Brazilian Hero is Gone
Dr. Ciro de Quadros, a Brazilian doctor who carried his work around the world, including through the middle of war zones, died last week in Washington. He was 74 years old. Dr. Quadros lead the immunization campaign that eliminated polio in Latin America and the Caribbean.
The last reported case of polio in Latin America was recorded 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.
Dr. Quadros was relatively unknown outside the national and international health authorities that 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 projects in modern medical history.
Dr. Quadros was from a small city in Rio Grande do Sul. Beginning in 1985, he dispatched teams of health workers in 15 countries to the most remote, underdeveloped, and war-torn areas of Latin America to reach the most vulnerable people: un-immunized children under age 5.
The World Health Organization (W.H.O.) at first opposed Dr. Quadros’s plan, saying it made less money available to expand primary health care in the remotest regions. But the W.H.O. soon came to share Dr. Quadros’s view that vaccination was a starting point for delivering primary health care to children in those remote places.
“Medicine, sanitation, nutrition, education all are necessary and interrelated components of preventing and curing sickness,” he wrote in an article for The Huffington Post 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.”
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 much less than the injected Salk vaccine. But Dr. 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, the so-called “tranquillity days,” so health workers could administer immunizations. In Peru, where they failed to win the cooperation of the Shining Path rebels, 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.
Dr. Quadros made record keeping an essential element 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.
Recently, medical experts made a disturbing discovery in Brazil. According to reports, the polio virus was found in sewage water sampled from the Viracopos International Airport in Campinas. The W.H.O. requires all member states to perform such investigations at regular intervals. In Brazil, water samples have been taken frequently since 1994. The good news is that W.H.O. officials consider the polio finding to be isolated, and don’t believe Brazil is about to experience an outbreak. In fact, experts suspect that the virus was imported to Brazil from another country — specifically, Equatorial Guinea, which is currently experiencing a polio outbreak. Thanks to Dr. Quadros and his team, 95 percent of Brazil’s children already have received the polio vaccine.
“It is difficult to grasp the magnitude of Ciro’s achievement,” said Dr. Donald A. Henderson, who led the W.H.O.’s global smallpox eradication initiative in the 1960s and 70s. Dr. Henderson, who recruited the young Dr. Quadros to help organize smallpox eradication in Ethiopia, said Dr. Quadros was not only a great epidemiologist but also a fearless and inspirational leader.
In recent years, Dr. 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. “Getting rid of polio throughout the world would mean more than eradicating one disease,” he wrote in his Huffington Post article. It would require a global commitment to delivering all vital vaccines and health care programs to the world’s children. “Now is the time,” he added, “to harness the power of vaccines to end polio for good.”
Dr. Henderson recalled Dr. Quadros’s persistence in the midst of Ethiopia’s civil war in the 1960s 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,” Dr. Henderson said. “Even that helicopter pilot, who had vaccine aboard when he was hijacked, vaccinated the rebels who held him.”
[This article originally appeared in The New York Times. It was edited by CIE.]