Eradicating Smallpox: Delivery Strategies to Reach the Last Mile


In this teaching case, Dr. William Foege - the former director of the US Centers for Disease Control and Prevention who many credit with eradicating smallpox - helps readers understand what it took to eradicate it. The case gives background information on the disease, as well as earlier immunization efforts, and describes how the social, political, and economic complexities of India impacted public health initiatives. As international endeavors to fight smallpox expanded in the 1960s, India continued to account for a disproportionate percentage of new cases. Cases remained high until a more organized and targeted strategy in the 1970s increased staffing, improved reporting, boosted vaccination rates, and expanded national and international resources. Specific national and local strategies, a coordinated and centralized decision making structure, and an understanding of and clear communication with the population were crucial to the nation’s success. The state of Bihar was the most challenging state to address, with cases remaining stubbornly high. A final campaign intensified surveillance, containment, and vaccination efforts in Bihar, and the Global Commission for the Certification of Smallpox Eradication declared India smallpox-free in 1977. The case ends with Dr. Foege wondering what lessons from smallpox eradication in India can be applied to the COVID-19 pandemic, as well as future threats.

Learning Objectives:

This case documents the eradication of smallpox in India. A productive class discussion will allow students to appreciate the following:

  • The role of power dynamics in global health
  • The role of data and the importance of measuring the right outcome to inform program management 
  • Human resource management and its relationship to stakeholder management
  • The relationship between disease presentation and public health strategy and decision-making
  • How to build on what is known in confronting new contexts, diseases, and environments

Exhibit 5a Decade in Which Smallpox Ceased to be Endemic by Country

Keywords: India, public health, pandemic response, vaccine delivery, workforce management, collaboration, multilateral engagement


Last updated on 12/15/2022