House on Fire (33 page)

Mather, Cotton,
41

Maulana Azad Medical College in Delhi,
124

McPherson, Dr.,
94

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 also
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