PAHO: a century of healthy achievements.

• Author: Epstein, Daniel
• Position: Inter-American System - Pan American Health Organization

Health in the Americas has come a long way since the first epidemic recorded in the Hemisphere, a smallpox outbreak that started in Hispaniola in 1515 and spread to neighboring islands and the South American mainland. Decimating Amerindian tribes, the epidemic helped bring about the collapse of both the Aztec and Incan empires.

Without the Pan American Health Organization (PAHO), the world might still face the specter of smallpox. Though an English doctor, Edward Jenner, developed a primitive form of vaccination against smallpox in 1796, it was not until the late 1940s that a commercially feasible process for production of a stable freeze-dried vaccine was perfected, and that possibilities for smallpox control improved markedly.

"Recognizing the value of such a vaccine, the Pan American Health Organization decided, in 1950, to undertake a hemisphere-wide eradication program and by 1967 succeeded in eliminating smallpox from all countries of the Americas except Brazil," wrote Dr. D.A. Henderson, who led the global smallpox eradication effort and is now a bio-terrorism advisor to the U.S. Department of Health and Human Services. (Brazil's last smallpox cases appeared in 1971 and certification of eradication in the Americas occurred two years later.)

PAHO's eradication program using the new freeze-dried vaccine laid the groundwork for a global drive to eradicate smallpox, one of mankind's greatest challenges. The Americas were instrumental in making smallpox history. An international worldwide effort succeeded in eradicating this dreaded disease from the world, as certified by the World Health Assembly on May 8, 1980. This marked one of the paramount victories of public health and paved the way for future disease eradication campaigns aimed at polio and measles. It had taken more than four centuries for the Americas to drive smallpox from the continent, and the global eradication of smallpox was widely considered one of humanity's greatest achievements--the first time a disease had been wiped off the face of the earth.

But an unexpected dark side of smallpox eradication arose after the terrorist attacks on the United States on September 11, 2001. This was the fear that clandestine stocks of the virus could be used in a bio-terrorist attack that could affect millions of people who have not been vaccinated. Now, PAHO, as part of its emergency preparedness efforts, is working with the member countries to protect against that prospect, as well as the possibility of chemical and radiological attacks. PAHO is supporting the development of national plans to address the threat of bio-terrorism through increased preparedness, better surveillance to quickly identify epidemics caused by deliberate infections, and upgraded laboratory capacity. Advances in these areas have the advantage of also helping the countries strengthen their health systems to fight "natural" as well as potential man-made epidemics.

One hundred years ago, the threats to public health were different and the response in the Americas was an uncoordinated jumble, as individual countries made separate efforts to protect themselves and their people against the threat of "imported" diseases. Yet over the next century, through coordinated action, health progress unrivaled in history would sweep the Western Hemisphere as health leaders together fought...