Implementing a Global Health Programme - Social Histories of Medicine by Susan Heydon Hardcover

About the Book

This book explores the topical issue of implementing a global vaccination programme. Focusing on smallpox, it explores why despite overwhelming challenges it succeeded in Nepal. Placing the country and people's perspectives at the centre, it offers an alternative to the top-down and centre-led standard narrative of the global smallpox programme.

Book Synopsis

Worldwide eradication of the devastating viral disease of smallpox was devised as a distant global policy, but success depended on implementing a global vaccination programme within nation states. How this was achieved remains relevant and topical for responding to today's global communicable disease challenges. The small and poor Himalayan kingdom of Nepal faced enormous geographical and infrastructure challenges if it was going to succeed in a nationwide vaccination programme. This book acknowledges the key role of the WHO but disrupts the top-down, centre-led standard narrative. Against a background of widespread internal political and social change, Nepal's programme was expanded, effectively decentralised and a vaccination strategy introduced that aligned with people's beliefs. Few foreign personnel were involved.

From the Back Cover

This book explores the topical issue of implementing a global vaccination programme. It illustrates why, despite being faced with overwhelming environmental and infrastructural challenges, the smallpox programme succeeded in Nepal.
The devastating disease of smallpox was common in Nepal in the 1960s. Implementing a global health programme highlights people's experiences with smallpox, and how this influenced ideas and behaviour, including attitudes to vaccination. It tells multiple and different stories, from the local to the global, and involves individual, community, state, extra-state, and foreign actors. Mass vaccination remained important throughout Nepal's smallpox programme, but after 1971 it was a time-limited annual campaign, administered in line with Nepali people's longstanding preference for it being given in winter.
Placing the country and people's perspectives at the centre, the volume offers an alternative to the top-down and centre-led standard narrative of the global smallpox programme. Project leaders in Nepal decentralised the programme's structure, not just on paper but in practice to achieve timely and effective response. Nowhere else in the official history in the conclusions drawn from different national programmes is such a decentralised strategy referred to as a reason for success - even the leader of the WHO-led global smallpox programme acknowledged the exceptionalism of Nepal. Although success with smallpox was more than forty years ago, implementing communicable disease health programmes with their many challenges remains highly topical and relevant today.

Review Quotes

"A rich, nuanced understanding of public health history... a must-read for anyone interested in a ground-level perspective on the global smallpox eradication campaign and in understanding the early influences and challenges that shaped Nepal's modern healthcare system."
- SINHAS Journal

About the Author

Susan Heydon is an Associate Professor in Social Pharmacy at the University of Otago