Disease Eradication Programs

by

Kirsten Moore-Sheeley

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0004

Introduction

Eradication programs aim to permanently reduce the worldwide incidence of a disease (or an infection caused by a specific agent) to zero as a result of deliberate efforts. They are often referred to as “vertical” health programs, which target a specific health problem using single-purpose interventions and infrastructure, in contrast to “horizontal,” broad-based approaches to public health, which target multiple health issues or people’s overall well-being. Eradication programs emerged in the early twentieth century, following the nineteenth-century discovery that specific microorganisms could be causally linked to specific diseases. Based on this “germ theory” of disease, public health authorities developed strategies to destroy pathogenic microorganisms and their vectors as a means of protecting people’s health. The United States Army’s efforts to rid Cuba and Panama of yellow fever in the 1900s and 1910s by systematically killing Aedes aegypti mosquitos (yellow fever’s vector) were early models for eradication programs. They laid the foundations for top-down, military-style campaigns targeting a single disease. They relied on conceptions of disease as biomedical, technical problems, as well as on the Army’s tight control over spaces and populations. International health agencies, such as the Rockefeller Foundation, Pan American Health Organization, and World Health Organization (WHO), launched subsequent eradication campaigns over the following decades, hoping to obviate the need for long-term disease control programs by getting rid of diseases altogether. These campaigns targeted various diseases (including hookworm, yaws, malaria, smallpox, and polio) following the “intensive” American approach. Organizations and governments designed these campaigns to target different geographic scales—from single colonies and countries, to multi-country regions, to the entire globe. Eradication programs have been variably successful in their goals of absolute, permanent elimination of a disease. For example, many Latin American countries had successfully eradicated Aedes aegypti by the early 1960s; however, incomplete eradication in the United States and Caribbean led to the reintroduction of this vector and a subsequent rise in yellow fever rates. The WHO’s Malaria Eradication Program (1955–1969) rid certain countries of malaria, while the disease persisted in many others. On the other hand, the WHO’s Smallpox Eradication Program (1959–1980) helped rid the world of naturally occurring smallpox in 1977, providing the only instance to date of the full, global eradication of a human disease. The success of smallpox eradication kept international health authorities from abandoning eradication programs altogether, since it illustrated the technical feasibility of this approach. However, eradication programs still remain less popular than they were in the interwar and post–World War II periods due to their immense difficulty and expense. From the 1970s onward, moreover, increasing numbers of health officials began criticizing the narrow scope of vertical public health programming, such as eradication campaigns.

General Overviews

Stepan 2011 provides one of the most comprehensive historical overviews of eradication programs in international health, including their origins, underlying philosophy, and challenges. The book surveys the major disease eradication programs of the twentieth century, describing their operation, challenges, and outcomes, as well as advocates’ justifications for eradication. It also highlights common themes from the historiography on disease eradication, including the disconnect between global/universal program models and local circumstances; the tension between vertical, highly technological approaches and horizontal or structural approaches to public health; and the influence of political and economic interests (particularly colonial and, later, Cold War interests) on eradication programs. Histories of international and global health also discuss the major eradication programs of the twentieth century and describe how they gained popularity in international health during the middle third of the century. This literature helps situate eradication programs in their broader political as well as institutional contexts. Farley 2004 surveys the work of the Rockefeller Foundation’s International Health Division—the leading international health organization before the establishment of the World Health Organization (WHO) in 1948—including its hookworm, yellow fever, and malaria eradication programs. Farley 2008 and Cueto, et al. 2019 examine the WHO’s eradication programs of the mid-twentieth century, showing how the Cold War informed the organization’s decision to initiate these programs. Unlike Farley 2008, Cueto, et al. 2019 examines how the WHO’s eradication programs played out, and how their outcomes shaped subsequent WHO policies. In looking at the history of global health more generally, Packard 2016 provides a broader view of the development of eradication programs from the early twentieth century to the recent past and analyzes the waxing and waning of their popularity as a public health paradigm over the longue durée. This work also analyzes the success and failure of eradication programs in global health in an instructive way for public health audiences. For example, it uses a biosocial analysis to argue that smallpox was an ideal target for eradication because smallpox was much easier to diagnose visibly compared to other diseases and had an effective, easy-to-administer preventive measure that did not require continuous or repeated intervention. This supplements analyses such as Cueto, et al. 2019 that point to administrative and operational flexibility as explanations for the success of smallpox eradication. Together this body of literature contributes to knowledge about why international health institutions and a selection of public health authorities advocated for eradication programs; the challenges of carrying out these programs, especially in low-income regions; and the consequences for international health programming as well as countries where eradication activities have taken place. However, it provides a more limited view of how specific populations, health workers, and governments targeted in these campaigns shaped eradication programs.

• Cueto, Marcos, Theodore Brown, and Elizabeth Fee. The World Health Organization: A History. Cambridge, UK: Cambridge University Press, 2019.

  DOI: 10.1017/9781108692878

  Institutional history that describes the political context of the WHO’s programming decisions, including its decisions to launch eradication programs against yaws, malaria, and smallpox during the Cold War. Analyzes these programs to see how they were organized, the challenges they faced, and some of the reasons for their success or failure. Good source for the history of international and global health from the WHO’s perspective.

• Farley, John. To Cast Out Disease: A History of the International Health Division of the Rockefeller Foundation, 1913–1951. Oxford and New York: Oxford University Press, 2004.

  Institutional history that situates the International Health Division’s disease eradication programs within the broader portfolio of the division’s public health work. Narrates the development and challenges of their various eradication programs targeting hookworm, yellow fever, and malaria. Provides substantial information about the work and decisions of officers in the Rockefeller Foundation’s International Health Division.

• Farley, John. Brock Chisholm, the World Health Organization, and the Cold War. Vancouver: University of British Columbia Press, 2008.

  Straightforward biographical and institutional history that situates the WHO’s post–World War II disease eradication campaigns—particularly its malaria eradication program—in their political and historical context. Provides a limited view of the arguments for and challenges of these programs, focusing on the wide array of other activities and causes WHO director general Brock Chisholm promoted.

• Packard, Randall. A History of Global Health: Interventions into the Lives of Other Peoples. Baltimore: Johns Hopkins University Press, 2016.

  DOI: 10.56021/9781421420325

  Synthetic social and political history of global health that situates eradication programs in their broader social, political, economic, and epidemiological contexts. Contextualizes common justifications for and arguments against eradication programs as an approach in public health. Describes the historical contingencies of successful eradication efforts and analyzes the challenges and consequences of failed eradication attempts. Aimed partly at a public health audience.

• Stepan, Nancy Leys. Eradication: Ridding the World of Diseases Forever? London: Reaktion Books, 2011.

  Historical overview of eradication programs and the concept of eradication in international health, aimed in part at a public health audience. Uses institutional, biographical, and political history to contextualize the major arguments for and against disease eradication over the twentieth century. Supplements this with more detailed examinations of the challenges of eradication programs in specific regions. Good source to start with for understanding the history of eradication programs.