GLOBALIZING MEASLES IN 1960S

WEST AFRICANoémi Tousignant

McGill UniversityUniversity of Montréal

What is West Africa doing in this film?

• Is measles a serious disease?

• At what cost should/must it be prevented?

• On what basis should the value of measles

vaccination be defined?

The coproduction of measles and vaccination• Measles “reinvented” in discussions and in the knowledge

produced, and transmitted, for and about vaccination.• Public education about seriousness of disease• Policy debate about mass vs. selective vaccination• Cost-benefit calculations• Exponential growth in scientific research

• Altered biologies/epidemiologies, sometimes unintended or unanticipated

• Vaccination policies and practices long “experimental” and shaped by diverse contexts (epidemiology, infrastructure, priorities, etc.): unstable and variable, coproduced with effects and understandings of measles

Coproducing unity/universality or plurality• Two (or +) measles or one?• How did vaccination differentiate or universalize measles?• 1960s: concerted mobilization of vaccination and

universalization of measles (but not uncontested)• 1970s-1990s: research on vulnerability and high-titer

vaccine• 2000s: global elimination, “SIAs”, generalization of second

dose, GAVI and Measles & Rubella Initiative

Multi-sited coproduction

• “Decentered” or multi-centric approach

• 1960s: U.S. institutions (Merck, USPHS, NIH,

USAID, CDC) major drivers of measles

vaccination

• How to re-center in West Africa?

“Discovering” West African Measles

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MEDICINE IN THE TROPICS

Severe Measles in the Tropics.-1

DAVID MORLEY,* M .D.

lmesi village, longitudinal study of under-5 mortalitv

Measles: Ho\V Serious Is It?'

How Advisable Is i 1easle cci11atio11?

First trialsUSA: 1954: isolation of measles virus in tissue culturesUSA: 1958, n=13, “institution for the mentally deficient” (ECG study 1956-1958)Panama: 1959, c.450 during epidemicUSA: 1960, 3-400 experimental vaccinationsNigeria: end 1960, n-56, WellcomeUK: early 1961, n=56, “mentally deficient children”USA: by 1961, 10 000 experimental vaccinationsUpper Volta: late 1961 n=683 (Merck, NIH)• WHO-sponsored studies (with USPHS grants) in Chile,

India, South Africa, Iceland Japan, Nigeria, USSR, Yugoslavia, 1962-1963 (then Canada, Switzerland…)

Upper Volta Trials and pilots• June 1961: Paul Lambin visits NIH• Nov 1961-Jan 1962: trial in Ouagadougou, to see whether reactions are “excessive”

• Oct 1962: pilot of jet injection and combined administration with yellow fever and smallpox

• Nov 1962-March 1963 pilot mass campaign, c. 730 000 NIH, OCCGE (by 1963, about 1.5 vaccinations in U.S.)

• Extension of trials to 7 other countries• Trial in Niakhar, 1963: Senegal refuses Edmonston B

• Extension of mass campaign: 3 M vaccinations by Ed B, 1 M w Schwartz

• Integration into “French” mass mobile medicine system of OCCGE. Still funded by USAID

The Smallpox and Measles Program• 1958: WHA resolution on smallpox eradication

• 1965: President Johnson announces U.S. will back SEP

and launch own program for smallpox eradication and

measles control in West Africa

• 1966-1972 USAID-funded, CDC-run “Smallpox

Eradication and Measles Control Program” in West then

also Central Africa

PICTORIAL PARADE GHANA LAUNCHES DRIVE AGAINST SMALLPOX ANO MEASLES

AS A PART OF NEW 19 ·NATION WEST AFRICAN CAMPAIGN

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Rafe Henderson• Joined CDC-EIS in 1965• Sent as technical advisor to OCCGE• Worked on SMP• Head of WHO’s Expanded Program on Immunization

(EPI)

R. H. Henderson on NIH trials“And it was an astounding success. They covered most of Upper Volta in a few months, with mobile teams, and did it very well. They had high vaccination coverage, and measles pretty well disappeared. Now, that was a self-serving exercise, in that we, the United States, wanted to test the measles vaccine on a large scale. Here was an area where this could be done, where it was desperately needed, where kids were dying of this disease, and you would have had to have a very, very bad vaccine indeed, not to be ethically justified in doing a [trial].”

R.H. Henderson on CDC/USAID• “One of the reasons that USAID was willing to go along with D. A. Henderson and others at CDC in joining a smallpox eradication program, which USAID wasn’t interested in, with the measles program, which USAID was interested in, was that they knew that they couldn’t do much with the measles program unless they had some good technical support… Because the United States had the measles vaccine and no other nation did, it was perceived that a measles immunization program allowed the United States entryway into West Africa, where the French culture was dominant…”

R.H. Henderson on WA demand and infrastructure• “But here was a neutral health ground – very popular concept. All the countries desperately wanted the measles vaccine because measles was such a bad disease.”

• “Now, the French were very good at doing mass campaigns; there was no problem with that. The problem was that they were not very good at dealing with this funny, electrical jet injector… and…not very good at dealing with the many, many difficulties in supply and logistics posed by our USAID and U.S. Gov contributions…”

Global Great Society and Smallpox Eradication

•B. Reinhardt: “S&T as way of to realize peace and prosperity while confronting communism”

•“achieve foreign policy objectives by mastering the non-human world”

CDC: abroad and at home• Langmuir creates EIS

• West Africa as opportunity to demonstrate international expertise and use USAID funding

• Jet injector (introduction of bifurcated needle in West African campaign in 1968, innovation of “escalation-eradication”

• Narrowed focus on smallpox eradication – achieved c. 1970 in WA – as “retreat” from global great society objectives

• Promotion of mass vaccination and eradication in U.S.

EPIDEMIOLOGIC BASIS FOR ERADICATION OF MEASLES IN 1967

David J. Sencer, M.D.

H. Bruce Dull, M.D.

Alexander D. Lang muir, M.D .

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The Global Elimination of Measles

WILLIAM H. FOEGE, MD

The West African Precedent There is an historic precedent for interrupting chains of transmission of measles, a first step in the direction of eradication. In 1967, 20 countries of West Africa integrated their measles immunizations programs with a coordinated regional program for smallpox eradi­cation. Mobile vaccination teams took vaccine to the

POTENT A CANDIDATES FC

World Eradication of Measles

an R. Hinman

From a theoretical and technical point or view, m1c

wor·~d . This disease has been e~iminated for a period in the d.eveloping world (The Gambia) .. Experience i -- -~11 L - - I! · - - : - - .1. • ..:I t' .. _ - - _ .i1.1- _ ... _ _ • .1. _. • • "" t . ill" ..

“African” demand?• “Instrumentalization” and simplification of enthusiasm?• Lobbying and negotiation at the WHA

• Lambin in 1963: measles “the most deadly disease among children in my country”

• In name of his people and sp. Mothers, to USA “how deeply grateful we are for its effective, speedy and valuable help which is responsible for snatching thousands of innocent chlidren from the jaws of death.”

• Hesitations muted:• Lambin in 1964, denies: “rumors circulated in certain quarter to the

effect that there had been a large number of casualties and the campaign ended in failure and that the gov authorities…had hushed the matter up.” Declares: unprecedented success, demand for continuation.

• Nigeria trials: Ed B type vaccine unsuitable• Senegal: demand for Schwarz

• Concerns about continuity• UV in 1965: “we are losing ground but I feel that with the aid of all

those concerned by the state of health in our countries and who are in a position to help us, we will again be able to combat the disease.”

• Broader hopes• Nigeria in 1965: “It [the USAID-funded SMP] will also provide an

infrastructure and organizational experience for tackling other epidemic diseases.”

West Africa and Measles in the 1960s• Testing grounds (laboratory)• Stage for display: killer measles, effective vaccine, American foreign aid and technocratic expertise

• Model for eradication• Intensity of demand for vaccination, legitimation of American intervention and value of vaccination

• Coproduction between US and WA• But how to re-center this story?