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September 1, 2016

Obituary: Donald Ainslie “D.A.” Henderson

D.A. Henderson, center, with students from Pitt’s Graduate School of Public Health

D.A. Henderson, center, with students from Pitt’s Graduate School of Public Health

Donald Ainslie “D.A.” Henderson, who led a worldwide effort that eradicated smallpox in 1977 — the first such successful effort in history — died Aug. 19, 2016, in Towson, Maryland. He was 87.

Donald Henderson

Donald Henderson

Henderson was a distinguished scholar in the UPMC Center for Health Security, which he helped found and direct at John Hopkins University in 1998 as the Center for Civilian Biodefense Strategies, before it moved to Pitt in 2005. He was also 21st Century Professor of Medicine and Public Health here — an honorary title awarded Henderson by Arthur S. Levine, senior vice chancellor for the Health Sciences and John and Gertrude Petersen Dean, School of Medicine. Henderson also was a Distinguished Service Professor and dean emeritus at the Johns Hopkins Bloomberg School of Public Health.

Said Donald S. Burke, Distinguished University Professor of Health Science and Policy, UPMC Jonas Salk Chair in Global Health and public health dean here: “He was probably the most significant player in global health of our generation.”

Burke knew Henderson for a quarter century, including a stint as office mates at Johns Hopkins. “He had an uncanny ability to get to the nub of important problems and was absolutely committed to solving them,” Burke said. “Nothing could get in his way … He had a big heart for anyone who was willing to work hard but no tolerance for fools.”

Henderson was recruited by the World Health Organization (WHO) in Geneva, Switzerland, to lead their anti-smallpox campaign, which met with resistance on a variety of fronts. He recalled his efforts to rid the world of this long-term scourge in a public health-sponsored 2008 John C. Cutler Memorial Lecture in Global Health. “It was a remarkable victory for international public health. But on more than one occasion, it was a very iffy situation.”

As Burke noted in jacket copy he wrote for Henderson’s 2009 book, “Smallpox: The Death of a Disease,” which was launched at Pitt and became the inaugural selection for the University’s One Book One Community program in public health: “Whilst the achievement was — in the end — glorious, in its day to day execution it was anything but. As D.A. retells it, his day-in day-out tasks were to cajole indifferent health ministers; upgrade woeful vaccine quality control; out-flank unsupportive superiors at WHO; bargain vaccination plans with anti-government rebels; snatch funds from other accounts; repair broken-down vehicles … This is the heroic stuff of true public health leadership!”

By the time Henderson began to lead the global eradication effort in 1966, smallpox had already killed 300 milllion-500 million people during the 20th century alone.

The acute, contagious disease, appearing only in humans, leaves a facial rash that leads to lesions and scarring. Those who survive smallpox then are immune, but the disease also can cause blindness.

Similar efforts had been discussed by the WHO in the 1950s but did not receive support from the world’s superpowers, who deemed it too expensive and not feasible. Henderson was recruited from his post at what was then the Communicable Disease Center (now the Centers for Disease Control and Prevention, or CDC) to lead a decade-long effort, which was at first woefully underfunded. As Henderson said during his 2008 lecture here: “We were better able to estimate the state of smallpox [in 1967] by doing surveys … There were about 10 million-15 million cases and 2 million deaths. Forty-three countries reported cases. The population of endemic areas was somewhere over 1 billion people.”

At its height, the program recruited 150,000 people to administer vaccinations in the field. A new vaccine had been developed that could be stored at high heat for a long time, and could be more easily administered through a new type of two-pronged needle. Under Henderson, the program created a pair of labs to keep testing the vaccine for efficacy, and maintained active searches for new cases.

“So the idea, a brand new idea, was establishing a surveillance system in the countries,” he explained, “so that every health center and hospital would report every week how many cases of smallpox they had.” Program volunteers then would surround new outbreaks with vaccinations, aiming to contain these outbreaks.
“We found that if you could vaccinate 30 houses in the surrounding area, you could stop the spread of the disease,” Henderson said.

His vaccination workers did their work through everything from civil wars and revolutions to stubborn bureaucracies.

“There is a growing recognition that we’re one world,” he concluded. “We have finite resources, which we have to share. We also have a great many organisms that we find we also have to share, from HIV/AIDS to West Nile virus, to possible pandemic influenza, to SARS. There’s a concern for humanitarian reasons for what’s going on in other countries, but it’s also in our own interests.”

Tom Inglesby, director of the health security center since 2009, noted that “D.A. was an incredible person, a public health leader who changed the world in huge and small ways.” While the world knew about his efforts against smallpox, people may not have realized Henderson’s impact on the public health field and its practitioners in training through Pitt and the center, Inglesby said: “He really helped expand the focus, to focus as much on practice and community intervention as on the academic science of public health.

“He always took the time to meet with the rising generation in public health,” Inglesby said. “Just watching him with new students considering careers, mid-career people — he was always generous with his time and spirit” in advising those people.

Henderson received his AB from Oberlin College in 1950, earned his MD at the University of Rochester in 1954 and his MPH at Johns Hopkins in 1960.

After interning at the Mary Imogene Bassett Hospital in Cooperstown, New York, Henderson became a commissioned officer in the U.S. Public Health Service, 1955-77. Through the years he was chief of the CDC’s Epidemic Intelligence Service and assistant to the chief of its epidemiology branch; then chief of its surveillance section before becoming chief of its smallpox eradication program, 1965-66, from which he was recruited to lead the WHO effort that made his name worldwide.

He joined Johns Hopkins as dean and professor of epidemiology and international health (1977-90) and Edgar Berman Professor in International Health at its School of Hygiene and Public Health (1990-93), after which he was appointed University Distinguished Service Professor.

Henderson also was associate director for life sciences in the Office of Science and Technology Policy, Executive Office of the President, in Washington, D.C. (1991-93) and deputy assistant secretary for health and senior science adviser in the Department of Health and Human Services (1993-95), working under three presidents: George H.W. Bush, Bill Clinton and George W. Bush.

His work garnered him numerous honors and awards, notably the Presidential Medal of Freedom in 2002, the National Medal of Science in 1986 and the National Academy of Sciences’ Public Welfare Medal in 1978 and three awards from the U.S. Public Health Service, including the Surgeon General’s Medallion in 1992, as well as many international awards. He published more than 250 scientific papers with an emphasis on smallpox, poliomyelitis, influenza eradication, epidemiology, immunization and biological terrorism, as well as a second book with three co-authors in 1988: “Smallpox and Its Eradication.”

He is survived by his wife of 64 years, Nana, and children Leigh, David and Douglas.

—Marty Levine 

Filed under: Feature,Volume 49 issue 1

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