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Smallpox: The Death of a Disease - The Inside Story of Eradicating a Worldwide Killer 1st Edition

4.8 out of 5 stars 21 customer reviews
ISBN-13: 978-1591027225
ISBN-10: 1591027225
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Editorial Reviews

From Publishers Weekly

In his introduction, The Hot Zone author Preston points to the fact that "in smallpox's last hundred years," 1879-1979, it killed more people than "all the wars on the planet during that time." For more than 50 years, doctor and public health expert Henderson combated the disease, first as director of the Center for Disease Control's Epidemic Intelligence Service, then (from 1965 on) as director of the World Health Organization initiative which would later be known as The Eradication. Henderson provides an overview of the painful disease, "a monster" that killed roughly a third of the unimmunized it infected. Chillingly, "variolation," the direct subcutaneous injection of a patient's pus into a healthy person, was used to spur immunity from before the 10th century. The much safer cowpox vaccination was discovered in 1796 (mandated by Washington for the Continental army); meanwhile, smallpox had decimated the Native American population. Henderson's "surveillance and containment strategy" would indeed eradicate smallpox globally; India, the last holdout, was rid of it in 1974 by 115,000 health workers, dispatched to villages throughout the country to identify, quarantine, and vaccinate. This inspiring achievement makes a stirring read for medical history fans, though readers of Preston may find it a bit dry.
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Review

"Outstanding! What a great read. D.A. Henderson pulls no punches as he tells the inside story of the global eradication of smallpox. He and his WHO team faced a formidable array of obstacles, frustrations, and outright disasters in their decade-long struggle; any one of a hundred of which could have doomed the effort to failure....The passion, commitment, and raw determination shine through. THIS is the heroic stuff of true public health leadership!" --Donald S. Burke, MD, University of Pittsburgh Medical Center-Jonas Salk Chair in Global Health, University of Pittsburgh

There has been no greater medical --or humanitarian--miracle in modern times than the eradication of smallpox, history's deadliest infectious disease. Now, for the first time, we learn the inside story from D. A. Henderson, the legendary public health official who led the global effort that brought this miracle about. Smallpox--The Death Of A Disease is more than a riveting account of the day-to-day struggle for international cooperation in a divided world; it also offers a winning blueprint for the great medical challenges to come." --David Oshinsky, winner of the 2006 Pulitzer Prize in History for Polio: An American Story



"Thorough, balanced and well-crafted, Smallpox--The Death of a Disease is the story of one of mankind's greatest achievements. The success of the eradication campaign is a testament to the difference the global public health community can make when it truly comes together for a common purpose. Whether one speaks of HIV/AIDS or Neglected Tropical Diseases, the solution lies in allies and adversaries working as one to alleviate suffering and save lives. This is the lesson to be drawn from Dr. Henderson's excellent book." --Tommy G. Thompson, Secretary of Health and Human Services (2001-2005); Governor of Wisconsin (1987-2001)
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Product Details

  • Hardcover: 334 pages
  • Publisher: Prometheus Books; 1st edition (June 23, 2009)
  • Language: English
  • ISBN-10: 1591027225
  • ISBN-13: 978-1591027225
  • Product Dimensions: 6.3 x 1 x 9.3 inches
  • Shipping Weight: 1.4 pounds
  • Average Customer Review: 4.8 out of 5 stars  See all reviews (21 customer reviews)
  • Amazon Best Sellers Rank: #159,856 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

By wiredweird HALL OF FAMETOP 1000 REVIEWER on December 26, 2009
Format: Hardcover
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.
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Format: Hardcover
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.
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Format: Hardcover
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.
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Format: Kindle Edition Verified Purchase
The eradication of smallpox relieved cataclysmic amounts of human suffering.

Henderson organized this book chronologically with plenty of illustrative, entertaining vignettes. I found it more useful to organize the things I learned categorically rather than chronologically.underplayed

Scientific: smallpox has several attributes that made it specially vulnerable to eradication. There is only one infected species. There are no asymptomatic carriers. Smallpox symptoms are easy to recognize.

Technological: from antiquity, variolation provided protection at the expense of infecting others during the variolation time. Jenner developed the first effective vaccine by working from a folk medicine story. Later vaccines were not heat-stable (decayed at room temperature). The most modern vaccine, freeze-dried, was heat-stable (I would have called it "room-temperature-stable"). That enabled the creation and distribution of enough doses for the whole world.

Technology 2: several generations of vaccination equipment culminating in the bifurcated needle which reduced the vaccine dose needed by 4x compared to previous needles.

Politics: initial funding and resource allocation. Working around reporting systems that lied, national health systems that hid patients (!), bureaucrats who know how to say "no" but don't know how to say "yes", people who want to do things differently or not at all. Working with both sides in countries embroiled in civil war.

Strategy: mass vaccinations vs surveillance and quick-response teams. Responding to waves of refugee migration and nomadic people.

Logistics: a great challenge. The programs in many countries took longer, cost more. Transportation broke down. Communication was difficult.
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