Even the leader of the WHO-led global smallpox programme acknowledged the exceptionalism of Nepal's success. Implementing a global health programme: smallpox and Nepal is about why when faced with overwhelming environmental and infrastructural challenges the smallpox programme succeeded in Nepal. Such problems are usually offered as explanations for failure. Why something worked is unusual.
The Himalayan region is a novel area for exploration of a global programme. Project leaders in Nepal decentralised the programme's structure, not just on paper but in practice to achieve timely and effective response. The WHO worked with governments of nation states. 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. It is also absent from the wider literature. The book tells multiple and different stories from the local to the global and involves individual, community, state, extra-state, and foreign actors. The devastating disease of smallpox was common in Nepal in the 1960s and the book places people's experiences at the forefront. These influenced ideas and behaviour, including vaccination. Mass vaccination remained important throughout Nepal's smallpox programme but after 1971 was a time-limited annual campaign administered in line with Nepali people's longstanding preference for it being given in winter.
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.
