29 The real 1991 dollar values of historic public health programs were derived using the latest United States CPI data, found in U.S. Department of Labor, Consumer Price Index, Detailed Report (Washington, D.C.: U.S. Government Printing Office, February 1992).
In 1991 dollars, the smallpox eradication effort cost $759.5 million, still a remarkably low cost when compared with the hundreds of billions now expended worldwide annually to combat just three diseases: AIDS, cancer, and heart disease.
30 Thirty-third World Health Assembly, Declaration of Global Eradication of Smallpox, Geneva, May 8, 1980.
31 U.S. Department of Labor. (1992), op. cit.
32 Ibid.
33 Institute of Medicine, Malaria: Obstacles and Opportunities, eds. S. C. Oates et al. (Washington, D.C.: National Academy Press, 1991).
34 DDT is dichloro-diphenyl-trichloroethane. Its insecticidal properties were discovered in 1939 by Swiss researcher Paul Müller, who received the 1948 Nobel Prize in medicine for his efforts. In the following years chemists developed several sister compounds that were also potent organochlorines, including dieldrin, chlordane, heptachlor, aldrin, and endrin. None was as effective in killing Anopheles mosquitoes as was DDT.
A second class of insecticides, organophosphates, was developed by the German Third Reich as nerve gases. It was discovered after World War II that these compounds could block crucial enzymes in insects, and parathion, malathion, and related chemicals came into use. Because of their acute human toxicity, the organophosphates were not widely used for malaria control in the 1950s and 1960s.
35 G. R. Coatney, “Simian Malarias in Man: Facts, Implications, and Predictions,†American Journal of Tropical Medicine and Hygiene 17 (1968): 147–55.
36 General Douglas MacArthur, who led Allied operations in the World War II Pacific theater, said, “This will be a long war, if for every division I have facing the enemy, I must count on a second division in the hospital with malaria, and a third division convalescing from this debilitating disease.â€
See P. F. Russell, C. S. West, and R. D. Manwell, Practical Malariology (Philadelphia: W. B. Saunders, 1946); and W. Hockmeyer, personal interview, Walter Reed Army Institute of Research, Washington, D.C., September 1986.
37 Institute of Medicine (1991), op. cit.
38 Several species of mosquitoes are capable of carrying malarial parasites, but A. gambiae is the best suited to spreading the disease.
39 IDAB later became the U.S. Agency for International Development, or US AID.
40 Anonymous, Malaria Eradication: Report and Recommendations of the International Development Advisory Board, April 13, 1956 (Washington, D.C.: ICA).
41 About $103.7 million in 1991 dollars. See U.S. Department of Labor, op. cit.
42 A. Spielman, U. Kitron, and R. J. Pollack, “Time Limitation and the Role of Research in the Worldwide Attempt to Eradicate Malaria,†Journal of Medical Entomology 30 (1993): 6–19; and J. A. Najera, “Malaria and the Work of WHO,†Bulletin of the World Health Organization 67 (1989): 229–43.
43 Written in deceptively simple prose, Silent Spring raised havoc when it was released in 1962, spawning the contemporary environmental movement and massive public outcry about the ecological destruction caused by improper pesticide use. The importance of Carson’s book cannot be overstated: it was to the budding environmental movement what Charles Darwin’s Origin of the Species was to evolution. Many have credited her book and the movement it started for the institution of environmental regulatory systems and laws in nations throughout the Western world.
44 R. Carson, Silent Spring (Boston: Houghton Mifflin Company, 1962).
45 Institute of Medicine (1991), op. cit.
46 The time lags between the commencement of DDT use and the apparent swelling of resistant mosquito populations varied dramatically around the world, depending on how the chemical was used. In countries where DDT use was enormous, resistant mosquitoes were obvious within a couple of growing seasons.
47 D. V. Moore and J. E. Lanier, “Observations on Two Plasmodium falciparum Infections with an Abnormal Response to Chloroquine,†American Journal of Tropical Medicine and Hygiene 10 (1961): 5–9.
48 M. D. Young and D. V. Moore, “Chloroquine Resistance in Plasmodium falciparum,†American Journal of Tropical Medicine and Hygiene 10 (1961): 317–20.
49 T. Harinasuta et al., “Chloroquine Resistance in Plasmodium falciparum in Thailand,†in UNESCO First Regional Symposium on Scientific Knowledge of Tropical Parasites (University of Singapore, 1962), 148–53.
50 S. Maberti, “Desarrollo de Resistencia a la Primetamino: Presentación de 15 Casos Estudiados en Trujilo, Venezuela,†Archivos Venezolanos de Medicina Tropical y ParasitologÃa Médica 3 (1960): 239–59.
51 D. C. Rodrigues, “Cases of Malaria Caused by Plasmodium falciparum Resistance to Treatment with Chloroquine.†Arquivos de Higiénica (S. Paulo) 26 (1961): 231–35.
52 G. R. Coatney, “Pitfalls in a Discovery: The Chronicle of Chloroquine,†American Journal of Tropical Medicine and Hygiene 12 (1963): 121–28.
53 D. J. Wyler, “The Ascent and Decline of Chloroquine,†Journal of the American Medical Association 251 (1984): 2420–22.
54 Between 1943 and 1984 the U.S. Army screened over 250,000 potential antimalarial drugs.
55 J. H. Meeuwissen, “Campaign Against Malaria with Medicated Salt in New Guinea,†Nederland T. Geneesk 108 (1964): 1241–43; and J. H. Meeuwissen, “Malaria Prevention in New Guinea with Drugs Added to Kitchen Salt,†Annals de la Société Belgique de Médecine Tropique 43 (1963): 209–12.
56 Julius Richmond served as U.S. Surgeon General during the administration of Jimmy Carter. Though he happily celebrated the smallpox victory, serving as U.S. representative to ceremonies held at WHO in Geneva, he warned American political leaders in 1978 that most infectious diseases would not so readily succumb to human attack. J. Richmond, personal interview, September 18, 1992.
57 Najera (1989), op. cit.
3. Monkey Kidneys and the Ebbing Tides
1 G. A. Martini and R. Siegert, Marburg Virus Disease (Frankfurt: Springer Verlag, 1971).
2 Ibid.
3 Ibid.
4 World Health Organization, “Viral Haemorrhagic Fevers: Report of a WHO Expert Committee,†Technical Report Series (1985): 721; and Anonymous, “Méthodes de Surveillance et de Prise en Charge du Monkeypox et des Fievres Hemorrhagiques d’Origine Virale,†CDS/80.1 (Geneva: World Health Organization, 1980).
5 Martini and Siegert (1971), op. cit.
6 Since 1980 Rhodesia has been called Zimbabwe, in recognition of the Shora culture that preceded the British colonization of the area, which was spearheaded by Cecil Rhodes.
7 J. S. S. Gear et al., “Outbreak of Marburg Virus Disease in Johannesburg,†British Medical Journal 4 (1975): 489–93.
8 J. S. S. Gear, “Clinical Aspects of African Viral Hemorrhagic Fevers,†Reviews of Infectious Diseases 11, Supplement 4 (1989): s777–s782.
9 L. Lapeyssonie, An Outbreak of Meningococcal Meningitis in Brazil, EM/BD/8 (Geneva: World Health Organization, September 1974).
10 The federal medical training program provided most of the physicians that staffed Public Health Service clinics in rural areas, on Indian Nation lands, and in inner-city areas. The Reagan administration would terminate the program in 1986, citing budgetary concerns and a physician surplus as reasons.
11 A. S. Benenson, Control of Communicable Diseases in Man (15th ed.; Washington, D.C.: American Public Health Association, 1990).
12 C. 0. Bastos et al., “Meningitis in So Paulo,†Revue Associacion Medicale Brasiliera 19 (1973): 451–56.
13 The Type B meningococcus was more common in developed countries. Years later, as Brazil developed, it would experience Ty
pe B epidemics too. See J. C. DeMoraes, B. A. Perkins, M. C. C. Camarago, et al., “Protective Efficacy of a Serogroup B Meningococcal Vaccine in So Paulo, Brazil,†Lancet 340 (1992): 1074–78.
14 Data from the International Air Transport Association, London. By 1980, 163 million people were flying annually between countries, and that figure reached 280 million by 1990. Within the United States, 42 million domestic tickets were sold in 1990.
15 World Health Organization, Epidemic Report, EM/EPID/39 (Geneva: World Health Organization, 1974).
16 L. Lapeyssonie, Report on a Second Visit to Brazil, 28 April to 28 May 1975, EM/BD/11 (Geneva: World Health Organization, September 1975).
17 The methods used to make such vaccines were fairly standard by 1974. See E. C. Gotschlich, M. Rey, W. R. Sanborn, et al., “The Immunological Responses Observed in Field Studies in Africa with Group A Meningococcal Vaccines,†Progress in Immunobiological Standards 5 (1972): 485–91.
18 In its 1976 summary of the Brazilian pestilence, PAHO concluded: “It has been shown that populations belonging to lower economic classes which are exposed to overcrowding, poor housing, and poor environmental sanitation, and which have low levels of personal hygiene, are the populations most affected. Improvement of living conditions, housing and personal hygiene—which should be coupled with general education and health education—would certainly be beneficial, although the effectiveness of such improvement has not been definitely assessed in quantitative terms.†See Pan American Health Organization, Report on the Meeting on Meningococcal Disease, So Paulo-Braslia, Brazil, 23–28 February 1976 (Washington, D.C.: Pan American Health Organization, 1976).
19 Since the Brazilian epidemic, other outbreaks of equally mysterious origins have occurred in Mali, Niger, Papua New Guinea, Senegal, Nigeria, Finland, Norway, Cuba, Mongolia, Vietnam, South Africa, Sudan, Gambia, and the United States. In January 1993 panic developed in the largely Dominican Washington Heights section of New York City when a six-year-old boy died of Type A meningococcal meningitis. The boy left school on a Thursday feeling fine, and was dead a day later. See Pan American Health Organization (1976), op cit; B. M. Greenwood, “Selective Primary Health Care: Strategies for Control of Disease in the Developing World. XIII: Acute Bacterial Meningitis,†Reviews of Infectious Diseases (Chicago: University of Chicago Press, 1984), 374–89; and M. Howe, “After a Meningitis Death, Striving to Calm the Fears of Other Pupils’ Parents, New York Times, January 29, 1993.
20 Centers for Disease Control,â€Yellow Fever Vaccine: Recommendations of the Immunization Practices Advisory Committee,†Morbidity and Mortality Weekly Report 39 (1990): 1–6.
21 M. S. Pernick,â€Politics, Parties and Pestilence: Epidemic Yellow Fever in Philadelphia and the Rise of the First Party System,†in J. W. Leavitt and R. L. Numbers, eds., Sickness and Health in America (Madison: University of Wisconsin Press, 1985), 356–71.
22 W. H. McNeill, Plagues and Peoples (New York: Doubleday, 1977).
23 Roughly translated, one such tune repeats these lines:
Only mosquito can save Nigeria.
Only mosquito can save South Africa.
Only mosquito can save Zimbabwe
Only mosquito can save Namibia.
Only mosquito can save Africa.
Only malaria can save Africa.
Only yellow fever can save Africa.
Translation courtesy of Bunmi Makinwa, John F. Kennedy School of Politics and Government, Harvard University.
24 R. M. Taylor, “Epidemiology,†in G. K. Strode, ed., Yellow Fever (New York: McGraw-Hill, 1971), 442.
25 G. Strode, The Conquest of Yellow Fever (New York: McGraw-Hill, 1951).
26 F. L. Soper et al., “Yellow Fever Without Aedes aegypti: Study of Rural Epidemic in Valle do Chanaan, Espirito Santo, Brazil, 1932,†American Journal of Hygiene 18 (1933): 555.
27 J. Boshell, “Marche de la Fievre Jaune Sylvatique vers les Regions du Nordouest de l’Amérique Centrale,†Bulletin of the World Health Organization 16 (1957): 431.
28 M. E. Wilson, A World Guide to Infections (Oxford, Eng.: Oxford University Press, 1991), 697–700.
29 T. P. Monath, “Yellow Fever: Victor, Victoria? Conqueror, Conquest? Epidemics and Research in the Last Forty Years and Prospects for the Future,†American Journal of Tropical Medicine and Hygiene 45 (1991): 1, 43.
30 Ibid.
31 Scientists in these outposts investigated eight more yellow fever outbreaks during the 1960s, ranging in size from those involving fewer than twenty people (Zaire) to massive epidemics involving 20,000 people (Senegal, 1965), and to a West African pandemic which struck well over 100,000 people (Nigeria, Mali, Burkina Faso, Togo, and Ghana, 1969). In these epidemics 25 to 35 percent of those infected with the virus perished. See ibid.
32 V. H. Lee et al., “Arbovirus Studies in Nupeko Forest, a Possible Natural Focus of Yellow Fever Virus in Nigeria. II: Entomologic Investigations and Viruses Isolated,†Transactions of the Royal Society of Tropical Medicine and Hygiene 68 (1974): 39–47.
33 T. P. Monath et al., “The 1970 Yellow Fever Epidemic in Okwoga District, Benue Plateau State, Nigeria. 2: Immunity Survey to Determine Geographic Limits and Origins of the Epidemic,†Bulletin of the World Health Organization 49 (1973): 123–28.
34 T. P. Monath et al., “The 1970 Yellow Fever Epidemic in Okwoga District, Benue Plateau State, Nigeria. 1: Epidemiological Observations,†Bulletin of the World Health Organization 49 (1973): 113–21.
35 Monath (1991), op. cit.
4. Into the Woods
1 According to Brinkmann, at least one member of the group attempted suicide. Brinkmann chose to protect the individual’s identity.
2 J. D. Frame et al., “Lassa Fever, a New Virus Disease of Man from West Africa,†American Journal of Tropical Medicine and Hygiene 19 (1970): 670–76.
3 Several sources of excellent information on the events of 1969 in Nigeria were consulted in preparation of this chapter. The reader is particularly referred to the following: J. G. Fuller, Fever: The Hunt for a New Killer Virus (New York: Reader’s Digest Press, 1974); and J. D. Frame, “The Story of Lassa Fever,†New York State Journal of Medicine:
“Part I: Discovering the Disease,†Vol. 92 (1992): 199–202;
“Part II: Learning More About the Disease,†Vol. 92 (1992): 264–67;
“Part III: The Disease in the Community,†Vol. 92 (1992): 440–44;
“Part IV: The Politics of Research,†Vol. 93 (1993): 35–40;
“Part V: The Fruits of Research†(in press).
4 The bubonic plague that claimed hundreds of millions of lives worldwide in two major sweeps across Europe and Asia was spread originally by fleas. But there was a form of the disease that spread pneumonically, or in the air from one person to another.
5 Frame (1992), Part I, op. cit.
6 S. M. Buckley, J. Casals, and W. Downs, “Isolation and Antigenic Characterization of Lassa Virus,†Nature 227 (1970): 174.
7 R. W. Speir et al., “Electron Microscopy of Vero Cell Cultures Infected with Lassa Virus,†American Journal of Tropical Medicine and Hygiene 19 (1970): 692–94.
8 E. Leifer, D. J. Locke, and H. Bourne, “Report of a Laboratory-Acquired Infection Treated with Plasma from a Person Recently Recovered from the Disease,†American Journal of Tropical Medicine and Hygiene 19 (1970): 677–79.
9 Frame (1992), Part I, op. cit.
10 F. P. Pinheiro et al., “Amapari, a New Virus of the Tacaribe Group from Rodents and Mites of Amapa Territory, Brazil,†Proceedings of the Society of Experimental and Biological Medicine 122 (1966): 531–35.
11 J. Casals et al., “A Current Appraisal of Hemorrhagic Fevers in the U.S.S.R.,†American J
ournal of Tropical Medicine and Hygiene 15 (1966): 751–64.
12 Buckley et al. (1970), op. cit.
13 S. M. Buckley and J. Casals, “Isolation and Characterization of the Virus,†American Journal of Tropical Medicine and Hygiene 19 (1970): 680–91; and Speir et al. (1970) op. cit.
14 The CDC has, over the years, upgraded its high-security laboratories repeatedly as the technology of biological containment improved. In the late 1960s the CDC’s top security facility housed labs-within-labs that formed a sort of concrete onion, layer upon layer of which had to be penetrated to reach the central core. At each level double air-lock doors sealed the air space tightly, and the chambers were kept under pressure that directed all air—and microbes—toward special ventilators where they were destroyed by ultraviolet light and filtered through several layers of sheets that strained out anything bigger than a large molecule. All personnel showered before and after entry and wore protective head-to-toe suits.
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