In 1975, smallpox eradication workers in the capital of Bangladesh, Dhaka, rushed to a village in the south of the country called Kuralia. They were abuzz and the journey was urgent because they thought they just might be going to document the very last case of variola major, a deadly strain of the virus. 

When they arrived, they met a toddler, Rahima Banu.

She did have smallpox, and five years later, in 1980, when the World Health Organization declared smallpox eradicated, Banu became a symbol of one of the greatest accomplishments in public health.

That’s the lasting public legacy of Rahima Banu, the girl.

Episode 8, the series finale of “Eradicating Smallpox,” is the story of Rahima Banu, the woman — and her life after smallpox.

To meet with her, podcast host Céline Gounder traveled to Digholdi, Bangladesh, where Banu, her husband, their three daughters, and a son share a one-room bamboo-and-corrugated-metal home with a mud floor. Their finances are precarious. The family cannot afford good health care or to send their daughter to college.

The public has largely forgotten Banu, while in her personal life, she faced prejudice from the local community because she had smallpox. Those negative attitudes followed her for decades after the virus was eradicated. 

“I feel ashamed of my scars. People also felt disgusted,” Banu said, crying as she spoke through an interpreter. 

Despite the hardship she’s faced, she is proud of her role in history, and that her children never had to live with the virus. 
“It did not happen to anyone, and it will not happen,” she said.

Voices From the Episode:

• Rahima Banu
  The last person in the world to have a naturally occurring case of the deadliest strain of smallpox
• Nazma Begum
  Rahima Banu’s daughter
• Rafiqul Islam
  Rahima Banu’s husband
• Alan Schnur
  Former World Health Organization smallpox eradication program worker in Bangladesh

Find a transcript of this episode here.

“Epidemic” is a co-production of KFF Health News and Just Human Productions.

To hear other KFF Health News podcasts, click here.

Subscribe to "Epidemic” on Apple Podcasts, Spotify, Google Podcasts, Pocket Casts, or wherever you listen to podcasts.

The 1970s was the deadliest decade in the “entire history of Bangladesh,” said environmental historian Iftekhar Iqbal. A deadly cyclone, a bloody liberation war, and famine triggered waves of migration. As people moved throughout the country, smallpox spread with them.

In Episode 7 of “Eradicating Smallpox,” Shohrab, a man who was displaced by the 1970 Bhola cyclone, shares his story. After fleeing the storm, he and his family settled in a makeshift community in Dhaka known as the Bhola basti. Smallpox was circulating there, but the deadly virus was not top of mind for Shohrab. “I wasn’t thinking about that. I was more focused on issues like where would I work, what would I eat,” he said in Bengali.

When people’s basic needs — like food and housing — aren’t met, it’s harder to reach public health goals, said Bangladeshi smallpox eradication worker Shahidul Haq Khan.

He encountered that obstacle frequently as he traveled from community to community in southern Bangladesh.

He said people asked him: “There's no rice in people's stomachs, so what is a vaccine going to do?”

To conclude this episode, host Céline Gounder speaks with Sam Tsemberis, president and CEO of Pathways Housing First Institute.

He said when public health meets people’s basic needs first, it gives them the best shot at health.

In Conversation With Host Céline Gounder:

• Sam Tsemberis
  Founder, president, and CEO of Pathways Housing First Institute
  @SamTsemberis

Voices From the Episode:

• Shohrab
  Resident of the Bhola basti in Dhaka
• Iftekhar Iqbal
  Associate professor of history at the Universiti Brunei Darussalam
• Shahidul Haq Khan
  Former World Health Organization smallpox eradication program worker in Bangladesh

Find a transcript of this episode here.

“Epidemic” is a co-production of KFF Health News and Just Human Productions.

To hear other KFF Health News podcasts, click here.

Subscribe to "Epidemic” on Apple Podcasts, Spotify, Google Podcasts, Pocket Casts, or wherever you listen to podcasts.

Global fears of overpopulation in the ’60s and ’70s helped fuel India’s campaign to slow population growth. Health workers tasked to encourage family planning were dispatched throughout the country and millions of people were sterilized: some voluntarily, some for a monetary reward, and some through force. 

This violent and coercive campaign — and the distrust it created — was a backdrop for the smallpox eradication campaign happening simultaneously in India. When smallpox eradication worker Chandrakant Pandav entered a community hoping to persuade people to accept the smallpox vaccine, he said he was often met with hesitancy and resistance.

“People's bodies still remember what was done to them,” said medical historian Sanjoy Bhattacharya.

Episode 6 of “Eradicating Smallpox” shares Pandav’s approach to mending damaged relationships.

To gain informed consent, he sat with people, sang folk songs, and patiently answered questions, working both to rebuild broken trust and slow the spread of smallpox. 

To conclude the episode, host Céline Gounder speaks with the director of the global health program at the Council on Foreign Relations, Thomas Bollyky. He said public health resources might be better spent looking for ways to encourage cooperation in low-trust communities, rather than investing to rebuild trust. 

In Conversation With Host Céline Gounder:

• Thomas Bollyky
  Director of the global health program at the Council on Foreign Relations
  @TomBollyky

Voices From the Episode:

• Chandrakant Pandav
  Community medicine physician and former World Health Organization smallpox eradication worker in India
  @pandavcs1
• Gyan Prakash
  Professor of history at Princeton University, specializing in the history of modern India
  @prakashzone
• Sanjoy Bhattacharya
  Medical historian and professor of medical and global health histories at the University of Leeds
  @joyagnost
   

Find a transcript of this episode here.

“Epidemic” is a co-production of KFF Health News and Just Human Productions.  

To hear other KFF Health News podcasts, click here.

Subscribe to “Epidemic” on Apple Podcasts, Spotify,  Google Podcasts, Pocket Casts, or wherever you listen to podcasts.
 

In spring 1974, over a dozen smallpox outbreaks sprang up throughout the Indian state of Madhya Pradesh. Determined to find the source of the cases, American smallpox eradication worker Larry Brilliant and a local partner, Zaffar Hussain, launched an investigation.

The answer: Each outbreak could be traced back to Tatanagar, a city run by one of India’s largest corporations, the Tata Group.

When Brilliant arrived at the Tatanagar Railway Station, he was horrified by what he saw: people with active cases of smallpox purchasing train tickets. The virus was spreading out of control.

Brilliant knew that to stop the outbreak at its source, he would need the support of the company that ran the city. But he wasn’t optimistic the Tata Group would help.

Still, he had to try. So, Brilliant tracked down a Tata executive and knocked on his door in the middle of the night.

Brilliant’s message: “Your company is sending death all over the world. You're the greatest exporter of smallpox in history.”

Much to his surprise, the leaders of Tata listened.

Episode 5 of “Eradicating Smallpox” explores the unique partnership between the Tata Group and the campaign to end the virus. This collaboration between the private and public sector, domestic and international, proved vital in the fight to eliminate smallpox.

To conclude the episode, host Céline Gounder speaks with NBA commissioner Adam Silver and virologist David Ho about the basketball league’s unique response to covid-19 — “the bubble” — and the essential role businesses can play in public health. “We need everyone involved,” Ho said, “from government, to academia, to the private sector.”

In Conversation With Host Céline Gounder:

• Adam Silver
  Commissioner of the NBA
• David Ho
  Director and CEO of the Aaron Diamond AIDS Research Center

Voices From the Episode:

• Larry Brilliant
  Former World Health Organization smallpox eradication worker in India
  @larrybrilliant

Find a transcript of this episode here.

“Epidemic” is a co-production of KFF Health News and Just Human Productions.

To hear other KFF Health News podcasts, click here.

Subscribe to “Epidemic” on Apple Podcasts, Spotify, Google Podcasts, Pocket Casts, or wherever you listen to podcasts.

At noon ET on Thursday Sept. 14, Epidemic host Céline Gounder and her guests will come together for a live web event. Click here to register for the event.

In Conversation With Host Céline Gounder:

Helene D. Gayle, a physician and an epidemiologist, is president of Spelman College. She is a board member of the Bill & Melinda Gates Foundation and past director of the foundation’s program on HIV, tuberculosis, and reproductive health. She spent two decades with the Centers for Disease Control and Prevention focusing primarily on HIV/AIDS prevention and global health.

William H. “Bill” Foege is an epidemiologist and a physician, and was a leader in the campaign to end smallpox during the 1970s. Foege is featured in Episode 2 of the “Eradicating Smallpox” docuseries.

Submit your questions for the panel here.

Shahidul Haq Khan, a Bangladeshi health worker, and Tim Miner, an American with the World Health Organization, worked together on a smallpox eradication team in Bangladesh in the early 1970s. The team was based on a hospital ship and traveled by speedboat to track down cases of smallpox from Barishal to Faridpur to Patuakhali. Every person who agreed to get the smallpox vaccination was a potential outbreak averted, so the team was determined to vaccinate as many people as possible.

The duo leaned on each other, sometimes literally, as they traversed the country’s rugged and watery geography. Khan, whom Miner sometimes referred to as “little brother,” used his local knowledge to help the team navigate both the cultural and physical landscape. When crossing rickety bamboo bridges, he would hold Miner’s hand and help him across. “We didn’t let him fall,” chuckled Khan.

Episode 4 of “Eradicating Smallpox” explores what it took to bring care directly to people where they were.

To conclude the episode, host Céline Gounder speaks with public health advocate Joe Osmundson about his work to help coordinate a culturally appropriate response to mpox in New York City during the summer of 2022. “The model that we're trying to build is a mobile unit that delivers all sorts of sexual and primary healthcare opportunities. They're opportunities!” exclaimed Osmundson.

In Conversation With Host Céline Gounder:

• Joe Osmundson
  Public health advocate and clinical assistant professor of biology at New York University
  @reluctantlyjoe

Voices From the episode:

• Tim Miner
  Former World Health Organization smallpox eradication program 
  worker in Bangladesh
• Shahidul Haq Khan
  Former World Health Organization smallpox eradication program 
  worker in Bangladesh

Find a transcript of this episode here.

“Epidemic” is a co-production of KFF Health News and Just Human Productions.

To hear other KFF Health News podcasts, click here.

Subscribe to “Epidemic” on Apple Podcasts, Spotify, Google Podcasts, Pocket Casts, or wherever you listen to podcasts.

In 1973, Bhakti Dastane arrived in Bihar, India, to join the smallpox eradication campaign. She was a year out of medical school and had never cared for anyone with the virus. She believed she was offering something miraculous, saving people from a deadly disease. But some locals did not see it that way.

Episode 3 of “Eradicating Smallpox” explores what happened when public health workers — driven by the motto “zero pox!” — encountered hesitation. These anti-smallpox warriors wanted to achieve 100% vaccination, and they wanted to get there fast. Fueled by that urgency, their tactics were sometimes aggressive — and sometimes, crossed the line.

“I learned about being overzealous and not treating people with respect,” said Steve Jones, another eradication worker based in Bihar in the early ’70s.

To close out the episode, host Céline Gounder speaks with NAACP health researcher Sandhya Kajeepeta about the reverberations of using coercion to achieve public health goals. Kajeepeta’s work documents inequities in the enforcement of covid-19 mandates in New York City.

In Conversation With Host Céline Gounder:

• Sandhya Kajeepeta - Epidemiologist and senior researcher with the NAACP’s Thurgood Marshall Institute.  
  @SandhyaKaj

Voices From the Episode:

• Bhakti Dastane  
  Gynecologist and former World Health Organization smallpox eradication program worker in Bihar, India.
• Steve Jones  
  Physician-epidemiologist and former smallpox eradication campaign worker in India, Bangladesh, and Somalia. 
  @SteveJones322
• Sanjoy Bhattacharya 
  Medical historian and professor of medical and global health histories at the University of Leeds. 
  @JoyAgnost

Find a transcript of this episode here.

“Epidemic” is a co-production of KFF Health News and Just Human Productions.  

To hear other KFF Health News podcasts, click here.

Subscribe to “Epidemic” on Apple Podcasts, Spotify, Google Podcasts, Pocket Casts, or wherever you listen to podcasts.

By the mid-1970s, India’s smallpox eradication campaign had been grinding for over a decade. But the virus was still spreading beyond control. It was time to take a new, more targeted approach.

This strategy was called “search and containment.” Teams of eradication workers visited communities across India to track down active cases of smallpox. Whenever they found a case, health workers would isolate the infected person, then vaccinate anyone that individual might have come in contact with.

Search and containment looked great on paper. Implementing it on the ground took the leadership of someone who knew the ins and outs of public health in India.

Episode 2 of “Eradicating Smallpox” tells the story of Mahendra Dutta, an Indian physician and public health worker who used his political savvy and local knowledge to pave the way to eradication. Dutta’s contributions were vital to the eradication campaign, but his story has rarely been told outside India. 

To conclude the episode, host Céline Gounder and epidemiologist Madhukar Pai discuss “decolonizing public health,” a movement to put leaders from the most affected communities in the driver’s seat to make decisions about global health.

In conversation with host Céline Gounder:

• Madhukar Pai
  Community medicine physician, professor of epidemiology and global health at McGill University in Montreal
  Twitter - https://twitter.com/paimadhu

Voices from the episode:

• Bill Foege
  Smallpox eradication worker, former director of the Centers for Disease Control and Prevention
• Yogesh Parashar
  Pediatrician living in Delhi
• Mahendra Dutta 
  Smallpox eradication worker, former health commissioner of New Delhi, India

Find a transcript of this episode here.

“Epidemic” is a co-production of KFF Health News and Just Human Productions.  

To hear other KFF Health News podcasts, click here.

Subscribe to “Epidemic” on Apple Podcasts, Spotify, Google Podcasts, Pocket Casts, or wherever you listen to podcasts.

In the mid-’60s, the national campaign to eradicate smallpox in India was underway, but the virus was still widespread throughout the country. At the time, Dinesh Bhadani was a small boy living in Gaya, a city in the state of Bihar. In his community many people believed smallpox was divine, sent by the Hindu goddess Shitala Mata. In Bihar people had misgivings about accepting the vaccine because, Bhadani says, they did not want to interfere with the will of the goddess. Others hesitated because making the vaccine required using cows, which are sacred in the Hindu religion. Still others hesitated because the procedure — which involved twirling a barbed disk into a patient’s skin — hurt.

But when Bhadani was 10 years old, he saw the body of a school friend who had died of smallpox. The body was covered in blistering pustules, the skin not visible at all.

Soon after, when eradication workers came to town, young Bhadani remembered his friend, gritted his teeth, and agreed to get the painful vaccine. 

Variola major smallpox was deadly and highly contagious. Infected people often died within two weeks – many of them young children. Those who survived could be left severely scarred, infertile, or blind.

Episode 1 of “Eradicating Smallpox” explores the layered cultural landscape that eradication workers navigated as they worked to eliminate the virus. Success required technological innovations, cultural awareness, and a shared dream that a huge public health triumph was possible. 

To close the episode, Céline Gounder wonders how the U.S. might tap into similar “moral imagination” to prepare for the next public health crisis. 

Find a transcript of this episode here.

To hear other KFF Health News podcasts, click here.

Subscribe to Epidemic on Apple Podcasts, Spotify, Google Podcasts, Pocket Casts, or wherever you listen to podcasts.

In Conversation with Céline Gounder:

adrienne maree brown
Social justice organizer and science fiction author

• Instagram: https://www.instagram.com/adriennemareebrown/
• Twitter: https://twitter.com/adriennemaree
• Website: https://adriennemareebrown.net/

Voices from the Episode:

• Rajendra Prasad Dhyani, temple priest at the Shitala Mata Temple in New Delhi
• Dinesh Bhadani, retired Indian Railways station manager living in New Delhi
• Priyanka Bhadani, journalist living in Delhi

"Eradicating Smallpox” is a journey to South Asia, the site of the last days of variola major smallpox. Many epidemiologists and global health leaders thought that ending smallpox was impossible. They were wrong. Dedicated public health workers made it happen.

“Eradicating Smallpox” is an eight-episode, limited series amplifying their voices.

Host Céline Gounder, a physician and epidemiologist, traveled to India and Bangladesh, and her field recordings anchor the season. Each episode mines the smallpox-eradication history for lessons relevant to the next public-health emergency. 

New episodes coming this summer. 

In the years leading up to the pandemic, Dr. Celine Gounder, the host of the EPIDEMIC and American Diagnosis podcasts, had the opportunity to care for patients part-time at several Indian Health Service facilities around the United States. Working on the “rez,” one theme came up over and over: resilience.

In this latest season of American Diagnosis, we’re going to share stories of Indigenous people who are taking action to protect the health and wellbeing of their communities in the face of incredible odds and we’ll ask hard questions about why they are confronting so many challenges to their health.

Listen to new episodes of American Diagnosis Season 4: Rezilience starting Jan. 18, 2022. Subscribe to American Diagnosis wherever you get your podcasts.