Summer reading: memoirs in global health and field epidemiology

I know summer is winding down, but there's still plenty of beach time left and some great books to take along with you. Two giants in the field have recently released memoirs of their respective fights against infectious diseases: William Foege's House on Fire: The Fight to Eradicate Smallpox and Peter Piot's No Time to Lose: A Life in Pursuit of Deadly Viruses.

I'll begin with William Foege. Foege is a native Iowan, an Epidemic Intelligence Service alum, and former director of the Centers for Disease Control and Prevention. His book, as the title suggests, focuses on his role in the fight against smallpox in the 1960s-70s, and primarily his work in Nigeria and India. Realizing that universal vaccination wasn't going to be possible for a number of reasons, Foege pioneered the implementation of "ring vaccination," where smallpox cases would be identified and their contacts vaccinated, then those contacts vaccinated, providing "rings" of protection. Hence, the "house on fire" metaphor--one needs to pour water where it will do the most good; on the burning house.

Peter Piot trailed behind Foege by about a decade, starting his scientific investigations in global health after the eradication of smallpox in most countries. Instead, his first field work was with the 1976 Ebola outbreak in Zaire. Piot, a Belgian, was a newly-trained infectious disease doctor, aided in the discovery of the Ebola virus from African samples, and was then sent to assist with the investigation of the outbreak in Belgium's former colony. The first third of the book details his work in Zaire and sets the stage for the rest of his career, which has focused on sexually transmitted diseases in general and HIV/AIDS in Africa in particular. Piot's career has included extensive field work, carrying out studies on the ground investigating the epidemiology of HIV, as well as extensive policy work--he was the director of UNAIDS from 1995 until 2008. The final part of the book covers this portion of his career, discussing Piot's successes and difficulties implementing global AIDS policies.

Both men present harrowing tales of working with deadly viruses in developing countries. Both discuss the difficulty of carrying out ethical research and interventions in places where medicine is more magic and less science. Both mention some perhaps less-than-ideal behavior, either coercing patients to participate (Foege) or hiding their own potential illnesses during the outbreak (Piot), and express frustration at times, detailing not only their successes but also their failures. Both also strongly encourage understanding culture as part of one's scientific investigations, and to work with local leadership rather than simply swoop in and take over. The books also compliment each other nicely, as Piot describes the first recognition of two novel diseases, while Foege's work covers the death of smallpox in the natural world.