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California/Milbank Books on Health and the Public
House on Fire: The Fight to Eradicate Smallpox (Volume 21)
A story of courage and risk-taking, House on Fire tells how smallpox, a disease that killed, blinded, and scarred millions over centuries of human history, was completely eradicated in a spectacular triumph of medicine and public health. Part autobiography, part mystery, the story is told by a man who was one of the architects of a radical vaccination scheme that became a key strategy in ending the horrible disease when it was finally contained in India.
In House on Fire, William H. Foege describes his own experiences in public health and details the remarkable program that involved people from countries around the world in pursuit of a single objective—eliminating smallpox forever. Rich with the details of everyday life, as well as a few adventures, House on Fire gives an intimate sense of what it is like to work on the ground in some of the world’s most impoverished countries—and tells what it is like to contribute to programs that really do change the world.
In House on Fire, William H. Foege describes his own experiences in public health and details the remarkable program that involved people from countries around the world in pursuit of a single objective—eliminating smallpox forever. Rich with the details of everyday life, as well as a few adventures, House on Fire gives an intimate sense of what it is like to work on the ground in some of the world’s most impoverished countries—and tells what it is like to contribute to programs that really do change the world.
240 pages, Hardcover
First published January 1, 2011
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Displaying 1 - 30 of 36 reviews
November 1, 2012
This is a tricky book for me to review, as I'm unashamedly biased, but I'm going to try anyway.
When you think about the vast volume of literature written about any major war, it's somewhat remarkable that smallpox eradication - a campaign to end an illness that killed half a billion people in the last century - hasn't received more attention. The other day I was on a bus with some med students and one actually asked, "what was that disease we eradicated? Was it polio?" (Fail, future doctor! Fail!!!)
That is one reason "House on Fire", a first hand account of a massive, organized human effort to end a major cause of human suffering (an anti-war?), is such a valuable book.
The main weapons required in this effort, it seems, were collaboration, coordination, and diligence. This is a story of many, many fieldworkers keeping grueling schedules; epidemiologists tracking cases; and prime ministers and ministers of health putting politics and ego aside (long enough) to complete a common goal. The overall lesson of the story? It's possible.
This probably isn't the first book I would recommend to someone with only a passing interest in global health, as the tone is fairly dry and Foege spends a lot of time explaining the work that different people played at different moments (Have you attended a meeting where hours are spent working out who is going to gather data, who is going to collect and organize it, who will analyze it, who will interpret the analysis, and how everyone will act on what they find? Like that.) However, to a student of public health or global health, it is indispensable.
When you think about the vast volume of literature written about any major war, it's somewhat remarkable that smallpox eradication - a campaign to end an illness that killed half a billion people in the last century - hasn't received more attention. The other day I was on a bus with some med students and one actually asked, "what was that disease we eradicated? Was it polio?" (Fail, future doctor! Fail!!!)
That is one reason "House on Fire", a first hand account of a massive, organized human effort to end a major cause of human suffering (an anti-war?), is such a valuable book.
The main weapons required in this effort, it seems, were collaboration, coordination, and diligence. This is a story of many, many fieldworkers keeping grueling schedules; epidemiologists tracking cases; and prime ministers and ministers of health putting politics and ego aside (long enough) to complete a common goal. The overall lesson of the story? It's possible.
This probably isn't the first book I would recommend to someone with only a passing interest in global health, as the tone is fairly dry and Foege spends a lot of time explaining the work that different people played at different moments (Have you attended a meeting where hours are spent working out who is going to gather data, who is going to collect and organize it, who will analyze it, who will interpret the analysis, and how everyone will act on what they find? Like that.) However, to a student of public health or global health, it is indispensable.
November 12, 2013
after reading schlosser's book about the atomic bomb i needed something uplifting. a book about smallpox.
read the subtitle "the fight to eradicate smallpox". the goodguys, author william h. foege among them, WIN the fight. going into this book we know smallpox lost, that's a good book to read.
the postscript;
"Over the years, on every return to India, I have searched the faces of people on the street, looking for pockmarks. Soon I could find no pockmarked face under the age ten, then twenty, and now, no pockmarks are to be found on people under the age of thirty-five."
to be able to read that postscript is amazing, to have been one of the diseases destroyers, Foege and his teams should be given parades whereever they go.
read the subtitle "the fight to eradicate smallpox". the goodguys, author william h. foege among them, WIN the fight. going into this book we know smallpox lost, that's a good book to read.
the postscript;
"Over the years, on every return to India, I have searched the faces of people on the street, looking for pockmarks. Soon I could find no pockmarked face under the age ten, then twenty, and now, no pockmarks are to be found on people under the age of thirty-five."
to be able to read that postscript is amazing, to have been one of the diseases destroyers, Foege and his teams should be given parades whereever they go.
August 2, 2012
This is part documentary, part autobiography of the amazingly successful worldwide work to eradicate smallpox. Call me a geek, but I found the statistics climactic and the developing world experiences funny or sobering, depending on the story. It reinforces my belief that we peeps can accomplish almost ANYTHING if we have the political will.
March 28, 2022
“People rarely reflect on the fact that they have not had to deal with smallpox, tuberculosis, whooping cough, diphtheria, rabies, or other controlled maladies in their lifetimes. Yet this is not by chance. Every disease encounter missed is the result of deliberate actions taken by unknown benefactors in the past. It is one of the clear attractions of work in public health: the public health practitioner can remain anonymous.”
Dr. Foege is another example of a public health hero whose work has had a monumental impact on global health and still most people have never heard his name or know his work, even though they continue to directly benefit from it. ‘House on Fire’ is a detailed telling of one of the most significant public health achievements of the 20th century: global eradication of smallpox.
Dr. Foege is another example of a public health hero whose work has had a monumental impact on global health and still most people have never heard his name or know his work, even though they continue to directly benefit from it. ‘House on Fire’ is a detailed telling of one of the most significant public health achievements of the 20th century: global eradication of smallpox.
January 6, 2016
Dr. Foege looms large in my life (and not in the literal sense, as his unusual height would suggest) as the founder of the organization I work for, so, disclaimer, that may have influenced my experience reading House on Fire. It is, however, an extraordinary book documenting the years of grueling work that finally led to the worldwide eradication of smallpox. In relating the details of the smallpox effort's challenges and successes, Dr. Foege highlights the importance in disease elimination efforts of strong coalitions, adjusting strategies on the fly when needed based on the evidence, and being ready to deal with unavoidable political roadblocks. And regarding those roadblocks, it struck me as terribly sad that the greatest threats to the success of the smallpox eradication efforts were not biological or epidemiological, but were political. When the viral tenacity of a millenia-old disease presents LESS of a barrier to eradication than politicians getting hung up on turf wars, power struggles and PR issues, humanity has really bungled something.
Smallpox eradication is the single greatest public health success in human history, so it has perhaps the most valuable global health lessons at our disposal. In his conclusion, Dr. Foege says: "Smallpox eradication did not happen by accident. Stephen Hawking, in his book, A Brief History of Time, says the history of science is the gradual realization that things do not happen in an arbitrary fashion. This is a cause-and-effect world, and smallpox disappeared because of a plan, conceived and implemented on purpose, by people. Humanity does not have to live in a world of plagues, disastrous governments, conflict, and uncontrolled health risks. The coordinated action of a group of dedicated people can plan for and bring about a better future. The fact of smallpox eradication remains a constant reminder that we should settle for nothing less."
Also, I ran across this postcard in the CDC museum last year written in 1979 to Bill Foege from a health officer in Kenya who'd been stationed in Somalia (possibly Dr. Don Millar, who was one of the directors of the Global Smallpox Eradication Program and who would go on to become the Assistant Surgeon General, but I'm having trouble reading the handwriting well enough to be sure) to announce the official end to smallpox, and thought it was an interesting piece of history:
.
Smallpox eradication is the single greatest public health success in human history, so it has perhaps the most valuable global health lessons at our disposal. In his conclusion, Dr. Foege says: "Smallpox eradication did not happen by accident. Stephen Hawking, in his book, A Brief History of Time, says the history of science is the gradual realization that things do not happen in an arbitrary fashion. This is a cause-and-effect world, and smallpox disappeared because of a plan, conceived and implemented on purpose, by people. Humanity does not have to live in a world of plagues, disastrous governments, conflict, and uncontrolled health risks. The coordinated action of a group of dedicated people can plan for and bring about a better future. The fact of smallpox eradication remains a constant reminder that we should settle for nothing less."
Also, I ran across this postcard in the CDC museum last year written in 1979 to Bill Foege from a health officer in Kenya who'd been stationed in Somalia (possibly Dr. Don Millar, who was one of the directors of the Global Smallpox Eradication Program and who would go on to become the Assistant Surgeon General, but I'm having trouble reading the handwriting well enough to be sure) to announce the official end to smallpox, and thought it was an interesting piece of history:
.February 26, 2022
Normally, I find battles between Good and Evil to be a bit dull. I like sympathetic villains, grey morality and complex dilemmas. But this book was an exception worth making. The eradication of smallpox is a strong contender for 'the most awesome thing humanity has ever accomplished'. And Foege was one of its chief architects. In this book, you know exactly who the good guys and the bad guys are, and you know that it has a happy ending.
After reading this I have a much clearer and more concrete picture of what this actually involved, and exactly why it was hard. And an appreciation that, even though it was overwhelmingly hard, humanity managed it anyway.
If you don't have much of an emotional reaction to smallpox eradication, I highly recommend this essay on just how great an accomplishment it was: https://blog.jaibot.com/500-million-b...
Particular points that stood out:
- People, culture and logistics are HARD. I'd mostly conceived of smallpox eradication as "the hard part was developing a vaccine, and then it was all pretty easy". This significantly changed my view and emphasised the difficulty of distribution, logistics without good infrastructure, culture and getting people to cooperate.
- For truly ambitious projects, it's important to have people able to navigate a bureaucracy and actually try, rather than just do their job. Foege came up with an innovative vaccination strategy that made eradication much more realistic, but had to fight hard to get other people to try it out and take it seriously. The success of big projects can hinge on things like this.
- Sometimes people REALLY suck, no matter how big a deal something is. There was a cottage industry of 'fetisheurs' in Africa, who would variolate people for pay (expose them to a tiny dose of smallpox, to create immunity with a 10x lower chance of death). And they sometimes would deliberately start outbreaks to create business. Some of them tried to collect virus from the last ever victim of smallpox to restart outbreaks, because eradicating smallpox destroyed their jobs (and they thankfully failed!)
And the author is delightfully modest and understated about his role in events, which makes for a very fun tone. My biggest complaint is that the pace was sometimes a bit slow and meandering
Overall, I would highly recommend, and you should definitely go read this!
After reading this I have a much clearer and more concrete picture of what this actually involved, and exactly why it was hard. And an appreciation that, even though it was overwhelmingly hard, humanity managed it anyway.
If you don't have much of an emotional reaction to smallpox eradication, I highly recommend this essay on just how great an accomplishment it was: https://blog.jaibot.com/500-million-b...
Particular points that stood out:
- People, culture and logistics are HARD. I'd mostly conceived of smallpox eradication as "the hard part was developing a vaccine, and then it was all pretty easy". This significantly changed my view and emphasised the difficulty of distribution, logistics without good infrastructure, culture and getting people to cooperate.
- For truly ambitious projects, it's important to have people able to navigate a bureaucracy and actually try, rather than just do their job. Foege came up with an innovative vaccination strategy that made eradication much more realistic, but had to fight hard to get other people to try it out and take it seriously. The success of big projects can hinge on things like this.
- Sometimes people REALLY suck, no matter how big a deal something is. There was a cottage industry of 'fetisheurs' in Africa, who would variolate people for pay (expose them to a tiny dose of smallpox, to create immunity with a 10x lower chance of death). And they sometimes would deliberately start outbreaks to create business. Some of them tried to collect virus from the last ever victim of smallpox to restart outbreaks, because eradicating smallpox destroyed their jobs (and they thankfully failed!)
And the author is delightfully modest and understated about his role in events, which makes for a very fun tone. My biggest complaint is that the pace was sometimes a bit slow and meandering
Overall, I would highly recommend, and you should definitely go read this!
November 30, 2014
Since the eradication of smallpox ranks as one of the most successful efforts in public health, or human endeavor in general, the story of how it happened already draws interest. House on Fire: the fight to eradicate smallpox is William Foege's attempt to tell this tale, through his experience in Africa and India. I found the beginning, as he described how eradication was first accepted as a feasible goal, to be more interesting than the foregone conclusion. The story was told in a very linear fashion, with due credit to collaborators. One memorable quote was "You get what you inspect, not what your expect." In a way, it contradicts Margaret Meade's assertion to "Never underestimate the power of a few committed people to change the world. Indeed, it is the only thing that ever has" since it took a massive effort to defeat the virus in India. I think those interested in public health should read this book not necessarily for the quality of the storytelling, but for inspiration to think big and insights on what it takes to achieve it.
July 3, 2018
Despite only being 200 pages, this book is extraordinarily dense in terms of its content and its focus. It's a memoir of one of the architects of the greatest public health achievement in human history; it's a bird's-eye history of the fight to eradicate smallpox in West Africa and India; it's a deep-dive on public health bureaucracies and their organization and ticks. If anything, it might be too dense, packing too many years and too many things into too few pages, but Foege's writing is concise enough that it didn't feel dense. The eradication of smallpox ranks as one of history's genuine miracles. To hear Foege's telling of it is refreshing and eye-opening and moving.
October 12, 2014
I found this interesting, if not fast paced. It is indeed a book about a war, fought viciously by both sides, with numerous problems and pitfalls. While Foege is obviously passionate about smallpox and his experience (and rightly so), the book is so heavily scientifically based and loaded with facts and numbers, that the people behind the scenes got lost for me. That's a minor complaint - I was reading this to learn about the methods and successes, not so much for personalities, but it may put other readers off.
March 8, 2019
Favorite book of 2018.
"Life accumulates"
You get what you inspect, not what you expect.
If a house is on fire, no one wastes time putting water on nearby houses just in case the fire spreads. They rush to pour water where it will do the most good -- on the burning house. The same strategy turned out to be effective in eradicating smallpox.
He tells stories not about what he has done, but about what others have done (Foege)
We lose histories far too fast.
There was -- and is -- no cure for smallpox.
Variolating the troops may have been Washington's most important tactical decision in the pursuit of independence.
Our house was always intensely busy but well organized, and at the end of the day we children fell asleep to the comforting sounds of our mother playing hymns or classical music on the piano or violin, after which she often worked on correspondence courses. My mother was not only well organized and interested in everything; she was also quite resourceful.
I would come to realize that the best mentors not only have qualities one want to emulate but also take a personal interest that often leads to involvement with their families and a relationship that continues through the years.
two of the constants in India: heat and crowding
what I expected to be a totally overwhelming experience turned out to be surprising as I saw how people could be cheerful, resourceful, and productive in situations that would have left most Westerners demoralized and unable to function.
While village life in Africa offered a predictable rhythm and the benefits of community, I was also struck by its limitations. People with wealth and education in a country like the U.S. can read about a new idea in the New York Times in the morning and be applying it in the afternoon. Those without education or money, whether in the US or in Africa, cannot. Lacking the resources to change their future, they fall prey to a certain fatalism. Through the years I have come to see fatalism,t he assumption that you can't really change your future, as one of the great challenges in global public health.
The problem with mass vaccination is that an exceedingly obsessive program is required to make inroads into the last 20 percent of any population...it becomes clear that herd immunity is easy in theory but not fully effective in practice.
The standard response was to vaccinate everyone within a certain radius while attempting to determine the extent of the outbreak. However, we did not have enough vaccine to do this.
Forced to look for another solution, we raised the question: if we were smallpox viruses bent on immortality, what would we do to extend our family tree? The answer of course was to find the nearest susceptible person in which to continue reproduction. Our task, then, was not to vaccinate everyone within a certain range but rather to identify and protect the nearest susceptible people before the virus could reach them.
"Life accumulates" was a favorite saying of Jim Laney, former president of Emory University. In many ways the strategy that stopped the virus was a logical extension of the firefighting principle I was taught back int he summers of 1956 and 1957. By removing the fuel one step ahead of the virus, we had build a fire line around it.
putting most of our resources into surveillance and containment
Once a geographical area began the surveillance/containment strategy, smallpox rarely persisted there for more than twelve to fifteen months.
Former US surgeon general Julius Richmond, commenting on the miracle of smallpox eradication in West Africa in such a short time, said that the smallpox workers sent by CDC were "simply too young to realize they coudn't do it." In fact, they were well chosen for the job, people who proved they could meet any problem -- difficulties with vehicles, jet injectors, camels, communications or government officials -- with high spirits and humor.
When surveillance and containment are made the primary strategy, mass vaccination can be dropped totally. In fact, it becomes a wasted effort.
The smallpox eradication story contains many lessons, but giving up mass vaccination as a methodology for other diseases is not one of them. Rather, the lesson is that every problem has to be considered individually.
eradication....it started that night in Ogoja province during a problem-solving discussion about inadequate supplies.
Dr. David J. Sencer, then director of the CDC, had a passion for getting smallpox eradicated. He was a bright, dedicated physician who took delight in solving problems.
Even living in Africa did not adequately prepare us for the adventure of life in India. During the twenty months we were there, the children never lost their fascination with it....Michael, now age seven, had his nose pressed tot he window. Suddenly he turned and said, "This is the second best day in my whole life." Surprised, I asked him, "What was the first best day?" He said, "Yesterday."
India is overwhelming in its scope and confusing in its detail
Spread of vaccine throughout the country was not simple. When attempts to ship dried cowpox material on cotton threads proved unsuccessful, the decision was made to deliver the virus from place to place through a series of children. As lesion developed in their skin, they in turn became the donor of virus to the next susceptible child, in this way maintaining a chain of viable cowpox virus propagated in human lymph.
A summary of countless pages of depressing statistics suggests that more than half a century after the introduction of the smallpox vaccine, the disease continued its relentless decimation of humanity in India.
The euphoria of starting a new program had already run into the brick wall of reality.
The study's pursuit of the truth set the tone for the frequent admonishment to smallpox workers int he 1973 campaign, borrowed from the American Management Association: "You get what you inspect, not what you expect."
bifurcated needle...incredibly simple...several advantages
In the state of Uttar Pradesh alone, preparations for the first search required over 60 training sessions simply to get down to the district level, and an additional 930 training sessions at the district and PHC levels. I would sometimes think: this is a lot like the logistics of war.
Looking through the records from those times decades later, I am struck by how often I was optimistic while simultaneously having no idea what I was talking about.
The results of our trip were at first intriguing, then sobering, and finally scary. The search teams were finding far more smallpox cases than we had anticipated.
we realized were were in fact facing a disaster. In September, via the existing reporting system, Uttar Pradesh had reported 437 cases of smallpox. Now, just one mothe later, searchers had found 5,989 new cases.
At a time when we anticipated a low point in numbers, we found smallpox everywhere.
The search had revealed what actually existed, not what we hoped existed.
...schoolchildren were some of the best informants. They knew what was happening in their own neighborhoods and were not as reticent as their parents.
Perhaps most significant, the smallpox workers were learning and improving every month, while the smallpox virus, for all of its evolutionary success, could not respond with the same agility.
It has been said that genius is seeing one's field as a whole.
integrity, cultural sensitivity, optimism: indicators of a successful smallpox-eradication worker
India's vast bureaucracy, often maligned, was ideally suited for an operation of this scale....once the power of the Indian bureaucracy was harnessed, there was not stopping the innovation and energy of the thousands who took on the challenge of defeating smallpox. Creating effective forms requires you to picture the desired results, how to achieve those results , and how to report on them. Forms proliferated, and in a very real sense we can say, in retrospect, that smallpox was suffocated by a mountain of paper.
Once the pending outbreak list began to decline, it would do so at an accelerating rate.
The fact that a single smallpox outbreak in a European country would be seen as an emergency, with untold resources deployed, provides some insight into the work required to address almost 5,000 outbreaks simultaneously in a single state.
At last we understood the enemy...The intelligence gathered allowed us to outflank a virus that had the supreme confidence of thousands of years of finding new victims without a break int he chain of transmission.
It seemed almost anticlimactic. A virus that for millennia had spread such despair, inspiring religious ritual and even the worship of a goddess, was suddenly gone from the country. In twenty months, the surveillance/containment approach had proved itself ideally suited for eradicating a virus that had eluded the best efforts of mass vaccination programs for 175 years. It was the right tool for the task.
Two weeks later, on October 26, 1977, he developed the last smallpox rash that Africa would ever see. He recovered without transmitting the virus. The global chain of smallpox transmission was finally broken. Smallpox had been eliminated from the world because of a plan. It did not happen by accident.
Coalitions are powerful.
Be optimistic. . . it is the way to live.
Thank you Bill Foege. Amazing.
"Life accumulates"
You get what you inspect, not what you expect.
If a house is on fire, no one wastes time putting water on nearby houses just in case the fire spreads. They rush to pour water where it will do the most good -- on the burning house. The same strategy turned out to be effective in eradicating smallpox.
He tells stories not about what he has done, but about what others have done (Foege)
We lose histories far too fast.
There was -- and is -- no cure for smallpox.
Variolating the troops may have been Washington's most important tactical decision in the pursuit of independence.
Our house was always intensely busy but well organized, and at the end of the day we children fell asleep to the comforting sounds of our mother playing hymns or classical music on the piano or violin, after which she often worked on correspondence courses. My mother was not only well organized and interested in everything; she was also quite resourceful.
I would come to realize that the best mentors not only have qualities one want to emulate but also take a personal interest that often leads to involvement with their families and a relationship that continues through the years.
two of the constants in India: heat and crowding
what I expected to be a totally overwhelming experience turned out to be surprising as I saw how people could be cheerful, resourceful, and productive in situations that would have left most Westerners demoralized and unable to function.
While village life in Africa offered a predictable rhythm and the benefits of community, I was also struck by its limitations. People with wealth and education in a country like the U.S. can read about a new idea in the New York Times in the morning and be applying it in the afternoon. Those without education or money, whether in the US or in Africa, cannot. Lacking the resources to change their future, they fall prey to a certain fatalism. Through the years I have come to see fatalism,t he assumption that you can't really change your future, as one of the great challenges in global public health.
The problem with mass vaccination is that an exceedingly obsessive program is required to make inroads into the last 20 percent of any population...it becomes clear that herd immunity is easy in theory but not fully effective in practice.
The standard response was to vaccinate everyone within a certain radius while attempting to determine the extent of the outbreak. However, we did not have enough vaccine to do this.
Forced to look for another solution, we raised the question: if we were smallpox viruses bent on immortality, what would we do to extend our family tree? The answer of course was to find the nearest susceptible person in which to continue reproduction. Our task, then, was not to vaccinate everyone within a certain range but rather to identify and protect the nearest susceptible people before the virus could reach them.
"Life accumulates" was a favorite saying of Jim Laney, former president of Emory University. In many ways the strategy that stopped the virus was a logical extension of the firefighting principle I was taught back int he summers of 1956 and 1957. By removing the fuel one step ahead of the virus, we had build a fire line around it.
putting most of our resources into surveillance and containment
Once a geographical area began the surveillance/containment strategy, smallpox rarely persisted there for more than twelve to fifteen months.
Former US surgeon general Julius Richmond, commenting on the miracle of smallpox eradication in West Africa in such a short time, said that the smallpox workers sent by CDC were "simply too young to realize they coudn't do it." In fact, they were well chosen for the job, people who proved they could meet any problem -- difficulties with vehicles, jet injectors, camels, communications or government officials -- with high spirits and humor.
When surveillance and containment are made the primary strategy, mass vaccination can be dropped totally. In fact, it becomes a wasted effort.
The smallpox eradication story contains many lessons, but giving up mass vaccination as a methodology for other diseases is not one of them. Rather, the lesson is that every problem has to be considered individually.
eradication....it started that night in Ogoja province during a problem-solving discussion about inadequate supplies.
Dr. David J. Sencer, then director of the CDC, had a passion for getting smallpox eradicated. He was a bright, dedicated physician who took delight in solving problems.
Even living in Africa did not adequately prepare us for the adventure of life in India. During the twenty months we were there, the children never lost their fascination with it....Michael, now age seven, had his nose pressed tot he window. Suddenly he turned and said, "This is the second best day in my whole life." Surprised, I asked him, "What was the first best day?" He said, "Yesterday."
India is overwhelming in its scope and confusing in its detail
Spread of vaccine throughout the country was not simple. When attempts to ship dried cowpox material on cotton threads proved unsuccessful, the decision was made to deliver the virus from place to place through a series of children. As lesion developed in their skin, they in turn became the donor of virus to the next susceptible child, in this way maintaining a chain of viable cowpox virus propagated in human lymph.
A summary of countless pages of depressing statistics suggests that more than half a century after the introduction of the smallpox vaccine, the disease continued its relentless decimation of humanity in India.
The euphoria of starting a new program had already run into the brick wall of reality.
The study's pursuit of the truth set the tone for the frequent admonishment to smallpox workers int he 1973 campaign, borrowed from the American Management Association: "You get what you inspect, not what you expect."
bifurcated needle...incredibly simple...several advantages
In the state of Uttar Pradesh alone, preparations for the first search required over 60 training sessions simply to get down to the district level, and an additional 930 training sessions at the district and PHC levels. I would sometimes think: this is a lot like the logistics of war.
Looking through the records from those times decades later, I am struck by how often I was optimistic while simultaneously having no idea what I was talking about.
The results of our trip were at first intriguing, then sobering, and finally scary. The search teams were finding far more smallpox cases than we had anticipated.
we realized were were in fact facing a disaster. In September, via the existing reporting system, Uttar Pradesh had reported 437 cases of smallpox. Now, just one mothe later, searchers had found 5,989 new cases.
At a time when we anticipated a low point in numbers, we found smallpox everywhere.
The search had revealed what actually existed, not what we hoped existed.
...schoolchildren were some of the best informants. They knew what was happening in their own neighborhoods and were not as reticent as their parents.
Perhaps most significant, the smallpox workers were learning and improving every month, while the smallpox virus, for all of its evolutionary success, could not respond with the same agility.
It has been said that genius is seeing one's field as a whole.
integrity, cultural sensitivity, optimism: indicators of a successful smallpox-eradication worker
India's vast bureaucracy, often maligned, was ideally suited for an operation of this scale....once the power of the Indian bureaucracy was harnessed, there was not stopping the innovation and energy of the thousands who took on the challenge of defeating smallpox. Creating effective forms requires you to picture the desired results, how to achieve those results , and how to report on them. Forms proliferated, and in a very real sense we can say, in retrospect, that smallpox was suffocated by a mountain of paper.
Once the pending outbreak list began to decline, it would do so at an accelerating rate.
The fact that a single smallpox outbreak in a European country would be seen as an emergency, with untold resources deployed, provides some insight into the work required to address almost 5,000 outbreaks simultaneously in a single state.
At last we understood the enemy...The intelligence gathered allowed us to outflank a virus that had the supreme confidence of thousands of years of finding new victims without a break int he chain of transmission.
It seemed almost anticlimactic. A virus that for millennia had spread such despair, inspiring religious ritual and even the worship of a goddess, was suddenly gone from the country. In twenty months, the surveillance/containment approach had proved itself ideally suited for eradicating a virus that had eluded the best efforts of mass vaccination programs for 175 years. It was the right tool for the task.
Two weeks later, on October 26, 1977, he developed the last smallpox rash that Africa would ever see. He recovered without transmitting the virus. The global chain of smallpox transmission was finally broken. Smallpox had been eliminated from the world because of a plan. It did not happen by accident.
Coalitions are powerful.
Be optimistic. . . it is the way to live.
Thank you Bill Foege. Amazing.
March 10, 2021
3.5
Less informative than anticipated but did provide a 50000ft view of the smallpox eradication program namely in Nigeria and India. Would have liked additional perspectives on the efforts but this was written decades retrospect. The best part was the conclusion aka how to tackle seemingly impossible global health goals; seek the truth, truth holds teams together, social will is critical, implementation depends on good management, the measure of civilization is how people treat each other and more. I would be curious on his opinion of how COVID was handled by various global leaders.
Less informative than anticipated but did provide a 50000ft view of the smallpox eradication program namely in Nigeria and India. Would have liked additional perspectives on the efforts but this was written decades retrospect. The best part was the conclusion aka how to tackle seemingly impossible global health goals; seek the truth, truth holds teams together, social will is critical, implementation depends on good management, the measure of civilization is how people treat each other and more. I would be curious on his opinion of how COVID was handled by various global leaders.
December 8, 2019
I was very skeptical of this book in the beginning. But, as soon as I finished the first 2 chapters I was hooked and couldn’t put it down. One could say this was a complete about-face. Foege’s writing was very easy to follow allowing even lay non-public health folks to appreciate and understand the immense efforts required by a multi-sector approach to eradicate smallpox.
March 28, 2020
A guidebook to good global health work, House on Fire describes the global collaborative effort to eradicate smallpox. It details the surveillance and containment method versus mass vaccination that ultimately proved successful. A must-read for those interested in international health work & history.
June 14, 2018
One statement that rings again and again in the mind with goosebumps- "Small pox eradication did not happen by accident" !
October 27, 2019
Really thought this one would be more interesting. Great cure to insomnia! Read this book at night and you will fall right asleep.
February 9, 2020
coverage of the eradication of smallpox in Africa and India; changed my mind to understand and support the polio eradication campaign
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March 6, 2017This was one of the most informative and inspiring history of medicine reads I've encountered! My favorite book of the year so far.
May 23, 2019
This is an incredible story. It's not one that it's easy to recommend to everyone. I loved it and it was a thrill, but I don't think it'll read that way to everyone. If you're wondering if you'll like this book, imagine you went to one of his powerpoint lectures and then joined him and a couple of colleagues for a single drink and continued discussing it. If that sounds exciting, you will love this book.
February 27, 2012
Read this for a paper I was writing for a vaccines development class. I have bad memories of that class which may color my review, so take this review with a grain of salt lol. Gives some interesting insight into the logistics needed to solve the biggest public health campaign ever conducted (eradicating a disease from the earth). Unfortunately, while the issue itself is fascinating, Foege's writing is neither compelling nor emotionally engaging. One chapter is just an extended acknowledgments list (a who's who in the WHO -haha- and CDC, etc.) Too bad-- I wish I could have enjoyed this more.
I try to rate books purely on my personal enjoyment, so my rating says nothing about this read's usefulness. Bottom line: if you are a layperson who is curious about the smallpox eradication effort and you want to learn more, try something else that isn't so dry (I'll update this review if I have any recommendations later on). On the other hand, if you are a public health student/practitioner, I would suggest to give the book a try. It is a fairly quick read and could prove to be a handy reference.
I try to rate books purely on my personal enjoyment, so my rating says nothing about this read's usefulness. Bottom line: if you are a layperson who is curious about the smallpox eradication effort and you want to learn more, try something else that isn't so dry (I'll update this review if I have any recommendations later on). On the other hand, if you are a public health student/practitioner, I would suggest to give the book a try. It is a fairly quick read and could prove to be a handy reference.
August 15, 2016
Summer reading theme: smallpox, cont.
Although the element of surprise may be missing from this book (smallpox is eradicated), that in no way diminishes this excellent book. If anything, it enhances it. As Foege described smallpox, from its smell to appearance to physical impact on a person, and documented its widespread grip on continents and countries, one wonders how it could ever actually disappear. A great system of surveillance (to count cases) and subsequently contain them is almost disastrous: far more cases were lurking than had been known, or documented, or even guessed at, which makes the problem of finding every case and containing each outbreak seem monumental. And yet ... it works. This book is a tribute to inter-agency, governmental, and industrial collaborations, from CDC and WHO, from the Indian Ministry of Health to Tata Industries it somehow just ... succeeds. Foege's writing style is clear, lucid, and compelling, making this story of success hard to put down.
Although the element of surprise may be missing from this book (smallpox is eradicated), that in no way diminishes this excellent book. If anything, it enhances it. As Foege described smallpox, from its smell to appearance to physical impact on a person, and documented its widespread grip on continents and countries, one wonders how it could ever actually disappear. A great system of surveillance (to count cases) and subsequently contain them is almost disastrous: far more cases were lurking than had been known, or documented, or even guessed at, which makes the problem of finding every case and containing each outbreak seem monumental. And yet ... it works. This book is a tribute to inter-agency, governmental, and industrial collaborations, from CDC and WHO, from the Indian Ministry of Health to Tata Industries it somehow just ... succeeds. Foege's writing style is clear, lucid, and compelling, making this story of success hard to put down.
February 6, 2012
This book explains when and how smallpox was eradicated in Nigeria and in India, which are the 2 countries in which the author worked on the program. It is an interesting story of remarkably dedicated people that explains the science and the politics behind the campaign to eliminate smallpox. While it tells how horrible it is to have smallpox, the book’s emotional depth does not go beyond eliciting moderate engagement.
July 13, 2014
An easy to read book that captures the personal story of the people who worked so hard to eradicate Smallpox. In hindsight Smallpox eradication seems simple and inevitable, but Bill Foege helps the reader understand the many challenges and near misses that may have lead to us still hiding from Smallpox. The book is inspirational for anyone working on Public Health. The message about the need to be Optimistic is an important one for weary development professionals.
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December 5, 2021Not only a good narrative about the elimination of smallpox worldwide but a useful field tool for implementing vaccination campaigns. Foege argues the importance of surveillance and containment versus mass vaccination. Put the water on the house that's on fire instead of the neighbor's house.
June 20, 2013
This is a well written chronicle of the process by which smallpox was eradicated told by the epidemiologist who was at the center of the fight. His descriptions of the seemingly insurmountable challenges of defeating this ancient scourge in India makes for riveting reading. Even a reader unfamiliar with medicine or global health initiatives will find this fascinating and understandable.
March 8, 2015
There used to be smallpox and there isn't anymore. That is not an accident and the tremendous amount of coordination and planning required to make this happen was awe inspiring to read about. We could do this with measles too, you guys.
May 24, 2011
Great read. Smallpox eradication was not inevitable. Best global health success story I know of.
Want to read
August 18, 2011As seen in the
New York Times
.
July 7, 2012
For anyone interested in public health, a must read.
July 1, 2013
Great book, however it assumes a lot of prior knowledge so if you don't know much about infectious disease epidemiology, have google open and ready.
June 11, 2013
I really liked Foege's earnest and sincere account of his role in the global effort to eradicate polio, one of the most ambitious medical accomplishments ever.
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