17 December 2011

'House on Fire: The Fight to Eradicate Smallpox', by William Foege

William Foege, a physician who went on to become Director of the Centers for Disease Control, recently wrote memoirs of his experiences leading the smallpox eradication efforts in Nigeria and India. Foege pioneered the successful "surveillance and containment" eradication strategy, which let health teams avoid vaccinating the entire population. Instead, dedicated search teams located infections, and containment teams vaccinated those cities that were sites of outbreaks. Using this method, smallpox was eradicated worldwide in the 1970's. Interestingly, eradication saved the U.S. a substantial amount of money--what it spent on smallpox eradication was only a fraction of what it spent each year on domestic vaccination and on verifying that travelers to the U.S. were immune. It's important to note the debt owed to many countries, including the U.S.S.R., which first championed global eradication and donated a tremendous amount of vaccine.

Given how deadly, disfiguring, and persistent smallpox was worldwide, its eradication is perhaps the proudest accomplishment of global public health. Foege's account illustrates how this monumental effort succeeded only because of scrupulous planning, careful research, a shared vision among health workers, and several strokes of good luck. He writes of his experiences in Nigeria, where civil war broke out, and in India, the leaders of which were largely skeptical of eradication.

I found the book fascinating, insightful, and brief. I strongly recommend it to those interested in public health, health systems management, and infectious disease.