In December 1974, the last cases of smallpox in its deadliest form were confined to a Bangladesh slum. Public health workers were preparing the scourge’s coup de grâce, but were horrified when government bulldozers arrived, scattering 50,000 people across the countryside.
The ill-timed demolition of the slum spread the disease throughout the country, sparking outbreaks in several locations and extending the suffering and death from smallpox for another 10 months. The chapter illustrates the difficulty of ridding the world of a human disease, even one down to its last few cases, and how important it is that eradication efforts include whole societies.
A group of scientists, government officials, nonprofit leaders, malaria-control program directors, and others gathered at Harvard Business School last week sought to draw lessons from past eradication efforts as they embarked on a weeklong leadership program focused on eradicating another age-old scourge: malaria.
Though the program’s 56 participants have been involved in different aspects of the fight against malaria for years, Dyann Wirth, the Richard Pearson Strong Professor of Infectious Disease, chair of the Harvard T.H. Chan School of Public Health’s Department of Immunology and Infectious Diseases, and director of the Harvard Malaria Initiative, said that shifting officials’ focus from control and treatment of the disease to eradication requires shifting strategies as well.
“We want to give them the overview of the problem of malaria, all the way from the genes to the globe,” Wirth said. “Many of them work [on malaria]… and although most in the room probably have had this material at one point, they haven’t thought about it in this lens of elimination/eradication, which is quite different from treating symptomatic cases or preventing symptomatic cases.”
Smallpox stands as the only human disease successfully stamped out, so the intensive leadership program kicked off with a talk by Myron Levine, a University of Maryland professor who was a World Health Organization (WHO) consultant in Bangladesh during the final days battling smallpox’s most virulent strain, variola major. It would take another two years to eradicate a less deadly strain, variola minor, though there were laboratory-related cases in 1978.
Global anti-malaria efforts have made significant progress, Wirth said, with cases down 30 percent and deaths down 50 percent over the last 15 years. Even with that decline, however, malaria is far from on the ropes. In 2013 alone, there were an estimated 198,000,000 cases and 584,000 deaths, according to the WHO.
The leadership development program, called “Science of Eradication: Malaria 2015,” provided a broad overview, including the disease’s basic biology, challenges facing vaccine development, social determinants of transmission, economic advantages to eradication, the importance of communication, and ways to integrate eradication into existing control efforts.