Jury chairman Pedro Alonso stressed that “this is not an award for lifetime achievement but for a knowledge-based contribution of immeasurable impact. De Quadros is a hero of global health, one of the greats. 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.”

Educated and trained in his native Brazil, De Quadros quickly rose to prominence in his chosen field and was recruited by the World Health Organization to work on its smallpox eradication program in Africa. From there he transferred to the Pan American Health Organization, where he headed the successful drive to eliminate poliomyelitis and measles from the American continent. Since 2003, he has held the post of Executive Vice-President with the Washington-based Sabine Vaccine Institute.

His role in eradicating smallpox

He describes his role in eradicating smallpox as a life-defining experience: “What you feel at being part of conquering a disease that has caused millions of deaths is just indescribable. There is this sense of a mission accomplished but also the determination to continue working for the betterment of global health. That is what has given me the energy to keep going, and here I am, as active at 72 as someone of the age of 40.”

'What you feel at being part of conquering a disease that has caused millions of deaths is just indescribable'.

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“Through his work with UN agencies, governments and academic,” the citation continues, “Dr. de Quadros had changed the paradigm for development coordination in public health.”

This paradigm shift, as the jury terms it, rested on securing government ownership of immunization campaigns by convincing them that the economic and welfare benefits of vaccination far outweighed the costs. De Quadros gives the following example: “A number of studies have shown that vaccinated children perform better at school than their unvaccinated peers and that the vaccinated population adds more overall to the generation of national wealth.”

De Quadros, furthermore, has championed a new supply model whereby a number of countries establish joint purchasing centers in order to acquire vaccines more cheaply.

In the jury’s view, “His programs have shown that introducing existing vaccines can be done in an economically sustainable way that promotes country ownership, particularly in low and middle income countries. This has facilitated an unprecedented effort against vaccine preventable diseases such as rubella, pertussis, rotavirus, pneumococcus and human papilloma virus, especially in high disease burden areas and underprivileged communities in Asia, Africa and the Americas.”

'The 21st century will be known as the century of vaccines'.

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Asked how he sees the future, De Quadros doesn’t hesitate: “The 21st century will be known as the century of vaccines. The large number now available will be joined by others still in the study phase, including, for instance, a vaccine against stomach cancer. There are also conditions long considered chronic or degenerative that we are now discovering may be due to infectious agents amenable to vaccination.”

De Quadros remains active today in research and education. “Through his work,” the jury concludes, “the world is closer to achieving the millennium development goal that aims at reducing morality rates in children under five by two thirds before the year 2015.”

International jury

The jury in this category was chaired by Pedro Alonso, Director of the Institute for Global Health of Barcelona (Spain), with Norman Loayza, Lead Economist in the Development Research Group of the World Bank (United States) acting as secretary. Remaining members were Maricela Daniel, Spanish representative of the United Nations High Commissioner for Refugees (UNHCR) (Spain); Vicente Larraga, Director of the Center for Biological Research at the Spanish National Research Council (CSIC); José García Montalvo, Professor of Economics at Pompeu Fabra University in Barcelona (Spain) and Francisco Pérez, Research Director at the Valencian Economic Research Institute (Spain).

Biography

Ciro de Quadros was born in Brazil, where he first studied medicine (1966) then went on to take a master’s degree in public health (1968). Before leaving medical school he joined a health center in the Brazilian Amazon and set out with his staff to bring immunization levels up to 100% in its catchment area. An ambitious goal, since in the late 1960s immunization rates in many parts of Brazil were less than 10%.

In November 1970, the World Health Organization (WHO) offered him a posting in Africa as Chief Epidemiologist on its Smallpox Eradication Program, working out of Addis Ababa (Ethiopia). The world’s last ever case of the endemic disease was diagnosed in the port town of Merka, in neighboring Somalia, on October 26, 1977.

A bare seven months before, with smallpox on the point of disappearing from Ethiopia, De Quadros had returned to the continent of his birth to join the Pan American Health Organization (PAHO) as Senior Advisor on Immunization and Head of the Expanded Program on Immunization for the Americas.

On arriving at PAHO, De Quadros began work on systematic vaccination campaigns against poliomyelitis. By 1981, he had set himself the goal of eradicating polio from the Americas, which many of his colleagues saw as unrealistic. He disagreed, pointing to promising data from two weekends of National Immunization Days held in Brazil. “On each of those weekends, about 20 million children under 5 years of age received a dose of oral polio vaccine”.

“Cases of polio dropped dramatically from an average of over 100–200 cases per month to fewer than 20.” By 1989, polio had been eliminated from Brazil. It was this success that persuaded PAHO’s director, Carlyle Guerra de Macedo, to announce the goal of eradicating polio from the Americas at a press conference in 1985. Donors to the enterprise included Rotary International, UNICEF, the Inter-American Development Bank, and the U.S. Agency for International Development, who committed the funds needed to stock up on vaccines.

Civil unrest in countries like El Salvador and Peru meant immunization workers at times feared for their lives. De Quadros accordingly called on the help of UNICEF, the Red Cross, and the Catholic Church, as well as appealing directly to the authorities and guerrilla forces. The result in El Salvador was an agreement to hold what the parties called “days of tranquility”. “We organized three days of tranquility each year,” De Quadros recalls, “and vaccinated nearly every child in El Salvador.”

In Peru, similar negotiations with the guerrilla movement Sendero Luminoso soon broke down. Undeterred, De Quadros and his team organized a series of “mop-up” campaigns to help limit poliovirus transmission to just a few areas. They also called on the support of the media, organizing press conferences to appeal to everyone – including the guerrillas – to cooperate with vaccination efforts. By 1991, Peru had reported the last confirmed case of wild polio, and in 1994, an international commission officially declared the disease eradicated from the Americas region.

In 1999, when leading PAHO’s Division of Vaccines and Immunization, De Quadros decided to follow up his successes against smallpox and polio with an all-out campaign to eradicate measles, building on the work done since 1994. In November 2002, the region was able to report having successfully interrupted transmission of the last endemic strain of measles virus.

De Quadros is 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. He has also served as Adjunct Professor in the School of Medicine at Case Western Reserve University.

The author of over 80 papers in international journals and four books, he has 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.