Struggling to a monumental triumph: re-assessing the final phases of the smallpox eradication program in India, 1960-1980

Abstract

The global smallpox program is generally presented as the brainchild of a handful of actors from the WHO headquarters in Geneva and at the agency's regional offices. This article attempts to present a more complex description of the drive to eradicate smallpox. Based on the example of India, a major focus of the campaign, it is argued that historians and public health officials should recognize the varying roles played by a much wider range of participants. Highlighting the significance of both Indian and international field officials, the author shows how bureaucrats and politicians at different levels of administration and society managed to strengthen-yet sometimes weaken-important program components. Centrally dictated strategies developed at WHO offices in Geneva and New Delhi, often in association with Indian federal authorities, were reinterpreted by many actors and sometimes changed beyond recognition.

Precision global health for real-time action

“…However, socalled one size fits all interventions tend to neglect the idiosyncrasies of social-ecological systems and the heterogeneity of populations, including underlying health determinants. 2 In view of growing complexities in global health challenges, there is a need for increased precision and adoption of more tailored strategies.…”

Crónica de un éxito consolidado: las políticas de erradicación de la viruela en Brasil (1962-1973)

“…En Asia, a su vez, principalmente en India, país que en 1962 albergaba más del 60% de los casos de viruela notificados en el mundo (34,35) , la actuación de la campaña de la OMS se mostró más complicada. Para que la tarea de erradicación de la enfermedad fuese llevada a cabo, la OMS y su sucursal regional, la World Health Organization in South-East Asia (SEARO), tuvieron que juntar esfuerzos con el gobierno indio, tanto a nivel federal, negociando con el Poder Ejecutivo y el Ministerio de Salud, como a nivel local, lidiando con los estados y los líderes y burocracias de salud locales (12,34,36,37) . Al mismo tiempo, para que la empresa de la erradicación fuese exitosa, el plan estratégico de acción de los vacunadores y del equipo de combate contra la viruela tuvo que ser adaptado para dar cuenta de la realidad local, como en el caso del uso de la vigilancia epidemiológica en vez de la vacunación masiva, como mostraré más adelante (13,14) .…”

Political will and international collaborative frameworks in infectious diseases

“…Until 1950, it is estimated that over 100,000 people died in India annually as a result of smallpox . While in 1951 India had 52% of the smallpox cases in the world, this percentage decreased in 1975 to 7.5%, and the country was certified to be smallpox‐free on 23 April 1977 .…”