measles, 38, 46–47, 72–73
Meiklejohn, Gordon, 114–115
Merck, 168, 205n30
metrics: belief in eradication strategy and, 161–162, 172; data analysis and, 145–147; evaluation criteria and, 154–155; number of outbreaks and, 118–119, 146, 161–162, 172, 182; number of vaccinations and, 93, 97; tracking of data and, 145–148. See also program evaluation
Millar, Don, 19, 37, 85, 132, 167; African eradication program and, 47, 69, 71, 72
Ministry of Health (India), 86, 123, 125, 166–167, 177, 180
Ministry of Health (Nigeria), 61, 66, 67–69
Montague, Lady, 41
morale, 99, 121, 138, 141, 142–143, 164, 172
Morris, Leo, 84
mortality rate, 6, 7, 10; in India, 91–92, 96, 97, 146
Moynihan, Daniel Patrick, 160–161
multiple pressure vaccination technique, 49
Narayan, J. P., 158
National Institute of Communicable Diseases (NICD), 86–87, 99–100, 102, 124, 204n27
Native Americans, 6, 7, 10
Nelmes, Sara, 8
New England Journal of Medicine, 25
New Mexico, smallpox threat in, 19–22
NICD. See National Institute of Communicable Diseases (NICD)
Nigeria, 28–42; eradication in Eastern region of, 60–72; fetisheurs in, 41–42; last case of smallpox in, 73; possibility of eradication and, 27; smallpox in rural areas of, 37–39; surveillance and containment strategy in, 11, 60–72; variolation in, 40–42; village life in, 30–36; war in, 61–69; WHO eradication program in, 46–53
Nordstrom, Frank, 19
Norton, Charles, 93
Ogoja, Nigeria, outbreak, 54–59, 77, 79
Onitsha Bridge incident, 64–65
Operation Smallpox Zero, 182–184
optimism: unwarranted, 117; value of, 191. See also morale
oral histories, 206n5
Orissa (Indian state), 176
Ottemüller, Hector, 54
outbreaks: number of, as metric, 118–119, 146–147, 161–162, 172, 182; search results in Uttar Pradesh and, 113–114, 115, 173; transmission in Africa and, 38–39; variolation and, 40
Parasher, Umesh, 126
pathogen combinations, 36
Patna, Bihar, 158
Patwadangar. See Uttar Pradesh
Peace Corps, 27, 86
Ped-O-Jet, 50–51, 102
personnel. See health workers
Pfizer, 168
pharmaceutical philanthropy, 168, 205n30
PHC. See Primary Health Center (PHC)
Phipps, James, 8–9
physical effects of disease, 4–5
physicians, managerial skills of, 207n2
polio vaccine, 200n8
politics: Bihar’s Minister of Health and, 169–172; climate in India and, 157–161; foreign workers and, 137, 159; risks to eradication program and, 61–69
Polybius (Greek historian), 52
population density, 8, 91, 99, 107
population size, 107
Precision Fabrics, 168
prevention: medical missions and, 28–29
Primary Health Center (PHC), 103, 108, 112, 119, 153–154
program evaluation, 99, 100, 192; assessments in India and, 100–102, 173–175; number of vaccinations, as measure, 93, 99; value of, 153–155. See also metrics
public health field, 17, 186–187; lessons from smallpox program for, 188–192
publicity, 166–167
quality control: evaluation system and, 154–155; monthly meetings in India and, 140–144; standards for vaccine and, 48–49, 104; training and, 108
Ramses V, 6, 89
Rao, A. R., 85, 134–135
Rao, C. K., 127
Ravenholt, Rei, 17, 18, 27, 200n1
Raya, Krishna, 88
recognition cards, 108, 109, 158
recordkeeping: containment in India and, 151, 155–157; early vaccination activities in India and, 93, 95, 96; forms and, 155–157; program in Uttar Pradesh and, 112
Reid, Gordon, 204n29
repeat vaccination, 93, 99, 100
reporting system: Africa and, 39; data tracking from, 145–147; forms and, 156; in India, 100, 103–104, 111, 112, 114, 117, 119
resource allocation, 191
reward system, 131, 181–182, 185
Richmond, Julius, 73
Ristad, Paula (wife of author), 16–17. See also Foege, Paula; Foege family
roadblocks, 61–63, 64–65
Roberto, Ron, 24
rotary lancet, 49, 50, 101
Rubin, Benjamin, 101
Sacco, Luigi, 92
Schweitzer, Albert, 15
Scott, Helenus, 92
search teams, 107–108, 148–150
SEARO. See Southeast Asia Regional Office (SEARO)
Sencer, David J., 84, 86, 132–133, 160, 183
Seva Foundation, 206n1
Shah Jehan. See Jehan (Indian Shah)
Sharma, M. I. D., 124–125, 126, 130, 145, 169–172, 176
shortcuts, 120
Shrivastav, J. B., 167, 177, 180
Shriver, Sargent, 27
SIDA. See Swedish International Development Authority (SIDA)
Sierra Leone, 73
Singh, Jit, 87, 88
Singh, Karan, 124, 135–136, 166, 177, 180
Singh, Mahendra, 127
Singh, Rajendra, 139–140
six-foot perimeter concept, 152–153
“Smallpox Zero,” 87. See also Operation Smallpox Zero
Solex motorbikes, 54–55
Somalia, 186
South America, 7
South Asia, 83–84
Southeast Asia, 7–8
Southeast Asia Regional Office (SEARO), 86, 103, 105, 117, 135, 136; team members at, 127–129
South India, 85–86
special epidemiologists, 103, 117, 134–140, 142–143, 159–161
Steiger, Tony, 15
storytelling, 62–63
Strunk, Bill, 16
Stuart, Johannes, 133
supervision, 108
supplies, 63–65. See also vaccine
surveillance and containment approach: containment planning and, 108–110; in Eastern Nigeria, 60–72; efficiency of containment and, 162, 163, 174, 181; efficiency of searches and, 107, 120–121, 145, 154, 162, 166, 174; Eradication Escalation effort and, 72–75; history of, at CDC, 75–79; in India, 102, 105–122, 184 (see also India); indicators of containment and, 146, 161; nature of searches and, 107; personnel involved in, 106–111; reasons for effectiveness of, 77–79; search planning and, 107–108; as secondary strategy, 54, 75–77, 85; shift to, as primary strategy, 11, 73, 84–86; skepticism about, 83–86, 177, 180; smallpox bioterrorism and, 195–196; testing of, as primary strategy, 11, 60–72
Swain, Clara, 139
Swedish International Development Authority (SIDA), 131, 181–182
tactical flexibility, 190–191
take rates, 26, 100
talking drum, 45–46
Tamil Nadu, South India, 85
Tata Industries, 124, 168
tenacity, 191
terrorist threat, 195–196
Thompson, David, 44, 54–55, 58, 60, 70
Thompson, Joan, 44
Tonga research, 24–25, 26
training programs: EIS and, 18; for in India, 59, 106–111; special epidemiologists and, 136–137
Tranneus, J. E., 131
transmission of smallpox: decline in rate of, 162; endemic countries and, 72; epidemiological understanding and, 74–75; households and, 110; outbreaks in Africa and,
transmission of smallpox (continued) 38–39; risks of spread and, 56–57; sex trade and, 205n2
travel: drivers and, 136–137; political matters and, 157–161, 176–177; searches in India and, 112–113, 114; spread of virus in Nigeria and, 67–68; WHO staff and, 129–130
trust, importance of, 190
underreporting, 39. See als
o reporting system
UNICEF. See United Nations Children’s Fund (UNICEF)
United Lutheran Church of America, 28–29
United Nations, 52
United Nations Children’s Fund (UNICEF), 104
United States: bioterrorism threat in, 195–196; consultants from, 136 (see also foreign workers; special epidemiologists); global perspective and, 52, 132; smallpox in history of, 6–7; surveillance and containment approach in, 195–196, 205n1
U.S. Agency for International Development (USAID), 46, 47, 69, 72, 200n1
USSR, 48, 99, 104
Uttar Pradesh (Indian state), 139, 140; mortality rate in, 91–92; rise in numbers in, 147–148; surveillance and containment approach in, 106, 111, 112–119; turning point in, 162, 173–175; vaccine depot in, 95, 104
vaccination: benefits of, 93; as compulsory, 96; discovery of, 8–10; early efforts in India, 92–97; resistence to, 59, 89, 91, 93–94, 140, 153, 206n1; vs. variolation, 40
vaccinations, number of, as metric, 93, 97
vaccination strategy: critical shift in, 11; in nineteenth-century India, 93–96. See also mass vaccination; surveillance and containment approach
vaccination teams: in Nigeria, 59; Peace Corps volunteers and, 27. See also containment teams; health workers
vaccination techniques: advances in, 48–52, 101–102; dilution and, 24–25, 51; instruction sheet on, 109, 197; multiple pressure vaccination technique, 49; in nineteenthcentury India, 94; possibilities for global eradication and, 10. See also jet injector
vaccinators. See health workers
vaccine: delivery of, in India, 92–93; dilution of, 24–25, 51; freeze-drying and, 104; production in affected countries, 10, 48, 94, 95, 104; sources of, 94, 99; standards for, 48–49, 104. See also supplies
vaccinia virus, 75
van Bibber, Dr. (Lincoln’s physician), 7
variola minor, 185–186
variolation: development of, 40; in India, 89, 91, 95–96; Jenner and, 8–9; in Old World, 40–42
Washington, George, 6–7
watch guards, 152, 153
Watson, William, 133
Weller, Tom, 25–26, 200n8
West Africa, 72–75
West and Central African Smallpox Eradication/Measles Control Program (CDC handbook), 76
West Bengal, India, 106, 121, 177
World Health Assembly (WHA), 10, 27, 47–48, 98
World Health Organization (WHO), 10; archival records and, 143–144; CDC involvement and, 84, 160; Ethiopian program and, 185–186; improvement of tools and, 189; program in India and, 100–102, 104, 105, 117, 129–131, 155, 164; program in Nigeria and, 46–53; surveillance and containment approach and, 74, 75–76. See also Southeast Asia Regional Office (SEARO)
Wyeth Pharmaceuticals, 101, 205n30
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10/14 Palatino
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Univers Condensed Light, Bauer Bodoni
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BookMatters, Berkeley
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House on Fire Page 24
