st smallpox vaccination was developed in the 18th century. Since then, attempts to eradicate yellow fever, malaria, yaws and smallpox have been instituted. Most public health professionals have been rightfully skeptical. Indeed, the success with smallpox was fortuitous and achieved only by a narrow margin. It is unlikely that any other disease will be eradicated, lacking the perfect epidemiological characteristics and affordable technology. The key to success with smallpox was the principle of surveillance. This concept has a vigorous developmental history in the discipline of epidemiology, derived from the work of Langmuir and Farr. It involves meticulous data collection, analysis, appropriate action and evaluation. In the case of smallpox, only these techniques permitted the key observations that smallpox vaccination was remarkably durable, and that effective reporting was fundamental for success. The currently popular goal of health for all, through horizontal programs, is contrary to the methods of epidemiology because its objective is vague and meaningless, no specific management structure is envisioned, and no system of surveillance and assessment is in place.
Washington, D.C., Regional Office of the World Health Organization, 1980. x, 189 p. (Official Document No. 173)The World Health Assembly decided in 1977 that the main social target of the Governments and the WHO in the decades ahead should be "the attainment by all the citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life." Subsequently, the World Health Assembly in 1979 urged the member states to define and implement national, regional, and global strategies for attaining the goal of health for all by the year 2000. This monograph reprints UN documents dealing with this goal. The 1st document addresses 2 specific issues, the developments in the health sector in the 1971-1980 decade, and strategies for attaining the goal of health for all by the year 2000. The 2nd document addresses 8 areas of interest; 1) social and environmental aspects of the region of the Americas; 2) evaluation of the 10-year health plan for the Americas; 3) implications of the goal and the new international economic order for the achievement of the objectives; 4) a method for analyzing strategies and developing a primary health care work plan and indicators for evaluating progress towards the goal; 5) objectives for the health and social sectors; 6) regional baseline targets for priority health conditions; 7) summary of revised regional strategies for attaining the goal; 8) national, intercountry, regional, and global implications of the regional strategies. The 3rd and 4th documents are resolutions 20 and 21 of the 27th meeting of the directing council of the Pan American Health Organization. Resolution 20 addresses regional strategies for attaining the goal. Resolution 21 discusses the ad hoc working group to complement the regional strategies.
Mobilization of health manpower to meet health needs: lessons learned from the Smallpox Eradication Program.
In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American University of Beirut, 1980. 140-50.The last known naturally occurring case of smallpox was diagnosed on October 26, 1977, over 18 months ago. Since then, thousands of health workers in the recently endemic countries have searched from village to village and house to house in an attempt to detect other cases. Tens of thousands of persons who were ill with skin rashes have been screened. Thousands of specimens have been examined in World Health Organization (WHO) laboratories. None has been smallpox. 2 further cases of smallpox occurred in August of last year in Birmingham, England as a result of an accident in a laboratory. The accident dramatized the potential risk of spread as a result of laboratory infection and emphasized the need to reduce the number of laboratories retaining smallpox virus and to ensure that each provides maximum safety measures. At this time, smallpox virus is retained by only 7 laboratories and only 1 is conducting research. By the end of the year, the number of laboratories retaining smallpox virus should be reduced to 4. In October of this year, international commissions to certify smallpox eradication will be visiting the last endemic countries in the horn of Africa. On the basis of reports already documented, it is fully expected that it will be possible to certify that these countries are smallpox free and that global smallpox eradication has been achieved--the 1st disease ever to have been eradicated. It is surprising to find individuals who insist that the smallpox eradication program provides little or nothing of value to other programs. They question how the program could possibly have failed or what possible relevance it could have to primary health care provided by basic health workers. It is important to examine these beliefs in the context of the history of the program and its development and in the context of what is meant by primary health care. Global smallpox eradication was considered as anything but simple and certain when the program was adopated by the World Health Assembly in 1966. There are few, even today, who appreciate how little financial support the smallpox program was given. The single most important factor in the success of any program is to obtain the most competent, imaginative leadership possible at every level and to support and encourage those concerned. In the smallpox program, the attempt was made to identify and recruit the best possible people both for WHO and in the countries concerned. The 2nd principle of critical importance to the smallpox program was insistence that every program have a method for assessment and evaluation and that the data obtained be used in guiding the program. The 3rd key principle is that the responsibilities of village workers be clearly defined and that the worker understands what he/she is to do.
In: American University of Beirut. Faculty of Health Sciences. Human resources for primary health care in the Middle East. Beirut, Lebanon, American Univeristy of Beirut, 1980. 13-21.During 1979, the International Year of the Child, the World Health Organization (WHO) encouraged efforts to improve the collection of information on health and health related problems faced by underprivileged populations. To focus attention on health care for children, the theme of this year's World Health Day on April 7 was the well being of the child. The slogan, "a healthy child, a sure future," was chosen to promote breastfeeding, oral rehydration, nutrition, education, and immunization against the 6 major childhood diseases included in WHO's expanded immunization program. Currently, less than 10% of children in developing countries receive immunization. WHO and its member countries have committed themselves to providing immunization services for every child in the world by 1990, as part of the goal of "health for all by 2000." WHO recommends that each country appoint a program manager and supporting staff to provide detailed plans of operation for immunization. Emphasis in the planning stage should be on the integration of immunization services within the primary health care network for each country. Diarrheal diseases rank among the 1st 3 leading causes of death in children, taking an estimated 5-18 million lives a year, particularly among children under age 5. Dr. Halfdan Mahler, Director General of WHO, has said that the task of safeguarding the health of children cannot be realized through conventional means. What is required is a "radical new approach" which emphasizes the mobilization of national and international resources, the imaginative use of traditional medicine, and the development of health technologies relevant to local needs. A WHO study in 8 developing countries found that 90% of all child deaths could be avoided by safe water and sanitation. This can be regarded as the core of the problem, which indirectly relates to population dynamics and community attitudes. There also appears to be a link between child deaths and births. Maternal and child health care services are not well established in developing nations. Guidelines, quoted from David Werner's book "The Village Health Worker" are quoted to help bridge the gap in reaching the masses. Community health programs will have to be organized on the basis of local needs and priorities. Local health workers from within the community will have to be selected and trained in the delivery of simple basic health care and be responsible to the community.
In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 163-5. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)The Onchocerciasis Control Program in the Volta Basin is aimed at reducing the transmission of the disease so that it is no longer a major risk to public health and an obstacle to socioeconomic development. Aerial spraying of insecticides has been carried out over 7 countries of West Africa where 10 million people live. The economic advantages of the program come from 2 production factors: labor and land. As far as labor is concerned, the program will increase productive capacities by reducing the production losses resulting from vision disorders or blindness in the laborforce, decrease the debilitating effects of the parasite which leaves people more vulnerable to other diseases, and increase ability of farmers to cultivate land near rivers without constant exposure to hundreds of bites a day. The major economic development will come from developing new land. Several reports are cited indicating projected kilometers of new land that would become available. The major concern is the best way to organize the utilization of the new land, taking into account organized and unorganized migration. It is apparent that various areas and countries within the program have different demographic pressures on their land as well as different structures and planning institutions. Considerable resources of men and financial means are required to finance these land development programs and must come from international sources. Some of the costs and cost evaluations are given. A belief in the cooperation among rich and poor countries for a program without boundaries has already demonstrated the cooperative nature of the Onchocerciasis Control Program.
[Unpublished] . 8 p.A study tour was undertaken by the Social Marketing Project in Bangladesh to observe production facilities of oral rehydration salt (ORS) in Bangkok, Manila, and Bombay. This report describes raw materials, plants and equipment, methods and procedures, and quality control for each country. In Thailand the Government Pharmaceutical Organization, under the Ministry of Health, supervises ORS production. ORS has been produced for the last 3 years and presently about 200,000 packets/month (equivalent of 1 litre solution) are being produced, following the World Health Organization (WHO) UNICEF formulations. The Ministry of Health in Manila has been providing ORS based on the WHO formulations for the past 6 years. Currently production is about 2 million packets with proper equipment. Distribution is through district health officials and village health workers. As an adjunct to ORS distribution there is a plan to introduce water purification tablets. The Fairdeal Corporation in India is a commercial pharmaceutical organization which produces 2 ORS solutions: 1) Electral which does not include bicarbonate and accounts for about 80% of total production, and 2) Electral Forte which has sodium bicarbonate and is recommended in severe dehydration cases in adults. Their research has shown that the WHO formulation is inadequate for many countries. Presently sales are about 500,000-600,000 packets/month mainly distributed through medical practitioners. This study also found that: 1) organic lipidity of the product is critical for acceptance; the addition of a flavoring agent is considered important especially for acceptance by small children, and 2) closely controlled humidity conditions (30-35%) and temperature (23 degrees Centigrade) are essential to the formulation and increases the life of the salts to 10-15 days even after opening the packs.
Bulletin of the World Health Organization. 1980; 58(3):341-52.Chloroquine resistant strains of Plasmodium falciparum were initially reported during the early 1960s and are currently found in many areas of Asia and South America. The prevalence and degree of resistance are increasing in all affected areas, representing a serious setback to antimalaria programs. Alternative drugs are much more expensive and frequently more cumbersome to use. Consequently, it is essential that a concerted effort be made to arrest the spread of resistant strains by developing standardized national policies on drug use. The probable genetics and epidemiology of drug resistance are considered in this report, and attention is directed to the problems involved in its control. Antimalarial drugs interfere with important physiological functions of the parasites. Chloroquine and mepacrine apparently block acid proteases and peptidases in the phagosomes of intraerythrocytic parasites. Circumstantial evidence from "in vitro" tests suggests that strains of P. falciparum from various parts of the world, although primarily susceptible to chloroquine, exhibit, "a priori," different sensitivities. P. falciparum in the Sobat valley of Ethiopia and in central Sudan appears to be significantly less susceptible to chloroquine than the Uganda I strain. There are no indications yet of chloroquine resistance in P. vivax, P. malariae, or P. ovale. The relative prevalence of chloroquine resistant infections and the degree of resistance are still on the increase in all affected areas. The development of drug resistance in areas with previously susceptible parasites has thus far always been associated with the use of the particular medicaments. 4 main factors seem to be involved: the degree of drug pressure; the degree of host/parasite contact; the duration of drug pressure; and the type of drug used. The occurrence of chloroquine resistant falciparum malaria requires the urgent attention of the health authorities and that several operational measures be undertaken. Instructions must be provided concerning the principles of drug use in antimalaria programs in the event of the spread of drug resistance, and these instructions are reviewed. The methods for the monitoring of drug sensitivity are also reviewed. The World Health Organization (WHO) has developed global monitoring program, initially implemented in 1977 in the Southeast Asia Region. Program objectives are identified.
WHO Chronicle. 1980 Mar; 34(3):118-9.The World Health Organization (WHO) plan is to hold 2 meetings with tuberculosis experts for the purpose of examining the implications of a large scale trial in the south of India that has shown no protection against lung tuberculosis from BCG vaccination. Launched in 1971, the trial covered some 260,000 persons older than age 1 month. It was aimed at preventing lung tuberculosis in the population of 209 villages as well as in a town in the district of Chingleput, west of Madras. Results with the BCG vaccines have varied in the scientifically valid controlled studies that have been conducted. The success of BCG vaccines has varied by population group, ranging from good (80% effectiveness) to poor (as in the Indian trial). The following were among the questions raised by the findings of the Indian trial: were there procedural flaws; were the BCG vaccines used of adequate potency; could other factors have played a role; and should BCG vaccinations be stopped. According to the published report, there were no apparent flaws in the procedures followed in the Indian study. In the Indian trial, 2 BCG strains--Danish and French--were used in the highest tolerated doses. The strains were selected for their relatively high efficacy in experimental studies, and extensive laboratory control showed the vaccines to be of good quality. The WHO experts found the epidemiology of tuberculosis in the trial area to be peculiar in the sense that the tuberculosis occurred long after an individual was infected. Not far from the trial area, and also in south India, disease occurred soon after infection. The experts noted that this phenomenon, which requires further study, may influence the effectiveness of vaccination. According to the experts, the findings in the study population were not applicable in other parts of India. Where many factors may play a role and when the level of protection is nonexistent, as in the India trial, little can be deduced about the worth of the vaccine and its effect under different circumstances.
Geneva, Switzerland, WHO, 1980. 290 p.This Sixth Report on the World Health Situation tries to bring out the main ideas on health and health care issues and how to deal with them that arose during the 1973-1977 period. The primary sources of information used in the preparation of the report were the following: information routinely passed on by Member Governments to the World Health Organization (WHO); country reviews specially submitted by Member Governments for the Sixth Report; information routinely collected by other organizations of the United Nations system; and information for the reference period collected by WHO on an "ad hoc" basis to meet specific policy and program requirements. A background chapter focuses on general considerations, population, food and nutrition, education, social changes, economic trends, employment, poverty, health-related behavioral factors, evaluation of development progress and data needs, and policy issues. Subsequent chapters examine health status differentials, health action, research, and the outlook for the future in terms of demographic prospects, social and economic aspects, health status trends, health manpower supply and demand, and world health policies. Most significant during the 1973-1977 period was the explicit recognition of the view that health development is a reflection of conscious political, social, and economic policy and planning rather than merely an outcome (or by-product) of technology. The goal of "health for all by the year 2000" expresses the political commitment of health services and the agencies responsible for them to a "new Health order." Primary health care is the most important vehicle for achieving this new health order. The most important social trends during the report period are reflected in the still low and in some areas worsening nutritional level of the majority of the population. The overall picture with regard to mortality continues to be mixed, with a few notable cases of marked decline and many of continuing unspectacular decline. The data on morbidity are even less reliable than those on mortality, but it appears that there has been a significant increase or resurgence of certain communicable diseases. There is evidence of decreasing dependence on physicians in some parts of the world and a related strengthening of various paramedical and auxiliary groupings. Some of the important new health programs are to be found in the area of family health. The overall role and importance of primary health care are emphasized in many parts of the report. There are some specific indications of ways in which primary health care activities are being integrated with the more traditional activities of the health sector.
Geneva, Switzerland, WHO, 1980. 412 p.This report on the world health situation comes in 2 volumes, and this, the 2nd volume, reviews the health situation by country and area, with the additions and amendments submitted by the governments, and an addendum for later submissions. Information is presented for countries in the African Region, the Region of the Americas; the Southeast Asia Region, the European Region, the Eastern Mediterranean Region, and the Western Pacific Region. The information provided includes the following areas: the primary health problems, health policy; health legislation; health planning and programming; the organization of health services; biomedical and health services research; education and training of health manpower; health establishments; estimates of the main categories of health manpower; the production and sale of pharmaceuticals; health expenditures; appraisal of health services; demographic and health data; major public health problems; training establishments; actions taken; preventive medicine; and public health.
Brazzaville, Congo, World Health Organization, Regional Office for Africa, 1980. 86 p. (Health Development in Africa 1)Primary health care has been accepted by the 44 Member States and Territories of the African Region of the World Health Organization (WHO); the Health Charter for 1975-2000 was adopted in 1974 with its humanistic approach oriented to satisfying basic needs. Genuine technical cooperation between Member States is essential for health development and can be achieved on the regional level. By 1990 the following steps should be taken: 1) vaccination of all infants under 1 year against measles, pertussis, tetanus, poliomyelitis, diphtheria and tuberculosis, 2) supply of drinking water to all communities and 3) waging a war on hunger. Health development is seen as a social development policy requiring combined efforts in the fields of education, agriculture, transport, planning, economics, and finance as well as a national strategy which WHO can help to define. A new international economic order must aim at meeting basic needs of the poorest in the population and includes health needs. Basic health services must provide primary health care which includes preventive and curative care, promotional and rehabilitative care, maternal and child health, sanitation, health education, and systematic immunization. Secondary care includes outpatient services with specialized teams; tertiary care provides highly specialized services. These services must be geographically, financially, and culturally accessible to the community. Communication between health workers and community leaders is fundamental in setting up those services and group dynamics can be utilized in promoting change. WHO's 4 health priorities in Africa are: 1) epidemiological surveillance, 2) promotion of environmental health, 3) integrated development of health manpower and services, and 4) health development research promotion. The components of Africa's health care program are: 1) community education, 2) promotion of food supply and nutrition, 3) safe water and sanitation, 4) maternal and child health, 5) immunization, 6) disease prevention, 7) treatment of injuries and diseases and 8) provision of essential drugs. Proper training of personnel is crucial for the success of these steps, along with effective personnel management.
Brazzaville, Congo, World Health Organization, Regional Office for Africa, 1980. 16 p. (AFR/EXM/1)In this opening address of the 30th session of the Regional Committee for Africa of the World Health Organization (WHO), Dr. Quenum notes that new program policies already put into action include the substitution of technical cooperation for the idea of assistance, the improvement of managerial processes for health development and the promotion of primary health care to achieve health for all by the year 2000. He asserts that the latter idea is not utopian since regional strategy in Africa, although long-term, has already become a reality and that constant monitoring and evaluation will affect the needed changes. 2 aspects of health planning for Africa which must be kept in mind are unity with present generations and with those of the future. Regarding the correlation between health and politics he states that whereas it is not WHO's place to intrude in a country's government, health policy cannot be developed apart from the society which it is to affect. He asks if WHO must be concerned in the political will voiced by government and their health priorities and replies that it is WHO's duty to respect the political choices of member states of WHO if genuine technical cooperation is to be established peacefully, while concerning itself with social justice. Health must also be considered in developing socioeconomic policy and cannot make a contribution to establishing a new international economic order unless it is firmly integrated into a development process focused on people. Health for all by the year 2000 is a revolutionary idea, the author contends, since it implies radical changes in the delivery of health care involving international solidarity. In many African countries primary health care has gotten off to a good start through administrative reforms or the training of new health development workers, and enthusiasm for such work should not be allowed to dwindle. Knowledge of the primary importance of health should provide the impetus for these projects in order to reach the goal of health for all.
Alexandria, World Health Organization (WHO), Regional Office for the Eastern Mediterranean, 1980. 133 p.An assessment of health progress in the Eastern Mediterranean Region (EMR) is provided through narration and photographs. The renewed threat of malaria and efforts to control it are discussed. Other traditional diseases of the area examined in today's terms are schistosomiasis, cholera, tuberculosis, trachoma and smallpox. Modern health problems, including cancer, heart diseases, mental disorders and occupational hazards are explored. Environmental problems, or "the fall-outs of technology," are discussed, along with urban sprawl, water shortages, air and marine pollution and desertification. It is stressed that changing times demand changing attitudes towards the environment. Specific areas that need to be addressed, particularly food safety, are pointed out. WHO's work with EMR countries in health manpower development includes planning, educational development and support, and the actual training of individuals. The need for more health personnel is documented. Nursing as a profession in the EMR is discussed, as is its growth; 1 problem in education of nurses is the lack of textbooks in Arabic. The prospects of health for all by the year 2000 are discussed. The importance of using appropriate technology in providing primary health care is stressed. Family health and planning is examined, including child care priorities such as newborn care, the critical weaning period, and immunization. Current biomedical research in the EMR is discussed, including health services research, efforts for diarrhea and streptococcal infection control, drug utilization studies, tropical disease studies and the search for a malaria vaccine. MEDLINE, the regional health literature service, is described. Technical cooperation among the countries of the EMR is discussed. Profiles showing the population, medical manpower and health facilities of each country in the EMR are provided.
Population Review. 1980 Jan-Dec; 24(1-2):5-8.The medical system perfectd in India--"Knowledge of the Span of Life"--in many ways foreshadowed the World Health Organization's (WHOs) own definition of health as a "state of complete physical, mental and social wellbeing." The goal of "health for all by the year 2000" envisages strengthening of public health programs of developing countries, where most diseases are concomitants of economic backwardness. Yet, it should not be assumed that developed countries are without health problems. They are experiencing the tensions, mental and physical, to which residents of densely populated cities succumb. Once it is recognized that better health is not simply an offshoot of overall economic development, and that major improvements in health are possible in the absence of industrialization, it follows that the patterns of public health and health administration of advanced countries are not necessarily appropriate for developing nations. What must be stressed is the need for a health revolution in developing countries, to wipe out diseases and to make available specialized treatment as well as to provide basic health care and to take preventive measures. Education from the earliest stages needs to include certain elementary information about health, sanitation, cleanliness, the avoidance of contagious diseases, and the preservation of the environment which is closely linked to these. There is a need at this time for a global campaign for eradication of leprosy, prevention of blindness, and greater research to produce an ideal contraceptive. Family planning programs are awaiting a big breakthrough. Without a safe, preferably oral, drug which women and men can take, no amount of government commitment and political determination will bring success.