Book Discussion | Implementing a Global Health Programme: Smallpox and Nepal

Details

8 June 2025/२५ जेठ २०८२ (आइतबार, दिउँसो ३ बजे)
Book Discussion
Implementing a Global Health Programme: Smallpox and Nepal
(Manchester University Press, 2025)
with author Dr Susan Heydon, University of Otago
and
discussant Dr Anup Subedee, Kirtipur Hospital

Abstract:
Nepal in the 1960s had no nationwide healthcare programs, faced enormous environmental and infrastructure challenges in implementing any policies, and was one of the poorest countries in the world. Yet Nepal succeeded with eradicating smallpox. Nepal had the severe form of the disease and in the mid-twentieth century it was still widespread and deadly. How eradication was achieved as part of the worldwide WHO-led program makes Nepal important in the global history of smallpox – the only human infectious disease to have been eradicated. The book is not about the controversial concept of eradication or making an eradication program work but instead uses Nepal’s story to understand vaccination programs and public health interventions and their implementation more generally. Although success with smallpox was forty years ago, implementing communicable disease health programs with their many challenges remains highly topical and relevant today.

The book contains considerable new knowledge. It makes visible Nepal’s last major epidemic in 1963-64. A local initiative in 1965 in the Tarai better demonstrated that improved results could be achieved using local vaccinators who people trusted. At an international level the global eradication of smallpox was seen as a triumph for the epidemiological or population-based approach to health, but a novel aspect of the book is its focus on the clinical disease and people’s experiences and how these shaped people’s attitudes. Smallpox was looked after in the home. The book explores the evolving and ever-changing interplay between global and local – and the many levels between – that is integral both to understanding both Nepal’s experiences and the global story of smallpox. Adapting to the local context, project leaders in Nepal in 1967 decentralised the program’s structure, not just on paper but in practice, to achieve a timely and effective response. Nowhere else in the vast official history of the program – the only published account of Nepal’s program - is a such a decentralised strategy acknowledged as a reason for success. A time-limited annual vaccination strategy was introduced in 1971 that aligned with people’s beliefs about when best to vaccinate. Vaccinations increased. Nepal’s last case of smallpox was in 1975 and in 1977 the country was officially declared free of the disease. Today, local detail is lost in more recent literature and Nepal’s contribution to the global story has become invisible.

About the Speakers:
Susan Heydon (PhD History) is Associate Professor in Social Pharmacy at the University of Otago in Dunedin in the South Island of New Zealand. She teaches and supervises undergraduate and postgraduate students about medicines and society. Her research uses qualitative and historical methods to explore health issues and much of it focuses on Nepal where she spent two years with her family as a volunteer in the Mt. Everest region. She is author of Modern Medicine and International Aid: Khunde Hospital, Nepal 1966-1998, as well as several book chapters and journal articles. Her book Implementing a Global Health Programme: Smallpox and Nepal was published in February 2025 by Manchester University Press as part of their Social Histories of Medicine series.

Dr Anup Subedee completed internal medicine residency (2011), infectious diseases fellowship (Tulane University School of Medicine, 2014) and a Masters in Public Health-Tropical Medicine (Tulane University School of Public Health, 2015) in the USA. Since returning to Nepal in 2018, apart from his clinical duties, his main research and advocacy interests are addressing emerging infectious diseases, antimicrobial resistance, infection prevention and control, along with health system improvement in low-resource settings. He also likes to participate in various citizen-led campaigns, mostly regarding environment or healthcare, in the country.