Saturday, 27 August 2016

D.A. Henderson, ‘disease detective’ who eradicated smallpox, dies at 87

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.”

Tuesday, 16 August 2016

21st Pradnaya : Annual Conference on SMART Healthcare for India

21st Annual Conference on SMART Healthcare for India 
29th -30th September, 2016 

The healthcare sector, in India and across the developing countries, is both complex as well provides immense opportunity. Despite new technological advancements and developmental progress, the accessibility and accountability to affordable basic health and wellness care remains an important challenge. This is imperative for attainment of goals of the health care sector. 
In this context, the United Nation’s 2030 Sustainable Development Agenda is of unprecedented scope and ambition, applicable to all countries. This Agenda includes 17 Sustainable Development Goals (SDGs) and 169 targets comprising of a broad range of economic, social and environmental objectives. Health has a central place in SDGs: Ensure healthy lives and promoting well-being for all at all ages. 
Taking into consideration the current challenges which the healthcare sector is confronted in context of the SDGs, this conference on “SMART Healthcare for India” will provide a platform for deliberation on these important issues.
In accordance with the theme of the conference, following topics will be discussed by eminent speakers from the academia and industry: 
Sustainable Healthcare, SDGs: A sustainable healthcare is a widely-discussed and crucial issue for developing countries. Sustainable healthcare ranges from primary healthcare to super specialty care, thereby engendering comprehensive health. India is seeing a significant improvement in public healthcare, but has to address a multitude of problems. Governments and other stakeholders should come together to develop a framework which is feasible and attainable within available resources. 
Managing Healthcare: Well managed health care setups have a profound effect on the quality of care. As competition intensifies, patient experience, service quality, and efficient resource management provides the evidentiary basis for measuring patient, clinician, and organizational outcomes. With emphasis on “quality outcomes,” it is becoming increasingly critical for health care organizations to develop and implement a sound management strategy for providing result oriented effective care. The future success of the organization will largely depend on judiciously managing the healthcare institutions while delivering consistently effective and efficient care. 
Accessibility and Accountability in Healthcare: Access to healthcare is fundamental in the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified by the varying interpretations of the different agencies. A conceptual framework and accountable, health care system is the need of the hour to meet the national and organizational level healthcare goals, with data for decision making being the key strategy. 
Resources in Healthcare: Rising cost of healthcare is a challenge world over. Delivery of good quality affordable healthcare remains an enormous challenge to the health system. Although, there have been many improvements and innovations in the healthcare delivery system, the effective management of resources, lack of funding and dismal scenario of health insurance remains an unsolved issue. There is a need to harmonize the different stakeholders involved in this process to address these challenges.
Technological Advancements in Healthcare: The technology shift has cast itself over the field of healthcare, bringing with it a digital transformation in the way doctors and patients interact. Due to the increasing convergence of technology and healthcare, there is a huge opportunity for providers to improve the patient experience and operate more efficiently due to augmented association and information sharing among providers.

 Injuries and Road Traffic Accidents 
 Fitness and Return to Work (Healthy Workplace) 
 Emerging Pharma Growth Opportunities in NCD 

 Executives and managers from public and private healthcare, pharmaceutical, development sector 
 Healthcare providers 
 Academia and researchers 
 Students of health, hospital, pharmaceutical and rural management 

Papers and posters are invited on the above- mentioned major conference themes of the Pradanya, 2016. Delegates or Students from Hospitals, Healthcare, and Pharmaceutical Management and Rural Management institutions are encouraged to submit abstracts. We are seeking high quality primary and secondary research based studies that analyze issues.

 Abstract: Title of poster (Font size 14), Names of the author and co-author –Initial name followed by surname (Font size – 12), Affiliation(s) of authors(s) (Font Size – 12). Maximum 500 words should include the rationale, objectives, methodology, key findings and conclusion.  Poster Size & Material – 2 ½ ft. (width) x 4 ft. (length) – Vertical, Vinyl. 
 Text, visuals (graphs, photographs, schematics, maps, etc) can be used. Text and visuals should be readable from 5 feet away. 
 Single line spacing with 1” left and right margins. 
 Make sure that any visual can "stand alone" (i.e., graph axes are properly labeled, symbols are explained, etc.). 
 Poster to be displayed at the venue of the conference. 
 Poster presentation of 10 minutes will be done in front of the expert of panels. 
 First three winners will be awarded at the Valedictory session of Pradanya,2016 
 Maximum two presenters per poster. 

 Structured Abstract: Title of paper (Font size 14), Names of the author and co-author – Initial name followed by surname, Affiliation(s) of authors(s) (Font Size – 12). Maximum 500 words, should include the rationale, objectives, methodology, key findings and conclusion. 
 Paper: 3000-3500 words for paper (Times New Roman, Font size – 12), Single line spacing with one inch. Justify margins. 
 The research paper should be arranged in the following sections: Title, Author(s), Address, Structured Abstract, Keywords, Introduction, Materials and methods, Results and Analysis, Discussion, Conclusion(s) and References. 
 Table and charts should be adjuncts to the text and must not repeat material already presented. 
 Author or co-author will make the 15 minutes power point presentation in front of the expert of panels. 
 First three winners will be awarded at the Valedictory session of Pradanya, 2016. 

Abstract for Paper and Poster on above mentioned thematic areas are invited at email: 
All Abstracts selected for oral/ poster presentation will be published in the conference report. Selected papers will be published in special issue of Journal of Health Management. E-mail full paper/ Poster with declaration of original work on or before 17th September 2016. 


Payment shall be made by Cheque/ Demand Draft/ Online in favour of “Institute of Health Management Research” payable at Jaipur. 
Online Transfer: 
Bank Name: HDFC Bank Ltd. 
Bank Address: D-54, SiddiVinayak, Ashok Marg, C-Scheme, Jaipur, Rajasthan (India), 
Bank Account No: C.A. No. 00540330002103, 
Bank IFSC Code: HDFC0000054 
Bank Account Holder Name: Institute of Health Management Research 

Last Date for Abstract Submission 27th Aug, 2016 
Last Date of Paper /Poster Submission 17th Sept, 2016 
Conference Date 29th -30th September 2016 

For all quieries mail us at :