Dr Larry Brilliant

01. Vaccine science improvements, epidemiology

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Larry presents his views on why the strategy of mass vaccination was unworkable, especially in a country like India. The annual growth in population, which he identifies as 50 million, would negate mass vaccination work (if that was possible in a country with more than a billion inhabitants).

02. Mass vaccination and its problems

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Larry presents his views on why the strategy of mass vaccination was unworkable, especially in a country like India. The annual growth in population, which he identifies as 50 million, would negate mass vaccination work (if that was possible in a country with more than a billion inhabitants).

03. Variola major's last stand

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Larry tells us here about the important role played by Nicole Grasset, the person selected by Donald A. Henderson to head the smallpox eradication programme in India and other South Asian countries served by the South East Asia Regional Office of the World Health Organization (based in New Delhi, India).

05. Rallying political and public support

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Larry tells us here about the importance of rallying political and public support for the smallpox eradication programme. In relation to this, he talks about how millions of households were visited and searched, and how the development of a public health education exercise was crucial; Larry describes the development of an effective system of providing rewards for reporting smallpox, and how this strategy was widely advertised through posters placed on the backs of elephants, alongside cycle rickshaws etc.

06. Sitala & cultural concerns

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Larry talks about Sitala, the smallpox deity widely worshipped in India; he mentions that people attributed a touch of divinity to the disease and refers to religiously informed opposition to smallpox vaccination. At the same time, he refers to the complex bases of resistance to the smallpox eradication programme, highlighting the existence of vaccinal complications, and the fact that some people had weak or compromised immune systems, which meant that vaccination did not protect them from the disease.

07. 1974, smallpox explodes in India

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Here Larry describes how 18 countries still suffered from smallpox in 1970 and how only 5 were in the same position by 1974. However, the disease re-appeared in epidemic form in India in 1974, to Larry’s great consternation. He clearly remembers the events on the 14th August 1974, a time when Donald A Henderson had put him in charge of the Indian programme: Indian reporters reported ‘history’s worst’ epidemic in New Delhi that day, but when Larry reached the World Health Organization’s regional office, he found a group 35 international reporters keen only to report the fact that India had exploded its first nuclear device.

08. Setbacks, reimportation of the disease

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Larry describes the difficulties encountered in Tatanagar (Jamshedpur), Bihar state (presently in Jharkand state), India, in 1974 – this was the last major epidemic outbreak of smallpox in the country, which led to the re-importation of the disease into five states that had previously managed to eliminate the disease. There is reference here to the significant assistance provided to the World Health Organization’s workers operating in the region by J.R.D. Tata, the Chairman of the Tata industrial group, whose firm ran the iron and steel mills located in Tatanagar

09. The strategy of containment

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Larry tells us about the strategy of containment – its logic, aims and evolution through the course of the smallpox eradication programme.

10. Forced vaccination

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Larry describes his experiences of using force to vaccinate people in Bihar state in 1974, during and after the smallpox epidemic in Tatanagar; he tells us how this strategy involved members of the Indian administrative establishment, especially the local police forces.

11. Strengths of the eradication programme

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Larry assesses the strengths of the smallpox eradication programme, the management skills of some of its leaders and, not least, the evolution of the strategies employed over a period of time.

12. The last case

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Larry tells us of the last case of variola major in the world – Rahima Banu, whose case was discovered in Bhola Island, Bangladesh in 1975; Banu, a young girl at the time, survived the infection. Larry also describes the optimism resulting from the successful eradication of smallpox, in South Asia and across the world – he highlights the usefulness of international co-operation in health programmes.

Dr Larry Brilliant

Dr. Larry Brilliant is President of the Skoll Global Threats Fund and Senior Adviser to Jeff Skoll. Prior to this, Larry served as the inaugural Executive Director of Google.org and, later, Chief Philanthropy Evangelist. Larry is an M.D. and M.P.H. who is board certified in preventive medicine and public health. He is a founder and director of The Seva Foundation, which works in dozens of countries around the world, primarily to eliminate preventable and curable blindness. Larry lived in India while working as a United Nations medical officer for more than a decade, where he played a key role in the successful World Health Organization (WHO) smallpox eradication program. He recently worked for the WHO polio eradication effort as well. He was Associate Professor of epidemiology, global health planning and economic development at the University of Michigan..