Summit convened by:

Center for Biosecurity of UPMC

Canadian Policy Research Network

Center for Science Technology and Security Policy at AAAS

National Consortium for the Study of Terrorism and Responsed to Terror

Keynote Address
Why the Public's Trust and Help Matter in Health Emergencies

D.A. Henderson

Speaker biography  |  Transcript  |  Audio  |  Q&A transcript  |  Q&A audio

Summary
D.A. Henderson, an internationally recognized public health leader and former head of the World Health Organization's campaign to eradicate smallpox, provided a historic perspective on the role of community and citizen participation in managing health emergencies.

Both the prospect of large-scale outbreaks of infectious disease and the need for public involvement to help remedy these crises are foreign concepts in the present-day U.S. A severe pandemic influenza, however, could catch the country flat-footed as a result of such thinking, when a tidal wave of patients overwhelms the healthcare and public health systems. Given the rate of illness among the medical community itself, who will care for all of the patients? Volunteer groups with fundamental training in some medical procedures will be needed, as will people to help with other needs such as delivering critical supplies and manning phone banks.

In comparison with the rest of the world over the past century, North Americans have had only limited experience in dealing with epidemic disease, and even less experience in implementing public health programs with limited resources. Few outbreaks-whether hepatitis, West Nile virus, encephalitis, whooping cough, etc.-have seriously tested our health systems, and virtually all of them were handled by existing public health and medical care authorities. Chronic disease has displaced infectious disease as the primary focus of the CDC and state and local health departments.

Volunteers, however, have been a necessary component of international efforts to combat infectious disease. The case of smallpox eradication is a prime example. Large-scale vaccination efforts in Africa and South America depended upon the organizational contributions of village headmen, religious leaders, and school principals who could advise on how to carry off a program. Local people became trained vaccinators who were both reliable and enthusiastic. Schoolchildren acted as sentinels, reporting whether an infected person was present in a village.

Polio control efforts have similarly relied upon voluntary groups such as Rotary International for their success. The elimination of polio in the U.S. depended upon the public's ability to raise funds, set priorities for politicians, and help vaccinate a large proportion of the population. The Sabin Oral Polio Vaccine challenged the medical and public health community to accept volunteers, since the vaccine did not require a needle and could be easily administered. The Junior Chamber of Commerce organized and operated "Sabin on Sunday," a mass vaccination program in cooperation with health departments that reached 80-90% of the target population. Volunteers around the world have also been the engine for National Immunization Days. Volunteers in Brazil, for example, helped to vaccinate nearly all children younger than five years old against polio on a single day.

Drawing from his smallpox eradication days, Dr. Henderson had additional lessons to share on productive interactions with the public in the context of an epidemic:

• Never use the police or military to enforce vaccination. Enlisting the aid of trusted community leaders is a more effective means of encouraging vaccination.
• Never impose quarantine on individuals exposed to infectious persons. Isolation of patients is an important disease control measure, but sequestering whole families often leads to people trying to hide cases.

Summary by Jonathan Gross, MPH