This timeline starts with the birth of the WER in 1926, marking milestones through the years: epidemics, technological breakthroughs, the establishment of the World Health Organization in 1948, the conquest of infectious disease scourges, such as smallpox in 1979 and the ongoing battle against new and re-emerging infectious diseases.
On 1st April 1926, the Health Office of the Secretariat of the League of Nations published the first issue of the Weekly Epidemiological Record (WER). The WER was initially tasked with informing the world about disease hazards that, at that time, mostly travelled by sea: cholera, plague, yellow fever and typhoid fever.
The yellow fever virus was first isolated in Nigeria in 27 June 1927, (known as the Asahi strain) then in 1928 a separate strain was isolated in Dakar (the French strain). This then led to development of the first yellow fever vaccine.
The fortuitous discovery of penicillin on a mouldy Petri dish by Alexander Fleming launched a new era in medicine. This natural compound, produced by the Penicillium fungus, was found to be toxic to bacteria, but safe for use in humans. The use of penicillin in World War II is credited with saving the lives of hundreds of thousands.
Live attenuated vaccine developed by J. Robic and G. Girard at Madagascar became the first effective plague vaccine. In the following years, mass vaccination campaigns reduced the incidence of the disease in that country tenfold.
Influenza A virus, which, when it undergoes ‘antigenic shift’ can cause pandemic influenza, was isolated.
The discoverer of penicillin, Alexander Fleming, first warned of the potential importance of the development of resistance. Soon the evidence became alarming. In 1946, a hospital in the United Kingdom reported that 14% of all Staphylococcus aureus infections were resistant to penicillin. By 1950, this proportion had increased to 59%. In the 1990s, penicillin-resistant S. aureus had attained levels greater than 80% both in hospitals and in the community.
The antibiotic streptomycin was discovered by Schatz A., Bugie E. and Waksman S. Its therapeutic introduction has saved many lives since then.
The United Nations Conference in San Francisco, USA, held from 25 April to 26 June, unanimously approved the establishment of a new, autonomous international health organization.
On 22 July 1946, 61 member states of the UN adopted and signed the Constitution of the World Health Organization at the International Health Conference in New York .
Concerns that antigenic shift could lead to an in fluenza pandemic on the scale of the 1918–1919 pandemic prompted the World Health Organization to establish an influenza surveillance programme, providing information about the epidemiology of the disease and enabling updating of vaccine formulations. The World Infl uenza Centre was eventually set up at the National Institute for Medical Research in London with responsibility for collecting and distributing information, carrying out and coordinating laboratory work on infl uenza and training laboratory workers.
The World Health Organization Constitution came into force on 7 April 1948.
The first daily rediotelegraphic bulletin from WHO, providing the latest information on cases of notifiable diseases in ships, seaports and airports, quarantine measures imposed or withdrawn and other data on epidemics of international significance including influenza, was sent on 27 January 1949 via Radio-Suisse S.A., Geneva. The earliest radio-telegraphic bulletins were those sent by the Singapore epidemiological stations via a wireless network in the 1920s.
Mass tuberculosis immunization gets underway using the Bacille Calmette-Guérin (BCG) vaccine in children.
The World Health Assembly establishes World Health Day to take place annually on 7 April.
Although the WHO Infl uenza Control Programme was established in 1947, it became clear a worldwide network of laboratories was needed to improve surveillance and support countries lacking virology capacity. To overcome these di fficulties, an Expert Committee on Infl uenza was convened in 1952 and recommended the establishment of an extensive international network of laboratories to conduct surveillance and provide WHO with the information it required to advise its Member States on the most e ffective infl uenza control measures.
An injectable vaccine developed by Jonas Salk proved to be safe and effective for protecting children against polio.
The Global Malaria Eradication Programme was approved by the 8th World Health Assembly in Mexico. The campaign succeeded in eliminating malaria from Europe, North America, the Caribbean and parts of Asia and South-Central America. But no major success occurred in sub-Saharan Africa. The programme was abandoned in 1969. In 1992, leaders attending a Ministerial Conference on Malaria in Amsterdam adopted a Global Strategy for Malaria Control that was more realistic, more pragmatic and more sustainable than previous approaches to malaria control.
The Asian fl u pandemic of 1957 began in East Asia in February and spread to every continent, causing 1-2 million deaths.
In 1961, a major cholera pandemic began in Indonesia and spread rapidly to other countries in Asia, Europe and Africa. The pandemic continued over three decades, eventually reaching Latin America (in 1991), which had been free of cholera for more than a century. The disease spread rapidly in Latin America, causing nearly 400 000 reported cases and over 4000 deaths in 16 countries.
The Staphylococcus aureus bacterium (S. Aureus), a major source of human infection was widely treated with penicillin in the 1940s. However, in the late 1940s and throughout the 1950s, S. aureus developed resistance to penicillin. Methicillin, a form of penicillin, was introduced to counter the increasing problem of penicillin-resistant S. aureus. However, in 1961, British scientists identi ed the fi rst strains of S. aureus bacteria that resisted methicillin. This was the so-called ‘birth’ of methicillin resistant staphylococcus aureus or MRSA.
Dr Albert Sabin developed a "live" oral vaccine against polio (OPV), which, due to its ease of administration, rapidly became the vaccine of choice for mass polio immunization programmes.
After demonstrating its safety and efficacy, John Enders and colleagues declared their measles vaccine capable of preventing infection.
The mumps live attenuated virus vaccine was developed by Maurice Hilleman who isolated the virus from his daughter, Jeryl Lynn, who was recovering from mumps. It became known as the Jeryl Lynn strain of mumps virus.
In the Director-General’s Report to the 19th World Health Assembly, a new strategy was proposed and accepted with special funds authorized. An intensified effort to eradicate the disease began in January 1967. That year, there were more than 10 million cases and 2 million deaths in 43 countries. The basic strategy consisted of two components: carefully monitored mass vaccination programmes to reach 80% of the population and a new approach to disease prevention — surveillance and containment. This required weekly reports of smallpox cases from all health units with special teams to quickly investigate cases and outbreaks.
In 1968, an antigenic shift to a new infl uenza subtype, H3N2, caused a pandemic now known as the ‘Hong Kong fl u’. It was the third flu pandemic in the 20th century, following the ‘Spanish flu’ in 1918 and the ‘Asian fl u’ in 1957. Although the case-fatality rate for this pandemic was lower than that for the ‘Spanish fl u’, it still caused about one million deaths.
The fi rst rubella vaccine—a live, attenuated vaccine—was licensed in 1969. It was developed by the prolifi c vaccine researcher Maurice Hilleman, using rubella virus obtained from scientists Paul Parkman and Harry Meyer. Hilleman’s rubella vaccine was used in the combination measles-mumps-rubella (MMR) vaccine, which was licensed in 1971.
The International Health Regulations adopted by the Twenty-second World Health Assembly on 25 July 1969, represent a revised and consolidated version of the previous International Sanitary Regulations.
Rifampicin, developed from bacteria in soil from a pine forest on the French Riviera by a pharmaceutical research team led by Piero Sensi and Maria Teresa Timbal, was introduced for clinical use in 1971. Its use revolutionized treatment of tuberculosis, drastically reducing the necessary treatment time.
An automatic telex reply service (ATRS), operating from WHO Headquarters, Geneva, was established on 11 December 1972 to inform Member States promptly of the occurrence of communicable diseases of international importance. Each Friday information intended for publication in the Weekly Epidemiological Record (WER) was summarized and fed into the machine for automatic transmission. This enabled national health administrations to obtain important information well before the WER reached them.
Formal recommendations for virus strains to be included in infl uenza vaccines were fi rst issued by WHO in 1973, based on data compiled through the Global In fluenza Surveillance Network (renamed the Global Infl uenza Surveillance and response System in 2009). From 1998 onward, recommendations have been issued twice per year, in February and September, for infl uenza seasons in the Northern and Southern Hemisphere in fluenza seasons respectively.
Following the dramatic consequences of onchocerciasis in West Africa, WHO partnered with the World Bank, the United Nations Development Programme (UNDP) as well as Food and Agriculture Organization (FAO) to launch the OCP. These UN agencies constitute the sponsoring agencies of OCP. The programme stretched over 1 200 000 Km² to protect 30 million people in 11 countries from the river blindness.
In May 1974, the 27th World Health Assembly resolved to build on the success of the smallpox eradication programme and established the Expanded Programme on Immunization (EPI) to ensure that all children, in all countries, could benefit from life-saving vaccines. The EPI recommended the use of vaccines to protect against six diseases: tuberculosis (BCG), diphtheria, tetanus, pertussis (DTP vaccine), measles and poliomyelitis.
The Special Programme for Research and Training in Tropical Diseases was established to help coordinate, support and in fluence global eff orts to combat neglected infectious diseases that disproportionately aff ect poor and marginalized populations.
The Ebola virus was fi rst identi fied in 1976 during an outbreak that began on 3 September 1976 in the village of Yambuku, in the Democratic Republic of the Congo (Zaire). The Zaire Ministry of Health requested an international commission, including health experts from WHO and other organizations to assist in the control and further understanding of the outbreak of haemorrhagic fever.
Starting from 12 November 1976 issue, WER regularly published latest situation of smallpox eradication programme that had reached the point that progress was by then monitored in terms of the number of "infected villages" in each area.
On 17-21 October 1977, a WHO Expert Committee was convened in Geneva to determine the selection of essential drugs for achieving good health. The fi rst WHO Model List of Essential Medicines included 204 pharmaceutical drugs. It has been updated every two years since then.
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care (PHC), Almaty (formerly Alma-Ata), Kazakhstan (formerly Kazakh Soviet Socialist Republic), 6-12 September 1978. It set the historic goal "Health for all" which assumed that enlightened policy could raise the level of health in deprived populations and thus drive overall development. The declaration broadened the medical model to include social and economic factors, and acknowledged that activities in many sectors, including civil society organizations, shaped the prospects for improved health. Fairness in access to care and effi ciency in service delivery were overarching goals.
The global eradication of smallpox was certi fied, based on intense verifi cation activities in countries, by a commission of eminent scientists on 9 December 1979. It was then endorsed by the World Health Assembly on 8 May 1980.
Since the beginning of the epidemic, almost 78 million people have been infected with the HIV virus and about 39 million people have died of HIV. Globally, 35.0 million (33.2–37.2 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide.
The 1969 International Health Regulations, which initially covered six “quarantinable diseases” were amended in 1973 and 1981, primarily to reduce the number of “quarantinable diseases” from six to three (yellow fever, plague and cholera) and to mark the global eradication of smallpox.
In 1983 the virus that caused AIDS was discovered by scientists in France and the ways of transmission were con firmed. The virus eventually became known as the human immunodefi ciency virus (HIV).
On 17-18 February 1986, the first WHO consultation on the composition of in fluenza vaccines was convened in Geneva. Ten days later, WHO’s recommendation on the composition of in fluenza virus vaccines appeared in the WER.
The Global Polio Eradication Initiative was established by WHO in collaboration with Rotary International, the US Centers for Disease Control and Prevention and UNICEF, aiming to eradicate polio worldwide.
Cholera first re-emerged in Latin America in Peru in January 1991, then spread to Ecuador within two months and to Colombia, Brazil, and Chile within five months. By December 1991, 15 countries were reporting cases, with rural areas the most severely aff ected.
In 1991 WHO committed itself to promoting the elimination of leprosy as a public health problem by the year 2000 and pledged support to its member states in achieving this goal. The elimination of leprosy as a public health problem is defined as the reduction of prevalence to a level below one case per 10 000 population.
Following the abandonment of the Global Malaria Eradication Programme in 1969, a number of major agencies withdrew their support for malaria programmes. The economic crisis of the early 1970s contributed to an accelerated contraction of funding for malaria control. Malaria resurgences were reported in areas where transmission had been successfully reduced. In 1992, leaders attending a Ministerial Conference on Malaria in Amsterdam agreed to launch a renewed attack on malaria that was more realistic, more pragmatic and more sustainable than previous approaches to malaria control. A WHO Global Strategy for Malaria Control was unveiled the following year.
In 1995, to eradicate dracunculiasis (Guinea worm), WHO established an independent International Commission for the Certi fication of Dracunculiasis Eradication (ICCDE). Since its establishment in 1995 to the end of 2013, the ICCDE has certifi ed 197 countries, territories and areas (belonging to 185 Member States) as free of dracunculiasis. The latest to attain this status in December 2013 include formerly endemic countries Côte d’Ivoire, Nigeria and Niger.
DOTS or Directly Observed Treatment Short course is a an approach for tuberculosis control that involves providing a short course of treatment given under direct and supportive observation (DOT) and has been recognized as a highly effi cient and cost-e ffective strategy.
The growth in international travel and trade, and the emergence or re-emergence of international disease threats and other public health risks prompted the Forty-eighth World Health Assembly (1995) to call for a substantial revision of the International Health Regulations adopted in 1969.
While WHA 44.9 resolution of 1991 had recognised the widespread effectiveness of multidrug therapy (MDT) in treating leprosy, adoption by national leprosy elimination programmes was slow, due to its high cost. To support countries and the more widespread adoption of MDT, WHO took steps to negotiate a donation of funds to procure the drug itself. The Nippon Foundation (TNF) funded this over a five year period 1995-1999 at a total cost of USD 50 million, and WHO procured the MDT in patient friendly blister packs. In collaboration with national programmes, WHO managed the supply to countries using its own agents. Following further negotiations in 1999 with Novartis (the main manufacturer and supplier of MDT) the company agreed to supply WHO with the drugs free of charge. The donation is still ongoing and will run at least until the end of 2020.
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