Bruce Weniger Oral History

Files

If you are having trouble viewing this content, please make sure your browser is up-to-date with at least Windows Internet Explorer 9 or the latest Firefox.
2008-03-31
Sencer, David (Interviewer)
Weniger, Bruce (Interviewee)
Bruce Weniger served in the Smallpox Eradication Program as a short-term consultant for WHO in Bangladesh beginning in June 1975. Bruce explains how the smallpox program worked in Bangladesh and reads aloud from the journal he kept during that time, including a letter to his parents detailing his experience during the coup.

Source

Citation

Sencer, David (Interviewer), “Bruce Weniger Oral History,” The Global Health Chronicles, accessed March 30, 2017, http://globalhealthchronicles.org/items/show/3511.


 Interview Transcript

Interview

Dr. Bruce Weniger with Dr David Sencer
Transcribed: January 2009 | 0:31:56]



Dr. Weniger:     First, this is Dr. Bruce Weniger, who is  currently  a  CDC
           employee. I am Dr. Sencer doing  the  interviewing.  It's  March
           31st 2008 at 1:15-Bruce knows that this is  being  recorded  and
           has signed permission for us to use it.

Dr. Sencer:      Tell me a little about your early days, Bruce.

Dr. Weniger:           Well,  I  got  involved  with  the  Smallpox  Program
actually before I -

Dr. Sencer:            Let's go back to  earlier  than  that-where  are  you
from?

Dr. Weniger:     Well, I was born in New York, and grew up in New  York  and
           went  to  college  at  Brown  for  a  few  years  and  then   an
           Experimental  School  in  New  York  State,  University  at  Old
           Westbury, and then did a year of Law  School  at  Berkeley,  and
           then did my pre-med courses when I decided that law was  not  as
           interesting as I thought medicine would be, and  then  completed
           those and got into UCLA School of Medicine and  did  my  Medical
           and Public Health Degrees at UCLA in Los Angeles.

Dr. Sencer:            Why did you come into Public Health Service?

Dr. Weniger:     Well, my role model there was  Sandhu  -  I  am  trying  to
           remember his name. I am forgetting the name of  the  person  who
           was on the staff there who had been a  CDC  EIS  graduate,  I'll
           probably think of it eventually-and became interested in  public
           health because you were treating the whole community rather than
           one patient at a time and it was exciting. So immediately  after
           doing that two years of pediatrics training I applied to the EIS
           Program and got in, in 1980 and started  in  Parasitic  Diseases
           and then did Preventive Medicine Residency at the University  of
           Oregon State Health Department and then Phil Brockwin[unsure  of
           0:02:22] assigned me to the Field Epidemiology Training  Program
           in Thailand where I did a three-year tour of duty as the  Second
           WHO Advisor to  the  FETPs  as  they  were  called,  which  were
           basically carbon copies of the  Epidemic  Intelligence  Service,
           and the Thailand one was the first one outside of CDC around the
           world. I went back to CDC after that for a few years, working in
           International Health and then went back in  1990  to  found  and
           start the CDC HIV AIDS Field  Research  Station  in  Bangkok  in
           collaboration with the Thai Government that I'd gotten  to  know
           during my first assignment there. So we began that  project  and
           when I left it had about 40 Thai nationals and two Americans, me
           and Nancy Young, and now it's  a  multi-million  dollar  project
           with like 10 or 15 Americans  and  100  or  so,  or  more,  Thai
           nationals.

Dr. Sencer:            How did you happen to get involved with the  Smallpox
Program?

Dr. Weniger:     Well, I was at the  time  at  the  UCLA  School  of  Public
           Health and Medicine and Davida Coady was on the  faculty  there,
           had worked in India on smallpox and at the time in '75 there was
           a need for surge, if you  pardon  the  expression,  of  a  large
           number of personnel to go into Bangladesh and India  because  of
           some problems with the  displacements  of  people  from  natural
           disasters  and  a  whole  bunch  of  new  outbreaks  that   were
           occurring, and so I was among about a dozen or  so  people  from
           Los Angeles, UCLA and elsewhere that were brought over as short-
           term consultants for WHO and  she  recommended  my  name.  Peter
           Drockman[inaudible name0:03:40], Mike Cenerelli, Mark Strasburg,
           and a number of other names you may recall were in  that  cohort
           that went around June of 1975  to  Bangladesh  and  spent  three
           months there.

Dr. Sencer:            This was before you came to CDC?

Dr. Weniger:     It's actually before I came to CDC, but I still got  credit
           with my little ribbon on my uniform, Stan Foster was kind enough
           to give me credit for that.

Dr. Sencer:            Who was your supervisor in Bangladesh?

Dr. Weniger:     I would say Nick Ward was one  of  them.  Of  course,  Stan
           Foster ran the program and Andy Hagel[inaudible name0:04:17] was
           there handing out the big stacks of money  that  we  needed  for
           buying off this epidemic, which is how I sort of feel we  solved
           - we basically eradicated smallpox by buying it off with  hiring
           tens of thousands, and hundreds of thousands of  health  workers
           around the world to do the  grassroots  work  of  searching  for
           every last case and surrounding the cases and vaccinating and so
           forth. Those are two of the  names,  and  Daniel  Tarantola  was
           there as well, and a number of other names  that  will  come  to
           mind I think as we progress.

Dr. Sencer:            What  was  your  first  impression  of  the  Smallpox
Program?

Dr. Weniger:     Well, it was remarkable in many ways. Obviously as a  young
           epidemiologist still  in  training,  technically,  I  just  took
           everything for granted: that we would hire people on  the  spot,
           15 or 20-30 people off the street literally, or the  brother  or
           cousin of somebody who was already on our team, pay  them  Seven
           Taka a day, and the nature of the job was basically assigned  to
           search teams to go to this village, you go here, you  go  there,
           and then our role for the  most  part  was  checking  that  they
           actually did the work and when we went to  a  village  and  they
           said nobody showed up showing this Smallpox Recognition Card, we
           knew that fellow didn't do the work, he didn't get paid  and  he
           was fired. So it was basically a supervisory role of  organizing
           search campaigns and of course once we found cases, we  assigned
           people to stay in that village and vaccinate, guard the patient,
           pay money to the patient's family to feed  them,  keep  them  at
           home and vaccinate within that containment ring.

Dr. Sencer:      What were some of your most vivid recollections  of  things
           that happened while you were there?

Dr. Weniger:     After 30 or so years, one's memory fades.  I  brought  some
           journal entries that I  had  written  back  then  that  I  think
           captured more live what I was feeling. Let me see if I can  turn
           to some of my impressions here. These are still on my way to the
           location, here's our welcome in  Delhi  on  the  15th  of  June;
           Martin Jones from WHO brought us in. I do remember it was  about
           114 degrees as we walked from  the  airplane  to  the  terminal.
           Let's see if I can come up with something interesting other than
           the details with the actual work in the field.

           I am in Narshingdi, we had our district meeting in Dhaka -  this
           is 23rd of June, 1975 - I'm in Narshingdi, we had  our  district
           meeting in Dhaka this morning, ordered some supplies and already
           ate a hearty  lunch  at  the  American  Recreation  Association,
           courtesy of Finance Officer, Tim so-and-so, loaded the jeep with
           my luggage and took off. Roland and I -


           This is Roland Sipple -


           ...rode two  Suzuki  80s  on  the  two-hour  drive  through  the
           countryside. What a thrill to speed along on a  motorcycle  past
           the rice paddies and lush fields of  green  jute  with  the  sun
           setting behind one's shoulder and the  clouds  making  beautiful
           formations in the clear, blue and pink sky. Bangladesh  has  the
           most lovely clouds, majestic, substantial and pure white  almost
           like kinetic sculpture. We rode into Narshingdi under  the  full
           moon's light. What  a  challenge  riding  a  cycle  through  the
           crowded hamlets and bus stops that clustered along the highway."

           Let me skip some of this now, and I can leave copies  with  you.
           Let's turn to 25 June, 1975.

           Yesterday a trip to Parkouri outbreak; today,  we  took  a  five
           hour ride in a dingy to two outbreaks  down  the  Magoni  River.
           Many forced vaccinations and  a  magnificent  meal.  Details  to
           follow when I have time - Very tired, left at 5:00 am,  returned
           at 5:00 pm.

           The village of Chardigaldi had no active cases,  but  there  had
           been much resistance to the vaccinating team, so  Roland  and  I
           split up to carry out what was becoming standard  procedure,  to
           vaccinate by force those  villagers  who  have  intimidated  the
           vaccinators. These refusers are often the young,  strong  family
           men; but the surprising fear of seeing a white man with absolute
           assurance and calmness, walk into  their  home,  asking  to  see
           their vaccination scar and ordering the  vaccination,  overcomes
           all resistance. Often it is the older women who try to run away,
           and whose arms must be grabbed and held. One man locked  himself
           in his house. At first I thought it was a woman, since they  are
           more afraid of vaccination and extremely embarrassed about being
           seen by a man. I told the  resident  supervisor  to  inform  the
           person that if the door was not opened in one  minute,  I  would
           break it down. Half the village was screaming at him to open up.
           Finally, the door was unlatched and I discovered  an  absolutely
           terrified man clutching his child. I tried to reassure him  with
           an arm round  his  shoulder,  but  the  fear  in  his  eyes  was
           unchanged. I shall never forget his look and the absolute terror
           that I must have caused him. We vaccinated them both immediately
           and left and perhaps the relative painlessness of it  and  speed
           of our departure afterwards calmed him down.

           Unfortunately this is the price that must be paid if smallpox is
           to be eradicated from its last stronghold among this illiterate,
           uneducated, poverty-stricken rural population. We  were  treated
           to a royal meal in  the  [inaudible  0:09:25]  of  the  resident
           supervisor of a nearby outbreak in  Chandwani.  As  several  men
           cooled us with palm frond fans in the tiny crowded hut, we  were
           served rice and curry, roasted duck, eggs, chicken,  prawns  and
           lentil chickpea stew. The custom seems to  constantly  put  more
           food on your plate, unless you make a fuss  that  you  have  had
           enough. They seem prepared to  serve  Roland,  Metteus[inaudible
           name 0:09:46] and myself enough for 10 people. After  a  dessert
           of Bengali spaghetti served in warm milk and sugar, of  which  I
           ate half, balancing my responsibility to  be  a  gracious  guest
           with my concern over milk that might have sat for hours; covered
           with   flies   in   the   hot   sun   after   coming   from    a
           tuburculous[inaudible0:10:02] cow. Then we were treated to  pan,
           which I decided I might as well try. Its sliced  betel  nut  and
           lime rolled in a betel leaf and  chewed  for  many  minutes  and
           eventually swallowed. After  chewing  mine  about  10  times,  I
           realized it would make me sick to swallow it and  an  unmannered
           guest to spit it out. So I stuck it in my cheek and  prayed  for
           the soonest opportunity to get rid of it. Within a  few  minutes
           that side of my mouth was numb and every swallow of the  copious
           juices that were being  secreted  by  my  captive  mouth  was  a
           carefully planned exercise  in  controlled  nausea.  Fortunately
           conversation was not possible with our interpreter  chewing  his
           pan and  after  taking  a  picture  of  this  incredible  repast
           surrounded by half the village peering in  the  windows,  I  was
           able to leave for our boat jettisoning my pan on the way.

           I think that will be enough for now and as  we  have  some  more
           opportunities.

Dr.  Sencer:             Do  you  think  you  contributed  anything  to  the
eradication?

Dr. Weniger:     Well, I don't think I contributed anything in  the  way  of
           new strategies. I was just another foot  solider  on  the  front
           lines, working  in  my  assigned  areas.  Originally  I  was  in
           Narshingdi with Roland Sipple from the United Kingdom  and  then
           the latter half of my three-month tour of duty was in Dhaka, the
           capital city; responsible for the southern suburbs on the island
           of Keraniganj in the Northern suburbs, and obviously I was  just
           one small component of the procedure of  the  whole  effort.  In
           retrospect in terms of what we think now about how the  campaign
           was done, I really wonder if we could have done it again in  the
           same way. These days we'd have to have written consent forms and
           so forth for vaccinating and -

Dr. Sencer:            How did you communicate?

Dr. Weniger:     Well, I knew a  few  words  of  Bengali.  You  know,  "Bugi
           ashanti  ase[inaudible  0:11:54]?"  "Are  there   any   smallpox
           patients here?" But I had an interpreter.

Dr. Sencer:      I was thinking, how did you  communicate  with  Dhaka  when
           you were in the field? How did Dhaka communicate with Atlanta?

Dr. Weniger:     Well, we were in Narshingdi  which  is  only  a  couple  of
           hours away by  ferry  boat  and  motor  cycle  that  travel,  or
           vehicles when we finally had  them.  We  did  not  have  radios.
           Others who were more remote used radios to communicate  back  to
           Dhaka, but I don't recall having a radio to make - I'm not  sure
           how we did it, it's been so long, we might have  sent  telegrams
           or just come in on a weekly basis.

Dr. Sencer:            You didn't have a cell phone?

Dr. Weniger:           No, we didn't have cell phones.

Dr. Sencer:            You didn't have email?

Dr. Weniger:           No email, no cell phones.

Dr. Sencer:            Do you think  your  experience  in  smallpox  changed
your career?

Dr. Weniger:     Oh! I think it  definitely  did.  I  think  I  was  already
           focused on public health and coming to CDC at the time,  but  it
           certainly cemented that to be part of that great effort  and  so
           when polio eradication came around 15 or 20 years later,  I  was
           clearly quite excited about that and I think  some  day  measles
           would be eradicable because it doesn't have a natural  host  and
           someday it would be nice  if  the  world  could  figure  how  to
           eradicate measles. But it was seminal  in  that  respect.  Since
           that time of course, I have been working  in  many  areas,  most
           recently vaccine technology and have an  interest  in  injection
           safety and I have realized that some of the  practices  that  we
           did carry out in terms of the bifurcated  needles,  although  we
           provided plenty of needles to the health workers, it's clear  we
           weren't thinking or educating, or strict enough as we  would  be
           today with ensuring that every patient got  a  separate  sterile
           needle put back in the holder  to  be  re-sterilized,  and  it's
           probable that in those days  we  were  effectively  transmitting
           Hepatitis-B  from  patient  to  patient  in  a   large   degree.
           Fortunately, HIV was not around at the time and I  think  if  it
           had been we would have seen the effects of it.  But  clearly  it
           would be difficult to conduct the campaign today in the same way
           we did then, or at least it would cost so much  more  and  would
           require so much more manpower and perhaps take much more time.

Dr. Sencer:      If you were in charge of the program in the 70s, would  you
           have organized things differently?

Dr. Weniger:     I don't think so, and I am not sure,  at  the  time  I  had
           enough experience to be able to see  areas  where  it  could  be
           improved. Clearly we were working with difficult  circumstances.
           We didn't have the fancy satellite telephones  they  have  today
           for communications and I do recall that if you had  four  things
           or five things you wanted to accomplish in one day,  whether  it
           was buying fuel for your vehicle, or arranging some shipment  of
           something, or getting to a village, if you accomplished  one  of
           those  five  things  you  had  succeeded.  I  mean  things  were
           difficult in those circumstances.

Dr. Sencer:      Did you work with  other  people  from  the  United  States
           while you were out in the field, or were you the only -?

Dr. Weniger:     Well, for the first part of  my  assignment  I  shared  the
           Narshingdi District with Roland Sipple and we  lived  in  a  Dak
           Bungalow, which is like a Government  guesthouse  in  that  town
           about two hours or so away from Dhaka. But for the most part  we
           were working with interpreters that we hired locally  who  could
           speak enough English for us and who could work  with  the  local
           population. I  do  recall  that  one  of  our  missions  was  to
           publicize the reward for reporting a case  of  smallpox,  and  I
           recall vividly we had one individual who had reported a case. It
           turned out to be a real case, and so it was time  to  recompense
           him. I can't remember exactly how many Takas he was  getting  at
           the time or what its value is in U.S. dollars, but  probably  it
           was the equivalent of US$500.00 in his income situation  and  we
           made sure that everyone in that whole area, we had  bull  horns,
           and anytime you make any kind of noise, crowds assemble and  you
           have 500 or 1000 people watching you, we announced clearly, this
           gentleman had reported a case of smallpox and he was  now  being
           paid this princely sum and that was part of the  effort  to  get
           the public to cooperate in finding all these every last case and
           stopping the chain of transmission.

Dr. Sencer:            Did you get a lot of chickenpox reported?

Dr. Weniger:     Yes. Most of the reports we were  getting  were  chickenpox
           and the big differential which we learned  quite  carefully  was
           how to distinguish one from the other, and to me one of the  key
           criteria was if you could take your thumb and  push  it  over  a
           blister or a pox and it burst and liquid came out that was  more
           likely chickenpox, among all the  other  differential  criteria.
           This was just a few months: this was June, July, August of 1975.
           The last case in Bangladesh was in October of 1975, so it was on
           the tail  end  of  the  epidemic.  We  had  basically  only  one
           confirmed outbreak to deal with in Narshingdi.

Dr. Sencer:            Were you involved in any of the refugee camps?

Dr. Weniger:     Yes-the refugee camps were in my area of responsibility  in
           the Northern suburbs of Dhaka and I do recall when  we  went  to
           visit the refugee camps searching for cases, that  the  refugees
           themselves seeing foreign personnel, white persons, assuming  we
           were connected to the refugee effort, would come up and complain
           to us that the responsible authorities  were  stealing  all  the
           donated food and other supplies for the refugees and  they  were
           not getting anything, and this was just a few weeks before there
           was a revolution in which  Mujibur  Rahman  was  overthrown  and
           assassinated  and  it  had  been  rumored  that  the  amount  of
           corruption going on in terms of selling rice, donated  by  other
           countries, on the  black  market  or  to  other  countries,  was
           occurring widely, and that was  one  of  the  many  reasons  for
           overthrowing him. So I  remember  waking  up,  I  probably  have
           another letter home that I wrote to my parents after the coup in
           Bangladesh. I have to look and talk at the same time.

Dr. Sencer:            Did  you  ever  have  a  feeling  that  you  were  in
physical danger?

Dr. Weniger:     Yes. There was one time when we had a disagreement  with  -
           Roland and I with the storekeeper who  wanted  to  charge  us  a
           deposit for some bottles and we discarded the bottles and all of
           a sudden a crowd of 500 people surrounded us and  right  outside
           the Dak Bungalow; and it's a such a populated  country  that  we
           were really probably in danger  of  being  torn  apart  for  the
           disagreement with the shopkeeper, and so a  senior  official  in
           the town brought us into the Dak Bungalow with  the  person  who
           was complaining  about  us  and  resolved  it  with  payment  of
           whatever the value was of the Coke bottles or Fanta bottles that
           we had discarded;  and  it  was  not  a  danger  resulting  from
           smallpox eradication, but  just  from  a  disagreement;  and  we
           learnt quite easily, you've got to be very careful when you  are
           a foreigner in a country, to avoid crowds forming. We were told,
           for example, if there was ever a car accident, if you  are  ever
           involved in a car accident, don't stop the car because the local
           villagers who are upset there wouldn't be any justice, will tear
           you apart and kill you-just keep driving to the  next  town  and
           turn yourself into the district officer and  if  you  have  ever
           driven in Bangladesh, you know people don't pay  much  attention
           to vehicles, they are using the roads to walk and it's driving -



           Here's the letter I was looking for about the coup d'état.  It's
           dated the 16th of August, 1975.

           Dear everybody: Since I have been here I haven't  had  a  boring
           day and yesterday was no exception. At 5.30  in  the  morning  I
           woke to the sounds of machine gun and  rifle  fire  that  seemed
           really close. Every so often the house  shook  from  explosions,
           probably the cannons of tanks. Somehow I knew  immediately  that
           this was a revolution. The Sheikh's house is only a  few  blocks
           away...

           This was the Sheikh Mujibur Rahman, leader of Bangladesh -

           ...and we guessed correctly, this fighting was  the  assault  on
           his residence. It  was  really  rather  exciting  standing  just
           inside the doorway to the roof of our house. We could  hear  the
           bullets flying overhead, sharp cracking noises  that  seemed  to
           come from the President's residence which we could just see from
           our roof. Probably 200 rounds were fired during the  first  half
           hour and about 10 explosions, tapering off to some sporadic fire
           for the rest of the morning. Bangladesh radio came on about 7:00
           am to report the death of the Sheikh and to announce the curfew.
           Jennifer,  my  assistant,  lives  five  blocks  from  the  guest
           house...

           She was the daughter of a U.S. diplomat in the country  and  was
           volunteering to help us with the smallpox eradication.

           ...and awoke with a tank in front of her house. Amazingly enough
           the telephones worked and we telephoned the Smallpox Director to
           inform them of the fighting...

           This was Dan Foster.

           ...since his part of Dhaka was quiet, by calling friends  around
           the city I  was  able  to  learn  that  probably  half  a  dozen
           Government Ministers, mostly relatives of the Sheikh,  had  also
           been wiped out. Our first fears were that the  Iraqi  Bahini,  a
           sort of private army of the Sheikh,  not  unlike  Hitler's  S.S.
           might oppose the army coup and fighting between the  two  groups
           could lead to a messy Civil War. But 36 hours later as  I  write
           this letter, things are calm and getting more  relaxed  all  the
           time.

           During the hour and a half lifting of the  curfew  yesterday,  I
           rode my motorcycle over to the house of  a  Bengali  friend  who
           knows a lot about the political situation; and she reported  how
           the house of another minister was attacked and all killed except
           one servant that managed to  escape.  The  streets  were  eerily
           empty, a strange sight in a city that is normally bustling  with
           every imaginable form of  vehicle,  ox  carts,  rickshaws,  baby
           taxis, cars, buses and  hordes  of  pedestrians.  Soldiers  were
           posted with rifles and machine guns on strategic corners and the
           streets were scarred with the tread marks  of  tanks.  There  is
           somewhat of  a  holiday  atmosphere  among  the  people  on  the
           streets, since except for the deaths of the few corrupt families
           that were in control of the Government there is no indication of
           any other violence. Last night  the  city  was  as  quiet  as  a
           graveyard. We sat on the roof watching the moon and the  clouds,
           listening to the B.B.C. and Voice of America as  well  as  Radio
           Bangladesh, the source of all  the  information.  Military  cars
           would occasionally drive by, presumably patrolling the curfew.

           This morning  we  received  a  cross-notification  from  another
           district that someone had died of smallpox after coming  from  a
           certain section of Dhaka. So we were faced with the necessity of
           going out to check out the information to see if there  was  any
           smallpox there. We heard that some vehicles were  traveling  the
           roads despite the curfew, such as diplomatic cars and  such.  So
           we decided to go to the smallpox office  to  organize  a  search
           team. We had heard that the army would  probably  stop  us,  but
           being internationals and showing something official looking,  we
           would be allowed to proceed. So we put our U.N. passports in our
           pockets, picked the  Land  Rover  that  had  the  most  official
           looking  insignias,  seals  and  posters  on  it  and  took  our
           houseboy, in case we needed an interpreter for  the  three  mile
           ride. I drove slowly and carefully and  was  fully  prepared  to
           stop if anyone flagged us down, but  surprisingly  none  of  the
           troops bothered us as we  drove  by  the  tanks  and  machinegun
           emplacements. It confirmed to me my long-held  belief,  that  no
           matter where you are or what you do; if you act like you  belong
           there nobody bothers you. At the smallpox office, we  were  able
           to learn that things were quiet in the countryside  as  well  as
           Dhaka and that our radio contact with the advisors in the  field
           is still in operation. By the time we put big red crosses on our
           car to look even more official, we found out the curfew had been
           lifted for three hours anyway. Old Dhaka where we  searched  for
           outbreak was as crowded and normal looking as ever.  We  weren't
           able to find any smallpox, but it will be necessary to send in a
           really large search team to comb the area in  a  few  days  when
           things are expected to be back to  normal.  I  tried  sending  a
           message home to say I am alright, but the U.S. Embassy says they
           can only send general messages to Washington that all  Americans
           are believed to be safe, which is probably true.

           This is a letter to my parents and family in the States.

           I expected that some sort of revolution in Bangladesh in a  year
           or two, but was really surprised that it would happen  now.  Not
           that  the  Sheikh  didn't  deserve  to  be  overthrown.  He  had
           appointed all his relatives to Government posts, which they used
           to rake in large amounts of money, doing things like taking  the
           relief supplies donated from abroad and  smuggling  and  selling
           them in India. He had also been bringing the country closer  and
           closer to India and the Soviet Union and further away  from  the
           Islamic world. That is probably why the army chose  the  day  of
           India's  Independence  celebration  to  stage   the   coup   and
           indirectly slap India in the  face.  There  is  fear  among  the
           Bengalis that India might invade a  la  Czechoslovakia  in  1968
           when [inaudible word 0:25:10] Government crisis effectively ties
           our hands vis-à-vis Bangladesh interference. We are  all  hoping
           that in a few days the curfews will be  over  and  our  smallpox
           work can continue. There are  only  38  known  active  cases  of
           smallpox left in the country and it would be  a  shame  if  this
           political crisis prevented the success of our program. As it is,
           the WHO Director General who is due to arrive today to meet  the
           Sheikh has cancelled  his  trip.  Unfortunately  the  Government
           health structure will probably be in a shambles  for  weeks  and
           this is not good for our program. I spent the afternoon swimming
           and sunning by the pool at  the  InterContinental  talking  with
           other foreigners staying there during the crisis. It's really  a
           rather pleasant way to spend the revolution. I love their banana
           splits. Love Bruce.

Dr. Sencer:      Of the foreign nationals who worked at Bangladesh, I  think
           there were more people from the United States than  any  of  the
           other countries. Were you involved with people from some of  the
           other countries?

Dr. Weniger:     Yes; we had periodic meetings in Dhaka for those who  would
           get to Dhaka and we had Olof Ringard[inaudible name0:26:20] from
           Sweden. Right now I can't remember off the top of my  head,  I'd
           have to open up the  small  Pox  Bible  and  read  the  list  of
           expatriates that were there, but they  were  coming  from  many,
           many countries. In fact,  many  years  later,  when  I  went  to
           Thailand for my assignment, my counterpart in  the  Ministry  of
           Health was Dr. Pa... Koona....[inaudible name0:26:41] who was  a
           fellow smallpox worker in Bangladesh, who then  became  Head  of
           the Division of Epidemiology that  ran  the  Field  Epidemiology
           Training Program in Thailand.

Dr. Sencer:      The smallpox program was really a sort of  breeding  ground
           for many people who made a  very  profitable  career  in  public
           health?

Dr. Weniger:     That's right,  and  I  think  that  the  Polio  Eradication
           Program over the last decade or so has been the same  thing  for
           the next generation of bringing people into the field.

Dr. Sencer:            You think they are going to make it with polio?

Dr. Weniger:     I think so, eventually. There are some  difficult  problems
           in that there is virus sitting in test tubes frozen in  freezers
           around the world from laboratories, and every last one  has  got
           to be found out. Another problem we face in our work is  how  to
           convert from the inexpensive easy oral polio vaccine to the much
           more expensive injectable vaccine which costs ten times as much;
           and so people -

Dr. Sencer:            In which you won't be able to use the jet injector?

Dr. Weniger:     Well, you will; and we are actually  studying  the  use  of
           the jet  injector  for  an  intradermal  delivery  of  influenza
           vaccine. Others in Cuba  and  Oman  under  WHO  sponsorship  are
           studying the use of injectable  polio  in  an  intradermal  dose
           which can reduce the dose by 20% of the normal  dose,  and  that
           would affect dose-sparing and as well perhaps be a way to do  it
           without needles which is a  big  problem.  So  we  are  actually
           working  in  our  vaccine  technology  program  on   intradermal
           delivery with or without needles for such indications.

Dr. Sencer:      I think the fear has been, again of Hepatitis  and  so  on,
           but with the intradermal you don't think that's an issue?

Dr. Weniger:     Well, if you are using standard needle syringe,  there  are
           many drawbacks to using intra-dermal. The Mantoux test  is  very
           difficult to do. Even here at CDC, I recall my  last  two  intra
           dermal T.B. skin tests were not performed correctly by the nurse
           and if they can't do right here at Mecca, you  can  imagine  how
           difficult it is  in  much  of  the  world.  But  there  are  new
           technologies being developed for quick and simple  intra  dermal
           delivery  that  don't  have  the  high  failure  rate   of   the
           traditional Mantoux test. The ideal  ones  would  of  course  be
           without a needle, so you don't have  the  problem  of  potential
           reuse or the syringe or needle-stick injuries and so forth.

Dr. Sencer:            Anything else about smallpox you'd like to add?

Dr. Weniger:     Well-probably I will think of it as soon  as  we  turn  off
           the camera. But I think it represents in my  mind  what  can  be
           accomplished when the world works together and overcomes all the
           tremendous boundaries that existed.  We  had  the  Soviet  Union
           cooperating with the United States  across  that  terrible  Iron
           Curtain and Cold War. We had all  racial  groups  and  political
           groups meeting  together,  and  to  some  extent  that  type  of
           cooperation continues to occur. We still have truces in  various
           Civil Wars around the  world  to  let  the  kids  be  vaccinated
           against polio during the Polio Eradication Program;  and  so  it
           shows you what can be accomplished if people come  together  and
           set their minds on very difficult goals. You will never  satisfy
           every possible objection, and there are those who also say polio
           can't be eradicated so why are you wasting all this money. But I
           think  if  you  have  the   vision   as   Duff   Hagee[inaudible
           name0:30:14:5] and D. Henderson and others who were the  leading
           strategic strategists for this effort, it can  be  done  and  it
           will be done again with other diseases I hope.

Dr. Sencer:            That's a good note to end on. Thank you, Bruce.

Dr. Weniger:           Thanks a lot.

                                 * * * * * *

Dr. Sencer:       That  will  end  the  formal  interview,  but  here,  your
           briefcase there would you hold it up so I could get a -?

Dr. Weniger:     Yeah, well what this is:  these  were  carrying  bags  that
           were given to all the eradication people. It  is  obviously  WHO
           sponsored:  World  Health  Organization;   and   this   Smallpox
           Eradication Program. I can't read the  Bengali  but  these  were
           made in Bangladesh for the staff to carry their papers. I  ended
           up actually bringing an attaché case with a WHO logo on  it  and
           it was necessary because we were carrying  bundles  of  cash,  I
           mean literally  stacks  of  money.  This  was  probably  in  the
           equivalent of their society; hundreds of  thousands  of  dollars
           walking around because we would have to pay all  these  hundreds
           of health workers and one of the photographs  there  is  payday,
           where we would sit down and we'd check if someone was  still  on
           the list and had done their job, and would get a stack of  bills
           and that would be once a month. So I'm surprised we didn't  have
           more armed robberies carrying around that kind of money.

Dr. Sencer:      I remember riding a train from Delhi  to  Patna  with  Bill
           Foege with a briefcase so big of Rupees.

Dr. Weniger:           And nobody knew what was in there?

Dr. Sencer:            Right. Well thank you  very  much,  Bruce.  That's  a
good interview.

Dr. Weniger:           Dave, you're welcome. Thank you.


[End of audio 0:31:56]