I started writing this book in 1977 after Girija and I returned home to Michigan. Following the death of our teacher, Neem Karoli Baba, and the last case of Variola major, I wanted to tell this story. My friend Dan Goleman, then a writer at Psychology Today and, later, the New York Times, encouraged me to write about my experiences living in the ashram and working on the smallpox campaign. I was a professor at the University of Michigan by then and only had time to write with Girija a magazine article. “Death for a Killer Disease” was published in 1978 in Quest/78, a spiritual magazine. A few years later, I wrote an academic book detailing how we ran the eradication program, called The Management of Smallpox Eradication in India.
After those early efforts, I did not write much about smallpox until 2010, when Google colleague Corrie Conrad and I co-authored a chapter, “The Eradication of Smallpox from India,” in The Global Eradication of Smallpox, which Sanjoy Bhattacharya and Sharon Messenger edited. Though I rarely wrote about my time in India again, I spoke about my experience in India in speeches over the years and even lent a few of these stories for use in other people’s books, including Ram Dass’s Miracle of Love and Wavy Gravy’s Something Good for a Change. Other writers also wrote about my experiences in their books, writers like Richard Preston (The Demon in the Freezer), Jonathan Tucker (Scourge), D. A. Henderson (Smallpox: The Death of a Disease), Bill Foege (House on Fire), and Joel Shurkin (The Invisible Fire). I want to thank all of them for preserving these stories so that I can now borrow them back again.
My colleague and friend at Google Sheryl Sandberg playfully suggested I write the entire history of my experience in India and smallpox, if only so she didn’t have to hear about it again and again. Instead of mentioning smallpox in every speech, she teased, I could simply refer people to my book.
My agents, John Brockman and Katinka Matson, were patient with me, as I saddled them with unsellable proposals like “Zeropox Battle Chronicles,” “The Education of Doctor America,” “Talking Notes for Meeting God,” and “The Business of Doing Good,” which HarperCollins eventually acquired when I became an executive at Google in 2006. Mark Tauber, the publisher of HarperOne, and Gideon Weil, my editor, together inherited an unloved and unlovable contract for a book about how to do good while doing well in business, but they somehow saw the potential for a more personal work and kept the contract alive.
When my world collapsed beginning in 2008 with my wife’s illness and then the death of my son Jon, I was sure I would never be able to write anything again, especially not a “business book.” I told Mark Tauber that I was going to quit the book and return the advance. Instead, Mark waited patiently as I gradually came a little way out of my deep black hole and one day told me he had an idea, an offer I could not refuse. I could write a book about anything I wanted, he said. And he would increase the advance on the condition that I use the extra funds to hire someone to “work closely with you as editor and helper.” He had a few people in mind for me to interview, but the first person on his list could not have been more perfect. This book would never have been written without that person, Amy Hertz, a remarkably talented woman, a celebrated publisher and editor, who had previously worked on books of people I respected immensely. She helped me with every part of this book and quickly became its principal architect, going above and beyond the call of duty and, in the process, becoming so much more than an editor or collaborator. Sometimes Brilliant is at least as often Sometimes Amy. Thank you, Amy.
I want to thank, too, the team at HarperOne. Particularly Gideon Weil, my patient and wise editor, who pushed me when I needed pushing and let me be when I needed patience. I hope he has enjoyed the ride as much as I have. And thanks to a remarkable HarperOne editor, Miles Doyle, with his lyrical edits, and for finding the spiritual core of the book. My sincerest gratitude goes to Sydney Rogers, Terri Leonard, and Lisa Zuniga, who somehow kept us all on course despite so many centrifugal forces.
But most of all, as with every element of my life, it was my loving and wonderful wife, Girija, who made it possible for this book to exist. She has suffered through the many incarnations of the book, and has lived through the many incarnations of me. I never would have worked for WHO nor would I have met our teacher Maharaji if she had not ignored my arrogance and dragged me to India in the first place. For nearly half a century, she has honored me as my wife and the amazing mother of Joe, Jon, and Iris. Speaking of our wonderful children, I have worked on iterations of this book on and off throughout their entire lives, and both Joe and Iris have remained great sports about the amount of time it has taken me. We all so much wish Jon were here to share the final product with them.
Years ago, Isao Arita and D. A. Henderson, then chiefs of the WHO global smallpox program, suggested I write The Management of Smallpox Eradication in India. So many people helped me with that book, and as the epidemiological building block of this book, I want to thank them again here: in addition to D.A. and Isao, Bill Foege, Nicole Grasset, M. I. D. Sharma, Zafar Hussein, R. N. Basu, Mahendra Dutta, C. K. Rao, Stan Foster, and Steve Jones all read the manuscript prepared by University of Michigan research assistants Tonya Kennedy and Mariane Zebrowski and typed by our friend Judy Gallagher. Only two people have ever told me that the book was of any use to them: President Jimmy Carter once phoned me in Ann Arbor to ask permission to photocopy twenty copies of the book for a class he was teaching at the Carter Center. (Years later, he wrote a letter nominating me for Time magazine’s 100 list.) The second person was Dr. Jim Kim. Now the head of the World Bank, Dr. Kim visited my office at Google in 2008 as a professor at Harvard. He showed me a copy of The Management of Smallpox Eradication in India, teasing me about the ridiculous amount of money he had to pay for it on Amazon because it was out of print. Since then, following much-renewed interest in the campaign to eradicate smallpox, a long list of much better books about smallpox have been published. I have included some of these books in the “Further Reading” section.
The story of Rahima Banu and my visit to her is emotionally central to me, and knowing that she was the last case of killer smallpox is central to others who worked on smallpox in India and Bangladesh as well. This book is a memoir. It is not intended to be a comprehensive treatise on smallpox, its epidemiology, or its history, but because there are several other cases of smallpox that have the same importance to other epidemiologists as Rahima Banu to me, I wanted to honor some of them as well.
Rahima Banu was the last little girl with killer smallpox, the last case of smallpox in Asia, the last naturally occurring case of Variola major, and, for me, an emotional end to the deadly chain of transmission that scientists say began thousands or tens of thousands of years ago. But there were and still are viruses frozen in nitrogen in a few labs around the world. In 1978, at the University of Birmingham Medical School, a British medical photographer named Janet Parker contracted smallpox when the virus escaped from its container, wafted through a ventilation system, and infected her. Her family was placed under quarantine; her father died of cardiac arrest after seeing her in the emergency room. No autopsy was performed on him because of fear of smallpox contamination. Her mother, Hilda Witcomb, contracted smallpox as well but survived and, chronologically, is the last person infected with smallpox. Janet Parker died on September 11, 1978, the last person in history to die from smallpox. The doctor who had retained the sample of Variola major in his lab—against the directive of the World Health Organization—committed suicide while under quarantine. He left behind a note, which read, “I am sorry to have misplaced the trust which so many of my friends and colleagues have placed in me and my work.”
There is another type of smallpox. Variola minor, also called alastrim, is a much milder and less often fatal form of smallpox. Although the two viruses look the same under an electron microscope, Variola minor kills one in a hundred cases, compared to Variola major, which kills one in three. No one could be sure that if Variola minor had not been eradicated, that a mutation to killer smallpox would not have taken place. Hence Variola minor was fought, with D. A. Henderson leading the charge, as aggressively as Variola major was. For many people, a Somalian cook named Ali Maow Maalin, the last person sick with Variola minor (October 1977), is for them the emotional center of the smallpox battle, the last case of the Variola family of viruses in nature.
I do not want to take anything away from any of these stories or diminish their importance. Each step was one of many toward a world free of smallpox. But I myself return to Rahima Banu every time I think of the long chain of transmission. Rahima Banu was the last child with Variola major, the end of a chain of transmission of agony and death, the end of this particular burden of suffering off the shoulders of humankind.
There would be no book if we had not conquered smallpox, and the long list of smallpox workers is still incomplete. Please forgive me for any name I have inadvertently omitted. But I want to name as many as I can remember because just seeing all these names brings me pleasure and reminds me what a multinational, multiracial, multireligious community it took to conquer smallpox: D. A. Henderson; Bill Foege; Isao Arita; M. I. D. Sharma; the remarkable Nicole Grasset, whose moniker Hurricane on High Heels does not do service to her incredible intelligence and huge heart, protecting her team and her values; the first person who took the time to teach me epidemiology was my beloved friend Zdeno Jezek; a man I wish all Indians could know better because they would be so proud is Mahendra Dutta, one of the key members of the Central Team; David Heymann; Stan Foster; Dr. Viswakarma; Don Francis; P. Diesh; Jay Friedman; H. M. Gelfand; J. S. Koopman; Mike McGinnis; G. Meiklejohn; D. Preston; the remarkable Alan Schnur; M. Strassburg; Dick Keenlyside; Roy Mason; D. M. Parkin; David Coxhead; W. M. Hamilton; J. Hatfield, P. Rotmil; B. Karwacka; T. Olakowski; K. K. Shah, who I still think should have been elected regional director of WHO; P. N. Shresta; M. Castet; J. Ryst; D. Tarantino; B. Bagar; V. Jaout; K. Markvart; V. Zikmund; Henry Smith; the heroic Afghan Abdul M. Darmangar; M. K. Al Aghbari; G. P. Marchenko; N. Maltseva; I. Selivanov; F. S. Kingma; J. M. Lane; dear Don Millar; our friends Bev Spring and Alan Morinis, who joined us as travelers in India, worked with us at WHO, and founded Seva in Canada; W. Orenstein; M. I. Rosenberg; David Sencer; Steve Solter; Joel Bremen; Mary Lou Clements, who died much too young in the explosion of a Swiss airliner; Connie Davis; S. N. Ray; my dearest friend Steve Jones, or as our children, his godchildren, call him, “Uncle Steve”; Nick Ward; Tony Scardacci; Roy Mason; my working and writing partner Lev Khodakevich—I wish his untimely death had not prevented our plan to meet in Moscow with so many years of history to reflect upon—and his wife, Lydia Khodakevich; J. P. Rikushin, who so loved mangos; Albert Monnier; V. A. Moukhopad; D. G. Olsen; Vladamir Zikmund; and that most remarkable, competent, and kind “Tata man,” Sujit Gupta, and the pater familias, J. R. D. Tata; my constant companion for more than five years and my “paramedical assistant” but really my teacher, Zafar Hussein; E. M. A. Sheluchina; A. N. Slepushkin; I. D. Ladnyi; A. I. Gromyko; J. W. Doss; Karan Singh; R. N. Basu; Edna Boyer; Jan de Vries; David Sencer; Don Hopkins, who will surely soon preside over the last case of Guinea worm; Mahendra Singh; C. K. Rao; Mohan Singh, who taught me a most important situational moral lesson and one I would wish I could translate into a general rule of life; and Justin Bhakla, who tragically lost the genetic lottery, but still led an important and meaningful life. I also want to thank those with whom I served as an administrative assistant when Nicole Grasset had to “cook up” a job description that could get me hired through the labyrinth of WHO and international rules: P. K. Anand; R. Satyanarayana, who learned English and speedwriting by listening to BBC broadcasts; M. S. Victor; K. K. Talwar; Prem Gambhiri; Mahesh Gupta; the leader of the administrators gang, R. K. Malhotra; V. B. Malik; S. Balasubramaniam; and K. K. Bajaj. I was a strange addition to your team and you were so kind to me.
How many people are lucky enough to say that their best friend is a clown, and not only that, but the clown prince of the counterculture? Thank you to Wavy Gravy and his wife and our friend Jahanara for helping me talk through these stories for forty years. After all these years, Wavy and Jahanara, and Girija and I are still married and remain friends for life. You can hardly find two couples who have been through so much and keep on truckin’ together. And to all my wonderful and crazy brothers and sisters, from the Hog Farm commune to splendid Camp Winnarainbow and through the Seva Foundation, and to all the co-founders and staff of Seva, especially those who helped on this book: our beloved Suzanne and Tim Gilbert, who we dragged from Ann Arbor to northern California (it was not so difficult), Bev Spring, Aaron Simon, and Tamara Klamner.
The center of the book is Neem Karoli Baba, who we called Maharaji, and the wonderful people around him in his ashrams, especially Siddhi Ma and the other mas, Kainchi’s own Vinodh Joshi and dear K. K. Shah. I also cherish the memory of Dada Mukerjee and several Indian families: the Barman, Soni, and Vaish families, who welcomed us to their India. And a then-young Ravi Khanna, who translated these wondrous words of wisdom and love. Maharaji’s children, A. S. Sharma, Dharm Narayan Sharma, and Girija Bhatele, and his grandchildren, Dhananjay, Sashi, and Bobby. Some of the Westerners who lived with us in the ashrams during smallpox days have also helped with this book, especially: Ram Das, Dan Goleman, Sunanda, Mirabai, Krishna Das, Ravi Das (Michael Jeffery), Parvata, Mira, and Balaram (Peter Goetsch). I think I recounted nearly every story in this book at one time or another to Steve Jobs, who I first met when he was nineteen. I was twenty-nine. We were both in India trying in our own ways to understand Maharaji’s lessons. Over four decades of friendship, Steve asked me more about the “meaning” of smallpox and the “meaning” of Maharaji than anyone else. He told me my article “Death for a Killer Disease” inspired him to join Seva. It would have meant so much for me if he could have been here to read this book. Girija and I consider ourselves very fortunate to have his extraordinary wife, Laurene Powell Jobs, as a dear friend, and his children and family as part of our extended family.
Besides Maharaji, or rather because of him, Girija and I spent much of our time in India seeking out wise teachers from a wide variety of faiths. It is too superficial to simply name these great masters, gurus, and spiritual leaders, but I write about most of them in the book and do not want to fail to thank them whether they are alive or have passed on: our friends Lama Govinda and Li Gotami; His Holiness the Sixteenth Karmapa and Jamgon Kongtrul Rinpoche, and His Holiness the Dalai Lama; our first meditation teacher, Goenka; other teachers we deeply respect like Jack Kornfield, Sharon Salzberg, the Sufi of Bhola Island, Rabbis Morris Adler and Sherwin Wine, Martin Luther King Jr., the Jesuit father who gave me communion in Bihar, and many other teachers, Christian and Jewish and Muslim and Zoroastrian and Jain and Buddhist and Hindu alike.
Financial support for this book over the years has come from the Rockefeller Foundation and from Jeff Skoll and his organizations, the Skoll Foundation, Skoll Global Threats Fund, and Jeff Skoll Group. A fellowship from the Rockefeller Foundation allowed me to live and work in Bellagio, where I was inspired by the ghosts of so many great writers.
At the height of my optimism about Google, I met Jeff Skoll, the former president of eBay. After leaving eBay, Jeff started the Skoll Foundation, a globally respected organization that focuses on social entrepreneurship. When I met him, I teased him about the fact that he wasn’t all that familiar with India. “Anyone who’s never spent much time in India,” I used to joke, “is missing a big chunk of his life.” Jeff and I agreed to meet in India, and we traveled together to small villages and big cities for a couple of weeks. I showed him villages with working polio eradication programs. Jeff even accompanied me to the Kainchi ashram, where we talked at length about Maharaji’s prediction about smallpox. He is Canadian and would be embarrassed if I say too many nice things about him, so I want to bury one story about him here. When we visited Kainchi, Maharaji was gone but Siddhi Ma was there. When I introduced Jeff to her, she said to me, “He is a saint in training.” I think it is true. Like me, Jeff was also concerned with pandemics, as well as climate change and global wars. He invited me to join the board of his Skoll Foundation, an invitation I happily accepted. To tackle a host of “global threats,” Jeff created another foundation called the Skoll Global Threats Fund—of which I am now chairman—focused on such issues as pandemics, climate change, water, nuclear weapons, and the crisis in the Middle East.
I want to specifically thank my colleagues from the Skoll Global Threats Fund who have supported me and allowed me time away from various projects to complete this book: in particular Jeff Skoll; Jim DeMartini; Sally Osberg, who introduced me to the foundation world and to our beloved Skoll world; Annie Maxwell and Mark Smolinski; Lindsey Spindle; Lauren Diaz, who has helped with this book and all the craziness it added to my already crazy life; Bruce Lowry; and especially Veronica Garcia, who, in addition to being one of this book’s loudest cheerleaders, created an archive of every speech, every photo, and every PowerPoint that I ever made, organizing my personal history into a loving, living database for this book. Because she cared more for preserving these memories than even I have, I owe her so much I can never repay her.
Grants from the World Health Organization and the University of Michigan, as well as a fellowship from the American Institute of Indian Studies, paid for the research and publication of my first book on smallpox. Part of the proceeds from the TED Prize allowed me to buy a library of reference books that I have referred to constantly in the process of writing this book.
People sometimes assume that because I wrote one of the first books on the smallpox eradication campaign in India that I was one of the leaders or visionaries of the smallpox eradication program, but that is not true at all. I was just a young kid in my first job out of medical school, the team mascot, hired as a secretary, who outstayed mostly everyone and wound up closing down the shop. Big accomplishments like the eradication of a disease are always a team sport and I was just one among the almost 150,000 smallpox warriors in India alone. And so was my smallpox partner Zafar Hussein, who was born in poverty, raised in poverty, and became my paramedical assistant and my guide. He risked his life many times for smallpox eradication and there were no big shiny awards for him. He was one of my great heroes.
Floating out to sea after leaving Rahima Banu on Bhola Island and often since, I thought about my great smallpox mentors and their tremendous dedication over such a long, sustained effort to conquer this terrible disease. I thought about D.A. and his decades-long struggle with countless bureaucracies to keep the program going and how he worked. This is the first publication I have written that D.A. did not proofread word for word, editing, suggesting, cajoling even, at every page. That is because D.A. passed away while I was still writing this book. I offer this book as a tribute to his leadership. I often had the wise counsel and help of the noble Isao Arita, who often came to India to bail me out of whatever trouble I had gotten myself into. And David Sencer, as head of CDC, and Alex Langmuir, who helped launch the Epidemic Intelligence Service program at CDC. I thought of Nicole Grasset and her fire and grace, her fierce determination to bring about the day when the world would be free of killer smallpox, and our decades-long partnership after smallpox, in Seva, and lifelong family friendship. Nicole epitomized the best in a global public servant. I think about Bill Foege’s wisdom and compassion from the day he showed me my first case of smallpox, and his ingenuity in creating the early-detection/early-response surveillance-and-containment strategy. And how he served with such dignity through his time as head of CDC and his influence on Jimmy Carter’s and Bill Gates’s global health breakthroughs. I am not telling any secrets to those who know him that we speak of him in almost reverential tones and all of us would like to be like Bill. It is not only in height that he stands out among everyone everywhere he goes.
And I thought about Justin Bhakla, Lev and the other Russians, the Americans, the Brits, the Swedes, the Czechs like my friend Zdeno Jezek, and the hundreds of thousands of health workers who had joined hands to defeat a common enemy. And even today I think of those who should have had a much bigger part in the book: Steve Jones, who embarrassed a UN agency into feeding and caring for homeless smallpox victims so they did not become beggars spreading the disease, went on to stop addicts from dying because of dirty needles, and served as one of the co-founders of the Seva Foundation; David Heymann, who ran the smallpox program for an Indian state, then as assistant director general of WHO led the fierce battle against SARS, and ran the WHO global polio program and innovated game-changing ideas like the Global Outbreak Response Network and CORDS, a global NGO consisting of a group of twenty-seven countries and three UN agencies. And Stan Foster, from a family of missionaries who led the Bangladesh smallpox program through tumultuous days and who had a wonderful career at CDC; Don Francis—one of my oldest friends from our civil rights and antiwar days in medical school, through running the state smallpox program in Uttar Pradesh and the Bihar state polio program, to becoming the brave hero of the early days of HIV/AIDs and the hero of the bestseller And the Band Played On; and Don Hopkins, who I met only briefly in India, but whose work at the Carter Center on Guinea worm disease is a treasure and part of the legacy of the smallpox experience. There were so many more young Americans who fought smallpox and went on to become warriors in the fight against AIDS and pandemic flu, and to help run the CDC and rise through the ranks of WHO.
And the Indians, oh my lord, the Indians, who seemed to never take a day off, never waiver, like “Papa” M. I. D. Sharma, who not only saved me from being kicked out of India but led the country through the massive epidemics, harsh press coverage, and frightened bureaucrats, and, in the process, made possible the WHO-India teamwork when skeptics were cropping up everywhere. My friend Mahendra Dutta later took his place at the NICD and eventually become one of the leaders of the polio eradication program in India.
Because space was limited in the book I often just refer to the Indian members of the Central Team (or Central Appraisal Team) but I would be remiss in not naming each of them: R. N. Basu, Mahendra Dutta, Mahendra Singh, C. K. Rao, R. R. Arora, and M. I. D. Sharma. In addition, Purushottem Diesh, in the early days, A. G. Acharia, head of the Bihar program, and Health Minister Karan Singh. I vividly remember him chanting Sanskrit verses from the Vedas at the funeral ceremony of the mother from Aurobindo’s ashram in Pondicherry, as well as at the NICD on the occasion of the celebration of the end of smallpox. The extraordinary mapmaker professor and my friends from Tata—and they became lifelong friends—Sujit Gupta and his family, Russi Mody, and, of course, J. R. D. Tata, whose handwritten monthly letters in turquoise-colored ink I will always cherish in some ways even more than the millions he gave to redeem the honor of the Tata name and help eradicate smallpox from its last hiding places in India.
Thank you also to those who have allowed me to interview them or who have read parts of the book, or listened to my stories and offered suggestions or inspiration. Special thanks to Dan Goleman, who has always believed in this book; Elliot Schrage, who, despite a job that would take all the energy out of most people, never ceases to energize me with his wit and wisdom and warm support for this project; my guru-brother, Ram Dass, and his willingness to pour over the photos and epigraphs and nuances of this book, helping me remember and put stories in their proper context; Bill Foege, who has opened doors to so many of the firsts in my life and will always be my mentor in things both technical and moral along with his dear wife, Paula.
And to other dear friends who have helped me give birth to this book: Sheryl Sandberg; Rameshwar Das; Steve Jones; Sunanda Markus; Judge Michael Jeffery (Ravi Das); Tamam Kahn; Rep. Bob Inglis; Roger Martin; Kirk Hansen; Susan Ewens; Rev. Earl Smith; Marc Benioff; Mark Smolinski; my brother, Barry Brilliant; my batch mate at CDC EIS program and constant thought leader, Roger Glass; Barbara Cromarty; Jack Kornfield; Roger Martin; Krishna Das; Ravi Khanna; Mahendra Dutta; my mom, Sylvia Bloom; cousin Sherry Sherman; Suzanne Gilbert; Rev. Jim Wallis; Jeff Skoll, my friend and someone whose movies have inspired a generation but whose life will inspire even more; Janet Cardinell; Irene Taylor Brodsky; Salman Ahmed; Lauren Diaz; Bev Spring; and Nauren Shaikh.
I remember coming back from India and spending hours telling my mentor Ben Spock most of the stories in this book and how happy he was with the tales of smallpox because it showed that I had “returned to medicine from all that hippie stuff.”
Thank you to each one of you for your help in making this book a reality. And a special thanks to our guru-brother, fellow student, teacher, and dear friend, Baba Ram Dass (Richard Alpert), who inspired us with his book Be Here Now to go to India, inspired us to become students of Maharaji, inspired us when we were working on smallpox and worked his butt off helping to raise money and start up the Seva Foundation, and continues to teach us and inspire thousands every day. I wrote the last chapters of this book staying at his ashramlike home in Maui with his wonderful assistant Dassima (Kathleen Murphy), looking out the window at the mango tree my daughter, Iris, planted in memory of Jon, a frequent visitor there.
Jon’s mango tree is bearing fruits that are quite large and sweet these days.