Tag Archives: World Health Organization (WHO)

Baby Milk Campaigns and Eastern Europe

In 1983 Oxfam ran a Baby Milk campaign, which aimed to challenge the promotion of artificial baby milk in poor countries and promote breastfeeding. This is a good example of the type of campaigns material which we are just starting to catalogue:

Front cover of Oxfam’s Baby Milk campaign leaflet (MS. Oxfam CPN/3/311, Bodleian Library)
Inside of Oxfam’s Baby Milk campaign leaflet (MS. Oxfam CPN/3/311, Bodleian Library)

Yet, in 1995 the Baby Milk Action Coalition (BMAC) was still campaigning on the same issue. Oxfam was a founding member of BMAC, a British group which was set up to monitor and coordinate a response to infringements of the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes (1981). From a series of project files in the archive, it is clear that Oxfam continued to financially support this group.

Baby Milk Action Update, Issue number 17, November 1995 (MS. Oxfam PRF EEG 011, Bodleian Library)

WHO/UNICEF International Code of Marketing of Breastmilk Substitutes

The WHO/UNICEF code was originally implemented to try and regulate advertisements for baby milk. This was because the percentage of women who breastfed in countries where baby milk was  heavily promoted and publicised, including by health care professionals, was much lower.

The code also highlighted the risks of using milk supplements, which were thought to be exacerbated by advertising. The most prominent of the risks are listed in the document below; it notably includes: contaminated water supply, illiteracy and poverty.

‘The Baby Food Controversy – John Clark March 1980’ (Oxfam Archive, Bodleian Library)


Campaigns such as Oxfam’s and BMAC’s were launched to raise awareness of these issues and to highlight instances in which the code was not being upheld.

Eastern Europe

 There are various reasons why this issue had not gone away in the period between 1981 and 1995. The issue was re-surfacing in the mid-1990s due to the humanitarian situation in Eastern Europe. Ultimately, companies were ignoring the code. The following excerpts from documents in the BMAC project files allude to the difficulties surrounding the use, and promotion of, baby milk in the context of aid.

1. A note prepared for Stewart Wallis by C. Mears, dated 23.7.93 (MS. Oxfam PRF WGE 199 A5):

Breast milk substitutes are assuming a lot of importance currently because of the humanitarian crisis in Eastern Europe. Some aid agencies are sending breast milk substitute products apparently without due care.

 2. from MS. Oxfam PRF EEG 011’s application form, 1995:

Financial insecurity is forcing women to restrict maternity leave and return to paid work if they can. Also baby food companies have been able to establish themselves in the region and are promoting their products efficiently in a context of lack of awareness of the issues and possible risks.

 3. Memo from Dr. Mohga Kamal Smith (Health Policy Advisor, Policy Development Team) addressed to Tony Vaux, Head of Bureau (Eastern Europe), dated 3 May 1995:

I think there is a real danger in EE of declining breast feeding with the negative impact on children’s health and nutrition status. The time is crucial because now it is still not too late to reverse the tide if we to learn from other countries experiences of the difficulties of returning to breast feeding after establishing formulas and baby foods environment. 


‘From a true story, as reported by Dr. Elizabeth Hillman, from Nairobi’s Kenyatta National Hospital’. A cartoon prepared by US pressure groups but part of Oxfam’s ‘Baby Foods Campaign Pack’, 1980 (Oxfam Archive, Bodleian Library)

To counteract these comments, there is an interesting memo, dated 25 June 1995, from Jovanka Stojsavljevic (Oxfam’s Representative for Former Yugoslavia), to Tony Vaux, Head of Bureau (Eastern Europe). This was her response to the project proposal above in point 2:

I do not think there is a real fear of commercial baby food companies being able to create a dependency on their products, as they did in the Third World. Nor do I think there is a desperate need to promote breast-feeding.

I think that this proposal and the approach of UNICEF here, is much more connected to their distinctive competence developed through their work in developing countries, rather than a detailed assessment of the problems for mothers within a society, w[h]ere the health care system is collapsing as a result of war, rather than a lack of awareness, expertise and knowledge.

‘Yugoslavia’ had quite an advanced health care system before the war and breast feeding was commonly upheld to be the best for the child. If anything, the problem was that women who could not breast feed felt they were ‘inadequate mothers’.

This is a revealing insight which demonstrates the conflict between global policy, such as the WHO/UNICEF code, and what is actually happening on the ground at the grassroots level in a particular region.

The debate surrounding breast feeding continues to be discussed today.


Oxfam’s role in smallpox eradication

Oxfam jeeps and vaccination teams at work, 1974 (MS. Oxfam PRF BIH 014 Vol. 1 = Box 101)
Oxfam jeeps and vaccination teams at work, 1974 (MS. Oxfam PRF BIH 014 Vol. 1 = Box 101)

Files in the Project files and Directorate sequences of the Oxfam Archive shed some light on Oxfam’s small yet important role in one of the major medical achievements of the twentieth century – the eradication of smallpox.

Smallpox was an acute contagious disease caused by the Variola virus, causing death in 30-35% of cases, and in other cases, complications including blindness, limb deformities and severe scarring. It was officially declared eradicated in 1980, following an immunization campaign led by the World Health Organisation (WHO).

Following the outbreak of a smallpox epidemic in Bihar state, India, in 1974, Oxfam sent its Medical Adviser, Dr. Tim Lusty, to make an emergency visit to the area in July of that year. On his recommendation and that of Oxfam’s Field Director for East India, R. Subramaniam, Oxfam made a grant of £42,193 towards the WHO campaign in the region.  The funds were used for the provision of jeeps, plus salaries for drivers and mechanics and medical equipment, to be used by 14 of the programme’s 56 ‘search and containment’ teams in South Bihar. Oxfam also played a hands-on role, recruiting voluntary nurses and other volunteers and sending two of its staff members out to India to help administrate the project.

Weekly statistics BIH 014 Vol.1
Weekly report on smallpox outbreaks, filed by the vaccination teams, 28th December 1974
(MS. Oxfam PRF BIH 014 Vol. 1 = Box 101)

The search and containment tactic used by the teams of volunteers was key to the success of the Bihar Smallpox Eradication Programme. The teams comprised one medical officer, one assistant and 4-6 vaccinators, working under the supervision of two epidemiologists recruited by WHO. Rather than attempting mass vaccination, the programme concentrated on identifying individual cases of the disease, tracing the source of infection and containing it by vaccinating all contacts of the infected person.

This was often far from easy, as is revealed by a report from Oxfam field worker Suresh Kumar, dated 2 September 1974. Aside from early starts, long days and long journeys in difficult conditions, the teams often met resistance from the local people themselves:

“People are very much resisting vaccination because 1. They believe that they will have fever and cannot work. 2. They are afraid of the needles. 3. This is the first time in their lives they have been vaccinated, or if they have been vaccinated, it was a very long time ago. 4. The people think that the babies are too young to be vaccinated. 5. Small children run away and we have to chase them.”

Aside from Oxfam’s financial contribution to the project, the organisation made another, perhaps even more important contribution, in the form of a survey technique, based on studies carried out by Oxfam volunteers. The technique used local markets, which always drew large crowds, as venues for disseminating information about the disease and uncovering new outbreaks. The Oxfam volunteers wrote up detailed guidelines for those carrying out such surveys, based on what they had experienced.

Guidelines for Market Surveys by Alan Marinis and Bev Spring, page 1, 1975
(MS. Oxfam PRF BIH 014 Vol. 1 = Box 101)

The importance of the technique to the Bihar smallpox eradication programme is underlined in an undated copy of a letter from Dr. L.B. Brilliant, WHO Medical Officer, to R. Subramaniam, received 3 Mar 1975:

“This has proven to be one of the best methods we have for finding hidden cases of smallpox, and I have no doubt that this innovative technique will shorten the period necessary to find and contain all of the smallpox left in Bihar. We are very grateful to Oxfam for many things that you have given us, but this technique may prove to be the most valuable gift of all to the smallpox Programme.”

Emergency Health Kits and Wellcome Pharmaceutical Supplies

Whilst sorting through the ‘project files’ in the Oxfam archive, I found several volumes relating to Afghanistan from the mid-1980s (Oxfam reference AGN 008, Vols. 1-5). These volumes all relate to grants made to the Islamic Aid Health Centre for Afghan Refugees (IAHC), whose head office was in Quetta, Pakistan. The majority of the grants were to enable the IAHC to supply clinics inside Afghanistan with medical supplies.

An initial description of the project’s objectives was: ‘Assistance with supplies of basic medicines and equipment and some funds to six clinics inside Afghanistan which provide rudimentary curative medical facilities to war affected people who otherwise would not be able to have access to such services’. The war referred to here is the conflict between Soviet troops, government forces and the Mujahideen from December 1979 to February 1989.

From its inception, when the Oxford Committee for Famine Relief awarded its first grant to alleviate the suffering of women and children in Nazi occupied Greece, Oxfam’s policy has been to direct aid to ‘where need is greatest, without distinction of nationality’ and ‘irrespective of the political framework in which that need manifests itself’.

There are a number of photographs accompanying the project reports and these help to document how Oxfam’s grants were being used. In a handful we can see the medical supplies that were sent to the clinics in Afghanistan piled high in offices or on the backs of pick-up trucks. Amongst the myriad of brand names and logos on the boxes, I was intrigued to spot some with the blue unicorn logo of the Wellcome pharmaceutical company (Wellcome Foundation Ltd).

Written on the back: ‘A’ unit Arghistan Clinic, 1986 (Bodleian Libraries, Oxfam Archive)

This was an interesting discovery as The Wellcome Trust is a generous sponsor of the work on the Oxfam archive being carried out here at the Bodleian Library. However, in 1995 trustees sold their remaining interest in Wellcome plc to Glaxo plc, an independent company which was known as GlaxoWellcome after the merger. Equally, Oxfam no longer supply medicines or medical equipment.

Written on the back: ‘Four ‘A’ units medicine for Ghazni clinic’, 1987
(Bodleian Libraries, Oxfam Archive)

Written on the back of both these photographs is a reference to ‘A’ units. A’ units were supplied to ‘established clinics inside Afghanistan’, as opposed to ‘B’ units which went to mobile clinics and ‘C’ units which were first aid kits for the Mujahideen.

These references stem from the World Health Organisation guide-lines for an ‘Emergency Health Kit’, and these files contain a copy of lists (A-C) itemising which drugs constitute each unit. There is also one table of likely symptoms and proposed treatment, and another of standardised treatment schedules. According to the WHO guide-lines ‘List A’ is the ‘Basic drug requirements for 10, 000 persons for 3 months’. Whereas ‘List B’ is ‘Drugs for use by doctors and senior health workers, in addition to List A’ and which can only treat 70-150 people. Finally, ‘List C’ is only ‘Basic medical equipment’, which in this case was for Mujahideen fronts where there were no medical workers.

There are five dense volumes packed with reports and photographs relating to IAHC projects, as in addition to medical assistance they were also involved in educational and agricultural projects. Most notably, there is a great deal of information about a Medical Training Course (MTC) which was run by the director of IAHC Dr. A. B. Haqani and the project manager Dr. Susan Welsby.

The International Histocompatibility Workshop comes to Oxford

During the early period of Sir Walter Bodmer’s career in Oxford (1970-79) he was able to dedicate his time to research in addition to teaching. The papers of Sir Walter and his wife, Lady Julia, illustrate the development of their valuable laboratory research into human gene mapping, and work on the human leukocyte antigen system (HLA), which they initially collaborated on at StanfordUniversity in the lab of haematologist Rose Payne.In the new Genetics Laboratory at Oxford University, the couple progressed with their HLA research. Walter Bodmer also continued his work on somatic cell genetics and the biochemistry of HLA. Julia had a particular interest in studying the relationship between HLA types and diseases.


Seventh International Histocompatibility Workshop Conference, Oxford, 1977


The gene mapping aspect of genetics and the role of HLA in disease association was flourishing during this period as a major field of research. The first international HLA Workshop Conference had taken place in 1964 at Duke University, North Carolina, and would continue to be a seminal event. The Workshops provided scientists with a forum to collaborate on their investigations into immunogenetics research.  In September 1977 Walter and Julia Bodmer were responsible for bringing the Workshop to Oxford University.


Julia 1977
Julia Bodmer, Oxford, 1977

Approximately 200 laboratories scattered worldwide participated in this Workshop, studying antisera, lymphocytes and typing cells. It was during this Workshop that HLA-D region types were properly defined for the first time, a major step forward in the HLA field. Additionally, as a consequence of the conference, 19 new HLA specificities were given World Health Organisation (WHO) designations.


Bodmer seated 1977
Sir Walter Bodmer (seated), Oxford, 1977

In 1979, the Bodmers left Oxford for the Imperial Cancer Research Fund (ICRF) in London. Sir Walter eventually became Director-General of the ICRF while Lady Julia was head of the Tissue Antigen Laboratory.