EIS Leads Effort to Eradicate Smallpox from the World

It's hard to believe that a quarter century ago, smallpox existed in the world. One of humankind's greatest scourges, this life-threatening disease caused fever and a dramatic skin eruption that resulted in severe scarring. Millions of people were infected and one in four infected people died from it. It changed the order of secession for a variety of national dynasties. It affected battle and war outcomes. It affected colonization. With no cure, generations watched helplessly as their children succumbed to the disease or were disfigured or blinded by it. In Central and West Africa as well as parts of Asia, smallpox flourished well into the 1970's.

In 1968, the world's public health organizations – led by the United States and the then-Soviet Union – came together to join in the fight to eradicate smallpox from the world. Some of the key foot soldiers of this battle included CDC's cadre of EIS officers and alumni, among them Stan Foster and Bill Foege, graduates of the EIS class of '62, as well as Stan Music, EIS '71, and Donald Hopkins, a former deputy director of CDC who was made an honorary EIS officer in 1985.

Jeffrey P. Koplan, director of CDC, remembers the period well. As a young EIS officer in 1972, he was assigned to Stan Foster's team in Bangladesh, one of the last outposts of smallpox. His mode of transportation was a converted Red Cross x-ray boat, which enabled him and his Bangladeshi colleagues to quickly reach isolated populations to identify cases and control the spread of the disease.

"I worked with a Bangladeshi team of a half-dozen people. It was exciting. We were finding outbreaks of cases and trying to control them. Smallpox was still rampant throughout the country," recalls Koplan, who came to the EIS with a strong interest in community medicine following his studies at Mount Sinai School of Medicine in New York.

Koplan's initial smallpox work included investigating suspected cases of smallpox coming into the United States and educating U.S. state and local public health departments about ending routine smallpox immunizations. No cases were imported into the United States during his service.

In December 1972, Koplan made his first trip to Bangladesh to conduct a double-blind controlled study on a new drug to assess its potential treatment for smallpox. He convinced Dow Chemical to donate free equipment for the study, assembled the necessary supplies, and spent three months running a smallpox ward in the infectious disease hospital in Dhaka.

"We had about 40 patients who ranged in age from 11 to about 45 years old," recalls Koplan. The study eventually concluded that the drug was not effective and CDC abandoned its use. "It was important to establish that there was no treatment because if people thought there was a drug that could treat smallpox, there would be less emphasis on prevention."

During this period, Koplan interacted often with his two mentors – Stan Foster, who at the time was the World Health Organization's country leader for smallpox eradication in Bangladesh and today is a visiting professor at Emory University's Rollins School of Public Health; and Bill Foege, who ran CDC's entire smallpox program and then directed eradication efforts in India. Today, he is senior medical advisor for the Bill and Melinda Gates Foundation. Both men served as role models and helped steer Koplan toward a public health career.

"I thought that they were exceptional in how they lived and how they approached public health as the most exciting opportunity in medicine – the idea of having an impact on a community – on more than one person at a time. They served as a model for what I wanted to do for the rest of my career," he says.

Throughout his two years of EIS work, Koplan recalls seeing steady progress in the eradication of smallpox. He remembers how airports posted yellow signs with the names of countries that still reported cases of smallpox and advised travelers to those countries of the steps to take if they began to have symptoms.

"When I began in the EIS, perhaps 25 or 30 countries were listed. Over time, those lists would whittle down to fewer and fewer in number – from 24 to 18 to 12 to 6. We saved those yellow pieces of paper. Ultimately, it got down to two, three, one country and then no place left."

Koplan's service in the EIS ended in 1974, but CDC's smallpox crusade continued, and, in 1979, two years after the last smallpox case was found in Somalia, the world was declared smallpox-free. Today, Koplan is one of the few, if not the only, Westerner who has taken care of patients with smallpox on a day-to-day basis.

For Koplan, this work from more than 25 years ago was a defining moment for a career that has taken him to his current post as head of CDC.

"For most of us involved in smallpox eradication, it was a lifelong experience. It served to motivate us to continue to work in public health and gave us an unfailing optimism for the success of public health programs even in the face of overwhelming odds," says Koplan.