Twentiethcentury multinational public health initiatives

The development of effective vaccines led to interest in worldwide disease control and the possibility that some diseases might be eliminated altogether. The first such effort was the smallpox eradication campaign, which began in 1966 as a joint proposal of the United States and the Soviet Union with the approval of the World Health Assembly (Barquet and Domingo, 1997). Fourteen years later, this effort came to fruition when the 33rd World Health Assembly declared the world free of smallpox in 1980, confirming Jefferson's prediction that Jenner's legacy would be the eradication of smallpox. This success set a precedent and inspired the search for other disease candidates with which similar success could be achieved (Foege, 1998; Henderson, 1999). Among these were poliomyelitis and measles.

In 1988, the World Health Assembly resolved to eradicate polio as an extension of the Expanded Programme on Immunization (EPI). Since then, the number of countries with endemic polio has declined from 125 to 6, with worldwide cases now less than 1000 (CDC, 2004a). Efforts are ongoing to maintain this success and reach the goal of eradication by sustaining polio immunization of young children, identifying new cases of polio through Acute Flaccid Paralysis surveillance, and focusing campaigns in areas with endemic disease with the goal of eliminating reservoirs of polio (Global Polio Eradication Initiative, 2006).

In contrast with eradication, which involves removing the disease altogether, elimination involves the containment of the disease to levels that no longer pose a public health threat. The goal to eliminate measles from the Western Hemisphere by the year 2000 was set in 1994. This was achieved in 2002 through efforts led by the Pan American Health Organization (PAHO), which included a major focus on increasing vaccine coverage in high-risk areas, conducting nationwide supplemental immunization activities to maintain high rates of measles vaccination in the population, and surveillance activities to identify, investigate, and respond to new measles cases in a timely manner (CDC, 2004b).

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