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Avoid use of police or army to enforce public heath

By Maggie Fox

Dr. D.A. Henderson, who helped wipe out smallpox around the world, has a piece of advice for governments fighting bird flu -- Don't use the military or police to enforce public health.

Henderson, who likes to describe how he was vaccinated thousands of times against smallpox to demonstrate the immunization's safety to wary villagers, says it is much easier to halt epidemics by winning the trust of community leaders and making use of gossipy schoolchildren.

He is critical of parts of the U.S. national pandemic plan that call for the use of quarantine and other imposed types of enforcement should influenza or any other infectious disease cause a pandemic.

"Never use the police or the military," Henderson told a meeting organized by the University of Pittsburgh Medical Center's Center for Biosecurity, where he works. "Once we brought military or police in, we found many citizens retired to the woods," he said Tuesday.

When health teams tried to quarantine families, had a similar response. "People hid," he said. "They didn't want to be quarantined so they hid cases."

As H5N1 avian influenza spreads in birds across Asia, Europe and into Africa, global health officials are trying to switch into high gear to control it. But they are running into problems with local residents in many places, including most recently the village of Kubu Simbelang on the Indonesian island of Sumatra, where six people died from H5N1 infection.

"They are not angry, just unfriendly. They are unfriendly to the people from the central government, the provincial government," said Sidharta Pinem, head of animal husbandry in the region.


Henderson said the drive to eradicate smallpox, which was eliminated in 1979, relied heavily on winning people's trust.

"What was the most effective was the support from religious leaders and village leaders," he said. For instance, they found they could train villagers to administer the vaccine, which is given using a fork-like needle that scratches the vaccine fluid into the skin.

"How responsive and enthusiastic and reliable these people were," Henderson said. "The only thing we could pay these people with was a thank you."

And an unexpected resource came from the youngest citizens. "For detection of cases we relied on schoolchildren," Henderson continued. "What is remarkable is how much 9- to 12-year-olds know about what is going on in their communities, and how willing they are to tell you."

Henderson said his team showed the children pictures of what a person looked like with the distinctive smallpox pustules and asked them if anyone in their communities seemed infected. Sometimes their information was more reliable than word from official sources, he said.

Henderson said he was concerned that the U.S. national pandemic plan includes the possibility of forced quarantine of travelers and perhaps of affected areas. Henderson does not believe quarantine works.

When severe acute respiratory syndrome (SARS) hit Canada in 2003, quarantine and isolation were used to try to control the respiratory infection. Some people who worked in hospitals developed fevers and respiratory symptoms.

"But they made the decision that they were so key to what was going on in the hospital that they came in to work," Henderson said.

Hospitals ended up being a source of SARS infection for many of the nearly 800 people who died from the virus before it was brought under control.

"So many people in so many professions feel they are key," Henderson added.

Any flu plan, Henderson feels, should do more to incorporate community organizations. He cited Rotary International, which has raised hundreds of millions of dollars for global polio vaccination campaigns, and Brazil, which eradicated polio by holding an annual Carnival-like mass vaccination festival.