CIRO de QUADROS 1940-2014
Dr. Ciro de Quadros was a Brazilian epidemiologist who navigated war zones and reimagined outmoded public health practices to lead an immunization campaign that eradicated polio in Latin America and the Caribbean.
De Quadros was relatively little known outside the loosely affiliated web of national and international health authorities that track and combat communicable diseases. But as a director of one of those groups, the Pan American Health Organization, he was widely credited with carrying out one of the boldest – and seemingly least likely – projects in modern epidemiological history.
Beginning in 1985, he dispatched teams of health workers in 15 countries to the most remote, underdeveloped and war-torn areas of the region to reach Latin America’s most vulnerable people: unimmunized children under 5.
Mustering support was not easy. The World Health Organization’s director general, Halfdan Mahler, at first opposed de Quadros’s plan, saying it made less money available to expand primary health care in the remotest regions. But Mahler and other experts soon came to share de Quadros’s view that vaccination was a starting point for delivering primary health care to children in those places.
“Medicine, sanitation, nutrition, education – all are necessary and interrelated components of preventing and curing sickness,” de Quadros wrote in an article last year. “But there is one tool that stands out as the most effective: vaccines. Every child – no matter where he or she is born – has a fundamental right to vaccines.”
De Quadros focused his efforts primarily on polio, but he also equipped his teams with vaccines against measles, diphtheria, pertussis, tetanus and tuberculosis.
The incidence of polio had declined significantly in Latin America since the development in the early 1960s of the inexpensive Sabin vaccine, which is administered orally and costs a fraction as much per dose as the injected Salk vaccine. But de Quadros and his colleagues knew that epidemics would always be possible until the disease was tracked down and populations immunized against it.
In remote regions, his health workers organized local volunteers, drummed up publicity, enlisted the cooperation of the local health clinic’s few employees and sometimes timed their mass immunizations to coincide with local religious festivals.
They negotiated 24-hour cease-fires between rebel and government forces in El Salvador and Guatemala – so-called tranquillity days – so health workers could administer immunizations. In Peru, where they failed to win the cooperation of the Shining Path guerrillas, the teams worked around those areas controlled by the rebels, keeping the country’s polio hot spots isolated and clearly defined for health workers, who would revisit them after the battle lines had shifted.
De Quadros made record keeping a hallmark of his program. Teams kept track of all families in their assigned areas and sent vaccinators to locate any child who missed an immunization appointment.
The last reported case of polio in Latin America was in Pichinaki, Peru, in 1991. An independent health survey commissioned by the Pan American Health Organization officially declared the disease eradicated in the region in 1994.
“It is difficult to grasp the magnitude of Ciro’s achievement,” said Dr Donald A. Henderson, who led the World Health Organization’s global smallpox eradication initiative in the 1960s and ’70s, and who was dean of the Johns Hopkins School of Public Health from 1977 to 1990.
Henderson, who recruited the young de Quadros to help organize smallpox eradication in Ethiopia, said he was not only a great epidemiologist but also a fearless and inspirational leader.
He recalled de Quadros’s persistence in the midst of Ethiopia’s civil war as a half-dozen of his teams were kidnapped and one of his United Nations helicopters was commandeered with its pilot aboard. He helped negotiate the return of the health teams and the pilot, all of whom resumed their work in the field.
“That’s a measure of the dedication he inspired,” Henderson said. “Even that helicopter pilot”, who had vaccine aboard when he was hijacked, “vaccinated the rebels who held him.”
Ciro Carlos Araujo de Quadros was born into a middle-class family in Rio Pardo, Brazil, on January 30, 1940. After medical school, he graduated from the National School of Public Health in Rio de Janeiro and served his first tour of duty as head of a government clinic in a remote Amazon area.
He worked with Henderson’s WHO campaign from 1970 to 1977. From 1977 to 2002, he held a series of executive positions at the Pan American Health Organization, a subsidiary of the United Nation’s WHO program.
He also taught at Johns Hopkins’s schools of medicine and public health.
In recent years, de Quadros led the Sabin Vaccine Institute’s efforts to eradicate polio globally, as smallpox had been eradicated in the 1960s and ’70s and as polio was in Latin America two decades later.
Getting rid of polio would mean more than “eradicating one disease”, he wrote. It would signal a global commitment to delivering vital vaccines and health programs to all of the world’s children. “Now is the time,” he added, “to harness the power of vaccines to end polio for good.”
Ciro de Quadros is survived by his wife, Susana, daughters Julia and Cristina and stepsons Marcelo and Alvaro. Paul Vitello. New York Times