By Emily Langer August 20
Donald “D.A.”
Henderson, an American epidemiologist who led the international war on smallpox
that resulted in its eradication in 1980, the only such vanquishment in history
of a human disease and an achievement that was credited with saving tens of
millions of lives, died Aug. 19 at a hospice facility in Towson, Md. He
was 87.
The cause was
complications from a broken hip, said his daughter, Leigh Henderson.
A self-described
“disease detective,” Dr. Henderson spent the defining years of his career as an
official of the Centers for Disease Control and Prevention and the World Health
Organization. Later, he served as dean of Johns Hopkins University’s school of
public health and as a science and bioterrorism adviser in three presidential
administrations.
But it was in the
fight on smallpox — perhaps the most lethal disease in history and one that
killed an estimated 300 million people in the 20th century alone — that he
became known around the world. Lent from the CDC to the WHO for a decade in the
1960s and 1970s, he commanded a small cadre of public-health officials and an
army of field workers in an endeavor that amounted to a medical moonshot.
“I think it can be
fairly said that the smallpox eradication was the single greatest achievement
in the history of medicine,” Richard Preston, the best-selling author of
volumes including “The Hot Zone,” about the Ebola virus, and “The Demon in the
Freezer,” about smallpox, said in an interview. He described Dr. Henderson as a
“Sherman tank of a human being — he simply rolled over bureaucrats who got in
his way.”
D.A. Henderson in
1974. (CDC)
For millennia, at
least since the time of the Egyptian pharaohs, smallpox had ravaged its way
around the world. Caused by the variola virus, it was an
exceptionally painful and gruesome disease. Victims suffered from fever and
other flulike symptoms before developing a rash of the pustules that gave the
disease its nickname: the speckled monster. It killed a third of its victims
and left survivors disfigured, sometimes blind.
“Smallpox has been
called one of the most loathsome diseases,” Dr. Henderson told The Washington
Post in 1979. “I know that no matter how many visits I made to smallpox wards
filled with seriously ill and dying patients, I always came away shaken.”
Populations had long
sought to protect themselves from smallpox through crude methods of
inoculation, the process by which a patient is intentionally exposed to a
disease to provoke a mild reaction and thereby obtains immunity from a more
serious infection.
In the 18th century,
an English physician, Edward Jenner, discovered that exposure to the less
dangerous cowpox virus produced immunity to smallpox. He is regarded as the
father of the smallpox vaccine, which was perfected over the years and severely
curtailed the spread of the disease in areas where the vaccine was distributed.
Because of large-scale immunizations, the United States was free of smallpox by
1949.
But the disease
continued to bedevil countries around the world, particularly in South America,
South Asia and Africa. In the late 1950s, the Soviet Union began to apply
pressure on the WHO, which is an agency of the United Nations, to mount a
campaign to wipe out smallpox.
Many WHO officials
were hesitant to embark on such an ambitious operation, fearing that a defeat
would erode the organization’s credibility. Previous efforts to eliminate other
diseases, such as yellow fever and malaria, had “failed spectacularly,”
according to Jason Schwartz, a historian of medicine at the Yale School of
Public Health.
[The world is closer
than ever to eradicating Guinea worm]
D.A. Henderson in
2011. (Michael Temchine/The Washington Post)
When
it was agreed that the WHO would take on the smallpox initiative, the
organization turned to the United States, which, under Dr. Henderson’s
leadership, had already launched a smallpox-eradication program in Africa. In
an oral history with
the online Global
Health Chronicles,
Dr. Henderson recalled that the WHO director general, the Brazilian
malariologistMarcelinoCandau, called the U.S. surgeon general with a demand.
“I want an American
to run the program,” Candau said, “because when it goes down, when it fails, I
want it to be seen that there is an American there and the U.S. is really
responsible for this dreadful thing that you have launched the World Health
Organization into, and the person I want is Henderson.”
Pressed by the
surgeon general, and apprehensive about his chances of success, Dr. Henderson
arrived in Geneva in 1966. For the next 11 years, he shuttled between Geneva
and far-flung smallpox hot spots — obtaining funding, coordinating with nations
including the Soviet Union amid Cold War tensions, and inspiring heroics from
the tens of thousands of field workers who ventured into countries racked by
deprivation, natural disaster, political instability and war.
The campaign, which
cost an estimated total of $300 million, employed a strategy called ring
vaccination that was credited to the American epidemiologist William Foege.
Rather than attempting to vaccinate everyone — a technique determined to be
superfluous — the WHO located smallpox patients, isolated them, vaccinated
everyone who had contact with the victims, and then vaccinated everyone who had
contact with those people.
The smallpox campaign
benefited from an effective vaccine, ingeniously reconstituted in a
freeze-dried form that could withstand the high temperatures of tropical
environments. It was administered by a sharp, two-pronged rod that was easy for
nonprofessionals to use. The nature of smallpox also offered advantages: With
its telltale sores, it was easy to identify in patients, and it had no animal
vector, or means of transmission.
Much credit for its
success went to Dr. Henderson personally.
“He gives a sense of
certainty on things,” Foege said in an interview, “and people like to follow a
leader that is quite certain about what they are doing.”
When Dr. Henderson
feared that the Soviet Union was delivering substandard vaccines for the effort,
he traveled to Moscow, over the prohibition of his bosses, to confront
authorities there, the New York Times reported. When the health minister under
Ethiopian Emperor Haile Selassie proved insufficiently helpful, Dr. Henderson
entered the country and cozied up to the emperor’s personal physician.
Dr. Henderson shared
credit for his accomplishments with the many WHO collaborators who performed
vaccinations in the field.
“The
obstacles were unbelievable,” Dr. Henderson told the Times in 2011, recalling
the efforts of Ciro de Quadros, a Brazilian epidemiologist who
later helped lead an assault on polio. “The emperor assassinated, two
revolutionary groups fighting, nine of his own teams kidnapped, even a
helicopter captured and held for ransom. He kept the teams in the field — and
that helicopter pilot went out and vaccinated all the rebels.”
Recalling their work
together, Foege said that Dr. Henderson displayed profound concern for the
field workers who risked their safety to carry out their work.
“I don’t know how
many stories I’ve heard of the mothers of people who had gone to India calling
him directly,” Foege said. “For some of them, it was their first time overseas.
You can see why their parents might have been nervous if they didn’t hear from
their child after a couple of weeks. Some of these mothers would call D.A.
Henderson in Geneva and ask him to find out if their child was okay. And he
would.”
To ensure total
eradication, field workers offered rewards for reports of smallpox cases. When
offers of cash went unanswered, Dr. Henderson told The Post, “we knew we had
done it, but we couldn’t believe it.”
Ali MaowMaalin, a
Somali who died in 2013, contracted the disease in 1977 and was identified as
the world’s last patient with naturally occurring smallpox. Three years later,
the World Health Assembly certified that smallpox had been eradicated.
Donald Ainslie
Henderson was born in Lakewood, Ohio, outside of Cleveland, on Sept. 7, 1928.
His mother was a nurse, and his father was an engineer.
He had not yet turned
20 when, in 1947, New York City suffered a smallpox outbreak. The episode,
which resulted in the vaccination of millions, spurred Dr. Henderson’s interest
in the disease and how it might be stopped.
He received a
bachelor’s degree in chemistry from Ohio’s Oberlin College in 1950 and a
medical degree in 1954 from the University of Rochester in New York. The next
year, he joined the CDC, then called the Communicable Disease Center, where he
was mentored by Alexander Langmuir, the founder of the CDC’s Epidemic
Intelligence Service, a sort of epidemiological special forces.
“I decided I was never
going to be a practicing doc,” Dr. Henderson once told an interviewer,
according to the reference guide Current Biography. “It was just too dull,
really.”
He received a master
of public health degree from Johns Hopkins University in 1960. At the CDC, he
became chief of the virus surveillance section before leading the African and
then global smallpox eradication campaigns.
Dr. Henderson was the
author of “Smallpox: The Death of a Disease” (2009). His honors included the
National Medal of Science in 1986 and the Presidential Medal of Freedom, the
nation’s highest civilian honor, in 2002.
Survivors include his
wife of 64 years, the former Nana Bragg of Towson; three children, Leigh
Henderson of Baltimore, David Henderson of Brooklyn and Douglas Henderson of
Berlin.
When Dr. Henderson
left the WHO in 1977, he quipped that as the chief expert on a disease that had
been wiped out, he was “left there high and dry with no marketable skills,”
with no option but to become a dean.
He joined Johns
Hopkins, where he remained until 1990, later returning to found a center for
civilian biodefense studies. Dr. Henderson served in the administrations of
George H.W. Bush and Bill Clinton. After the Sept. 11, 2001, terrorist attacks
and subsequent anthrax mailings, he served under President George W. Bush as
director of the Office of Public Health Preparedness, a new unit to combat
bioterrorism.
At the time, some
U.S. intelligence analysts feared that Iraq or North Korea might possess
strains of the smallpox virus and be capable of using them as biological
weapons. Fears subsided after the 2003 invasion of Iraq, where no smallpox was
found, but some experts still perceive a threat from North Korea.
The only officially
sanctioned stores of the smallpox virus are held at heavily secured facilities
at the CDC in Atlanta and at a Russian facility in Siberia. Some researchers
contend that the samples should be preserved for use in the development of
future vaccines or treatments.
Dr. Henderson
strenuously argued that the samples should be destroyed because, in his view,
any amount of smallpox was too dangerous to tolerate. A side effect of the
eradication program — and one of the “horrendous ironies of history,” said “Hot
Zone” author Preston — is that since no one in generations has been exposed to
the virus, most of the world’s population would be vulnerable to it in the
event of an outbreak.
“I feel very — what
should we say? — dispirited,” Dr. Henderson told the Times in 2002. “Here we
are, regressing to defend against something we thought was permanently
defeated. We shouldn’t have to be doing this.”
