We believe in the work we do, and we are engaging public health stakeholders and the community to better understand, address and combat infectious diseases. Included below are a few personal stories about diseases that, while not represented in Merck’s portfolio, inspire our commitment to innovation and motivate us to continue efforts to research and develop approaches for tackling infectious diseases.
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The West and Central African Smallpox
Eradication Program and its Impact
BY JOEL BREMAN, MD, DTPH
Joel G. Breman, MD, DTPH, is Senior Scientist Emeritus at the Fogarty International Center, National Institutes of Health, and the President-Elect of the American Society of Tropical Medicine and Hygiene.
By taking bold steps to understand smallpox and implement a well-planned and managed strategy driven by the vision of young epidemiologists and operational staff, we were able to erase a disease that had plagued the world for thousands of years
When I joined the CDC Smallpox Eradication Program in 1967, Guinea had one of the highest rates of smallpox in the world. The disease had been in sub-Saharan Africa for at least a thousand years and infected tens of millions of people annually, killing up to one-third of them.1 As a result of childhood mortality, including smallpox, a Guinean child born in 1967 had a life expectancy of 36 years.2
Many Africans believed smallpox could never be defeated. The population had ineffective health services due to lack of trained staff, medicine, and poor access to high quality vaccine. High fever, headache, and weeping lesions covering the body meant patients could not go to work or school. Despite grievous efforts to implement a mass-vaccination strategy, smallpox continued to have a huge impact on the Guinean population and left a helpless and hopeless feeling for any attempt to tackle the problem.
Unaware of the long odds of eradicating smallpox, I arrived in Guinea in 1967 to join a team of young, bright, and optimistic medical professionals. Fresh from my internal medicine residency, I had little concept of the success we might achieve in a few short years. The US-supported smallpox eradication effort relied on understanding local conditions to implement a new approach in disease epidemiology that relied on field-focused management and a flexible vaccination and epidemic control strategy. The program was flexible. Instead of focusing mainly on vaccinating 80% of the entire population, we employed a novel approach that involved concentrating on containing the seasonal occurrence of smallpox outbreaks.
In nothing short of a miracle, I witnessed this strategy, the union of the devoted Guinean nationals and we expatriates. The result was that the hard work of the entire smallpox eradication team eliminated smallpox from Guinea by January 1969. On May 8, 1980, the World Health Organization declared that smallpox had been globally eradicated, a designation that no other human disease in history has earned. By taking bold steps to understand the disease and implement a well-managed and planned strategy driven by the vision of young epidemiologists and operational staff, we were able to erase a disease that had plagued Sub-Saharan Africa and the world for thousands of years.
1 Breman, J.G., Alecaut, A.B., Lane, J.M. (1977, July 1). Smallpox in the Republic of Guinea, West Africa I. History and Epidemiology. The American Journal of Tropical Medicine and Hygiene, 24(4), 756-764.
2 The World Bank. Data: Guinea Life Expectancy at Birth, Total Years. https://data.worldbank.org/country/guinea?view=chart. Accessed on April 5, 2019.
Flu Historical Perspective
BY DR. MARK HONIGSBAUM
Dr. Mark Honigsbaum, Lecturer at City, University of London, and author of The Pandemic Century: One Hundred Years of Panic, Hysteria, and Hubris. New York. Norton, April 2019
While flu surveillance has come a long way since 1918 and we are much better equipped to predict pandemics today, the flu virus has a habit of springing surprises. All of which makes it imperative that scientists guard excessive hubris and cultivate an alertness to the unexpected.
“There are few things more certain in life than influenza. Like the fiery leaf displays that light up a New England fall day, flu comes round every season, causing misery for some and inconvenience for others. These variations in our immune responses are still not fully understood. Nor can we say precisely when the next pandemic will occur. But if history teaches us anything it is that there will always be pandemics and we would be wise to prepare for them. Whether the next pandemic will be as severe as the 1918-19 “Spanish influenza,” which killed in excess of 50 million people worldwide, no one can say. One hundred years ago, there were no proven scientific treatments for flu. Worse, many doctors dismissed flu as a nuisance rather than as a mortal threat. The result is that health officials were slow to recommend social distancing and hygiene measures that might have reduced the death count. Today, thanks to advances in preventive medicine and veterinary ecology, we are in a better position to predict pandemics by inspecting live animal markets for ducks and geese that harbor wild strains of bird flu, and we are also better at mobilising scientific networks to respond to unforeseen outbreaks. But while surveillance technologies have come a long way since 1918 the world is also far more interconnected than a century ago. And, as we saw in 2009 when a pandemic strain of swine flu that no one predicted suddenly emerged in Mexico, the virus has a tendency to spring surprises. All of which makes it imperative that scientists cultivate an alertness to the unexpected and acknowledge that there is still a lot they don’t know about the wily influenza virus.”
In August 2016, at age 30, I had reached the peak of my career. I landed my dream job travelling around Australia for work in aged care. I was happy. I was independent. But my life was turned upside down in a matter of hours. When tragedy struck I thought I only had a bad bout of the flu, but when my condition rapidly worsened, I was taken to the hospital. It took meningococcal disease 12 hours to take hold of my body and shut it down.
In August 2016, at age 30, I had reached the peak of my career. I landed my dream job travelling around Australia for work in aged care. I was happy. I was independent. But my life was turned upside down in a matter of hours.
When tragedy struck I thought I only had a bad bout of the flu, but when my condition rapidly worsened, I was taken to the hospital. It took meningococcal disease 12 hours to take hold of my body and shut it down.
After doctors carried out a lumbar puncture, I looked at my legs and the rash began to appear. I knew I was in trouble, and the look on my mother’s face is something I will never forget. I was placed in an induced coma as that was my only chance at possibly surviving, and I was on life support for 8 days. Doctors confirmed that I had meningococcal disease, the deadly W strain that can kill within hours. During this time my family were told I wasn’t expected to survive and were told to say good bye to me multiple times. After 8 days I surprised everyone by waking up. I was in the ICU for 60 days and have spent the majority of the last 18 months in the hospital.
I soon realized just how much strength I needed and had no choice but to fight. I had several fingers and toes amputated, experienced the loss of four major organs – my gallbladder, spleen, large bowel (leaving me with an ileostomy), and I now require a kidney transplant. You don’t know how strong you are until being strong is your only choice.
My life has completely changed. All from meningococcal disease. And I still face daily challenges. I am now a proud public speaker and share my story and information about meningococcal disease. In addition to this, I aspire to help and motivate others who are facing challenges they have no control over. I advocate and share my story in the hope of helping other people and preventing this from happening to others.
The stories included on this site reflect expert views and individual patient experiences and have been authorized to be shared by Merck for informational purposes only. The information provided on this site is not intended to be a substitute for professional medical advice. Please consult your healthcare provider directly with any questions you may have regarding your health, condition or treatment. Your healthcare provider should be your primary source of information regarding your medical condition and treatment.