House on Fire: The Fight to Eradicate Smallpox

"House on Fire is a fantastic book about the fight to eradicate smallpox. Before becoming director, Foege led the efforts to eradicate smallpox in India and Africa and came up with a key innovation that led to eradication. As one of the staff at the CDC said of this book, “Even though we know how it comes out, it’s still a page-turner”. It’s so exciting. One of the things this book really brought home to me was how important innovation is. The eradication of smallpox was not inevitable. When we think back on what happened we might assume that we knew what to do, we did it and smallpox went away. That wasn’t it at all. They were continuously innovating, coming up with new ways to vaccinate, a new actual needle to do vaccinations. It wasn’t high tech, it was low tech. It turned out that high speed, pump-powered vaccine guns, where you could vaccinate lots and lots of people in a short space of time, didn’t work well. What did work was a very simple bifurcated needle. They figured out that if you dip that into the smallpox vaccine it had exactly the right amount of liquid and then if you pushed it into the person’s arm 15 times it would result in what’s called a “take” to the smallpox vaccine at a much higher rate, and you could teach a non-literate person to do that in 10 minutes. It wasn’t just innovations like that, it was who to vaccinate, how to vaccinate and how to manage programmes. This book gives the reader a wonderful sense of what it took to get the job done. First, we need to get over the finish line in polio. Second, we need to continuously innovate in small and big ways to figure out, for example, how to get into places where it’s not safe to vaccinate or where healthcare workers may be under attack. For all our health programmes we need to figure out how to put together a community mobilisation. If you look at India, which has been polio free for over a year – India made polio elimination eradication a social mission and that’s the kind of thing that makes a public health programme successful. CDC is a wonderful institution. One of the areas where we can always do better is the integration of our science and our expertise with public health practice on the front lines. We need to make sure that the gears are engaged, that when we take action, when we make recommendations, when we provide funding, the result is a programme that keeps people safer and healthier."