House on Fire: The Fight to Eradicate Smallpox

House on Fire: The Fight to Eradicate Smallpox

House on Fire: The Fight to Eradicate Smallpox

House on Fire: The Fight to Eradicate Smallpox


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.


The eradication of smallpox from the entire world has been justly described as one of the most remarkable achievements in the history of medicine and public health. In India—a country one­third the size of the United States but with three times the population, with 638,365 villages and thirty­five cities with a million­plus population—the campaign to eradicate smallpox involved the most acute and challenging difficulties encountered anywhere in the entire smallpox eradication effort. The story of India’s successful eradication program can be told fully only by those who were on the team that brought about this achievement, and this book is written by one of the team’s two pivotal participants. It is so much richer because this participant happens to have one of the most impressive memories in the world, and he has used his own extensive notes and references from others involved in the campaign.

The other pivotal participant, Dr. M. I. D. Sharma, was the director of the smallpox eradication program for the Government of India during the years when this final effort was mounted and brought to a successful conclusion in 1975. He also served concurrently as the director of India’s National Institute of Communicable Diseases. His unflagging commitment to eradication, the excellence of his leadership, and his skillful use of the human, fiscal, and material resources—committed from all over the world—in the Indian eradication effort constituted a central and indispensable element in the success of this program.

Dr. William Foege, as a Centers for Disease Control and Prevention (CDC) epidemiologist assigned to the Southeast Asia Regional Office of the World Health Organization (WHO), worked on the eradication effort throughout the Indian subcontinent. The methodology of surveillance and containment, an alternative to mass vaccination refined in the 1960s in Africa, enabled the Indian and multinational team to successfully eradicate smallpox in India. Dr. Foege’s tenacious advocacy of the containment approach, together with his meticulous monitoring of the continually changing status of the Indian eradication effort and his adjustment of strategy and resources in response to altered circumstances, was an essential ingredient of this success.

Much has been said about the humanitarian benefits derived from the eradication of smallpox, and the importance of these benefits to all the nations of the world cannot be disputed. But another benefit of almost equal weight in the minds of many public health professionals was the demonstration that the Indian government and its people could apply principles of sound management and deliver a program that stretched from the remotest village to the most populous urban centers of their country. Supervision, delegation, evaluation, performance appraisal, and accountability—all commonplace terms in the business schools of the world—acquired operational reality in this vast undertaking. The concepts and practices of sound management became a reality in the work of more than 250,000 workers throughout the nation.

The health and well­being of people throughout the world have been enhanced by the dedication of these Indian smallpox eradication workers, by the responsiveness of the hundreds of millions of Indian people who accepted vaccination and actively collaborated in the reporting of disease and suspected cases, and by the hundreds of health workers . . .

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