Renowned epidemiologist Dr. Donald A. (D.A.) Henderson ’54M (MD), who earned his degree from the University of Rochester School of Medicine and Dentistry in 1954, and is credited with the global eradication of smallpox, died Aug. 19 in Towson, Md. He was 87.
Hard-driving, uncompromising and ferociously devoted to every mission he tackled, Dr. Henderson was revered as the “Gen. Eisenhower” who in 1966 led the World Health Organization in the war on smallpox—and won. For more than a decade, he and his army of “eradicators”—scientists, doctors, nurses, linguists, medical technicians, soldiers, and academics—tracked down everyone infected with the lethal disease across 50 countries, immunized all those within a ring of proximity to the infected, and effectively shut down its spread.
The $300 million campaign was an astonishing undertaking that many had initially doomed to failure, but instead saved tens of millions of lives, and is held up as one of medicine’s greatest triumphs. Smallpox was proclaimed officially eliminated by the WHO in 1980.
“Dr. Henderson’s body of work exemplifies everything we aspire to accomplish across the University of Rochester Medical Center,” said Mark B. Taubman, M.D., CEO of URMC and Dean of the School of Medicine and Dentistry. “We work to understand the molecular causes of disease so that knowledge can be applied to urgent health care needs here at home and across the globe.”
Growing up in Lakeland, Ohio—the son of a nurse and an engineer—Henderson knew early on he wanted to be a physician, and was leaning toward Cardiology. But in 1947, while still an undergraduate at Oberlin College, there was a smallpox outbreak in New York City, which stirred an early interest in the disease and how it could be stopped.
After that, his interest in epidemiology evolved somewhat fortuitously. In his senior year of medical school at the University of Rochester, he competed for a prize of $200 by entering a project about the 1833 cholera epidemic in Upstate New York.
“To a penurious medical student, I admit the prize money was the primary motive,” he said in a 2005 interview for Epidemiology.
The study involved plotting cases and deaths by time, age and geographic area, estimating survival curves and attack rates—all skills he would later call upon. It not only earned him the $200, but helped him land a position in 1955 with the Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS), when he was later drafted to the military during the Korean War.
“I applied to the CDC not because I was interested in public health or anything like that,” he said in a 2002 interview with Rochester Medicine. “But we all had to do military service then and I thought, ‘Well, I’ll spend two years in public health.’”
Having completed his residency in internal medicine in Cooperstown, N.Y., he worked closely under the CDC’s then-chief epidemiologist, Alex Langmuir, M.D., who he named often as his strongest career influence.
“Through him, I discovered the excitement and challenge of epidemiology and its special attraction in requiring solutions that bring together epidemiologic insights, clinical observations, sociologic characteristics, laboratory findings, and all matter of other insights in solving what are wonderfully fascinating puzzles,” he said in Epidemiology in 2005. “Alex also said that good collaboration requires people with equivalent ego strength and intelligence, and that teams work best when the individuals see the product as the primary objective, rather than who gets credit for the work.”
As the chief of viral disease surveillance for the CDC, he took part in the initial field introduction of the Salk polio vaccine, then the oral polio vaccine, and next the measles vaccine. He oversaw studies to test the simultaneous administration of multiple antigens, particularly useful in developing countries. He then began studying how to administer smallpox vaccination using a new jet injector that could vaccinate 1,000 people per hour. Later, in his work for the WHO, he proposed the use of a bifurcated (forked) needle, which was easy to teach, rapid to execute, and required one-fourth as much vaccine.
“It was one of the key factors in the success of the eradication program,” said Dr. Henderson, who went on to earn a master of public health degree from Johns Hopkins University in 1960.
In 1965, the U.S. Agency for International Development (AID) was fighting a losing battle against measles in West Africa and turned to Dr. Henderson for more manpower, which the EIS couldn’t spare. But rather than say it that way, he proposed a massive, combined effort to fight measles and smallpox in 18 countries at a staggering cost of $35 million—thinking they would turn it down.
But instead, President Lyndon Johnson—looking for a ‘cause’ to showcase American cooperation and improve relations with the Soviet Union—ordered AID to fund the joint smallpox-measles program. The idea snowballed, and before long the United Nations voted to launch a 10-year effort to eradicate smallpox. The idea passed by only two votes. Realizing it would be a heavy lift, the WHO director, a Brazilian, wanted an American to lead the program and be the “fall guy” if it failed. Dr. Henderson, whose proposal was later called a “bold stroke of managerial genius” was the man tapped for the role.
Over the next 12 years, launching from the WHO’s home base in Geneva, Switzerland, Dr. Henderson spent most of his time visiting smallpox-stricken countries, some of which were in the middle of civil wars. He was involved in seven coup d’etats, and had to forge special treaties so that vaccinations could proceed in countries like Nigeria and Ethiopia. Team members were kidnapped and helicopters held for ransom. In Bangladesh, his team dodged landmines. And when the Soviets shipped weak vaccines, he flew to Moscow and confronted them.
“It wasn’t always pleasant working for him,” Don Millar, M.D., a 32-year veteran of the CDC told Rochester Medicine in 2002. “He expected the best from people, so he often got it. He could often drive people past what they thought they could do, but still have them feel wonderful at the end.”
In 1977, success in hand, Dr. Henderson became dean of what is now the Johns Hopkins Bloomberg School of Public Health, where he shifted the curriculum to send more students into the field.
He was also in demand as an expert on bioterrorism. In 1998, he founded the Center for Civilian Biodefense Studies at Hopkins, leading a nationwide effort to urge scientists, health care workers, and policymakers to prepare for the possibility of bioterrorism. After the Sept. 11, 2001, terrorist attacks and subsequent anthrax mailings, he served under President George W. Bush as director of the newly-created Office of Public Health Preparedness.
In 2002, he received the Presidential Medal of Freedom, the nation’s highest civilian honor, and although there was talk of a Nobel Prize, none has ever been given for the eradication of smallpox.
Dr. Henderson maintained a strong connection to Rochester, returning for medical school class reunions and often speaking at URMC on the subject of bioterrorism, as the prevention of a manmade epidemic became just as daunting as stopping a natural one.
Whether travelling around the globe to fight small pox, or maneuvering through thick layers of bureaucracy in Washington, DC to fight bioterrorism, Dr. Henderson said he was often guided by the Romano and Engel biospychosocial philosophy of medicine he learned as a medical student in Rochester.
“(I was taught to) take time, question the patient thoroughly, listen carefully,” he said in a Rochester Medicine interview. “More often than you can imagine, the patient has a remarkably keen insight and understanding of his problem, and will effectively provide you the diagnosis before you do the physical examination or laboratory study.”
This approach served him especially well in far-flung countries when trying to find out where a disease originated, he said. Against popular wisdom, he would ask patients, “Where do you think you got the disease?”
“It sounds simple and obvious, but all too few people seem to understand this very simple precept that came straight from an introductory course in Rochester,” he said.