Thoughts on economics and liberty

Donald Henderson and the index case problem (“patient zero”)

I’ve commented on this issue elsewhere and

But since 98% of the world’s epidemiologists don’t understand this, let me also note here.

David Henderson, Dean of the Johns Hopkins School of Public Health, who helped eradicate small pox, was a staunch opponent of international border closures and quarantines. Australia’s public health “experts” are monumentally ignorant in comparison.

On 5 March 2010 in a conference on “The 2009 H1N1 experience: policy implications for future infectious disease emergencies” he said (this is an extract):

When even small pox could never be stopped, how can respiratory viruses be stopped at the border?

International border closures and quarantines were antiquated as a public health policy by the 1960s and were NEVER recommended since then. THEY HAVE BEEN RE-INVENTED BY THE CCP.


“Born in Ohio, Henderson received his medical degree in 1954. After his residency he served a stint in the Epidemiology Intelligence Service of the CDC, creating a Smallpox Surveillance Unit to guard against any imported epidemic.” [Source: Barry Youngerman (2008) Pandemics and Global Health. Infobase Publishing]  – SEE ALSO AFTER THE TRANSCRIPT.


In the smallpox program there were the questions: What do we do about screening people?

And this was something we were really deeply concerned about with smallpox.

And so, we went into the records rather thoroughly since about 1945. And there are about just under 50 importations of smallpox that could be well-documented.

And the question is: How many might we have intercepted who might have had just fever or rash?

And the fact was none.

So, anything we were doing at a border crossing to try to interrupt smallpox coming across the border would have been quite futile.

I then had some discussions with our CDC colleagues and the quarantine group down there and thought about this. I thought, you know, as I said to them, CDC investigates a lot of different outbreaks, and many of these you can tell which are the first case [THE INDEX CASE], and so forth. It’d be interesting to see how many instances we could identify in which that first individual might have been intercepted coming into the country.

And I’m still waiting for one example so far.

I think the point is that this idea that in this day and age one is going to intercept people coming across the border and you’re going to stop the spread of the disease is a concept that was antiquated a very long time ago.

He talks about this issue in his 2013 book:

In 1963 and 1964 two events reinforced our concerns. The first involved a fourteen-year-old boy who arrived in New York from Brazil and then traveled by train to his home in Toronto. He developed fever while en route, followed by a smallpox rash soon after reaching home. I flew to Toronto and quickly ascertained that the Canadian authorities had done everything necessary. They had isolated the boy, had vaccinated his contacts, and were actively seeking to find anyone else who might have had contact with him. I telephoned this reassuring news to the US surgeon general, only to learn that he was about to meet with departmental officials. He said they were on the verge of a decision to close the borders with Canada and to recommend vaccination for everyone who had been in Grand Central Station or on the train to Toronto on the same day as the boy. Some alarmists even argued that the residents of all cities on the train route should be vaccinated as well.

I pointed out that the rash had not developed until after the patient had reached Canada. Thus he would not have infected anyone en route because smallpox is not contagious until the rash develops. Did we really need to close the border, I asked—after all, if the case had been in Pennsylvania, we would not consider closing its border with New York. Why close the Canadian border? I suggested that, for public health purposes, we consider Canada to be another state. This idea was happily accepted. Later, I informed Canadian authorities that Canada was now being considered just another state. National sensitivities being what they are, this was not a good way to explain the decision. They were not amused.


Lessons from the eradication of smallpox: an interview with D. A. Henderson


The reason why Henderson wrote this 2006 article – to fight quarantines and such stupid ideas of computer programmers

An extract from Jay Bhattacharya’s video comment on Donald Henderson:


In this video I explain the index case problem in English.

In this video I explain the index problem in Hindi.

FROM HENDERSON’S BOOK (D.A. Henderson (2013). Smallpox: the death of a disease: the inside story of eradicating a worldwide killer.Prometheus Books.)

Fourteen years later, in 1961, I would be assigned national responsibility for dealing with smallpox, should it be imported into the United States. My position was chief of the surveillance section at the US Communicable Disease Center (CDC). It was a time of high anxiety. Major smallpox epidemics were then erupting across India and Pakistan. Travelers flying by jet aircraft were rapidly increasing in number, and some were infected with the smallpox virus. From 1958 through 1960, the disease had been imported into Europe from Asia six times; eleven more importations occurred in 1961. By the end of 1963, twenty-three importations had resulted in nearly 400 cases. Not surprisingly, we had a number of false alarms in the United States—primarily patients with chicken pox. I assumed that it was only a matter of time before we would have to cope with smallpox.

There were two basic approaches to prevention. One was the well-established defensive strategy—continued compulsory vaccination of children, inspection of travelers’ vaccination certificates showing that they had been successfully vaccinated within the previous three years, and rapid investigation of all suspected cases. The longer-term approach was to work with other countries to stop smallpox epidemics at their source—to eradicate the disease. Thus began my career adventure with smallpox and smallpox eradication.

…I, with four colleagues, documented the story of smallpox eradication in a detailed archival history—a fourteen-hundred-page account (familiarly known as “The Big Red Book”). That book, Smallpox and Its Eradication, was published by the World Health Organization in 1988. It is now out of print but is available on the World Health Organization Web site.


Within just two months of his recruitment to the Epidemic Intelligence Service (EIS), the disease-detection branch of the Centers for Disease Control and Prevention in Atlanta, Ga, Henderson suddenly found himself at the helm — at 27, the acting chief of the elite unit.

Thrust into the role after his boss departed for another job, Henderson was “obviously underqualified,” as he recalled years later. But he thrived and soon became the CDC’s director of viral disease surveillance. Taking after his mentor, EIS founder Alexander Langmuir, Henderson practiced what he called “shoe leather epidemiology,” often leaving the office to collect data and conduct interviews in the field. (“The converse type was the office-bound ‘shiny pants’ epidemiologist,'” he noted.)  [Source]

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Sanjeev Sabhlok

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