Accessibility statement

Dr Joel Breman

1. Introduction - medical background

Joel Breman describes his training and background – and those of others – before he was posted to work in Guinea and other parts of western Africa. He also tells us about the negotiations and arrangements that preceded the departure of the Centers of Disease Control workers to western Africa.

2. Guinea

Joel Breman describes here the geographical location and terrain of – and political situation within – Guinea in order to give us a better idea of the complexity of planning work in the country.

3. How Smallpox got to Africa

Joel Breman describes the long history of smallpox within Africa.

4. The miracle of eradication

Joel Breman highlights the important roles played by many thousands of African workers, as well as Centers of Disease Control employees, in the eradication of smallpox.

5. Epidemiology & spread

Joel Breman describes the epidemiology of smallpox, how it was spread and the different stages of distinct kinds of variola (the causative virus).

6. Operational issues

Joel Breman argues that disease eradication is best approached like a military campaign. But, he also highlights the importance of flexible operational plans that need to be shared openly with all involved. The importance of spending time in the field is highlighted – this, it is pointed out, is the basis for winning the respect and support of local workers and the trust of communities.

7. Statistical evaluation - supervision

Joel Breman speaks here about the significance of statistical evaluation.

8. Frustration

Joel Breman tell us of the frustrations that he experienced whilst working in western Africa. This related sometimes to the CDC, and at other times to a nationalist government in Guinea; socialist in constitution, this government was suspicious of the goal of US workers in the country. 

9. Leadership

Joel Breman highlights the leadership attributes required in a disease eradication programme. He highlights the leadership of people like Donald A. Henderson, the Director of the Global Smallpox Eradication Programme in WHO Geneva, Dr. David Sencer, Director of the CDC during the West Africa campaign, Dr. Bill Foege of the CDC, and Bangura Aleko, Breman’s counterpart in Guinea.

10. Flexibility

Joel Breman reminds us here that D.A. Henderson has pointed out that all effective ideas about smallpox eradication came from field workers. He highlights the impact of the sharing of movement of ideas, from country to country, and from continent to continent.

11. Vehicles

Joel Breman talks here about the importance of having access to well-maintained vehicles for smallpox vaccination and surveillance, as well as campaign evaluation.

12. Politics - cold war

Joel Breman talks here about the impact of the Cold War, and the operational difficulties that this sometimes created. He also talks about post-colonial nationalism, and how this impacted on negotiations with the USA as plans were made for regional smallpox eradication.

Dr Joel Breman, photo Chris Carter © Wellcome Trust

Joel G. Breman, M.D., D.T.P.H., F.I.D.S.A., is Senior Scientific Adviser, Fogarty International Center of the U.S. National Institutes of Health.  Following the confirmation of smallpox eradication in 1980, Dr. Breman returned to the U.S. Centers for Disease Control and Prevention, where he began work on the epidemiology and control of malaria. Dr. Breman joined the Fogarty International Center in 1995 and has been director of the International Training and Research Program in Emerging Infectious Diseases and other institutional strengthening programs in low-income countries. Since 2001, Dr. Breman has been co-managing editor of the Disease Control Priorities Project ( and lead editor of three volumes of articles on "the intolerable burden of malaria" published as supplements to the American Journal of Tropical Medicine and Hygiene (