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Smallpox- the Death of a Disease: The Inside Story of Eradicating a Worldwide Killer

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Smallpox reigned through history as one of the most destructive diseases the human species ever suffered. Hundreds of millions of people are estimated to have died from it in the twentieth century alone. Its eradication, twenty years ago this year, remains unique: no other disease has been eliminated, once and and for all.

To some extent, smallpox almost aided in its own demise. Unlike life-long HIV infections, smallpox runs its course, to survival or death, within a few weeks. Unlike bubonic plague, there is no animal reservoir for the pathogen - when no more people have the disease, it can't come back. Unlike influenza, for which new vaccines are needed every year, only one vaccine was needed during the decades of intensive eradication effort. The disease's deadliness was only one reason it was such an attractive target for elimination.

This book tells the story of that elimination effort, written by the man who led that effort. Not just a medical miracle, it required cooperation from every nation on earth plus the warring factions that controlled areas where smallpox was endemic. That feat of cooperation very nearly counts as a miracle in itself and represents, to my mind, Dr. Henderson's most stunning achievement.

That cooperation faced continuous threats through the decades of the eradication program. As in any field, funding was always uncertain - especially when so many 'experts' said the goal was impossible, and that the funds should be directed to other diseases. The funding agencies quarreled amongst themselves, too. In one case Henderson describes, a funding group refused to pay for fuel for the team's trucks, on the grounds that a different agency had provided the trucks. Then, the team faced challenges from the terrain they had to cover, often in remote and nearly inaccessible areas - or in areas of active war, where the medical team needed permission from both sides to vaccinate and monitor the population. Not just doctors, educators, and negotiators, Henderson's team had to be mechanics as well, to deal with the inevitable breakdowns days away from the nearest repair shop. Then, they had to change their way of working to accommodate the unique political environment of every country in which they worked.

But, in the end, Henderson and his team succeeded, except for samples in two laboratories. Henderson and his team previously documented their approach to the eradication in a World Health Organization document over a thousand pages in length. The story deserves a wider audience, however. This book presents a lively and very readable summary of that massive report. Today we face challenges of our own, from other pathogens. Techniques specific to smallpox eradication might not be appropriate to malaria, HIV, or other diseases. Any eradication effort, however, can learn from the creativity and heroic determination of the team that drove smallpox to extinction.

-- wiredweird

After reading several other books that explore smallpox eradication, Henderson's account appears more in-depth and personal. It places the reader in the situation, its stresses and successes. The reality of the narrative is supported by both strong personal biases and fast-paced anecdotes. The bias is shown in dark portrayals of bureaucratic figures that were shown to impede progress instead of assisting eradication. Henderson writes with strong, liberal voice that is true to life. He is blunt and decisive, and this is reflected in the text.

The anecdotal clippings that are boxed and scattered in the book depict unique struggles and solutions of the eradication campaign. Cultural and environmental barriers of the campaign are exposed in the brief accounts. "A novel way to detect hidden cases" is one example of an unusual solution; in order to reveal denied cases of smallpox, a vehicle was driven into deep mud to interest infected villagers, bringing them out of their homes.

Henderson also emphasizes the need for rule-breaking. He boldly suggests that certain conditions require radical action. His assertions are projected by scenarios and are proven valid by the ultimate success achieved by Henderson and other members of the campaign to bring the death of a disease.

This book fills a gap on the smallpox eradication bookshelf.

D. A. Henderson, who was chief of smallpox eradication at WHO from 1966 to 1977, co-authored with Frank Fenner and colleagues the 1988 magnum opus, Smallpox and Eradication, an encyclopedic overview of the disease and its eradication. That WHO publication, now on the Internet, is as close to an official history of smallpox eradication as we are likely to see.

In this briefer, 300 page narrative, printed without the WHO imprimatur, Henderson looks at the people and institutions who, in his view, assisted or impeded the march towards smallpox eradication. He is not very kind to some people in some governments (he is especially hard on the Siyad Barre regime in Somalia, to some of the WHO regional offices, and to some people in the US Agency for International Development). He is unfailingly supportive of the compact teams in Geneva, CDC/Atlanta and the field who, with the governments of the endemic countries, gave us the world's first and last cheap disease eradication effort ($125 million in agency expenditure).

On the technical side, Henderson points to the innovations (vaccine quality control, the bifurcated needle, surveillance and containment, and smallpox identification cards) which moved the global program forward.

No book on smallpox can be exhaustive. [...]is a bit daunting at 1400 pages; some readers will prefer Donald Hopkins' briefer account of the historical consequences of smallpox, Horace Ogden's richly anecdotal CDC and the Smallpox Crusade, or Lawrence Brilliant's out of print book on the management of smallpox eradication in India. Henderson's brief bibliography is a good starting point for those who want to explore the subject more deeply.

If you can only read one book on the subject. this is the one.

This is an excellent book about the history of the eradication program. I could not believe the road blocks the had to be overcome to achive the eradication of smallpox. As a relative of the author, I had grown up knowing about the program and the disease, but never really knew the story behind it. To know the author you would never know the things that he has done and accomplished. The positions that he has held and the people that he has known and worked with could fill a Whos Who book, but he will talk to you as a real person and put you totally at ease. I found the book to be very enlightening and exciting (I think that is the word I want). You wanted to find out how they (the smallpox team at WHO) would get past another hurdle that was thrown up by a goverment or a regional director. I would recommend this book to everyone, but to medical professionals and definately public health professionals.

Dr. D.A. Henderson's "Smallpox: The Death of a Disease" is an intriguing, macro-level look at how one of the most horrible diseases known to mankind was eradicated from the face of the Earth. I thoroughly enjoyed Dr. Henderson's experiences, perspectives, insights, and stories! His work is certainly reflective of the past, but also offers hope for the future and other diseases through the collective institutional knowledge of and lessons learned from the efforts undertaken by the thousands of tireless workers of the global smallpox eradication effort. I cannot recommend this work highly enough!

As a follow up to Dr. Henderson's book, I read Dr. Bill Foege's "House on Fire: The Fight to Eradicate Smallpox." Reading both of these works allowed me to have the best experience possible at trying to understand the environment at the time that these brave and tenacious individuals were trying to eliminate this "loathsome" disease!

One of the most interesting books I have read about infectious diseases. What a loyal and committed group accomplished this incredible disease.

Smallpox: The Death of disease is an intriguing, true story about the smallpox global eradication campaign told by the man who ran it himself, Dr. D.A Henderson. After providing a solid foundation with a summary of smallpox history, he plunges into the course of eradication. Henderson gives a unique anecdotal insight into a few of the intricacies and personalities that shaped the campaign program. The story travels through each country and phase of the eradication where floods, mechanical problems and not to mention cultural resistance were around every corner. Misguided politics had a significant influence as well. Fortunately, Henderson's hands on approach and disregard for inhibitive regulations lead the effort to success.
The reader also gets a glimpse behind the scenes of the eradication certification program as well as the chilling biosecurity issues that have surfaced post-eradication. Henderson has continued to play an important role in advising the government on how to prepare for potential bioterror attacks involving smallpox. However, he concludes with a surprising opinion about future eradication efforts.
Overall, the story is engaging from cover to cover. Henderson's anecdotal account of the campaign provides a unique dimension, which no other smallpox literature can provide. The lessons learned from this achievement should serve as a template for future global effort as well as personal life goals. In addition, smallpox aside, this inspiring account is evidence that no obstacle can inhibit a strong a will.

Any interested in a history of disease control - especially any health library - needs Smallpox: The Death of a Disease. It charts 3,000 years of the relentless, incurable disease and the author's own campaign to eliminate this disease from the world. Dr. Henderson's personal story of how he led the World Health Organization's efforts is riveting and provides an insider's account of international health issues. Recommended for health and general-interest libraries alike.

Henderson takes one of the monumental achievements in disease history and makes it readily accessible to the general public in a very fascinating portrayal of the eradication of smallpox.

What strikes me most about Henderson's perspective is how candid he is about his experience as head of the eradication. He is characteristically open about his efforts, often revealing the actual disease to be less of a problem than dealing with his superiors. If he makes anything obnoxiously clear, it's that when working on a global project one must choose the people to work with and ignore the calls of everyone else to get something done. The ins and outs of the WHO bureaucracy are very clearly present throughout the entire book, necessitating a search for loopholes that could only be carried out by our very cheeky, irreverent author. It's difficult not to admire his no-nonsense approach.

The book itself quickly documents how Henderson serendipitously was given the position that would define his career and then jumps into eradication. He goes through in minute, yet engaging detail the evolving strategy needed to tackle such a beast with little more than a picture of a dude with smallpox, freeze-dried vaccine, and a bifurcated needle. The only thing that I would chance criticizing in his book would be the slight repetitiveness of some of the chapters. While I'm sure the actual process was much more complicated, the ring-vaccination technique coupled with stringent surveillance seemed to be the general gist of more than half of the discussed regions, with slight adaptations for weather and political conditions in the remaining situations.

Even so, for one who is interested in the topic, I can't think of a better source than Henderson. The last few pages are a very nice capstone to the book, collecting what he gathered from his experiences to formulate his own strong opinion on where we should go from here. Definitely worth the read if you like poxy stuff.

D.A. Henderson's book on smallpox is an outstanding, well-written account of the success of the incredibly difficult task of eradicating smallpox,starting with a small staff and relatively little funding.

(One disclaimer: I've known D.A. Henderson since the early 1980s, when he was chairman of a technical advisory group on vaccination, and have always liked and admired him.)

This entertaining, sometimes astonishing story of how he and his team of health workers accomplished the difficult, and sometimes the impossible, in remote villages and cities from Bangladesh to India to Ethiopia, is well worth reading. It details the hard-fought success story that later came to be called one of mankind's greatest accomplishments: The complete eradication of a disease.

What happened after eradication is just as interesting, with the 9/11 terrorist attacks spurring very real fears of biological warfare. As it turned out, the Soviet Union had been stockpiling huge quantities of deadly smallpox for use as a weapon, as described by defector Ken Alibek, so the possibility of a deadly smallpox attack was real.

This book is well worth reading, not only for the history but also for the insight it gives us on the disease and the health systems around the world and how they dealt with the eradication program, called target zero.

It's also fascinating to read. Highly recommended.