Birth of a Bureau

The OAS traces its origins to the First International Conference of American States in 1889-90, in which participants from across the Americas created the juridical, if not yet institutional, foundation for what by 1910 would be known as the Pan American Union. It had as its principal objective the collection and dissemination of economic and commercial information to help promote trade among the nations of the Western Hemisphere.

The Second International Conference of American Republics, held in Mexico City in 1902, adopted a resolution to hold an international sanitary convention that same year. It was this convention that President Roosevelt greeted, and that established the International Sanitary Bureau, which by 1923 was renamed the Pan American Sanitary Bureau and would eventually become known as PAHO. The Bureau's initial raison d'être was the prompt and regular transmittal of data on sanitary conditions of seaports, maritime quarantines, and the control of communicable diseases, particularly yellow fever and bubonic plague. It started life with a seven-person committee, but no full-time staff, and a budget of just US$5,000. The Pan American Union assumed responsibility for collecting and safeguarding quotas for the Bureau paid by member states.

In hindsight, the immediate threat of yellow fever and other epidemic diseases may have been a necessary, although not entirely sufficient, condition for the early growth of inter-American cooperation in public health. Cultural factors likely also played a role. The first decade of the 20th century was one of exuberant belief in the infinite and universal possibilities of progress. In this belle époque, Pan-Americanism became a popular world view, and the early development of the Sanitary Bureau reflected that view.

The Americas' First Sanitary Conference was followed nearly every two years by a subsequent conference. The report of the Fourth Sanitary Conference (1909) declared: "The hour has arrived when the world is awakening to the need for sanitary betterment. Typhus fever, yellow fever, malaria, smallpox, plague, cholera can be eliminated." This "awakening" led to a shift in focus from sanitation of ports and regularization of maritime relations to the eradication of communicable diseases at their source.

Dr. Carlos Finlay of Cuba was one of PAHO's founding fathers. His theory of yellow fever transmission was key in routing the disease in the early 20th century. (Photo ©National Library of Medicine)

The outbreak of World War I brought efforts at inter-American cooperation in health to a virtual halt. A Fifth Sanitary Conference was held in Santiago, Chile, in 1911, but a sixth conference, scheduled to take place in Uruguay in 1914, was cancelled. During these war years, the Bureau was so dormant that, according to its own records, "there was frequently a balance remaining at the end of the year from the U.S. quota" of just US$2,830, which reverted to the U.S. Treasury. But by the end of the decade, the sobering effects of both the Great War and the great flu epidemic of 1918-19 led the countries of the Americas to refocus their attention on the need to control communicable disease.

When the Sixth Sanitary Conference finally did meet in Montevideo, Uruguay, in 1920, delegates made a concentrated effort to reorganize and reinvigorate the Bureau to confront more seriously the problems discussed in previous conferences. Criticizing those earlier meetings (and by inference, the Sanitary Bureau), U.S. Assistant Surgeon General J.H. White argued that the objective of these efforts should be the "permanent betterment of our international sanitary relations and not as up to now a mutual exchange of reports on sanitation and demography in our respective lands with nothing done between meetings."

This sixth conference broadened the Bureau's mission to embrace the promotion of health as a whole. It would henceforth concern itself with malaria and tuberculosis campaigns, monitoring of contagious diseases, national health legislation, and scientific study of tropical diseases. The fact that yellow fever had by 1919 retreated throughout the Americas facilitated this broader, more ambitious focus.

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