To initiate a surveillance network that intends to cover the entire world, not to mention the entire spectrum of infectious disease epidemiology, it helps to have wide experience in the field, which is definitely the case with Woodall. He was raised in China by English parents and schooled in mosquito-borne diseases at the London School of Hygiene and Tropical Medicine. He has worked on yellow fever in Uganda and hemorrhagic fever in Bolivia, done lab work in the old Rockefeller Foundation labs in Manhattan and at Yale University in New Haven, and has run virus labs in the Amazon rain forest and in Puerto Rico. Before moving to Albany to take up his post with the New York State Health Department, he spent 13 years as an international health expert working for the WHO in Geneva. “Although I wasn’t just in Geneva,” he says. “I traveled all over the world-China, Africa, all over. Because I was the only virologist in Geneva who spoke Portuguese, I ended up setting up the first AIDS programs in the Portuguese-speaking countries of Africa. I did all kinds of things. I was a jack-of-all-trades.”
Woodall eventually ended up in the WHO branch of epidemiology, surveillance and health statistics, which is where he was when he started down the path that led to ProMED-Mail. After co-authoring a paper on biological weapons disarmament, as Woodall tells it, he ended up on the Iraq desk of the WHO during the Gulf War. In 1993, that assignment brought him into contact with the Federation of American Scientists, which was co-sponsoring a meeting in Geneva with the WHO on a program to set up ProMED centers around the world that could monitor outbreaks of emerging pathogens as well as the kind of disease activity that might signify biological warfare and bioterrorist activities. Woodall was in charge of the task force on communication, whose goal was to determine how best to connect the centers.
While the centers have yet to be funded, Woodall took his part of the project and developed it into ProMED-Mail, with the crucial help of SatelLife, a Boston-based organization founded in 1989 by Bernard Lown. Lown is a cardiologist and inventor-of the defibrillator, most famously-and founder of the International Physicians for the Prevention of Nuclear War, an association that won the Nobel Peace Prize in 1985. After winning the prize, Lown set out to establish a network that would bridge the gap between medicine in the developed and underdeveloped worlds.
Lown decided that the technology needed to accomplish that task was a communications satellite dedicated to the purpose. In 1989, SatelLife became the first nonprofit organization in the world to launch its own communications satellite, HealthSat 1, which was supplanted in 1993 by HealthSat 2. The satellite, roughly the size of a television set, circles the globe every 100 minutes in a “low-Earth” orbit at an altitude of 550 miles. It passes over ground stations anywhere from four to 14 times a day, at which times the ground stations can upload or download messages. When the satellite is over Boston it downloads incoming messages to the SatelLife offices and takes on outgoing mail. The ground stations themselves are simple: desktop computers with a small radio and an omnidirectional antenna. “Uploading and downloading e-mail four times a day doesn’t sound like much today,” says Woodall, “but even today in countries like Zaire with no telephone and no e-mail provider, four times a day is a hell of a lot better than nothing at all.”
In 1994 Woodall was introduced to SatelLife executives, who offered to host ProMED-Mail for free until funding could be obtained. ProMED-Mail officially went online that August with a $50,000 startup grant from the Rockefeller Foundation, $1,000 a month for expenses from the Federation of American Sciences, and SatelLife subsidizing the rest. Woodall enlisted half a dozen chronically overworked and unpaid moderators to serve as editors and to oversee the correspondence and weed out the more obvious rumor-mongering.
After four years, Woodall calls ProMED-mail the “CNN of outbreaks,” a description few epidemiologists dispute. “We have more subscribers from the CDC alone then we have from any other entire country in the world except Australia,” says Woodall. “We have subscribers from NIH, FDA, you name it; they know we’re the place to get breaking news on outbreaks.”