Smallpox eradication: selected management issues.

The eradication of smallpox was dependent on the attainment of a high level of herd immunity during the consolidation and maintenance phases of the eradication program, after mass vaccination effort had reduced the incidence of the disease to a few endemic areas in the world. Immunity was possible through the immunization of susceptible population. Attainment of effective immunization in both large and small countries, with both concentrated and dispersed population settlement patterns, was dependent not only on improved vaccination technology, notably the widespread availability of heat-stable freeze-dried vaccine and the use of the bifurcated needle, but also on the way eradication programs were designed and implemented. This paper will outline important components of the smallpox eradication program, particularly, information management, personnel management, and material resources management. Although they were critical to the eventual success of the program, there has been little consolidated effort to review these management strategies. The paper, to a large extent, concentrates on the eradication programs of Bangladesh, India, and West Africa, given that these come to the forefront in terms of reviewing management strategies in the internationally available literature.