Ciro de Quadros (Rio Pardo, Brazil; 1940 – Washington DC, United States; 2014) first studied medicine in 1966, and then went on to take a master’s degree in public health (1968). He worked for the World Health Organization (WHO) as Chief Epidemiologist on the Smallpox Erradication Program (1970-76). Later on, he joined the Pan American Health Organization (PAHO) as Senior Advisor on Immunization and Head of the Expanded Program on Immunization for the Americas. In 1994, he was appointed Director of PAHO’s Special Program for Vaccines and Immunization and from there moved to the post of Director of the Division of Vaccines and Immunization, where he remained from 1999 to 2002. In the United States, he was also Executive Vice President of the Albert B. Sabin Vaccine Institute, Associate Adjunct Professor in the Department of International Health of the School of Hygiene and Public Health at the Johns Hopkins University, and Adjunct Professor in the Department of Tropical Medicine at the George Washington University School of Medicine.
His role was key to the eradication of smallpox in Africa in the 1970s, and of poliomelyelitis in the Americas region in the 1990s. De Quadros’ strategy in Peru involved getting the media to appeal to everyone – including the guerrillas – to cooperate with vaccination campaigns. Later on, he decided to follow up his successes against smallpox and polio with an all-out campaign to eradicate measles, a goal achieved in the region in the beginning of the 2000s.
The author of over 80 papers in international journals and four books, he had an honorary doctorate from the Federal University of Medical Sciences in Porto Alegre (Rio Grande do Sul, Brazil) and a long list of distinctions including the World Health Day Award of the American Association for Public Health (1987). In 2002, the President of Mexico awarded him the title of Public Health Hero. In April 2014, he was named a Public Health Hero of the Americas by the PAHO/OMS. He died a month later, in Washington DC (United States), on 28 May, 2014.
Speech
Development Cooperation, 4th edition
It was when studying medicine in his native Brazil, he now recalls, that Ciro de Quadros realized that most disease has a social origin, with its roots in poverty, and decided to take up a career in public health. This marked the start of a lifelong social commitment that was the badge of identity of the 2011 BBVA Foundation Frontiers of Knowledge Award laureate in the Development Cooperation category. Perhaps the other hallmarks of his professional enterprise were the way he bolstered this commitment with scientific evidence and his willingness to go beyond the strictly medical sphere. For de Quadros, in his time, was a planner, strategist and manager… and even a negotiator with guerrilla groups.
In 1968, while studying a master’s degree in public health, de Quadros joined a health center in the Brazilian Amazon and set out with his staff to vaccinate the entire population in its catchment area, at a time when immunization rates in the region were less than 10%.
Indeed this was another constant in Ciro de Quadros’ career: setting goals that others saw as impossible and making them happen. Could we describe him then as a Utopian who got lucky? “I have certainly had the luck to work with dedicated teams and to bring all my projects to a successful conclusion,” he acknowledged. He admitted to setting his sights higher than others, but insisted that however ambitious his goals, they were always based on the real possibilities held out by science. “When we know we have the technological resources to solve health problems,” he contended, “it would be immoral not to apply them.” For each concrete goal, a set of tangible results.
His work in Brazil came to the attention of the World Health Organization (WHO), which offered him a posting in Ethiopia as Chief Epidemiologist on its Smallpox Eradication Program. “My laboratory is the field,” he was fond of saying, and in fact he had the privilege as a doctor of treating some of the world’s last cases of smallpox. De Quadros did not hide his personal satisfaction at what he called a career-defining experience. “What you feel at being part of conquering a disease that has caused millions of deaths is just indescribable.”
The world’s last ever smallpox case was diagnosed in Somalia in 1977. A few months before, Ciro de Quadros returned to the Americas, where the Pan-American Health Organization (PAHO) appointed him to head its continent-wide immunization program. Over the next 25 years and from different positions of responsibility, de Quadros deployed his manifold skills to defeat polio and measles across the Americas.
These were among the achievements singled out by the international jury, whose members hailed de Quadros as “a hero of global health. He has not only researched but has also led and inspired the fight against infectious diseases, applying knowledge to produce successes comparable to the discovery of penicillin.”
After years of carrying forward institutional projects like the eradication of smallpox, he decided the time had come to lead his own campaigns. In 1981, in the face of widespread scepticism, he resolved to drive poliomyelitis from Brazil, where an average of up to 200 new cases were declared each month. Among the ideas he came up with in this period was the much commented “immunization weekend.” By 1989, the disease had been eliminated nationwide, and in 1985 PAHO invited de Quadros to extend his efforts to the rest of the Americas.
This was a tough mission beset with obstacles, not least the civil unrest gripping several countries, which called on all de Quadros’ powers of diplomacy and persuasion. In El Salvador he succeeded in organizing national “days of tranquillity” coinciding with immunization weekends. In Peru, talks with the guerrillas of Sendero Luminoso soon broke down, but de Quadros marshaled the support of the media and pressed on with intensive vaccination campaigns. By 1994, poliomyelitis had been officially eradicated from the American continent. The next enemy was measles, whose conquest would follow in 2002.
The jury’s certificate granting de Quadros the BBVA Foundation Frontiers of Knowledge Award included the following affirmation: “Through his work, the world is closer to achieving the millennium development goal that aims at reducing by two thirds the mortality rates in children under 5 years old by 2015.”
His obsession was to ensure that available vaccines are accessible to all: “The challenge in the future will not lie so much in the technological development of vaccines as in getting them equitably distributed to the whole population.” And it is here that we perceive the scale of the enterprise that won him the Development Cooperation award, for de Quadros, since his student years, was clear that health is intimately bound in with a country’s potential for progress. Hence his insistent reminder that studies have shown that vaccinated individuals perform better – at school or at work – than their unvaccinated peers, and therefore add more overall to the national wealth.
De Quadros’ pro-development discourse was anything but paternalistic, and his strategy was to convince developing nations of their duty to their population. “We have to urge health ministries, but also ministries of economy and finance and national parliaments to set aside sufficient funds for vaccination programs instead of relying so much on international aid.”
But he also had a message of optimism for tomorrow’s generations, based on scientific advance. De Quadros was convinced that the 21st century will be known as the century of vaccines: “We are going to obtain vaccines for conditions long considered chronic or degenerative which we are now discovering may be due to infectious agents.” This general objective stood alongside his specific ambition for the developing countries: the achievement of vaccines against diseases of poverty and the launch of treatment programs focusing on neglected or forgotten ailments. Even after decades of intense, on the ground labor, de Quadros confronted these challenges with his faith undimmed. For as he said: “When you have managed to solve some of humanity’s problems, you find every motivation to go on working.”
