The Lancet, Volume 384, Issue 9939, Page 228, 19 July 2014

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doi:10.1016/S0140-6736(14)61202-2Cite or Link Using DOI

Copyright © 2014 Elsevier Ltd All rights reserved.

Ciro de Quadros

Geoff Watts

Full-size image (62K) Sabin Vaccine Institute

Public health physician who rid Latin America of polio. He was born in Rio Pardo, Brazil, on Jan 30, 1940, and died in Washington, DC, USA, on May 28, 2014, aged 74 years.

The last case of polio in Latin America was detected in 1991 in the small Peruvian town of Pichanaki. 3 years later, the Pan American Health Organization (PAHO) declared the disease eradicated within its region. If one man can be said to deserve personal credit for this achievement, it is Ciro de Quadros.

A physician trained in public health, he joined PAHO in 1977 to advise on matters related to immunisation, and to implement the Expanded Programme on Immunization in Latin America. “At that time vaccine coverage rates were only 5 to 20%”, says Donald Henderson, Professor of Medicine and Public Health at the University of Pittsburgh. “What Ciro did was amazing.” He persuaded countries to join what became a hemisphere-wide effort. “Within 5 or 6 years all except Haiti had well over 80% coverage.” de Quadros also created a fund for buying vaccines on behalf of PAHO members, one of the largest ever bulk purchasing schemes in the public sector. Countries were able to buy vaccines in quantities that would otherwise have been unaffordable.

It was in 1985 that de Quadros put forward his programme for eliminating polio from the Americas, an ambition that Henderson admits to having viewed with scepticism. But he succeeded—and then managed something similar for indigenous measles. Henderson attributes de Quadros's success to the way he did his job. “He travelled extensively, he talked with staff, he talked with ministers. He persuaded them that it was their programme. He could help, yes—but it was their programme.”

de Quadros trained at the Catholic School of Medicine in Porto Alegre, did a master's degree in public health, and in 1967 joined the Brazilian public health service working at a health centre in the Amazon region. He became involved in the smallpox campaign and, with three colleagues, began testing the value of a surveillance and containment strategy as an alternative to the proven but unaffordable policy of mass vaccination. Over the next 8 months they identified more than 100 cases of smallpox, vaccinated all their contacts, and succeeded in breaking the chain of transmission.

On the strength of this achievement de Quadros became the chief epidemiologist to WHO's smallpox eradication programme in Ethiopia. “He took on smallpox in the field with something like ten Ethiopian health officers and a dozen or so US Peace Corps people”, recalls Henderson. “Ethiopia's a big place and the roads were terrible. He was working under very difficult conditions, but within 12 months they'd turned up 600 cases.” Among those Peace Corps volunteers was Peter Carrasco, now Director of the Secretariat of the International Association of Immunization Managers based at the Sabin Vaccine Institute in Washington, DC. Two previous Peace Corps groups had dealt with all locations that were accessible by road. “When Ciro and I hooked up we were looking at the hardest parts of Ethiopia to get to”, Carrasco recalls. There was no way they could do the job on foot, so they started to use helicopters in the highlands and camels in the desert areas.

It was after the success of the Ethiopian smallpox project that de Quadros joined PAHO to head up the Expanded Programme on Immunization. Between 1994 and 1998 he spent 4 years as special adviser on vaccines to the Director-General of WHO, but continued to work for PAHO until his retirement in 2002. Even then, he maintained his lifelong connection with vaccination through his appointment as a Vice-President of the Sabin Vaccine Institute in Washington.

Throughout de Quadros's life, Henderson thinks, if he was told something couldn't be done, he wanted to do it. And usually he succeeded. “His work was a marvellous illustration of community involvement in accomplishing a task”, says Henderson. “He understood management”, adds Carrasco. He used his smallpox experience in building the Expanded Programme on Immunization and ridding Latin America of polio. “He showed the doubters, and there were many of them, that polio could be eradicated. He was very practical and had very clear insights”, says Carrasco. Despite de Quadros's many awards and the medals, “he was very down to earth”, notes Carrasco. “He was the kind of man who could sit down with an ordinary health worker, have a beer with him, and motivate that guy to do a better job.” de Quadros is survived by a wife, two daughters, and two stepsons.