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A pox on smallpox


From 1966 to 1977, a global vaccination campaign under the auspices of the World Health Organization (WHO) eradicated smallpox from the planet in one of the greatest public health achievements of the 20th century. [...] the absence of the disease has saved an estimated 60 million lives. Because the WHO director-general believed that eradication was impossible, he insisted on putting an American in charge so that when the program failed, the United States would be held responsible for the debacle.

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									A pox on smallpox
                           BOOKS             noble cause. The reader vicariously
                                             experiences the deep emotional lows and
                                                                                           demics by collecting data and inter-
                                                                                           viewing patients. Eventually, he became
                                             exhilarating highs of participating in a      deeply engaged by public health and
Smallpox—The Death of a                      hugely ambitious international effort         decided to devote his career to it.
                                             whose ultimate success depended on the           At the time, smallpox imposed a
Disease: The Inside Story of                 vision, dedication, and teamwork of a         major burden of illness and death on
Eradicating a Worldwide                      relatively small group of individuals.        the developing world. Although the
Killer                                       Although the technical recounting of          last case in the United States had been
                                             the eradication program is at times           in 1949, the CDC considered it almost
by D. A. Henderson. Amherst, NY:
                                             overly detailed for the general reader,       inevitable that a traveler from a coun-
Prometheus Books, 2009, 334 pp.
                                             the book provides valuable lessons for        try where smallpox was endemic would
Jonathan B. Tucker                           anyone interested in global health or the     reintroduce the disease. Several aspects
                                             management of large and complex               of smallpox made it theoretically sus-
Smallpox is a severe viral disease that      multinational projects. Those seeking         ceptible to eradication, including the eas-
claimed hundreds of millions of lives        a balanced, objective treatment of small-     ily diagnosed facial rash and the lack
during the course of history. A uniquely     pox-related issues should look else-          of an animal reservoir. In 1958, the
human affliction, it killed a third of its   where, however. Henderson pulls no            Soviet Union had persuaded WHO to
victims and left the survivors disfigured    punches in assigning credit or blame          launch a smallpox eradication pro-
with pockmarks and sometimes blind.          where he considers it due and in con-         gram, but it was seriously underfunded
From 1966 to 1977, a global vaccina-         veying strong personal views on a vari-       and made little headway.
tion campaign under the auspices of the      ety of controversial topics.                     After Henderson was promoted to
World Health Organization (WHO)                 The book weaves Henderson’s per-           section chief at the CDC, he submit-
eradicated smallpox from the planet          sonal history with that of the small-         ted a proposal to the U.S. Agency for
in one of the greatest public health         pox virus. An Ohio native, he attended        International Development for a five-
achievements of the 20th century. Since      Oberlin College and then went to med-         year program of smallpox eradication
then, the absence of the disease has         ical school at the University of Rochester.   and measles control in 18 countries of
saved an estimated 60 million lives. In      In 1955, he was drafted for two years         West Africa. Unexpectedly, President
a dark irony, however, eradication cre-      of military service and offered a posi-       Lyndon Johnson decided to fully fund
ated a new vulnerability with respect        tion with the Epidemic Intelligence           the project in late 1965 and later
to the potential use of the smallpox         Service of the Communicable Disease           expanded it. This U.S. engagement
virus as a biological weapon.                Center (CDC), later renamed the Cen-  
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