smallpox vaccine and vaccination in the intensified ... - libdoc.who.int

542 SMALLPOX AND ITS ERADICATION
Donations of Vaccine, 1958-1 966
Apart from encouraging the establishment of national smallpox eradication pro-
grammes, the only important consequence of the resolution on global smallpox eradication
adopted by the Twelfth World Health Assembly in 1959 (see Chapter 9) was the initiation
of donations of smallpox vaccine, both to WHO and on a larger scale in bilateral assistance
programmes. Between 1958 and 1966 the vaccine donated to WHO totalled 47 062 500
doses (from Jordan, Madagascar, Mexico, the Netherlands, the Philippines, Switzerland,
Thailand, the USSR and the United Kingdom). Of this amount, 25 million doses of vaccine
had been pledged by the government of the USSR in 1958 when it proposed that WHO
should undertake a global smallpox eradication programme ; they were delivered between
1960 and 1964. In bilateral donations between 1961 and 1966 the USSR also provided some
700 million doses of vaccine, which met the annual requirements of Afghanistan, Burma,
India and some other countries during this period.
Shortfalls in Vaccine-Quality and
Quantity
Since, although smallpox vaccine had
been in use since 1800, standardized vaccine
production procedures and reliable assay
methods for quality control were not de-
veloped until the 1950s (see Chapter 7), the
quality of the vaccine varied significantly in
different countries. Although the quality of
vaccines donated to WHO had been tested
since 1959, until 1967 such vaccines account-
ed for an average of only 7 million doses per
year (Table 11.1), or less than 2% of the
vaccine needed in endemic countries. The
remaining vaccine was provided by domestic
production or through bilateral aid pro-
grammes and by a number of producers who
sold vaccine to the endemic countries. The
titre of most of these vaccines was unknown
to WHO and, even when known, the tests
used to determine it were of uncertain reli-
ability and conducted mainly by the produc-
tion laboratories themselves. In many labora-
tories, the potency was tested by vaccinating
10 children and determining the proportion
of takes, or by using the rabbit skin scarifica-
tion method, which was imprecise; in addi-
tion, few laboratories tested the vaccine for
heat stability.
Thus WHO was faced, not with the rela-
tively small problem of closing a gap between
the total requirement and supplies obtained
from existing vaccine donors and local pro-
duction of vaccine in the endemic countries,
but with the much larger task of developing a
production-donation system to serve most of
the endemic countries and their neighbours.
Table I I. I. Quantities of smallpox vaccine distri-
buted through WHO, 1958- 1979
Year
Doses of vaccine (thousands)
Recelved Dlstrlbuted "lance at end
of year
As is shown in Table 11.1, vaccine dona-
tions to WHO were substantially increased
after the Intensified Smallpox Eradication
Programme was initiated in 1967. In the early
days of the programme, one of the difficulties
in increasing the amounts donated was that
laboratories producing smallpox vaccine in
most countries had only a limited capacity
that was barely enough to meet their national
programme requirements, let alone help to
supply the very much larger amounts of
vaccine needed for a global eradication
programme.