The history of polio vaccination with "Sabin's OPV" 60 years after its introduction in Italy: an unforgivable "delay"

In the spring of 1964, polio vaccination with the oral vaccine developed by Albert Sabin began in Italy. Polio was feared in the world and in Italy. Thus, between 1957 and the beginning of 1958, Italian children began receiving the "Salk vaccine", though the results were not particularly convincing. In July 1960, the international scientific community was able to verify the data from the mass testing of the Sabin vaccine. It became clear that the OPV, could prevent the virus from multiplying, thereby providing greater protection and determining the eradication of the disease. In 1960 over 70 million people in the USSR alone had already received the oral vaccine and mass vaccination in the USA would start in March 1961. However, in Italy there was no similar initiative; only later the new vaccine was accepted but was not made compulsory at the beginning. As a result of the commission's report, registration of the "Polioral" vaccine, was authorized in September 1962 but the sale of the vaccine was not authorized until November 1963. At the beginning of 1964, the production of "Polioral" started and the product was marketed and on the 1 st of March 1964, anti-polio vaccination with the "Sabin anti-polio vaccine" also began in Italy. This manuscript focuses on a crucial issue about a historical delay for public health and it points out as the preparation and diffusion of the Sabin polio vaccine demonstrates that decisions regarding health treatments, and specifically vaccination campaigns, must be based exclusively on the results of clinical studies and on independent evaluation by the scientific community. This process ensures trust in vaccines, adequate protection of public health andcitizens' well-being.

Seven decades towards malaria elimination in Yunnan, China

BACKGROUND

Yunnan Province was considered the most difficult place in China for malaria elimination because of its complex malaria epidemiology, heterogeneous ecological features, relatively modest economic development, and long, porous border with three malaria endemic countries: Lao People's Democratic Republic, Myanmar, and Viet Nam.

METHODS

Academic publications and grey literature relevant to malaria elimination in Yunnan covering the period from 1950 until 2020 inclusive were considered. The following academic indexes were searched: China Science Periodical Database, China National Knowledge Infrastructure Database, and MEDLINE. Grey literature sources were mainly available from the National Institute of Parasitic Diseases (NIPD), the Chinese Center for Diseases Control and Prevention, and the Yunnan Institute of Parasitic Diseases (YIPD).

RESULTS

A malaria elimination campaign in the 1950-1960s, based mainly on mass administration of antimalarial drugs and large-scale vector control, reduced morbidity and mortality from malaria and interrupted transmission in some areas, although elimination was not achieved. Similar strategies were used to contain outbreaks and a resurgence of disease during the 1970s, when malaria services were discontinued. From the 1980s, malaria incidence declined, despite the challenges of large numbers of mobile and migrant populations and an unstable primary health care system in rural areas following economic transformation. Launch of the national malaria elimination programme in 2010 led to adoption of the '1-3-7' surveillance and response strategy specifying timely detection of and response for every case, supported by the establishment of a real-time web-based disease surveillance system and a new primary health care system in rural areas. Border malaria was addressed in Yunnan by strengthening the surveillance system down to the lowest level, cross-border collaboration with neighbouring countries and non-governmental organizations, and the involvement of other sectors.

CONCLUSIONS

Seven decades of work to eliminate malaria in Yunnan have shown the importance of political commitment, technically sound strategies with high quality implementation, a robust surveillance and response system at all levels, community participation and effective management of border malaria. The experiences and lessons learned from elimination remain important for prevention re-establishment of malaria transmission in the Province.

Prevention of re-establishment of malaria: historical perspective and future prospects

Prevention of re-establishment (POR) refers to the prevention of malaria outbreak/epidemic occurrence or preventing re-establishment of indigenous malaria in a malaria-free country. Understanding the effectiveness of the various strategies used for POR is, therefore, of vital importance to countries certified as "malaria-free" or to the countries to be thus certified in the near future. This review is based on extensive review of literature on both the POR strategies and elimination schemes of countries, (i) that have reached malaria-free status (e.g. Armenia, Mauritius, Sri Lanka), (ii) those that are reaching pre-elimination stage (e.g. South Korea), and (iii) countries at the control phase (e.g. India). History has clearly shown that poorly implemented POR programmes can result in deadly consequences (e.g. Sri Lanka); conversely, there are examples of robust POR programmes that have sustained malaria free status that can serve as examples to countries working toward elimination. Countries awaiting malaria elimination status should pre-plan their POR strategies. Malaria-free countries face the risk of resurgence mostly due to imported malaria cases; thus, a robust passenger screening programme and cross border collaborations are crucial in a POR setting. In addition, sustained vigilance, and continued funding for the national anti-malarial campaign programme and for related research is of vital importance for POR. With distinct intrinsic potential for malaria in each country, tailor-made POR programmes are built through continuous and robust epidemiological and entomological surveillance, particularly in countries such as Sri Lanka with increased receptivity and vulnerability for malaria transmission. In summary, across all five countries under scrutiny, common strengths of the POR programmes are (i) a multipronged approach, (ii) strong passive, active, and activated passive case detection, (iii) Indoor residual spraying (IRS), and (iv) health education/awareness programmes.

The World Health Organization's changing goals and expectations concerning malaria, 1948-2019

From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.

Ioannis Kardamatis (1852-1942): Pioneer of the Anti-Malaria Battle in Greece

Few scientists have contributed as much to medicine and society as Ioannis Kardamatis (1859-1942). Kardamatis was an important historical figure whose vast medical knowledge was recorded in a spectrum of medical publications, including monographs, bibliographic reviews, books, and experimental and statistical studies. His studies have been published in both Greek and foreign journals. He is most notably remembered for his contribution to the battle against malaria in Greece.

Re-assessing the Foundations: Worldwide Smallpox Eradication, 1957-67

An expansive, worldwide smallpox eradication programme (SEP) was announced by the World Health Assembly in 1958, leading this decision-making body to instruct the World Health Organization Headquarters in Geneva to work with WHO regional offices to engage and draw in national governments to ensure success. Tabled by the Soviet Union's representative and passed by a majority vote by member states, the announcement was subject to intense diplomatic negotiations. This led to the formation, expansion and reshaping of an ambitious and complex campaign that cut across continents and countries. This article examines these inter-twining international, regional and national processes, and challenges long-standing historiographical assumptions about the fight against smallpox only gathering strength from the mid-1960s onwards, after the start of a US-supported programme in western Africa. The evidence presented here suggests a far more complex picture. It shows that although the SEP's structures grew slowly between 1958 and 1967, a worldwide eradication programme resulted from international negotiations made possible through gains during this period. Significant progress in limiting the incidence of smallpox sustained international collaboration, and justified the prolongation and expansion of activities. Indeed, all of this bore diplomatic and legal processes within the World Health Assembly and WHO that acted as the foundation of the so-called intensified phase of the SEP and the multi-faceted activities that led to the certification of smallpox eradication in 1980.

Missed vaccinations and critical care admission: all you may wish to know or rediscover-a narrative review

Most vaccines are so effective that they could lead to the control/elimination of the diseases they target and directly impact on intensive care admissions or complications. This is best illustrated by the use of vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, zoster, yellow fever, Ebola virus, influenza or measles-but also by third party strategies such as maternal, toddler and care-giver immunization. However, each of these vaccine-induced protection is threatened by insufficient vaccine uptake. Here, we briefly discuss how vaccine hesitancy has led to the resurgence of diseases that were considered as controlled and explore the effect of vaccine-hesitant healthcare workers on nosocomial infections. As intensive care physicians are in charge of polymorbid patients, we briefly summarize the current recommendations for vaccinations in high-risk patients. We finally give some perspective on ongoing research, and discuss how institutional policies and intensive care physicians could play a role in increasing the impact of vaccination, overall and in intensive care units.

The CORE Group Polio Project: An Overview of Its History and Its Contributions to the Global Polio Eradication Initiative

The CORE Group Polio Project (CGPP) has contributed to polio eradication by successfully engaging civil society, particularly the non-governmental organization (NGO) community. This engagement, which began with a grant from the U.S. Agency for International Development in 1999, has contributed to improvements in routine immunization programs, polio campaign quality, and surveillance for acute flaccid paralysis in many challenging geographic areas. The CGPP has worked closely with polio eradication partners in a collaborative and supportive role. The CGPP has focused largely on high-risk areas with marginalized or hard-to-reach populations where health systems and immunization programs have also been weak and where transmission of poliovirus had not been stopped. The CGPP has engaged local civic leaders and communities in ways to complement top-down vertical efforts of ministries of health and other partners in the Global Polio Eradication Initiative. The CGPP has developed innovative strategies to detect cases using community-based surveillance, promoted independent campaign monitoring, established cross-border initiatives, and developed a strong and creative cadre of community mobilizers to track missed children and deliver behavior change education. Many of the innovations and approaches that the CGPP helped to develop are now being replicated by governments and international agencies to tackle other public health priorities in underserved and marginalized communities around the world. This article is the first in a series of articles describing the work of the CGPP. Because the article describes the work of more than 40 NGOs in 11 countries over 20 years, it provides only an overview, leaving many important details and variations of the CGPP's work to be described elsewhere, including in other articles included in this series.

Chronicle of a consolidated success: smallpox eradication policies in Brazil (1962-1973)

The aim of this article is to understand actions taken towards smallpox eradication in Brazil, in the framework of the Smallpox Eradication campaign that took place in the 1960s and 1970s. The article argues that, in addition to the bifurcated needle and the lyophilized vaccine, epidemiological surveillance - based on the construction of instruments and protocols for health surveillance - was the third key element that guaranteed the eradication of the disease. The hypothesis is that the actions taken towards the control and eradication of smallpox contributed to the construction of new health institutions within Brazil. As an exercise of socio-historical analysis, this research was based on documentary sources (reports, newsletters and legislation), interviews with professionals directly involved in the eradication of smallpox, and part of the intellectual production on the subject.

Piero Sepulcri (1899-1980) and malaria eradication in Veneto

Piero Sepulcri may be considered the antimalaria pioneer in the Italian region of Veneto during the 20th century. Through his activity with the Regional Antimalarial Institute he made a major contribution to one of the most important successes of medicine in the 20th century: malaria eradication in Italy. His writings on the activity of the Antimalarial Institute display the phases of eradication. In the first period antimalarial drugs were used to cure infected patients and as prophylaxis against infection. In the second period, eradication of vectors permitted the lack of transmission and consequent eradication of malarial disease. The history of malaria eradication in Italy is of the utmost importance because it established a series of steps to be taken against any transmittable disease that could return and spread once again in Italy or elsewhere. Keywords: malaria, anopheles, prophylaxis, treatment, history, Veneto.

Measles and the Modern History of Vaccination

The modern era of vaccination was heralded with the licensure of the first 2 measles vaccines in 1963. This new era was distinct from the preceding era of vaccination for 4 main reasons. First, federal leadership in support of immunization at the local level grew. Second, immunization proponents championed the required vaccination of children as the best means of ensuring a protected population. Third, immunization proponents championed the idea that mass vaccination would not only help manage infectious diseases but also eradicate them. Fourth, the focus of local and federally supported immunization initiatives began to extend to the "mild" and "moderate" diseases of childhood (eg, measles), so-called because they were seen as less severe than previous targets of mass vaccination, such as smallpox, polio, and diphtheria. This article follows the history of measles to explore immunization successes and challenges in this modern era, because measles was the first of the mild and moderate diseases to become the target of a federally supported eradication-through-vaccination campaign, one that relied heavily on the preemptive, required vaccination of children. Its story thus epitomizes the range of political, epidemiological, cultural, and communications challenges to mass immunization in the modern era of vaccination.

Long-term impacts of early-life exposure to malaria: Evidence from Taiwan's Eradication Campaign in the 1950s

This paper utilizes the eradication campaign in Taiwan in the 1950s to estimate the long-term impacts of early-life (in utero and postnatal) exposure to malaria. Matching adults in the 1992-2012 Taiwan Social Change Survey to the malaria intensity in their individual place and year of birth, difference-in-difference estimation shows strong evidence that the eradication increased men's own educational attainment as well as their family income in adulthood. We also use the 1980 census data to show there was a sharp education increase after the eradication. Furthermore, the eradication increased the educational attainment of married men's spouses. Finally, quantile regressions show that the effect concentrated on the lower percentile of the income distribution. Overall, our results suggest negative effects of early-life exposure to malaria.

Yoshitaka Komiya's visits to China and schistosomiasis investigation

This article is about a Japanese parasitologist, Yoshitaka Komiya (1900-1976), who was invited to China for a schistosomiasis investigation in 1956. In 1955, Chairman Mao initiated a national campaign to eliminate schistosomiasis, which at that time was still common in southern China, and for this purpose, the People's Republic of China invited Yoshitaka Komiya to China. He published a report based on his observations during this visit. This article aims to explore the meaning of Komiya's visit to the People's Republic of China and his observations about the anti-schistosomiasis campaign.

[The phase after the eradication of smallpox in Mexico, 1952-1977]

This paper studies the phase after the declaration of the eradication of smallpox in Mexico and covers the period from June 1952 (the date on which the health authorities officially proclaimed this event) to 1977 (the year in which the National Institute of Hygiene prepared the last batch of glycerinated anti-smallpox vaccine). It is revealed that during these years, the Ministry of Health and Assistance continued to invest resources in work aimed at combating smallpox to maintain the levels of protection against smallpox and to prevent the reintroduction of the disease at a time when it was still endemic in several countries worldwide; and states that the population continued to report suspected cases and attribute deaths to this disease.

Microgeographic Heterogeneity of Border Malaria During Elimination Phase, Yunnan Province, China, 2011-2013

Malaria was concentrated in a few townships along the China–Myanmar border.

To identify township-level high-risk foci of malaria transmission in Yunnan Province, China, along the international border, we retrospectively reviewed data collected in hospitals and clinics of 58 townships in 4 counties during 2011–2013. We analyzed spatiotemporal distribution, especially hot spots of confirmed malaria, using geographic information systems and Getis-Ord G_i*(d) cluster analysis. Malaria incidence, transmission seasonality, and Plasmodium vivax:P. falciparum ratio remained almost unchanged from 2011 to 2013, but heterogeneity in distribution increased. The number of townships with confirmed malaria decreased significantly during the 3 years; incidence became increasingly concentrated within a few townships. High-/low-incidence clusters of P. falciparum shifted in location and size every year, whereas the locations of high-incidence P. vivax townships remained unchanged. All high-incidence clusters were located along the China–Myanmar border. Because of increasing heterogeneity in malaria distribution, microgeographic analysis of malaria transmission hot spots provided useful information for designing targeted malaria intervention during the elimination phase.

Modeling and Managing the Risks of Measles and Rubella: A Global Perspective Part II

Measles and rubella continue to circulate globally. Complementing Part I of the special issue, this introduction provides a contrast between other global eradication initiatives and the experience with measles and rubella eradication to date. This introduction builds on the syntheses of the literature provided in Part I and it describes the creation and application of a national risk assessment tool and the development of a dynamic disease transmission model to support global efforts to optimally manage measles and rubella globally using vaccines. Currently, efforts to eradicate measles and rubella suffer from the lack of a commitment to global eradication by key stakeholders, despite strong evidence that their eradication represents a better health and financial option than continued control.

Between Colonial, National, and International Medicine: The Case of Bejel

In the 1920s and 1930s, doctors stationed in the Middle East and North Africa debated whether bejel, a form of endemic syphilis, was an Arab version of syphilis, or a separate disease altogether. Using their clinical experience in the region, they tried to weave this unfamiliar phenomenon into a civilizational narrative, which placed European civilization at the top of a hierarchy. The assumption was that there was something inherent to Islamic societies and their hygienic habits that accounted for this difference. After World War II, the eradication of bejel was declared to be one of the objectives of both the Iraqi government and the newly founded World Health Organization. Examining the postwar life of bejel, I question how colonial legacies affected postcolonial and international medical theories and practices, on both national and international levels.

An Aspect of the History of Medicine in Ancient Korea as Examined through Silla Buddhist Monks'Annotations on the "Chapter on Eliminating Disease"in the Sutra of Golden Light (Suvarnabhāsa-sūtra)

Nearly nothing is known of medicine in ancient Korea due to insufficient materials. With several extant prescriptions and esoteric methods of treating diseases alone, it is impossible to gauge in depth the management of medicine during this period. If one exception were to be cited, that would be the fact that the annotations for understanding the contents on Indian medicine in the "Chapter on Eliminating Disease" in the Sutra of Golden Light, a Buddhist sutra originating from India, reflected the medical knowledge of Buddhist monks from Silla (57 BC-935 AD) who were active immediately after the nation's unification of the two other kingdoms on the Korean Peninsula (668 AD) such as Wonhyo (617-686 AD), Gyeongheung (620?-700? AD), and Seungjang (684-? AD). Along with those by other monks, these annotations are collected in the Mysterious Pivot of the Sutra of Golden Light, which was compiled by Gangyō(835-871 AD), a Japanese monk from the Heian era (794-1185 AD). Representative versions of the "Chapter on Eliminating Disease" in the Sutra of Golden Light include: a classical Chinese translation by the Indian monk Dharmakṣema (385-433 AD); the eight-volume edition by Chinese monk Baogui, which differs little from the preceding work in terms of the contents of the "Chapter on Eliminating Disease"; and the ten-volume edition by Yijing (635-713 AD), who had full-fledged knowledge of Indian medicine. When the contents of the annotations thus collected are examined, it seems that Wonhyo had not been aware of the existence of the ten-volume edition, and Gyeongheung and Seungjang most certainly used the ten-volume edition in their annotations as well. Especially noteworthy are Wonhyo's annotations on the Indian medical knowledge found in the "Chapter on Eliminating Disease" in the Sutra of Golden Light. Here, he made a bold attempt to link and understand consistently even discussions on Indian and Buddhist medicine on the basis of the traditional East Asian medical theory centering on the yin-yang and five phases (wuxing). In accordance with East Asia's theory of the seasonal five phases, Wonhyo sought to explain aspects of Indian medicine, e.g., changes in the four great elements (catvāri mahā-bhūtāni) of earth, water, fire, and wind according to seasonal factors and their effect on the internal organs; patterns of diseases such as wind (vāta)-induced disease, bile (pitta)-induced disease, phlegm (śleṣman)-induced disease, and a combination (saṃnipāta) of these three types of diseases; pathogenesis due to the indigestion of food, as pathological mechanisms centering on the theory of the mutual overcoming (xiangke) of the five phases including the five viscera (wuzang), five flavors (wuwei), and five colors (wuse). They existed in the text contents on Indian medicine, which could not be explicated well with the existing medical knowledge based on the theory of the five phases. Consequently, he boldly modified the theory of the five phases in his own way for such passages, thus attempting a reconciliation, or harmonization of disputes (hwajaeng), of the two medical systems. Such an attempt was even bolder than those by earlier annotators, and Wonhyo's annotations came to be accepted by later annotators as one persuasive explanation as well. In the case of Gyeongheung and Seungjang, who obtained and examined the ten-volume edition, a new classical Chinese translation produced following Wonhyo's death, annotated the "Chapter on Eliminating Disease" based on their outstanding proficiency in Sanskrit and knowledge of new Indian and Buddhist medicine. This fact signifies that knowledge of the eight arts of Ayurvedic medicine in India was introduced into Silla around the early 8th century. The medical knowledge of Wonhyo, Gyeongheung, and Seungjang demonstrates that intellectual circles in contemporary Silla were arenas in which not only traditional East Asian medicine as represented by works such as the Inner Canon of the Yellow Emperor (Huangdi Neijing) but also Indian medicine of Buddhism coexisted in almost real time.

The prevention and eradication of smallpox: a commentary on Sloane (1755) 'An account of inoculation'

Sir Hans Sloane's account of inoculation as a means to protect against smallpox followed several earlier articles published in Philosophical Transactions on this procedure. Inoculation (also called 'variolation') involved the introduction of small amounts of infectious material from smallpox vesicles into the skin of healthy subjects, with the goal of inducing mild symptoms that would result in protection against the more severe naturally acquired disease. It began to be practised in England in 1721 thanks to the efforts of Lady Mary Wortley Montagu who influenced Sloane to promote its use, including the inoculation of the royal family's children. When Edward Jenner's inoculation with the cow pox ('vaccination') followed 75 years later as a safer yet equally effective procedure, the scene was set for the eventual control of smallpox epidemics culminating in the worldwide eradication of smallpox in 1977, officially proclaimed by WHO in 1980. Here, we discuss the significance of variolation and vaccination with respect to scientific, public health and ethical controversies concerning these 'weapons of mass protection'. This commentary was written to celebrate the 350th anniversary of the journal Philosophical Transactions of the Royal Society.

The Juscelino Kubitschek government and the Brazilian Malaria Control and Eradication Working Group: collaboration and conflicts in Brazilian and international health agenda, 1958-1961

Malaria, a disease which was under control in the beginning of Juscelino Kubitschek government, became the most important endemic disease in 1958, when Brazil made a commitment with the World Health Organization to convert its control programs into eradication programs. For this purpose a Malaria Control and Eradication Group was set up under the leadership of the malaria specialist Mário Pinotti. Malaria would become an important bargaining chip in the context of the development policies of Kubitschek. This article focuses on path of the Malaria Control and Eradication Working Group in Brazil, in its varying relationships with the arguments and guidelines established at international level.

[The "culture of survival" and international public health in Latin America: the Cold War and the eradication of diseases in the mid-twentieth century]

This article analyzes the main campaigns run by international agencies and national health bodies to eradicate infectious diseases in rural Latin America in the 1940s and 1950s. The political dimensions of the period have been studied but there has been little attention as yet to the health dimensions. This article proposes the concept of a "culture of survival" to explain the official public health problems of states with limited social policies that did not allow the exercise of citizenship. Public health, as part of this culture of survival, sought a temporary solution without confronting the social problems that led to infections and left a public health legacy in the region.

[Looking beyond the campaign to eradicate ancylostomiasis: the diary of the American physician Alan Gregg]

Between 1916 and 1923, the Federal District and 11 Brazilian states entered into cooperation agreements with the International Health Board of the Rockefeller Foundation to combat a rural endemic disease, namely ancylostomiasis. This paper presents the diary of Alan Gregg, one of the American physicians who worked in Brazil from 1919 to 1922. An interesting source to discuss issues relating to the history of public health in Brazil, in addition to information about the activities to combat ancylostomiasis developed by the Rockefeller Foundation in the country, the diary of the physician presents his impressions concerning nature, culture, politics and society in Brazil. In the diary excerpts presented here, however, aspects related to the professional activities performed by Gregg are prioritized.

[The road to polio eradication via the Pan American Health Organization]

OBJECTIVE

Reconstruct the activities of the Pan American Poliomyelitis Eradication Program, through documents produced by the Pan American Health Organization (PAHO) from 1985 to 1994.

METHODS

Documents on polio eradication produced from 1985 to 1994, obtained through the publications portal at the official PAHO website, were used as primary sources of information. Documents were categorized by type and their contents studied, revealing their context in the framework of the history of international public health.

RESULTS

Two hundred sixty documents were found and categorized as bulletins, resolutions, articles, and books. In 1985, PAHO implemented an initiative to eradicate transmission of wild poliovirus in the Americas by 1990. National commissions, a Technical Advisory Group, cross-border meetings, and other coordination mechanisms were established. Eradication activities were monitored by the International Commission for the Certification of Polio Eradication, using five indicators. The Region of the Americas was officially certified in 1994.

CONCLUSIONS

The road to polio eradication in the Region of the Americas was affected by different political, social, and economic circumstances in the different member countries and was not problem-free. Nonetheless, important collaboration agreements were reached and experiences and resources were shared. This led to achieving the final goal before other regions. PAHO played a key role and spearheaded the entire process.

Dracunculiasis (guinea worm disease): eradication without a drug or a vaccine

Dracunculiasis, commonly known as guinea worm disease, is a nematode infection transmitted to humans exclusively via contaminated drinking water. The disease prevails in the most deprived areas of the world. No vaccine or medicine is available against the disease: eradication is being achieved by implementing preventive measures. These include behavioural change in patients and communities--such as self-reporting suspected cases to health workers or volunteers, filtering drinking water and accessing water from improved sources and preventing infected individuals from wading or swimming in drinking-water sources--supplemented by active surveillance and case containment, vector control and provision of improved water sources. Efforts to eradicate dracunculiasis began in the early 1980s. By the end of 2012, the disease had reached its lowest levels ever. This paper reviews the progress made in eradicating dracunculiasis since the eradication campaign began, the factors influencing progress and the difficulties in controlling the pathogen that requires behavioural change, especially when the threat becomes rare. The challenges of intensifying surveillance are discussed, particularly in insecure areas containing the last foci of the disease. It also summarizes the broader benefits uniquely linked to interventions against dracunculiasis.

Rinderpest: the veterinary perspective on eradication

Rinderpest was a devastating disease of livestock responsible for continent-wide famine and poverty. Centuries of veterinary advances culminated in 2011 with the UN Food and Agriculture Organization and the World Organization for Animal Health declaring global eradication of rinderpest; only the second disease to be eradicated and the greatest veterinary achievement of our time. Conventional control measures, principally mass vaccination combined with zoosanitary procedures, led to substantial declines in the incidence of rinderpest. However, during the past decades, innovative strategies were deployed for the last mile to overcome diagnostic and surveillance challenges, unanticipated variations in virus pathogenicity, circulation of disease in wildlife populations and to service remote and nomadic communities in often-unstable states. This review provides an overview of these challenges, describes how they were overcome and identifies key factors for this success.

Lessons from the eradication of smallpox: an interview with D. A. Henderson

It has been more than 35 years since the last naturally occurring case of smallpox. Sufficient time has passed to allow an objective overview of what were the key factors in the success of the eradication effort and what lessons smallpox can offer to other campaigns. Professor D. A. Henderson headed the international effort to eradicate smallpox. Here, we present a summary of D. A. Henderson's perspectives on the eradication of smallpox. This text is based upon the Unither Baruch Blumberg Lecture, delivered by D. A. Henderson at the University of Oxford in November 2012 and upon conversations and correspondence with Professor Henderson.

A 'textbook pattern'? Malaria control and eradication in Jamaica, 1910-65

In 1965 Jamaica was declared free of malaria by the World Health Organisation (WHO), thus ending centuries of death and suffering from the disease. This declaration followed the successful completion of the WHO’s Malaria Eradication Programme (MEP) on the island, initiated in 1958. This account first explores the antecedent control measures adopted by the government up to the MEP. These, as advocated by the previous malaria ‘experts’ who had reported on the disease on the island concentrated on controlling the vector and the administration of quinine for individual protection. Although Jamaica suffered no catastrophic epidemics of island-wide scope, malaria was a constant cause of mortality and morbidity. Major change came in the wake of the Second World War within the changing political context of national independence and international development. In 1957 the Jamaican government joined the global WHO programme to eradicate malaria. The Jamaican campaign exposes many of the problems noted in other studies of such top–down initiatives in their lack of attention to the particular circumstances of each case. Despite being described as ‘a textbook pattern’ of malaria eradication, the MEP in Jamaica suffered from a lack of sufficient preparation and field knowledge. This is most obviously illustrated by the fact that all literature on the programme sent to Jamaica in the first two years was in Spanish. That the MEP exploited the technological opportunity provided by dichlorodiphenyltrichloroethane (DDT) with advantage in Jamaica is not disputed but as this analysis illustrates this success was by no means guaranteed.

The history of the Greek Anti-Malaria League and the influence of the Italian School of Malariology

In 1905, a group of eminent Greek physicians led by Professor of Hygiene and Microbiology Constantinos Savvas and the pediatrician Dr. Ioannis Kardamatis founded the Greek Anti-Malaria League. The League assumed a role that the State would not, and for the next 25 years organized the country's anti-malaria campaign. During its first steps, the Greek Anti-Malaria League adopted the principles of Professor Angelo Celli's Italian Anti-Malaria League. The League's accomplishments include a decrease in malarial prevalence, due to mass treatment with quinine, new legislation ensuring the provision of quinine, State monopoly and the collection of epidemiologic data. However, defeat in the Greek-Turkish War (1922) and the massive influx of one million Greek refugees that ensued, led to a change in malarial epidemiology. In 1928, following a visit to Italy, the Greek League adopted the organization and knowledge of the Italian Malaria Schools in Rome and in Nettuno, and this experience served as the basis of their proposal to the State for the development of the anti-malaria services infrastructure. The State adopted many of Professor Savvas' proposals and modified his plan according to Greek needs. The League's experience, accumulated during its 25 years of struggle against malaria, was its legacy to the campaigns that eventually accomplished the eradication of malaria from Greece after World War II.

Elimination of terrestrial rabies in Germany using oral vaccination of foxes

Oral rabies vaccination (ORV) has become the method of choice in fox rabies control in Europe. During the past three decades fox-mediated rabies virtually disappeared from Western and Central Europe. Following Switzerland, Germany was the second European country to launch ORV field trials on its territory in 1983. This paper provides a historical overview on the emergence of fox rabies in Germany; describing the basic principles and milestones of the German rabies eradication programme and presenting results of two decades of efforts to control the disease in foxes. Also, setbacks as well as country-specific differences and particularities on Germany's long way to rabies elimination in comparison to other European countries are addressed. Since the first field trials in Germany the number of rabies cases steadily decreased from 10 484 in 1983 to three cases recorded in 2006. On February 3rd 2006 the last case of terrestrial rabies in Germany was detected in a fox near the town of Mainz, Rhineland-Palatinate. In 2008, ORV ceased after 25 years and Germany was officially declared as free from terrestrial rabies. The German rabies eradication programme did cost approximately 100 million euro of which 37 million euro were covered by the EU. For the future, efforts should focus on maintaining a rabies free status by implementing measures to prevent reintroduction of terrestrial rabies from endemic countries.

Preventing the reintroduction of malaria in Mauritius: a programmatic and financial assessment

Sustaining elimination of malaria in areas with high receptivity and vulnerability will require effective strategies to prevent reestablishment of local transmission, yet there is a dearth of evidence about this phase. Mauritius offers a uniquely informative history, with elimination of local transmission in 1969, re-emergence in 1975, and second elimination in 1998. Towards this end, Mauritius's elimination and prevention of reintroduction (POR) programs were analyzed via a comprehensive review of literature and government documents, supplemented by program observation and interviews with policy makers and program personnel. The impact of the country's most costly intervention, a passenger screening program, was assessed quantitatively using simulation modeling.On average, Mauritius spent $4.43 per capita per year (pcpy) during its second elimination campaign from 1982 to 1988. The country currently spends $2.06 pcpy on its POR program that includes robust surveillance, routine vector control, and prompt and effective treatment and response. Thirty-five percent of POR costs are for a passenger screening program. Modeling suggests that the estimated 14% of imported malaria infections identified by this program reduces the annual risk of indigenous transmission by approximately 2%. Of cases missed by the initial passenger screening program, 49% were estimated to be identified by passive or reactive case detection, leaving an estimated 3.1 unidentified imported infections per 100,000 inhabitants per year.The Mauritius experience indicates that ongoing intervention, strong leadership, and substantial predictable funding are critical to consistently prevent the reestablishment of malaria. Sustained vigilance is critical considering Mauritius's enabling conditions. Although the cost of POR is below that of elimination, annual per capita spending remains at levels that are likely infeasible for countries with lower overall health spending. Countries currently embarking on elimination should quantify and plan for potentially similar POR operations and costs.

Eradication of disease - the case study of polio

Launched in October 1988 by the 41st World Health Assembly (WHA Resolution 41.28), the Global Polio Eradication Initiative aimed to eradicate poliomyelitis from the planet by the year 2000. It is the largest international public health initiative ever undertaken, costing several billion dollars and immunising billions of children worldwide. It has also been mired in controversy almost since its outset.