Fifty Years of Global Immunization at CDC, 1966-2015

On November 23, 1965, President Lyndon Johnson announced plans for a 5-year smallpox eradication and measles control program in West Africa that enabled the Centers for Disease Control and Prevention (CDC) to establish a Smallpox Eradication Program in January 1966. Since then, CDC’s global immunization endeavors have encompassed global smallpox eradication, the establishment and growth of the Expanded Program on Immunization (EPI) to strengthen national immunization programs, global efforts to eradicate polio and eliminate measles and rubella, and vaccine introduction into national immunization schedules beyond the original 6 EPI vaccines. CDC has provided scientific leadership, evidence-based guidance, and programmatic strategies to build public health infrastructure around the world, needed to achieve and measure the impact of these global immunization initiatives. This article marks the 50th anniversary of CDC’s global immunization leadership, highlights key historical events, and provides an overview of CDC’s future directions. Before 1955, smallpox and diphtheria-tetanus-pertussis vaccines were the only routinely recommended childhood vaccines in the United States. The roots of global immunization at CDC began after clinical trials for the Salk inactivated polio vaccine (IPV) in 1954. After investigators announced on April 12, 1955, that Salk IPV was safe and effective, large-scale vaccination campaigns were implemented across the United States, and IPV was set to join diphtheria-tetanuspertussis and smallpox vaccines in the childhood vaccination schedule. However, improperly prepared IPV by Cutter Pharmaceuticals used for the vaccination campaigns led to 200 cases of paralysis and 10 deaths. Referred to as the ‘‘Cutter incident,’’ this tragedy set the stage for CDC’s leadership in global immunization, highlighting both the importance of population-based surveillance and CDC’s ability to rapidly analyze data to inform the response to public health emergencies. CDC’s response to the Cutter incident was a major factor leading to the transfer of responsibility for collection and reporting of communicable disease data in 1960 from the National Office of Vital Statistics to CDC. CDC’s use of vaccine-preventable disease (VPD) surveillance data to inform program and policy decisions developed during the Cutter incident has been a foundation of CDC’s mission and subsequent VPD control initiatives. In 1961, incoming CDC Epidemic Intelligence Service Officer Donald Millar was assigned by Epidemic Intelligence Service founder Alexander Langmuir to ‘‘keep an eye on smallpox around the world and see if you can make sense of the trends. ’’ This directive led to the formation of a smallpox surveillance unit that grew into the Smallpox Eradication Program. (Global eradication is defined as the worldwide absence of a disease agent in nature as a result of deliberate control efforts that may be discontinued when the agent is judged no longer to present a significant risk of infection.) During the early 1960s, CDC established itself as an organization with the practical capability to implement immunization work in field conditions by supporting US Agency for International Development–funded measles vaccination campaigns in West Africa and by conducting evaluations of jet injectors (medical devices used for vaccination that use a high-pressure narrow stream of fluid to penetrate the skin instead of a hypodermic needle), which