Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-21T20:53:18.241Z Has data issue: false hasContentIssue false
  • English
  • Français

Priority, Invisibility and Eradication: The History of Smallpox and the Brazilian Public Health Agenda

Published online by Cambridge University Press:  07 December 2011

Gilberto Hochman
Gilberto Hochman
Affiliation:
Casa de Oswaldo Cruz, Oswaldo Cruz Foundation, Av. Brasil 4036/403, 21045-900 Rio de Janeiro, Brazil; e-mail: hochman@coc.fiocruz.br
Rights & Permissions [Opens in a new window]

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This article describes three periods in Brazil's modern history when governmental action was (or was not) taken against smallpox: first, when smallpox control became a priority in the Brazilian sanitary agenda from the nineteenth century to the beginning of the twentieth century; second, when it was rendered politically invisible during decades when greater attention was given to yellow fever and malaria control; third, when it reappeared at the centre of Brazilian health policy in the 1960s until its eventual eradication in 1973. Smallpox control in the latter two periods is suffused with paradox. For example, evidence suggests that the nearly fifty-year absence or lack of policies and agencies to deal with smallpox actually favoured the mobilization of local, national and international resources once the eradication programme was launched in 1966; these new approaches were accelerated from 1969 until the completion of eradication in 1973. Equally paradoxical, it was during the specific context of the military regime after 1964 that the Brazilian health system developed the capacity to mobilize existing but dispersed resources and flexibly to innovate, incorporate, and adapt new policies. Another important element in this period was institutional learning based on other vertical programmes such as the malaria eradication campaign. Although the Brazilian smallpox eradication programme was constrained by international agencies and by bilateral co-operation with the United States, the period after 1964 offered opportunities for the realization of a new and wide-ranging national health capacity including the creation of a national system of epidemiological surveillance and a national childhood immunization programme. It also saw the empowerment of young physicians who would later come to occupy key positions in Brazilian public health and in international health organizations.

Type
Articles
Information
Medical History , Volume 53 , Issue 2 , April 2009 , pp. 229 - 252
Copyright
Copyright © The Author(s) 2009. Published by Cambridge University Press

References

1For example, Frank Fenner, D A Henderson, I Arita, Z Ježek and I D Ladnyi, Smallpox and its eradication, Geneva, World Health Organization, 1988; Donald A Henderson and G Miller, The history of smallpox eradication, Baltimore, Johns Hopkins University Press, 1980; Bichat A Rodrigues, ‘Smallpox eradication in the Americas’, Bull. Pan Am. Health Organ., 1975, 9: 53–68; Carolina S Barreto, ‘Fragmentos da história da erradicação da varíola nos estados da Bahia e Sergipe’, Revista baiana de saúde pública, 2003, 27: 106–13. Few historians have written about the Brazilian smallpox eradication campaign; the exception is Tania Maria Fernandes, ‘Varíola: doença e erradicação’, in D R Nascimento and D M de Carvalho (eds), Uma história brasileira das doenças, Rio de Janeiro, Paralelo 15, 2004, pp. 211–28.

2Sanjoy Bhattacharya, Expunging variola: the control and eradication of smallpox in India, 1947–1977, New Delhi, Orient Longman, 2006; Steven Palmer, ‘Central American encounters with Rockefeller public health, 1914–1921’, in G M Joseph, C C LeGrand and R D Salvatore (eds), Close encounters of empire: writing the cultural history of U.S.–Latin American relations, Durham, NC, Duke University Press, 1998, pp. 311–32; Anne-Emanuelle Birn, ‘O nexo nacional-internacional na saúde pública: o Uruguai e a circulação das políticas e ideologias de saúde infantil, 1890–1940’, Hist. Cienc. Saude-Manguinhos, 2006, 13: 675–708; André L V Campos, ‘Politiques internationales (et réponses locales) de santé au Brésil: le Service Spécial de Santé Publique, 1942–1960’, Can. Bull. Med. Hist., 2008, 25, 111–36; Marcos Cueto, Cold war, deadly fevers: malaria eradication in Mexico, 1955–1975, Washington, DC, Woodrow Wilson Center Press, and Baltimore, Johns Hopkins University Press, 2007.

3Outbreaks of cholera were also important in the middle of the nineteenth century, while bubonic plague gained sanitary relevance in the second half of that century. See Donald B Cooper, ‘Brazil's long fight against epidemic disease, 1849–1917, with special emphasis on yellow fever’, Bull. N. Y. Acad. Med., 1975, 51: 672–96, pp. 673–5.

4Cooper, op. cit., note 3 above; Plácido Barbosa and Cassio B Rezende, Os serviços de saúde pública no Brasil, especialmente na cidade do Rio de Janeiro, 1808–1907 (esboço histórico e legislativo), Rio de Janeiro, Imprensa Nacional, 1909; Sidney Chalhoub, Cidade febril: cortiços e epidemias na corte imperial, São Paulo, Companhia das Letras, 1996; Jaime L Benchimol, Pereira Passos: um Haussmann tropical. A renovação urbana da cidade do Rio de Janeiro no início do século XX, Rio de Janeiro, Prefeitura da Cidade do Rio de Janeiro, 1990.

5Lycurgo de Castro Santos Filho, História geral da medicina brasileira, 2 vols, São Paulo, Hucitec/Edusp, 1991, vol.1, pp. 270–1; Chalhoub, op. cit., note 4 above, p. 107.

6Tania M Fernandes, Vacina antivariólica: cie^ncia, técnica e o poder dos homens, 1808–1920, Rio de Janeiro, Editora Fiocruz, 1999, pp. 29–46; Chalhoub, op. cit., note 4 above.

7Fernandes, op. cit., note 6 above. Vaccination institutes were also created in the provinces of São Paulo, Rio Grande do Sul and Minas Gerais.

8Fernandes, op. cit., note 6 above; Tania M Fernandes, ‘Vacina antivariólica: seu primeiro século no Brasil (da vacina jenneriana à animal)’, Hist. Cienc. Saude-Manguinhos, 1999, 6: 29–51, p. 37; Massako Iyda, Cem anos de saúde pública: a cidadania negada, São Paulo, Editora Unesp, 1994, pp. 15–22.

9Some authors stress that the only obligation actually met was the vaccination of the African slaves that worked on farms; this was due to the demand from land- and slave-owners. See Fernandes, op. cit., note 8 above. Other authors also suggest that the main targets of vaccination were the newly arrived African slaves about to be sold. Chalhoub, op. cit., note 4 above; Mary C Karasch, A vida dos escravos no Rio de Janeiro (1808–1850), São Paulo, Companhia das Letras, 2000, pp. 214–16. There are suggestions that outbreaks in the 1830s and 1840s coincided with the years when high numbers of slaves arrived in Brazil from Africa. Karasch, op. cit.; Dauril Alden and Joseph C Miller, ‘Out of Africa: the slave trade and the transmission of smallpox to Brazil, 1560–1831’, J. Interdiscip. Hist., 1987, 18: 195–224.

10Santos Filho, op. cit., note 5 above, in vol. 2.

11Tania M Fernandes, ‘Imunização antivariólica no século XIX no Brasil: inoculação, variolização, vacina e revacinação’, Hist. Cienc. Saude-Manguinhos, 2003, 10: 461–74, suppl. 2; idem, ‘Vacina antivariólica: visões da Academia de Medicina no Brasil imperial’, Hist. Cienc. Saude-Manguinhos, 2004, 11: 141–63, suppl. 1.

12Barbosa and Rezende, op. cit., note 4 above; Galdino do Valle, ‘Leis orgânicas de hygiene e saúde pública’, in Livro do centenário da Câmara dos Deputados, 2 vols, Rio de Janeiro, Imprensa do Brasil, 1926, vol. 1, pp. 497–518.

13Records from 1873 show 697 deaths per 100,000 inhabitants; by 1878 deaths had reached 783 per 100,000. ‘Varíola – Trabalho para a Comissão Internacional de Certificação, 1973’, box 51, fol. 3, Cláudio do Amaral papers, Casa de Oswaldo Cruz-Oswaldo Cruz Foundation (hereafter COC-Fiocruz), Rio de Janeiro, table I, p. 2. This is the best source for data relating to the history of smallpox cases and mortality.

14Ibid. Deaths rose to the impressive number of 874 per 100,000 inhabitants in the city. For the so-called “First Republic” (1889–1930), the available information about vaccination, smallpox cases and mortality relates almost exclusively to Rio de Janeiro city.

15Fernandes, op. cit., note 6 above, pp. 40–54; Fernandes, op. cit., note 8 above, pp. 42–6.

16Benchimol, op. cit., note 4 above; Jaime L Benchimol (ed.), Manguinhos do sonho à vida: a cie^ncia na belle époque, Rio de Janeiro, Casa de Oswaldo Cruz-Fundação Oswaldo Cruz, 1990, pp. 22–6; Teresa A Meade, “Civilizing” Rio: reform and resistance in a Brazilian city, 1889–1930, University Park, Pennsylvania State University Press, 1997, pp. 75–101.

17For further information about Oswaldo Cruz, see Nara Britto, Oswaldo Cruz: a construção de um mito na cie^ncia brasileira, Rio de Janeiro, Editora Fiocruz, 1995; Gilberto Hochman and Nara Azevedo, ‘Oswaldo G. Cruz', in W F Bynum and H Bynum (eds), Dictionary of medical biography, 5 vols, Wesport, CT, Greenwood Press, 2007, vol. 4, pp. 378–80; Benchimol, op. cit., note 16 above; Jaime L Benchimol, Febre amarela: a doença e a vacina, uma história inacabada, Rio de Janeiro, Editora Fiocruz, 2001, pp. 41–68; Fernandes, op. cit., note 6, pp. 47–82.

18Britto, op. cit., note 17 above; Benchimol, op. cit., note 16 above; Benchimol, op. cit., note 17 above; Jaime L Benchimol and Luiz Antonio Teixeira, Cobras, lagartos & outros bichos: uma história comparada dos institutos Oswaldo Cruz e Butantan, Rio de Janeiro, Editora UFRJ, 1993; Nancy L Stepan, Beginnings of Brazilian science: Oswaldo Cruz, medical research and policy, 1890–1920, New York, Science History Publications, 1976. Oswaldo Cruz directed the Instituto Oswaldo Cruz until his death in 1917; his successor was Carlos Chagas, who discovered American trypanosomiasis or Chagas disease.

19Benchimol, op. cit., note 16 above; Chalhoub, op. cit., note 4 above, ch. 3; Fernandes, op. cit., note 6 above, pp. 54–71; Meade, op. cit., note 16 above; José Murilo de Carvalho, Os bestializados: o Rio de Janeiro e a república que não foi, São Paulo, Companhia das Letras, 1987.

20On the revolt, see the references in Benchimol, op. cit., note 4 above; Carvalho, op. cit., note 19 above; Chalhoub, op. cit., note 4 above, ch. 3; Meade, op. cit., note 16 above; Teresa A Meade, ‘“Civilizing Rio de Janeiro”: the public health campaign and the riot of 1904’, J. Soc. Hist., 1986, 20: 301–22; Nilson do Rosário Costa, Lutas urbanas e controle sanitário: origens das políticas de saúde no Brasil, Petrópolis, Vozes/Associação Brasileira de Pós-Graduação em Saúde Coletiva, 1985; Jeffrey D Needell, ‘The Revolta contra vacina of 1904: the revolt against “modernization” in belle-epoque Rio de Janeiro’, Hisp. Am. Hist. Rev., 1987, 67: 233–69; Nicolau Sevcenko, A revolta da vacina: mentes insanas em corpos rebeldes, rev. ed., São Paulo, Brasil, Scipione, 1993.

21This argument is developed in Chalhoub, op. cit., note 4 above, pp. 134–51.

22Carvalho, op. cit., note 19 above, pp. 95–113.

23‘Varíola – Trabalho para a Comissão Internacional de Certificação, 1973’, op. cit., note 13 above, pp. 3–4.

24Ibid.; Achilles Scorzelli Jr, ‘A importância da varíola no Brasil, 1964’, Arquivos de Higiene, 1965, 21: 3–64, p. 17.

25Barbosa and Rezende, op. cit., note 4, pp. 890–901; Meade, op. cit., note 16 above, pp. 112–13; Dinis Almáquio, O estado, o direito e a saúde pública, Rio de Janeiro, n.p., 1929, pp. 9, 16.

26The State Superior Court revoked the decision. A Noite, 21 Jan. 1926, in ‘Livro de recortes de jornais’ (Newspapers clipping book), Carlos Chagas papers, COC-Fiocruz.

27‘Varíola – Trabalho para a Comissão Internacional de Certificação, 1973’, op. cit., note 13 above, p. 4.

28Luiz Antônio de Castro Santos, ‘O pensamento sanitarista na primeira república: uma ideologia de construção da nacionalidade’, Dados-Revista de Cie^ncias Sociais, 1985, 28: 237–50; Gilberto Hochman, A era do saneamento: as bases da política de saúde pública no Brasil, São Paulo, Hucitec-Anpocs, 1998, ch. 2; Nísia Trindade Lima, Um sertão chamado Brasil: intelectuais e representação geográfica da identidade nacional, Rio de Janeiro, Editora Revan-Iuperj, 1999, ch. 4.

29Benchimol, op. cit., note 17 above; John Farley, To cast out disease: a history of the International Health Division of the Rockefeller Foundation (1913–1951), Oxford University Press, 2004; Ilana Löwy, Vírus, mosquitos e modernidade: a febre amarela no Brasil entre cie^ncia e política, Rio de Janeiro, Editora Fiocruz, 2006.

30Hochman, op. cit., note 28 above, ch. 3.

31Gilberto Hochman and Cristina O Fonseca, ‘O que há de novo? Políticas de saúde pública e previde^ncia, 1937–45’, in D Pandolfi (ed.), Repensando o Estado Novo, Rio de Janeiro, Editora FGV, 1999, pp. 73–93.

32Gilberto Hochman, ‘Cambio político y reformas de la salud pública en Brasil. El primer gobierno Vargas (1930–1945)’, Dynamis, 2005, 25: 199–226.

33João Baptista Risi Júnior, ‘A produção de vacinas é estratégica para o Brasil: entrevista com João Baptista Risi Júnior', Hist. Cienc. Saude-Manguinhos, 2003, 10: 771–83, suppl 2.

34On vaccine production during Getúlio Vargas's government, see Benchimol, op. cit., note 17 above; Dilene R do Nascimento, Fundação Ataulfo de Paiva – Liga Brasileira contra a Tuberculose, um século de luta, Rio de Janeiro, Quadratim-Faperj, 2002, pp. 89–106.

35‘Anais da I Confere^ncia Nacional de Saúde’, GC 36.05.26, Gustavo Capanema papers, Centro de Pesquisa e Documentação em História Contemporânea do Brasil/Fundação Getúlio Vargas. For analysis of the conference, see Gilberto Hochman and Cristina O Fonseca, ‘A I Confere^ncia Nacional de Saúde: reformas, políticas e saúde pública em debate no Estado Novo’, in Angela M C Gomes (ed.), Capanema: o ministro e seu ministério, Editora FGV, 2000, pp. 173–93.

36About the eradication of the Anopheles gambiae in Brazil, see Randall Packard and Paulo Gadelha, ‘A land filled with mosquitos: Fred L. Soper, the Rockefeller Foundation and the Anopheles gambiae invasion of Brazil’, Parassitologia, 1994, 36: 197–213; Farley, op. cit., note 29 above, pp. 138–41.

37At the same time other national services were created to combat diseases considered then as priorities: yellow fever, tuberculosis, leprosy, bubonic plague, mental diseases and cancer.

38Hélbio Fernandes Moraes, SUCAM: sua origem, sua história, 2 vols, Brasília, Ministério da Saúde, 1990.

39For SESP, see Campos, op. cit., note 2 above; Nilo C B Bastos, SESP/FSESP: evolução histórica, 1942–1991, 2nd ed., Brasília, Ministério da Saúde, Fundação Nacional de Saúde, 1996. SESP remained autonomous in its important preventative actions and basic health services until the 1970s and participated in the smallpox eradication campaign between 1966 and 1973.

40The new department was authorized to combat what were called “rural endemic diseases”: malaria, leishmaniasis, Chagas disease, plague, brucellosis, yellow fever, schistosomiasis, ancylostomiasis, hydatiosis, goitre, buboes and trachoma. Smallpox was never included in this category.

41Regarding Kubitschek's developmentist project and term, see Angela M C Gomes (ed.), O Brasil de JK, 2nd ed., Rio de Janeiro, Editora da FGV, 2002; Celso Lafer, JK e o programa de metas (1956–61): processo de planejamento e sistema político no Brasil, Rio de Janeiro, Editora FGV, 2002. For Brazilian programmes for the control and eradication of malaria, see Gilberto Hochman, ‘From autonomy to partial alignment: national malaria programmes in the time of global eradication, Brazil, 1941–61’, Can. Bull. Med. Hist., 2008, 25: 201–32.

42Juscelino Kubitschek de Oliveira, Mensagem ao Congresso Nacional remetida pelo Presidente da República por ocasião da abertura da sessão legislativa de 1956, Rio de Janeiro, Imprensa Nacional, 1956, pp. 185–6.

43The idea of bounded approach is taken from Randall M Packard and Peter J Brown, ‘Rethinking health, development, and malaria: historicizing a cultural model in international health’, Med. Anthropol., 1997, 17: 181–94.

44“A nosso favor está a coincide^ncia de que, exatamente para muitas destas enfermidades que mais afligem as populações dos países subdesenvolvidos, novas descobertas da terape^utica e da profilaxia tenham tornado o seu combate, e consequ¨entemente sua grande redução, ou mesmo eliminação, independente dos problemas de desenvolvimento econômico e de aparelhamento médico-sanitário de custo elevado.” Brasil. Kubitschek de Oliveira, op. cit., note 42 above, p. 187.

45AID/United States AID Mission to Brazil, ‘Audit report of Malaria Eradication under Project Agreement n.512-11-510-014 for the period 1 Nov. 1960 through 30 Sep. 1964’, Rio de Janeiro, 9 Dec. 1964, (http://dec.usaid.gov/); Enrique Villalobos, et al., ‘Evaluation of the malaria eradication programme in Brazil', USAID, 1964; Eugene P Campbell, ‘The role of the International Cooperation Administration in international health’, Arch. Environ. Health, 1960, 1: 502–11.

46Kelley Lee, ‘Intensified smallpox eradication program’, in K Lee, Historical dictionary of the World Health Organization, Lanham, MD, Scarecrow Press, 1998, pp. 131–2; Rodrigues, op. cit., note 1 above.

47Juscelino Kubitschek de Oliveira, Mensagem ao Congresso Nacional remetida pelo Presidente da República por ocasião da abertura da sessão legislativa de 1958. Rio de Janeiro, Imprensa Nacional, 1958, p. 274.

48Ibid., p. 272.

49Rodrigues, op. cit., note 1 above, p. 55; Scorzelli Jr, op. cit., note 24 above, p. 15; ‘Topic 23: Status of smallpox eradication in the Americas’, XV Pan American Sanitary Conference, San Juan, Puerto Rico, Pan American Sanitary Organisation, 1958, CSP15/17 (Eng.), Cláudio do Amaral papers, COC-Fiocruz, Rio de Janeiro.

50Rodrigues, op. cit., note 1 above, p. 55; Fenner, et al., op. cit., note 1 above, pp. 593–603.

51Kubitschek de Oliveira, op. cit., note 47 above.

52Alexandra de Mello Silva, ‘Desenvolvimento e multilateralismo: um estudo sobre a Operação Pan-Americana no contexto da política externa de JK’, Contexto Internacional, 1992, 14: 209–39.

53Ibid.; Paulo F Vizentini, Relações exteriores do Brasil (1945–1964): o nacionalismo e a política externa independente, Petrópolis, Vozes, 2004.

54On the ‘Discurso sobre a Operação Pan-Americana’, of 20 June 1958, see Silva, op. cit., note 52 above; ‘Operation Pan America’, in Larman C Wilson and David W Dent, Historical dictionary of Inter-American organizations, Lanham, MD, Scarecrow Press, 1998, p. 131.

55Silva, op. cit., note 52 above.

56Vizentini, op. cit., note 53 above; ‘Alliance for Progress’, in Wilson and Dent, op. cit., note 54 above, pp. 27–9.

57See ‘Información general – Reunión de Punta del Este, Uruguay’, Bol. Oficina Sanit. Panam., 1961, 51: 473–93.

58Socrates Litsios, The tomorrow of malaria, rev. ed., Karori, NZ, Pacific Press, 1997; José A Nájera, ‘Malaria control: achievements, problems and strategies’, Parassitologia, 2001, 43:1–89; Javed Siddiqi, World health and world politics: the World Health Organization and the UN system, Columbia, SC, University of South Carolina Press, 1995, pp. 141–5.

59‘Anuário estatístico do Brasil 1961’, Rio de Janeiro, Instituto Brasileiro de Geografia e Estatística, 22, 1961, table IIIB3a (CD-ROM Estatísticas do Século XX, IBGE, 2003); ‘Anuário Estatístico do Brasil 1964’, Rio de Janeiro Instituto Brasileiro de Geografia e Estatística, 25, 1964, table IIB3 (CD-ROM Estatísticas do Século XX, IBGE, 2003).

60Benchimol, op. cit., note 17 above, pp. 310–19.

61Vizentini, op. cit., note 53 above; Leticia Pinheiro, Política externa brasileira (1889–2002), Rio de Janeiro, Jorge Zahar, 2004, pp. 33–6.

62The rise of this group was aborted by the fall of democracy; many of them were accused of being communists and were persecuted by the military regime. Maria Eliana Labra, ‘1955–1964: o sanitarismo desenvolvimentista’, in S Fleury Teixeira (ed.), Antecedentes da reforma sanitária, Rio de Janeiro, Escola Nacional de Saúde Pública-Fundação Oswaldo Cruz, 1988, pp. 9–36; Nísia Trindade Lima, Cristina O Fonseca and Gilberto Hochman, ‘A saúde na construção do estado nacional no Brasil: a reforma sanitária em perspectiva histórica’, in N T Lima, S Gerschman, F C Edler and J M Suárez, Saúde e democracia: história e perspectivas do SUS, Rio de Janeiro, Editora Fiocruz, 2005, pp. 27–58, on pp. 54–5.

63For example, the news was published in Jornal do Brasil, 18 Jan. 1962, p. 3; O Correio da Manhã, 24 Jan. 1962, p. 2.

64See O Estado de São Paulo, 16 Jan. 1962, p. 4. After the transfer of the capital from Rio de Janeiro to Brasília, the latter became the new city-state of Guanabara. Although no longer the seat of the national government, many federal organizations and public services remained in Rio until the 1970s, and during this transition period it continued to be one of the country's most important cities and the main point of departure from the country and entry from abroad.

65Bastos, op. cit., note 39 above, pp. 270–1.

66‘Plano de operação para o Programa de Erradicação da Varíola no Brasil’, c.1966, Box 20, fol. 20, Cláudio do Amaral papers, COC-Fiocruz, tables 1 and 2, pp.13–16; ‘Varíola – Trabalho para a Comissão Internacional de Certificação, 1973’, op. cit., note 13 above, pp. 5–7; Risi Júnior, op. cit., note 33 above, p. 774.

67In retrospect, the main actors involved in the post-1966 eradication campaign are strongly critical of the 1962–66 campaign, including the alleged decrease in the number of cases. In their evaluation, the confusion about numbers was a result of the unreliable registration system. Another drawback was that critical problems such as the production of vaccine in sufficient amounts and of proper quality had not been resolved. The newspaper O Correio da Manhã of 27 Jan. 1962, stated that the campaign would have to wait until the Oswaldo Cruz Institute had sufficient freeze-dried vaccine in stock, p. 2.

68Rodrigues, op. cit., note 1 above; Donald A Henderson, ‘Smallpox eradication—the final battle’, J. Clin. Path., 1975, 28: 843–9, p. 845, fig. 1.

69Presidential Decree n.59153, 31 Aug. 1966, regulated the Smallpox Eradication Campaign (CEV). By the Presidential Decree n.61376, 18 Sep. 1967, CEV became directly subordinated to the Ministry of Health.

70“… lamentavelmente ainda se inscreve entre os mais importantes focos de varíola do mundo e o mais relevante do continente americano.” The Minister's explanations and declarations were published in daily newspapers in Rio de Janeiro and São Paulo: O Correio da Manhã, 27 Aug. 1966, p. 11, and 31 Aug. 1966, p. 7; Folha de São Paulo, 27 Aug. 1966, p.7; O Globo, 27 Aug. 1966, p. 3, and 30 Aug. 1966, p. 9; O Estado de São Paulo, 31 Aug. 1966, p. 6.

71See O Globo, 27 Aug. 1966, p. 3.

72In 1970 USAID financed 30 per cent of the total budget for the programme, and in 1971 75 per cent. ‘Varíola – Trabalho para a Comissão Internacional de Certificação, 1973’, op. cit., note 13 above, Quadro XXII, p. 44.

73O Globo, 27 Aug. 1966, p. 3; O Correio da Manhã, 27 Aug. 1966, p. 11.

74For example, Oswaldo José da Silva, first director of the eradication programme, and his successor Cláudio do Amaral Jr. The SESP Foundation (FSESP), created by the Brazil-United States agreements in 1942 (see note 39) remained as an autonomous department within the Ministry of Health with rigorous training standards and higher wages than the other departments in the Ministry. Da Silva also had worked with Fred Soper in the eradication of the mosquito A. Gambiae. Other FSESP physicians had outstanding leadership roles in the campaign in the states, such as João Batista Risi Jr, coordinator of eradication in the city of Rio de Janeiro. Marcolino Candau, then OMS General Director, began at SESP and was its Director in the period 1947–50. Bastos, op. cit., note 39 above; Risi Júnior., op. cit., note 33 above; Márcio M Andrade, ‘Proposta para um resgate historiográfico: as fontes do SESP/FSESP no estudo das campanhas de imunização no Brasil’, Hist. Cienc. Saude-Manguinhos, 2003, 10: 843–8. suppl. 2.

75On the strategy of vaccination and surveillance teams creation, see ‘Plano de operação para o Programa de Erradicação da Varíola no Brasil’, c.1966, op. cit., note 66 above.

76Tests described by Ricardo Veronesi, L F Gomes, M A Soares and A Correa, ‘Importância de “jet-injector” (injeção sem agulha) em planos de imunização em massa no Brasil: resultados com as vacinas antitetanica e antivariólica’, Ver. Hosp. Clin. Fac. Med. Sao Paulo, 1966, 2: 92–5; J D Millar, T M Mack, A A Medeiros, L Morris and W Dyal, ‘Relatório à Organização Pan-Americana da Saúde sobre o emprego da injetora a pressão na Campanha Nacional Contra a Varíola’, Arquivos de Higiene, 1965, 21: 65–140; J D Millar, L Morris, A Macedo Filho, T M Mack, W Dyal and A A Medeiros, ‘The introduction of jet injection mass vaccination into the national smallpox eradication program of Brazil’, Trop. Geogr. Med., 1971, 23: 89–101.

77The eradication programmes were divided into four phases: preparatory, attack, consolidation, and surveillance and maintenance. ‘Varíola – Trabalho para a Comissão Internacional de Certificação, 1973’, op. cit., note 13 above.

78Ibid., pp. 12–71.

79This strategy was deliberate and made explicit in ‘Plano de operação para o Programa de Erradicação da Varíola no Brasil’, c.1966, op. cit., note 66 above, pp. 7–9, and appears in the ‘Manual do Vacinador’(Vaccinator Guide), Box 50, fol. 15, Cláudio do Amaral papers, COC-Fiocruz.

80“… obter suficiente motivação da comunidade, trabalhando seus líderes naturais e utilizando meios de divulgação e demonstração adequados ao nível educacional das referidas comunidades.” ‘Plano de operação para o Programa de Erradicação da Varíola no Brasil’, c. 1966, op. cit., note 66 above, p. 22.

81The social and political environment of the campaign was described by a journalist on the final phase of the mass vaccination and published in Jornal do Brasil, 30 Apr. 1971, p.13: “Three hundred civil servants of the Ministry of Health spread through 150 vaccination posts initiated yesterday in Recife [capital of State of Pernambuco, north-east region] the Smallpox Eradication Campaign, vaccinating 78,450 persons. The success of the first day brings enthusiasm to the vaccinators and they are certain that the work will be finished in less time than previously established. When the vaccination is over in Pernambuco, the group will go to Alagoas, Rio Grande do Norte and Piauí, the last Brazilian states to benefit from the Campaign.” (“Trezentos funcionários do Ministério da Saúde, espalhados em 150 postos iniciaram ontem no Recife, a Campanha de Erradicação da Varíola, vacinando 78.450 pessoas. O sucesso no primeiro dia entusiasma os vacinadores, que te^m certeza de que vão acabar o trabalho num prazo muito menor do que o estabelecido. Quando terminar a vacinação em Pernambuco, o grupo seguirá para Alagoas, Rio Grande do Norte e depois Piauí, os últimos estados brasileiros a serem beneficiados pela Campanha.”)

82Rodrigues, op. cit., note 1 above, p. 60.

83Fenner, et al., op. cit., note 1 above, pp. 622–4; Rodrigues, op. cit., note 1 above, p. 59; ‘Surveillance in the Brazilian Smallpox Eradication Program’, 1970 (Report to PAHO), Box 17, fol. 01, p. 2, Cláudio do Amaral papers, COC-Fiocruz. On the role of the Connaught Laboratories, see Christopher J Rutty, ‘Canadian vaccine research, production and international regulation: Connaught Laboratories and smallpox vaccines, 1962–1980’, in K Kroker, P Mazumdar and J Keelan (eds), Crafting immunity: working histories of clinical immunology, Aldershot, Ashgate, 2008, pp. 273–300.

84Fenner, et al., op. cit., note 1 above, pp. 622–4; Rodrigues, op. cit., note 1 above, p. 59.

85Carlos F da Ponte, ‘Vacinação, controle de qualidade e produção de vacinas no Brasil a partir de 1960’, Hist. Cienc. Saude-Manguinhos, 2003, 10: 619–53, suppl. 2; José G Temporão, ‘O programa nacional de imunização no Brasil: origens e desenvolvimento’, Hist. Cienc. Saude-Manguinhos, 2003, 10: 601–17, suppl. 2.

86‘Plano de Operação para o Programa de Erradicação da Varíola no Brasil’, c.1966, op. cit., note 66 above, pp. 11–12. Information on epidemiological surveillance can be found in ‘Varíola – Trabalho para a Comissão Internacional de Certificação, 1973’, op. cit., note 13 above, pp. 45–71.

87‘Surveillance in the Brazilian Smallpox Eradication Program’, op. cit., note 83 above.

88José F de S Verani, Eduardo P Maranhão and F Laender, ‘Desenvolvimento dos sistemas de vigilância epidemiológica da varíola e da poliomelite: a transformação de conceitos em categorias operacionais’, Cad. Saude Pública, 1993, 9: 28–38; Arlene A B Gaze^ta, Diana M de Carvalho, Luiz Fernando R Tura and Rosangela Gaze, ‘A campanha de erradicação da varíola no Brasil e a instituição do sistema de vigilância epidemiológica’, Cadernos Saúde Coletiva, 2005, 13: 323–38.

89‘Varíola – Trabalho para a Comissão Internacional de Certificação, 1973’, op. cit., note 13 above, Quadro XXXI, p. 62; Gaze^ta, et al., op. cit., note 88 above.

90Fenner, et al., op. cit., note 1 above, pp. 624–5, Rodrigues, op. cit., note 1 above, pp. 63–4.

91Information published in O Estado de São Paulo, 27 Mar. 1971, p. 10; Jornal do Brasil, 18 Mar. 1971, p. 1; 27 Mar. 1971, p. 6. The last cases of smallpox in poor residential area in Rio de Janeiro enabled the public demonstration of the epidemiological surveillance system. This involved house-to-house investigations and visits to places where the sick had passed through; it also involved containment vaccination, and the testing and follow-up of suspected cases. On the investigation and survelliance related to the last cases, see box 50, fols 5, 41, Cláudio do Amaral papers, COC-Fiocruz.

92Fenner, et al., op. cit., note 1 above, pp.1151–3.