Summary:
House on Fire: The
Fight to Eradicate Smallpox is a memoir written by William H. Foege, the
physician best known for developing the strategy of ring-vaccination in the
eradication of smallpox. Concisely put
by New Scientist, his book is “a mixture of memoir, dry public health guide, and
riveting tale of an all-consuming mission.”
Though a brief read, House on Fire is comprehensive on
each of these fronts. Foege walks us
through his life, starting first with his upbringing in Washington state and
ending with his role in India as part of the smallpox eradication team
there. Notably, the book’s narrative ends before Foege’s tenure as CDC Director in the late 1970s and early
1980s, focusing explicitly on his involvement in combating smallpox. Using his career in public health as a
framework, he details how he became involved in global health and how each
deployment around the world, whether for the CDC, WHO, or Peace Corps, added to
his understanding of contagious disease and of how to better approach smallpox
containment. Ever the epidemiologist, Foege
does not shy away from including graphs and charts to emphasize his points,
especially as they relate to public health data collection. He takes the reader behind the scenes of
conferences, regular meetings, and everyday discussions to show the collaboration
necessary for global health work, the planning needed, and the good-natured
humor and guile it often requires. At
times, his interactions seem like a who’s
who of American public health:
throughout his career, he works with D.A. Henderson, Alexander Langmuir,
David Sencer (who also writes the book’s
foreword), and Don Francis.
Outside of his own history, Foege acknowledges that in order to
understand smallpox and to understand the mission of eradication it is
necessary to understand the disease’s
complex history. He begins the
book with the history of smallpox and details the development of the vaccine
from its crude precursor,
variolation, to Edward Jenner’s
early version derived from cowpox. As he
progresses through his story, he notes important historical moments in the
battle against smallpox: the development
of the jet injector and bifurcated needle as ways to better administer the
vaccine, the elimination of the virus first from countries and then whole
continents, and, most poignantly, the final cases of smallpox ever recorded.
Though the book necessitates some level of public health
knowledge, or at least a comfort with viral disease and baseline public health
interventions, it consolidates its role as a basic public health guide at the
appendix. In the last pages, Foege reflects
on what to do if there were ever a bioterror attack with smallpox, complete
with a diagram on how to administer the smallpox vaccine.
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